General Hip Replacement Information | Before Surgery | Surgery | After Surgery
General Hip Replacement Information
Q: What is arthritis and why does my hip hurt?
A: 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 within your 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. Rubbing of bone against bone causes discomfort, swelling and stiffness.
Q: What is a total hip replacement?
A: A total hip replacement is an operation 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.
Q: What are the results of total hip replacement?
A: 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.
Q: When should I have this type of surgery?
A: 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 is usually no harm in waiting if conservative, non-operative methods are controlling your discomfort.
Q: Am I too old for this surgery?
A: 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 personal physician for his/her opinion about your general health and readiness for surgery and to obtain medical clearance for surgery.
Q: How long will my new hip last and can a second replacement be done?
A: 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 will vary in every patient. It is important to remember that an implant is a medical device subject to wear that 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 particular implant will last for any specific length of time.
Q: Why might I require a revision?
A: Just as your original joint wears out, a joint replacement will wear over time as well. The most common reason for revision is loosening of the artificial surface from the bone. Wearing of the plastic spacer may also 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.
Q: What are the major risks?
A: Most surgeries go well, without any complications. Infection and blood clots are two serious potential 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 orthopedist will discuss ways to reduce that risk.
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Q: Should I exercise before the surgery?
A: Yes, you should consult your surgeon and physical therapist about the exercises appropriate for you.
Q: How long will I be incapacitated?
A: Some patients will be able to get up on the day of surgery. By the next morning most patients will get up, sit in a chair or recliner and should be walking with a walker or crutches later that day.
Q: How long will I be in the hospital?
A: Most hip patients will be hospitalized for two to four days after their surgery. There are several goals that you must achieve before you can be discharged.
Q: What if I live alone?
A: Two options are usually available to you. You may return home and receive help from a relative or friend. You can have a home health nurse and physical therapist assist you at home for two to four weeks. You may also stay at a rehab facility following your hospital stay, depending on your insurance, and if you qualify.
Q: Will I need a second opinion prior to the surgery?
A: The surgeon's office surgery scheduler will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.
Q: How do I make arrangements for surgery?
A: After your surgeon has scheduled your surgery, the Joint Care Coordinator will contact you. The Joint Care Coordinator will guide you through the program and assist you in making arrangements for both pre-op and postop care. The coordinator's role is described in the GuideBook along with a phone number.
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Q: How long does the surgery take?
A: We reserve approximately 2 to 2 1/2 hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Q: Do I need to be put to sleep for this surgery?
A: You may have a general anesthetic, which most people call "being put to sleep." Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you, your surgeon and the anesthesiologist. For more information, read "Anesthesia and You" in your GuideBook appendix.
Q: Will the surgery be painful?
A: You will have discomfort following the surgery, but we will try to keep you comfortable with the appropriate medication. Generally, most patients are able to stop very strong medication within one day. Most patients control their own medicine with a special pump that delivers the drug directly into their IV.
Q: Who will be performing the surgery?
A: Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and that assistant will bill you separately.
Q: Where will my scar be located?
A: Your scar will be either in front of your hip or to the side of your hip.
Q: Will I need a private nurse?
A: No, you do not need a private nurse, but if you want one, we can assist you in making these arrangements.
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Q: Will I need a walker, crutches or cane?
A: Yes, for about six weeks we do recommend that you use a walker, a cane or crutches. The physical therapist can arrange for them if necessary.
Q: Will I need any other equipment?
A: After hip replacement surgery, you will need a high toilet seat for at least three months. We can arrange to have one delivered to you, or you may rent or borrow one. You will also be taught to use assistive devices to help you with lower body dressing and bathing. You may also benefit from a bath seat, a tub transfer bench or grab bars in the bathroom, which can be discussed with your occupational therapist. Other equipment needs (with instructions for use) will be arranged by physical therapy.
Q: Where will I go after discharge from the hospital?
A: Most patients are able to go home directly after discharge. Some patients may transfer to a rehab or skilled nursing facility. The discharge planner will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have rehab or skilled nursing facility benefits.
Q: Will I need help at home?
A: Yes, the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. If you go directly home from the hospital, the discharge planner will assist you in making the necessary arrangements. Family members or friends need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed and single portion frozen meals will reduce the need for extra help.
Q: Will I need physical therapy when I go home?
A: Yes, you will have either outpatient or in-home physical therapy. The discharge planner will help you arrange for home therapy or outpatient therapy services.
Q: How long until I can drive and get back to normal?
A: 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 three to four weeks. If the surgery was on your right hip, your driving could be restricted as long as six weeks. Please note, patients are instructed to avoid driving if taking narcotic pain medications. Getting "back to normal" will depend somewhat on your progress. Consult with your surgeon or therapist for their advice on your activity.
Q: When will I be able to get back to work?
A: 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. Return to work will be discussed with your surgeon at your first post-op visit.
Q: When can I have sexual intercourse?
A: The time to resume sexual intercourse should be discussed with your orthopedic physician.
Q: How often will I need to be seen by my doctor following the surgery?
A: You will be seen for your first postoperative office visit 2 to 4 weeks after discharge. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, twelve weeks and then yearly.
Q: Do you recommend any restrictions following this surgery?
A: Yes, high-impact activities, such as running, singles tennis and basketball, are not recommended. Injury-prone sports, such as downhill skiing, are also restricted. Hip patients will be restricted from crossing their legs, twisting an operated leg, bending 90 degrees at the hip or twisting side-to-side for a period of time following the surgery.
Q: What physical and recreational activities may I participate in after my surgery?
A: You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.
Q: Will I notice anything different about my hip?
A: In many cases, patients with hip replacements think that the new joint feels completely natural. However, we always recommend avoiding extreme position 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.
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