Hip pain from arthritis or other conditions that damage the surface of the joint can lead to life altering pain. When one’s quality of life and daily function are affected despite conservative treatments like over the counter medications and activity changes, hip replacement surgery can provide long lasting pain relief and a return to an active lifestyle.
Why does Osteoarthritis cause pain?
Osteoarthritis is the most common reason for needing hip replacement surgery. This particular type of arthritis results from gradual wear-and-tear that can happen over many years and can even have a strong genetic component.
The articular cartilage is a healthy and slippery protective coating that protects the bone ends. As this protective coating wears thinner, the exposed bone beneath can rub together leading to inflammation and pain. As the cartilage continues to get thinner and disappear, the joint damage increases, the pain worsens, and the joint stiffens. This often leads to what is called bone-on-bone arthritis.
Because your hips are supporting at least some of your weight all the time, these large joints get very little rest. If you develop osteoarthritis in your hips, anything that requires hip movement – including standing, walking, and dressing – becomes increasingly challenging. This pain is most often in the groin area, but can also be felt in the buttock and down the thigh into the knee.
While conservative treatments like physical therapy, medication, and injectables can help for a while, eventually, the joint deterioration is so great that the only way to find relief from your symptoms is with hip replacement surgery.
What techniques are used in hip replacement surgery?
There are several different ways of performing hip replacement surgery:
Posterior approach
The posterior approach is where your surgeon makes an incision through the muscles in your buttock to reach your hip joint. This is a very common approach with a proven track record of excellent results on both primary and revision hip replacements.
Anterolateral approach
The anterolateral approach is where your surgeon accesses your hip through the side of your body. This approach avoids the dissection of posterior structures. It can be used for primary and revision hip replacements.
Anterior approach
Using the anterior approach, Dr. Morrison accesses your hip through the front of your leg. Often a special table is used to facilitate the procedure and live x-ray and computer navigation are used to ensure appropriate component size and position. The surgical approach goes between muscles rather than through muscles.
Dr. Morrison will evaluate which approach best suits your needs to optimize your results. The anterior approach is his preferred technique in over 95% of patients.
Same-day or outpatient surgery is standard for patients who have hip replacement surgery, and the team offers multimodal pain management to keep you comfortable and help you get moving again.
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 and/or cane for two to four weeks after your operation. Your physical therapist will guide you through this progression. You will gradually return to normal function without any assistive devices. In four to six weeks you will begin low impact aerobic exercise and should be very functional in day to day activities. It is common to feel tired earlier in the day for up to three months after surgery. At this time, a patient can engage in more strenuous physical exercise including weight lifting with the operative leg. Your new joint and surrounding tissues will continue to heal even up to a year after your procedure.
What are the dislocation precautions for my hip (positions I should avoid)?
Anterior Hip Precautions for 6 weeks
No attempting lunge position. (Hip extension with weight bearing).
Posterior Hip Precautions for 6 weeks
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.
Can I sleep on my side?
For patients with an anterior (front) incision You may sleep on your operative side whenever you feel comfortable. For patient with a posterior (back) approach you should wait two weeks to sleep on your operative side.
How long do I need to keep a bandage on my incision?
Waterproof bandage should be worn for 7 days after your surgical procedure. Your therapist will remove the waterproof bandage after 7 days post-op. You will have dermabond (skin glue) over the incision. You may continue to shower as normal without a bandage as long as there is no drainage from the incision.
When can I shower (get the incision wet)?
You may shower as soon as returning home as long as the waterproof bandage is in place for the first 7 days. After waterproof bandage is removed, continue to shower as normal.
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 or bath tub for six weeks. However, in some circumstances we will allow patients to do so after four weeks if there is no drainage. Check with your therapist and surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication including Tylenol and an anti-inflammatory medication (e.g. Meloxicam or Celebrex) for 6 weeks. Some patients also require a stronger pain medication (narcotic or opioid) for a shorter time period after surgery. Ice, rest, and elevation also play an important part in managing pain and swelling.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist the day of your surgery. If you are unable to go home the day of surgery, the physical therapist will see you during your hospital stay. Over 95% of patients go to outpatient physical therapy starting one week after surgery for a period of 4-6 weeks. The therapist should follow the protocol that has been issued to you on your pre-op visit and/or discharge from the hospital. Your therapist will keep your surgeon informed of your progress.
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 from arthritis and muscle contractions. Your surgeon has restored the natural height of your hip during the surgery. In the operating room, leg lengths are assessed very carefully. Using technology, including live x-ray and computer navigation, 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 anyone measures or 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.
How long will I be on a blood thinner?
Typically, you will be on baby Aspirin as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a stronger blood thinner after your surgery depending on your medical history and risk of blood clots. You will normally need to be on a blood thinner for six weeks. This will be decided prior to your discharge from the hospital. This will all be discussed with you at your pre-op appointment.
When can I drive?
Once you are strong enough to walk without a walker and are completely off narcotic medication you can drive. This is typically 2-3 weeks after surgery.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately two to four weeks. If your work requires prolonged standing, walking, or travel you may need 6 weeks off. If your work is more rigorous and requires heavy lifting, squatting, or climbing you may require up to two to three months before you can return to full duty.
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 every two hours when taking long trips. This is important to help prevent blood clots.
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 any blood thinner avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should always avoid taking narcotics or other medications if consuming alcohol.
Can I go up and down stairs?
Yes, however for the first two weeks after your surgery we want you to avoid any extra stairs. Initially, you will lead with your non-operated 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 six weeks).
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.
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.
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given instructions explaining this in detail at your surgical discussion and first follow-up visit. This is also located your joint replacement booklet. Avoid any dental cleaning or non-urgent procedures for six weeks postoperatively.
I feel depressed and/or have a loss of appetite. Is this normal?
It is not uncommon to have feelings of depression and/or loss of appetite 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/loss of appetite will typically fade as you begin to return to your regular activities. If your feelings of depression and/or loss of appetite persist, consult your primary care physician.
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. In general, 9 out of 10 patients will still have a well-functioning hip replacement fifteen years after surgery. Newer implants and technologies may have even better success rates.
When do I need to follow up with the office for x-rays?
Routine post-operative follow-up appointments should be made for six weeks, six months, year one, year two, year five, and every five years after that. More frequent follow-up may be requested if needed.
Normal things about your new hip:
- Clicking noise with hip motion is possible
- Skin numbness near or around your incision
- Swelling around hip, knee or lower leg
- Bruising from your buttock all the way down your leg and foot
- Warmth around hip
- “Pins and needles” feeling at or near your incision or the side of your leg
- Dark or red incision line
- Increased bruising if on blood thinner
Abnormal things about your new hip (call your surgeon if you experience any of these):
- Increasing bright 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
