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Introduction

This page is designed to provide information about total hip replacements and what to expect before and after this surgical procedure. Instructions are provided to help you prepare for surgery, recovery and rehabilitation. It is recommended that you read this booklet before your surgery and write down any questions you may have. If you have questions, please feel free to ask your consultant doctor. The doctor’s goals are to restore your hip to a painless, near functional status and to make your hospital stay as beneficial, informative, and comfortable as possible

Contents

  • Total Hip Replacement
  • Preparing for Surgery
  • Pre-op Visit
  • Day of Surgery
  • After Surgery
  • Home Exercises

Total Hip Replacement

Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts–the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the ” ball „ or head of the thigh bone (femur). During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. These artificial pieces are implanted into healthy portions of the pelvis and thigh bones and affixed with a bone cement (methyl methacrylate).

Cement less total hip replacement

An alternative hip prosthesis has been developed that does not require cement. This hip has the potential to allow bone to grow into it, this is an important consideration for the younger patient. In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cement less. This would be called a ”Hybrid„ hip prosthesis.

When do we consider total hip replacements?

Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or aseptic necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is occasionally performed on younger persons. Circumstances vary, but generally patients are considered for total hip replacements if:

Pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living

  • Pain is not relieved by arthritis (anti-inflammatory) medicine, the use of a cane, and restricting activities
  • Significant stiffness of the hip
  • X-rays show advanced arthritis, or other problems

What can be expected of a total hip replacement ?

A total hip replacement will provide complete or nearly complete pain relief in 90 to 95 percent of patients. It will allow patients to carry out many normal activities of daily living. The artificial hip may allow you to return to active sports or heavy labor under your physician’ s instructions. Most patients with stiff hips before surgery will regain near-normal motion, and nearly all have improved motion.

What are the risks of total hip replacement ?

Total hip replacement is a major operation. The effect of most complications is simply that the patient stays in the hospital longer. The most common complications are not directly related to the hip and do not usually affect the result of the operation. These include:

  • Blood clots in the leg
  • Blood clots in the lung
  • Urinary infections or difficulty in urinating
  • Complications that affect the hip are very un common, but in these cases, the operation may not be as successful:
  • Difference in leg length
  • Stiffness
  • Dislocation of hip (ball pops out of socket)
  • Infection in hip

A few of the complications, such as infection or dislocation, may require re–operation.

How do artificial hips stand up over time?

As we noted earlier, 90 to 95 percent of hip replacements are successful up to 10 years. The major long-term problems are loosening or wear. Loosening occurs either because the cement crumbles (as old mortar in brick building) or because the bone melts away (reabsorbs) from the cement. By 10 years, 25 percent of all artificial hips will look loose on an X-ray. Somewhat less than half of these (about 5% to 10% of all artificial hips) will be painful and require revision.

Wear can occur in the plastic socket after some years. Small wear particles can cause inflammation resulting in thinning of the bone and risk of fracture. Loosening and wear are in part related to how heavy and how active you are. It is for this reason we do not operate on very obese patients or young, active patients. Loose, painful artificial hips can usually, but not always, be replaced. The results of a second operation are not as good as the first, and the risks of complications are higher.

Preparing for Surgery

Maintaining good physical health before your operation is important. Activities which will increase upper body strength will improve your ability to use a walker or crutches after the operation.

Pre-operative Visit

The day begins in the clinic, where an interview by the Doctor concerning past medical history and current medications will be taken. You may be instructed to stop taking your anti-inflammatory medications (ibuprofen, Naprosyn, Relafen, DayPro, aspirin) one week before surgery. You will be attending a teaching session which will include the following topics and other information about your surgery. There will also be time for discussion and questions. Bring a written list of past surgeries and of the medications and dosages that you normally take at home.

Diet

You should follow your regular diet on the day before your surgery. DO NOT EAT OR DRINK AFTER MIDNIGHT. The day of surgery you may brush your teeth and rinse your mouth without swallowing any water.

Bathing

A shower, bath or sponge bath should be taken the evening before and morning of surgery

Deep Breathing Exercises

You will be instructed in deep breathing exercises to minimize the risk of lung complications after surgery. These exercises are necessary to remove any excess secretions that may settle in your lungs while you are asleep during surgery. These exercises are to be done every one or two hours after surgery. An incentive spirometer may be demonstrated. This bedside device assists you in deep breathing exercises.

Blood Clot Prevention

You may be fitted with elastic support stockings. The morning of surgery, you will receive these stockings to aid in the circulation of your legs and feet to reduce the risk of blood clots.

Examination

The physician will also review your medical history and the medications that you take. He will listen to your heart and lungs, and do a general physical exam. He will check for any type of infection. Any blisters, cuts, or boils should be reported. If infection is found, surgery is generally delayed until the infection is cleared. During your pre-op visit, blood will be drawn and lab tests one to ensure that you are in good general health. X-rays are taken if necessary (an ECG is obtained if you have not had one taken for six months or if otherwise indicated).

After all of these tests and exams are completed, an anaesthesiologist will talk with you to determine the type of anaesthesia that is best suited for you. After you see the anaesthesiologist, your pre-op evaluation is usually over. Before you leave the hospital make sure your questions are answered. If at any time you become ill, such as with a cold or flu, you need to call your physician. Remember we want you to be in your best possible health.

Care after Surgery

After surgery you will be taken to the Recovery Room for a period of close observation, usually one to three hours. Your blood pressure, pulse, respiration and temperature will be checked frequently. Although circumstances vary from patient to patient, you will likely have some or all of the following after surgery

You will find that a large dressing has been applied to the surgical area to maintain cleanliness and absorb any fluid. This dressing is usually changed 2 to 4 days after surgery by the surgeon.

A hemovac suction container with tubes leading directly into the surgical area following surgery. The hemovac is usually removed by your doctor two to three days after surgery.

Post-operatively you may have temporary nausea and vomiting due to anesthesia or medications. Anti-nausea medication may be given to minimize the nausea and vomiting.

Diet: You will be allowed to progress your diet as your condition permits; starting with ice chips and clear liquids to diet as tolerated.

Coughing and Deep Breathing: To help prevent complications, such as congestion or pneumonia, deep breathing and coughing exercises are important. Inhale deeply through your nose; then slowly exhale through your mouth. Repeat this three times and then cough two times.

You will be encouraged to use your incentive spirometer.

Activity

Some patients experience back discomfort after surgery. This is caused by the general soreness of the hip area and partly by the prolonged lack of movement required before, during, and after surgery. Periodic change of position helps to relieve discomfort and prevents skin breakdown. The head of your hospital bed should not be elevated more than 70 degrees during the first few days after surgery. Sitting up may allow the artificial ball to dislocate from the hip socket. There will be some precautions, mostly to prevent dislocation, which is more likely to occur the first six to eight weeks after surgery. These precautions include:

  • Using 2-3 pillows between your legs and not crossing your legs
  • Not bending forward 90 degrees
  • Using a high-rise toilet seat

Initial rehabilitation

The first day after surgery you will be assisted to a reclining chair, and physical therapy may begin. You will gradually begin to take steps, walk, and learn to climb stairs with the aid of a walker or crutches. This initial rehabilitation generally takes 4-6 days. During this time, discomfort may be experienced while walking and exercising. Pain medication will be ordered by the doctor as needed. Most patients are relieved of their painful pre-surgical hip condition.

Therapy and rehabilitation program

Following surgery, you will work with a physical therapist to become independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of your hip. You will be instructed by your physical therapist in a specific home exercise program to meet your needs.

Do the home exercises two to three times a day (see home exercises section). Do your exercises indefinitely. Walking is not a substitute for exercise. If an exercise is causing pain that is lasting, reduce your intensity. If it continues to cause pain, contact your physical therapist or physician.

Home Exercises

Here is a list of potential exercises you may be asked to complete. Please refer to the exercises given in Articular resurfacing these exercises are sometimes done before surgery to help maintain the strength and range of motion of your hip.