DOES IT HURT
SOMEWHERE ELSE?



Hip

Your hips and knees have one of the most challenging jobs of the body: they must bear your full weight while allowing for a wide range of motion at the same time. It's no wonder these two large joints often give us pain. Injury, disease, wear and tear, and genetic disposition can all play a part in hip and knee pain.

Whether you are experiencing hip or knee problems, or bone or joint diseases, Texas Health Resources has the services you need to help ease your pain, increase your range of motion and get you back to active living. A multidisciplinary team of experts including physicians on the medical staff can diagnose the source of your pain and provide you with a range of treatment options. Texas Health has hip and knee specialists on the medical staff who can perform advanced surgeries, as well as provide less invasive treatments. Plus, many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists.

Your hip is the joint where your thigh bone meets your pelvis bone. Hips are called ball-and-socket joints because the ball-like top of your thigh bone moves within a cup-like space in your pelvis. Your hips are very stable, and when they are healthy, it takes great force to hurt them.

However, hip pain can make daily activities, such as getting in and out of a car or climbing the stairs, nearly impossible. The pain can be caused by deformity, injury or most commonly by osteoarthritis.

Texas Health Resources has a multidisciplinary team of experts including physicians on the medical staff who can quickly and effectively diagnose the source of hip pain and provide you with a range of treatment options. After treatment, Texas Health is committed to helping you recover and return to a healthy and active life. Plus, you can take steps today to keep your hips healthy or ease the pain of aching hips.

Don't have a physician? Texas Health has many physicians who specialize in treating hips. Find the right hip specialist for you.

Keep your hips healthy and pain free

    While we engage in cardio workouts to keep our hearts strong and lift weights to build muscle, we usually don't think about keeping our hips healthy. Take these steps to keep your hips healthy and ease your aches and pains:
  • Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
  • Warm up before exercising and cool down afterward. Stretch your hips, low back and thighs.
  • Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
  • Learn how to prevent osteoporosis.
  • Maintain a healthy weight.
  • Choose a low-impact or no-impact exercise routine, such as walking or swimming.
  • Add some weight training to your exercise routine; weight training helps strengthen the muscles and ligaments surrounding joints, protecting them from damage.
  • Ice your hips after exercise to help manage pain and prevent swelling.

Osteoporosis

    Certain people are more likely to develop osteoporosis than others. Factors that increase the likelihood of developing osteoporosis and broken bones are called "risk factors." Risk factors include:
  • Being female
  • Older age
  • Family history of osteoporosis or broken bones
  • Being small and thin
  • History of broken bones
  • Low estrogen levels in women, including menopause
  • Low levels of testosterone and estrogen in men
  • Diet
  • Low calcium intake
  • Low vitamin D intake
  • Excessive intake of protein, sodium and caffeine
  • Inactive lifestyle
  • Smoking
  • Alcohol abuse

Prevention

    Together, the following five steps can help optimize bone health and help prevent osteoporosis:
  • Get the daily recommended amounts of calcium and vitamin D.
  • Engage in regular weight-bearing and muscle-strengthening exercise.
  • Avoid smoking and excessive alcohol, and limit caffeine.
  • Talk to your health care provider about bone health.
  • Have a bone density test, and take medication when appropriate.

You should also pay attention to your diet to help optimize bone health. As you age, your body may need less food to maintain your weight. However, the need for vitamins and minerals may stay the same or even increase.

Choosing a variety of nutrient-rich foods is very important. Small bouts of physical activity with some muscle strengthening should also be a part of your daily routine as recommended by your doctor.

Nutrients Needed

    Unique Nutrient Needs and Amount per Day:
  • Calcium – 1,200 milligrams (mg), Vitamin D – 400 International Units
    • (IU) for adults 51-70 and 800 IU for those over 70 years of age:
    • For strong bones
    • Will aid in preventing hip fractures from occurring/reoccurring
    • Nonfat or lowfat milk offer an excellent source; Nonfat dairy products offer the best sources
    • Consider calcium + vitamin D supplement twice daily if your intake is not adequate to meet needs
  • Vitamin B12 – 2.4 micrograms (mcg)
    • May not efficiently absorb B12 found in animal products, therefore vitamin B12-fortified foods such as breakfast cereals or supplements are better absorbed
    Additional Reminders/Tips:
  • Check with your physician or health care provider before taking vitamins or other supplements to make sure they do not interfere with other medications you may be taking. You should never exceed recommended dosages.
  • Also, contact your health care provider when your food choices are limited over a period of time due to illness, difficulty chewing, lack of or decreased appetite, or inability to shop or prepare food. A basic multivitamin and mineral supplement may be warranted.
  • Oral nutritional supplements can be an excellent alternative to supplement your food intake when appetite has decreased or for promoting weight gain. Discuss oral supplements with your doctor or registered dietitian.

Diagnosing the source of hip pain

Because there are a number of causes of hip pain, diagnosing the source of the pain can be complex. Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

Hip pain can be caused by injury, such as a hip fracture, or by conditions such as tendinitis, bursitis and osteoarthritis. Your physician will diagnose your knee pain based on the findings of a medical history, physical exam and diagnostic tests.

    For your medical history, the physician will likely ask questions such as:
  • When did your hip first begin to hurt?
  • Do you feel the pain continuously or off and on?
  • Have you overused your leg?

During the physical exam the physician will manipulate your hip to determine how well the hip moves and where the pain is located. The physician will pay careful attention to your hips, thighs, back and gait.

Depending on the findings of the medical history and physical exam, your physician may use X-ray to diagnose the problem.

Hip pain treatment options

Depending on the cause of the hip pain, treatment can range from behavior modification and anti-inflammatories to partial or total hip replacement. Physicians on the medical staffs of Texas Health Resources'  hospitals provide some of the most advanced surgical procedures available for relieving hip pain, and restoring strength and mobility.

Surgical options include:

Hip resurfacing (including the Birmingham Hip Resurfacing System) - Hip resurfacing is a longer-lasting and bone-conserving alternative to hip replacement surgery that can return physically active adults to their active lifestyles. In the past, traditional hip replacement surgery was the only option for active adults with hip pain caused by arthritis and degenerative hip disease. The surgery had the potential for multiple revision surgeries to later repair worn-down implants. By leaving more bone intact, hip resurfacing allows for a future total hip replacement, if needed.

The major difference in total hip replacement and hip resurfacing is how each procedure affects the top portion of the femur (the long bone in the thigh that fits into the hip socket). In hip resurfacing, the head of the femur is shaved to a rounded shape and then covered with a metal cap. The cap is anchored by a small metal stem cemented into a small hole that is drilled into the center of the bone. In total hip replacement, the entire head of the femur is removed and replaced by a large round device that is anchored by a larger metal stem that is driven deeper into the femur. This major alteration of the femur can leave too little solid bone for a follow-up replacement procedure.

Partial hip replacement - A surgical procedure that deals with a hip in which only one part of the joint is damaged or diseased; usually, the socket is left intact and the ball part of the joint (femoral head) is replaced.

Total hip replacement - A surgical procedure that replaces a damaged or diseased hip joint with a prosthetic device; this implant replicates the ball-and-socket design of a natural hip and is designed to allow a normal range of movement; an artificial hip can last for years. This surgery can also be performed as minimally invasive surgery, featuring small incisions and a potentially shorter recovery time. Learn more about total hip replacement.

Hip replacement surgery

Today, joint replacement surgery does not have to cause a major disruption to your life. Texas Health hospitals provide joint replacement programs that focus on wellness and rehabilitation, and are committed to shortening your hospital stay while speeding up the recovery process.

    From how to prepare your home to what the procedure involves, access our comprehensive information about hip replacement surgery:
  • Indications and risks
  • Preparing for surgery
  • Procedure
  • Recovery in the hospital
  • Recovery at home
  • Hip replacement exercises
  • Activities of daily living
  • Long-term success
  • Frequently asked questions

Indications and risks

    The indications for the replacement of the hip joint include:
  • Hip pain that has failed to respond to conservative therapy (NSAID medication for six months or more)
  • Hip osteoarthritis or arthritis confirmed by X-ray
  • Inability to work, sleep or move because of hip pain
  • Loose hip prosthesis
  • Some hip fractures
  • Hip joint tumors
    This surgery is not recommended for:
  • Current hip infection
  • Poor skin coverage around hip
  • Paralysis of the quadriceps muscles
  • Severe disease of the blood vessels of the leg and foot (peripheral vascular disease)
  • Nerve disease (neuropathy) affecting the hip
  • Severe limiting mental dysfunction
  • Serious physical disease (terminal disease, such as metastatic disease)
  • Morbid obesity (more than 300 pounds)

Please note that obesity always complicates hip replacement surgery. Obese patients should discuss their options with their surgeon.

Risks

    Potential risks associated with total hip replacement include:
  • Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolus)
  • Pneumonia
  • Infection that requires removal of the prosthesis
  • Prosthesis dislocation
  • Heterotypic bone formation (extra bone growth that can cause stiffness)

People who have a prosthetic device (such as an artificial joint) need to take special precautions against infection. They should carry a medical identification card indicating that they have a prosthetic device. Also, they should always inform their health care provider of their prosthetic hip joint. They should receive antibiotics prior to dental work or any invasive procedure.

Preparing for surgery

There are a number of ways you can prepare your home for your return after surgery.

    Meal planning:
  • Prepare and freeze or purchase small portion meals for times you may be alone.
  • Stock up on staples which can be frozen for later use such as bread, vegetables and fruit.
    Safety:
  • Remove throw rugs from around the house.
  • Have a well lit pathway to your bathroom (night lights).
  • Make sure all stairways are secure and have hand railings.
  • Tuck away long phone, computer or lamp cords. Plan to use a cordless phone if you have one.
  • Arrange your furniture so you move easily through the house with your walker/crutches.
  • If possible, have rails installed in your tub or shower. You may also want to purchase a shower bench or chair, nonskid mats and a hand-held shower nozzle.
  • Arrange for care of small pets that may run "under foot".
  • If your bedroom is upstairs, you may want to prepare a sleeping area downstairs for the first week or two after you return home from surgery.
    Help at home:
  • You may need help at home for the first few days after returning home. Have a family member or friend that can assist you with meals, bathing and dressing, and to take you to your follow-up appointment with your surgeon and to your outpatient rehabilitation therapy appointments.

Packing for the hospital

    Pack your suitcase for the hospital a day or two before surgery. Include the following items in your bag:
  • Personal care items such as a toothbrush, toothpaste, deodorant, hairbrush, comb, etc.
  • Slippers, tennis shoes or flat, rubber-soled shoes with an enclosed heel and toe for walking in the hall.
  • Clothing such as short gowns, shorts, T-shirts, short pajamas and a short lightweight bathrobe.
  • Glasses, dentures, hearing aid and other personal care items with their cases.
  • Bring loose fitting clothing to wear home.
  • A list of medications you are currently taking, including the amount, strength and how often you take it.
  • A copy of your Living Will, Advanced Medical Directive (if you have one).

Maintain good hygiene

It is important to maintain good hygiene by keeping skin clean and dry, especially in the days before surgery. To help reduce bacteria living on your skin, it is recommended you shower with Hibiclens® (Chlorhexidine gluconate), an antiseptic/antimicrobial skin cleanser daily for 5 days prior to surgery. Leave this product on your skin (making sure to get in skin folds) for at least 90 seconds before rinsing. Do not wash your face with Hibiclens® (Chlorhexidine gluconate), as it can cause corneal burns. Do not apply with a cotton washcloth, as it is inactivated by cotton. Hibiclens® (Chlorhexidine gluconate) is available over the counter at most pharmacies.

    Leaving for the hospital
  • You need to shower.
  • Brush your teeth. You may brush and rinse with water but do not swallow the water.
  • Take medications. Take only the medications as instructed by your physician, with a small sip of water as soon as you get up.
  • Wear proper clothing. Wear loose fitting clothing that is easy to remove.
  • Leave jewelry and other valuables at home.
  • Remove all make up.
  • Remove all fingernail and toenail polish.
  • Bring your eyeglasses and or hearing aids. If you wear contacts, bring the case.

Procedure

The hip is essentially a ball and socket joint, linking the "ball" at the head of the thigh bone (femur) with the cup-shaped "socket" in the pelvic bone. A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint. The surgeon will decide which type of implant and implant material - metal, plastic or ceramic - will work best for their patient.

    Total hip prosthesis consists of three parts:
  • A cup that replaces your hip socket.
  • A ball that will replace the fractured head of the femur.
  • A metal stem that is attached to the shaft of the bone to add stability to the prosthesis.

If the surgery is a "hemi-arthroplasty," the only bone replaced with a prosthetic device is the head of the femur.

Patients receive an extensive pre-operative evaluation of their hip to determine if they are a candidate for a hip replacement procedure. Their health care provider will assess the degree of disability, impact on their lifestyle, and pre-existing medical conditions. The health care provider will also evaluate their heart and lung function.

The surgery will be performed using general or spinal anesthesia. The orthopedic surgeon will replace the hip socket and head of the femur, and then will insert the metal stem into the femur.

After surgery

After surgery, you will likely need immediate, careful monitoring, while you recover from anesthesia and gradually awaken. You will be moved directly from the operating room to the recovery room, which is called the PACU (post-anesthesia care unit). In PACU, you will be provided with cardiac (heart) respiratory monitoring and oxygen while your anesthesia wears off.

You will likely receive medications for pain as needed, and nurses may check your dressings and circulation to your operative leg; and encourage you to take deep breaths and to move your ankles and feet. Once you are stable, you will be transferred to your hospital room.

Recovery in the hospital

You will likely have a large dressing on the hip area, and a small drainage tube may be placed during surgery to help drain excess fluids from the joint area. Some surgeons may also place a knee immobilizer or special pillow between the legs in the operating room to prevent the hip from dislocating.

    You may experience the following:
  • Fluids may be administered intravenously so that you remain properly hydrated.
  • A urinary catheter may be placed to drain your bladder, which will likely be removed 48 hours after surgery.
  • Instruction on how to use an incentive spirometry device (a plastic device to encourage deep breathing), and cough and deep breathing exercises to gradually increase the depth of breaths in order to prevent lung collapse and pneumonia.
  • A drain may have been placed in the surgical site to remove fluids.
  • You may have an oxygen tube under your nose to help you breathe.
  • Compression devices may be wrapped around your legs or feet to prevent blood clots.
  • After surgery you will typically be started on a clear liquid diet. The nursing staff will advance you to a regular diet according to your tolerance.
  • You may lose your appetite and feel nauseous or constipated for a couple of days. These are ordinary reactions. You may be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery.

Staying ahead of the pain

Patients typically experience moderate to severe pain after surgery. However, you may receive patient-controlled analgesia (PCA), intravenous (IV) analgesics or epidural analgesics to control the pain for the first couple of days after surgery. PCA is a locked machine which allows you to give your own pain medication as ordered by your physician. You cannot give yourself too much medication. It is designed so that you can give yourself pain medication, because no one knows your pain level like you do. It is important you push the pain button before you become too uncomfortable. Your family members and friends should not push the button for you.

The pain should gradually decrease, and by the first day after surgery, oral analgesic medications may be sufficient to control pain.

It is important to control the pain enough to enable you to participate in physical therapy. Nurses typically administer pain medications about one-half hour prior to therapy so you will be comfortable during the therapy session.

Physical therapy

Physical therapy may begin the day after surgery. Some pain should be expected when starting activities after surgery, but it is very important to begin moving as early as possible.

A physical therapist can assist you in learning how to safely get in and out of bed, and walk with your walker or crutches. A physical therapist helps assist you in regaining strength and motion and will likely review precautions with you that will protect your new joint as you recover. After surgery, you will often be told how much weight you can put on your new joint when walking. This will be referred to as your "weight bearing status."

You will also likely be encouraged to do ankle pumps every hour after surgery, which help increase the circulation in your lower legs.

    A typical physical therapy schedule often includes:
  • Physical therapy evaluation
  • Instruction in specific exercises
  • Training in bed mobility and sitting on the side of the bed
  • Instruction in walking with a walker or crutches
    The first day after surgery and throughout your hospital stay you may:
  • Have physical therapy once or twice a day
  • Receive ongoing reinforcement in total hip precautions if applicable
  • Continue specific exercises and increase repetitions as tolerated
  • Continue with bed mobility and instruction in sitting and standing
  • Begin walking at least 25 feet and increase the distance with each treatment as tolerated
    Typical minimum goals include:
  • Walk 75-100 feet with an assistive device, using the correct weight bearing
  • Walk up and down stairs and/or steps with assistance
  • Demonstrate your home exercise program,
  • Demonstrate safe transfers, mobility and sitting techniques
  • For total hip replacement patients: verbalize and demonstrate the ability to perform activities without breaking the precautions

Keep in mind that participating in physical therapy strongly increases your recovery.

Your length of stay

Patients typically remain in the hospital two to four days after surgery. However, some patients may need to stay temporarily at a rehabilitation unit or long-term care center until mobility has improved, and they are safely able to live independently. These centers provide intensive physical therapy to assist patients in regaining muscle strength and flexibility in the joint.

Recovery at home

With today's modern, less invasive surgical techniques, the goal of joint replacement is to speed recovery and help patients return to their normal, productive lives as soon as possible. You should talk to your surgeon about what kind of recovery you can anticipate. Permitted activities and rate of recovery depend on the type of condition you had prior to surgery and the surgical method that was performed.

    Once you are home, call your health care provider right away if you experience:
  • A fever of more than 101°
  • Pain that gets worse after 24 hours
  • Shortness of breath or coughing up blood
  • Foul-smelling drainage coming from the surgical wound
  • Unusual swelling, warmth, or redness of your calf, thigh, or hip
  • Chest pain

A dedication to working at recovery is essential for the best results from joint replacement surgery. Patients will receive written instructions concerning physical therapy when they leave the hospital, and the patient's physician will typically refer them to either home therapy services or send them to an outpatient rehabilitation center. Patients will learn exercises they should do at home, and a commitment to these exercises should help patients recover faster.

Patients may want to participate in an aquatic program offered at some of our Texas Health hospitals. In this program, participants are led by certified aquatic fitness professionals through a series of specially designed exercises that, with the aid of the water's buoyancy and resistance, can help improve joint flexibility and muscular strength. The warm water and gentle movements can also help relieve pain and stiffness. A physician's permission is required to participate in the class. For more information on aquatic programs, call 1-877-THR-WELL.

Special precautions

The use of crutches or a walker may be necessary for as long as three months, although many people who did not use them before are able to walk without them in several weeks.

    The new joint has a limited range of movement. Patients need to take special precautions to avoid displacement of the joint. Most precautions are temporary, but some are more permanent. You should discuss precautions with your surgeon. In general, patients who have undergone total hip replacement should abide by the following guidelines:
  • Avoid crossing their legs or ankles even when sitting, standing or lying.
  • When sitting, feet should be kept about six inches apart.
  • When sitting, knees should be kept below the level of the hips. Avoid chairs that are too low, and sit on a pillow to keep the hips higher than the knees.
  • When getting up from a chair, slide toward the edge of the chair, and then use a walker or crutches for support.
  • Avoid bending over at the waist. Consider purchasing a long-handled shoehorn or a sock aid to assist in putting shoes and socks on without bending over. Also, an extension reacher or grabber may be helpful for picking up objects that are too low to reach.
  • When lying in bed, place a pillow between the legs to keep the joint in proper alignment.
  • A special abductor pillow or splint may be used to keep the hip in correct alignment.
  • An elevated toilet seat may be necessary to keep the knees lower than the hips when sitting on the toilet.

Let your dentist and health care providers know that you have an artificial joint. If you have a dental infection or skin infection, you may need to start antibiotics right away. If you have a condition such as diabetes that puts you at higher risk for infection, you may need to take antibiotics before dental procedures or some kinds of surgery. For simple dental and surgical procedures, most people with replacement joints do not need to take antibiotics in advance, but you should check with your provider about this.

Hip replacement exercises

Typical hip replacement exercises include the following. Please talk with your physician before attempting any of these exercises.

    Ankle pump
  • Lay on the floor or a flat surface
  • Bend your ankle up toward your body as far as possible
  • Now point toes away from your body
  • 15-20 repetitions two to three times per day
    Quad set
  • Sit or lie on your back with your legs straight
  • Press the back of your knee down
  • This will tighten the muscle on the top of your thigh
  • Hold three to five seconds
  • 10-15 repetitions two times per day
    Buttock squeeze
  • Lie on your back
  • Tighten buttocks together
  • Hold three to five seconds and relax
  • 10-15 repetitions two times per day

Helpful tips for activities of daily living

Getting in and out of the car

    Getting INTO the front passenger seat:
  • Push the car seat all the way back and recline it, if possible.
  • Place a hip cushion on the seat.
  • Back up to the car with your walker until you feel it touch the back of your legs
  • Reach back for the car seat with one hand, keeping your other hand on your walker or cane.
  • Keeping your operated leg in front of you, duck your head as you carefully sit down.
  • Turn your body slowly as you lift one leg at a time into the car. Be sure to lean your upper body back onto the reclined seat when you lift your operated leg into the car. You might need to use your hands to assist your operated leg into the car.
  • You can move the seat back to a more upright position, but keep it slightly reclined.
    Getting OUT of the front passenger seat:
  • Again, recline the seat back if possible.
  • Turn your body slowly as you lift your legs out of the car, leaning back to prevent yourself from bending too far forward at the hip.
  • Keep your head down as you push off the seat back with one hand. The other hand should be on your walker or cane.
  • Keeping your operated leg in front of you, stand up carefully and hold onto your walker or cane. Get your balance before starting to move.

Helpful tips for getting in and out of bed

    Getting IN bed
  • If you have an adjustable bed, make sure the head is reclined so the mattress is flat.
  • Back up toward the bed until you feel the backs of your knees touching the mattress. You should be standing beside the middle of the bed, at an equal distance from the head and foot of the bed.
  • Place your operated leg in front of you. As you sit down on the edge of the mattress, place one hand on your walker and the other on the bed.
  • Once you are sitting, place both hands behind you. Pushing with your unoperated leg and using your arms, move yourself backwards across the bed until most of your operated leg is on the mattress.
  • Now move your upper body toward your pillow using your arms and non-operated leg.
  • Remember to keep your legs apart and your toes pointed towards the ceiling.

IMPORTANT: Be sure you don't bend your operated leg more than 90 degrees at the hip. Also, do NOT cross your legs to help move your operated leg.

    Getting OUT of bed
  • Slide yourself to the edge of the bed, using your arms and pushing with your unoperated leg.
  • Keep your legs apart and your toes pointed toward the ceiling.
  • Slowly move both legs over the edge of the mattress, gradually coming into a seated position with your hands behind you on the mattress to give you support.
  • Now slide your hips to the edge of the bed, and place your operated leg in front of you. Be sure that the foot of your unoperated leg is flat on floor, ready to take your weight when you stand up.
  • Place one hand on your walker and then push up from then bed with your other hand until your are standing.
  • Be sure to keep your body upright and do NOT lean forward at the waist as you stand.
  • When using a walker, balance yourself by holding onto it with both hands.

IMPORTANT: Do not pull on the walker or rely on it to support your full weight. It can tip over easily and you could fall.

Be sure you don't bend your operated leg more than 90 degrees at the hip. Also, do NOT cross your legs to help move your operated leg.

Going up and down stairs

    It's important that all stair railings, both in and outside your home, are secure. In the first few weeks at home, limit stair climbing to one round trip per day if possible. Hold onto the railing at all times to keep your balance.
  • Put your hand on the railing. If using a cane, hold it in the hand opposite your operated leg.
  • If possible, start UP the stairs with the foot of your unoperated leg.
  • Lift your cane and your operated leg at same time as you step up.
  • Take one step at a time. Don't move until you feel strong and steady.
  • Always start DOWN the stairs with your cane and the foot of your operated leg.
  • Now move the foot of your unoperated leg down onto the same step.
    Taking a shower
  • Keep your hip precautions in mind at all times.
  • DO NOT step out of the shower stall or tub onto a scatter rug or towel.
  • If you want a soft surface, tape a non-skid bath mat securely to the bathroom floor beside the tub.
  • Until you feel steady on your feet, use a shower bench or seat which rests on a rubber mat or non-skid adhesive on the bottom of the tub or stall.
  • A long-handled sponge or hand-held shower hose can be used to wash your lower legs and feet while you can't bend over.
  • If you will be using any grab bars beside the tub or on the wall, make sure they have been properly installed and can support your weight.
    Getting INTO the shower
  • Place the shower chair in the tub or stall facing the faucets.
  • Reach back for the seat of the shower chair with one hand. Your other hand will stay on your cane or walker.
  • Carefully lower yourself on the shower seat. Turn to face the faucets and lift your legs into the shower one at a time. Keep your operated leg out straight. This is especially important after hip replacement and may be helpful in the first days and weeks after knee replacement.
    Getting OUT of the shower
  • Turn around on the seat and bring your legs out of the shower, one at a time. Push yourself up from the seat of the shower chair with one hand, while the other hand is resting on your cane or walker.
  • Stand up outside the shower. Be sure that you have regained your balance before moving again.

TIP: An easy way to think about it is: "Up with the good leg; down with the bad."

IMPORTANT: If you are unsteady or anxious, you should have someone with you to help you get in and out of the shower stall or bathtub safely.

Long-term success

The results of hip prosthesis surgery are usually excellent. The operation relieves pain and stiffness, and most patients (more than 80 percent) need no help walking. Implants need to be checked with an X-ray every two to three years to establish normal wear patterns. Modern implants are designed to be repaired. Repairing the implant is typically a much less serious surgery than complete revision to a new prosthesis but must be done before there is any damage to the bone or possible loosening of the fixation of the implant.

Frequently asked questions

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 usually does not hurt.

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 typically 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 likely 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, physicians typically order antibiotics and blood thinners. Special precautions in the operating room are taken to reduce the risk of infections. Your orthopedist will discuss ways to reduce that risk.

Before surgery

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.

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 typically between you, your surgeon and the anesthesiologist.

Q: Will the surgery be painful?

A: You will likely have discomfort following the surgery, but your physician 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 likely 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, your hospital caregivers can assist you in making these arrangements.

After surgery

Q: Will I need a walker, crutches or cane?

A: Yes, for about six weeks it will likely be recommended 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 may 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 rehabilitation 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 rehabilitation 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: It is typically recommended 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. Returning 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 likely be seen for your first postoperative office visit two to four 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.

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 will likely be 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, you should avoid 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.