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When you check in for your surgery, you'll be asked to remove your clothes and put on a hospital gown. The first member of the medical team to visit may be the anesthesiologist. You'll be given either general anesthesia or a spinal block, which numbs the lower half of your body.
Because infection and blood clots are possible complications of hip replacement surgery, your surgeon may order preventive medications — antibiotics and blood thinners — to be given before the surgery begins.
During the procedure
First, the surgeon will make an incision over the side of your hip, through the layers of tissue. Diseased and damaged bone and cartilage are removed, leaving healthy bone intact. Next, the prosthetic socket is implanted into your pelvic bone to replace the damaged socket. Then, the surgeon replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone. Your new, artificial joint is designed to mimic the natural, gliding motion of a healthy hip joint.
In recent years, various techniques have evolved for performing hip replacements. Some of these techniques are referred to as minimally invasive hip replacements, although this can refer to many different types of hip replacement procedures. The hope is that less invasive techniques reduce the recovery time and pain compared with standard hip replacements. However, studies comparing the outcomes of standard hip replacement with those of minimally invasive hip replacement have had mixed results. All hip replacement surgeries have benefited from newer anesthetic techniques that result in better pain management, speeding the traditional recovery time.
After the procedure
After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off. Nurses or other anesthesia aides will watch your blood pressure, pulse, alertness, pain or comfort level, and your need for medications.
Blood clot prevention
After your surgery, you'll be at increased risk of blood clots in your legs. Possible measures to prevent this complication include:
- Early mobilization. You'll be encouraged to sit up and even try walking with crutches or a walker as soon after surgery as possible, usually after one day of recovery.
- Pressure application. Both during and after surgery, you may wear elastic compression stockings or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted by the inflated sleeves helps keep blood from pooling in the leg veins, reducing the chance that clots will form.
- Blood-thinning medication. Your surgeon may prescribe an injected or oral blood thinner after surgery. Depending on how soon you walk, how active you are and your overall risk of blood clots, you may need blood thinners for several more weeks after surgery.
Physical therapy
A physical therapist may help you with some exercises that you can do in the hospital and at home to speed recovery.
Activity and exercise must be a regular part of your day to regain the use of your joint and muscles. Your physical therapist will recommend strengthening and mobility exercises and will help you learn how to use a walking aid, such as a walker, a cane or crutches. As therapy progresses, you'll gradually increase the weight you put on your leg until you're able to walk without assistance.
Home recovery and follow-up care
Before you leave the hospital, you and your caregivers will get tips on caring for your new hip. For a smooth transition:
- Arrange to have a friend or relative prepare some meals for you
- Place everyday items at waist level, so you can avoid having to bend down or reach up
- Consider making some modifications to your home, such as getting a raised toilet seat
About six to eight weeks after surgery, you'll have a follow-up appointment with your surgeon to make sure your hip is healing properly. If recovery is progressing well, most people resume their normal activities by this time — even if in a limited fashion.
- Erens GA, et al. Total hip arthroplasty. http:www.uptodate.com/home/index.html. Accessed Feb. 16, 2009.
- Erens GA, et al. Complications of total hip arthroplasty. http:www.uptodate.com/home/index.html. Accessed Feb. 16, 2009.
- Questions and answers about hip replacement. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Hip_Replacement/default.asp. Accessed Feb. 16, 2009.
- Total hip replacement. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00377. Accessed Feb. 16, 2009.
- Huo MH, et al. What's new in hip arthroplasty. The Journal of Bone and Joint Surgery. 2008;90:2043.
- Lenssen AF, et al. Role of physiotherapy in peri-operative management in total knee and hip surgery. Injury. 2006;37(suppl):S41.
- Ferrara PE, et al. Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty. Clinical Rehabilition. 2008;22:977.
- Vukomanovic A, et al. The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty. Vojnosanitetski Pregled. 2008;4:291.
- O'Donnell M, et al. Reduction of out-of-hospital symptomatic venous thromboembolism by extended thromboprophylaxis with low-molecular-weight heparin following elective hip arthroplasty. Archives of Internal Medicine. 2003;163:1362.
- Cawley Y. Mechanical thromboprophylaxis in the perioperative setting. Medsurg Nursing. 2008;17:177.
- Prokuski L. Prophylactic antibiotics in orthopaedic surgery. Journal of the American Academy of Orthopedic Surgery. 2008;16:283.
