This document provides an overview of total hip replacement surgery. It discusses the anatomy of the hip joint and causes of hip pain and loss of mobility like osteoarthritis and fractures. It describes the surgical procedure for total hip replacement, which involves removing the femoral head and inserting prosthetic components. Post-surgery rehabilitation and potential complications are also outlined.

1. TOTAL HIP
REPLACEMENT
Presented by: Atillio Castellani
Brendan Cochren
Trevor Kelly
Shuntaro Maruyama
Mustafa Sharif
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2. General Anatomical Overview
 The hip is one of your body's largest weight-
bearing joints.
 Consists of two main parts:
 a ball (femoral head) that fits into a rounded
socket (acetabulum) in your pelvis.
 Ligaments connect the ball to the socket and
provide stability to the joint
 The bone surfaces of your ball and socket have a
smooth durable cover of articular cartilage that
cushions the ends of the bones and enables them
to move easily. Brought to you by

3. Hip Anatomy
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4. More…
 All remaining surfaces of the hip joint are
covered by a thin, smooth tissue called synovial
membrane. In a healthy hip, this membrane
makes a small amount of fluid that lubricates and
almost eliminates friction in your hip joint.
 Normally, all of these parts of your hip work in
harmony, allowing you to move easily and
without pain.
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5. Total Hip Replacement
 A prosthetic hip that is implanted in a similar
fashion as is done in people. It replaces the
painful arthritic joint.
 The modular prosthetic hip replacement system
used today has three components – the femoral
stem, the femoral head, and the acetabulum.
Each component has multiple sizes which allow
for a custom fit.
 The components are made of cobalt chrome
stainless steel and ultra high molecular weight
polyethylene. Cementless and cemented
prosthesis systems are available. Brought to you by

6. Statistical Overview
 First performed in 1960.
 Since then, improvements in joint
replacement surgical techniques and
technology have greatly increased the
effectiveness of this surgery.
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7. Number of Total Hip and Total Knee Replacement Procedures Performed
in Canada, 1994–1995 to 2001–2002
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8. Age
group
Males Females
1994-
1995
2001-
2002
7-year %
chang
e
1994-
1995
2001-
2002
7-year %
chang
e
<45 years 489 553 13.1% 475 484 1.9%
45-54
years
716 1,055 47.3% 630 943 49.7%
55-64
years
1,609 1,753 8.9% 1,659 1,966 18.5%
65-74
years
2,475 2,798 13.1% 3,746 3,748 0.1%
75-84
years
1,470 1,976 34.4% 2,798 3,547 26.8%
85+ years 194 315 62.4% 526 839 59.5%
Total 6,953 8,450 21.5% 9,834 11,527 17.2%
Source: Hospital Morbidity Database, CIHI
Number and Distribution of Total Hip Replacement Procedures by Age
Group and Sex, Canada, 2001–2002 Compared to 1994–1995
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9. Subjective Assessment
 Pain localized in hip region
 Exaggerated gait pattern (limp)
 Increase in pain when weight barring
 Reduction in the degree of ROM
 As the degeneration of the joint worsen,
individual may be awakened at night with
pain
 Bone spurs may occur Brought to you by

10. Objective Assessment
 Gait pattern – Adaptive walking pattern that
reduces pressure on the affected side.
 Muscle atrophy – Muscles in affected area are
not used as much due to pain, therefore, use-it-
or-lose-it applies.
 Active Range Of Motion – Limited ROM, stiffness
 Passive ROM – End feels causes severe pain
 X-ray – clear degeneration of the bone
 MRI – determines underlying complications
(e.g.avascular necrosis) Brought to you by

11. Common Causes of Hip Pain and Loss
of Hip Mobility
Osteoarthritis
 Usually occurs after age
50 and often in an
individual with a family
history of arthritis. In
this form of the disease,
the articular cartilage
cushioning the bones of
the hip wears away.
The bones then rub
against each other,
causing hip pain and
stiffness.
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12. Causes (cont’d)
Rheumatoid Arthritis
 a disease in which the
synovial membrane
becomes inflamed,
produces excessive
synovial fluid, and
damages the articular
cartilage, leading to pain
and stiffness.
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13. Causes (cont’d)
Traumatic Arthritis
 Can leads to a serious
hip injury or fracture. A
hip fracture can cause a
condition known as
avascular necrosis. The
articular cartilage
becomes damaged and,
over time, causes hip
pain and stiffness.
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14. Osteoarthritis Fracture
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15. Operation
Removing the Femoral Head
 Once the hip joint is
entered, the femoral
head is dislocated
from the acetabulum.
 Then the femoral
head is removed by
cutting through the
femoral neck with a
power saw. Brought to you by

16. Reaming the Acetabulum
 After the femoral head
is removed, the
cartilage is removed
from the acetabulum
using a power drill and
a special reamer.
 The reamer forms the
bone in a hemispherical
shape to exactly fit the
metal shell of the
acetabular component. Brought to you by

17. Inserting the Acetabular Component
 A trial component, which is
an exact duplicate of your
hip prosthesis, is used to
ensure that the joint will be
the right size and fit for the
client.
 Once the right size and
shape is determined for the
acetabulum, the acetabular
component is inserted into
place.
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18. Preparing the Femoral Canal
 To begin replacing the
femoral head, special rasps
are used to shape and
scrape out femur to the
exact shape of the metal
stem of the femoral
component.
 Once again, a trial
component is used to
ensure the correct size and
shape. The surgeon will also
test the movement of the hip
joint.
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19. Inserting Femoral Stem
 Once the size and
shape of the canal
exactly fit the
femoral component,
the stem is inserted
into the femoral
canal.
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20. Attaching the Femoral Head
 The metal ball that
replaces the
femoral head is
attached to the
femoral stem.
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21. The Completed Hip Replacement
• Client now has a new
weight bearing surface
to replace the affected
hip.
• Before the incision is
closed, an x-ray is made
to ensure new prosthesis
is in the correct position.
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22. Treatment by Kinesiologist
-Early Postoperative Exercises-
 Regular exercises to restore your normal hip
motion and strength and a gradual return to
everyday activties.
 Exercise 20 to 30 minutes a day divided into 3
sections.
 Increase circulation to the legs and feet to prevent
blood clots
 Strengthen muscles
 Improve hip movement
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23. Exercise Prescription
Early Stage
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24. Kinesiologist’s Role (cont)
 The patient is released few days after the surgery
 A list of Do’s and Don’ts
 Hip is sore and weak
 Start with light exercises
 Ergonomics: Rearrange furniture in the house to
make using crutches easier. Setup a ‘recovery
centre’, a table where u put phone, remote
control, radio, medication and other essential
things that you need. It makes it more accessible.
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25. Educate Clients
- Do’s and Don’ts -
 To avoid hip dislocation:
 Using 2-3 pillows between your legs when
sleeping (roll onto your ‘good side’
 Not crossing your legs
 Use chairs with armrest
 Not bending forward past 90 degrees
 Using a high-rise toilet seat if necessary
 Avoid pronation the legs
 To avoid stairs, sleep in the living roomBrought to you by

26. Exercise Prescription
- Later Stages -
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27. Post-Surgery Complications
 Thrombophlebitis
 the blood in the large veins of the leg forms
blood clots within the veins.
 If the blood clots in the veins break apart they
can travel to the lung.
 Infection in the joint
 Dislocation of the joint
 Loosening of the joint Brought to you by

28. 3 QUESTIONS
1. What are the two structures involved in the total hip replacement surgery?
a) head of femur (ball)
b) acetabulum (socket)
c) greater trochanter (femur)
d) Ischial tuberosity
Answer: a & b
2. Which of the following (s) could lead to a total hip replacement?
a) high blood pressure
b) rheumatoid arthritis
c) hip fracture
d) all of the above
Answer: b & c
3. Which of the following (s) is a possible post-surgery complication for a total hip replacement?
a) thrombophlebitis
b) infection in joint
c) dislocation of joint
d) all of the above
Answer: d
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29. Reference
 Unversity of Iowa Hospitals and Clinics. (January 2005). Total Hip Replacement: A Guide for
Patient. Retrieved on Novemember 20th
2005, from
http://www.vh.org/adult/patient/orthopaedics/hipreplace/
 American Academy of Orthopedic Surgeons. (June 2001). Total Hip Replacement. Retrieved on
November 20th
2005, from http://orthoinfo.aaos.org/booklet/view_report.cfm?
thread_id=2&topcategory=Hip
 MedicineNet.com. (October 2005). Total Hip Replacement. Retrieved on November 20th
2005,
from http://www.medicinenet.com/total_hip_replacement/article.htm
 Gulf Coast Veterinary Specialists. (2002). Total Hip Replacement. Retrived on November 20th
2005, from http://www.gcvs.com/surgery/total_hip.htm
 Medical Multimedia Group. (May 17th
1997). A Patient’s Guide to Total Hip Replacement
Surgery. Retrieved on November 20th
2005, from
http://www.healthpages.org/AHP/LIBRARY/HLTHTOP/THR/INDEX.HTM
 Canadian Institute of Health Information. (March 31st
2004). More than 10% of Total Hip
Replacements are for Repeat Surgeries, Reports Canadian Institute for Health Information
(CIHI). Retrieved on November 21st
2005, from http://secure.cihi.ca/cihiweb/dispPage.jsp?
cw_page=media_09oct2002_e
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