TOTAL HIP REPLACEMENT
A total hip replacement, or arthroplasty, is a surgical procedure done when the cartilage covering the surface of the bones of the joint is worn away and the "bone is rubbing against bone." This abnormal friction causes pain and limited motion. The most common reason for this degenerative process is osteoarthritis. The hip joint is classified as a ball and socket joint comprised of the femoral head (“ball”) and acetabulum (“socket”). The procedure involves relining of the joint with artificial parts called prostheses. The main goals of surgery are to reduce and/or eliminate pain and to restore function by improving the movement of the hip joint.
Surgical procedure
One the day of your procedure, you are taken to the operating room and given
anesthesia. Once asleep, an incision is made over your hip in a "hockey stick" pattern
and the "ball" or femoral head is moved out of position from the "socket" or
acetabulum. The head of the femur is removed with special tools and replaced with a
titanium component. Next, the acetabulum is resurfaced and reshaped to accommodate
the prosthetic cup. If you have good bone quality, a pressfit procedure is performed to
allow bone to grow into the porous prosthesis. However, if you have low bone density,
it may be necessary to use cement as a glue to bond the implants to the surrounding
bone. After the components are placed, the joint is restored by manipulation to its
normal anatomical location and the incision is closed with staples.
Pre-operative testing and preparations
You will be advised, if possible, to donate at least 2 units of your own blood
approximately 1 month prior to your surgery date. We will provide you with the
information to schedule this appointment with the American Red Cross. Usually, only
one unit is donated at a time, so it may take you two to three visits to the blood bank to
acquire the necessary amount of blood. In some cases, family members with the same
blood type may donate instead, which is called directed donor blood. If for some
reason you or your family cannot donate blood, screened donor blood from the blood
bank may be used.
Prior to your surgery date, you will be required to undergo routine laboratory tests, EKG and a chest x-ray. If you are over 50 years of age or have any history of cardiac or pulmonary problems, you will also be required to have a clearance by a cardiologist or pulmonologist, respectively. You will also be given information on what medications, both prescription and over the counter, that need to be discontinued preoperatively as many can interfere with wound healing and bleeding time.
What to expect in the hospital post-operatively
You will wake up in the recovery room after the operation is over. Once stable,
you will be taken to your room where you may be greeted by friends and family. You
will have a catheter placed into your bladder to drain urine. Your incision will be
covered by a sterile dressing which will stay in place for 2 to 3 days. You will have a
drain which will be removed after 3 days.
It is important to begin moving as soon as possible to prevent blood clots and speed your recovery. The day after your surgery, you will be visited by a physical therapist that will assist you. Getting out of bed is also a very important step in helping your lung function return to normal. Areas or your lungs collapse during surgery and a couple of days post-operatively, which is known as "atelectasis." Additionally, deep inspirations and the use of you "incentive spirometer" are essential.
You may shower after at least 2 days in the hospital, but it is important to keep the incision dry for 5 days. The nurse will help you cover your wound with Aquaguard to keep it dry or you may take a sponge bath.
Patients typically stay in the hospital for 4 to 5 days. Before your discharge, you will be provided with a list of "do's and don'ts" and arrangements will be made for home health if necessary. You may need to be sent to an extended care facility after the hospital for 7 to 10 days depending on your assistance at home.
Once you arrive home
Continue to walk with the use of aids. Slowly increase your activity level.
You may shower, but do not soak in the bath or hot tub for 4 to 6 weeks.
Monitor your incision. It is common to have a small amount of blood and fluid
leakage, however, if there is persistent drainage contact the office. Additionally,
watch for opening of the incision, redness or warmth around the incision, or
fever greater than 101ºF.
You will need to return to the office to have your staples removed approximately
10 days after surgery.
Care for your incision by avoiding sun exposure. Once the incision is healed,
sunscreen can be used on the incision for 6 months to one year. This will help
decrease its appearance.
No driving for 4 to 6 weeks or until advised.
Typical recovery time is 3 months.
Precautions
Never squat – when picking objects off of the floor, bend the non-operated knee
while keeping the operated leg back or USE A REACHER.
Never lean forward.
Never turn knees or feet inward toward midline of you body.
Never cross your legs in any position.
Use a raised toilet seat.
When lying down, keep a large pillow between your knees.
Sit in high chairs and use a cushion.
Use a bath bench in tub or shower. Never sit on the bottom of the tub.
Wear safe, low heel shoes.
Don’t lie on operated hip.
Remove all scatter rugs – they are hazards.
Beware of and avoid wet spots or objects on the floor.
Do not pivot or make sudden turns..
Looking after your new hip joint
Avoid jumping, high-impact sports or activities, and sudden jolts to the leg.
Control your weight by diet and low-impact exercise.
Please contact our office if you are scheduled for any dental procedures,
colonoscopy or other procedure that introduces bacteria into your bloodstream
so that we may give you a prescription for antibiotics. This applies for at least
two years after your surgery date..