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YOUR GUIDE TO

TOTAL HIP REPLACEMENT

SURGERY

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YOUR GUIDE TO TOTAL HIP REPLACEMENT SURGERY

Table of ContentsWho is a Candidate for Hip Replacement Surgery? ....... 4

How to Find a Hip Replacement Surgeon ..................... 8

What to Expect During Surgery .................................. 10

Recovery and Pain Management ................................. 12

Conclusion .................................................................. 15

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Have you sustained hip damage due to a fracture or arthritis? Are daily routines such as climbing the stairs or putting on your shoes painful and cumbersome? If you have tried medications, injections, and assistive devices and continue to suffer from severe symptoms, you may want to consider hip replacement surgery. Depending on your specific hip condition, you could be a good candidate for either a partial or a total hip replacement.

Each year, there are over 330,000 hip replacement surgeries performed in the United States and nearly one million worldwide. This safe, effective procedure is proven to relieve pain, increase range of motion, and help people return to their normal functioning. This resource covers the following aspects of hip replacement surgery:

• Who is a candidate for hip replacement surgery?

• How do you find a hip replacement surgeon?

• What should you expect during surgery?

• What should you expect during the recovery?

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WHO IS A GOOD CANDIDATE FOR HIP REPLACEMENT SURGERY?You may be a good candidate for a partial or total hip replacement if you fit one or more of the following criteria:

• Severe chronic pain – It is not unusual to experience sporadic hip pain. However, if you have ongoing hip pain that interferes with your daily functioning, you should have it checked out. This pain can come about through osteoarthritis, osteonecrosis, avascular necrosis, or rheumatoid arthritis. Hip fractures and injuries, post-traumatic arthritis, and bone tumors can also lead to hip joint breakdown which necessitates surgery.

• Damage and/or deformities – You may have a bowed leg or severe joint damage caused by osteoarthritis or another condition. Typically, the only way to correct these problems is with surgery.

• Alternative treatments are not working – Orthopaedic surgeons use surgery as a last resort for hip problems, and first opt for less invasive treatments which have significantly less risks and complications. Have you already tried medications, injections, and assistive devices (e.g., canes, walkers) without success? Whether they simply haven’t worked or the effects have worn off over time, surgery may be the next option.

• Good health and activity level – You must be in good physical condition and be able to maintain a moderate activity level to have a good chance of responding well to a hip replacement and recovering successfully.

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Essentially, you can be any age to be considered for hip replacement surgery. Once upon a time, the surgery was reserved for individuals age 60 or older. Since older people tend to be less active and put less stress on their hips than their younger counterparts, it was believed that the surgery was a better fit for them. However, new technology has improved artificial parts, which means that they last longer and can withstand higher levels of stress and strain. There have been more and more successful hip replacement surgeries performed on younger people in recent years – with advanced bearings, even teenagers can benefit from hip replacements if their hip is arthritic, deformed or painful. While most hip replacement patients are age 50 to 80, orthopaedic surgeons evaluate patients individually based on pain and disability. That said, according to a recent study in 2014, researchers have found that total hip replacements for individuals in their 90’s are showing very positive results, similar to those results of younger patients.

If you fit one or more of the following criteria, you may not be a good candidate for hip replacement surgery:

• Advanced joint deterioration – Deformed or deteriorated joints may pose more difficultly for a total hip replacement surgery, but many individuals with these joint conditions can benefit from the surgery.

• Infection or high risk of infection – If you currently have an infection or a chronic condition that makes you highly susceptible to infection, you run a higher risk of complications during and following surgery. That said, patients with infections can undergo total hip replacement surgery, but it may require two separate surgeries: one surgery to clear the infection and one to implant the new hip.

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• Certain types of health problems – People who have chronic disorders, such as Parkinson’s disease, or conditions that result in significant muscle weakness are more likely to dislocate or damage an artificial hip. People who have osteoporosis are also not good hip replacement surgery candidates because their bones are significantly thinner than normal. If you are in poor health, you are also less likely to tolerate the anesthesia and less likely to recover successfully.

• Unknown cause of pain – If an orthopaedic surgeon cannot determine the cause of the pain, he will continue testing and run more imaging before narrowing down a treatment option. There are lots of reasons for severe hip pain, such as nerve damage, that cannot be fixed with a hip replacement.

• Severely overweight – Replacement joints are more likely to fail in people who are very overweight.

• Involved in physically demanding sports or heavy manual labor – Unless you are planning to change careers so your joints won’t have the same level of physical demands following the surgery, you will still be continuing the same behavior that lead to the hip pain and stiffness to begin with. This will obviously put added strain and wear on the artificial hip.

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Do you believe that you are a good fit for a hip replacement? If so, it is best to set up a consultation with an orthopaedic doctor. Your initial appointment will most likely include the following components:

A surgeon uses all of this information to understand your current condition, discover any existing complications (e.g., an infection), and determine the ideal treatment option. Once the surgeon has presented the treatment option, he will discuss its potential risks and complications, the recovery and rehabilitation process including a hospital stay (if applicable), and the costs.

• Medical history exam – Be prepared to describe your current pain including the degree of the pain and how it affects your daily functioning. If there is pain that does not seem related to your hip issue, it is still worth mentioning because there may be a connection. If you have been recording instances of pain, bring this documentation with you. Describe your general health, any previous injuries that may play a role in your current orthopaedic condition, and any existing conditions that you have including anemia, arthritis, diabetes, hypertension, obesity, and osteoporosis.

• Physical tests – The orthopaedic surgeon will use physical tests to examine range of motion, reflexes, swelling, and skin condition. He will observe your ability to move while walking, standing, sitting, climbing stairs, bending backward and forward, and completing other basic movements.

• X-rays and other imaging – X-rays can shed light on any number of changes in the hip such as narrowing or thickening, cysts, deformity, and improper alignment. A surgeon may also order an MRI to detect early stages of disease. If you have any previous imaging, the surgeon is likely to review it to determine whether or not there has been any change or deterioration in the hip over time.

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HOW TO FIND A HIP REPLACEMENT SURGEONConsult reputable resources about varying options for hip replacement surgery such as partial versus full replacement and general versus localized anesthesia. The following resources offer detailed information about hip replacement:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

• National Institute of Health (NIH) Osteoporosis and Related Bone Diseases – National Resource Center

• American Academy of Orthopaedic Surgeons (AAOS)

• American Osteopathic Association (AOA)

• Arthritis Foundation (AF)

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One of the most important aspects of undergoing any kind of surgery is finding the right surgeon for you. Talking with your surgeon beforehand is an essential, but often overlooked, part of the process. There are a few things you need to know before going under the knife.

The first is, what will the procedure be like? What can you expect while going through this experience, and what will the recovery time be? More importantly, you need to get a feel for the personality of the doctor performing the operation. What experience do they have with this kind of surgery? How many times have they performed this surgery? How well do their patients usually recover? Research their background, and make sure you’re getting the best person for the job.

Once you’ve talked to the surgeon, it’s also important to get a second opinion. This is standard procedure for any major medical decision, and most doctors are not only happy to assist you in finding another expert, but also grateful to have a second set of eyes on the problem. Different doctors approach the same issue in different ways, so a second point of view can provide some extra depth in finding the best solution.

If the two opinions are similar, then you can be more confident that the recommended treatment is the right one. If they provide very different opinions, carefully examine both of their recommendations to see which one makes the most sense for you and your condition.

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WHAT TO EXPECT DURING SURGERYPartial versus total replacementA partial hip replacement, or hip hemiarthroplasty, is a surgical procedure in which the femoral head or ball of the damaged hip is replaced. In comparison, the acetabulum, or socket, is also replaced in a total hip replacement. Typically, a partial replacement is used for a broken or fractured hip, and a total replacement treats a degenerative condition such as arthritis. Doctors may attach replacement joints to the bones with or without cement.

Partial hip replacement is most commonly done for elderly patients who are sick, with limited life and daily activity.

Minimal incision surgerySometimes doctors are able to perform a minimally invasive surgery for a hip replacement. In this situation, they make a small incision that results in less blood loss and a smaller scar. Because a minimally invasive surgery is more complicated, it is more time consuming than the traditional surgery. In some instances, a surgeon cannot fit the new hip properly with the smaller incision and needs to make the larger opening anyway. As such, it is rare that surgeons use minimally invasive procedures for hip replacements. An orthopaedic surgeon will determine whether or not a minimally invasive surgery is a good fit for your condition, their training, and the medical practice.

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AnesthesiaMost doctors use general anesthesia for hip replacements, which means you are unconscious during surgery. Regional anesthesia, which is becoming the preferred method, is when you can’t feel the surgery area and are still awake, but quite sleepy. Your doctor considers your overall health and, to some degree, your anesthesia preference when deciding which type of anesthesia to use for your hip replacement surgery.

AntibioticsMany doctors recommend taking antibiotics preceding and following a surgery to decrease the risk of infection. If you are in need of any major dental work, it is wise to have it done before the surgery. An infection that results from dental surgery can spread from the mouth to the artificial hip, which could present a serious problem.

Blood managementSince modern total hip replacement techniques such as smaller incisions, faster surgery and improved medications, surgeons have been able to drastically reduce patient blood loss. Now, pre-op blood donations and post-op transfusions have been almost completely eliminated, unless the patient is anemic.

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RECOVERY AND PAIN MANAGEMENTThe recovery of a patient is dependent on their attitude, motivation and pain tolerance (to a degree, as pain is managed with medication).

Right after surgeryPain is usually managed through a multi-modal approach, which includes several medications, less narcotics and more activity. Typically, this results in fewer side effects for most patients.

You will receive intravenous (IV) antibiotics, medication to control the pain, and possibly anticoagulants to prevent blood clots following the surgery. You may also have a catheter, a compression pump or stocking to keep the blood circulating and prevent blood clots in the leg, and a cushion between your legs to keep the new hip positioned correctly. While your activity level will be limited, your recovery will begin with simple breathing exercises and muscle flexing.

The first few daysThe pain medication will slowly be decreased as your recovery progresses. The rehabilitation process will be dictated by whether the surgeon used cement or cementless methods to attach the joint replacement. Most people get out of bed with help on the same day or the day after surgery and will need a cane, crutches, or a walker to get around for several weeks.

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The physical therapist and possibly an occupational therapist will assist you with exercising and walking and will teach you how to complete routine activities such as getting dressed and cooking. The surgeon will give you a number of instructions for the new hip such as not raising your knee higher than your hip and not bending over more than 90 degrees. Make sure to follow these instructions very carefully.

Continued recoveryTypically, the hospital stay for people after surgery is between a few days to one week after surgery. If you need extensive rehab or you don’t have someone who can help you out at home, you may have to go to a specialized rehab center for further treatment. Once you are at home, monitor your general health and the surgery site. If you have a fever over 100.5 ºF or any drainage or redness from the wound, contact your doctor right away.

Most people need to use an assistive device to get around for several weeks following the surgery. The doctor will let you know when you can bear your full weight and move around safely without pain and a risk of falling. You will have an exercise program to follow at home as well as physical therapy, which will take a minimum of six months. Walk for short stints two or three times per day, and if you get sore, use a cold pack on your hip. In order to recover in a timely manner, it is okay to decrease your activity level as needed, but whenever possible, never stop exercising completely.

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Living with a hip replacementYou should visit your doctor at least once a year so he can monitor the hip replacement. Over time, you will be able to return to most normal functioning. Stay active to maintain your strength, endurance, flexibility, and control your weight. Because every pound of body weight adds three to four pounds of stress on the hips, keeping a steady weight extends the lifespan of the new hip joint.

Approved exercises following hip replacement surgery include walking, cycling on a stationary bike, cycling on level surfaces with a standard bike, swimming, cross-country skiing, moderate weight training, dancing, golfing, doubles tennis, and horseback riding. All of these medium-impact exercises aid in the healing process and increase muscle strength and cardiovascular fitness without hurting the new hip. Avoid contact sports, basketball, jogging, activities that involves jumping, high-impact aerobics, and heavy lifting – these activities can damage the hip or result in some of the new parts becoming loose.

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For a minimum of two years following the surgery, it is best practice to take antibiotics before dental work or invasive medical procedures to reduce the risk of infection around the hip replacement. After this time, your doctor and dentist will use your general health to determine whether or not you must continue taking antibiotics.

CONCLUSIONA total hip replacement is a major surgery. You should not take this decision lightly. Do all the research you can to learn about the procedure so you’ll know what to expect preceding, during, and following the surgery. If you have any questions, write them down as you think of them so you can address them with your orthopaedic surgeon. When you are unsure of anything, don’t hesitate to ask. It is critical to feel comfortable before going into the surgery.If you or a loved one is considering total hip replacement surgery and would like to speak with an experienced physician, click here to find a Premier Orthopaedic office in your neighborhood and to schedule a consultation with one of their qualified orthopaedic physicians.