Total Hip Replacement

Hip replacement is one of the most important surgical advances of this century. Today, more than 300,000 procedures are being performed every year in the United States alone. Total hip replacement, also called total hip arthroplasty, involves removing the diseased bone and cartilage and replacing it with orthopaedic implants. Hip replacement may be recommended only after careful diagnosis of your joint problem. You may benefit from surgery if you have little pain relief from anti-inflammatory drugs, you have harmful or unpleasant side effects from your hip medications or other treatments such as physical therapy do not relieve hip pain.

The first step to returning to an active lifestyle is to make an appointment with your orthopaedic surgeon. After a thorough examination, your surgeon will make a recommendation regarding surgery. Generally speaking, you are a candidate if you experience hip joint pain that is severe enough to prevent you from carrying out normal daily activities and your pain is not responsive to nonsurgical treatments. Chronic hip problems can prevent you from enjoying everyday activities, but thanks to today’s advanced technology, you no longer have to live with pain. Total hip replacement surgery is the second step toward returning to a normally active, pain-free lifestyle.

Complications/Risks

Joint replacement surgery is a major operation. As with any major operation, there are possible complications. Some of these are related to the anesthesia, while others are associated with the joint surgery itself. Every possible effort is made by the medical team to prevent complications, but this cannot be accomplished without your participation. Therefore, it is important that patients know about the following, which include but are not limited to, infection, blood clots, implant breakage, dislocation, malalignment and premature wear. Any of these can require additional surgery. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as a patient’s post-surgery activities and weight can affect longevity. Your surgeon will discuss these and other risks with you.

There are many things that your surgeon will do to minimize the potential for complications. Your surgeon may have you see your family physician before surgery to obtain tests. You also may need to have any upcoming dental work completed or prepare your home to avoid any post-surgery falls.

Preparing for Surgery

Prior to surgery, your surgeon will conduct a complete physical examination to determine the condition of your hip and your overall state of health. The examination may include x-rays and blood tests. Your surgeon will review your medical history and inquire about any medications you are currently taking. It’s very important to inform the surgeon about all medications you are taking, including over-the-counter and herbal drugs.

Planning ahead can make the recovery process considerably easier. Have someone help you around the house in the weeks following surgery. If no one is available to help you in your home, you might consider staying in an extended care facility. If your home has more than one floor, try setting up a temporary bedroom on the ground floor, since going up and down stairs may be difficult during the early stages of recovery.

After Surgery

After surgery you will receive pain medication and begin physical therapy. It is important to start moving your new hip as soon as possible after surgery to promote blood flow, to regain motion and to facilitate the recovery process. You may be out of bed and walking with crutches or a walker within 24 hours of your surgery.

You will be shown how to perform activities of daily living such as safely climbing and descending stairs, getting into and out of a seated position and how to care for your hip once you return home. It is a good idea to enlist the support of family or friends to help you when you return home.

Most patients are ready to go home between two to five days after surgery; however, some people may go to a separate rehabilitation facility, which your surgeon should discuss with you before surgery. Many patients will go directly home and begin supervised therapy either at home or as an outpatient.

Recovery

Exercise is necessary for proper healing. Therapy will begin in the hospital and continues either on your own or with a therapist after discharge for approximately six weeks.

Therapy, a healthy diet and willingness to follow all of your surgeon’s recommendations will contribute to a more successful recovery after surgery. Most patients are able to walk without support and drive three to six weeks after surgery. Activities such as golf, doubles tennis and swimming can usually be resumed, but only with the approval of your surgeon. Recovery time will vary for each patient.

There will be exercises to help circulation, as well as strengthen muscles and improve joint motion. Your surgeon, physical therapist and every member of your health care team are there to support you, but your progress is up to you. Be sure to follow movement and any weight-bearing limitations. Also, do your prescribed exercises on your own so you can continue along the road to recovery. Exercise is necessary for proper healing.

High-impact activities or contact sports are typically not recommended. These types of activities place an extreme amount of pressure on the joints, which could lead to complications. There are also certain precautions (avoiding certain positions and movements) of which you must be aware. Your surgeon will discuss this with you.

Your surgeon will schedule follow-up appointments shortly after your hip replacement and at regular intervals following your surgery to evaluate your progress. It is important to see your surgeon if you notice any unusual changes regarding your new joint.

When to Call Your Surgeon

You should phone anytime you have questions regarding your condition, care and activity level. Report any changes with your incision, such as an increase in swelling, redness or drainage that worsen during your recovery. Call your surgeon if you experience persistent pain not relieved by pain medication, have side effects from medication or persistent swelling not relieved with ice or rest.