Your hips are one of the largest joints in your body that bears weight. They’re the reason you can walk, squat down, twist, turn, and carry heavy items.
Hips are ball-and-socket joints. They’re the intersection of your pelvic bone and the upper end of your femur.
Those bones are covered with articular cartilage, or tissue that helps the ball glide in and out of the socket. This happens smoothly thanks to synovium, a thin lining that lubricates the cartilage.
When you have rheumatoid arthritis (RA), your overactive immune system makes the synovium swell and produce chemicals that attack your articular cartilage and damage your bones. This could cause one or both of your hips to feel painful to the point of disability and make you a candidate for hip surgery.
Who Gets Hip Surgery?
When RA attacks your hip joint, you may have less mobility and feel severe pain and swelling in your groin, up and down your thigh, and in your buttock. It can cause you to lose sleep, limp, and have a hard time walking, working, and doing everyday tasks.
Hip replacement is an effective option for people with moderate to severe RA, if medication and less invasive treatment methods no longer manage your pain. It won’t cure your RA, but it can decrease your pain and get you moving again.
To make sure hip surgery is right for you, your doctor will take into account your age, overall physical health and condition of your hip, and the severity of your RA.
Who Should Consider Arthroscopy Instead?
Hip replacement is a major surgery: You should only have it if the pain in your hip area is severe and your motion is severely limited.
If you have RA with mild hip pain, ask your doctor about arthroscopy. It’s much less invasive. A surgeon makes a small cut in your skin to clean out and smooth out the area around your joint.
Like hip surgery, it’s not a cure, and it won’t slow down your RA, but it can decrease your pain and increase your ability to move around.
How Does Hip Surgery Work?
Hip surgery for RA takes about 2 hours.
Before surgery, your anesthesiologist will determine the best sedation method for your condition so you don’t feel any pain during the process.
Common methods include general anesthesia, spinal block, epidural, and a regional nerve block.
Once you’ve been sedated, your surgeon will:
- Make an incision on the front or side of your hip
- Take out the damaged bone and cartilage
- Replace your damaged socket with a prosthetic version
- Replace top of your femur, or the ball that fits in the socket, with a prosthetic version
Depending on your condition, you may go home after your anesthesia wears off. But you may have to stay for a day or more while your doctor keeps an eye on how you’re healing.
Are There Any Post-Surgery Risks?
The possible complications of this surgery are the same for anyone who has it, but they’re more likely for people who have RA. These include the most common ones:
Infection. These can happen at your incision site or deeper inside your tissue, near your new prosthetic hip. Look for redness, swelling, warmth, or pus. Most infections can be treated with antibiotics. If the infection affects your prosthesis, you may need another hip replacement.
To lower your risk of infection, your doctor may make some changes to your RA medications. Biologics such as TNF-alpha blockers have a link to higher rates of infection, so your doctor may have you stop taking them for about a week before and after your procedure. If you take steroids, you may need to take a lower dose until you’ve recovered.
Dislocation. When your hip is new and healing, it may pop out of the socket when you’re in certain positions. A brace will keep it from dislocating until you heal further. If that doesn’t stabilize your hip, another surgery may be necessary to keep it in place.
Mechanical failure. Wear and tear, loosening, or breakage of the prosthesis is a possibility. Your overactive immune system may attack the bone around your replacement, which would make it come loose or break off.
Other risks include:
Blood clots. This is a risk in many different kinds of surgeries. Clots can form in your legs, break off and cause serious injury in your lungs, heart, or brain. To increase circulation, your medical team will make sure you move as soon after surgery as possible. You may also wear compression socks or inflatable sleeves and take blood thinners for a short while.
Nerve damage. Nerve damage around your hip is rare. Tell your doctor if you feel numb or weak in that area.
Changes in the length of your leg. After your hip surgery, one leg may be shorter for a while. This is because the muscles around your hip are tight. Talk to your doctor about ways to stretch your muscles without dislocating your hip.
Will Hip Replacement Affect My RA Medications?
When you have RA, you have a higher risk of infection after a surgery like a hip replacement. If you take medications that affect your immune system, such as biologics and JAK inhibitors, your doctor may have you stop taking them temporarily before and after surgery. Your procedure will be scheduled for after the time that you would have taken your last dose. Your doctor will let you know how to manage your medications before and after your operation.
What If I Don’t Have Hip Surgery?
Without hip surgery, your RA will continue to destroy the tissue and bone around your hip, making it harder to function. You can offset some of the pain with medication and steroids.
The majority of people who have hip surgery report either mild or no pain 5 years after recovery.
What Can I Expect After Surgery?
Even before you leave the hospital, you may work with a physical therapist to show you safe ways to move with your new hip while it heals. This may include a cane, walker, or crutches. Expect to move daily and have physical therapy weekly or more to build your muscles up and increase mobility.
Until you’re able to bend and turn easily again, ask a friend or family member to help you make it easier to reach the things you need at home.
When Can I Start Moving Normally Again?
Six weeks after your surgery, you should be able to walk without a cane or crutch and get back to normal, everyday movement.
Focus on low-impact activities and exercise: Nothing that puts too much stress on your hip joints like running, jumping, or downhill skiing.