Frequently asked questions about total hip replacement surgery

In the hip joint, there’s a layer of smooth cartilage on the ball of the upper end of the thighbone, or femur, and another layer in the hip socket. This cartilage serves as a cushion and allows for smooth motion of the hip. Arthritis is a wearing away of this cartilage. Eventually, it wears down to bone. The rubbing of bone against bone causes discomfort, swelling and stiffness.

A total hip replacement is a procedure that removes the arthritic ball of the upper thighbone or femur as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that’s fixed solidly inside the femur. The socket is replaced with a plastic or metal liner that’s usually fixed inside a metal shell. This creates a smoothly functioning joint that doesn’t hurt.

Results will vary depending on the quality of the surrounding tissue, the severity of your arthritis at the time of surgery, your activity level and your adherence to the physician’s orders.

Your orthopedic surgeon will decide if you’re a candidate for the surgery, based on your history, exam and X-rays. Your orthopedic surgeon will ask you to decide whether your discomfort, stiffness and disability justify undergoing surgery. Usually, there’s no harm in waiting if conservative, nonoperative methods are controlling your discomfort.

Age isn’t an issue if you’re in reasonable health and have the desire to continue living an active life. You may be asked to see your primary care provider or specialist for his or her opinion about your general health and readiness for surgery.

All implants have a limited life expectancy, depending on an individual’s age, weight, activity level and medical conditions. A total joint implant’s longevity varies in every patient, but can be up to 20 years or more. It’s important to remember an implant is a medical device subject to wear, which may lead to mechanical failure. While it’s important to follow all your surgeon’s recommendations after surgery, there’s no guarantee your implant will last for a specific length of time.

Just as your original joint wears out over time, so will your joint replacement. The most common reason for needing a revision is the artificial surface loosening from the bone. Wearing of the plastic spacer can result in the need for a new spacer as well. Dislocation of the hip after surgery is a risk. Your surgeon will explain the possible complications associated with total hip replacement.

Yes. Please read the educational materials provided by your surgeon for more information.

Most surgeries go well without any complications. Infections and blood clots are two serious complications. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce the risk of infections. Your surgeon will discuss ways to reduce risk.

Many surgeons advise their patients to stop smoking before surgery and to think about quitting for good. Tobacco products have an adverse effect on blood vessels, which can affect the body’s way of healing wounds and bones. The risk of infection and lung problems after surgery is also greater for patients who use tobacco. There are many sources of information offered to help people quit smoking.

We reserve approximately two to two and a half hours for this surgery. Some of this time is taken by the operating room staff to prepare for the surgery.

You may have a spinal or epidural anesthetic, which numbs only your legs and doesn’t require you to be asleep. Some patients prefer to have a general anesthetic, which most people call being put to sleep. The choice is between you, your surgeon and the anesthesiologist.

You will have discomfort following the surgery, but we’ll try to keep you as comfortable as possible with the appropriate medication. Generally, most patients are able to stop very strong IV medication within one day.

Your heart will be monitored during surgery. If it is necessary, your heart will be monitored after surgery during your hospital stay.

Your orthopedic surgeon will perform the surgery. A physician assistant often helps during the surgery and you will be billed separately by the physician assistant.

Most patients get up, sit in a chair or recliner and start to walk with a walker or crutches with their physical therapist or nursing staff on the day of surgery.

Most hip patients will be hospitalized from one to two days after surgery. There are several goals you must achieve before you can be discharged.

We have found that going through this program with a “coach” leads to more successful outcomes for all patients, especially those that live alone. A coach can be a family member or friend, who is able to assist you throughout this program. Having a coach allows most patients to return to their own homes and get back to activity sooner. We encourage you to plan the timing of your surgery to coincide with the availability of your coach. If no arrangements for a coach are possible, our staff will assist you with developing safe discharge plans based on your needs and insurance requirements.

The scar will be approximately six inches long on the side of your hip if you have a posterior approach and smaller if the minimally invasive anterior approach is used. Your surgeon will discuss the best approach for your situation.

Most patients don’t need a private nurse, but if you need one, we can assist in making the arrangements.

Yes, we recommend you use a walker, cane or crutches for about six weeks.

Other equipment needs will depend on your exact surgery, home situation and physical ability following surgery. During the pre-operative education class, our therapy staff will review post-surgical home safety and possible equipment options. During your hospital admission, therapy staff will help you decide if you would benefit from other equipment.

With proper planning, most patients are able to return to their own home after being discharged. You are encouraged to discuss the timing of your surgery with your surgeon to ensure you will have time to prepare and have assistance arranged. The ultimate goal will be to discharge you to your home. Despite the best planning, some patients will need to be discharged to a subacute facility for a short period before returning home. During the pre-operative education class and your hospital admission, our staff will help you determine if this is necessary for you. You should check with your insurance company to see if you have subacute rehab benefits.

Yes. During the first several days or weeks, depending on your progress, you’ll need someone to assist you with meal preparation, dressing, bathing, etc. Family members or friends should be available to help, if possible. Preparing ahead of time can minimize the amount of help required. You can reduce the need for extra help by doing laundry, cleaning the house, completing yard work, putting fresh linens on the bed and preparing single-portion frozen meals before your surgery.

Depending on your surgery, your surgeon may want you to have physical therapy after discharge from the hospital. For the majority of patients, this will begin shortly after discharge and take place in an outpatient physical therapy clinic. Our care coordinator will help you make these arrangements if they are not already in place prior to surgery. If for medical or safety reasons attending outpatient physical therapy is not appropriate, the care coordinator will help you make arrangements for in-home physical therapy as required.

The ability to drive depends on whether surgery was on your right hip or your left hip, and the type of car you drive. If the surgery was on your left hip and you have an automatic transmission, you could be driving two weeks after your surgery. If the surgery was on your right hip, your driving could be restricted for as long as six weeks. Getting back to normal will take time. Consult with your surgeon and therapist for their advice.

We recommend that most people take at least one month off work, unless their jobs are quite sedentary and they can return to work with crutches. An occupational therapist can make recommendations for joint protection and energy conservation on the job.

You’ll have your first postoperative office visit two to three weeks after discharge. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, at 12 weeks and then yearly.

Yes. High-impact activities are not recommended, such as running, tennis and basketball. Injury-prone sports such as downhill skiing are restricted as well. Hip patients will be restricted from crossing or twisting their legs, bending 90 degrees at the hip or twisting side to side.

You’re encouraged to participate in low-impact physical and recreational activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.

In many cases, patients with hip replacements think the new joint feels completely natural. However, we always recommend avoiding extreme positions or high-impact physical activity. The leg with the new hip may be longer than it was before, either because of previous shortening due to hip disease or because of a need to surgically lengthen the hip to avoid dislocation. Most patients get used to this feeling in time, or can put a small lift in the other shoe. For a few months after surgery, some patients experience aching in the thigh when they bear weight on it.