Total Hip Replacement

When the hip joint has worn down to the point when it no longer does its job, an artificial hip (called a prosthesis) made of metal, plastic and ceramic can take its place. The surgery to implant the prosthesis is termed a total hip replacement. While the idea of getting an artificial hip joint may be frightening to some, it is one of the safest and most effective surgical procedures. Patients rank total hip replacements as one of the most satisfying surgeries in the human body.

The most apparent benefit of total hip replacement is dramatic pain relief. Almost all patients have complete, or near complete, relief of arthritic hip pain. As the pain lessens, function often improves. After having hip replacement, most patients have great results, including better range of motion, less pain, better balance and stability, and less limping.

Total hip replacement replaces the original ball and socket joint.  The hip socket (acetabulum) is replaced with an artificial cup and liner,  and the  upper thigh bone is replaced with an artificial stem and new ball (femoral head). It is an excellent procedure designed to improve pain relief, motion and function.

Possible surgical complications of the hip include: loosening, wear or breakage of the prosthesis, hip dislocation, infection, pain, stiffness, limp, leg length inequality, delayed healing of bone and soft tissues, and extra (heterotopic) bone formation. Other rare complications include fracture of the femur or acetabulum, nerve and blood vessel (vascular) injury.

Medical complications can include: thrombophlebitis, pulmonary embolism, blood clots in the legs, bleeding, urological complications, and very rarely even death. Other rare complications, which can be encountered with any surgery, include cardiac, gastrointestinal, kidney and lung problems.
While inflammation of the leg veins (phlebitis) is not rare, the occurrence of symptomatic blood clots has been greatly reduced with the use of compression devices on your legs in the hospital and blood thinning medications such as aspirin. Early mobilization (walking and moving one’s foot up and down) are extremely important for helping to reduce the development of blood clots.
Long-term complications such as wear, stiffness or loosening of the parts relate as much to patient behavior as to surgical success. In the instances where one of these complications occurs, they can often be corrected with revision surgery.  
 

What To Bring

  • X-rays, see explanation below
  • Completed Patient Information
  • Signed Insurance Authorization (white enclosure)
  • Your insurance cards
  • Referral from your Primary Care Physician, if applicable
  • A list of any medications you are taking

X-rays, Bone Scans, CAT Scans, MRI’s of the Hip or Knee

If you are scheduled for an x-ray at Rothman Institute, please arrive at least 15 minutes before your scheduled appointment.

If you are bringing x-ray films to your appointment, they must be current to be of value for your appointment with the doctor (no older than three to four months). If you have older films, please bring them in for comparison.

If you are bringing Bone Scans, CAT scans, or MRI films of the hip or knee please bring a copy of the written report as well.

 

If You Are Coming For An Evaluation Of A Painful Hip Or Knee Replacement Please Bring The Following Additional Items

Labs

Please bring any recent (no older than three to four months) laboratory blood work related to your joint replacement such as an Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP).

If you have had your total hip or knee aspirated (“tapped”) please bring the laboratory results from this procedure.

Operative Records

  1. The “operative report” from your last surgery on your hip or knee. This is a report dictated by the surgeon which tells what was done during the operation and importantly what implants or “parts” were put in or taken out during the surgery.
  2. The “part stickers” from the implants or hardware that were put in during your last surgery. These are labels from the box of the implant that are placed in the patient’s chart or operative record during the operation. These are necessary if the operative report does not specify the type of implants used.

For revision surgery, your doctor needs this information to order replacement parts which will match up with the implant that you currently have in place. For conversion surgery (converting previous surgery, such as fixation of a hip fracture, to a total joint replacement), this information allows us to have the necessary tools available to remove the hardware in place.

Due to health care privacy laws, your written permission is necessary in order for you to obtain this information for us. The best places to obtain this information are either from:

  • The hospital (Medical Records Department) where the surgery was performed (they should have both the operative report and the part stickers)

   OR

  • The office of the surgeon who performed the surgery (they will usually just have the operative report). 


Where can I find additional information on the Internet on Total Hip Replacements?

The American Academy of Orthopaedic Surgeons (AAOS) is an organization dedicated to caring for orthopaedic patients. This is a link to their website that provides additional information about Hip Replacements:

http:/What does my hospital stay look like?
You will arrive in the morning of your surgery and get prepared for surgery. You will be taken down to the preoperative holding area where your surgeon or member of the team will mark the correct operative location. You will meet the anesthesia team at that time and be taken back to surgery.

After surgery, you will recover in the post-anesthesia care unit (PACU) as your anesthesia wears off. You will then be transferred to your room.  Once your spinal anesthesia wears off and you can move your legs again, physical therapy will work with you on walking. Once you can walk, eat normal food and have your pain controlled, you can leave the hospital.  

How long will I be in the hospital?
Most patients go home within 1 day after total hip replacement surgery. Your discharge may be as early as the day of surgery, or may rarely be prolonged for other reasons.

How painful is hip replacement surgery?
No surgery is painless, and hip replacement surgery is no exception. However, postoperative pain from hip replacement surgery is very manageable. Despite their surgical pain, it is not unusual for patients to state that they feel immediate relief after surgery from the deep preoperative arthritic pain. While the experience of pain is unique to each individual, most patients manage the immediate postoperative pain from hip replacement without difficulty.

How will my pain be managed?
Most patients getting hip replacement surgery undergo spinal anesthesia with sedation, so they are not awake during the surgery. This type of anesthesia has many benefits, not the least of which is the continuation of pain relief for several hours after surgery. Additionally, spinal anesthesia has been demonstrated in studies to have other benefits, such as decreased surgical blood loss and a decreased risk of developing lower extremity blood clots when compared with general anesthesia. The muscle relaxation provided by spinal anesthesia also makes performing the surgery easier and therefore may be less traumatic for the patient.

After surgery, patients are treated with other pain medicine, mostly taken by mouth. While it may seem surprising, often the postoperative pain from hip replacement can be managed simply with oral pain medicine. This spares patients from the side effects of stronger intravenous medicines. If it is felt that intravenous medicine is needed, patients are usually provided with occasional injections depending on the level of pain. These types of pain control are generally provided until the day after surgery. After this, most pain medicine is provided in pill form as needed. Patients are often discharged with a prescription of the pills that worked for them during their hospital stay.

Patients can also help relieve their pain with means other than pain medicine. For example, applying ice and elevation to the hip area after therapy can go a long way toward controlling the swelling that often causes discomfort after such activity. On the other hand, when patients have discomfort from stiffness, usually doing some exercises will help relieve this pain more than any medicine will.

How long will I have pain after surgery?
It is difficult to give a specific answer for this, but most patients notice good pain relief within the first 1-2 weeks after surgery, followed by continued recession of pain over the first 1-3 months. Surgical pain is usually at its worst for the first 24 to 48 hours after surgery. After this, patients are usually more comfortable. They may experience some increased pain when doing exercises or therapy, but this can be easily managed by taking pain medicine before therapy.

Is it OK to take pain medicine?
Many patients express concerns about taking pain medicine after surgery, particularly with respect to narcotic addiction.  While it is possible to become addicted to narcotic pain medication, this is rare when the medicine is taken appropriately after surgery.  Postoperatively, patients have a good reason to have pain and it is okay to take pain medicine at this time. It often takes less narcotic to control a person’s pain when the medicine is taken appropriately – that is, when the patient begins to experience real discomfort. In the early postoperative period, patients should not try to “hold off” on taking pain medicine because they think the pain will calm down in time. These patients who “hold off” until their pain becomes too severe often need more narcotic to control their pain than they otherwise would have needed if they had taken their pain medicine earlier.

What are the side effects of pain medicine?
Side effects of pain medicine and anesthesia include nausea, constipation, mood changes and sometimes a tired feeling. Having these side effects does not mean that a patient is allergic to the medication. If a patient has a problem with these side effects, often the medication can be adjusted or a different medication tried in order to minimize these effects.

When is my first post-operative office visit?
The 1st office visit after surgery is between 2 and 6 weeks from the date of surgery. If you have staples, the 1st office visit after surgery is often 2 weeks from date of surgery.

When will my staples or sutures be removed?
Approximately 2 weeks after your surgical date, the staples or sutures will be removed. Some patients will have no visible staples or sutures and therefore will not need to have anything removed.

When will my dressing be removed?
If you have a specialized dressing that looks like a large band-aid, you may shower with the dressing in place . The dressing should be removed 5-7 days from the day of surgery. If you have a gauze dressing and tape on your hip, it will most likely be removed before you are discharged from the hospital. If not, it can be removed 2 days after surgery and the area should be kept clean and dry.

How long will I remain on anticoagulation (blood thinners that help avoid blood clots)?
Typically 2 to 6 weeks after surgery. For most patients, aspirin is prescribed. For other patients, especially those who are unable to take aspirin, low-molecular weight heparin (Lovenox) or warfarin (Coumadin) are used. If you are on warfarin, you will need bloodwork drawn 1 to 2 times per week and your medical consultant will adjust your medication dosage. If you are placed on aspirin or low-molecular weight heparin injections, you will not require blood testing.

Is swelling of my hip, knee, leg, ankle, and foot normal?
Yes, for three to six months. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day).

Is it normal to feel numbness around the hip?
Yes, it is normal to feel numbness around the incision.

Why is my leg bruised?
It is common to have bruising on the skin. It is from the normal accumulation of blood after your surgery. You can see bruising all the way down to your foot due to gravity.

What exercise should I perform at home?
Please do exercises as instructed by your surgeon. Remember, you are using your hip every time you stand up and walk around – this is actually doing physical therapy for your hip. Focus on walking as much as you can. This is often all that is necessary to appropriately heal from hip replacement. Additionally, you may have been given a link for FORCE Therapeutics that will help guide you on which exercises are safe after your total hip replacement. 

How long will I need to use a walker, cane, or crutches?
This varies with each patient. Patients often use a walker at first, followed by a cane for typically 2-6 weeks. Some patients are discharged from the hospital with a cane/crutches and do not need to use a walker.

Do I have to observe hip precautions?
Our general policy is that hip precautions are not required. You should avoid things that are uncomfortable, but you are allowed to sit on regular chairs, use regular toilet seats, go in a car, and lay or sleep on your side. You do not ‘need’ to use high chairs, elevated toilet seats or pillows between your legs, but they may be more comfortable for you in the initial period after surgery. Interestingly, you do not have to be concerned about stretching your hip as the hip joint will gradually loosen up on its own over 6 months after surgery. There may be exceptions where certain patients need to avoid bending, crossing legs, or twisting at the waist - this will be explained to you specifically by your surgeon.

May I go outdoors prior to my first postoperative visit?
Yes, we encourage you to do so.

May I drive or ride in a car before my first postoperative visit?
Yes, you may ride in a car; however, you must be off all narcotic pain medications prior to driving. It is a patient's responsibility to determine their own safety. If your right hip is replaced, you will usually need to wait longer before driving, depending on your ability to maneuver your leg to the brake.

May I ride in an airplane before my first postoperative visit?
Yes, you may ride in an airplane. Be sure to get up and move around at frequent intervals to prevent blood clot formation. You may find it more comfortable to sit in an aisle seat.

What is the short-term outlook?
The short-term outlook of total hip replacement is excellent. Most patients can stand the afternoon of surgery and begin exercise that day. With the support of walkers, crutches and canes, patients can walk with confidence, climb stairs and ride in a car by the time they leave the hospital. Some swelling, aching and numbness are normal during this time. Most patients are up and about within six weeks after surgery. It is normal to limp for 2-3 months after surgery.

When can I return to work?
Most patients will return to work within 1-3 months after surgery.  This typically depends on the type of work you do and the speed of your recovery.  A more sedentary job can be performed even sooner than a month (as soon as a week). A more physically demanding job may require as much as 3 months for you to properly recover before returning.

Can I return to my normal activities after a hip replacement?
Fortunately, hip replacement surgery not only restores our patients' quality of life but, of equal importance, allows them to return to their activities of daily living. Please discuss specific activities with your surgeons, as some activities may need to be limited.

Please note:
All questions will be answered at your follow-up exam. For non-emergency questions, please call the allied health professional for your physician.

For all emergencies or questions after 4:30PM or on weekends, please call 267-339-3500. If you do not speak with someone immediately, then please go to your nearest emergency room.

Message left on voicemails during business hours will be answered. Messages left on voicemails AFTER business hours will NOT be answered until the next business day. Messages left on Force Therapeutics will be answered during the next business day. Clinical questions/comments should NOT be left on Force Therapeutics and should be directly addressed to the allied health professional by a phone call.orthoinfo.aaos.org/topic.cfm?topic=a00377

Total hip replacement is recommended for patients with arthritis that results in severe pain and limited function. Pain cannot be measured, and the degree of pain sufficient to warrant surgery should be decided by the patient and doctor together. Age (young or old) is rarely an issue anymore. It is important for patients to work with their medical and orthopaedic physicians to be in the healthiest possible condition before undergoing surgery.


Where can I find additional information on the Internet on Total Hip Replacements?

The American Academy of Orthopaedic Surgeons (AAOS) is an organization dedicated to caring for orthopaedic patients. This is a link to their website that provides additional information about Hip Replacements:

http://orthoinfo.aaos.org/topic.cfm?topic=a00377

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