Hip Replacement FAQ
Patients have asked many questions about hip replacements. Below is a list of the most frequently asked questions along with their answers. This should help provide you with additional information. If there are any other questions that you need answered, please ask. We want you to be completely informed about this procedure.
What is arthritis and why does my hip hurt?
In the hip joint there is a layer of smooth cartilage on the upper end of the femur (thighbone) called the femoral head. The femoral head fits within a cup portion of the pelvis bone called the acetabulum. This cartilage serves as a cushion and allows for smooth motion of the hip. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
What is a hip replacement?
A hip replacement is really a cartilage replacement with an artificial surface. The hip itself is not replaced, as commonly thought, but rather an artificial substitute for the cartilage that is inserted on the end of the bones. This is done with ball and stem on the femur and plastic cup fit into a metal shell in the acetabulum. This creates a new smooth cushion and a functioning joint that does not hurt.
What are the results of total hip replacement?
Ninety to ninety-five (90-95%) percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, x-rays and response to conservative treatment. The decision will then be yours.
Am I too old for this surgery?
Age is not a problem, 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.
How long will my new hip last and can a second replacement be done?
We expect 80-95% of hip replacements to last more than 20-30 years. However, there is no guarantee and the age and activity level can be a factor. A second replacement may be performed if necessary.
Why do they fail?
The most common reason for failure is loosening of the artificial surface from the bone. Wearing of the plastic spacer may also result in the need for a new spacer.
What are the major risks?
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infection and blood clots such as using space suits and special stockings to pump blood through your legs. Complications can also occur to your skin, arteries, veins, nerves, tendons, ligaments, and bones. Overall, the complications rates are historically around 10%. Your surgeon has already discussed these with you during your visit, but if you have any further questions or concerns, please ask us at anytime.
Should I exercise before the surgery?
Yes. You should either consult an outpatient physical therapist or follow the exercises provided by the office. Exercises should begin as soon as possible.
Will I need blood?
Most patients do not require blood transfusions after hip replacement surgery. However, we use many pre-operative, intra-operative and post-operative techniques to reduce blood loss and the need for a transfusion. You will have several tests including blood work performed prior to the surgery. Your doctor will use these tests anticipate your potential need for blood products. If you do need blood following surgery, we recommend the blood from the blood bank. This blood is screened thoroughly for infectious disease and recommended by the American Red Cross as safer and more effective when compared to self donation.
How long am I incapacitated?
The goal is to have you standing and walking the day of surgery.
How long will I be in the hospital?
Most hip patients will be hospitalized for 1 day or less after their surgery if they plan to go home with home care. There are several goals that you must achieve before you can be discharged. Our goal is a safe recovery and whatever and how long this takes varies with each patient.
What if I live alone?
Many of our patients who live alone have arranged for continual home care through their family, local church, or social group, during the first three weeks after surgery. If you decide on private nursing services, we can provide a list of unendorsed service centers for you to review.
Will I need a second opinion prior to the surgery?
A second opinion is always a good idea if considering any type of surgery. This can be arranged through our office or through your family physician. We will be more than happy to provide you with some recommendations.
How do I make arrangements for surgery?
After your surgeon has scheduled your surgery the surgical scheduler in our office will contact you. She will send you information in the mail detailing all of your upcoming appointments.
How long will the surgery take?
We reserve approximately two hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” However, an overwhelming majority of patients prefer to have a spinal anesthetic, which numbs your legs, providing you with prolonged pain relief; protects you from blood clots; and allows for “twilight” sedation. The choice is between you and the anesthesiologist.
Will the surgery be painful?
You may have discomfort following the surgery, but we will keep you comfortable with appropriate medication. We continually improve and refine our pain control methods to make you as comfortable as possible. We use many methods to make you comfortable such as medication and even relaxation techniques. We are there to help and fit the best method of pain relief to your specific needs.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant often helps during the surgery and that assistant will bill your insurance separately.
How long, and where, will my scar be?
The scar will be approximately 6-8 inches long. It will be over the side of your hip and curve towards your buttock. Sometimes the incisions need to be longer to visualize your hip. There may be some numbness around the scar. This will not cause any functional problems. We use skill and care to make the scar as cosmetically appealing as possible. Normally, there are NO visible staples or sutures
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, the Discharge Planning nurse can help provide a list of references. If you do not have someone taking care of you at your home, you may also need to arrange for private nursing. Your insurance is unlikely to reimburse for this benefit.
Will I need a walker or crutches or cane?
Yes. For about six weeks, we do recommend that you use a walker, a cane or crutches. The surgical scheduler will mail a prescription to your home. You may bring your own or a borrowed one if you have one available to you.
Will I need any other equipment?
Yes, a raised toilet seat, a tub bench and grab bars in the tub or shower may also be necessary. An occupational therapist can help you decide. Some patients will use braces. This will be decided at the time of discharge and the hospital will make all the necessary arrangements for delivery.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to a nursing home. The Discharge Planner will help you with this decision and make the necessary arrangements at the time of your orientation. You should check with your insurance company to see if you have extended care or rehab benefits.
Will I need help at home?
Yes. The first several weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. We ask that you plan to have someone stay with you around the clock for the first week after surgery. Everyone recovers at different rates but we normally recommend one week of care. Family members or friends need to be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on bed and single portions of frozen meals will reduce the need for extra help.
Will I need physical therapy when I go home?
Yes, the Discharge Planner at the hospital will arrange for physical therapy to be provided in your home or with a local physical therapist. Most patients choose to have therapy at our office. Generally patients will go to therapy 2-3 times per week. The length of time required for this type of therapy varies with each patient.
How long until I can drive and get back to normal?
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 weeks. If your surgery was on your right hip, your driving could be restricted for six weeks. When you start to drive again, please practice first with someone else in the car. One option is to have someone drive you to an empty parking lot where you can practice parking, pulling out and braking in a safe environment. Drive on some side streets first and when you and your partner feel comfortable drive on some major streets when the weather is optimal. You must be off all narcotic pain medications prior to driving.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, unless their job is quite sedentary and they can go to work with crutches. However, some people require 6 to 12 weeks to return to more demanding work.
When can I have sexual intercourse?
Any positional restrictions due to hip precautions are typically lifted 6 weeks after surgery.
How often will I need to be seen by my doctor following the surgery?
Four weeks after discharge, you will be seen for your first post-operative office visit. The frequency of follow-up visits will depend on your progress. Many patients are seen at four weeks, 3 months, and then yearly. Patients with a wound vac are typically seen about a week after surgery. If there are any issues, you will be seen sooner than four weeks.
Do you recommend any restrictions following this surgery?
Yes, high-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing can be dangerous for the new joint.
What physical/recreational activities may I participate in after my recovery?
You are encouraged to participate in low impact activities such as walking, dancing, golfing, hiking, swimming, bowling and gardening. Most patients can return to stationary bike riding or elliptical machines in 3-4 weeks. Treadmills may be used on a low speed and with no incline at 4 weeks or later. Weight machines are used with your therapist starting after the 4th week and continue till you are discharged. Your physical therapist can answer specific questions about special exercises and machines
Will I notice anything different about my hip?
Yes. You may have a small area of numbness to the outside of the scar that may last a year or more and is not serious. Sometimes this numbness is permanent. Some patients notice some clicking when they move their hip. This is the result of the artificial surfaces coming together and is not serious. In addition, most patients have some swelling and warmth to the hip and leg that may last up to one year. However, this swelling is usually not associated with any pain.
A few days after I went home from the hospital, I noticed more bruising and swelling. Why?
Swelling and bruising, which occurs about 3-6 days after discharge from the hospital, is normal. This is due to the ecchymosis (or bruising) produced during the surgery itself working its way up to the surface of the skin where it is visible. This is normal, and will subside in about 4-6 weeks. During this time after surgery, it is very important to elevate the leg to reduce the symptoms. You should continue to use ice. If you notice any increasing calf pain, please call our office as soon as possible. Occasionally patients will notice some blisters on their surgical leg at their period of maximum swelling. This is because there is no room available for the swelling and fluid to go within the skin and therefore pockets (or blisters) form. These should not be popped. If they pop on their own, cleanse them with warm soapy water and leave them open to air. Do not apply any creams or lotions over the blisters. If you have any concerns of infection, contact us immediately.
What about warmth and swelling around my hip?
It is very normal for the hip to be warm and have a feeling of swelling. The hip will be warm for up to 6 months after the surgery. During this time, your body is forming a wall around the new hip replacement because it recognizes this as a foreign body. During this wall forming process, your hip will feel warm to the touch. It will also feel thicker and tense at times. All of this is also due to the body getting used to the new metal and plastic. Once the wall stops forming (usually 6 months), these symptoms will reduce.
What are the “six week blues?”
Approximately 5-6 weeks after surgery many patients begin to feel both depressed and frustrated. It is normal to have these feelings during this period. During the first six weeks you make great strides in the reduction of pain and with your range of motion. However, at the six week mark, you often feel as though you have “hit a wall” in your progress. At this point, it is important to realize how far you have come, and don’t be discouraged. The key to getting off of this plateau is building strength. Muscle strength takes at least 12 weeks to build. Thus, until you reach 12 weeks postoperatively, you are on a plateau. You will get through this! It is important to remember that your exercises will pay off. Continue to build strength by focusing on the strengthening exercises from you notebook and from therapy for at least another 4-6 weeks. As time passes, you will slowly notice that you will feel better. The next phase you will enter is the endurance phase. During this phase, you will feel more tired than usual at the end of the day or even after a few hours of work. This phase will take anywhere from 3-6 months and even up to a year in some patients to regain.
What about some drainage from my incision?
A layer of stitches are placed just below the skin. This is in place of metal staples or outer sutures on your skin. Although this special plastic surgery type of suture makes your incision look better, it will dissolve and sometimes, this causes fluid collections under and above the skin. Sometimes, during the dissolving process, there will be some redness and swelling. In some cases, this even forms a small amount of milky white fluid that looks like pus but is only the byproduct of the dissolving suture. If this occurs, wash out the area with antibacterial soap and water and cover with a large Band-Aid for 24 to 48 hrs. Do not apply any gels or lotions to the area. After 48 hrs, this area normally dries up by itself. However, if this worsens, contact our office.
Will my leg lengths be equal after surgery?
The number one goal of surgery is to reduce your hip pain and attempt to improve your function. The second is to provide you with a stable hip that is not apt to dislocate. If the hip is not stable and is prone to dislocate, a longer implant may be needed. The downside is some slight leg lengthening, but the benefit is stability. A majority of patients prior to surgery have some shortening of the leg as a result of their underlying hip arthritis or disease, and even if the leg length is very close it initially after surgery this feels longer. Most patients adjust to any difference over the first 3 months and rarely is a shoe lift required.