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Total Hip Replacement

We are glad you have chosen the Spine and Joint Surgery Center to care for your hip. Patients usually have many questions about total hip replacement. Below is a list of the most frequently asked questions along with helpful answers. If you have any further questions, please contact your surgeon. We want our patients and their coaches to be completely informed about this procedure.

What is arthritis and why does my hip hurt?
In the hip joint there is a layer of smooth cartilage on the ball of the upper end of the thighbone (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.

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

What are the results of total hip replacement?
Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient’s activity level and the patient’s adherence to the doctor’s orders.

When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam and X-rays. Your orthopedic surgeon will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There usually is no harm in waiting if conservative, non-operative methods are controlling your discomfort.

Am I too old for this surgery?
Age is not an issue if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your primary care provider or specialist for his/her opinion about your general health and readiness for surgery.

How long will my new hip last and can a second replacement be done?
All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition(s). A total joint implant’s longevity varies in every patient. It is important to remember an implant is a medical device subject to wear, which may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your implant will last for a specific length of time.

Why might I require a revision?
Just as your original joint wears out, a joint replacement will wear out over time as well. The most common reasons for revision are loosening of the artificial surface from the bone; and wearing of the plastic spacer may result in the need for a new spacer. Dislocation of the hip after surgery is a risk. Your surgeon will explain the possible complications associated with total hip replacement.

Should I exercise before the surgery?
Yes. Please read the Patient Care Guidebook for more information.

Will I need a second opinion prior to the surgery?
The surgeon’s secretary can contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.

What are the major risks?
Most surgeries go well, without any complications. Infection 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 that risk.

How long does the surgery take?
We reserve approximately 2–2½ hours for this surgery. Some of this time is taken by the operating room staff to prepare for the surgery.

Will I be asleep during this surgery?
You may have a spinal or epidural anesthetic, which numbs only your legs and does not 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.

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

Who will be performing the surgery?
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.

Will I need blood? Can I donate my own blood?
You may need blood after surgery. You can donate your own blood (if you are able), use the community blood supply or have your relatives donate for you. Bank blood is considered safe, but we understand if you want to use your own. If this is the case, call your surgeon’s office; they can work out the details of your blood donation.

How long will I be incapacitated?
You will probably stay in bed most of the day of your surgery. However, later on the day of surgery, most patients get up, sit in a chair or recliner and are starting to walk with a walker or crutches with their physical therapist.

How long will I be in the hospital?
Most hip patients will be hospitalized from one to three days after their surgery. There are several goals you must achieve before you can be discharged.

What if I live alone?
If you live alone, two options are available:
1.You can return home and receive help from a relative or friend, and you may need a home health nurse and physical therapist to assist you at home for two or three weeks.
2.You can stay at a sub-acute facility following your hospital stay, depending on your insurance requirements.

How big will my scar be?
The scar will be approximately six inches long and along the side of your hip.

Will I need a private nurse?
Most patients do not need a private nurse, but if you need one,we can assist in making these arrangements.

Will I need a walker, crutches or cane?
Yes, for about six weeks we do recommend that you use a walker, a cane or crutches.

Will I need any other equipment?
After hip replacement surgery, you will need a high toilet seat for about three months. You also will be taught to use assistive devices to help you with lower body dressing and bathing. You also may benefit from a bath seat or grab bars in the bathroom, which can be discussed with your occupational therapist. Other equipment needs (with instructions for use) will be determined by physical therapy staff.

Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some patients may transfer to a sub-acute facility and stay there for three to seven days. The care coordinator can help you with this decision and make the necessary arrangements. Check with your insurance company to see if you have sub-acute benefits.

Will I need help at home?
Yes. During the first several days or weeks, depending on your progress, you will 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, before surgery, can minimize the amount of help required. Having laundry done, house cleaned, yard work completed, clean linens on the bed and single-portion frozen meals ready, will reduce the need for extra help.

Will I need physical therapy at home?
You may need this service. If so, you will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. If you need in-home physical therapy, we can arrange for a physical therapist to provide therapy in your home. Following this, you may go to an outpatient facility two to three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.

How long until I can drive and get back to normal?
The ability to drive depends on whether surgery was on your right hip or your left hip and the type of car you have. If the surgery was on your left hip and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right hip, your driving could be restricted as long as six weeks. Getting “back to normal” will depend somewhat on your progress. Consult with your surgeon or therapist for their advice on your activity.

When will I be able to get back to work?
We recommend that most people take at least one month off from 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.

How often will I need to be seen by my doctor following the surgery?
You will be seen for 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, 12 weeks and then yearly.

Do you recommend any restrictions following this surgery?
Yes. High-impact activities, such as running, tennis and basketball, are not recommended. Injury-prone sports such as downhill skiing also are restricted. Hip patients will be restricted from crossing their legs, twisting operated legs, bending 90 degrees at the hip or twisting side-to-side.

What physical/recreational activities may I participate in after my surgery?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.

Will I notice anything different about my hip?
In many cases, patients with hip replacements think that 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 the hip disease or because of a need to lengthen the hip to avoid dislocation. Most patients get used to this feeling in time or can use a small lift in the other shoe. Some patients have aching in the thigh on weight bearing for a few months after surgery.