Total Hip Replacement

Total Hip Replacement

Total hip replacement or "arthroplasty" is the replacement of the ball and socket of the hip joint with artificial parts called prostheses. There are two main components used in total hip replacement. The femoral component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made entirely of a very hard medical-grade plastic called polyethylene. It may also be made of a metal and polyethylene combination in which the polyethylene cup is placed inside a metal shell. The acetabular component is then secured inside the natural pelvic socket
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The natural ball portion of the femur (thigh bone) is removed during surgery and the inside of the femur (the canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. The socket portion of the pelvis is also enlarged with a special surgical instrument to make room for the new artificial socket component. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles, just as your original hip had been.TOP

Your Hip Evaluation

An orthopaedic surgeon specializes in problems affecting bones and joints. Your hip evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain, limitations in activity and the progression of your hip problem.

After your history is taken, a physical exam is performed. The range of motion of your hips and knees are measured and your muscle strength is evaluated. The surgeon will observe how you walk, sit, bend and move.

X-rays are taken of your hip joint. You should bring any X-rays that may have been taken of your hip in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new hip prosthesis.

A small amount of fluid may be taken from your hip joint to check for infection.

After your initial orthopaedic evaluation, the surgeon will discuss possible alternatives to surgery. If the X-rays show severe joint damage and no other means of treatment has provided relief, total hip replacement may be recommended.

Before Surgery

You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you are taking estrogen (i.e. Premarin), your surgeon will probably advise you that it will be necessary to stop taking it one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.

Your Surgery

You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery. The day of your surgery, you will be taken to the operating room about a half hour early.

In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery, and discuss the type of anesthetic to be used.

The Recovery Room

You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.

What To Expect After Surgery

You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that may accumulate in the surgical area. The drain will probably be removed several days after surgery. Your dressing will be changed and a smaller one applied.

You may move the leg that was not operated on as soon as you awaken. As you lie on your back, flexing the unoperated hip will reduce aching in your lower back. The nurse will help you find comfortable positions. You may turn with a pillow between your legs. The nurse will encourage you to do ankle pumping exercises every hour to protect against blood clots.

Example of correct procedure for putting on socks or stockings.

Preparing To Go Home

Just prior to your discharge, you will receive instructions for your at-home recovery. Until you see the surgeon for your follow-up visit, you must take certain activity precautions.

As soon as you are home from the hospital, make an appointment to see the doctor.

Look for any changes around your incision. Contact your surgeon if you develop any of the following:

1. Drainage and/or foul odor coming from the incision.

2. Fever (temperature about 101 degrees F or 38 degrees C) for two days.

3. Increased swelling, tenderness, redness and/or pain.

Take time to adjust to your home environment. It is normal to feel frustrated, but these frustrations will soon pass. It is okay to take it easy.

When working at a counter top, you will have to sit on a high stool.

Resuming Activities

Depending upon the physical demands of your job, you normally can resume work when authorized by your surgeon.

You usually may begin driving once you are able to bear full weight on your hip. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.

Sexual intercourse may be resumed at any time as long as all hip precautions are kept in mind.

We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activities such as walking, bicycling and swimming. Jogging, high-impact aerobics and certain sports should be avoided. Your new hip is artificial, and although made of extremely durable materials, it is subject to wear and tear.

Since your rehabilitation is an individual one, please seek advice on future activities from your surgeon.

Medication/Pain Control

It is normal for you to have some discomfort. You will probably receive a prescription for pain medication before you go home. If a refill is needed, please call your surgeon's nurse a few days before you run out of pills. Contact your surgeon if your discomfort or pain increases.

Special Instructions

You may be seen six weeks, five months and twelve months after your surgery. It may be requested that you see your surgeon once a year after the first year, even if you are not having any problems, to check out the condition of your new hip joint.

Any infection must be promptly treated with proper antibiotics because infection can spread from one area to another through the blood stream.

Every effort must be made to prevent infection in your artificial joint. You should always tell your dentist or physician that you have an artificial joint. If you are to have dental work performed, please call your surgeon prior to having this work done. Your surgeon will most likely prescribe an antibiotic for you. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.

Patient education material provided by the American Academy of Orthopaedic Surgeons.