Total Hip Replacement

What is a total hip replacement?
A hip replacement uses the combination of one surface gliding on another surface, to recreate the normal ball and socket of the normal joint.  These artificial component are used in order to eliminate the arthritis one has in their hip joint, and re-establish the normal characteristics that we see in an undamaged hip joint.  The acetabulum (socket) of the artificial hip is a metal cup.  The femoral head (ball) is also made of metal and glides within this cup.  Depending on the type of total hip that is performed, sometimes there is a plastic liner or sometimes it is metal-on-metal, rubbing against each other.  The ball of the hip joint is secured to a metal stem which goes down into the femur (thigh bone).  

The painful parts of the arthritic hip are thereby completely replaced with these surfaces. The surfaces that touch each other have a very low frictional resistance and a very low wear-rate against each other. 

Most of the time a total hip replacement is done without the use of cement, because this is what is best for the implant. 

What are some of the possible complications of surgery?
While complications are not common, all surgery has associated risks.  Possible complications include stiffness of the hip after surgery or continued pain.  Other complications include infection, bleeding, nerve injury, blood clots, or problems with anesthesia or underlying medical conditions.  In the hospital, we usually have a medical doctor follow patients for their medical conditions and we take every precaution against blood clots and infection. 

What kind of anesthesia is used?
Total hip replacement is usually performed with general anesthesia (going to sleep), but sometimes it may be performed with regional anesthesia (spinal or epidural block).  The type of anesthesia will depend on your choice, as well as what the anesthesiologist best recommends for you. 

What do I need to do to prepare for surgery?
My staff will help to set up the surgery through your insurance company and will instruct you on any paperwork that may be necessary.  If you are over the age of 50, or have significant health conditions, you may require an EKG and a chest x-ray.  You may also need to see your internist or family doctor to obtain a letter of medical clearance. 

The day before surgery a member of the hospital will contact you about what time to arrive for your surgery.  You may not eat or drink anything after midnight before the surgery. 

How long will I be in the hospital?
Hospitalization is usually a 3 to 4 day length.  Sometimes patients get out sooner, but rarely do patients spend any time longer than 4 days.  Sometimes patients are not able to go home but are required to go to a rehab or skilled nursing facility to get added physical therapy before they go home.  This will be individualized while you are in the hospital and social services will help us coordinate this if it is a necessary option. 

What happens the day of surgery?
The day before surgery you will be told what time to report to the hospital.  You will be admitted and taken to a pre-operative holding area where you are prepared for surgery.  You will be asked several times which extremity I am operating on.  Please note that you are asked this question many times on purpose. 

Please be aware that the process of getting checked in, prepared for surgery, undergoing the operation, and recovering from anesthesia takes the majority of the day.  I would recommend that you and your family members bring along some reading material to make the process easier for all. 

After your surgery, you will then be taken to the recovery room to be monitored.  Once the effects of anesthesia have worn off and your pain is under good control, you will be transferred to your room in the hospital.  All of the rooms at Des Peres Hospital are private rooms.

After your surgery you will have a drain in your joint as well as a Foley catheter in your bladder.  The drains are usually removed the next day in all patients and the Foley catheter is removed the next day for men.  In women, I usually leave the Foley catheter in for several days until a patient is able to get up better and get to the bathroom much easier.

How should I care for my hip after surgery?
Physical therapy will begin on postoperative Day 1.  The therapist will help you to get up out of your bed and into a chair.  They will also help you with ambulation and will start you with the use of a walker to advance your weightbearing as you feel comfortable.  Most often, patients use a walker while in the hospital and will switch to a cane at home in about a week as instructed by the home physical therapist.  Simple exercises will be taught to you in the hospital regarding strengthening and range of motion exercises.  While in the hospital, you will have a pillow between your legs to help with position and stability.  When patients go home, I tell them to use just a regular bed pillow between their legs when sleeping. 

Medication:
You will be given a prescription for pain medication as well as an antibiotic.  We also will give you a prescription for a blood thinner, called Coumadin, to be taken for the first three weeks after surgery.  This requires some blood test monitoring at home to ensure that we have you at the right level.

Showering:
You may shower when you get home from the hospital.  If you have a safe shower, you may go ahead and take your dressing off and enter the shower.  I do not want you soaking the hip, but do not mind a little shower water coming down across your hip.  After you get out of the shower you will be instructed to take a little bit of hydrogen peroxide on a clean washcloth and dab the incision to clean it.  You will then place a dressing on for that day.  If you do not take a shower, we still want you to clean the incision off once a day with hydrogen peroxide. 

Diet:
Your regular diet will be resumed in the hospital as tolerated. 

Follow up:
A follow up appointment will be made at two weeks post-operatively, where we will remove the staples. 

What will rehabilitation involve?
The rehabilitation is based on several goals:  1) allowing the tissues to heal; 2) regaining motion; 3) regaining strength; and 4) return to normal activities or activities that you have not been able to do for some time because of your arthritis.  Most of the time patients will not need any formal physical therapy after the home physical therapy.  However, if a patient is having trouble with motion, an outpatient physical therapy program may be recommended.  A continuance of the exercises learned in the hospital and by the home physical therapy after discharge from the hospital can usually be performed by a patient to continue to obtain better range of motion and better strength.

When can I return to regular activities or work?
A return to a desired activity level certainly depends on how fast a patient may heal.  In general, people may return to a sedentary type job at four weeks or so.  Certainly more strenuous jobs will take longer and may be in the neighborhood of two to three months. 

I want you to have good motion, strength, and control of your hip before returning to your job.  How quickly you return depends on several factors including:  1) your rate of healing; 2) the presence of any complications; 3) how well you follow physical therapy and post-operative instructions; and 4) how hard you work in rehabilitation.