What is the recovery time?
Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for one month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This usually takes about three months but can take longer.
What is a dislocation of the hip?
A dislocation of the hip occurs when the femoral head (ball) comes out of the acetabulum (socket). While the risk is very small, typically less than 2 percent, you are given dislocation precautions to help prevent this from happening.
What are the dislocation precautions for my hip (positions I should avoid)?
You should avoid flexing (bending) at the hip more than 90 degrees. Avoid low chairs and furniture because they require too much bending at the hip in order to get up. If you must reach to the floor when seated, always reach between your legs, not to the outside. Use an elevated toilet seat to avoid excessive bending of the hip. If possible, use a chair with arms. The arms provide leverage to push you up to the standing position. When sitting, position your legs so that you can see your inner thigh, calf and foot (not the outside). If your physician orders different precautions, you will be instructed on them by your physical therapist.
How long do I need to follow my dislocation precautions?
Follow your precautions very carefully for the first six weeks. You should avoid extreme positions of the hip flexion (bending) forever.
Can I sleep on my side?
You may sleep on your operative side whenever you feel comfortable. You may sleep on your nonoperative side at four weeks with a pillow between your knees.
When will my stitches be removed?
Your stitches are absorbable and do not need to be removed. The Steri-Strips can be kept in place until they fall off on their own. They will help keep the skin edges together. If they have not fallen off after two weeks, it is OK to remove them.
How long do I need to keep a bandage on my incision?
Approximately one week or until there is no drainage from the incision. This should be changed daily to a new, dry sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation.
When can I shower (get the incision wet)?
Five days after your operation, as long as there is no drainage present at the incision. (Initially, try to keep the incision dry with plastic wrap.) If it gets wet, pat it dry.
When can I immerse my hip in water (e.g., bath, swimming pool, ocean, hot tub)?
Typically, you should not swim or get in a hot tub for six weeks. However, some surgeons allow their patients to do so after two weeks if there is no drainage. Check with your surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication for about three months. Initially, you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off their strong pain medication after one month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g., aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting with your internist.
Will I go to a rehabilitation facility or a home?
It depends. Most people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to return home safely. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, postoperative functional status as evaluated by a physical therapist in the hospital and overall evaluation by our hospital team.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually two to three times a week). Sometimes you will be referred to an outpatient physical therapist. If you go to a rehabilitation facility, you will receive therapy there. Your therapist will keep your surgeon informed of your progress.
What exercises should I do?
You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and stationary bicycles are good exercise options. These should be continued indefinitely even after your recovery is complete. Do not begin using a stationary bike or swimming until four weeks after your surgery or until you have been seen by your surgeon.
I think my leg lengths are different. What should I do?
It is not uncommon to feel as though your leg lengths are different. Your leg was most likely slightly shorter to begin with as a result of the loss of cartilage. Your surgeon has restored the natural height of your hip during the surgery. In the operating room, leg lengths are accessed very carefully, and an attempt is made to make them as equal as possible. Sometimes, the new hip has to be lengthened in order to obtain proper muscle tension (to help avoid hip dislocation). Wait three months before making any final judgments about your leg length. Your muscles and body take time to adjust to a new hip. In rare cases, a shoe lift may be prescribed for a true difference in leg lengths. In most cases, however, no treatment is necessary.
Can I use weights?
Generally not for the first two months. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with and gradually progress from 1 pound to a minimum of 5 pounds.
How long will I be on a blood thinner?
Typically, you will be on Coumadin (warfarin) as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a dose of Coumadin the night before surgery and continue you on Coumadin while in the hospital. At the time of your discharge, you will be enrolled in our Coumadin Clinic. They will arrange for you to have blood draws at home. They will then adjust your Coumadin dose for you by phone. You will normally need to be on a blood thinner for four to six weeks. This will be decided prior to your discharge from the hospital. Some surgeons prefer to use an injectable blood thinner. This is something that you will administer yourself at home. Your surgeon will discuss the specifics of this with you prior to your discharge.
How long should I take iron supplements?
Four weeks is usually sufficient. These supplements help your body replenish its iron stores, which may be depleted postoperatively.
When can I drive?
If you had surgery on your right hip, you should not drive for at least one month. After one month, you may return to driving as soon as you feel comfortable. If you had surgery on your left hip, you may return to driving as soon as you feel comfortable as long as you have an automatic transmission. Be careful getting into and out of a car, and avoid crossing your operated leg over the other. DO NOT DRIVE IF TAKING NARCOTICS! Some surgeons do not allow their patients to drive until they have seen them back in their office four to six weeks after surgery. Check with your surgeon.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately one month. If your work is more rigorous, you may require up to three months before you can return to full duty. In some cases, more time may be necessary.
When can I travel?
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.
Will I set off machines at airport security? Do I need a doctor's note about my surgery?
You may set off the machines at airport security depending on the type of hip implant you have and the sensitivity of the security checkpoint equipment. At your follow-up visit you may ask to have a wallet card to carry with you for travel.
What activities are permitted following surgery?
You may return to most activities as tolerated, including walking, gardening and golf. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.
What activities should I avoid?
You should avoid impact activities, such as running, downhill skiing on expert slopes and vigorous racquet sports, such as singles tennis or squash. In addition, you should avoid any activity that may put your new hip at risk for dislocation.
Can I have sex?
You should wait several weeks postoperatively before resuming sexual intercourse. Follow your hip dislocation precautions. Having your legs apart is a safe position.
Can I drink alcohol?
If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should avoid taking narcotics or other medications.
How long should I use compression stockings (TEDs)?
These should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat. Once the initial swelling has decreased, you may use ice or heat. Check with your surgeon.
Can I go up and down stairs?
Yes. Initially, you will lead with your nonoperated leg when going down stairs. You can use the phrase, "Up with the good, down with the bad" to help you remember. As your legs get stronger, you will be able to perform stairs in a more regular pattern (about one month).
Can I kneel?
Yes, after six weeks. To kneel, touch down with the knee of your operative leg first. To arise from kneeling, use your nonoperative leg first.
When can I discontinue using a raised toilet seat?
Six to 10 weeks after your operation.
What should I expect for my range of motion at six weeks? At one year?
Everyone's range of motion varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have enough motion to put on socks and tie your shoes. Clipping toenails may be difficult.
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or nonurgent procedures for six weeks postoperatively.
I feel depressed. Is this normal?
It is not uncommon to have feelings of depression after your hip replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.
I have insomnia. Is this normal? What can I do about it?
This is a very common complaint following hip replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed to you.
How long will my total hip replacement last?
This varies from patient to patient. For each year following your hip replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate. Newer implants and technologies may have even better success rates.
When do I need to follow up with my surgeon?
Follow-up appointments should be made postoperatively at four to six weeks, one year, two years, five years, seven years and ten years.
Normal things about your new hip:
- Clicking noise with hip motion
- Skin numbness near or around your incision
- Swelling around hip, knee or lower leg
- Warmth around hip
- “Pins and needles” feeling at or near your incision
- Dark or red incision line
- Increased bruising if on Coumadin
Abnormal things about your new hip (call tour surgeon if you experience any of these):
- Increasing redness, particularly spreading from incision
- Fevers (above 101 degrees)
- Persistent drainage from your wound
- Calf swelling or pain, particularly associated with ankle motion
- A sudden "giving way" of your hip with inability to bear weight
- Ankle swelling that does not resolve or decrease overnight
- Bleeding gums or blood in urine/stool
What is arthritis and why does my hip hurt?
In the hip joint, there is a layer of smooth cartilage on the ball of the upper end of the thighbone (femur). There is another layer within your hip socket. This cartilage serves as a cushion. It allows for smooth motion of the hip. Arthritis occurs when there is a wearing away of this smooth cartilage. In fact, this cushion can wear down to bone. Rubbing of bone against bone causes discomfort, swelling, and stiffness.
What is a total hip replacement?
A total hip replacement is an operation that removes the arthritic ball of the upper thighbone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal or ceramic ball. Once the damaged femoral head is removed, a stem is either glued or “press fit” into the center of the femur. The socket is replaced with a plastic liner. This liner is usually fixed inside a metal shell. This creates a smooth functioning joint. Pain is reduced or eliminated.
What are the results of a total hip replacement?
Ninety to ninety-five percent of patients have good to excellent results with relief of discomfort after the hip replacement. Most patients can significantly increase activity and mobility. The procedure has become quite common. According to the Agency for Healthcare Research and Quality, more than 300,000 total hip replacements are performed each year in the U.S.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a candidate for the surgery. This is based on your medical history, exam, X-rays, and response to conservative treatment — age is usually not a factor. The decision will then be yours.
Am I too old for this surgery?
Age is not a problem if you are in good health and have the desire to continue living a productive, active life. You may be asked to see your personal physician regarding your general health and readiness for surgery. We have successfully performed total joint replacement surgery on patients ages 18 to 100.
How long will my new hip last and can a second replacement be done?
We expect most hips to last more than 10 to 15 years. However, there is no guarantee. A second replacement or revision may be needed.
Why do they fail?
The most common reason for failure is loosening of the artificial ball where it is secured in the femur. Wearing of the plastic spacer may also result in the need for a revision, although newer bearings may last for more than 25 years.
Do you recommend any restrictions following this surgery?
Yes. High-impact activities, such as running, singles tennis and basketball are not suggested. Injury-prone sports such as downhill skiing are also dangerous for the new joint. Depending on the approach of the surgery, hip patients may be restricted from crossing their legs or bending their hips more than 90 degrees. Please check with your doctor for possible restrictions.
Will I notice anything different about my hip?
Patients with hip replacements think that the new joint feels completely natural. We recommend avoiding extreme positions, or high impact, or physical impact activities. The leg with the new hip may feel longer than it was before. This is because of the shortening due to hip disease. After surgery, the leg is restored to its original height and this makes it feel longer than before. Most patients get used to this feeling in a short time. Some patients have aching in the thigh with weight bearing for a few months after surgery. You may have a small area of numbness to the outside of the scar. This may last a year or more and is not serious or cause for concern.
More than 600,000 people go through total joint replacement surgery every year. Candidates are those with chronic joint pain from arthritis. The pain interrupts daily activities, walking, exercise, recreation, and work. The surgery helps to relieve pain, and helps restore your independence and gets you back to work and other daily activities.
Total joint replacement patients recover quickly. Patients will be able to walk the day of surgery. Generally, patients are able to return to driving in two to four weeks, dance in four to six weeks, and golf in six to 12 weeks.
What are the major risks?
Most surgeries go well, without any complications. However, infection and blood clots are two serious complications that can occur. To avoid these complications, you will be prescribed antibiotics while in the hospital and medications to thin the blood. Special precautions are taken in the operating room to reduce the risk of a surgical infection. The chances of this happening in your lifetime are one percent or less. A more common risk is dislocation of your surgical hip. Hip dislocation is more common with posterior hip replacements. Your doctor will discuss ways to reduce this risk.
Should I exercise before the surgery?
Yes. You should either consult an outpatient physical therapist or follow the exercises listed in your notebook. Exercises should begin as soon as possible (avoid the affected extremity if it is causing more pain or swelling).
How long am I incapacitated?
In most cases, patients will ambulate within a few hours after leaving the recovery room. We encourage sitting up post-operative day one in a chair or recliner for all meals. In addition, you will be encouraged to ambulate with a walker or crutches a couple of times a day on postoperative day one.
How long will I be in the hospital?
Most total joint patients will be hospitalized for one to two days after surgery. There are several goals that you must meet before you can be discharged.
What if I live alone?
In most cases, you will be able to go home directly from the hospital and safely get around your house without help. An outpatient physical therapy appointment or home physical therapy appointment will be made depending on your needs. On the rare occasion that you are unable to manage at home safely, a Nurse Case Manager will discuss your options with you.
How do I arrange for surgery?
In most cases a referral will be sent from your surgeon’s office to your primary care physician’s office notifying them that you will be having total joint replacement. If you have questions or concerns, feel free to speak with the scheduler at your surgeon’s office and they will be able to further direct you.
How long does the surgery take?
We reserve approximately two- to two-and-a-half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery. Your surgeon is a great source for a more specific timeframe.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you and your anesthesiologist. For more information: read “Anesthesia and You” in the appendix section of this guide.
Will the surgery be painful?
You will have discomfort following the surgery. We will keep you as comfortable as possible with the correct medication. Pain will slowly decrease and you will be able to wean off your pain medication. Please remember each patient responds to pain differently. If your pain is not tolerable once you are discharged to home, please call the surgeon's office.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant helps during the surgery.
Will I need a private nurse?
No. For about two to six weeks we do recommend that you use a walker, a cane or crutches. The total joint team can help arrange for them if necessary.
Will I need a walker or crutches?
In most cases, we do recommend that you use a walker, a cane, or crutches for the first several weeks. Your therapist and surgeon will help you decide if you need an assistive device. Case Management will help arrange for equipment if needed. Please do not purchase these items prior to your hospital stay, insurance may not reimburse you.
Where will I go after discharge from the hospital?
Most patients are able to go directly home after discharge. In the case that you are unable to go home safely, the surgeon and case management team will discuss options with you.
Will I need help at home?
Not necessarily. For the first several days, it can be helpful for someone to prepare meals, and handle other household tasks. If you go directly home from the hospital, the total joint team may arrange a home health nurse to come to your house if needed. Many patients discharge home with home health physical therapy only. Preparing ahead of time, before your surgery, can reduce the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single portion frozen meals will reduce the need for extra help.
What physical/recreational activities may I participate in after my recovery?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling, doubles tennis, and gardening.
Will I need physical therapy when I go home?
Yes. You will have either outpatient or in-home physical therapy. Patients are encouraged to attend outpatient physical therapy. If you need in-home physical therapy, we will arrange for therapy and provide you with the contact information of the company. The length of time required for home therapy differs with each patient.
When will I be able to get back to work?
This is based on each individual’s job and progress. If your job is more sedentary such as office work, you may return as early as two to three weeks after surgery, with crutches. Individuals who have a much more strenuous job may require two to three months of rehab before returning to work. A physical therapist can make suggestions for joint protection and energy management on the job.
How often will I need to see my doctor following the surgery?
One to two weeks after discharge, you will be seen for your first postoperative office visit. The schedule of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks, and then yearly. Your surgeon will let you know what is recommended as it can differ with each patient.
When can I have sexual intercourse?
There are no true restrictions with sexual activity; normally you may resume when your joint feels comfortable enough. Further discussion resuming sexual intercourse should be discussed with your doctor.
Will I need any other equipment?
Most patients are stable with a walker for the first few weeks after surgery. Purchase of a 3:1 commode or shower can be done prior to surgery if you feel it will be beneficial. This equipment can be purchased at a medical supply store or online. Most insurance companies do not cover this equipment. You may call your insurance for further information. With a knee replacement, you have the option to purchase an ice-cooling unit — again this is generally not covered by insurance. You may use gel ice packs in place of this unit — the purchase of four to six flexible ice packs should be sufficient to reduce pain and inflammation.
Will I receive a card stating that I had joint replacement surgery?
Yes, you may receive a card that states you had a joint replacement. You may carry the card with you. However, when you go to the airport you will still have to be scanned and you will set off the alarms. If you ask to go through the body scanner right away, it will help prevent any further delays.
How long until I can drive and get back to normal?
Driving depends on the type of surgery performed and whether it was the right or left extremity. The right side may require a longer delay in driving. The left side will depend on type of car. If you have an automatic, you could be driving again within two to four weeks. “Getting back to normal” will depend on your progress. Ask your doctor or therapist for their advice on your activity. However, you may never drive under the influence of narcotic pain medicine, if pulled over while under the influence of narcotics you can be charged with a DUI.
Will I be eligible for a temporary disabled placard?
Yes, you will be eligible for a temporary disabled placard for about six to eight weeks postoperatively.
What time should I arrive to the hospital?
You will be asked to come to the hospital one-and-a-half to two hours before the surgery time. Please arrive at the time provided. This gives the nursing staff time to start IVs, prep you for surgery, and answer any additional questions.