Total Hip Replacement

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What is a total hip replacement?

Total hip replacement is surgery that is done to take out a damaged hip and replace it with a new artificial hip. Hip damage is painful and affects your ability to walk and move. The goal of total hip replacement is to relieve pain and make the hip joint work better so you can walk and move more normally again.

Most hip damage is a result of osteoarthritis (os-tee-oh-ahr-thry-tis) of the hip. With this type of arthritis, the cartilage cushion between the joints wears away. As the cartilage wears away, the bones rub together and the joint doesn’t work well. Other types of arthritis, such as rheumatoid (roo-muh-toid) arthritis, can also cause hip damage. Total hip replacement is a possible treatment for people with other types of hip damage, including damage caused by hip fractures, bone tumors, or diseases that cause bones cells to die.

Your doctor may try other treatments for your hip problem before suggesting surgery. Your doctor may first have you try physical therapy, medicine, or using a cane (or other aid) to help you walk. Surgery for total hip replacement may be a good idea if you’ve tried these things but still have too much pain and stiffness to do your daily activities.

What are the risks and/or side effects?

Total hip replacement works best for people who are otherwise healthy and strong. It is not a good treatment for people who have muscle weakness or other conditions that will make it hard to recover from surgery and get stronger. Exercise is essential for recovery from hip surgery, so you must be able to do the exercises.

Any surgery comes with some risks. These are the risks for total hip replacement:

  • Infection. Anytime the body is opened up, infections can get in. Surgeons are very careful about keeping things sterile and clean during surgery, but there is always a chance of infection. An infection can happen near the skin where the wound is, or near the hip replacement parts. When it happens near the parts (the prosthesis), the parts may have to be removed.
  • Blood clots. Sometimes the body forms a blood clot where the surgery was done, and the clot blocks an important blood vessel to the lungs, heart, or brain.
  • Different leg lengths. Sometimes one leg is longer than the other after hip surgery. The surgeon will try to keep them even, but sometimes may need to make the leg slightly longer or shorter so it is stable and working properly with the new hip.
  • Dislocated hip. The new hip parts have a ball at the end of your thighbone that goes into a socket in the hip joint. Sometimes the ball comes out of the socket. This risk is greatest in the first few months after surgery, but is not very common. 
  • Reaction to anesthesia. Some people don’t react well to anesthesia and may have nausea and vomiting.
  • Pain. You will likely have some soreness and pain as you recover from surgery.
  • Wear and tear on the parts. The new hip parts can wear out over time.

What are the benefits?

Total hip replacement has these benefits:

  • Relief from hip pain when other treatments haven’t worked
  • Ability to get back to the daily activities you haven’t been able to do because of your hip pain and stiffness

How do I prepare?

One of the most important things you can do as you prepare for total hip replacement is to take care of yourself. This surgery will work best when you are as healthy and strong as you can be. If you are overweight, the doctor may work with you on weight loss before surgery.

Below are some other ways to prepare for your surgery.

  • Follow Instructions. The doctor or nurse will tell you how to prepare for your surgery. Most likely, you will have instructions about not eating or drinking before the surgery. The doctor may also tell you to stop taking some of your medicines or vitamins before surgery. Follow all instructions you get for preparing for surgery. 
  • Make a Plan for Getting to the Hospital and Back Home. Have a plan for who will take you to the surgery and who will take you home.
  • Make a Plan for Recovery. The first weeks after you get home are very important. Plan for who will help you in the days following your surgery. Set up your house so that it’s easy to get everything you need without having to go up and down stairs. Decide where you will do your physical therapy and exercises. Make sure you have a grip bar, shower chair, and other supports in the bathroom. Have food in the cupboards or a plan for someone to bring meals. Consider making some meals and freezing them.

How is it done or administered?

Your total hip replacement surgery will be done in the hospital. You will spend at least 1 day in the hospital but usually not more than 4 days.

  • A total hip replacement takes 1 to 2 hours.
  • You will have general anesthesia (an-uhs-thee-zhuh) so you will be in a deep sleep during surgery and won’t feel it. 
  • The surgeon will make a cut over your hip. The surgeon will remove the damaged parts of your hip and put the new replacement parts in.
  • You will go to a recovery room until you fully wake up from surgery (1 to 2 hours)

When will I know the results?

You will know how the surgery went soon after it is done. However, some problems can develop after surgery. See the section, “What should I expect during recovery?” to learn more about what to watch for.

What are follow-up requirements and options?

Total hip replacement works best when you do your part. Follow all instructions your doctor gives you during recovery. It is especially important to do your physical therapy and exercises so your body can heal and adjust to the new hip. See “What should I expect during recovery?” for more information.

What should I expect during recovery?

You will have a homecare team to help you after surgery. Below is a summary of what you need to do to help your hip recover. Following these instructions carefully will help you get better faster.

  • Protect against infection. After surgery you have a greater chance of getting an infection.
    • Good handwashing is the most important thing you — and those who care for you — can do to prevent infection. Wash your hands before you touch the area where your surgery was done. 
    • Deep breathing will help prevent a respiratory infection. Do the deep breathing exercises you learned in the hospital. Do them every hour until you are back to your regular activities.
    • Call your doctor if you notice symptoms of an infection, such as fever, redness or swelling at the area of your surgery, more drainage from the area of your surgery or different color drainage, or a lot more pain. 
  • Care for the surgery site. If your doctor closed your wound with staples, you’ll get instructions on how to clean the area and change the dressing. Your doctor or physical therapist will remove them. If your wound is closed with Steri-strips, leave the Steri-strips on until your healthcare provider tells you it’s okay to remove them. It’s okay to get the Steri-strips wet in your shower — just gently pat the area dry when you are done. Unless your doctor says otherwise, you can shower if you can safely move in the shower.
  • Prevent swelling. Keep your leg elevated when you are lying down and use an ice pack for swelling in the area of your surgery. Wear a compression stocking for as long as the doctor tells you to.
  • Take medicine and follow a diet that helps your medicine work. Take all of your medicines just as your doctor tells you, including your pain medicine. Avoid alcohol. The doctor may prescribe other medicines, like Coumadin (warfarin). Some foods cause this medicine to not work as well as it should. Follow the diet instructions your doctor or nutritionist has given you.
  • Protect your new joint. While your hip heals, there are certain positions and movements that could cause your new hip joint to come out of the socket (dislocate). To learn more, talk to the physical therapist or see the instructions on the Intermountain fact sheet Hip Replacement Surgery: Home Instructions .
  • Use assistive equipment. Use tools or equipment to help you do things while you recover. You may have a tool to reach items, a raised toilet seat, a tool to help you put on your shoes or socks, pillows to position your legs when you sleep, or equipment to help you walk.
  • Follow an exercise plan to help you heal. Your physical therapist has created an exercise plan to strengthen and retrain your muscles as you get used to using your new joint. See the Intermountain fact sheet Total Hip Exercises for more information. Do the exercises just as you were taught. If you feel a lot of pain, stop doing the exercises and call your physical therapist.
  • Know who to contact when you need help. Call your doctor if you notice signs of infection or new symptoms, or if you are bleeding easily (for example, nosebleeds). Call the doctor right away if you notice signs of a clot forming in your lower leg. Watch for pain, warmth, or tenderness in the calf of your leg that gets worse when you pull your foot forward. Don’t rub your calf. Call 911 if you have severe bleeding, chest pain, or severe shortness of breath.