Introduction
Is Hip Replacement Surgery for you?
The orthopaedic evaluation
Preparing for surgery
Your surgery
Your stay in the hospital
Complications
Recovery
Avoiding problems after surgery
How your new hip is different
If your hip has been damaged by arthritis, a fracture or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. You may even feel uncomfortable while resting. If medications, changes in your everyday activities and the use of walking aids are not helpful, you may want to consider hip replacement surgery. By replacing your diseased hip joint with an artificial joint, hip replacement surgery can relieve your pain, increase motion and help you get back to enjoying normal, everyday activities.
Whether to have hip replacement surgery should be a co-operative decision made by you, your family, your primary care doctor and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.
Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability and general health status -- not solely on age.
You may benefit from hip replacement surgery if:
hip pain limits your everyday activities such as walking or bending;
hip pain continues while resting, either day or night;
stiffness in a hip limits your ability to move or lift your leg;
you have little pain relief from anti-inflammatory drugs or glucosamine sulphate;
your hip medications produce harmful or unpleasant side effects;
other treatments such as physical therapy or the use of a gait aid such as a cane do not relieve hip pain.
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options such as medications, physical therapy or other types of surgery also may be considered. Your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.
The orthopaedic evaluation will typically include:
a medical history, in which your orthopaedic surgeon gathers information about your general health and asks questions about the extent of your hip pain and how it affects your ability to perform everyday activities;
a physical examination to assess hip mobility, strength and alignment;
X-rays to determine the extent of damage or deformity in your hip; and
occasionally, blood tests or other tests such as MRI or bone scanning may be needed to determine the condition of the bone and soft tissues of your hip.
1) Medical evaluation
If you decide to have hip replacement surgery, you may be asked to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to assess your health and identify conditions that can interfere with your surgery or recovery.
2) Tests
Several tests may be needed to help plan your surgery: blood and urine samples may be tested and a cardiogram and chest x-rays (radiographs) may be obtained.
3) Preparing your skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a programme to improve your skin before surgery.
4) Blood donations
You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.
5) Medications
Tell your orthopaedic surgeon about the medications you are taking. Your orthopaedist or your primary care doctor will advise you which medications you should stop or can continue taking before surgery.
6) Weight loss
If you are overweight, your doctor may ask you to lose some weight before surgery to minimise the stress on your new hip and possibly decrease the risks of surgery.
7) Dental evaluation
Although infections after hip replacement are not common, an infection can occur if bacteria enter your 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.
8) Urinary evaluation
Individuals with a history of recent or frequent urinary infections and older men with prostate disease should consider a urological evaluation before surgery.
9) 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 orthopaedic 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.
10) Home planning
The following is a list of home modifications that will make your return home easier during your recovery:
Securely fastened safety bars or handrails in your shower or bath.
Secure handrails along all 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.
A reacher that will allow you to grab objects without excessive bending of your hips.
Firm pillows for your chairs, sofas and car that enable you to sit with your knees lower than your hips.
Removal of all loose carpets and electrical cords from the areas where you walk in your home.
You will most likely be admitted to the hospital on the day of your 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 anesthetises 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.
The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and 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 made 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 orthopaedic surgeon will choose the type of prosthesis that best meets your needs.
After the surgery, you will be moved to the recovery room where you will remain for 1 to 2 hours while your recovery from anesthesia is monitored. After you awaken fully, you will be taken to your hospital room.
You will usually stay in the hospital for a few days. 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.
To protect your hip during early recovery, a positioning splint, such as a V-shaped pillow placed between your legs, may be used.
Walking and light activity are important to your recovery and will begin the day of or the day after your surgery. Most patients who undergo total hip replacement 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.
The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in fewer than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Your orthopaedic surgeon may prescribe one or more measures to prevent blood clots from forming in your leg veins or, if they do form, measures to prevent them from 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. Your orthopaedic 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 and blood vessel injury, bleeding, fracture and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.
Over years, the hip prosthesis may wear out or loosen. This problem will likely be less common with newer materials and techniques. When the prosthesis wears, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.
The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery:
1) 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 approximately 2 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.
2) 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.
3) 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 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.
Your activity programme should include:
a graduated walking programme, initially in your home and later outside;
a walking programme to slowly increase your mobility and endurance;
resuming other normal household activities;
resuming sitting, standing and walking up and down stairs;
specific exercises several times a day to restore movement; and
specific exercises several times a day to strengthen your hip joint.
You may wish to have a physical therapist help you at home.
1) Blood clot prevention
Follow your orthopaedic surgeon’s instructions carefully to minimise the potential risk of blood clots, which can occur during the first several weeks of your recovery.
Warning signs of possible blood clots include:
pain in your calf and leg that is unrelated to your incision;
tenderness or redness of your calf;
swelling of your thigh, calf, ankle or foot.
Warning signs that a blood clot has travelled to your lung include:
shortness of breath;
chest pain, particularly with breathing.
Notify your doctor immediately if you develop any of these signs.
2) Preventing infection
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.
Following your surgery, 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.
Warning signs of a possible hip replacement infection are:
persistent fever (higher than 100°F orally);
shaking chills;
increasing redness, tenderness, or swelling of the hip wound;
drainage from the hip wound;
increasing hip pain with both activity and rest.
Notify your doctor immediately if you develop any of these signs.
3) 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 orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.
4) Other precautions
To assure proper recovery and prevent dislocation of the prosthesis, you must take special precautions:
Do not cross your legs.
Do not bend your hips more than a right angle (90°).
Do not turn your feet excessively inward or outward.
Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it.
Your surgeon and physical therapist will give you more instructions prior to your discharge from the hospital.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find them minor compared with the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. You may ask your orthopaedic surgeon for a card confirming that you have an artificial hip.
After surgery, make sure you also do the following:
Participate in a regular light exercise programme to maintain proper strength and mobility of your new hip.
Take special precautions to avoid falls and injuries. Individuals who have undergone hip replacement surgery and experienced 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 2 years after your surgery and possibly longer, depending on your past health history.
See your orthopaedic surgeon periodically for routine follow-up examinations and X-rays (radiographs), even if your hip replacement seems to be doing fine.