If you’re experiencing a lot of pain in your hip, your healthcare provider may recommend a procedure called a hip replacement. This common surgery replaces your hip bone(s) with an artificial one, enabling you to move easier and without pain. Recovering from a hip replacement takes time, and there are many rules to follow to keep you safe and healing.
What is a hip replacement (hip arthroplasty)?
This surgery is where your hip (or parts of it) is replaced with a manmade implant (prosthesis). It’s usually performed on adults after other treatments like using a cane or walker, weight loss, medicines and physical therapy have failed to help. You may need a hip replacement because of:
Your hip is a joint — a ball-and-socket joint — that connects the thigh bone (femur) of your leg to your pelvis. Your femur has a “head” at its top that’s shaped like a ball, and it fits into the acetabulum (the socket). It’s kept in place by ligaments, tendons and muscles around the joint. Your hip is the most flexible and free-moving joint in your body and can move backwards and forwards, to the side and can perform twisting motions.
There are two major types of hip replacements:
Total hip replacement (the most common type): A total hip replacement switches both the femoral head and the acetabulum with a prosthesis.
Partial hip replacement: A partial replacement substitutes the femoral head only. This is typically done for patients with certain types of hip fractures.
If a hip replacement is the best treatment for you, your healthcare provider may send you to an orthopaedic surgeon for evaluation. Your orthopaedic surgeon will evaluate your hip joint with a full physical exam and X-rays and develop a treatment plan for how surgery can best benefit you.
Some of the following symptoms may be related to conditions that hip replacements address. They include:
Hip replacement surgery isn’t for everyone. Even if someone is in pain and can’t move their hip as well as expected, they aren’t automatically considered for a hip replacement. You might be ineligible if you have:
Is a hip replacement surgery outpatient or inpatient?
Most people need to stay in the hospital for about one to two days.
In order to prepare for surgery, you’ll schedule a series of appointments to receive testing and clearance. During these appointments, studies including lab testing, urine analysis, an EKG and X-rays may be performed. Based on the results of these tests and your health history, clearance is or is not initiated for the surgery.
Before surgery, your medical risk will be assessed. Your healthcare providers need to make sure that the risks of a hip replacement don’t outweigh the benefits. They will check for:
Your lower extremities will be evaluated before surgery. Your healthcare providers will do the following:
You will have radiographs (X-rays) of the hip and pelvis to assess the status and structure of the hip joint. Occasionally advanced imaging (MRI or CT scan) may be needed to assist in the diagnosis or treatment planning.
Your healthcare provider will likely require some tests before surgery. Tests may include:
You can also take some steps to help ensure an easier and safer recovery after surgery. Make a few simple changes around the house, and arrange for someone to help you following surgery. If you smoke, quit or cut down to improve your surgery risk and recovery rate. It’s also helpful to lose weight if needed, have an obstructive sleep apnea screening, and try to resolve other conditions you have. Don’t eat or drink anything after midnight the night before surgery.
You can try these tips at home prior to surgery:
Inform your surgeon about all of your medications, both over-the-counter and prescription. Some medications don’t react well with anesthesia, and others such as aspirin, ibuprofen and blood thinners increase bleeding. For these reasons, you may need to stop taking certain medications before your hip replacement. If you’re taking aspirin or aspirin-based medication for arthritis, you must stop taking these two weeks before your surgery. If you’re taking medications for other medical problems, don’t discontinue taking these without checking with your primary healthcare provider. Make sure to bring a list of all medications, the dosages and how often you take them. This includes all herbal supplements and vitamins. This is important information that will be documented in your hospital records.
Antibiotics: Medication to help prevent infection.
Anesthesia: An anesthesiologist will meet with you before your surgery. They will explain the various types of anesthesia available to you and the risks and benefits of each with your health history. The spinal, or regional anesthetic block, is the most common method used for orthopaedic joint replacement procedures. You’ll also be asked to complete a health questionnaire from the anesthesia department for surgery clearance to ensure your safety.
Thromboprophylaxis: Medication to help prevent blood clots (thrombosis).
Pain control: Various medications can help control pain, including NSAIDs, narcotic pain medications and peripheral nerve block.
You may be evaluated by a physical therapist before surgery. After surgery, you’ll have daily physical therapy.
The prosthesis is constructed of metal and plastic. Titanium, stainless steel, cobalt-chromium, ceramic and polyethylene are the most common materials. A prosthesis for a total hip replacement consists of four components:
They are linked, but flexible, so that the surgeon can adjust for anything unexpected. The prosthetic is then fixed to the remaining bone using either:
One to two hours is typically how long the surgery takes.
Relief from pain is the greatest benefit and the major reason for hip replacement surgery. The procedure offers other benefits, including:
There are some risks and complications that may happen through a hip replacement surgery associated with anesthesia, including respiratory or cardiac malfunction. Other complications that can happen right after surgery or even years later include:
After surgery, you’ll be given pain medication and an antibiotic. Medicines or physical therapy may be prescribed by your surgeon to prevent blood clots. To decrease your chances of having a Deep Vein Thrombosis (DVT) after surgery, you may be given medication, wear special stockings and do ankle pumps for two to three days following surgery. You may have an appointment depending on the wound closure method preferred by your surgeon to have the staples or external sutures removed (if present). You should call your surgeon if you experience any of the following symptoms:
You may be in the hospital up to two days after surgery. If it is unsafe for you to return directly home from the hospital, you might have to go to a rehabilitation center prior to discharge home. Talk to your healthcare provider about the best recovery plan.
How long that ends up being in the hospital depends on three things:
What does recovery look like? What’s the rehabilitation after hip replacement surgery?
Rehabilitation and physical therapy are started immediately following surgery and continue throughout hospitalization and at home for one year after surgery. Your physical therapist will monitor the strength and flexibility in your leg and hip, as well as your ability to stand and sit. In addition, a physical therapist will provide goals and instructions for you to complete while in the hospital and at home.
Although discharge home is the goal for the majority of patients, your healthcare provider may determine that it’s best for your recovery if you go to a rehabilitation center or nursing home after discharge from the hospital. At the rehabilitation center, you will have concentrated time with a physical therapist and occupational therapist and will regain your strength, learn about all your exercises and the precautions that you’ll need to follow. Your length of stay at this facility is approximately five to 14 days, depending on your recovery progress. Your healthcare provider’s assistant or nurse will discuss facilities available for your needs, and a case manager specializing in discharge planning will meet with you during your admission. The case manager handles all of the planning for your rehabilitation.
Several variables affect the ultimate success of a hip replacement surgery and the length of the recovery time. These include the strength of your bones and muscles and your general health and lifestyle. Commitment to a rehabilitation program is also an important part of the recovery process, since improvement to the hip joint is determined by your rehabilitation efforts.
You’ll perform daily exercises that strengthen and stretch the muscles around your hip joint — likely 20 to 30 minutes two to three times per day. You’ll also slowly return to climbing stairs, bending and walking, gradually regaining motion and strength. It will be several weeks to several months before you’re completely back to normal.
Joint replacements don’t last forever — although experts have noticed that modern prostheses can last longer than the ones that were used years ago. Hip revision surgery may become necessary if an artificial hip becomes painful.
Do not drive for several weeks after surgery. You may resume driving once you have good strength and control of the legs, are comfortable sitting in a car, and are off of pain medication. Discuss this with your surgeon based on your recovery.
After surgery, your physical therapist will instruct you regarding hip movement precautions and any limitations you may have for range of motion. Keep in mind that your physical therapy and strengthening exercises will help you gain greater mobility and ensure an easier recovery following surgery. It’s highly recommended that you continue therapy treatment for the recommended timeframe prescribed by your physical therapist.
Your physical therapist will tell you that there are several basic rules about positioning that you should be aware of following surgery. The specific precautions will vary based on the surgical approach (window into the hip joint) used during surgery. Precautions may include that you don’t bend forward more than 90 degrees, and do not lift your knee on the surgery side higher than your hip. Also, don’t cross your legs or rotate your leg outward, or twist or pivot your operated hip.
There are some general safety tips to keep in mind. For example, simplify your surroundings:
What side effects of hip surgery mean that I should contact my orthopedic surgeon?
You should contact your surgeon right away if you experience any of the following:
How frequently should I schedule follow-up appointments with my healthcare provider?
Post-operative visits help your surgeon know that your hip is healing well. Make sure to schedule your first evaluation within the timeframe your surgeon recommends. It’s important to comply with this schedule and to see your healthcare provider regularly for routine office visits to ensure safe and effective recovery from total hip replacement.
