Hip Replacement Surgery
Total joint replacement involves surgery to replace the ends of both bones in a damaged joint to create new joint surfaces.
Total hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball and resurfaces the hip socket in the pelvic bone with a metal shell and plastic liner.
Total hip replacement surgery replaces damaged cartilage with new joint material in a step-by-step process.
View a slideshow on hip replacement to see what happens during this surgery.
Doctors may attach replacement joints to the bones with or without cement.
Doctors often use general anesthesia for joint replacement surgeries, which means you'll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can't feel the area of the surgery and you are sleepy, but you are awake. The choice depends on your doctor, on your overall health, and, to some degree, on what you prefer.
Your doctor may recommend that you take antibiotics before and after the surgery to reduce the risk of infection. If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.
Some doctors are doing hip replacement surgery through smaller incisions. This is called minimally invasive surgery. It may mean less blood loss and a smaller scar. But it can also mean a longer time in surgery because the surgery is harder to do. And if the new hip cannot be fitted properly through the smaller incision, the doctor may have to make a larger opening anyway. Minimally invasive surgery is not done often for hip replacement. If you are interested in this type of surgery, talk to your doctor. Whether the procedure is a good idea for you depends on your doctor's opinion and also on his or her training and practice.
What To Expect After Surgery
Right after surgery
You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots (anticoagulants). It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you feel ill.
When you wake up from surgery, you may have a catheter, which is a small tube connected to your bladder, so you don't have to get out of bed to urinate. You may also have a compression pump or compression stocking on your leg, which squeezes your leg to keep the blood circulating and to help prevent blood clots. And you may have a cushion between your legs to keep your new hip in the correct position.
Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is decreased. You may also learn to move your feet up and down to flex your muscles and keep your blood circulating. And you may begin to learn about how to keep your hip in the correct positions while you move in bed and get out of bed.
The first few days
You will probably still be taking some medicine. You will gradually take less and less pain medicine. You may continue anticoagulant medicines for several weeks after surgery.
Rehabilitation (rehab) after hip replacement surgery may vary depending on whether the surgeon used cement or cementless methods to attach the joint replacement surfaces. Whether your surgeon used cement also determines how much weight you can put on your leg. Your surgeon will let you and your rehab team know what limitations you have. Usually, you cannot put any weight on an uncemented hip for about 6 weeks. With a cemented or hybrid (one piece cemented and one piece uncemented) hip, you can usually put some weight on your leg right away. But you'll still need a walker, a cane, or crutches for several weeks.
In general, most people get out of bed with help on the day after surgery. Over the next few days, you will learn how to walk with a walker or crutches. Your physical therapist and sometimes an occupational therapist will teach you how to exercise, walk, and do activities such as dressing and cooking while you allow your hip to heal. Depending on the type of surgery you had and your doctor's instructions, you may learn the following precautions to keep your hip from dislocating:
Most people go home within a few days to a week after surgery. Some people who need more extensive rehab or those who don't have someone who can help at home go to a specialized rehab center for more treatment.
After you go home, monitor the surgery site and your general health. If you notice any redness or drainage from your wound, notify your surgeon. You may also be advised to take your temperature twice each day and to let your surgeon know if you have a fever over 100.5°F (38.1°C).
For a while, you may need to sit only in high chairs (not on low seats that flex your hip more than 90 degrees), use a toilet seat raiser, and sleep on your back.
You may need to use a walker or crutches for several weeks after surgery until you can bear your full weight, have less pain, and can safely move around without falling. How long you need to use crutches or a walker depends on the condition of your bones and what type of procedure your doctor used as well as his or her experience working with other people who had similar surgery.
Physical therapy typically continues after you go home from the hospital until you are able to function more independently. Total rehabilitation after surgery will take at least 6 months.
You will have an exercise program to follow when you go home, even if you are still having physical therapy. You should also take a short walk several times each day. If you notice any soreness, try a cold pack on your hip and perhaps decrease your activity a bit, but don't stop completely. Staying with your walking and exercise program will help speed your recovery.
For most people it is safe to have sex about 4 to 6 weeks after a hip replacement. Talk to your doctor about how and when it is safe. And ask your physical therapist or occupational therapist about positions that will not put your new hip joint at risk.
Living with a hip replacement
Your doctor will probably want to see you at least once every year to monitor your hip replacement. Gradually, you will return to most of your presurgery activities. If you drive a car, your doctor will probably allow you to start driving an automatic shift car in 6 to 8 weeks, as long as the seat is not too low and you are no longer taking pain medicine.
Because of the way the hip is structured, every added pound of body weight adds 3 pounds of stress to the hip. Controlling your weight will help your new hip joint last longer. For suggestions, see the topic Weight Management.
Stay active to help maintain strength, flexibility, and endurance. Your activities might include walking, swimming (after your wound is completely healed), dancing, golf (don't wear shoes with spikes, and do use a golf cart), and bicycling on a stationary bike or on level surfaces. More strenuous activities, such as jogging or tennis, are not advised after a hip replacement.
Your doctor may want you to take antibiotics before dental work or any invasive medical procedure for at least 2 years after your surgery. This is to help prevent infection around your hip replacement. After 2 years, your doctor and dentist will decide whether you still need to take antibiotics. Your general health and the state of your other health conditions will help them decide.
Why It Is Done
Doctors recommend joint replacement surgery when hip pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use X-rays to look at the bones and cartilage in your hip to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.
Total hip replacement may not be recommended for people who:
But doctors evaluate each person individually.
How Well It Works
People who have hip replacement surgery have much less pain than before the surgery and are usually able to resume daily activities. You will probably be able to do your daily activities more easily because the joint moves better.
Most artificial hip joints will last for 10 to 20 years or longer without loosening, depending on such factors as:
The younger you are when you have the surgery and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.
Your artificial joint should last longer if you are not overweight and if you do not do hard physical work or play sports that stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint probably will last the rest of your life.
Doctors continue to discover new ways to improve the life span of artificial hip joints. What we know today about the long-term outcomes of hip replacement surgery comes from studies of joints that were replaced 10 to 20 years ago or longer. People who have hip replacement surgery today may expect the artificial joint to last longer than joints replaced 10 to 20 years ago.
The risks of hip replacement surgery can be divided into two groups:
The risks of each complication depend in part on your other health problems and on the surgeon.
Risks of the surgery and recovery period
What To Think About
Continued exercise (such as swimming and walking) is important for your general well-being and muscle strength. Discuss with your doctor what type of exercise is best for you.
You may donate your own blood to use during surgery if needed. This is called autologous blood donation. If you choose to do this, start the donation several weeks before the surgery so that you have time to donate enough blood and rebuild your blood volume before surgery.
If you need more than one joint replacement surgery, such as a knee and a hip, there are some general guidelines that may help you and your doctor decide in which order to do the surgeries.
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