About Total Hip Replacement

If hip pain limits your ability to walk, work or perform simple activities and less invasive procedures (such as medication, physical therapy, and injections) have failed, then total hip replacement might be right for you. Hip replacement surgery removes the parts of the hip that are causing you pain and replaces them with artificial parts. This procedure aims to make it less painful to move the hip, improve its function and improve your quality of life.

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Hip Replacement Surgery

What is hip replacement surgery?

Hip replacement (total hip arthroplasty) is surgery to replace a worn out or damaged hip joint. The surgeon replaces the old joint with an artificial joint (prosthesis). This surgery may be a choice after a hip fracture or for severe pain because of arthritis.

Various types of arthritis may affect the hip joint:

  • Osteoarthritis. This is a degenerative joint disease that affects mostly middle-aged and older adults. It may cause the breakdown of joint cartilage and adjacent bone in the hips.
  • Rheumatoid arthritis. This type of arthritis causes inflammation of the synovial lining of the joint. It causes extra synovial fluid. It may lead to severe pain and stiffness.
  • Traumatic arthritis. This is arthritis is caused by an injury. It may also damage the hip cartilage.

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The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged. It also helps relieve hip pain that can’t be controlled by other treatments.

A traditional hip replacement involves an incision several inches long over the hip joint. A newer approach uses 1 or 2 smaller incisions to do the surgery. This is called minimally invasive hip replacement. But the minimally invasive procedure is not suited for all people who need hip replacement. Your healthcare provider will figure out the best procedure for you.

Why might I need hip replacement surgery?

Hip replacement surgery is a treatment for pain and disability in the hip. Osteoarthritis is the most common reason for hip replacement surgery.

Osteoarthritis causes loss of joint cartilage in the hip. Damage to the cartilage and bones limits movement and may cause pain. People with severe pain from degenerative joint disease may not be able to do normal activities that involve bending at the hip. These activities include walking and sitting.

Other forms of arthritis such as rheumatoid arthritis and arthritis that results from a hip injury can also damage the hip joint.

Hip replacement may also be used to treat certain hip fractures. A fracture is an injury often from a fall. Pain from a fracture is severe. Walking or even moving the leg causes pain.

If other medical treatments don't control your arthritis pain, your healthcare provider may recommend a hip replacement. Some medical treatments for degenerative joint disease may include:

  • Anti-inflammatory medicines
  • Glucosamine and chondroitin sulfate
  • Pain medicines
  • Limiting activities that are painful
  • Assistive devices for walking such as a cane
  • Physical therapy

Your healthcare provider may have other reasons to recommend a hip replacement surgery.

What are the risks of hip replacement surgery?

Any surgery can have complications. Some possible complications may include:

  • Bleeding
  • Infection
  • Blood clots in the legs or lungs
  • Dislocation
  • Need for revision or additional hip surgery
  • Nerve injury that causes weakness, numbness, or both

You may have other risks depending on your specific health condition. Discuss any concerns with your healthcare provider before the surgery.

How do I get ready for hip replacement surgery?

  • Your healthcare provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete health history, your healthcare provider may do a physical exam to make sure that you are in good health before having the surgery. You may have blood tests or other diagnostic tests.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia (both local and general).
  • Tell your healthcare provider about all medicines you are taking. This include prescription and over-the-counter medicines, and herbal supplements.
  • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinners (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the surgery.
  • Tell your healthcare provider if you are pregnant or think you may be pregnant.
  • You will be asked to fast for 8 hours before the surgery. This usually means after midnight.
  • You may get medicine (sedative) before the surgery to help you relax.
  • You may meet with a physical therapist before your surgery to talk about rehabilitation.
  • If you smoke, stop before your surgery. Smoking can delay wound healing and slow down the recovery period.
  • Lose weight if you need to.
  • Do conditioning exercises as prescribed to strengthen muscles.
  • Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
  • Based on your health condition, your healthcare provider may order other specific tests or exams.

What happens during hip replacement surgery?

Hip replacement usually requires a stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Hip replacement surgery is done while you are asleep under general anesthesia or sedated under spinal anesthesia. Your anesthesiologist will discuss this with you before the surgery.

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Generally, hip replacement surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An IV (intravenous) line may be started in your arm or hand.
  3. You will be positioned on the operating table.
  4. A urinary catheter may be inserted after you are asleep.
  5. The anesthesiologist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  6. The skin over the surgical site will be cleaned with an antiseptic solution.
  7. The healthcare provider will make an incision in the hip area.
  8. The healthcare provider will remove the damaged parts of the hip joint and replace them with the prosthesis. The hip prosthesis is made up of a stem that goes into the thighbone (femur), the head joint (ball) that fits into the stem, and a cup that is inserted into the socket of the hip joint. The stem and cup are made of metal. The ball may be made of metal or ceramic. The cup has a liner that may be made of plastic or ceramic. The 2 most common types of artificial hip prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface. The bone grows onto this surface to attach to the prosthesis. Sometimes a combination of the 2 types is used to replace a hip.
  9. The incision will be closed with stitches or surgical staples.
  10. A drain may be placed in the incision site to remove fluid.
  11. A sterile bandage or dressing will be put on the site.

What happens after hip replacement surgery?

In the hospital

After the surgery you will be taken to the recovery room to be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Hip replacement surgery usually requires you to stay in the hospital for several days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise rehabilitation program for you. Your pain will be controlled with medicine so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your healthcare provider will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

At home

Once you are home, it is important to keep the surgical area clean and dry. Your healthcare provider will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

Call 911

Call 911 right away if you have any of the following:

  • Chest pain
  • Shortness of breath

When to call your doctor 

Call your doctor right away if you have any of the following:

  • Hip pain gets worse
  • Pain or swelling in your calf or leg not related to your incision
  • Tenderness or redness in your calf
  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
  • Shaking chills
  • Swelling or redness at the incision site gets worse
  • Fluid draining from the incision
You may go back to your normal diet unless your healthcare provider tells you differently.

Don't drive until your healthcare provider tells you to. You may need to limit other activities. Full recovery from the surgery may take several months.

It is important that you don't fall after your hip replacement surgery. A fall can damage the new joint. Your therapist may recommend an assistive device such as a cane or walker to help you walk until your strength and balance improve.

Making certain changes to your home may help you during your recovery. These changes include:

  • Proper handrails along all stairs
  • Safety handrails in the shower or bath
  • Shower bench or chair
  • Raised toilet seat
  • Stable chair with firm seat cushion and firm back with two arms. This will let your knees to be lower than your hips.
  • Long-handled sponge and shower hose
  • Dressing stick
  • Sock aid
  • Long-handled shoe horn
  • Reaching stick to grab objects
  • Firm pillows to raise your hips above your knees when sitting
Remove loose carpets and electrical cords that may cause you to trip. Your healthcare provider may give you other instructions after the surgery, depending on you need.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure
total hip replacement total hip replacement

Frequently Asked Questions

What is a joint replacement made of?

A replacement joint is a manufactured prosthesis made of titanium, chrome cobalt and polyethylene to replace an arthritic hip, knee and sometimes the ankle, shoulder, elbow or wrist.

Who needs a total joint replacement?

Someone who has moderate to severe arthritis, significant limits on normal daily activity, and severe pain they can no longer live with.

How do I know if I need surgery?

As a patient you may want to choose surgery if you have pain that is not managed by anti-inflammatories (NSAIDS) and your daily activities are limited by this pain to the extent that you cannot do what you would like to do; for example, you cannot go grocery shopping without severe pain in the involved joint.

Why have a total joint replacement?

A total joint replacement will allow you to return to more normal activities and relieve your pain (95% success rate).

What does the surgery involve?

For total hip arthroplasty, the femoral head is removed, the canal in the middle of the femur is shaped to accept the stem and the acetabulum (socket in the pelvis) is shaped to accept the cup. A liner is inserted into the cup and a head onto the stem.

Will I need a blood transfusion?

You may; though, we no longer need you to donate your own blood in advance.

How long will I be in the hospital?

In general, for an uncomplicated total knee or hip, the hospital stay is about one to three days after surgery.

What therapy will I have to do?

Starting the afternoon after surgery you will have physical therapy and after that twice a day, which includes exercises, learning to sit, stand and walk with your new total joint. Patients usually take a few steps the first day, then walk around their room and so on. After you leave the hospital, you will have a list of the exercises you have learned to continue yourself at home. Many patients will receive physical therapy at home.

What are the major risks to the surgery?

The major risks include the following:

Blood clot: We do reduce risk of this by using blood thinners (Enoxaparin, Aspirin or Coumadin), T.E.D. hose (compressive stockings) and compression boots on your feet to increase circulation.

Infection: You are given IV antibiotics before and after surgery.

Nerve, blood vessel damage: Because specialists performing this replacement work close to important vessels and nerves, they take great care not to injure these structures.

Total hip arthroplasty (THA) dislocation: As a patient you can avoid this by following total hip precautions. Complications with existing or new medical problems.

What if I get an infection?

Infection is very rare, but a diffcult complication. Read more about joint infection after replacement.

What are total hip precautions, and how long do I have to follow them?

Avoid internal and external rotation of the operated hip. Keep knees and toes straight ahead. Avoid flexing hip past 90% (for six weeks), though it’s best to follow precautions for life. Please no excessive stretching/yoga. Your THA could dislocate anytime even 10–20 years after surgery.

What happens when I leave the hospital?

You will usually need 24-hour help for a week. If you don't have adequate help at home, you should consider a rehab facility or extended care facility. You can check with your insurance to see who is approved, but the final plans will be made with our case management team while you are in the hospital.

What do I do at home while recovering?

Recovery will involve the following:

First four to six weeks: Do your physical therapy exercises; keep the wound clean: no ointments or lotion on the wound; wear your T.E.D. hose for those four weeks; take blood thinners (Coumadin managed by the anti-coagulation service); walk as tolerated with crutches/walker; transition to a single crutch/cane as tolerated.

After six weeks: Continue exercises and walk or ride a stationary bicycle; use a crutch/cane until walking without a limp; return to work part time or full time as tolerated (as early as four to six weeks from surgery). You may return to full activity when ready except for running/jumping activities; kneeling on a TKA may be difficult but won’t damage it.

The best lifelong activities at this point are walking, swimming and biking.

How long do I take narcotics?

Only as long as you need them, but usually about 5–14 days from the day of surgery; then Tylenol will usually handle the pain.

When can I drive?

Usually three to four weeks after surgery (make sure you have control of your leg, you have no spasms, you are off pain medication and use caution.)

When do I see my surgeon after surgery?

Two weeks after your surgery, your surgeon will remove your staples. You will also be seen six weeks after surgery, six months, one year and two years for the rest of your life. X-rays will be obtained at six weeks and yearly. (Even if you live out of town, we like to see copies.)

Who do I call if I'm having problems after surgery?

Please call the nurse/MA who works with your surgeon, and your post-operative instructions will give you a phone number to use. If you feel like it is an emergency, please call the clinic immediately or the University Hospital operator to have the orthopedic resident on call paged at the following number:

1-801-581-2121

If it is after 5 p.m., go to your nearest emergency department.

How long do total joints last? Will I need another surgery?

Today, total joints last 15–20 years depending on the amount of activity (demand) and your general health. You may need another surgery depending on how old you are and how much wear and tear you put on your total joint.

What lifelong activities can I do or not do?

We advise patients to resume just about everything, especially walking, swimming and bicycle riding. We discourage repetitive jumping and running, yoga or excessive stretching.

Why do I have to have x-rays every two years?

When a total joint starts to wear out, we can often see changes on the x-ray before you feel symptoms. If we x-ray your joint every two years, we can better determine the need and time for another operation.

Why do total joints wear out?

The metal components of total joints can loosen over time, but often the cause of wear is from the bearing surface. Your immune system attacks the particles from the bearing surface but also melts bone away. Now we are using a metal liner (metal-on-metal), ceramic-on-ceramic and cross-linked polyethylene liners that wear less than what we had years ago.

Why should I take prophylactic antibiotics for the rest of my life?

You should take prophylactic antibiotics because total joints are made of metal and are at risk for infection when bacteria circulate through your bloodstream. If your joint becomes infected, it requires more than two additional surgeries. Therefore, take antibiotics with any bacterial infection as prescribed by your family practitioner. We strongly recommend that you take antibiotics for all dental and invasive procedures for the rest of your life.

Jill A. Erickson, PA-C

Patient Rating:

4.7

4.7 out of 5

Jill Erickson has worked with our Adult Reconstruction Surgeons since 1999, and with Christopher Peters, M.D. exclusively since 2003, with Joint Replacements as well as Hip Preservation procedures. She is an integral member of our University of Utah Center for Hip & Knee Reconstruction team and coordinates our research, surgical and clinical ou... Read More

Jeremy M. Gililland, M.D.

Patient Rating:

4.8

4.8 out of 5

Dr. Gililland specializes in adult reconstructive orthopedic surgery of the hip and knee. He performs routine and complex primary and revision joint replacement operations. Additionally, his focuses include partial knee replacement and direct anterior total hip arthroplasty. He considers himself very fortunate to have a profession that he is passi... Read More

Christopher E. Pelt, M.D.

Patient Rating:

4.8

4.8 out of 5

Dr. Pelt specializes in hip replacement and revision, and knee replacement and revision. Minimally invasive joint replacement, partial knee replacement (unicompartmental, patellofemoral), cruciate preserving knee replacement, and direct anterior hip replacement are all aspects of his practice. Dr. Pelt is an Assistant Professor in the Department o... Read More

Specialties:

Adult Reconstruction, Direct Anterior Hip Replacement, Hip Dysplasia, Hip Instability, Hip Replacement, Hip Revision, Joint Infection, Joint Replacement, Knee Replacement, Knee Revision, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Oxford Partial Knee Replacement, Patello-Femoral Arthroplasty (PFA), Uni-Compartmental Knee Arthroplasty, Unicompartmental Knee Replacement

Locations:

University Orthopaedic Center (801) 587-7109

Christopher L. Peters, M.D.

Patient Rating:

4.7

4.7 out of 5

Dr. Chris Peters, Professor, specializes in adult reconstructive orthopaedic surgery of the hip and knee. He performs routine and complex joint replacements and bioregenerative hip preserving operations. One of his specialties includes the treatment of hip pain in young adults from acetabular dysplasia and/or femoro-acetabular impingement with pelv... Read More

University Orthopaedic Center 590 Wakara Way
Salt Lake City, UT 84108
Map
801-587-7109
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