Total Hip Replacement

Realistic Expectations

An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip (groin) pain and a significant improvement in their ability to perform the common activities of daily living.

With appropriate activity modification, hip replacements can last for many years. Normal use and activity begins to wear the material between the head and the socket of every hip replacement implant. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful.

Some swelling around the joint is the norm in the weeks and months after surgery.

Home Planning

Several modifications can make your home easier to navigate during your recovery.

• Secure handrails along all stairways.
• A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms.
• A raised toilet seat.
• A stable shower bench or chair for bathing.
• A long-handled sponge and shower hose.
• A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip.
• A reacher that will allow you to grab objects without excessive bending of your hips.
• Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips.
• Removal of all loose carpets and electrical cords from the areas where you walk in your home.

Protecting Your Hip Replacement

There are many things you can do to protect your hip replacement and extend the life of your hip implant.

• Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
• Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.

See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.

How Is Your New Hip Different?

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.

Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.

What are Hip Precautions?

Hip Precautions are positions you should avoid with your surgical limb to prevent dislocation of the artificial hip.

• Keep your feet in front of you.
• Do not bend at the waist more than a right angle (90 degrees or the shape of the letter "L").
• Do not cross yours legs at the knees.
• Do not turn feet excessively inward (pigeon toe) or outward.

Potential Complications

The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery. The following are other risks related to hip replacement surgery:

• Infection
• Blood Clots
• Leg-length Inequality
• Dislocation
• Loosening and Implant Wear

Activity After Surgery

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

Your activity program should include:

• A graduated walking program to slowly increase your mobility, initially in your home and later outside.
• Resuming other normal household activities, such as sitting, standing, and climbing stairs.

Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.

Sexual Relations

Many patients are concerned with the safe positions for sexual intercourse after hip replacement. In general, sexual activity may resume in 4-6 weeks following surgery. Positions that do not adhere to Hip Precautions increase the risk for dislocation of the hip replacement.

Both men and women initially find the missionary position favorable, with the person with the new joint on the bottom. This position minimizes motion of the hip, limits pain, and decreases energy expenditure. You should initially take a passive role, assuming positions that are as natural and relaxed as possible.

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.