Information For Patients Considering Total Hip Replacement

You have seen your OA doctor and are considering total hip replacement. Total hip replacement is a very good operation with over 95% of people having this procedure receiving excellent pain relief and use of the hip postoperatively. Despite this, total hip replacement is major surgery and should not be considered lightly. Hopefully this will answer some of your questions and increase your understanding of the procedure. It is not meant to replace talking with your OA doctor or asking any questions.

More information about Total Hip Replacement preparation which Dr. McGrory has helped design is available through the AAOS website brochure.

Before Surgery

Total hip surgery is major surgery and requires careful preparation to get the best result. There is a lot to be done before surgery and because of that you will probably find that the date of your surgery will be around six weeks after your visit with your OA doctor. In this period of time you will be asked to do several things.

• You will be asked to visit your dentist (if you have teeth) as cavities or gum disease can be a source of infection that can travel to the hip during or after surgery, creating major problems. A visit to your dentist could prevent this.
• You may be asked to donate some of your own blood (this is called autologous donation).
• You may be asked to see your regular doctor or perhaps a specialist for evaluation to ensure you can tolerate the surgery well.
• You will be asked to get some preoperative lab work done at Brighton Medical Center or Mercy Hospital and meet with the anesthesiologist.
• You will be asked to come into the office approximately two weeks before the surgery for a history and physical examination and possibly x-rays. This will also allow you to have any additional questions answered. Any medications that you take will be reviewed at that time. You will also be informed if any of those medications need to be stopped or changed prior to surgery.

Procedure

Total hip arthroplasty, sometimes known as hip replacement, involves the removal of bone from the end of the femur (thigh bone) and replacement with a metal or ceramic implant.

The acetabulum (cup of the hip joint) is also replaced with a metal and plastic or ceramic component. Bone near the hip may need to be cut (osteotomy) at the time of surgery. Bone cement is sometimes used to hold the femur (thigh part) in place, but this depends on the bone strength of the femur bone. This procedure generally takes about two hours in the operating room but takes longer (four to five hours) when you consider preparation for surgery and recovery time in the recovery room. It may be done under either general or spinal anesthesia. Spinal anesthesia is often suggested as it is usually safer for the patient. During and after the procedure there is blood loss that may require a blood transfusion.

As with any surgery, there are risks inherent with this procedure. The major risks for this procedure are the risks associated with anesthesia, risk of infection, risk of fracture, risk of phlebitis or blood clots in the legs, risk of the legs not being exactly equal after the surgery (necessitating a shoe lift), risk of nerve or artery damage, and the risk of the hip coming out of joint (dislocation) in the postoperative period.

In the long run, there is a risk that you will need re-operation, or that the wear particles that accumulate at the joint surface can cause bone softening (osteolysis).

There are limitations after the surgery that will protect the hip. There is always a risk of the hip coming out of joint (dislocation) if the hip is placed in the wrong position with a significant amount of force.

After Surgery

After surgery you can expect to have some pain, but you will be given pain medication to control this. You will also be given antibiotics to try to prevent infections. Patients are also placed on a blood thinning agent to prevent blood clots. If necessary, in the time after your surgery you may be given a blood transfusion. It is possible for you to donate and store your own blood prior to surgery in case you need a transfusion. This is called autologous blood donation. If you wish to do this, please ask and we will try and arrange this for you.

Most patients having a total hip replacement are in the hospital for three to four days. Generally, your MJRI doctor likes to have his patients able to safely get in and out of bed, climb stairs, and walk before they are discharged from the hospital. They must also be able to follow and maintain "hip precautions". Hip precautions are the restrictions that you must follow in order to prevent a dislocation of the hip. In the first ten weeks after surgery precautions are more strict so the fibrous capsule reforms around the new mechanical joint. While in the hospital you can expect to have physical therapy daily by a trained therapist. You can expect to get out of bed to a chair the day of or the day after surgery. You may ask your nurse to see a movie which reviews hip precautions and lets you know what to expect following surgery. You will need to continue using a walker or crutches for at least five weeks following your surgery. The therapist will explain how much weight you can put on the surgical leg. Immediately after surgery you will still have the intravenous lines that were started before surgery. These will be discontinued as soon as you are taking food and fluids well and are no longer requiring any intravenous medications. You will wear graduated compression stockings (TED hose) while in the hospital and will continue wearing these until the swelling in the operative leg is diminished. Normally, after you leave the hospital you will need to wear these for two weeks. You need only wear these during the day and may remove them at night.

After Discharge

After leaving the hospital you can expect to be walking with crutches or a walker and be able to get along well at home. Physical therapy is necessary in some circumstances at your home or at a facility near your home. Follow-up appointments will be arranged with your MJRI doctor's office and are arranged before surgery. Be sure to check the appointment dates and times. If necessary, you will be given pain medications to take home with you. Also, any other needed medications will be provided to you.

It is usually recommended that patients undergoing hip replacement do not drive for five weeks after surgery because muscle weakness will slow reaction time. It is also wise to avoid situations where you might fall, be jostled, or otherwise injure your hip.

As mentioned above, dental infections or bad teeth can be a source of infection for a total hip even after the surgery is completed. For this reason it is wise to advise your dentist that you have a total hip. We ask that you do not have any dental work done for three months following your surgery. For any dental procedures, including cleaning of your teeth, you should have antibiotic prophylaxis. This is taken one hour before the dental procedure. This single dose of antibiotics should prevent any problems. Other infections in the body such as boils or bacterial infection could also represent a source of problems for a person with a total hip. For this reason, if you should have any infection it is wise for you to consult your doctor promptly so that proper treatment can be carried out.

Expectations

Total hip replacement surgery is major surgery and should not be undertaken lightly. It is wise to keep in mind when considering this surgery that even the best total hip replacement is not as good as your hip was when it was healthy. It is hoped that the surgery will relieve your pain, if not totally, then at least somewhat. It is hoped that you will maintain reasonable stability and flexibility as well.

Even if you feel much better you must keep in mind that this metal and plastic or ceramic hip is a mechanical device. Just like any mechanical device, including your automobile, there can be problems or failures. In general, total hip replacements last ten years or more. It is hoped that in the near future this period of time can be extended to 20 years. As with any medical procedure, there is no guarantee.

Even if you feel much better following your surgery it is wise that you limit your activities, especially those which cause marked flexion of the hip and impact to the hip. It may be advised that you walk with a cane.

If you have any further questions, please feel free to call your OA doctor or his clinical assistant at (207) 828-2100.

Total Hip Replacements and Revisions - Frequently Asked Questions

1. What equipment will I need at home after my surgery and how do I get it?
   • Crutches or walker – possibly both
   • Cane
   • Raised commode (to put over your toilet because a regular toilet seat height is too low to sit on)
   • Shower/tub chair (so that you can sit while you shower/bathe)
   • Extended shoe horn (to assist in putting on your shoes)
   • Long handled grabber (to help reach things on the floor or in high places)
   • Hip chair (an elevated chair to help prevent you from bending greater than 90 degrees at the hip joint)
   • Sock aide (to assist in putting on your socks)
   • Elastic shoe laces (so that you do not have to bend down to tie your shoes)
   • Long-handled sponge for bathing

   Enclosed in your surgery packet will be a Letter Of Medical Necessity stating that this equipment is medically necessary. You can bring this letter to a medical supply store and they can assist you in obtaining these items. Also, the discharge nurses at the hospital can help you obtain some of these items before you leave the hospital if you were unable to obtain them ahead of time.

2. When do my staples get removed?

   Staples are removed two weeks from your surgery date.

   • If you go to rehab from the hospital, the staples will be removed at the rehab facility.
   • If you go home from the hospital and have home health care, you may have your staples removed by the home health nurse. (this is often the case with patients who live a distance away)
   • If you go home from the hospital and do not get home healthcare, then you will have a two week post-op appointment at the office to have x-rays taken and staples removed.
3. How long must I wear the white TED stockings?

   TED stockings must be worn for two weeks from the surgery date.

   • They need to be worn during the day and may be removed at nighttime as long as they are put back on when you wake in the morning. If there is no swelling after the two weeks are up, you may discontinue wearing the TED stockings.
   • If there is still swelling after the two weeks, continue wearing the stockings during the day until the swelling is gone. To reduce swelling, lie flat three times a day for 30 minutes. Elevate the leg on two or three pillows.
4. What are hip precautions?
   • Do not cross your legs at the knees
   • Do not twist your body at the waist
   • Do not turn operative foot inward
   • Do not flex your hip greater than 90°
   • Do not bend at the waist
   • Minimize lifting to no more than 20 pounds in the first three months and 40 pounds thereafter
   • Keep pillows between legs when sleeping
   • Sit only 30-45 minutes at a time
   • May ride in a car, stopping every 30 minutes to get out and stretch for 5 - 10 minutes
   • May sleep on operative side two weeks after surgery with a pillow between your legs
5. How long must I maintain hip precautions?

   Complete hip precautions must be maintained for ten weeks following surgery. After that, an abbreviated set of precautions is observed.

6. When can I drive?

   Driving usually can resume at five to six weeks post op. This will be discussed at the five week recheck appointment.

7. Can I swim?

   Swimming may resume at five to ten weeks post op. This will be discussed at the five week recheck appointment.

8. When can I fly in an airplane?

   Flying may resume at two months. You must sit in an aisle seat, and make arrangements for luggage and connections. Blood clots are a concern so you MUST do ankle pumps every 15 minutes, walk about the plane every 30 minutes, and be taking aspirin or Warfarin (Coumadin). You will want to make sure you have your precautions card with you to let the security guards know you have a joint replacement. This will help you when going through the metal detectors!

9. When can I take a shower?

   Showering may resume after discharge from the hospital. The wound must be covered with plastic wrap to keep water from the incision.

10. How long will I be out of work?

    You may usually return to work approximately ten weeks after surgery. If you have a sedentary job, you might be able to return sooner. Limitations and precautions in the workplace will be discussed prior to your return.

11. When may I resume sexual activity?

    Sexual activity may resume at four to six weeks post-op, but please ask your physician for the handout titled "Sex After Total Joint Replacement."

12. How long after surgery will I need to have antibiotic prophylaxis prior to dental work?

    This will be done for the rest of your life. If you or your dentist have any questions about this somewhat controversial topic, please see our "letter to area dentists." This can be obtained by asking our office.

    WE ASK THAT YOU DO NOT HAVE ANY DENTAL WORK FOR THE FIRST TEN WEEKS FOLLOWING YOUR HIP SURGERY.

13. When and how do I donate my own blood (autologous) for surgery?

    We will contact the American Red Cross or the Maine Blood Center and give them your surgery information. They will then contact you at home and make arrangements for your donation. If you are contacted by the Red Cross and they do not have a center in your area, they will look for the nearest blood drive in the time frame that is appropriate. If you do not hear from the Red Cross OR the Maine Blood Center by three (3) weeks prior to surgery, please contact our office and we will check with them for you.