Total Hip Replacement

When should it be considered?

When all other alternatives have failed to relieve the pain and restore quality of life for someone with a badly deteriorated hip, a hip replacement should be considered. Since only the individual living with the pain can decide how severe and how limiting the pain is, it should be up to that person to ultimately make the final decision. In the past, hip replacement surgery was an option primarily for people over 60 years of age, because older people tend to be less active and put less strain on the artificial joint. In recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well.

How to prepare for surgery.

As you prepare for the surgery you should educate yourself about the procedure. Knowing what to expect can ease many fears and make recovery much smoother. If possible, find someone who has had the surgery to talk to.

If you are physically able, exercises to strengthen your upper body might be a good idea. Crutches will be used after the surgery and can be tough on weak arms.

Blood transfusions are often needed after THR’s. Ask if you are a candidate for autologous blood donation, this means storing your own blood for transfusion. It is generally suggested you store 2-4 units of blood. The first donation must be given within 42 days of the surgery and the last, no less than seven days before your surgery.

Arrangements need to be made for your recovery. You will need assistance at home for several days to a couple of weeks after your discharge. If there is no one available to help you at home, a short stay in an extended care facility should be considered. Purchase or arrange rental of medical equipment you will need. Crutches, wheelchair, raised toilet seat and a long handled reacher will be needed during your recouperation.

What happens during the surgery?

You will be given a general or spinal anesthetic. The doctor will make a cut along the side of your hip, move the muscles connected to the top of the femur (thigh bone), and expose the hip joint. The ball of the joint will then be pulled away from the socket. The surgeon will remove the ball by cutting it with a saw and replace it with the artificial part. He will then attach an artificial socket to the hip bone. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a “cemented” procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient’s own bone to grow into the pores and hold the new parts in place.

Two drains may be put in to help drain any fluid or blood from the new joint. The doctor then reattaches the muscles to the top of the femur and closes the cut. The entire procedure takes 2 – 3 hours.

What happens after surgery?

You will stay in bed the day of surgery with a wedge shaped pillow between your legs to hold the joint in place. You will be given pain medication via your IV.

Physical therapy typically starts the day after surgery. A physical therapist will teach you exercises, such as contracting and relaxing certain muscles that can strengthen the hip. Because the new hip has a limited range of movement, the physical therapist also will teach you proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. You will stay in the hospital for 4 to 6 days, depending how fast your hip heals.

Before discharge you will be given very specific instructions. The best surgeon in the world does not mean a successful recovery, YOU are responsible for your recovery. Follow all instructions and do your exercises faithfully.

Some of the normal home-going instructions include:

Avoid sitting more than 60 minutes at a time. Do not cross your legs, keep your knees 12 to 18 inches apart. Always sit in a chair with arms. The arms provide leverage to push yourself up to the standing position.

For the first eight weeks, you should not bend over to pick up things from the floor or to put on shoes or socks. Slip-on-shoes are recommended.

Do not drive a car for 6 weeks following surgery. When getting into a car, back up to the seat of the car, sit and slide across the seat toward the middle of the car keeping your knees about 12 inches apart.

Wear elastic stockings (TEDS) until your follow-up appointment.

Do not shower until the staples are removed. Do not sit in a bathtub until your doctor says it is okay.

Keep the incision clean and dry. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor.

What is the expected outcome of a hip replacement?

A total hip replacement will provide pain relief in 90 to 95 percent of people. It will allow you to return to normal activities of daily living. Most people with stiff hips before surgery will regain near-normal motion, and nearly all have improved motion.

What complications may occur?

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, difficulty urinating and blood clots in the lung.

Complications that affect the hip are less common, but in these cases, the operation may not be as successful. These complications include difference in leg length, dislocation of hip and infection in the
joint.

For more information:

Total
Hip Replacement, A Guide for Patients

MedicineNet
– Hip Replacement
Good
Health Online – Total Hip Replacement