Frequently Asked Questions
Total hip replacement (THR) is the replacement of the ball and socket of the hip joint with implants. There are two main components used in total hip replacement. The acetabular shell replaces the hip socket. The femoral stem replaces the worn-out top of the femur. During surgery, the head of the femur (thigh bone) is removed and replaced with both a stem and socket, mimicking your existing anatomy.
If you have severe hip pain that is limiting your mobility and affecting your daily functions, you may benefit from hip replacement surgery.
The following three are the most common causes of joint damage due to arthritis:
Osteoarthritis: A disease which involves the wearing away of the normal smooth joint surfaces. This results in bone-on-bone contact, producing pain and stiffness.
Rheumatoid Arthritis: The body’s immune system attacks and destroys the synovial lining covering the joint capsule, the protective cartilage and the joint surface. This causes pain, swelling, joint damage and loss of mobility.
Trauma related arthritis: Resulting from damage to the joint from a previous injury. It also results in joint damage, pain and loss of mobility.
Treatment Options: When medication, physical therapy and other conservative methods of treatment no longer relieve pain, total hip replacement may be recommended by your surgeon.
A hip replacement may become necessary to prevent pain and increase mobility if your hip joint is damaged as a result of disease or injury. The most common cause of hip replacements is osteoarthritis, but the procedure may also be necessary for people with rheumatoid arthritis, osteoporosis, bone tumours or a fractured femur (thigh bone). Hip replacements may not be recommended for people who have a high likelihood of injury, such as people with Parkinson’s disease or a significant weakness of the muscles.
Excessive delay in intervention can cause further worsening of joint, at times fracture too. Damage to other joints and lower back because of over loading. Weight gain, stiffness, leg shortening and muscle wasting are other downsides in delay for surgery.
There exist a number of non-surgical alternatives, such measures as lifestyle modification, weight reduction, exercise and physical therapy, and medication should be implemented before deciding on surgery.
If all of these measures have been exhausted, then and your surgeon may recommend surgical intervention.
Here is a list of potential post-surgery complications:
- • Blood clots
- • Infection
- • Fracture
- • Dislocation
- • Loosening
- • Need for second hip replacement
At ELITE Orthopaedics, surgical team will evaluate your risk for complications and provide specific treatments to avoid these risks.
The scar will be approximately 6–8 inches long. It will be along the side or front of your hip. Usually staples are applied but in a couple of cases stitchless surgery is done.
It is true that today’s incisions for total hip replacement are typically shorter than in the past. Patients are recovering faster than previously due to a variety of factors including patient motivation, physical therapy advances and improvements in peri-operative pain control. Minimally invasive preserves cutting muscles and tendons and so less pain and more gain.
The success rate for this surgery is high, with greater than 95% of patients experiencing relief from hip pain. The success rate of hip replacements 10 years after surgery is 90- 95% and at 20 years 80-85%. Should an implant wear or loosen, revision to a new hip replacement is possible.
The newer articulating surfaces are more durable, wear less and so more longevity can be expected with better range of motion. The newer articulating materials are metal on metal, ceramic on ceramic and metal with highly cross linked polyethylene.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced prior to surgery.
Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.
With new innovative technologies in pain control concepts and minimally invasive surgeries done with FIFO, patients now recover way faster. They mostly walk on their feet around 3 hours after surgery, go to toilet seat next morning and outside their room in afternoon. Within 12 weeks following surgery, many patients will resume their recreational activities, such as talking long walk, cycling, or playing golf. It may take some patients up to 6 months to completely recover following a hip replacement.
Returning to work is highly dependent on the type of work you do, as well as your own recovery progress. If you have an office or desk job, you can expect to return after four to six weeks. With more physical jobs that require lifting, extensive walking or travel, you might need up to two months to fully recover. Your surgeon will tell you when you can return to work and if there are limitations.
With new innovative platforms like FIFO and Minimally Invasive Surgery hospital stay with new technique is mostly 2 to 3 days.
Yes. Physiotherapy is an essential part of your total hip replacement recovery process. Physical therapy begins the day of your surgery and will take place over the course of few weeks. At first, you will do some simple exercises like contracting and relaxing your muscles in order to strengthen your hip. You will also learn new techniques for movements such as sitting, standing, and bending, in order to prevent any possible damage to your hip replacement.
For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. If you go directly home from the hospital, family or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required.
About returning to activity…
Using FIFO coupled with modified anaesthesia techniques and improvised pain control techniques, you will be made to walk around 3 hours after surgery in majority of cases. Normal walking will take 2 to 4 to weeks as guided by your physiotherapist.
Yes. You will start with a walker until your muscle strength returns after surgery. Your outpatient physical therapist will advance you to a cane when appropriate.
Stair climbing can start in first few weeks after surgery as per comfort of patient, but it’s important to have support when you climb and descend stairs, especially immediately after surgery. … That means you should lead with your stronger leg that still has your original hip to walk up the stairway and your weaker leg to walk down it.
Some patients may drive as soon as 2 weeks after surgery, while others may need as long as 6 weeks. During this period, simply getting in and out of a car can be challenging, especially if the car’s seats are low to the ground. Patients must meet the following requirements:
- • The patient must be off of narcotic pain medication while driving.
- • The patient must be able to hit the brake quickly.
- • The patient must be able to get in and out of the car comfortably and safely.
In addition, reflexes and muscle strength should have returned to their pre-surgical levels.
As a general rule of thumb, sleeping on your back is the best position. In opposition, sleeping on your stomach is never recommended after surgery. Generally, if your surgeon approves, it is usually safe to sleep on your surgical side when it feels comfortable. This will not be until about the 6 week mark but if hip is operated from front, then much earlier. Always remember to keep a pillow between legs while changing sides.
If your waterproof dressing has been unstained for a 24-hour period and there is no drainage, then you can shower. You should avoid immersing your incision under water. When drying the incision, pat the incision dry, do not rub it.
Normally stitch less surgeries are done that do not require any removal, sutures dissolve on their own and do not have to be removed. If Sutures/staples are there, then removal approximately 2 weeks after surgery. This can be done by a visiting nurse if you are at home, or in hospital facility.
People can travel on an airplane six weeks after their surgery. During flying, exercise your calf muscles and ankles frequently. Also, get up and walk the aisle of the airplane to avoid the possibility of blood clots. Check with your surgeon about taking a blood-thinner medication before flying. Wear your white anti-embolism stockings to reduce the risk of blood clots.
Yes, the precautions are for life and should be strictly adhered to for the duration of the healing and muscle strengthening. However, hip precautions can be relaxed once the hip is strong and healed.
For a replacement operation on the right leg, it is wise to wait a four to six weeks and after you have stopped taking medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe.
It depends on your profession. If a patient has a sedentary or desk job, they may return to work in approximately 3-6 weeks. If your work is more labour intensive, patients may require up to 3 months before they can return to full duty. In some cases, more or less time is necessary.
After several months you may try to squat or sit cross legged. It may be painful at first, but will not harm or damage your hip replacement. Much of the discomfort comes from healing on your recent incision and the healing local tissues. These activities generally become more comfortable as time passes. Avoid sitting cross legged on floor.
As soon as your are comfortable taking care to avoid hip flexion of more than 90 degrees and rotation of the leg more than 35-40 degrees in either direction.
You will probably set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a hip replacement and will most likely set off the alarm. Wear clothing that will allow you to show them your hip incision without difficulty. We do provide patients with a special card that certifies you as having hip replacement; however, patients will usually be screened by security as well.
The latest advanced technology ANTERIOR HIP, involves sparing the surrounding muscles and tendons when performing total hip replacement surgery. This technique builds a traditional hip implant in-place without cutting any muscles or tendons. It has far lesser chances of leg length discrepancy, hip coming out (dislocation) after surgery and faster recovery.
Most patients have a sense that the operated leg feels longer early in their recovery and this may initially feel awkward. This is due to the fact that the affected leg is usually shorter than the unaffected leg prior to surgery. Arthritis is the process of the protective cartilage covering wearing away from the bone. As the cartilage in the hip joint is destroyed, this results in the leg becoming shorter. Eventually, patients become accustomed to their “new anatomy” following surgery, and do not have any long lasting sense of a leg length discrepancy. Occasionally, some patients choose to wear a small shim in a shoe. At times, the leg is intentionally lengthened at the time of surgery in order to tighten the surrounding soft tissues of the hip and prevent/limit the risk of dislocation. In the majority of cases your leg length will essentially be unchanged.
While not an exhaustive list, you can use this as a starting point to open a conversation with your doctor.