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Patient Education: Hip Replacement
Disclaimer
The following text is a list of facts and commonly asked
questions regarding joint replacement. The information provided below
is offered for general education purposes only and should not be used
for diagnosing orthopaedic problems, nor should it be considered a
replacement for consultation with a physician.
Only your healthcare provider can diagnose you and treat you in
the way best suitable for you. While BioPro has endeavored to make sure
the information contained in this site is accurate, BioPro can not
guarantee the accuracy of such information, and it is provided without
warrant or guarantee of any kind. If you have any questions or concerns
about your health, please contact your healthcare provider.
Hip Replacement
Understanding
Hip Replacement
Your hip is a simple ball and socket joint, where your thigh bone
joins with your pelvis. Surrounded by cartilage, muscles, and ligaments,
your hip is one of your largest weight bearing joints in your body.
Smooth cartilage and bone help you walk easily and without pain.
In a healthy hip (shown below), smooth cartilage covers the ends
of your hip bones allowing the ball to glide easily in the socket.
Smooth weight bearing surfaces allow for painless movement.
A
HEALTHY HIP
In
a problem hip (shown below), the cartilage wears away and the bones
rub together, becoming rough and pitted. The ball grinds in the
socket when you walk, resulting in pain and stiffness.
A
PROBLEM HIP
Your
damaged hip joint can be replaced with new, smoothly surfaced components
(shown below). A ball will replace the worn head of your thigh bone,
with a stem inserted into the bone for stability. A cup will replace
the worn socket. Like a healthy hip, your prosthesis has a smooth
gliding surface that will allow you to move with ease and without
pain. Unlike your healthy hip, however, your prosthesis has a limited
range of motion, and will need your special care after surgery.
A
HIP PROSTHESIS
When
is Total Hip Replacement needed? top of page
A painful, stiff, hip can keep you from doing the things you enjoy
in life, and your decision to replace your knee is your first step
toward regaining control of your life. Technical advances have given
us new materials to replace your problem hip with a prosthesis.
Therefore, when lesser methods are no longer able to control the
pain and disability to your satisfaction, hip replacement becomes
a reasonable option.
Hip replacement is usually performed to treat severe arthritic conditions.
The operation is sometimes performed for other problems such as
hip fractures or aseptic necrosis. Most patients who have artificial
hips are over the age of 55, but the operation is occasionally performed
on younger patents as well. Circumstances vary, but generally patients
are considered for hip replacements if:
1) Pain is severe enough to restrict work, recreation, and the ordinary
daily activities.
2)
Pain is not relieved by anti-inflammatory medicine, the use of a
cane, and other restricting devices.
3)
There is a significant stiffness of the hip.
4)
X-rays show advanced arthritis or other hip problems.
Hip replacement is an elective operation and there are always non-operative
alternatives. The decision to have the operation is not made by
your doctor, but by yourself. The doctor may recommend the operation;
however, your decision must be based upon weighing the benefits
of the operation against the risks. You may wish to discuss the
surgery with your own doctor or even get another opinion so all
your questions are answered before you decide to have the operation.
Commonly Asked Questions Regarding Hip Replacement top of page
Having concerns about hip replacement surgery is normal, and it
may be helpful and assuring if one knows what to expect after surgery.
Some of the commonly asked questions are discussed below.
1) Will the pain I had prior to surgery diminish?
As you recover your pain should lesson. Your prosthesis should relieve
the pain and stiffness you had prior to surgery. It is important
to note that medication and gentle exercise can help reduce the
pain from your operation.
2)
When will I be able to go home again?
Your health care team will assess your condition and will determine
when the best time for you to return home is. When you are ready
to leave, the health care team will help you make the transition
from the hospital to your home.
3)
Will my new hip be as good as normal healthy hip?
Your new hip will almost be as good as a healthy hip. Unlike a healthy
hip, your prosthesis will have a limited range of safe motion and
you will have to move a little differently from the ways you moved
before surgery. After some time, this movement becomes natural and
your replaced hip will seem to be as good as a normal hip.
4)
Will I be able to do the things I enjoy again?
As your hip heals and grows stronger, you will become more active.
Eventually, you'll be able to enjoy your favorite activities.
5)
When will I walk again?
You can expect to walk within a couple of days after surgery with
the help of your physical therapist and an assistive device such
as a walker or cane. By the time you leave the hospital, you will
be walking on your own using a walker, crutches, or cane.
6)
Will I regain my independence?
You should be able to manage most or all of your activity by yourself.
depending on how well you heal and how regularly you exercise.
Preparing for Hip Replacement Surgery top of page
Before
surgery, you may need a general physical exam by your regular doctor.
In addition to following your doctor"s instructions, there are several
things you can do to prepare yourself for surgery. You may be asked
to lose extra weight, since extra weight will put more stress on
your new hip. You may be asked to avoid aspirin for two weeks before
surgery to minimize bleeding. You may also be asked to stop smoking
to help decrease the chance of post-operative lung complications.
You should also finish any dental work that may be needed to prevent
germs in your mouth from entering the bloodstream and infecting
the joint. It is also important for you to know that if you are
having dental work (after you have received your prosthesis) that
you inform your dentist about your joint replacement. He or she
may want to put you on an antibiotic to prevent the possibility
of an infection to your new joint. Also, if you develop an infection
such as respiratory or bladder infection, you should notify your
physician for the same reason.
A blood transfusion is often necessary after a hip surgery. You
may wish to donate several pints of blood prior to surgery. Then
if you require a transfusion you will receive your own blood. It
is important to note that when donating blood you must be healthy,
with no cold or flu, as you would get this same illness when your
blood is transferred at the time of surgery.
When making preparation for surgery, you should begin thinking about
your recovery following surgery. A patient with a new hip replacement
may need help at home for the first few weeks to assist with dressing,
getting meals, and other essential tasks. Therefore, you should
look into possibly finding somebody to help assist you or making
arrangements to stay a few weeks in an extended care facility.
To prevent blood clotting you may be fitted with elastic supported
stockings. You should wear them on both legs to the hospital the
morning of your surgery. These stockings will aid in the circulation
of your legs and feet to reduce the risk of blood clots. You will
also be asked to shower the day before and the day of the surgery.
You will be instructed to perform a 5 minutes scrub to the surgical
area using a provided antiseptic brush. The brushes contain a special
soap that will reduce the risk of infection so if you are allergic
to Iodine or soap please notify the nurse or your doctor as soon
as possible.
Finally, you may be instructed in deep breathing exercise to minimize
the risk of lung complications after surgery. These exercises are
necessary to remove any secretions that may settle in your lungs
while you are asleep during surgery. These exercises should be done
every one or two hours after surgery.
The Surgical Procedure top of page
Hip replacement is one of the most common forms of
total joint replacements. To begin the surgical procedure, the patient
will be given an anesthetic (usually a spinal unless contraindicated).
The surgeon will then make an incision and prepare the hip bone
for implantation of the prostheses. The surgeon will remove the
rough surfaces of the bone at the joint and replace them with new
smoothly surfaced implants.
Like the human hip, this artificial joint is composed
of three components that fit together to form a ball and socket
joint. The components of the prosthesis are the ball, stem, and
cup. The ball will replace the worn upper end of the femur, while
the cup will replace the worn socket in the pelvis. The stem will
be inserted into the bone for stability. These components are implanted
separately and then brought together. In some cases, the incision
is closed after a small tube (called a hemovac) is inserted to help
drain fluids from the hip joint area for the first day or so following
surgery.
The surgical technique for the total hip replacement
is discussed in greater detail in the section labeled Surgical Techniques.
Complications of Hip Replacement Surgery top of page
Most complications that occur after hip replacement are successfully treatable. Possible complications after knee replacement include:
Infections:
Any infection in your body can spread to your joint replacement. Infections may occur while you are in the hospital or after you go home. Minor infections can be treated with antibiotics, while major infections may require surgery and removal of the prosthesis.
Blood Clots:
If there is a severe pain and / or swelling that develops in your calf or thigh, you may have developed a blood clot. Blood clots result from several factors, including decreased mobility that causes a slow movement of the blood through your leg's veins. Your doctor may take preventative action to reduce the possibility of blood clots, such as blood thinning medications, elastic stockings, exercises that increase the blood flow in the leg muscles, or plastic boots that inflate with air to compress the muscles in your legs.
Loosening:
Loosening of the prosthesis within the bone may occur after knee replacement. If the loosening is significant and there is a large amount of pain, a revision surgery to correct the loosening may be necessary.
Dislocation:
Occasionally, after total hip replacement, the ball can be dislodged from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs.
Wear:
Wear can be found in several joint replacements. Excessive wear can lead to loosening and pain and may require revision surgery.
Prosthetic Breakage:
Breakage of a knee replacement is extremely rare, but it can occur. If this case does occur, a revision surgery will be needed.
Nerve Injury:
Nerves in the vicinity of the total joint replacement can be damaged during the total replacement surgery. This type of injury is not common and may often improve and/or completely recover after some time.
Notify your surgeon or nurse if you experience any of the following symptoms:
1) Pain, soreness, swelling, or redness in the calf muscles of either leg.
2) Unexplained, increased pain in the operative area.
3) Redness, swelling, or puslike drainage from the area around the incision
4) Cough, high fever, or chills.
5) Chest pain, shortness of breath, or difficulty breathing.
What to Expect After Hip Replacement Surgery top of page
After
surgery, you will be taken to the Recovery Room for a period of
close observation. Your blood pressure, pulse, and temperature will
be monitored and close attention will be paid to the circulation
and sensation in your legs and feet. Post operatively, you may have
temporary nausea and vomiting due to anesthesia or medications.
(Anti-nausea medication may be given to you when you are in your
room to minimize nausea and vomiting.) It is also important to tell
your nurse if you experience any numbness, tingling, or extreme
pain in your legs or feet. When your condition is stabilized, you
will be transferred to your hospital room.
A tube (called a hemovac) that may have been placed in you during
surgery will drain excess fluid to keep swelling down, while an
intravenous (IV) line may be used to provide fluids for nourishment,
medication to prevent blood clots, and antibiotics to prevent possible
infection. You may also have a catheter placed to aid in urination.
To relieve pain, you can be attached to a special device that will
allow you to get pain medication when you feel it is necessary.
Despite the back discomfort that some patients experience after
surgery (caused by the soreness of the hip area and prolonged lack
of movement), you must remember a few precautions to prevent dislocations:
1)
The head of your hospital bed should not be elevated more than 70
degrees during the first few days after surgery.
2)
Use a high-rise toilet.
3)
Use 2-3 pillows between your legs.
4)
Do not cross your legs or bend them forward 90 degrees.
At first, you will be restricted to ice chips and clear liquids,
but your diet will be allowed to progress as your condition permits.
Meanwhile, the surgeon and physical therapist will work together
to set movement guidelines for you. The physical therapist will
continue to check the strength and flexibility in your leg and hip,
and your ability to stand and sit. The physical therapist may also
recommend some gentle exercises that will help strengthen and increase
your new hip's range of motion.
After total hip replacement surgery, it takes only a few months
to regain strength and confidence in your new hip. With the help
of your orthopedist and physical therapist, activities that you
were not able to do before surgery can be enjoyable again.
Hospital Recovery and Rehabilitation After Hip Replacement top of page
Exercises
will begin as soon as possible to help strengthen your leg muscles
and increase your ability to bend your knee. Your balance may seem
unsteady at first, but will improve as you progress with walking.
During your recovery period in the hospital, your recovery team's
goals are to minimize any swelling or pain caused by the surgery,
and to start your gentle physical therapy exercises. Your physical
therapist will initially teach you exercises that will increase
your circulation and will then continue to teach you exercises that
will improve your strength and increase your endurance so you can
recover more quickly. Your therapist will finally teach you how
to properly get out of bed, stand, sit, and walk, so you will be
able to do these activities safely on your own.
Below is a list of common exercises, but it is important that you
follow what your physical therapist and doctor feels is right for
you.
EXERCISES FOR INCREASING CIRCULATION AND STRENGTHENING MUSCLES
Exercise
both legs everyday or as advised by your physical therapist. To
reduce pain and to keep your muscles relaxed, breathe in as you
tighten the muscles, and out as you relax them. Breathe normally
while you hold a position.
Calf muscles: Using your ankles to flex, bend your feet toward you
and then point them away from you.
Thigh
muscles: Press the backs of your knees into the bed by tightening
the front of your thighs. Hold for 5 seconds and relax.
Buttocks:
Squeeze your buttocks together causing your hips to be lifted slightly
off the bed. Hold for 5 seconds, then release.
Hip:
use a towel or sling to pull your leg toward you a few inches, sliding
your foot along the bed. Slide your foot back down to the starting
point.
EXERCISES FOR BUILDING STRENGTH
Simple
exercises can speed your recovery and help you walk unaided sooner.
When exercising be sure to hold on to a firm surface.
Knee Raises: Bend your operated led toward your chest creating an
angle no greater than 90 degrees. Out your leg down and repeat motion.
Leg
to the Side: Slowly bring your leg out to the side. Be sure your
hip, knee, and foot are pointing forward. Keeping the same posture,
slowly return your leg to its original position.
Leg
to the back: Move your leg backward placing one hand on your lower
back to make sure your back is not arching. Return to your original
position.
Your Home Recovery After Hip Replacement top of page
Before
hip replacement surgery, the patient's problem hip probably kept
them from doing many activities. The decision to replace a painful
hip is the first step toward regaining control of your life. The
next step is to strengthen the replacement hip so one can return
to an independent and active lifestyle. Every patient will have
a different recovery program and your doctor can give you a list
of home exercises that will concentrate on your range of motion
and increase your flexibility by keeping your thigh muscles stretched
and your new hip joint flexed.
Once you are out of the hospital and in your own familiar setting,
it is easy to return to old habits. You must continue to follow
your doctor's instructions and keep up with the recommended exercises.
It is also important that you use handrails on stairs and wear low
-heeled shoes. At your home, you may be used to bending or standing
up from a chair quickly. But because of your new hip, you won't
be able to move as spontaneously as you used to be. To avoid injuries
always think before you move and become more aware of hazards in
your home.
Even
though your home setting is different from the hospital, use the
same technique and precautions that you learned at the hospital.
Your bed in your home, for example, may be lower than the hospital
bed. Get in and out of the bed the same way you did in the hospital,
adjusting your movements to accommodate the height. You may also
want to have your living space rearranged and / or cleared to avoid
falls and to make it easier to get around.
During the first few months following surgery, it is possible to
dislocates your new hip, unless you follow the following precautions:
1)
Avoid crossing or turning your operated leg outward whether sitting,
standing, or lying.
2)
Avoid bending the hip forward less than a 90-degree angle.
3)
Avoid excessive bending over at the waist. If necessary use a long-handled
shoehorn and sock aid to help you put on and take off shoes
and socks. A reacher can help you grab objects that are too
high or too low for you to reach.
The key to a full recovery and becoming independent is to stick
with your recovery program and work at is consistently. Whatever
your goals are, you can reach them by mastering one step at a time.
Make a commitment to going a little further with each new step you
take!
Caring for and Keeping Your Hip Healthy top of page
Your
hip prosthesis is the result of years of research. But like any
other device, your new hip's lifespan depends on how you care for
it. In your follow-up visits after surgery, your doctor will follow
your progress and answer any questions that you may have about caring
for your new hip. It is important that you follow these directions
that your doctor advises you to follow. It is also a good idea to
keep the telephone numbers of your surgeon and therapist handy so
you will have them if you need them.
You can keep your hip healthy by knowing the right moves and avoiding
the wrong ones. Some activities could harm your artificial hip and
may be permanently restricted. Below is a list of do's and don'ts:
DO
1) Do grasp chair arms to help you rise safely to standing position.
2)
Do get up from the toilet as directed by your therapist.
3) Do use a long handled reacher to pull up sheets of blankets
or do so as directed by therapist.
4)
Do keep a pillow between your legs when you roll onto your "good"
side. This is to keep your operated leg from crossing the midline.
DON'T
1) Do not move your operated hip toward your chest any more than
a 90 degree angle.
2)
Do not sit on chairs without arms.
3)
Do not turn your knee cap inward when sitting, standing, or lying
down.
4)
Do not cross your operated leg across the midline of your body (in
towards your other leg).
5)
Do not lie without pillow between legs.
Hip Replacement
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