What is Total Hip Replacement?

Total Hip Replacement surgery is a common procedure around the world, with hundreds of thousands performed annually. Hip replacements are done to alleviate pain and disability caused by conditions such as osteoarthritis, rheumatoid arthritis, avascular necrosis, congenital deformities, fractures, and other hip related problems.

The immediate benefits of total hip replacement include pain relief and improved function. In most cases a patient can expect to be relatively pain-free have full mobility of his or her hip, and walk with minimal or no limp following recovery. Recovery time has become faster, in recent years, with improved surgical techniques and better methods of pain control of anesthesia. The doctors at the Anderson Clinic are on the cutting edge in developing and utilizing these protocols.

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Frequently Asked Questions

When do I decide to have it done?

Even if the pain is significant and the X-rays show advanced arthritis of the joint, the first line of treatment is nearly always non-operative, to include weight loss if appropriate, an exercise regimen, medications, injections, or using a cane. If the symptoms persist despite these measures, then a patient would consider total hip arthroplasty. The decision to move forward with surgery is not always straight forward, and usually involves a thoughtful conversation with yourself, your loved ones, and ultimately your surgeon. The final decision rests with the patient, and is based on the pain and disability from the arthritis influencing the patient's quality of life and activities of daily living. Patients who decide to proceed forward with surgery commonly report that the symptoms from the hip keep them from participating in activities important to them (i.e. walking, work, sleep, putting on socks and shoes, sitting for long periods of time, etc.), AND have been non-responsive to non-operative measures.

How long do they last?

It is often quoted that total joint replacements last "15-20 years". This is not the ideal way to interpret the longevity of total joint replacements. The more accurate way to think about longevity is via the annual failure rates. Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint today, you have a 90-95% chance that your joint will last 10 years, and 80-85% that it will last 20 yrs. With improvements in technology, these numbers may improve.

What is minimally invasive surgery, and how big is my scar?

Minimally invasive surgery is a term that today describes a combination of reducing incision length and lessening tissue disruption beneath the incision. This includes cutting less muscle and detaching less tendon from bone. Combined with these techniques are the advanced techniques of anesthesia and pain management that take place around surgery. All of this combines to allow patients to feel better, have less pain, and regain function faster than in the recent past.

The size of the incision is variable, and depends on several factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeons' ability to adequately do the procedure.

When will my scar disappear?

The scar will heal within a few weeks, but then will remodel and change appearance over the course of 1-2 years. The color often fades and smoothes over time to blend into surrounding skin, but will likely never fully disappear. There will be significant variability on the final appearance of any individual scar based on the specific surgery and patient variables.

Is there a difference between different types of approaches?

When a hip is replaced the way a surgeon gains access to the hip is referred to as an "approach." There are various types of approaches named according to the direction that the surgery is performed. The most common approach today is referred to as the "posterior approach" and this is done from the back of the hip. Some more recent improvements to this approach (small incision and less tissue trauma) have been called "mini posterior approach." Another currently popular approach is known as the "anterior approach," because it is preformed from the front of the hip. The lateral approach is less popular. There are pros and cons of each approach and little science to endorse one over the other. A conversation with your surgeon should help decide which approach in the best for each patient.

Are there different types of hip replacements?

Most implants today have become more similar than different as surgeons and manufacturers have determined which designs work best. Having a discussion with your surgeon is best to detail the differences.

Is there a role for a computer, custom cutting guides, or a robot for my surgery?

This question is the subject of many studies that are attempting to evaluate these emerging technologies and their influence of the success of surgeries. In general these technologies have been more popular in total knee replacement than total hip replacement. To date, there appears to be both pros and cons to each of these technologies, but more research is required to determine what advantage, if any, these may offer. The best approach is to discuss this topic with your surgeon.

How long do I stay in the hospital?

Some people go home the day of surgery. Others stay 1-2 days in the hospital. If you are having revision surgery, or if you have other medical problems, your length of stay could be longer.

Is THR very painful?

Pain following total hip replacement has come a long way over the last 10-15 years with increased use of regional nerve blocks, spinal blocks, and various other modalities used for pain control. Early range of motion and rapid rehab protocols are also designed to reduce early stiffness and pain making the procedure in general much less painful than in years past. However, patients handle and perceive pain differently and as such; some patients may have relatively mild pain following the procedure while others have a more difficult time.

How long does it take to recover?

Most hip replacement patients are able to participate in a majority of daily activities by four to six weeks. Overall, by three months, most patients have regained much the endurance and strength lost around the time of surgery and are able to participate in daily activities without restriction.

Do I need Physical Therapy, and if so, how long?

Initially most patients will receive some physical therapy while in the hospital. Once discharged from the hospital, home healthcare will be arranged and a physical therapist will come to your home. Much of the therapy after hip replacement is walking with general stretching and thigh muscle strengthening which many patients can do on their own.

When can I walk after surgery?

Often on the day of surgery patients are walking with the assistance of a walker and weaning to a can by 2-3 weeks.

When can I shower?

You can take a shower when your wound is dry. If you have a plastic dressing, it is waterproof. If you have a gauze dressing, remove it before you shower.

When can I drive?

Most surgeons allow patients to drive two to four weeks after surgery as long as your physical therapist feels that you have adequate muscle control of your leg AND you have discontinued the use of narcotic pain medication.

When can I return to work?

Returning to work is highly dependent on activity level and demands of the job. Patients with sedentary jobs such as computer work can expect to return to work by four to six weeks. More demanding jobs may need up to three months prior to returning.

What are the major complications following THR?

Total hip replacement is an excellent pain relieving procedure and most patients receive approximately 95% pain relief. Although complications are relatively rare (1-5% of patients), patients may experience a complication in the postoperative period. These include very serious and possibly life threatening complications such as heart attack, stroke, pulmonary embolism and kidney failure. Infection (1%) is one of the most debilitating complications and often requires prolonged antibiotics with several additional surgeries to rid the infection. A blood clot in the leg is another possible complication after surgery which we treat prophylactically by requiring some type of blood thinner following surgery to reduce the incidence. The implants used can also fail over time due to wear of the bearing components or loosening of the components from the bone, both of which usually occur over many years. Another complication specific to hip replacement is dislocation of the joint (1%) that may require additional surgery if dislocation becomes recurring. Leg length differences following surgery are also a possibility and may be difficult to avoid sometimes in order to insure a stable hip. Often this leg length discrepancy is mild and rarely needs treatment.

What can I do/not do after hip replacement surgery?

Depending on how your surgeon performs your surgery, you may have slight differences in your rehabilitation instructions including restrictions. In general most surgeons prefer that you avoid certain positions of the hip that can increase your risk of dislocation of the hip for about 6 weeks following surgery. After 6 weeks the soft tissues involved in the surgery have healed and restrictions are often lifted allowing more vigorous activity. Many surgeons suggest that patients avoid any repetitive impact activities that can increase the wear on the implant such as long distance running, basketball, or mogul skiing. Otherwise limitations following hip replacement surgery are few.

How long do I have to follow up?

It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years. You need to meet with your treating doctor after surgery to insure that your replacement is continuing to function well. Your physician will consider all factors in your case and tailor a follow-up schedule to meet your needs. In general seeing your surgeon every three to five years is recommended.

Do I need to take antibiotics for certain procedures and how long?

It is possible, in some situations, for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint although this risk is low. Promptly treating any infection in your body will lower this risk. It is our opinion that the best practice is to continue our patients being treated with antibiotics prior to dental work for your lifetime because an infection of your joint replacement is a very serious complication that is best avoided. The dentist/physician caring for you will be able to provide the prescription for the proper antibiotic, but you should remind them that you have an artificial joint.

You do not need antibiotic prophylaxis before receiving manicures, pedicures, routine gynecological examinations, or injections.

Will my implant set off metal detectors at airports and courthouses?

Usually patients with joint replacements will set off metal detectors. It is reasonable for patients to inform individuals performing screening for metallic objects (i.e., the Transportation Safety Administration- TSA) that they have had a joint replacement. However, patients will still require screening and will need to follow the directions of screening agents.

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