One of the most widely performed surgical interventions for advanced arthritis of the hip joint is total hip arthroplasty . Osteoarthritis is the underlying pathology that accounts for most primary total hip procedures.

Indications for Surgery

The following are common indications for total hip arthroplasty (THA), also referred to as total hip replacement (THR).

• Severe hip pain with motion and weight bearing and marked limitation of motion as the result of joint deterioration and loss of articular cartilage associated with osteoarthritis, rheumatoid or traumatic arthritis, ankylosing spondylitis, or osteonecrosis (avascular necrosis) leading to impaired function and health-related quality of life

• Nonunion fracture, instability or deformity of the hip

• Bone tumors

• Failure of conservative management or previous joint reconstruction procedures (osteotomy, resurfacing arthroplasty, femoral stem hemiarthroplasty, total hip replacement)

Historically, primary THA was reserved for patients older than 60 to 65 years of age or the very inactive younger patient with multiple joint involvement because the projected life span of primary THA procedures is less than 20 years. For the younger patient with significant hip joint deterioration, surface replacement (resurfacing) arthroplasty, a more bone-conserving surgery than THA, is an alternative that may be considered. However, with advances in designs, materials, and particularly cementless fixation and subsequent broadening of patient selection criteria, THA also is considered an option for some younger, moderately active patients after evaluation on a case-by-case basis. These individuals are counseled by the surgeon to anticipate the need for revision arthroplasty later in life.

Preoperative Management

Preoperative patient education has been advocated as an important aspect of the overall rehabilitation plan for many years. Patient-related instruction in past years took place the day before surgery when patients were often admitted to the hospital for preoperative tests. In the current health care environment, hospital stays have been shortened dramatically. Preoperative contact with a patient prior to elective surgery now occurs on an outpatient basis individually or in a group several days before surgery. Preoperative management typically includes assessment and documentation of a patient’s status as well as patient education about the procedure and what to expect during the early postoperative period. Patient information sessions are often coordinated and conducted by a team of professionals from multiple disciplines who are likely to be involved with a patient’s postoperative care. summarizes possible components of preoperative management.

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