Hip and Knee News

News Resource About Hip, Knee and Orthopedic Surgery

hip surgery

From Hip surgery to skiing and competitive Triathlon

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Clare Roche started participating in Triathlons five years ago, but feared she may have to stop training when sudden pain on a regular run heralded the start of a hip problem.

Clare, who is in her 60s and lives near Wadhurst, has enjoyed a variety of sports from childhood. More recently she started to compete in Triathlons and has represented Great Britain in international competitions in her age group. One day whilst on a usual run, she developed severe pain and was unable to weight bear on her right leg. After hobbling home, things deteriorated quickly. She was unable to walk comfortably for any length of time and the night pain that radiated down the leg into the shin and ankle made sleeping difficult. Having to cancel her plans for a walking trip to the Himalayas, Clare made an appointment with her GP.

As a physiotherapist with over 40 years of experience in the Wadhurst area, she already knew that the problem was related to her hip. X-rays showed she had no articular cartilage left in the joint, and as a physiotherapist, she knew the only option was a hip replacement. Apart from her competitive sports she has a very busy family life with three children and an increasing number of grandchildren. Clare wanted to get back to training as soon as possible. She was keen to proceed quickly to prevent her muscle strength from deteriorating too dramatically. and decided to go privately.

She had witnessed great results in patients and friends following hip surgery performed by Mr Senthil Velayudham, Orthopaedic Hip Surgeon at Nuffield Health, Tunbridge Wells.

Following consultation with Mr Velayudham, he suggested a minimally invasive total hip replacement with ceramic on ceramic bearing surfaces was the way forward and her surgery was scheduled. A ‘total replacement’ means both parts of the joint are replaced – the ball and the socket.

The operation went well with no complications. For the first ten days Clare used crutches, after which she walked with a stick. At two to three weeks post-surgery she swam regularly and used an exercise bike. Within three-four weeks she walked unaided and could do about an hour of continuous walking. She was religious with her exercises, at home and in the gym, which helped her regain muscle strength; she is still doing them almost 18 months later. At around fourteen weeks after the operation, she began running and walking began, including short intervals of alternate slow jogging combined with brisk walking. Over the following weeks and months these exercises increased in duration and intensity. Four months after the operation, Clare went skiing with no problems. Seven months after her operation she was competing in a triathlon competition and nine months after came second in her first half ironman triathlon.

Prior to her operation Clare had gained a place to compete at the Triathlon World Championships in Lausanne at the beginning of September. She was worried she wouldn’t be fit enough to compete but at the end of August was on the starting line, less than a year following surgery.

In between competitions Clare enjoys her grandchildren, hiking, bird watching and conservation all of which are only possible with the pain free mobility that her new joint brings.

Mr Velayudham said: “Minimally invasive total hip replacement is a highly successful procedure helping patients return to good active lifestyle. Understanding patients’ expectation is very important. Using appropriate prostheses, restoring hip anatomy, preserving all the muscles controlling the hip and good rehabilitation helps patients to enjoy long good outcome following hip replacement.”

Claire added: “Having a surgeon who is not only technically excellent but someone who is empathetic to your situation and provides first-rate pre and post op oversight is crucial; Mr Velayudham more than fulfilled these criteria – as I knew he would having seen several of his patients over the years.  Also impressive was the care I received at the Nuffield at all levels, from porters to senior medical staff. One hears horrible stories of waiting ages for a nurse when you really need them. That was not my experience; everyone was attentive and  professional yet caring. The food was something special too.

“My advice to anyone who wants to get the most out of their joint replacement is firstly don’t leave it too long before having the operation, secondly try to choose a great surgeon like Mr V, and finally be serious and committed about exercises and general fitness both before your operation and for at least 12 month afterwards. We can all do more than we think we can!”

Originally Appeared Here

Is It Wise to Do Pilates Before or After Hip Replacement Surgery?

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If you are scheduled to have hip surgery, now is the perfect time to start doing Pilates. Even if it seems counterintuitive to start this joint, doing so with the guidance of a skilled and experienced Pilates instructor will strengthen the joint muscles safely. This is just one of the many benefits of participating in Pilates before hip surgery.Pilates before surgery will also help strengthen the tissue surrounding the hip joint and maintain its range of motion. The exercises are gentle and have little or no impact, which means they can be performed even when there is femoral deterioration in the hip. In addition, Pilates helps to break down the compensation habits you may have formed. These are movements or adjustments that you have developed in your body while trying to avoid pain in your hip joint.

“They’re normal,” says Ron Jegadeesh, a Pilates instructor, physiotherapist and owner of Southfield’s Pilates Fitness & Physical Therapy Center, “but they also throw the body out of alignment and further exacerbate their condition.”

Another consideration is the fact that some atrophy will occur after surgery, during the postoperative rest period. By strengthening the hip area before surgery, you will begin the process from a stronger place than if you had not performed any Pilates. In addition, you will also improve your balance by strengthening the core, which will help you after surgery. Maintaining balance will be important once you start rehabilitating this joint; you will be less likely to fall and feel more confident about re-exercising as needed. This is where Pilates comes into play after surgery.

Once you start rehabilitating the hip joint, logic would rule that you will only work the affected side, but there is an imbalance between the two sides of the body that has been exacerbated by the aforementioned compensatory habits you probably developed before surgery. In addition, when it is reached, although there is a clear imbalance around the hip joint and the incision point, the whole body experiences the consequences of the surgery. For example, the brain has to recover from the effects of anesthesia and the body’s immune system is weakened. All of these factors make Pilates a unique qualification for rehabilitation after hip surgery.

Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading. With the Pilates system, individual units work together in an organized scheme or method. In other words, while working to strengthen the area around the hip joint and increase its range of motion, the rest of the body is oriented as an integrated system.

This is done with an emphasis on core strength and two-way stretching. During hip surgery rehabilitation, you will learn to use the core muscles to support every movement of your body. Under the attention of the instructor, you will perform these exercises with proper alignment to make sure that the muscles establish new fibers in the most beneficial way for the joint. Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading.

The amount of time you need to recover before participating in Pilates after surgery will depend on many factors. For some patients, particularly those involved in preoperative Pilates, it could take as little as six weeks after surgery. For others, it can take two to three months. Obviously, you first want to get permission from your surgeon.

If available, look for a center that offers both Pilates and physical therapy. Physiotherapists in these settings are also trained in Pilates and use Pilates equipment and machines to further facilitate the recovery of their patients. After the initial physical therapy sessions, patients can be effectively transferred to Pilates with the guidance of their physiotherapist. If this place does not exist near the place where you live, be sure to work only with highly trained Pilates instructors who are able to approach your mobility safely, both before and after surgery.

Benefits of Robotic Hip Surgery Using MAKO

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Operating room robots aren’t just things from science fiction movies. In fact, many orthopedic surgeons already use them to increase their accuracy and precision. Total hip replacements are now being performed with the help of Mako, a robotic arm, and a three-dimensional modeling software system. Dr. David Cheong at Orthopedic Associates in West Florida, located in Clearwater, is one of the few surgeons in the state who uses MAKO to replace hip instead of just knee. Explain its benefits.

What is a macoplasty?

“Mako is the name of the robot used in makoplasty procedures. It’s basically robot-assisted arthroplasty or joint replacement surgery,” says Cheong. “Makoplastys begins with a computed tomography of the hip, which is then used to plan the placement of the implant. Not only planning, but execution can be done with significant accuracy because of this technology.” .

The procedure takes a few hours in an outpatient center. It starts with computed tomography (or CT), which becomes a 3D model of your natural anatomy, thanks to Mako software. The robotic arm is then directed by the surgeon to help place the hip implant at the correct point. Cheong says the Mako gives him auditory, visual, and tactile cues to help guide him in the right direction. Once completed, patients can leave the operation on the same day, without the need for hospitalization.

How long is the recovery time?

“Recovery lasts two to six weeks, which is also typical of traditional hip replacements,” says Cheong. “The only difference is the way the procedure is performed.”

In a matter of weeks, patients usually return to normal daily activities, but physical therapy is required to regain strength and make sure the implant is working properly. From here, follow-up appointments with the surgeon will be required. Implants can last from 10 to 25 years, depending on weight, activity level and general health.

How much does a macoplasty cost? Medicare and private insurers will cover the cost of a macoplasty because it is still considered a joint replacement surgery. Out-of-pocket costs will be the same as for traditional surgeries: $ 17,000 to $ 20,000. The cost of the robotic arm is expensive for doctors ’offices, so many hospitals don’t have it, just orthopedic practices.

Why don’t more surgeons use Mako’s robotic arms?

“A lot of doctors use this machine just for knee replacement, but the technology is a constantly evolving process. I think we’re going to start seeing more doctors implementing it,” Cheong says. “As surgeons, we are creatures of habit and it all depends on the type of doctor and the style they prefer, traditional or technological.” Cheong has been using the Mako arm for five years and believes it helps him place implants more accurately while eliminating other variables.

Who is a good candidate for a Makoplasty? According to Beaumont Health, makoplasties are for anyone suffering from non-inflammatory or inflammatory degenerative joint disease. Forms of degenerative joint disease include osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, avascular necrosis, and hip dysplasia. Cheong adds that patients who prefer not to receive surgery may apply cortisone injections or anti-inflammatory medications as alternative treatments.

“Ultimately, it’s up to the patient to decide what they’d like to do,” Cheong says. “But for many, this type of surgery greatly improves their quality of life.”

Tips to Help Adults Prevent Hip Surgery or Arthroscopic Hip Replacement

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Tips for Chiropractors and Care Providers to Avoid Arthroscopic Hip Surgery or Hip Replacement

In the United States, 3-7% of older adults will have some type of hip osteoarthritis during his lifetime. “Osteoarthritis” or “OA” is the appropriate term for overuse or age-related degenerative conditions. While there are other types of hip problems, such as fractures or soft tissue injuries, most people will be diagnosed and seek care for the degenerative type, eventually trying to avoid arthroscopic hip surgery.

Hip replacements and alternative methods

These degenerative hip problems result in nearly 200,000 hip replacements each year in our country. These surgeries are not only expensive, but involve intensive and time-consuming rehabilitation, as well as the potential for various post-surgical problems.

While some people may actually need arthroscopic hip surgery, many others are borderline surgical candidates or are not prepared to go under the knife without first exhausting other treatment options. In these cases, a combination of proper exercise and chiropractic care can significantly delay the need for surgery or even help prevent it altogether.

Exercise to support the muscles

Exercise and physical activity are known to have a positive effect on joint health and condition. When we look at the hip, we find a large “ball and socket” joint between the femur and pelvis that supports much of our weight when we do any “vertical” activity such as walking, running, or stopping.

Surrounding this joint and providing dynamic support is a complex arrangement of muscles, including the glutes, hip flexors, quads, hamstrings and adductors, to name just a few. Weakness in these muscle groups can cause unwanted additional load on the hips and cause excessive wear. By exercising regularly, especially in resistance exercise, we can make sure that the support muscles around the hip are strong and have the ability to support the hip during our daily activities.

Another added benefit of physical activity is that exercise can stimulate chondrocyte activity in the joints. Chondrocytes are the small cellular structures that hold and produce cushion-like connective tissue that surrounds and coats most of the joints in our body. If we can stimulate chondrocyte activity, we can aid in the physical process of repairing damaged tissue and creating new healthy tissue.

The good news is that if you don’t feel comfortable in a gym setting or your degeneration is too advanced to participate in “traditional” weight lifting, even the simplest bodyweight exercises can be extremely effective. Movements such as aerial positions, lunges, hip pushes / bridges, etc., are safe and efficient methods to improve endurance and muscle strength. If patients have the strength and ability to perform even more demanding exercises, encourage them to do so.

Strength exercises vs. cardio

If endurance exercise is good, what about cardio? Do you like walking or running? The answer is a bit complex.

Many studies show that, in the context of hip health, it is possible to overdo certain types of cardiovascular activity. A 2015 study, which measured the amount of load our hips experience when moving, showed that when walking, an average adult will experience hip contact forces approximately 4 to 5.5 times their body weight. This load can increase our body weight by up to 10 times when running 12 km / h (approximately the rate of one mile in 8 minutes).

For example, a 180-pound individual will experience hip contact forces of nearly 1,000 pounds when walking and more than 1,800 pounds when running. Does this mean that cardiovascular exercise is necessarily bad for the hip? No, but we must understand that these forces of contact with the hips create a cumulative effect over time. Several studies show a positive relationship between a runner’s age, running pace, total mileage, and degenerative hip disease, probably due to the increased hip contact forces that occur during the race. .

What does this mean for patients? While we can’t make specific recommendations for cardiovascular exercise, we know that extremely high mileage combined with a fast running pace can lead to an increased risk of degenerative hip problems, and the more degeneration there is, the more likely you are to encounter problems. . In the context of hip health, this means that a regular walking routine can greatly benefit patients, while running should be carefully monitored.

If you want to practice more vigorous cardiovascular exercise, try something like swimming or an elliptical shape that removes some of the load from the joints.

When adding exercise to a “surgical prevention routine,” the chiropractor or physiotherapist should determine what types of movements and loads are appropriate and make sure patients follow a proper and safe manner. When used correctly, exercise can play a valuable role in delaying the need for hip arthroscopic surgery or other surgery.

Research and the role of the chiropractor

Numerous studies have focused on the relationship between chiropractic / manual therapy and degenerative hip disease, but one highlights the benefits very well.

A 2004 study compared “manual therapy” with “exercise therapy” in 109 individuals who had previously been diagnosed with hip osteoarthritis. The exercise group focused on active exercises to improve muscle function and joint movement. Manual treatments (also known as chiropractic care) include: identification and stretching of short / tense muscles within the hip complex, traction of the hip joint, and manipulation of the joint in “each appropriate limited position.”

Participants were divided into two groups and treated for a period of five weeks, and the results were very impressive:

  • Success rates of primary outcomes were 81% for manual therapy, compared with only 50% for exercise therapy;
  • The manual therapy group had significantly better outcomes to improve range of motion, hip function, stiffness, and pain;
  • The positive results experienced by the manual therapy group lasted after 29 weeks.

In addition to manipulating the hip joint, another consideration should be the difference in leg length (LLD), a sign of biomechanical problems with the pelvis, SI joints, and / or lumbar spine. Interestingly, research shows a potentially strong relationship between LLD and the onset of degenerative hip disorders, probably because weight alteration in a joint could be a contributing factor to osteoarthritis. Although there are other methods for analyzing pelvic / lower back function and alignment, research focuses on LLD because it is easily quantifiable and reliable.

LLD and stressful

The researchers propose that pelvic tilt or torsion, visible through the measured difference in leg length, puts uneven load and tension on the hips and can reduce the area of ​​contact of cartilage in the joint.

The combination of these tensions can increase the pressure on the cartilage and bone of the joint, causing degenerative hip conditions. We see evidence of this in a survey of 100 patients who were diagnosed with hip osteoarthritis. The researchers measured each person’s LLD just before hip surgery and found that their hip osteoarthritis was next to the longest limb 84% of the time. Other studies have shown very similar findings regarding knee osteoarthritis.

For chiropractors treating patients with degenerative hip problems, the focus is on restoring normal movement of the joints to the hips, as well as eliminating or reducing the amount of measured difference in leg length. Regardless of what methods or techniques are used to achieve this, attending to these areas can significantly reduce the need for surgery and have a positive impact on patients ’overall function and pain levels.

Arthroscopic hip surgery and variable options

While some patients really need surgery or arthroscopic hip replacement to protect their quality of life, many others have options when it comes to degenerative hip problems.

Proper exercise scheduling, combined with specific chiropractic care, can dramatically improve an individual’s function and mobility, significantly reduce their pain levels, and delay or avoid the need for surgery.

 

“Mess” in Covid Passport Certification May Interfere with Hip Surgery

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A woman trapped in the crisis on the waiting list for a Northern Ireland hospital may not be able to travel for essential surgery due to the wreckage of her Covid-19 passport.

the woman, who is due to travel to Lithuania on Sunday for a hip replacement, has so far been unable to obtain a Covid vaccine certificate to prove she is twice vaccinated.

She has been forced to travel abroad for surgery due to spiraling hospital waiting lists, which can see patients here wait up to 10 years for procedures to treat painful and debilitating conditions. .

Anatomy of the Hip

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illustration of hip anatomy

On the upper side of the pelvis (hip) bone is the acetabulum, or socket, of the ball-in-socket joint. The surface of the acetabulum is the only part of the pelvis replaced in either hip replacement or resurfacing.

The femur, or thigh bone, is the longest bone in the body. The femoral head is the ball in the ball-in-socket joint, and fits into the acetabulum. It sits on top of the femoral neck. In hip replacement surgery, the femoral neck is cut and the head is completely removed. At the base of the neck is the greater trochanter, which marks the widest point of the hip area in the skeleton.

Cartilage is a tough, elastic, gel-like layer that lines the hip joint. It is the natural bearing surface in all joints. Cartilage absorbs the shock of impact and walking, and reduces the friction in the joint to allow smooth, pain-free movement. Once injured, cartilage in adults does not heal. With enough injury, progressive deterioration can result in a worn out (arthritic) joint. It can sometimes tear, leading to joint instability and pain.

The labrum is a ring of fibrocartilage that circles the rim of the acetabulum, deepening the socket. It adds strength to the joint, but limits the range of motion.

Synovial fluid is a transparent fluid that lubricates the hip joint, much like grease in mechanical, non-living joints.

The hip capsule is made up of multiple ligaments that completely enclose the hip joint, adding to its stability.

Life with an Artificial Hip

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Living with your new artificial hip

Medical advances have made living with an artificial hip a remarkably pain-free and effective solution to hip joint problems for most.

How long will the artificial hip last?

senior-walking-after-hip-surgeryIn most cases, the hip replacement should outlast your lifespan. The 15-to-20-year data on the longevity of hip replacement components is excellent, with more than 90 percent of the implants still functioning well in many studies. But, this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.

Many factors affect the future of a hip replacement or resurfacing, such as accidents, fractures, late infections, and deterioration in your overall health. How well you take care of yourself down the road is something the surgeon cannot control.

The longevity of a hip replacement thus depends on many factors, including the following:

  • Surgeon skill in implanting the components
  • Known history or track record of the implants
  • How well you take care of yourself and your health
  • Understanding and respecting the limitations of a prosthetic lifestyle
  • Your activity level and body weight
  • Avoiding high-impact or extreme sports

How do I know if I have a metal allergy to the hip part?

Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past several decades. Most instances of a persistently painful hip after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.

What will weather changes feel like in the hip?

Some patients report increased pain and stiffness, or can feel changes in the weather after hip surgery. These sensations are not common though, and usually will disappear over 1 to 2 years after surgery. For the first couple years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to sensitivity to weather and pressure changes.

How about future dental work and other surgery?

Because you have an artificial hip joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following hip replacement surgery, antibiotics are recommended for your lifetime after the surgery.

In what other situations will I need antibiotics after the hip replacement?

Antibiotics given for other medical procedures may vary. Contact your physician for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

If you have a cut anywhere that develops an infection, conditions like a tooth abscess or ingrown toenail developing, seek medical attention urgently. Ignoring a festering sore means that there is a risk the bacteria could migrate to the hip, resulting in a serious deep infection, even though it happens rarely.

Will the new hip set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. Your surgeon will supply you with an implant identification card that you can carry to prove that you have metal hip replacement parts.

Can I have a MRI scan after hip replacement?

Yes. MRI scans of other parts of your body are safe after hip replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with hip replacement parts. You may also have a CT scan of any part of your body after a hip replacement.

How will I know if my hip implants are recalled?

In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please let your medical team know.

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of hip implants?

Implants are engineered to withstand your body weight and activity level, but the moving parts of a hip replacement do wear over a period of several decades. A properly aligned hip replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.

Subtle component mal-positioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the hip is implanted in your body is a critical determinant of durability.

After Hip Surgery

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Recovering from Hip Surgery

What happens after hip surgery? Here are answers to commonly asked questions.

What can I expect during the hospital stay?

You can expect to see several people who will help with your recovery. A physical therapist will assist with hip exercises and walking. An occupational therapist will assist you with learning everyday activities, such as dressing and bathing, while your hip is healing. Your surgeon, his associates, medical doctors, and nursing staff will see you daily. A nursing assistant will help with bathing and activities that you are unable to do yourself.

The first night or two may be hard considering that you will have an unfamiliar bed, diet, and medications. Ask for a sleeping pill or anti-anxiety medication if that will help. Anticipate several weeks before your normal sleeping, eating, and resting patterns are restored.

How long will I stay in the hospital?

The average hospital stay after hip replacement is one or two days. The day after your surgery, you will be helped into a chair and you may be able to walk limited distances. Your activity will increase with each day that follows.

Recovery time varies from one patient to another. Much depends on other existing medical conditions. For example, arthritic disease in other major joints, heart disease, diabetes, obesity, depression, and other related conditions will affect recovery.

Most people return to their own place of residence after a hip replacement. Some elderly or debilitated patients may need to go to a nursing home to recuperate.

Preventing blood clots

What measures are taken to reduce the risk of blood clots?

For routine hip surgery, it’s common to use a blood-thinning medicine for about 4 weeks after surgery. In addition to a blood thinner, doctors also use early mobility, spinal anesthesia, leg exercises, foot pumps, and efficient surgery as adjunctive measures to minimize the risk of blood clots.

Why is a blood thinner needed after surgery?

This is to reduce the risk of a blood clot. Hip surgery is associated with a risk of blood clots developing in the calf, thigh, or pelvic veins. These clots often do not have any obvious symptoms or signs. Clots can cause chronic swelling of the legs, pain, and circulation and skin problems. In rare instances, a clot can break off and travel to the lungs, which can sometimes be fatal. This is why blood clots and blood-thinning medications are taken so seriously.

The risk of clots greatly decreases when the blood is thinned after surgery. Therefore, we use a blood thinner in every patient following hip surgery.

If you have ever had a blood clot before, or have ever had an adverse reaction to a blood thinner, please let your physician know so that he or she can plan an accordingly.

Common sensations

What sensations can I expect right after surgery?

Typically, patients have little to no pain, but nausea is more common. This nausea can come from the anesthetic drugs or from pain medicines and we can help control it by changing pain medicines and prescribing anti-nausea agents if necessary. If you have pain, nausea, or any other disagreeable sensation, let the nursing staff know. They are very knowledgeable in controlling such symptoms. Usually, an adjustment of medications is all that it takes to address any disagreeable sensations.

Why do I have a popping sensation in the new hip?

This can happen from a tendon, called the psoas tendon, rubbing against the new hip. With exercise and time, this sensation will disappear, assuming that it ever manifests in the first place. Usually this popping sensation occurs while the hip is healing, and while turning the leg side to side.

Why is the outside of my thigh numb?

This is normal after most anterior approaches to hip replacement or hip resurfacing. The incision cuts small nerve fibers that run from inside to outside of the hip, so the skin to the outside of the cut always feels numb after hip surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.

Is it normal for the muscles to spasm and tighten after surgery?

Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, your doctor can prescribe a muscle relaxant medicine, which can help.

Why are my appetite, mood, food-taste, and sleep different after surgery?

Altered appetite, bowel habits, depression, and mood swings are common after hip replacement. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.

All surgery elicits powerful psycho-social and physiological responses, which vary from one person to another. These responses are normal,; your medical team will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.

Caring for your incision

Should I keep the incision covered?

Yes. Covering daily with a gauze dressing is best. You can shower with the dressing on, protecting it as much as possible, and then changing with a new dressing after the daily shower. Avoid touching the incision; the skin around the scar should be kept clean with soap and water. No antibiotic ointments are necessary.

Alternatively, you can remove the dressing, wash around the incision with soap and water, pat dry, and cover with a new dressing. Showering is safe at any time after surgery, but immersing the incision in a bathtub should wait until the stitches/staples are removed.

Can I put any lotion on the scar?

While stitches or staples are still in, avoid applying anything to the incision; simply keep it clean and dry. Once stitches or staples are out, you can use Vitamin E cream to massage and loosen the scar. Massaging the thigh area with an anti-inflammatory or cortisone cream can reduce skin inflammation and tenderness; many such ointments are available over the counter.

What if I am allergic to the adhesive used in the dressing?

If your skin cannot handle the adhesive or tape, or if there is drainage from the incision, a useful tip is to use feminine hygiene pads as a dressing. These are self-adhesive, comfortable, very gentle on the skin, and very absorbent.

Who will remove stitches and when?

Usually the home health nurse will remove stitches or staples, no earlier than 21 days after surgery. In some cases, the stitches may be left in longer, depending on the rate of healing. Home health nurses should take a digital photo of the incision if there is a concern and send it to your physician via e-mail.

When can I shower, take a bath, or swim?

Shower anytime after the surgery, if you can sit or stand safely with help. The incision can be covered with a plastic wrap. A new, dry dressing should be used to cover the incision after the shower.

Tub baths and immersion into water, such as a swimming pool, should be delayed until the stitches or staples are out and the skin has sealed completely. This takes at least a couple of weeks after surgery.

Swelling

How long will I have swelling and warmth in the surgical site?

Swelling and warmth around the scar are common after a hip replacement or hip resurfacing operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.

Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.

Deep aches and swelling in the hip can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time.

When can I stop wearing the compression stockings after hip replacement?

Compression stockings may be applied to both legs after surgery to control swelling, and many patients inquire when these can be discontinued. The answer is that if swelling is not a concern, you can stop wearing the stockings at any time.

These stockings are prescribed to control one of the most common nuisances after any hip operation, namely, swelling in the leg and ankle. The stockings have nothing to do with preventing blood clots; for that problem, it’s common to use a blood thinner and other strategies discussed here.

Preventing infection

How do you prevent infections during hip replacement?

Some of the key factors in reducing the risk of infection involve scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols. It is impossible to completely eliminate this risk, but it’s possible to get the risk down to nearly zero. It is very rare to have an infection after routine hip replacement. .

Is there a long-term risk of infection in an artificial hip?

Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a hip joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning hip implant is essentially zero.

What if an infection does develop?

An early infection shows up as redness and pain around the healing incision. This can generally be treated with oral antibiotics alone, usually taken for 5 to 10 days. Very rarely, the hip joint has to be opened and washed out to clean the tissues and effectively treat an early infection.

A late infection that happens months or years after surgery is more serious, and will require additional surgery. Such infections occur because the immune system can be weakened by age, infirmity, tobacco use, heavy alcohol use, cancer, and other conditions.

In these cases, the infected prosthesis is removed and a temporary antibiotic-loaded hip is implanted. After three or more months, a new hip joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the hip. Fortunately, such cases are very rare, and late deep infections usually occur in immune-compromised patients with other serious medical problems.

Leaving the hospital

How will I manage at home?

after hip surgery nursing helpIf help from an adult family member or friend is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks after surgery. If you go home, a home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor.

The home health agency will send a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with your physician to keep them updated on your progress.

How is my hospital discharge handled?

Typically, a social worker will visit with you after surgery and work with the therapists and nurses to formulate a discharge plan. The social worker will assist in coordinating discharge to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home.

What determines when I can go home after hip replacement?

You can go home when you can ambulate safely with a walker, go up and down stairs, and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.

When must I come back for a visit after hip surgery?

You will return for a visit about one month after surgery; call or e-mail if you have questions before that time. This guide and your home health nurse can be helpful resources. Long-distance patients may use email, sending digital photos of their incisions and digital X-rays; this works very well and saves time and travel expense.

When should seek medical help?

Contact your doctor if you have any of the following:

  • persistent drainage from your incision;
  • excessive redness around the incision;
  • increase in the incision pain;
  • increased leg swelling;
  • pain and swelling in the calf of the leg;
  • temperature above 101 degrees;
  • numbness or tingling down the back of the operative leg;
  • chest tightness;
  • new cough;
  • difficulty breathing;
  • or any related concern.

Your family doctor is a good resource if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure, please contact your surgeon. If unable to reach a doctor, and you feel there is a problem, please go to the local emergency room.

Getting moving

Can I place full weight on the operated leg after surgery?

Yes. But, use some form of assistive device for at least a month after surgery, to avoid a sudden twist and fall. Hip implants are loaded in torsion (a rotational stress is placed on the implant each time you get up, turn in bed, or go up or down stairs), as well as loaded in compression (your weight pressing down). Putting full weight on your hip right after surgery is never a problem.

About a month after surgery, if you feel confident and balanced, you can walk without a cane, but if there is any question, stay with a cane until you feel safe.

In complex, repeat hip implant surgery, these instructions will be more specific to each unique situation. In almost all cases, however, at 12 weeks after such surgery, patients can resume all activities.

Can I kneel down after hip replacement surgery?

Yes. As soon as you’re comfortable, kneeling is safe, as is crossing our legs and lifting weights by bending the knees or back. It is not possible to damage the implants.

How soon can I drive after surgery?

With a left hip replacement, an automatic transmission, and a healthy right leg, you can drive any time after surgery that you are comfortable. Typically this time is about two weeks from surgery, but sometimes longer.

If the right leg is operated on, you can drive in 3 to 4 weeks after surgery. If you feel sleepy or sedated because of pain medications, then you should avoid driving until you are alert and can concentrate on driving.

How much therapy will I need?

You need approximately four weeks of therapy, usually at home, with a visiting home health nurse. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually 4 to 6 weeks will suffice. Once you learn basic hip exercises, you will be able to do them at home.

How much movement can I expect in the new hip?

The amount of movement you achieve should be close to that of a normal hip. That said, existing scar tissue, contractures of the hip joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, the amount of hip movement gained after replacement allows them to engage in all activities of daily life.

Should I exercise after hip replacement?

Yes. A regular program of light aerobic exercise is beneficial from many standpoints, and will optimize the outcome of your hip replacement. After your six- week post-operative appointment, recommended exercises include walking, swimming, golf, hiking, treadmill walking, stair climbers, light aerobics, weight training, and elliptical exercise equipment.

How active can a person be after a total hip replacement?

You can be as active as you want, and lift as much weight as you desire. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.

Strength and endurance will build up over time. Modern total hip implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.

When can I ride a lawn mower, tractor, horse, bicycle, or ATV?

Defer these things for one month after hip implant surgery. You may feel like you can handle such activities sooner, but there is no point in rushing things.

When can I go back to work after surgery?

It depends on the type of work. If you are in hard labor, it is best to wait for three months before swinging into full action. Prior to that time, you can return to some light duty work if this is possible.

For jobs that require some standing, sitting, and walking, it is possible to return earlier. It really depends a lot on the individual and the job. Typically, most people will give themselves at least 3 to 4 weeks after joint replacement before returning to work in some capacity, but some people have returned to work after just two weeks.

When can I drink alcohol after surgery?

Moderate, social alcohol use can be resumed anytime that you wish. Avoid alcohol while you are on any blood thinner or pain medication.

When can one resume sex after a hip replacement or resurfacing?

You can resume sex as soon as comfortable, and in any position that does not cause discomfort. With earlier hip replacement methods, certain restrictions and precautions applied, but these do not apply to modern hip replacements.

How soon can I travel?

As soon as you are comfortable with sitting down, you can travel by airplane or car; there is no specific time period. If you travel, be sure to exercise your calf muscles and ankles frequently. Also, get out of the car or walk the aisle of the airplane frequently to avoid the possibility of blood clots. Continue taking blood thinners while you travel during the first month after surgery.

How long does it take to feel normal after a hip replacement?

A great deal of the recovery takes place in the first two months, but complete return to normal takes longer. Bone around the metal parts keeps changing and remodeling for 1 to 2 years after surgery, which is why you can feel deep aches and can tell when the weather changes. After that time, the hip will feel normal.

Do you use a machine to move the hip after surgery?

No benefit has been shown from the use of continuous passive motion (CPM) machines in hip replacement. Some surgeons use such machines after knee replacement, but they are not needed following hip replacement.

How much can I lift after hip replacement?

You can lift as much weight as you can comfortably tolerate. Once tissues have healed, lifting, climbing ladders or stairs, getting up on roofs, and related activities are safe. Avoid these things for about three months after surgery, until we are sure that your bone has healed into the implants.

Mobility Tips

Tips on walking

The therapist will demonstrate proper and safe walking after a hip replacement, with the use of crutches or walker. The purpose of the walker or crutches is to avoid a fall or sudden twist. Weight-bearing is safe immediately after surgery. But until the implants have grown into the bone, a process that takes 4 to 6 weeks, a fall or other sudden twisting force on the leg can risk implant loosening or injury to the leg. Reflexes take time to return, and narcotic pain medications can further dull the senses. That is the reason for learning to use an assistive device as long as necessary after surgery.

The assistive device can be a walker, crutches, or a cane in either hand; as long as you feel confident and safe in balancing yourself and minimizing the risk of a fall. When using a walker, lean forward, and lead with either leg. When using crutches, avoid putting weight into the armpits; the proper technique is to load the arms as much as needed for a comfortable stride. When using a cane, the most bio-mechanical advantage comes from holding the cane on the side opposite the replaced hip.

Assistive devices can be discarded anywhere from 1 to 4 weeks after surgery, depending on a number of factors, such as narcotic use, return of strength, confidence in walking, return of reflexes, and patient preference. Patients recover differently from each other, and there is no harm in using an assistive device to help in walking for a longer or shorter duration. Because the hip replacement components are designed to heal directly to bone without use of bone cement, the skeletal stability of the implants is assured by 4 to 6 weeks, at the minimum. Around that time, the assistive devices can be discarded, in favor of normal walking in nearly all cases

Tips on stairs

The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, “up with the good and down with the bad.” In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.

You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.

Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Managing pain & discomfort

Should I apply ice or heat to the hip as it is healing?

After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin has occurred, you can use a moist heat pack if it feels comfortable. Soaking in a hot tub at this point may also be helpful.

Whom should I call for pain pills?

Please call the doctor’s office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.

How long can I have pain medications refilled?

Most patients will taper off the use of narcotic pain medications very quickly. Be aware that some narcotics cannot be phoned into pharmacies. If you will need refills over a weekend or holiday, be sure to contact medical staff during regular office hours.

Some patients require pain medications for a longer time, while others do not need them at all. Your physician will individualize treatment for every person.

How long should I take pain pills?

Most patients use pain medication for anywhere from 1 to 3 months. After three months, you should taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain.

When taken over a long period of time, narcotic drugs create a tolerance that makes them less effective. That is why it is preferable to taper off narcotic drugs quickly after surgery, unless there are compelling reasons to continue use.

What if I need narcotics three months after surgery or if I have been taking them before surgery?

In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics.

If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let your doctor know what you are taking before surgery so that they can adjust pain medicines accordingly.

Life with an artificial hip

How long will the artificial hip last?

In most cases, the hip replacement should outlast your lifespan. The 15-to-20-year data on the longevity of hip replacement components is excellent, with more than 90 percent of the implants still functioning well in many studies. But, this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.

Many factors affect the future of a hip replacement or resurfacing, such as accidents, fractures, late infections, and deterioration in your overall health. How well you take care of yourself down the road is something the surgeon cannot control.

The longevity of a hip replacement thus depends on many factors, including the following:

  • Surgeon skill in implanting the components
  • Known history or track record of the implants
  • How well you take care of yourself and your health
  • Understanding and respecting the limitations of a prosthetic lifestyle
  • Your activity level and body weight
  • Avoiding high-impact or extreme sports

How do I know if I have a metal allergy to the hip part?

Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past several decades. Most instances of a persistently painful hip after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.

What will weather changes feel like in the hip?

Some patients report increased pain and stiffness, or can feel changes in the weather after hip surgery. These sensations are not common though, and usually will disappear over 1 to 2 years after surgery. For the first couple years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to sensitivity to weather and pressure changes.

How about future dental work and other surgery?

Because you have an artificial hip joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.

The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.

For routine dental prophylaxis following hip replacement surgery, antibiotics are recommended for your lifetime after the surgery.

In what other situations will I need antibiotics after the hip replacement?

Antibiotics given for other medical procedures may vary. Contact your medical professional for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.

If you have a cut anywhere that develops an infection, conditions like a tooth abscess or ingrown toenail developing, seek medical attention urgently. Ignoring a festering sore means that there is a risk the bacteria could migrate to the hip, resulting in a serious deep infection, even though it happens rarely.

Will the new hip set off a metal detector at the airport?

Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. You will be given an implant identification card that you can carry to prove that you have metal hip replacement parts.

Can I have a MRI scan after hip replacement?

Yes. MRI scans of other parts of your body are safe after hip replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with hip replacement parts. You may also have a CT scan of any part of your body after a hip replacement.

How will I know if my hip implants are recalled?

In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please let your doctor know.

Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.

Is there a long-term risk of failure of hip implants?

Implants are engineered to withstand your body weight and activity level, but the moving parts of a hip replacement do wear over a period of several decades. A properly aligned hip replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.

Subtle component mal-positioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the hip is implanted in your body is a critical determinant of durability.

About Hip Replacement

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Hip Replacement FAQ

Hip replacements should not be undertaken lightly; below are some of the most common questions patients have.

What is a total hip arthroplasty?

Surgeons use the word “arthroplasty” to mean replacement. The word “total” means that both the ball and socket part of the hip are replaced. “Total hip arthroplasty” means the same thing as total hip replacement.

Is there a partial hip replacement?

Yes. In some cases of hip fracture in elderly patients who have no arthritis in the joint, surgeons may elect to replace only the ball. This means a metal ball moves inside the patient’s own socket.

In low-demand patients, this is a reasonable option, although a total hip replacement is usually more durable and offers more predictable pain relief (see illustration).

When should hip replacement be considered?

The ideal time for surgery is when other measures, such as medicines, exercise, weight loss, and alternative therapies no longer work. If hip pain causes a limp, affects your lifestyle, interferes with work or recreation, and negatively impacts your body image, then surgery is a reasonable option.

Will a new hip joint be a perfect substitute for my own hip?

Metal and plastic cannot fully replicate the complexity, intricate engineering, and healing ability of the human body. Hip replacement components are products of modern science and engineering that come close but cannot duplicate the natural hip joint.

However, a prosthetic hip provides dramatic pain relief and improves movement, function, and lifestyle. Many patients experience complete resolution of their pre-surgery pain and discomfort.

How does the artificial hip joint get lubricated?

The replaced hip develops a lining around it, and the cells secrete synovial fluid (a biological lubricant) into the synthetic joint. This fluid provides lubrication so that the artificial bearing is never dry.

Synovial fluid is recycled by the cells. No external lubrication of the new hip joint is ever needed. Injections into an artificial hip joint are not beneficial and will increase the risk of infection.

About how long does a hip replacement take?

It varies – a common time is about half an hour. However, patient preparation for surgery, safe positioning, safety checks, and anesthesia add considerably to this time. Individual patient and anatomic variations may also alter surgical times. Each person is unique and surgery is never an assembly-line procedure.

Is it possible to replace both hip joints at the same time?

Yes. This has become routine when patients need both hips replaced and are in good health otherwise. Rehabilitation time is perhaps slightly longer than for one hip replacement, but not noticeably so.

Many surgeons use the “anterior” surgical approach to hip replacement, which means that the patient is on his or her back, and muscles are spread, rather than cut. This usually makes surgery on both sides much simpler, safer, and faster.

Ask your surgeon about their surgical approach; new procedures are always being developed and refined to improve recovery and minimize surgery needs.

What is the optimal age for hip replacement?

Hip replacement is usually done in patients in their 50s through their 80s, although the operation is also done in patients who are older or younger than this age range. With modern implants and bearings, young age is not a contraindication to successful surgery. In the past, hip replacement was reserved for the elderly, because the implants and synthetic bearings were not as durable as they are today.

Should I wait, or get my hip replaced now?

The availability of new technology, streamlined surgical methods, and improved implants should not rush your decision to have a hip replacement. Non-surgical methods of relieving pain should be tried first; sometimes they can help postpone surgery for many years. A reasonable period of waiting and careful decision-making is always wise.

Will waiting to get a hip replacement make things worse?

No. Waiting is safe. Even if the hip joint gets becomes more deformed, the surgery is just as easy. The only downside to waiting is that muscles might get weaker and more stiff, thereby making recovery a bit longer. This can be offset by maintaining a reasonable body weight and following a program of light exercise to keep your muscles in shape.

One exception applies to revision hip implant surgery. If your joint was replaced many years ago, and the wear particles are starting to dissolve bone, your physician may advise you to have surgery sooner rather than later.

Another exception applies to joints that have been replaced, and are suspected of having a deep infection of the prosthetic device. In those cases, corrective surgery is recommended early, so that the infection does not penetrate the bone.

How many joints can one have replaced?

hip replacement implant installed in the pelvis boneIt is possible to have multiple joints replaced safely. For patients with other serious health conditions, it may be best to get these done one at a time, starting with the worst one first.

Some patients do have more than a single hip or knee replacement; it is not unusual for people to have artificial joints in both hips, knees, shoulders, and more. The ability to replace painful joints is a remarkable advancement in medicine.

What if my previous hip replacement surgery did not work out?

Hip surgery can be complicated by deep infection, implant mal-positioning, nerve injury, leg length discrepancy, and other unhappy outcomes. A second opinion is worth exploring even if a surgeon tells you nothing can be done.

Many factors can compromise the results of hip replacement, even though the X-rays look fine. A step-by-step approach to identifying the reason for an unsatisfactory outcome, and addressing it, can help patients who have had a poor outcome.

Hips can be replaced more than once. Modern technology allows replacement of deficient bone, even if the entire femur bone is lost.

Where else can I learn about hip surgery?

To learn more about the anterior hip replacement technique specifically, visit newhipnews.com. Another useful source is bonesmart.org, which even has a patient dialogue forum. Manufacturers of hip implants have patient education websites as well.

Can arthritis occur in a hip after it is replaced?

Replacement surgery eliminates all diseased cartilage in the hip joint. It is not possible to have arthritis since the native cartilage is gone and will never grow back.

However, arthritis is a complex disease that affects tissues around the joint, such as nerves, muscles, ligaments, and the synovial lining of the hip. This is why some pain, stiffness, and internal swelling can persist for many months even after X-rays show complete healing following a hip replacement.

Muscles and tendons, weakened and stiff from years of disuse, can take 1 to 2 years to stretch and adapt after hip surgery.

Will hip replacement get rid of all my pain?

Yes, if all the pain is really coming from the hip joint. But an artificial hip cannot relieve pain coming from an arthritic spine, weak muscles, arthritic knees, hernias, poor circulation, fibromyalgia, rheumatoid arthritis, and other such conditions.

How long is recovery after hip replacement?

Most recovery is in the first 4 to 6 weeks. By then, bone grows into the metal components and most patients become mobile enough to walk without a cane.

During the first 4 to 6 weeks, be cautious and use a walker or cane while walking, and avoid sudden twists and falls. Eight weeks after surgery, most patients can resume light lifting and other daily activities.

Very heavy lifting, returning to strenuous jobs, and extended exercise should wait until three months. These timeframes are approximate; healing varies from patient to patient.

The bone around the metal implants continues to adapt and remodel for 1 to 2 years after surgery. During that time, expect some mild aches and pains, and discomfort with pressure and weather changes. Ultimately, all such sensations will resolve.

Is recovery from hip replacement faster for younger patients?

No, not necessarily. The recovery appears to be more or less the same for young and older patients with hip arthritis. The recovery from hip replacement also seems to be very similar between men and women, as well as between thinner and heavier patients.

Is recovery faster after hip replacement than knee replacement?

Yes, people recover faster after hip replacement, with less pain and less need for physical therapy, when compared to knee replacement. There could be several reasons for this.

The knee joint is more complex, and involves many different types of movement; the knee may have more nerves transmitting pain sensations; hips have a heavier protective layer of muscle and tissue compared to knees, and there may be other explanations why recovery from hip replacement is usually easier than a knee replacement.

Patient perception between a knee replacement and a hip replacement is also different. It can take a couple of years, or longer, for an artificial knee to feel natural and like the real thing. In contrast, a hip replacement feels natural, and more like the real thing after considerably less time.

What are the inherent risks of hip surgery?

Inherent risks are those complications that can occur, no matter where you have surgery done, or who performs it. You should know these in order to make an informed decision about surgery.

No hospital, physician, or surgical method can eliminate the inherent risks associated with hip surgery; beware of any hospital or surgeon who claims otherwise.

Complications after hip surgery are rare, typically occurring with a frequency of 1 percent to 2 percent of the cases. Each complication listed below is discussed in more detail, elsewhere on this website. If you prefer to discuss this in person, please ask your physician.

Possible adverse outcomes after hip surgery include, but are not limited to, blood clots, pneumonia, nerve injury, blood vessel injury, blood transfusion risks, anesthetic complications, heart attack/cardiac complications, stroke, failure of implants, dislocation of the components, superficial or deep infections, bone fracture, leg length inequality, and even death.

How much does a new hip joint cost?

Insurance contracts, hospital pricing, medical billing, and other variables related to cost are complex. In fact, specially trained personnel are required to do medical billing. If you want to know the costs involved, please contact your physician’s office; their billing team will give you an accurate answer.

Will Medicare or my insurance cover hip surgery and therapy?

Yes. However, insurance plans and related benefits vary; to be certain, it is best that you check with your insurance company. Talk to your medical team as well, since surgery and hospital stays must be pre-authorized with insurance companies.

Before Hip Surgery

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Health Considerations Before Hip Surgery

This article will help you understand how to get ready for hip surgery. Hip surgery does come with possible complications.

What do I need to do to prepare for hip surgery?

Reading the information on this site, communicating with your surgical team, and paying close attention to any checklists provided will best help you prepare for knee replacement surgery. The importance of preparation and information to successful surgery cannot be overemphasized.

What health conditions must be considered before undergoing surgery?

Some patients have unusual problems, such as HIV infection, hemophilia, cancer, bleeding disorders, liver or kidney transplants, enzyme disorders, and other conditions that require specialty consultations before surgery. If these considerations apply to you, your medical team will work with you to obtain the necessary testing and treatment prior to surgery.

What medical testing is needed prior to hip replacement surgery?

xray illustration of damaged hipPre-surgical checks are essential for your safety and it is unwise to short-circuit them; they are comparable to pre-flight checks that every responsible pilot makes before taking off. Out-of-town patients, or those traveling long distances, can have local doctors perform these checks; your surgeon’s staff will work with your doctors to expedite this. Common pre-surgical checks are listed below.

Medical Check: Prior to your surgery, you should see an internal medicine specialist to identify and manage your health risks. Examples of increased risks are heart and lung disease, tooth and gum disease, infection, obesity, and diabetes. That is why patients should undergo testing and clearance by a medical doctor prior to hip replacement surgery.

Dental Check: A dental check-up is necessary to identify any hidden infection in your teeth or gums. Such infections must be treated before knee replacement to eliminate the risk that bacteria from decayed teeth enter the bloodstream and end up infecting the knee implants. If you are traveling from out of town, visit your dentist and forward the information to your surgeon.

Heart Check: If there is any reasonable suspicion of heart disease based on your history, it is best to find out ahead of time if your heart is healthy enough for knee replacement surgery. Heart disease is usually silent; patients do not have symptoms until the heart is stressed. If indicated, your surgeon will have you see a cardiologist before surgery for clearance.

What if I have bowel problems?

Pre-existing trouble with constipation usually leads to constipation and related problems after hip replacement. If you regularly take supplements to encourage bowel movements, let your doctor know so they can plan accordingly, since the medicines used during and after surgery can result in serious constipation.

You will be given a stool softener before surgery to avoid problems with constipation later. Even so, you can probably expect disturbance of bowel patterns and at least some degree of constipation after knee replacement surgery.

How does diabetes affect my surgery?

Blood glucose levels over 200 will lead to poor wound healing and increased risk of infection. Therefore, it is critical that your diabetes is under control prior to surgery. A medical consultation and lab data before surgery will ensure your diabetes is controlled and your surgical risk is minimized.

Does osteoporosis affect the success of a total knee replacement?

No. If bone has severe osteoporosis, it may not be possible to use an un-cemented prosthesis. However, the cemented version of total knees can be implanted in nearly every type of bone, including bone that has osteoporosis, and the outcomes are very successful.

What about alcohol and drug use?

Regular alcohol consumption should be disclosed to your anesthesiologist and surgeon ahead of time. Alcohol withdrawal can happen to anyone, regardless of economic or social background. When it happens, it can be life threatening and can complicate your recovery from surgery. If your medical team knows about alcohol consumption, they can take steps to avoid withdrawal. The same is true of recreational drugs. Be sure to talk about this with the anesthesia doctor.

What if I am a smoker?

Smoking increases the chance of lung complications during and after surgery, delays wound healing, increases the risk of complications after surgery, and increases the odds of residual knee pain even after successful hip replacement. Therefore, you should try to stop smoking, both for your general health, and to improve the odds of a successful result from knee replacement. Most hospitals are smoke-free, and you may not be able to smoke on the premises.

Does my body weight affect hip replacement?

Obesity will increase the risk of complications from surgery, such as blood clots and slower wound healing. Ideally, your weight should be within reasonable limits before knee replacement surgery. In some cases, for excessively heavy patients, knee replacement is not an option without drastic weight reduction, such as with gastric bypass surgery.

That said, many people are somewhat overweight and unable to lose weight while dealing with a painful arthritic knee. The knee components are designed to handle enormous loads, and are safe, even in very heavy people. There is no evidence to suggest that the components loosen up prematurely, or wear out prematurely in heavy people.

What about dieting and exercising before surgery?

Maintain a nutritionally sound diet including a variety of foods in preparation for surgery. Crash dieting is not necessary; rather, regular exercise will help control weight and improve overall health.

Exercise before surgery, done within reason, and within the capability of the patient, will improve the recovery from knee surgery. Therefore, a reasonable exercise program to strengthen your thigh and calf muscles before hip replacement surgery is the best thing you can do to speed up your recovery.

How can exercise before the surgery help my recovery after?

Exercising and strengthening the thigh and leg muscles before the operation will result in faster recovery and return to function, with less suffering, struggle, depression, and mood swings. Consultation with a physical therapist before surgery can be very useful.

The reason exercise helps is that the knee, even if worn out, is a living joint. Living tissues respond positively to physiologic stress, and exercise is known to improve self-perception, esteem, and outlook.

When do I first visit the hospital?

About a week or so before surgery, you will visit the pre-op department in the hospital. This visit is to read and sign consents for the surgery, for the anesthesia, and for blood products (if needed). You will have lab tests, possibly a chest X-ray, and an electrocardiogram. Please make a list of your medications and their dosages prior to this visit.

At this visit, you will be instructed on where to report on the morning of surgery. You will receive instructions on not eating or drinking after midnight the night before your surgery. This includes chewing gum and hard candy.

Keep in mind that surgery schedules change often; this is why the exact timing of the operation is not known until the day before. If you have a special preference, such as being the first in the day, or last, or in between, simply let the surgeon know and they’ll try to accommodate your request.

When will I be assigned a surgery time?

The hospital will contact you a day before the surgery to tell you what time to arrive at the hospital. Surgery schedules tend to change, which is why most hospitals will confirm the exact surgery time only a day or so before the operation. Please arrive early. The actual operation will usually be less than an hour in duration, but preparation takes much longer.

When do I see the anesthesiologist?

On the morning of your surgery, you will see an anesthesia doctor (anesthesiologist) who will have already reviewed your medical records. If your medical condition so requires, your surgical team will have  consulted with the anesthesia doctor ahead of time. This doctor will inquire about your health and plan the anesthetic technique, including any regional nerve pain blocks. If you know of a particular anesthesiologist at the hospital whom you would prefer to provide this service, simply let them know ahead of time.

Should I donate my blood for surgery?

No. This is not necessary since not everyone needs a blood transfusion after knee replacement. If you have religious convictions against blood products, let your doctor know so they can arrange to recycle your own blood. Blood loss differs from patient to patient, and pre-existing conditions such as anemia and other diseases can affect the odds of needing blood after surgery.

As a general rule, major bone surgery is associated with blood loss, but it is impossible to say how much blood a particular patient will lose. If needed, blood transfusions today are very safe and effective.

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