Rheumatoid arthritis (RA) is an autoimmune disease involving chronic inflammation of the joints. Over time, this inflammation can damage the joints, causing pain, swelling, and stiffness. The condition can affect any joints in the body, including the hips.
Medical treatments can help slow the progression of RA and alleviate the symptoms. If these treatments are ineffective, a person with RA of the hip may be eligible for hip replacement surgery to ease joint pain and improve mobility.
In this article, we describe who may be eligible to receive hip replacement surgery and cover the risks and benefits of this procedure. We also outline what to expect during the surgery and provide information on preparing for and recovering from it.
A person may need hip replacement surgery if they have RA of the hip that is no longer responding to conservative treatments, such as medications and physical therapy.
Doctors usually reserve this surgery for people whose hip joint has become worn or damaged to the extent that it reduces the person’s mobility, causes pain even when the person is resting, and affects activities of daily living. The aim of the surgery is to increase mobility, alleviate pain, and improve the person’s quality of life and physical functioning.
A doctor will carry out a medical assessment to determine whether a person is eligible for hip replacement surgery. A person may qualify if they experience one or more of the following:
- severe pain, swelling, and stiffness in the hip joint
- joint pain that is so severe that it interferes with the person’s sleep and quality of life
- reduced range of motion in the hip and decreased mobility
- difficulty performing everyday tasks, such as:
- getting out of bed
- putting on socks and shoes
- climbing stairs
- inability to work or have a social life
- depression due to pain and a lack of mobility
A doctor will also take into account a person’s age and general health status. Doctors may recommend against the procedure in younger people. The reason for this is that younger people are likely to need a follow-up hip replacement due to the initial one wearing out within their lifetime.
Some possible risks of hip surgery for RA include:
- Hip dislocation: RA can cause inflammation of soft tissues, such as tendons and ligaments. Over time, these tissues can become lax, increasing the risk of hip dislocation following hip replacement surgery.
- Differences in leg length: During hip replacement surgery, the surgeon will stretch and tighten the soft tissues around the new hip joint to ensure that the joint remains in place. Doing this can cause the leg to become slightly longer.
- Bone fracture: A person may develop a fracture in the bone surrounding the hip replacement. This may happen during or after surgery.
- Joint infection: People with RA may have an increased risk of infection following surgery. The risk may be higher for people who take biologic disease-modifying antirheumatic drugs to control their RA.
- Bone loss: The following factors can cause or contribute to bone loss following hip replacement surgery:
- debris in the hip joint
- bone remodeling in response to the prosthesis
- natural aging
- Blood clots: Any type of surgery increases the risk of blood clots.
- Local damage to nerves: Surgery may cause damage to nerves in the hip. This
may result inlocalized weakness or numbness.
- Hypersensitivity reactions: A person’s immune system may overreact to particles from the implant. This overreaction could lead to complications, such as:
- delayed healing
- implant loosening
- implant rejection
- Follow-up hip replacement: Research suggests that hip replacements last about 25 years in more than half of those who undergo this procedure, but they will not always last this long.
A person who has undergone hip replacement surgery can expect to experience lower pain levels and increased mobility.
A person may not be capable of returning to all their pre-surgery activities. However, they will typically notice significant improvements when comparing their presurgery and postsurgery mobility.
Prior to hip replacement surgery, a person will attend a pre-op appointment to check that they are healthy enough to undergo the procedure. They may receive the following tests:
- blood tests
- urine tests to rule out infection
- an electrocardiogram (EKG) to check heart health
- blood pressure checks
- X-rays of the hip
- a pregnancy test, for females
Depending on their personal risk factors, some individuals may also need to undergo an evaluation by cardiology, pulmonary, or rheumatology professionals.
On the day of the surgery, a person will receive either general anesthesia or spinal anesthesia. General anesthesia means that the person will be unconscious during the procedure, whereas spinal anesthesia means that the person will feel numb from the waist down.
During the procedure, the surgeon will make an incision in the skin around the hip and remove the diseased bone tissue and cartilage. They will then insert the new, artificial joints.
- plastic socket lining and metal ball joint
- plastic socket lining and ceramic ball joint
- ceramic socket lining and ceramic ball joint
- metal socket lining and ceramic ball joint
Hip replacement surgery typically takes 1–2 hours to complete.
When preparing for surgery, a person should follow the advice of their surgeon and anesthetist. The surgical team will provide information on the following:
- whether the person needs to avoid eating or drinking in the hours before the operation
- whether the person needs to stop taking certain medications before the operation
- whether it will be necessary to stay in the hospital overnight and, if so, for how long
- what a person needs to bring with them to the hospital
In general, a person should make the following preparations for surgery:
- quitting smoking, as smoking can increase the risk of complications during and after surgery
- avoiding alcohol and recreational drugs, as these could affect how the body metabolizes the anesthetic
- performing muscle-strengthening exercises to help aid recovery from surgery
- ensuring that their health insurance coverage is in order
- arranging for someone to take them home following the surgery
- arranging for someone to check in on them regularly after the surgery, if they live alone
- ensuring that they have easy access to things they may need within the home when they return from surgery
- ensuring that they have meals ready to eat when they return from surgery
A person can typically return home within 1–3 days of hip replacement surgery.
Doctors usually recommend that people begin walking within 12–18 hours of the surgery. A physical therapist may suggest exercises to help strengthen the tissues around the new hip to reduce the risk of dislocation. If a person’s recovery is slow, they may need to spend some time in a rehabilitation care facility.
People can usually resume their normal activities within about 6–8 weeks. A doctor will inform them when they can drive, but they should check that they will still have coverage from their insurance company. People should also ask their surgeon or physical therapist for advice on which activities and sports they can take part in safely.
People who have relatively sedentary jobs may be able to return to work after about 6 weeks. Those with more active jobs may be able to return to work after about 3 months. If a person’s job involves heavy manual labor, they may wish to consider changing to lighter duties, if possible.
A person who has had a hip replacement can expect to experience less pain and increased mobility.
The Arthritis Foundation provides the following statistics on hip replacement success rates among people who underwent their first surgery between the years 1993 and 2005:
- 90% of people who reported moderate pain before surgery reported mild or no pain 5 years after surgery.
- 89% of people who reported severe pain before surgery reported mild or no pain 5 years following surgery.
Rheumatoid arthritis is an autoimmune condition that causes inflammation, pain, and stiffness in the joints. The condition can affect any joints within the body, including the hip joints. People living with RA of the hip may require hip replacement surgery if their condition causes severe pain and a loss of mobility.
During the procedure, a surgeon will remove the damaged or diseased joint and replace it with a new, artificial joint. People can usually return home within a matter of days, though full recovery may take weeks or months.
Overall, the success rates for hip replacement surgery are good. However, anyone who is considering the procedure should talk with their doctor about the potential risks and benefits involved. A doctor can also advise the person on the steps they need to take when preparing for the surgery.