Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.
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. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.
If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.
The hip is one of the body’s largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.
A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.
Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.
The decision to have hip replacement surgery should be a cooperative one made by you, your family, and your orthopedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopedic surgeon for an initial evaluation.
Candidates for Surgery
There are no absolute age or weight restrictions for total hip replacements. Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
When Surgery Is Recommended
There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:
An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.
With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, hip replacements can last for many years.
Possible Complications after Surgery
The complication rate following total hip replacement is low. Serious complications, such as a joint infection, occur in about 1% of patients. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Infection: Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots: Blood clots in the leg veins are the most common complication of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopedic surgeon will outline a prevention program, which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.
Leg Length Inequality: Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
Dislocation: This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first 10 weeks after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.
Loosening or Implant Wear: Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.
Continued Pain: A small number of patients continue to have pain after a hip replacement. This complication is rare, however, and the vast majority of patients experience excellent pain relief following hip replacement.
If you decide to have hip replacement surgery, your orthopedic surgeon will ask you to have a complete physical examination through pre-admission testing before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.
Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Please bring a list of all the medications you are currently taking to your pre-admission testing appointment. There will be some medications that you will need to stop prior to your surgery date and they will be able to advise you how to correctly do this. Discontinue the following medications 7-10 days before your surgery:
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, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery.Routine cleaning of your teeth should be delayed for three months after surgery.
If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery. Being overweight can increase your complications after surgery. Any weight loss that can be achieved before or after surgery would be very beneficial in your recovery. Maintaining a healthy weight will put less stress on your joints, which in turn can cause less pain.
Losing weight can make a difference when it comes to joint pain. In fact, for every pound you lose, you remove about 4 pounds of stress from your knees. Following a balanced diet while exercising regularly can help you lose weight and reduce stress on your joints.
Staying active can help keep your joints flexible, reduce pain, and improve your ability to move. Low-impact activities like swimming or water aerobics can be good options because they put less stress on your joints. Stretching exercises, strength training, and aerobic exercise may also help to ease joint pain.
A social worker will work with you during your hospital stay to set up homecare services or rehab services. The majority of people will go home with home care assistance, but if you do need additional time in a rehab facility these arrangements can be made for you.
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
You will most likely be admitted to the hospital on the day of your surgery.
After admission, a member of the anesthesia team will evaluate you. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The majority of patients will receive a spinal anesthetic for total hip replacement, but the anesthesia team, with your input, will determine which type of anesthesia will be best for you.
The surgical procedure takes about an hour. Your orthopedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.
You will most likely stay in the hospital 2-3 nights. To protect your hip during early recovery, a positioning splint, such as a foam pillow placed between your legs, may be used.
After surgery, you will be in some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Pain management is an important part of your recovery. Movement will begin soon after surgery, and when you feel less pain, you can start moving sooner and get your strength back more quickly. Talk with your surgeon if postoperative pain becomes a problem.
Blood Clot Prevention
Your orthopedic surgeon may prescribe one or more measures to prevent blood clots and decrease leg swelling. These may include special support hose, inflatable leg coverings (compression boots), and blood thinners (lovenox, Coumadin, or aspirin).
Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.
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.
It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.
The success of your surgery will depend largely on how well you follow your orthopedic surgeon’s instructions at home during the first few weeks after surgery.
You will have staples or sutures that run along your incision site. If staples are present, they will be removed 10-14 days after surgery. If sutures are present they will not require removal and will absorb on their own.
Avoid soaking the wound in water until it has thoroughly sealed and dried. Once your incision has stopped draining for a total of three days, you may get it wet and leave it open to air. You may want to continue to bandage the wound to prevent irritation from clothing, bedding, or support stockings
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.
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 program should include:
Recognizing the Signs of a Blood Clot
Follow your orthopedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.
Warning signs of blood clots. The warning signs of possible blood clot in your leg include:
Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
A common cause of infection following total hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your hip replacement and cause an infection.
After your hip replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream.
Warning signs of infection: Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:
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 physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued
To assure proper recovery and prevent dislocation of your implant, you may be asked to take special precautions — usually for the first 10 weeks after the surgery
Your surgeon and physical therapist will give you more instructions prior to your discharge from the hospital.
How Your New Hip Is Different
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 these are 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.
Protecting Your Hip Replacement
Currently, more than 90% of total hip replacements are still functioning well 15-20 years after the surgery. There are many things you can do to protect your hip replacement and extend the life of your hip implant.
After surgery, your doctors and nurses will make every effort to control your pain. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain.
In order to effectively manage your pain, your surgeon will take into account several factors that are unique to you and your situation. That is why it is important for you to openly discuss your fears and expectations, as well as your past experiences with pain control, with your doctors and nurses.
Opioids are the most effective medicines for moderate to severe pain, especially for managing short-term pain after surgery.
Types of Opioids
Most patients will be started on some sort of opioid for pain control during their hospital stay. Most commonly, Percocet, Vicodin, and tramadol are used. You will also be sent home with a prescription for pain medication.
Possible side effects of these medications include:
Your usual medications will be ordered after surgery. We will also order a number of medications that are standard after joint replacement surgery.
Antibiotics: You will receive a dose of antibiotics in your IV prior to the start of your surgery. You will also receive two doses of antibiotics after your surgery.
Multivitamin: Will be given daily. This supplement helps to boost your nutritional stores while you are recovering.
Iron Tablets: Will be given once a day. This helps to replace your iron stores that have been lowered with surgery. Most patients remain on iron tablets for about 4 weeks after surgery. Some people may experience a stomachache or constipation with this medication.
Stool Softener: You will receive a stool softener capsule twice a day. After surgery, pain medication and a decrease in activities and diet may cause constipation. These can be purchased over the counter at any pharmacy at discharge, but a prescription will be provided if needed.
Anticoagulation: If you were on a blood thinner prior to surgery you will most likely be started on that same medication after surgery. If you were not on a blood thinner prior to surgery you will be started on Lovenox or Aspirin.
Lovenox: Is started the day after your surgery and is continued for a total of 10 days. After this is finished, you will need to start a baby aspirin (81mg) daily for 4 weeks.
Aspirin: 325mg of aspirin twice a day will be started the day after your surgery and continued for 4 weeks.
How do I care for my Incision?
When can I shower?
What can I do about swelling?
When can I travel?
When do I see my doctor again?
Ahuja Joint Replacement Class
Total Joint Replacement Timeline
Your second post op visit will be 8-10 weeks after surgery with Dr. Petersilge.
Regular exercises to restore your normal hip motion and strength and a gradual return to everyday activities are important for your full recovery. Your orthopedic surgeon and physical therapist may recommend that you exercise 20 to 30 minutes 2 or 3 times a day during your early recovery. They may suggest some of the following exercises.
Early Postoperative Exercises
These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve your hip movement. You may begin these exercises in the recovery room shortly after surgery. It may feel uncomfortable at first, but these exercises will speed your recovery and reduce your postoperative pain. These exercises should be done as you lie on your back with your legs spread slightly apart
Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until you are fully recovered.
Move your ankle inward toward your other foot and then outward away from your other foot. Repeat 5 times in each direction 3 or 4 times a day.
Slide your heel toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. Repeat 10 times 3 or 4 times a day
Tighten buttock muscles and hold to a count of 5. Repeat 10 times 3 or 4 times a day
Slide your leg out to the side as far as you can and then back. Repeat 10 times 3 or 4 times a day
Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.
Repeat this exercise 10 times during a 10-minute period.
Tighten your thigh muscle with your knee fully straightened on the bed. As your thigh muscle tightens, lift your leg several inches off the bed. Hold for 5 to 10 seconds. Slowly lower. aRepeat until your thigh feels fatigued.
Soon after your surgery, you will be out of bed and able to stand. You will require help since you may become dizzy the first several times you stand. As you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.
Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 counts and put your leg down. Repeat 10 times 3 or 4 times a day
Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor.
Repeat 10 times 3 or 4 times a day
Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts. Return your foot to the floor. Repeat 10 times 3 or 4 times a day
Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity helps your recovery by helping your hip muscles regain strength and movement.
Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step allow your toe to lift off the floor. Move the walker again and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can. Don’t hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg.
A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch is then used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand opposite the operated hip. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker.
Stair Climbing and Descending
The ability to go up and down stairs requires both flexibility and strength. At first, you will need a handrail for support and you will only be able to go one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than those of the standard height of seven inches and always use the handrail for balance.
Advanced Exercises and Activities
A full recovery will take many months. The pain from your problem hip before your surgery and the pain and swelling after surgery have weakened your hip muscles. The following exercises and activities will help your hip muscles recover fully.
These exercises should be done in 10 repetitions four times a day with one end of the tubing around the ankle of your operated leg and the opposite end of the tubing attached to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.
Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position.
Stand sideways from the door and extend your operated leg out to the side. Allow your leg to return to its previous position.
Face the door or heavy object to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position.
Exercycling is an excellent activity to help you regain muscle strength and hip mobility. Adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Pedal backwards at first. Pedal forward only after comfortable cycling motion is possible backwards. As you become stronger (at about 4 to 6 weeks) slowly increase the tension on the exercycle. Exercycle forward 10 to 15 minutes twice a day, gradually building up to 20 to 30 minutes 3 to 4 times a week.
Take a cane with you until you have regained your balance skills. In the beginning, walk 5 or 10 minutes 3 or 4 times a day. As your strength and endurance improves, you can walk for 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain your strength.
Dr. Petersilge’s Office:
Secretary Johanna: 216-202-6300
Fax Number: 844-785-6337
Appointment Line: 216-202-6300
Ahuja Pre-admission Testing: 216-285-4006
Home Care: 216-844-4663
Recommended Rehab Facilities:
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