Hip Replacement Surgery

What to Expect from Hip Replacement Surgery

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Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform daily activities.  

Following surgery, you will be advised to avoid certain activities, including jogging and high-impact sports, for the rest of your life.  You may be asked to avoid specific positions of the joint that could lead to dislocation

Even with normal use and activities, an artificial joint (prosthesis) can develop some wear over time.  If you participate in high-impact activities or are overweight, this wear may accelerate and cause the prosthesis to loosen and become painful.

Getting Ready for Hip Replacement

Pre-surgery Checklist:

  • Weight Loss 
    If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and potentially decrease the risks of surgery.
  • Dental Evaluation 
    Although the incidence of infections after hip replacement is very low, an infection can occur if bacteria enter the bloodstream.  Because bacteria can enter the bloodstream during dental procedures, you should consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) before your hip replacement surgery.  Routine cleaning of your teeth should be delayed for several weeks after surgery.
  • Urinary Evaluation
    A preoperative urological evaluation should be considered if you have a history of recent or frequent urinary infections.  For older men with prostate disease, any necessary treatment should be considered prior to hip replacement surgery.
  • Social Planning 
    Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing and laundry.  If you live alone, your surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home.  A short stay in an extended care facility during your recovery after surgery also may be arranged.
  • Home planning 
    Several suggestions can make your home easier to navigate during your recovery.  Consider these options:
    • Safety bars or a secure handrail in the shower or bath
    • Secure handrails along stairways
    • A stable chair for your early recovery with a firm seat cushion that allows your knees to remain lower than your hips, a firm back and two arms
    • A raised toilet seat
    • A stable shower bench or chair for bathing
    • A long-handled sponge and shower hose
    • A dressing stick, a sock aid and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
    • Firm pillows to sit on that keep your knees lower than your hips for your chairs, sofas, and car
    • Removal of all loose carpets and electrical cords from the areas where you walk in your home 
  • Pre-surgery
    Prior to admission, a member of the anesthesia team will evaluate you.  The most common types of anesthesia for hip replacement surgery are general anesthesia (which puts you to sleep throughout the procedure and uses a machine to help you breath) or spinal anesthesia (which allows you to breath on your own,  but anesthetizes your body from the waist down).  The anesthesia team will discuss these choices with you and help you decide which type of anesthesia is best for you.

In the Hospital

The Surgical Procedure

The surgical procedure takes one-and-a-half to two hours. Your orthopedic surgeon will remove the damaged cartilage and bone, then position new metal, plastic or ceramic joint surfaces to restore the alignment and function of your hip.

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell). Special surgical cement may be used to fill the gap between the prosthesis and remaining natural bone to secure the artificial joint. A non-cemented prosthesis has also been developed and is used most often in younger, more active patients with strong bone.  The prosthesis may be coated with textured metal or a special bone-like substance, which allows bone to grow into the prosthesis. A combination of a cemented ball and a non-cemented socket may be used. Your orthopedic surgeon will choose the type of prosthesis that best meets your needs.

Hospital Stay

After surgery, you will be moved to the recovery room where you will remain for up to two hours while your recovery from anesthesia is monitored.  After you awaken fully, you will be taken to your hospital room. After surgery, you will feel pain in your hip. Pain medication will be given to make you as comfortable as possible. To avoid lung congestion after surgery, you will be asked to breathe deeply and cough frequently. Walking and light activity are important to your recovery and will begin the day of or the day after your surgery.  Most hip replacement patients begin standing and walking with the help of a walking support and a physical therapist the day after surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

Call, Don't Fall

One of the highest risks for complications associated with joint replacement surgery is the danger of patients falling after surgery.

"Patients who have joint replacement surgery have typically experienced significant pain for prolonged periods of time. When they wake up post-operatively, they are suddenly pain-free due to the anesthesia and pain medication used in their operations and post-operativley,” said Kim Beekmann, R.N., CJRI’s executive director. “When they first try to stand, they often find themselves very unsteady.”

From pre-operative classes through surgical preparations, CJRI staff stress to patients that regardless of their age or condition, they are at risk to fall following surgery.

“When patients come in for their surgery, we partner with them and family members by asking them to sign a pledge stating that they are aware that they are at risk of falling and that they will promise to give us a call anytime they need to mobilize — getting in or out of bed, a chair or the bathroom, so we can assist them,” Ms. Beekmann said. Patients are reminded of this pledge by staff at eight-hour intervals following surgery and through a message on the communication boards in their rooms that reads: Call — Don’t Fall.

In a further step to prevent patient falls, the beds on CJRI’s post-operative units are equipped with special monitors. "The beds are weight-activated so that if a certain percentage of the patient’s weight is lifted off the bed, it will trigger an alarm at the nursing station so that staff can come to make sure they have the assistance they need,” Ms. Beekmann said.

At Home

Post-operative care at home is especially important in measuring the success of your surgery.

Wound Care - You will have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed about two weeks after surgery. Avoid getting the wound wet until it has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings.

Diet - Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.

Activity - Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

  • A graduated walking program, initially in your home and later outside
  • Resuming other normal household activities
  • Resuming sitting, standing, walking up and down stairs
  • Specific exercises several times a day to restore movement
  • Specific exercises several times a day to strengthen your hip joint

Avoiding Complications

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2 percent of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications.

Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Your orthopedic surgeon may prescribe one or more measures to prevent blood clots from forming in your leg veins or becoming symptomatic. These measures may include special support hose, inflatable leg coverings, ankle pump exercises, and blood thinners.

Leg-length inequality may occur or may become or seem worse after hip replacement surgery. Your orthopedic surgeon will take this into account, in addition to other issues, including the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

Other complications such as dislocation, nerve or blood vessel injury, bleeding, fracture, and stiffness can occur. In a small number of patients, some pain can continue, or new pain can develop after surgery.

Over years, the hip prosthesis may wear out or loosen. However with newer materials and techniques, this has become less likely. If the prosthesis wears, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.

Staying Healthy after Hip Replacement

The most common causes of infection following hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.  These bacteria can lodge around your prosthesis.

Blood Clot Prevention - Follow your orthopedic surgeon's instructions carefully to minimize the potential of blood clots that can occur during the first several weeks of your recovery.
Warning signs of possible blood clots in your leg include:  

  • Increasing pain in your calf
  • Tenderness above or below your knee
  • Increasing swelling in your calf, ankle and foot

If you are experiencing any of the above symptoms, go to the emergency room immediately.  

Warning signs that a blood clot has traveled to your lung include:  

  • Sudden increased shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

If you are experiencing any of the above symptoms, go to the emergency room immediately. 

Warning signs of a possible hip replacement infection are:  

  • Persistent fever (higher than 100 degrees orally)
  • Chills
  • Increasing redness, tenderness, or swelling of the hip wound
  • Drainage from the hip wound
  • Increasing hip pain with both activity and rest

If you are experiencing any of the above symptoms, call your surgeon.  

Avoiding Falls  

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery.  Stairs are a particular hazard until your hip is strong and mobile.  You should use a cane, crutches, a walker or handrails, or have someone help you until you improve your balance, flexibility and strength. Your surgeon and physical therapist will help you decide what assistive aides will be required following surgery, and when those aides can safely be discontinued.

Other Precautions  

To assure proper recovery and prevent dislocation of the prosthesis, you must take the following precautions:

  • Do not cross your legs
  • Do not bend your hips more than a right angle (90 degrees)
  • Do not turn your feet excessively inward or outward
  • Use a pillow between your legs at night when sleeping
  • You may need to take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream.

Your New Hip

It is normal to experience some numbness in the skin around your incision.  You may also feel some stiffness, particularly with excessive bending.  These symptoms will diminish over time.
Keep in mind, your new hip may activate metal detectors required for security in airports and some buildings.   

After surgery, make sure you do the following:  

  • Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
  • Take precautions to avoid falls and injuries.  Individuals who have undergone hip replacement surgery and suffer a fracture may require more surgery.
  • Notify your dentist that you have had a hip replacement.  You will need to take antibiotics before any dental procedure for a minimum of two years after your surgery and possibly longer, depending on your past health history.
  • See your orthopedic surgeon periodically for routine follow-up examinations and X-rays, even if your hip replacement seems to be doing fine.