Hip Replacement
Orthopaedic Faculty with this Specialization
Harold K. Dunn, M.D.
Christopher L. Peters, M.D.
Aaron A. Hofmann, M.D.
Q) What is total joint replacement/arthroplasty?
A) A manufactured prosthesis made of titanium, chrome cobalt and polyethylene to replace an arthritic hip, knee, and sometimes the ankle, shoulder, elbow or wrist.
Q) Who needs a total joint?
A) Someone who has moderate to severe arthritis, significant limits on normal daily activity, and severe pain they can no longer live with.
Q) How do I know if I need surgery?
A) Pain that is not managed by anti-inflammatories (NSAIDS). Limited daily activities to the extent that you cannot do what you would like to do. For Example: cannot go grocery shopping without severe pain in the involved joint.
Q) Why have a total joint?
A) So you can return to more normal activities and relieve your pain (95% successful).
Q) What does the surgery involve?
A) Total knee arthroplasty (TKA): Small slices of bone are removed from the ends of the bone, capped with metal components and then a polyethylene (plastic) liner is locked in between the metal components. Total hip arthroplasty (THA): The femoral head is removed, the canal in the middle of the femur is shaped to accept the stem, 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.
Q) Will I need a blood transfusion?
A) You may. Most total knees don't need a transfusion. But occasionally total hips do. Your surgeon will advise you prior to surgery if you need to donate your own blood in advance.
Q) How long will I be in the hospital?
A) In general, for an uncomplicated total knee or hip, the hospital stay is about 1-3 days after surgery.
Q) What therapy do I have to do?
A) Starting the afternoon after surgery you will have Physical Therapy and twice a day after that, which includes exercises, learning to sit, stand and walk with your new total joint. Patients usually take a few steps the first day, then walking around your 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.
Q) What are the major risks to the surgery?
A)
- Blood clot: we 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: we work close to important vessels and nerves, care is taken not to injure these structures.
- THA dislocation: avoid by following total hip precautions.
- Medical complications with existing or new medical problems.
- Total Joint Surgery is a major surgery that carries with it all the major risks of surgery, including but not limited to: infection, bleeding, ulcer, blood clot, pulmonary embolus, nerve injury, joint stiffness, continued pain, failure of fixation, heart attack, stroke, and death. By signing the consent for surgery you are aware that these complications could occur.
Q What are total hip precautions and how long do I have to follow them?
A) Avoid internal and external rotation of the operated hip - keep knees and toes straight ahead. Avoid flexing hip past ninety degrees (for 3 months). It's best to follow precautions for life. Please no excessive stretching/yoga. Your THA could dislocate anytime even 10-20 years after surgery.
Q) What happens when I leave the hospital?
A) If you have family at home - you will usually need 24 hour help for a week.
OR
If you don't have adequate help at home, we would 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're in the hospital.
Q) What do I do at home while recovering?
A)
- First 4-6 weeks: Do your Physical Therapy exercises;
- Keep the wound clean, no ointments or lotion on the wound;
- Wear your T.E.D. hose x 4 weeks
- Take blood thinners (Aspirin 325mg daily x 6 weeks, or finish Coumadin)
- Walk as tolerated with crutches/walker;
THA & TKA: transition to a single crutch/cane as tolerated.
- After 6 weeks: Continue exercises; walk, stationary bicycle;
- Use a crutch/cane until walking without a limp.
- Return to work part time or full time as tolerated (as early as 4-6 weeks from surgery).
- You may return to full activity after 3 months except for running/jumping activities, kneeling on a TKA may be difficult.
- The best lifelong activities are walking, swimming, biking.
Q) How long do I take narcotics?
A) 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.
Q) When can I drive?
A) Usually 3-4 weeks after surgery (use caution).
Q) When do I see my surgeon after surgery?
A) Staples will be removed 10-14 days from surgery. You will also be seen 6 weeks after surgery, 3 months, 6 months, 1 year and every year or two for the rest of your life. X-rays will be obtained at 6 weeks, and yearly (even if you live out of town we like to see copies).
Q) Who do I call if I'm having problems after surgery?
A) 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 its an emergency, please call immediately and go to your nearest emergency department.
Q) How long do total joints last? Will I need another surgery?
A) 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.
Q) What lifelong activities can I do or not do?
A) We advise patients to resume just about everything, especially walking, swimming and bicycle riding. We discourage repetitive jumping and running, yoga, or excessive stretching.
Q) Why do I have to have x-rays every 1-2 years?
A) Because when a total joint starts to wear out we can often see changes on the x-ray before you feel symptoms. We can better determine the need and time for revision.
Q) Why do total joints wear out?
A) The metal components 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. We are starting to use a metal liner (metal-on-metal), ceramic-on-ceramic and new cross-linked polyethylene liners that wear less than what we had years ago.
Q) Why should I take prophylactic antibiotics for the rest of my life?
A) Because total joints are made of metal and are at risk for infection when bacteria circulates through your bloodstream. If your joint becomes infected it requires 1-2 more surgeries. Therefore, take antibiotics with any bacterial infection as prescribed by your family MD. We strongly recommend that you take antibiotics before and after all dental and invasive procedures for the rest of your life.
The information provided may be useful for patients to become more knowledgeable about their specific injury, surgery or condition. It is provided for informational purposes only, and does not replace the advice of a physician.
