Total joint replacement involves surgery to
replace the ends of both bones in a damaged joint to create new joint
Total hip replacement surgery uses metal, ceramic, or plastic parts to replace the ball at the upper end of
the thighbone (femur) and resurface the hip socket in the
replacement surgery replaces damaged
cartilage with new joint material in a step-by-step process.
Doctors may attach replacement joints to the bones with or without
Doctors often use general
anesthesia for joint replacement surgeries, which
means you'll be unconscious during surgery. But sometimes they use regional
anesthesia, which means you can't feel the area of the surgery and you are
sleepy, but you are awake. The choice depends on your doctor, on your overall
health, and, to some degree, on what you prefer.
Your doctor may
recommend that you take antibiotics before and after the surgery to reduce the
risk of infection. If you need any major dental work, your doctor may recommend
that you have it done before the surgery. Infections can spread from other
parts of the body, such as the mouth, to the artificial joint and cause a
Some doctors are doing hip replacement surgery
through smaller incisions. This is called minimally invasive surgery. It may
mean less blood loss and a smaller scar. But it can also mean a longer time in
surgery, because the surgery is harder to do. And if the new hip cannot be
fitted properly through the smaller incision, the doctor may have to make a
larger opening anyway. These surgeries can also require special equipment that not all hospitals have. Minimally invasive surgery is not done often for hip
replacement. If you are interested in this type of surgery, talk to your
doctor. Whether the procedure is a good idea for you depends on your doctor's
opinion and also on his or her training and practice.
You will have intravenous (IV)
antibiotics for about a day after surgery. You will also receive medicines to
control pain and perhaps medicines to prevent blood clots (anticoagulants). It
is not unusual to have an upset stomach or feel constipated after surgery. Talk
with your doctor or nurse if you feel ill.
When you wake up from
surgery, you may have a
catheter, which is a small tube connected to your
bladder, so you don't have to get out of bed to urinate. You may also have a
compression pump or compression stocking on your leg, which squeezes your leg
to keep the blood circulating and to help prevent blood clots. And you may have
a cushion between your legs to keep your new hip in the correct position.
Your doctor may teach you to do simple breathing exercises to
help prevent congestion in your lungs while your activity level is reduced.
You may also learn to move your feet up and down to flex your muscles and keep
your blood circulating. And you may begin to learn about how to keep your hip
in the correct positions while you move in bed and get out of bed.
You will probably still be
taking some medicine. You will gradually take less and less pain medicine. You
may continue anticoagulant medicines for several weeks after surgery.
Rehabilitation (rehab) after hip replacement surgery may vary depending
on whether the surgeon used cement or cementless methods to attach the joint
replacement surfaces. Whether your surgeon used cement also determines how much
weight you can put on your leg. Your surgeon will let you and your rehab team
know what limitations you have. You'll probably need a walker, a cane, or crutches for several
In general, most people get out of bed with help on the day
of surgery or the next day. Over the next few days, you will learn how to walk with a walker
or crutches. Your physical therapist and sometimes an occupational therapist
will teach you how to exercise, walk, and do activities such as dressing and
cooking while you allow your hip to heal. Depending on the type of surgery you
had and your doctor's instructions, you may learn the following precautions to
keep your hip from dislocating:
Most people go home within a few days to a week after
surgery. Some people who need more extensive rehab or those who don't have
someone who can help at home go to a specialized rehab center for more
After you go home, monitor the
surgery site and your general health. If you notice any redness or drainage
from your wound, notify your surgeon. You may also be advised to take your
temperature twice each day and to let your surgeon know if you have a fever
over 100.5°F (38.1°C).
For a while, you may need to sit only in high chairs (not on low seats
that flex your hip more than 90 degrees), use a toilet seat raiser, and sleep
on your back.
You may need to use a walker or crutches for several
weeks after surgery until you can bear your full weight, have less pain, and
can safely move around without falling. How long you need to use crutches or a
walker depends on the condition of your bones and what type of procedure your
doctor used as well as his or her experience working with other people who had
Physical therapy typically continues after you go
home from the hospital until you are able to function more independently. Total
rehabilitation after surgery will take at least 6 months.
have an exercise program to follow when you go home, even if you are still
having physical therapy. You should also take a short walk several times each
day. If you notice any soreness, try a
cold pack on your hip and perhaps decrease your activity a bit, but don't
stop completely. Staying with your walking and exercise program will help speed
For most people it is safe to have sex about 4 to 6
weeks after a hip replacement. Talk to your doctor about how and when it is
safe. And ask your physical therapist or occupational therapist about positions
that will not put your new hip joint at risk.
Your doctor will
probably want to see you at least once every year to monitor your hip
replacement. Gradually, you will return to most of your presurgery activities.
If you drive a car, your doctor will probably allow you to start driving an
automatic shift car in 6 to 8 weeks, as long as the seat is not too low and you
are no longer taking pain medicine.
Because of the way the hip is
structured, every added pound of body weight adds 3 pounds of stress to the
hip. Controlling your weight will help your new hip joint last longer.
Stay active to help
keep your strength, flexibility, and endurance. Your activities might include
walking, swimming (after your wound is completely healed), dancing, golf (don't
wear shoes with spikes, and do use a golf cart), and bicycling on a stationary
bike or on level surfaces. More strenuous activities, such as jogging or
tennis, are not advised after a hip replacement.
Your doctor may
want you to take antibiotics before dental work or any invasive medical
procedure for at least 2 years after your surgery. This is to help prevent
infection around your hip replacement. After 2 years, your doctor and dentist
will decide whether you still need to take antibiotics. Your general health and
the state of your other health conditions will help them decide.
Doctors recommend joint replacement
surgery when hip pain and loss of function become severe and when medicines and
other treatments no longer relieve pain. Your doctor will use X-rays to look at
the bones and cartilage in your hip to see whether they are damaged and to make
sure that the pain isn't coming from somewhere else.
replacement may not be recommended for people who:
But doctors evaluate each person individually.
People who have hip replacement
surgery have much less pain than before the surgery and are usually able to
resume daily activities. You will probably be able to do your daily activities
more easily because the joint moves better.
Most artificial hip joints will last for 10 to 20 years or
longer without loosening, depending on such factors as:
The younger you are when you have the surgery and the more
stress you put on the joint, the more likely it is that you will eventually
need a second surgery to replace the first artificial joint. Over time, the
components wear down or may loosen and need to be replaced.
artificial joint should last longer if you are not overweight and if you do not
do hard physical work or play sports that stress the joint. If you are older
than 60 when you have joint replacement surgery, the artificial joint probably
will last the rest of your life.
Doctors continue to discover new
ways to improve the life span of artificial hip joints. What we know today
about the long-term outcomes of hip replacement surgery comes from studies of
joints that were replaced 10 to 20 years ago or longer. People who have hip
replacement surgery today may expect the artificial joint to last longer than
joints replaced 10 to 20 years ago.
The risks of hip replacement surgery can be
divided into two groups:
The risks of each complication depend in part on your other
health problems and on the surgeon.
Continued exercise (such as
swimming and walking) is important for your general well-being and muscle
strength. Discuss with your doctor what type of exercise is best for
You may donate your own blood to use during surgery if
needed. This is called autologous blood donation. If you choose to do this,
start the donation several weeks before the surgery so that you have time to
donate enough blood and rebuild your blood volume before surgery.
If you need more than one joint replacement surgery, such as a knee and a
hip, talk to your doctor about
guidelines that may help you and your doctor
decide in which order to do the surgeries.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Other Works Consulted
American Academy of Orthopaedic Surgeons (2009). Activities after hip replacement. Available online: http://orthoinfo.aaos.org/topic.cfm?topic=a00356.
Imamura M, et al. (2012). Single mini-incision total hip replacement for the management of arthritic disease of the hip: A systematic review and meta-analysis of randomized controlled trials. Journal of Bone and Joint Surgery, American Version, 94(20): 1897–1905.
Rethman MP, et al. (2012). Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Executive Summary on the AAOS/ADA Clinical Practice Guideline. Available online: http://www.aaos.org/research/guidelines/PUDP/dental_guideline.asp.
July 19, 2013
Anne C. Poinier, MD - Internal Medicine
& Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
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