Total Hip Replacement

Your doctor has recommended that you undergo a total hip replacement.  Total hip replacement surgery has been done in the United States for over thirty years.  The results continue to improve every year.  Presently we are telling patients that if you have a hip replacement at this time, there is a nine out of ten chance that he hip will be in good working order in ten years.  Our goal with hip replacement surgery is to restore motion to the hip, allow the patient to walk without a limp and to remove 95% of the pain in the hip area.

A total hip replacement is an inpatient surgical procedure where your doctor will resurface your hip joint.  At present, because of the arthritis in your hip, there is no longer a shock absorber between the bones.  When you walk, the bones are rubbing and grinding on each other.  Normally, there should be 1/8 to 1/4 inch of shock absorber on the end of the bones, which prevents friction and allows smooth gliding motion as you bend and straighten your hip.  This no longer exists.  By removing the worn ball and replacing the surface of the cup, a smooth gliding motion will be restored to the hip.  In most patients, the new cup and ball will be placed without cement.  In some cases, cement will be required.  Good to excellent results are expected in 90 to 95 percent of patients.

Your doctor may ask you to see your primary care doctor three to four weeks prior to surgery, for a complete history and physical examination.  If your internist feels a need for special testing prior to your surgery, this will allow ample time to get this done.  Prior to your surgery, you will receive an EKG, urinalysis, blood count and testing of your blood for clotting function.  If you are taking high blood pressure pills, or are diabetic, additional blood work will be checked.  If you are a smoker or have a history of asthma, you will receive a chest x-ray.  We will schedule an appointment with the hospital’s Surgical Day Care Program prior to surgery to have these tests done, so that you will have the opportunity to discuss anesthesia options with the hospital anesthesiologist.

Because of the arthritis in your hip, you are most likely taking aspirin, ibuprofen, Motrin, Advil, Aleve, Naprosyn or another kind of anti-inflammatory medication to help control pain.  This will need to be stopped ten days prior to surgery.  The reason for this is anti-inflammatory drugs can affect the clotting of your blood.  You may, however, take Tylenol or acetaminophen.  This does not have a clotting effect on your blood.  It is our goal for you to have normal clotting during the surgical procedure and the first 24 hours after surgery.  After that, we want to make the blood thinner to prevent any clotting in the veins.

One month prior to surgery, your doctor will ask you to start taking iron pills (ferrous gluconate) two times a day.  This is done in order to build up your blood count.  Because you are taking iron pills, there is a possibility that you may become constipated.  Bran and fruit juices, especially apple and prune, may help to keep you regular.  For some patients, Milk of Magnesia or other gentle laxatives may be required.

On the day of surgery, you will be admitted to the hospital.  You will be notified as to when to arrive by the pre-testing department of the hospital.  In most cases, you will start your day in the Surgical Day Care Department.  You will be admitted to this department and then brought to the Operating Room.  You will meet your anesthesiologist in the pre-anesthesia area about a half hour before surgery.  For most patients there are two options for anesthesia for your hip surgery.  Both are safe and effective.  Many patients choose to undergo general anesthesia.  For those patients, they receive a PCA pump for the initial recovery period.  This is a patient controlled pump where you hit a button and receive immediate pain narcotic medication into your IV.  This is a safe and effective way to control pain and allow you to have a smooth recovery from surgery.  Some patients undergoing a total hip replacement will receive a spine anesthetic.  After the spinal anesthetic wears off, you will then be started on the PCA pain pump to relieve post-operative pain.  In some patients who have had back surgery or have bleeding disorders, a spinal anesthetic cannot be done.  After your PCA is discontinued, usually on postoperative day two, you will receive an appropriate pain pill by mouth.  After your surgery, which will take approximately two to three hours, your doctor will call your family at home or speak to them in the waiting room of the hospital.

After your surgery is completed, you will go to the Recovery Room (also called the post-anesthesia unit in some hospitals) where the nurses will watch you very closely as you recover from anesthesia.  From the Recovery Room, you will be transported to the Surgical Nursing Floor.  Once settled in your room, you will start with physical therapy.  You will be shown some exercises that you can do in bed, such as ankle pumps, glut sets and quad sets.  The next morning the therapist will set you on the side of the bed and then advance you to walking as tolerated.  By starting your therapy early, this will help to speed your recovery and your return to normal activities.

On post-operative day one, you will be visited by the physical therapist who will start muscle exercises and stretching exercises to your leg.  On post-operative day two, your PCA pump will be removed, you will get out of bed and will progress with your walking.  Initially, you will walk with a walker or crutches and as your balance improves and your discomfort decreases, you will be advanced to a cane.  You can put as much weight on your operative leg as you feel comfortable with.

Your dressing will be changed daily.  You will receive an anti-coagulant to help prevent blood clots.  We will use Lovenox, an injection given twice a day.  You will remain on Lovenox for four weeks after surgery, and will need to have your blood checked at least once a week after discharge.

It will be our goal to discharge you home within two to four days after your hip replacement.  For some patients, because of arthritis in the other leg and /or other medical conditions, admission to a rehabilitation facility after the hospital for two to four days may be necessary (this will be an individual decision made by your doctor).  Your wound staples will be removed ten

days after surgery.  You can then shower regularly.  You will then be seen in your doctor’s office six and twelve weeks after surgery.  You will have an x-ray taken on your first post-operative visit after returning home from the hospital or rehabilitation facility (you will have physical therapy through the Visiting Nurse Association).  A physical therapist will work on range of motion of your hip, strengthening of your operative leg and restoring your balance when walking.  The therapist will also teach you important positioning of your leg to prevent hip dislocation.  You will ask to refrain from crossing your knees and bending at the waist over a right angle or 90 degrees.  The therapist will teach you the proper way to put on your socks and shoes and cut your toenails to prevent a hip dislocation.  After you move from a walker or crutches to a cane, you will use the cane until your limp entirely goes away.

We hope this information has been helpful.  If any questions should arise, please feel free to contact our office at 508-478-7135.