Total Hip Replacement Surgery

What is a total hip replacement?

A total hip replacement is a procedure in which the surgeon removes a painful hip joint and replaces it with an artificial hip joint.

When is it used?

Hip joint replacement is done mainly in people age 60 and older. Possible reasons for replacing the hip joint include:

• severe pain from arthritis in the hip that limits your ability to do the things you want to do
• hip joint fractures or tumors.

This surgery is usually not recommended if:

• You are very young.
• You have a hip infection.
• You are paralyzed or have nerve disease affecting the hip.
• You have a terminal disease such as cancer that has spread to other parts of your body.
• You are very overweight (over 300 pounds).

Alternatives to this procedure include:

• taking acetaminophen, aspirin, or other medicines for the pain and inflammation
• limiting your activity and using a walking aid such as a cane or walker
• avoiding activities that make the pain worse, such as climbing stairs or walking long distances
• using ice or heat to reduce pain and swelling.
• having surgery to fuse the hip joint.

Ask your healthcare provider about these choices.

How do I prepare for a total hip replacement?

Talk to someone who has had a hip replacement to get an idea of what the procedure and recovery period are like.

Because you may need blood transfusions during the operation or during recovery, you may want to donate some of your own blood before the procedure. Blood should be donated within 4 weeks of the procedure.

Install equipment that will help you while you recover at home, such as an elevated toilet seat, a shower seat, and grab bars or handrails. Remove rugs and cords that might cause a fall.

Plan for your care and recovery after the operation, especially if you are going to have general anesthesia. Allow for time to rest after the operation. Find people to help you with your day-to-day duties and care for at least the first week at home.

You may meet with a physical therapist before surgery to learn exercises that will help you after surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general or spinal anesthetic. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation. A spinal anesthetic is a drug that blocks pain in the lower part of your body. It should keep you from feeling pain during the operation.

The surgeon makes a cut along the side of your hip, moves the muscles connected to the top of the femur (thighbone), and exposes the hip joint. The surgeon pulls the ball portion of the joint (the end of the femur) away from the socket part of the joint (the hipbone). The ball of the femur is cut with a saw and an artificial replacement part is attached to the femur.

The surgeon prepares the surface of the hipbone and, if it is worn, attaches a metal or plastic socket part to the hipbone. The surgeon inserts the new ball part of the femur into the socket part of the hip. Two drains may be inserted to help drain any fluid or blood from the new joint. The surgeon then reattaches the muscles to the top of the femur and closes the cut in the side of your hip with stitches or staples.

You may need a blood transfusion. The hospital will use either your donated blood or blood from a donor that matches your blood.

What happens after the procedure?

After surgery, your hip will be covered with a padded dressing. Special boots or stockings will be put on your feet or legs to help prevent blood clots. A triangular shaped cushion may be positioned between your legs to keep your legs from crossing or rolling in. A tube (catheter) may be placed in your bladder if you have trouble urinating.

You will be given a regular program of exercises to do each day as long as you are in the hospital. Your physical therapist will start by helping you move from your bed to a chair. By the second day, you'll begin walking longer distances using your crutches or walker. Your therapist will teach you exercises to begin strengthening the thigh and hip muscles.

You may stay in the hospital about 4 to 6 days, depending on how fast your hip heals. You can leave the hospital and go to a short-term rehab facility or go home when:

• You can safely get in and out of bed.
• You can walk up to 75 feet with your crutches or walker.
• You can go up and down stairs safely.
• You have learned how to protect your hip while it recovers.

After you go home from the hospital, your physical therapist may visit you for in-home treatments. Your therapist will review your exercise program and continue working with you on your hip precautions. Your therapist will suggest safety tips such as using elevated toilet seats and bathtub benches and raising the surfaces of couches and chairs. Raised sitting surfaces keep your hip from bending too much when you sit down. The visiting nurse or therapist will also suggest ways to make your home environment safe.

Constipation is common after joint replacement surgery. It is caused by narcotic pain killers as well as inactivity. You may be given a stool softener and a laxative after surgery to avoid this. When you are home again, be sure to eat a high-fiber diet and plenty of liquids according to your provider's recommendations.

If medicine to help prevent clots has been prescribed for you, be sure to follow your healthcare provider's instructions for taking this medicine.

Your staples will be removed 2 weeks after surgery. You will probably start using a cane instead of crutches 3 to 4 weeks after the surgery. You will probably be able to drive within 3 weeks and walk without a cane or walker by 6 weeks. With your healthcare provider's approval, you will be able to resume sexual activity 1 to 2 months after surgery.

Let your dentist and healthcare providers know that you have an artificial joint. If you have a dental infection or skin infection, you may need to start antibiotics right away. If you have a condition such as diabetes that puts you at higher risk for infection, you may need to take antibiotics before dental procedures or some kinds of surgery. For simple dental and surgical procedures, most people with replacement joints do not need to take antibiotics in advance, but you should check with your provider about this.

Your surgeon will follow you closely after your operation. Ask what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may go back to a more normal life. You will be able to move your hip more easily and fully and less painfully. It will be easier for you to walk and do other activities that use your hip.

What are the risks associated with this procedure?

• There are risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• If you have a spinal anesthetic, the anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used for this type of anesthesia.
• Other bones may break during the surgery. This may require a longer hospital stay.
• A blood clot may form in the veins, escape into the bloodstream, and block an artery in the lungs. You may need to take medicine to prevent this.
• At the time of surgery the new ball joint is forced into the femur (thighbone) where the bone marrow is. As a result, pieces of fat in the bone marrow may become loose, enter the bloodstream, and get into the lungs.
• You may lose a lot of blood and need a blood transfusion. If you did not donate your own blood, the hospital will try to match your blood with donated blood. It is not always possible to avoid reactions with donated blood. You could also get a disease from donated blood, but the risk for this is low.
• The nerves in the hip area may be injured from swelling or pressure. This can cause some numbness.
• Your legs may not be the same length after the operation.
• The new hip joint will not move as well as a normal joint. It can be dislocated more easily. You must be careful not to sit too low or cross your legs.
• You may have infection or bleeding.
• The replacement parts may become loose or break. This happens a small percentage of the time and usually many years after the operation.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• You have a fever.
• You have pain that gets worse after 24 hours.
• You become short of breath or cough up blood.
• You have foul-smelling drainage coming from the surgical wound.
• Your calf, thigh, or hip has unusual swelling, warmth, or redness.
• You have chest pain.

Call your healthcare provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.