ABOUT YOUR HIP REPLACEMENT

The hip joint is a ball and socket type joint providing free movement in all directions. The ball is the head, or top, of the thighbone (femur) which fits in the socket (acetablum) in the pelvic bone. Both of the bone ends are normally covered by glistening articular cartilage, which permits smooth painless motion.

Joint Damage

Damage can occur in the hip joint for a variety of reasons. It can be caused if the joint has not been developed normally. It can occur from injuries to the bone of the hip joint, an inflammatory arthritis such as rheumatoid arthritis, or most commonly, routine wear and tear known as degenerative arthritis. Some forms of arthritis may involve only the hip joint and in others, the hip problem may be just part of a more widespread disease process.

A Healthy Hip

A Bad Hip

      
Advanced Osteoarthritis                              Rheumatoid Arthritis

In an arthritic hip, the cartilage “cushion” wears away, and the bones rub together, becoming rough and pitted. The ball grinds in the socket when you walk, causing pain and stiffness. This results in loss of motion and ability to function.

Reasons for Surgery

Joint replacement surgery is considered only for those people with severely damaged joints that cannot be successfully dealt with by more conservative means e.g., medication or exercises, and is performed for the following reasons:

1. To relieve pain (the primary reason in the majority of people)
2. To improve motion
3. To improve function, e.g., walking, sitting, dressing, and bathing

The Total Hip Replacement

The total hip replacement unit consists of two parts:

1. The metal ball and steam which fits into the femur- called the femoral component.
2. The plastic (high-density polyethylene) cup commonly supported by a metal shell, which fits into the acetabulum in the pelvic bone.

The joint replacement may be either cemented, uncemented, or a combination of both.

Cemented:
The components are held within the bone by bone cement. This is not glue but a material that is pressed into the small nooks and crannies of the bone to form a bond between the metal and the bone. It takes only minutes to harden permitting early motion and walking following surgery.

Uncemented: (Porous Coated)

The components have thousands of tiny pores on the outer surfaces. These pores provide a huge network of nooks and crannies into which new bone can grow. This provides direct bone to metal bond without cement. The new one, however, takes some time to grow and during this period of time (6-12), weeks it is necessary to protect the growing bone from strong forces such as walking. For this reason, crutches are used for at least six weeks and then canes.



Your Prosthesis in Place

Your Hip Prosthesis

Your hip prosthesis (cemented or cementless) has the same basic parts as your own hip. A ball, often metal, replaces the worn head of your thighbone with a stem inserted into the bone for stability. A cup, often plastic, replaces your worn socket.
Like a healthy hip, your prosthesis has smooth gliding surfaces that allow you to move easily and without pain. Unlike a healthy hip, however, your prosthesis has a limited safe range of motion, and will need your special care after surgery.

Expected Results

Although more than 90% of people experience good to excellent results following total hip replacements, in a small percentage of people, problems may develop. A serious complication that can occur is infection around the implant. This develops in a very small number of people following total hip replacement, requiring antibiotic therapy, and on occasion, further surgery.

A more frequent occurrence is that of loosening of the components over time- a factor that may relate to excessive use. This is why it is important to use moderation in our post-operative activity level and follow your physician’s instructions.

In the event of a component loosening, revision surgery is possible in the majority of cases, with implantation of a new component. It means, however, another surgical procedure and subsequent period of rehabilitation, with another possibility or a less satisfactory result.

Other possible complications that can occur on occasion are temporary or permanent stiffness and loss of motion, temporary or permanent nerve damage, foot drop, fracture, leg length discrepancy, post-operative instability and dislocations and/or blood clots in the legs or lungs.

Special care is taken during each phase of your hip replacement to avoid these complications whenever possible. This begins with thorough evaluation in the office with complete review of your history and physical examination, laboratory studies, x-rays, and ends with the use of anticoagulants and the use of post-operative compression stockings.

The Surgical Procedure

The surgical incision is usually on the back side of the hip and is 8-10 inches long; muscles attached to the femur are separated and the joint hip is identified. The hip is then dislocated and the socket prepared for the appropriate size cup, which is fixed in place.

The head of the femur is removed, and the shaft of the femur is prepared for the appropriate size metal stem, which is also fixed in place. This hip is then relocated and tested for movement and stability. The detached muscles are then repaired and the incision is closed.

You will return to your room with a dressing covering the incision over the hip and a drainage tube leading from the incision into a container. A foam wedge or pillow will be used to hold the limb in a safe position after surgery.

Post-Operative Management Overview

The length of stay in hospital following a total hip replacement is usually between 3 to 7 days, but the length of stay depends on many factors. With modern rehabilitation, hospital stays are becoming shorter and shorter.

The first priority is to ensure the incision heals well. Supervised exercises will be done to encourage movement in the new hip. In the latter part of your hospital stay some strengthening exercises maybe started. Most people will be permitted to stand without support within a day or two and from there progress to walking with a walker, crutches, then canes as tolerated depending on the type of implant used. You will also be instructed in walking stairs.

Rehabilitation/Hospital Stage

After your operation, the goal of the therapist is to prepare you for discharge by helping you achieve independence as safely and as quickly as possible.

Once you are over the immediate post-operative period, you will spend part of your day in an exercise area with other patients who have had similar surgery. You will be working on your mobility, strength, endurance, and you will be expected to get dressed daily.


In order to feel comfortable in the exercise area, clothing should be loose, casual, and suitable for exercising.

Precautions

There are certain precautions that must be taken in order to allow the new joint to become stable and prevent dislocation, as it takes up to 3 months from the date of surgery for the supporting tissues to heal.

1. DO NOT cross your legs.
2. DO NOT bend your operated hip more than 90 degrees.
3. DO NOT bring your knee higher than your hip.

Raised toilet seats are provided in the hospital during your stay.

To avoid incorrect positions follow these guidelines:

-DO NOT try to reach your feet or the floor (use the reaching devices demonstrated by your occupational therapist).
-DO NOT put on shoes and socks by reaching to your feet.
-DO NOT use pain as a guide for what you may or may not do.
-DO NOT sit in a chair if the level of the seat is below the level of your knees. Raise low seats with a firm cushion.
-When sitting down or raising from a chair, keep your operated leg out in front of you. Chairs with arms are recommended to assist you with standing.
-You MUST ALWAYS get out of and into bed one the side of the operated leg. Remember your precautions- keep your legs well apart and lean back to avoid excessive bending. DO NOT sit on the edge of the bed. Once your unoperated leg touches the floor, bend it back and push down through your hands on the bed to stand up straight. Keep the unoperated leg out in front until you are standing. Please practice this procedure before the operation.

We suggest that you continue with these precautions for 3 months following surgery, until the supporting structures are strong.

Car Travel

Place a firm pillow or wedge cushion on the car seat. Use front seat and push seat back as far as it will go. If the back of the seat is adjustable, increase the backward tilt.

Put your bottom on the seat first, lean back, and swing in your legs.

Driving

In an automatic transmission car and LEFT total hip replacement, you may drive as soon as you feel able to control the car.

In an automatic transmission car and RIGHT total hip replacement, or manual transmission, either right or left total hip replacement- you can drive at approximately 6 weeks, when you can control your leg to allow quick and comfortable transfer of the foot between pedals.

If the seat is low, sit on a wedge cushion for 3 months whenever you ride in the car.

After Discharge From Hospital

Physical therapy is necessary and may last up to 10 weeks or more depending on individual progress. It may be appropriate for you to go to a rehab center or a transitional care unit before being discharged to home. This is determined by your progress while in the hospital and home support system. Emphasis is on regaining range of motion in the hip, building up the strength of the muscles supporting the hip, and improving walking patterns and endurance.

Exercises will be progressed within each individual’s tolerance by the physical therapist.

Safety Tips and Suggestions:

Stair Climbing:

Going Up:
-Unaffected leg first
-Affected leg second
-Followed by crutches/canes

Going Down:
-Crutches/canes first
-Affected leg second
-Unaffected leg

Bathing:

Do not sit in a bathtub for the first 3 months after your surgery.

Do use:
-Raised bathboard 2”-3” (not a bath seat)
-Anti-slip rubber mat
-Grab bas
-Long handled sponge
-Handheld shower hose

Shower:

-The floor of shower stall must have a non-slip surface
-A walk-in shower stall with a rubber mat and safety grab bar is ideal
-You may use a high stool in the shower stall as you wish, providing it is stable

Drying:

-Use a towel wrapped around a reacher or long handled shoehorn to dry your feet
-Hold onto the ends of a longer towel to form a loop to rub feet dry

Toilet:

-DO NOT sit on a regular toilet seat for the first 3 months
-Use a raised toilet seat- this is 3”-4” higher for the average person

Reaching:

-Use a reacher or barbeque tongs to pick up items on the floor
-Remember not to lean forward to reach when sitting- use the reacher!

Dressing:

-When dressing, use a long handled shoehorn, elastic laces, sock aid, and a reacher. This avoids having to bend your hip more than 90 degrees.
-Dress your operated leg first and undress it last
-Obtain assistance to put on your elastic stockings. This will prevent hip dislocation.

Sitting:

-A firm chair or barstool is recommended. Reclining chairs are permitted.
-Avoid soft overstuffed chairs
-Avoid twisting- this requires having everything within your reach before you sit

DO NOT sit in deck chairs or beanbag chairs.

DO NOT cross legs when sitting, lying, or standing.

DO NOT reach to the floor when sitting.

Sleeping:

Lie on your back or on the side opposite to the scar. If lying on your back, a small pillow between the knees may remind you not to cross your legs. Do not pull the blankets up by reaching for your toes.

When lying on your side, place a pillow between your legs for approximately 4-6 weeks post-operatively or longer if the discomfort persists. When getting in/out of bed, you should get out of bed on the same side as your operated hip. If your bed is very low, it may need to be raised. When getting into bed, remember to keep the leg straight and the hip angle greater than 90 degrees and avoid twisting.

Medications:

Take pain medications as directed. Pain medications can be constipating. Eat high fiber foods, fresh fruit, and drink plenty of fluids to reduce this possibility.

Sexual Activity:

Following your hip surgery, sexual intercourse may be resumed as soon as you wish. Avoid any positions that cause pain. Some recommended positions are:

For men- side lying and lying on your back
For women- side lying

DO NOT allow the knee of the operated leg to point outward to the side.
DO NOT bring the knee of the operated leg to your chest.
DO keep the operated leg straight or slightly bent.
No restrictions apply to the non-operated leg.

Long Term Management

Infection Prevention

Should you develop an infection at any time or have dental work or surgery for any reason, contact your primary care physician or family doctor to be placed on preventive antibiotics to decrease the possibility of having an infection spread to your implant.

Airport Metal Detecting Device

The sensitivity of airport metal detectors may vary. They can be adjusted differently from airport to airport. Although your prosthesis may cause the alarm to sound, it is unlikely. Tell the security officer that you have a prosthesis in your hip and a hand held wand passed over your hip area will confirm its presence. Joint replacements are very common around the world and security staff is aware of them.

Other advice:
1. Keep your weight at a reasonable level. Keep in mind that extra weight means additional stress on the hip.
2. Contact our office if there is any problem or questions that concern you. This includes:
-If a limp returns
-If pain in the hip or leg returns lasting more than a few days
-If you notice a loss in range of movement in the hip
-If your leg feels shorter

Avoid the following whenever possible:
1. Any activity involving stop-start, twisting, or impact stresses. For example, tennis and jogging.
2. Excessive bending when weight bearing, for example squatting.
3. Lifting or pushing heavy objects.
4. Low surfaces, such as chairs, toilets and bathtubs.
5. Gaining excessive weight.

Activities that you may participate:
Swimming, walking, dancing, golf, and bicycling with high seats and handlebars to avoid excessive bending.

Activities to avoid:
Running, jogging, jumping, tennis, badminton, squash, skiing, contact sports, and horseback riding.

Preparation for the Hospital Stay and Your Surgery

The hospital will be contacting you 7 to 14 days prior to the date of your admission for pre-admission testing. At the time of your testing you will be told when and where to report the morning of surgery.

Please fast- NOTHING to eat or drink, NOT EVEN WATER, after midnight the night before your operation. If you are taking medication every morning, please ask the Physician Assistant at the time of your physical examination to see what you should do.

It may be necessary for you to obtain medical clearance from your cardiologist and/or family doctor if you have any significant past medical problems.

Please leave valuables at home and remove any nail polish or make-up before going to the hospital.

Please bring the following with you to the hospital:
-Sneaker or sensible walking shoes with low heels and non-slip soles (no sandals or open shoes)
-Underwear
-Socks or stocking
-Jogging suit/sweatsuit, slacks or shorts
-T-shirt
-Your canes, crutches or other aids if they were used before your operation



After surgery you will find it helpful to have some assistance with devices that enable you to perform personal functions and activities at home. You should arrange to have this equipment in your home before you are discharged from the hospital. Most of these supplies and devices can be purchased from a medical supply house. The nurse of social worker at the hospital can give you the name of one near your home.

These devices include:
-Raised toilet seat
-Grab bars
-Long handled sponge
-Elastic shoelaces
-Long handled shoehorn
-Sock aid
-Long handled reacher

Notify Our Office If You Develop

-Infection (bladder, respiratory, ear, tooth abscess, etc.) If any infection occurs, consult your family doctor for appropriate antibiotic treatment. Monitoring infection will apply throughout your lifetime.

-Fever of 100 degrees or more which lasts longer than 24 hours.

-Numbness or tingling in operated leg and/or foot.

-Drainage or odor from the incision.

-Increased swelling and/or pain in the knee.

-Lower leg tenderness.