Our goal is to restore your hip to a painless and functional status, and make your hospital stay as pleasant as possible.
Please review this information before your surgery and write down any questions you have so you can ask a member of your health care team.
Contents
Total Hip Replacement
What is it?
Total hip replacement is a surgical procedure to replace the
hip joint. This joint is composed of two parts:
- Hip socket
(acetabulum, a cup-shaped bone in the pelvis)
- "Ball" or head
of the thigh bone (femur).
Above: Bones of the normal hip form a ball and socket joint. The socket is part of the pelvis bone, and the "ball" is the upper part 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 or ceramic.
Above: A metal-backed, high-density plastic socket and stainless metal ball with stem are used to reconstruct the hip joint.
These artificial pieces are implanted into healthy bones of the
pelvis and femur.
Above: The artificial plastic socket (acetabular cup) is embedded in the pelvis bone, and the shaft protruding from the stainless metal ball is inserted into the hollowed-out thigh bone. The artificial parts are affixed with a bone cement (methyl methacrylate).
When do you consider total hip replacements?
Total hip replacements are usually performed for severe arthritic
conditions. It varies from person to person, but you would most likely be considered for a total hip replacement if:
- Pain is severe enough to restrict work,
recreation, and/or activities like walking, dressing, and preparing meals
- You have severe stiffness of the hip
- x-rays show advanced arthritis, or collapse of the head of the femur
- You have daily pain
What can be expected of a total hip replacement?
A total hip replacement provides complete or nearly complete arthritic pain relief in 90 to 95 percent of patients.
When you have recovered from total hip replacement surgery, you should be able to do your usual activities. Having a new hip may allow you to return to active sports or heavy labor under your doctor's instructions.
Most patients with stiff hips before surgery will have better motion.
What are the risks of total hip replacement?
Total hip replacement is a major operation and complications may happen. The most common complications are not related to the hip and do not usually affect the result of the operation. If they occur you may need to stay in the hospital longer than planned. These complications
include:
- Blood clots in the leg
- Blood clots in the lung
- Urinary infections or difficulty urinating
Complications that affect the hip are less 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
How do artificial hips stand up over time?
Research shows that artificial hips last a long time.
There is an increased risk of wearing your new hip out if you are overweight or very active. With joint replacement, the results of a second operation are not as good as the first, and the risks of complications are higher.
Preparing for Surgery
Preparing for a total hip replacement begins several weeks befor the surgery date. Good physical health before your operation is important.
Keeping or getting your upper body strong will improve your ability to use a walker or crutches after the operation. Performing leg strengthening exercises will help you recover quicker also.
Medical Management
You and your doctor will make a plan about what to do about the blood you will lose during surgery. Some surgeons have you donate some of your own blood; others use a blood transfusion device after your surgery.
Please schedule an appointment with your dentist if you have not had a dental check during the last six months. An infected tooth or gum can cause your new hip to get infected, too.
Your orthopaedic doctor will ask you to see an internal medicine doctor at University of Iowa Hospitals and Clinics, especially if medical problems have been present in the past.
The doctor may order blood tests and a urine sample before surgery to make sure you do not have a urinary tract infection. Urinary tract infections are common and many people don't even know they have an infection.
Preparing for Surgery and Recovery
When getting ready for surgery, you should begin thinking about the recovery period after surgery.
- You will be able to go home from the hospital two to four days after surgery
- You will need someone to stay with you at home for at least the first several days
- You will need help dressing, getting meals, etc.
- Your energy level will not be normal at this time
If you do not have anyone to help you when you go home, you may need to go to a nursing facility until you regain strength and can care for yourself. Your social worker can help with these arrangements.
Pre-operative Visit
All patients come to the clinic before their surgery to see the health care team.This visit can take several hours, so you should plan to spend at least half the day or more to complete it.
The visit begins in the Orthopaedic clinic, where a nurse will ask you about your medical history and the medicines you take. This includes prescriptions medicines and over-the-counter medicines. Bring a list of past surgeries and a list of the medicines with the dose (amount) you take at home.
The nurse practitioner will also meet with you and reviewed your medical history and the medicines that you take. She/he will check you for infection. Any blisters, cuts or boils should be reported. If you have an infection, surgery is delayed until the infection is gone. Additional x-rays are taken if needed.
Before you leave the hospital make sure your questions are answered. If at any time before your surgery, you become ill, such as with a cold or flu, you need to call your orthopaedic doctor right away. Remember we want you to be in your best possible health when you come for surgery!
Diet
You will be able to brush your teeth the day of your surgery but do not swallow anything. You can drink a total of eight ounces (one cup) of clear liquid from midnight until two hours before your surgery. You may not eat solid food on the day of surgery. Your choice of a clear liquid can include black coffee, clear tea, water, apple juice, or soda.
Bathing
You will be asked to take a shower or bath the night before your surgery and the morning of surgery if you can. Please use the special soap your were given you at your pre-operative visit. Wetell you how to do your scrub. If possible, shampoo your hair. Nail polish and make up should be removed. Do not shave your legs within five days of surgery.
Blood Clot Prevention
You may be fitted for foot pumps and/or elastic support stockings (TEDS) before surgery. These help keep your blood moving through your legs after surgery. You will be taught ankle exercises to help increase blood circulation in your legs while lying down. Medicine will be given to you to thin your blood after your surgery. Your doctor will decide what is best for you.
Anesthesia
You will see an anesthesiologist either in the late afternoon on the day of your pre-operative visit or on the day of your surgery. A nurse practitioner will talk about your choices of anesthesia and review your medical history. He/she will talk to you about what medicines to take on the day of your surgery.
If you are scheduled to see anesthesia on the day of your surgery, one of their staff will call you at home before your surgery and tell you which of your medicines you should/can take on the day of the surgery.
Pain Management
Good pain management is one of the best ways to ensure you get up and get moving after surgery. You will be asked to rate your pain on a scale of 0-10 with 0 being no pain and 10 being the worst possible pain.
You will be given pain medicine after your surgery. If your pain medicine is not working, we want to know so we can control your pain. You will be given pain medicine to take home.
Deep Breathing Exercises
The nurses will teach you how to do deep breathing exercises and how to use a device called an “incentive spirometer”. These exercises are needed to help remove secretions that may settle in your lungs while you are asleep during surgery and helps prevent pneumonia.
You will be instructed to take 10 deep breathes or use the spirometer 10 times every hour while you are awake.
Activity
Some patients have discomfort in their back after surgery. This is caused by the soreness of the hip area and by the lack of movement before, during, and after surgery.
Changing your position helps to relieve discomfort and will also help to prevent skin breakdown.
Therapy Program
After 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.
Your physical therapist will give you an exercise program for home. In addition to exercises for you to do in your home, you may have to go in to a clinic for more therapy after your discharge. Your doctors and therapists will let you know if this is needed.
Surgical Checklist
Night before Surgery
- Shower (with five minute wash to surgical area with soap provided)
- Nothing to eat after midnight, only clear liquids after midnight
- Pack t-shirt and shorts, tennis shoes, toiletries
- Do not bring valuables to the hospital
You will be called and given the time of your surgery and what time to arrive at the hospital. It is important that you arrive at the time given to you over the phone or your surgery may be delayed or cancelled.
Morning of Surgery
- Take your medicines as instructed with sips of water
- Take a second shower and wash the surgery site
Day of Surgery
Please arrive at the Day of Surgery Admissions at the instructed time, with your hip already washed. The nurse will spend a few minutes making sure you are still in good health and ready for surgery.
It is hard to predict how long each surgery will take, so expect some waiting time. Bring something to help pass the time.
You will be given a hospital gown and an intravenous (IV) line will be started for fluids and medicines during and after surgery. You will also have blood drawn to find your blood type and prepare blood for you in case you need a blood transfusion.
Your family can stay with you until you go to the operating room. You will be taken to the operating room after talking to your anesthesiologist. Your family will be sent to the Day of Surgery waiting room, Level 6.
The surgery may take two to four hours. Preparing for surgery as well as wake-up time may make your operating room and recovery room stay longer.
After Surgery
The surgeon let your family know how the surgery went. After surgery you will be taken to the recovery room for one to three hours. Your blood pressure, pulse, respiration and temperature will be checked often.
Close attention will be paid to the circulation and sensation in your legs and feet. When you wake up and your nurse and doctor feels you are ready, you will be taken to your room.
You will
likely have some or all of the following after surgery:
- A large dressing on your hip to keep the wound clean and absorb any fluid. This dressing is usually changed one day after surgery by the doctor.
- A Hemovac suction or blood recycling container with tubes leading into your hip area allows the nursing staff to measure and record the amount of drainage being lost from the wound after surgery. The hemovac is usually removed by your doctor the morning after surgery.
- The IV started before surgery will continue until you are taking enough fluid by mouth. When you are taking fluids well, the IV may be capped off so you do not need to be hooked up all the time. Antibiotics will be given for 24 hours after surgery to prevent infection.
- One side effect of anesthesia is trouble urinating after surgery. For this reason, a sterile tube called a catheter will be inserted into your bladder to keep your bladder empty. This will stay in place until the first day after surgery.
- Your doctor will decide what type of stockings or inflatable boots you will wear during and after surgery to help prevent blood clots from forming in your legs. You will be given medicines and exercise instructions (moving your ankles up and down) to help to prevent clots.
- After surgery you may have nausea and vomiting due to anesthesia or other medicines. Medicine will be given to help relieve nausea and vomiting.
- You will be allowed to eat and drink your usual diet, starting with ice chips, then clear liquids, and then to solid food.
- To help prevent lung 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.
- After 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. Your physical therapist will also provide you with an exercise program for at home.
Going Home Guidelines
When you go home from the hospital you will be independent in walking with crutches or a walker, climbing a few stairs, and getting into and out of bed and chairs.
You will need someone to help you at home for at least a few days, and then someone to help as needed, until your energy level gets better.
Medicine
- You will take your medicines as prescribed by your doctor.
- You will be sent home on medicines to prevent blood clots. Your doctor will decide whether you will take a pill (Warfarin or enteric coated aspirin) or give yourself a shot (Enoxaparin). If an injection is needed, the nursing staff will teach you or a family member how to give this medicine. If you go home on Warfarin, you will need to have your blood drawn two times per week. You will be given special instructions for the medicine the doctor wants you to take at home after surgery.
- You will be sent home on medicine to control pain. Plan to take your pain medicine 30 minutes before exercises. Preventing pain is easier than trying to catch up with your pain. If pain control continues to be a problem, call your doctor.
Activity
- Continue to walk with crutches or a walker as directed by the doctor or physical therapist
- Your doctor will determine how much weight you can place on your operated leg
- Walking is good for muscle strengthening
- Walking does not replace the exercise program that you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen your weakened muscles.
- If you have a lot of muscle aching, or sudden onset of pain, you should cut back on your exercises
Sitting and Resting
For the first week or two, avoid sitting more than 60 minutes at a time. Always sit in a chair with arms. The arms of the chair give you a place to push yourself up to the standing position.
A high kitchen or bar-type stool works well for kitchen activities. Avoid low chairs and overstuffed furniture because they may take too much work for you to get up.
Rest with your leg above the level of the heart and you may apply ice to your hip, two times a day for the first week or two.
If you sit up for more than an hour or two and develop a painful or swollen leg, use ice and keep your leg up for an hour to decrease pain and swelling. Be sure to follow the hip precautions your therapist taught you in the hospital.
Other Considerations
- Do not drive for six weeks after surgery or until your doctor tells you can
- 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 with your knees about 12 inches apart. A plastic bag on the seat will help you safely slide in/out of the car.
- For the next four to six weeks, do not engage in sexual intercourse. Sexual activity can often be resumed after your six-week follow-up appointment.
- You can return to work within two to three months, or as instructed by your doctor.
- Continue to wear elastic stockings (if ordered) until your return appointment.
- Do not shower until your sutures (stitches) are removed, unless you are instructed differently. Showers may be taken two days after your sutures are removed.
- Do not soak in a bathtub until your doctor has said you may
Your Incision
Keep the incision clean and dry. Watch for signs of infection. If you notice any swelling, increased pain, drainage from the incision, redness around the incision, or fever, report this right away to the doctor. If you have staples in your incision, they are either removed before you leave the hospital or two weeks after you go home.
Staple removal can be arranged with your local doctor. The wound sutures are removed in two to three weeks either by your local doctor or at your follow-up appointment in the Orthopaedic Clinic. If you have a clear dressing over your hip incision, you will be instructed to remove it 10 days after going home.
Prevention of Infection
If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, call your doctor. Antibiotics should be given as quickly as possible to prevent the complication of the infection settling in the area of your joint replacement.
Tell any or all of your doctors and dentists that you have had a joint replacement. You will be given a medical alert card. Carry this in your billfold or wallet. It will give information on antibiotics that are needed before any dental work or oral surgery, or if a bacterial infection develops.
When Do I Return to the Clinic?
Your first return appointment is three to six weeks after surgery. At your return appointment you will be examined and have x-rays. Appointments are then at three to six months, one year, and two years after surgery.
Should I Have a Total Hip Replacement?
The total hip replacement is an elective operation; it is not a matter of life or death. There are always non-operative choices. The decision to have the operation is not made by the doctor. It is made by you, for it is you who must accept the risks and complications.
The doctor may suggest the operation; but, your decision must be based on weighing the benefits of the operation against the risks. You may wish to discuss the surgery with your personal doctor or get another opinion. All of your questions should be answered before you decide to have the operation. Please feel free to ask any questions in order to make your decision easier.
Remember: Your doctor, physical therapist and nurses are working to make a painless, functional hip replacement possible for you. After the surgery, the success of your hip replacement, depends on you and how well you follow your exercise plan and follow the instructions you have been given. |
