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Home > Services > Cottage Center for Orthopedics > Hip Replacement Surgery Guide
Total joint replacement involves surgery to replace the ends of both bones in a damaged joint to create new joint surfaces.
Total hip replacement surgery uses metal, ceramic, or plastic parts to replace the ball at the upper end of the thighbone (femur) and resurface the hip socket in the pelvic bone.
Total hip replacement surgery replaces damaged cartilage with new joint material in a step-by-step process.
Doctors may attach replacement joints to the bones with or without cement.
The anesthesiologist will typically administer regional anesthesia for joint replacement surgery. The choice depends on your doctor, on your overall health, and, to some degree, on what you prefer. Regional anesthesia numbs the area of the surgery. The anesthesiologist is then able to titrate the degree of sedation easy patient desires.
Your doctor may recommend that you take antibiotics before and after the surgery to reduce the risk of infection. If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.
Orthopedic surgeons at Cottage Health, including Goleta Valley Cottage Hospital, are performing hip replacement surgery through smaller incisions. This is called minimally invasive surgery. It may mean less blood loss and a smaller scar, with less pain and easier rehabilitation. These surgeries can also require special equipment and resources such as; computer digital radiographs, computer generated custom surgery resection guides, computer assisted surgical intervention and computer assisted robotics.
You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you feel ill.
When you wake up from surgery, you MAY have a urinary catheter placed, which is a small tube connected to your bladder, so you don't have to get out of bed to urinate. You may also have a compression pump or compression stocking on your leg, which squeezes your leg to keep the blood circulating and to help prevent blood clots. And you may have a cushion between your legs to keep your new hip in the correct position.
Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced. You may also learn to move your feet up and down to flex your muscles and keep your blood circulating. And you may begin to learn about how to keep your hip in the correct positions while you move in bed and get out of bed.
You will probably still be taking some medicine. A postoperative multi-modality pain management regimen will be used. Every attempt will be made to adequately control each patient's pain and minimize any associated side effects associated with pain medication. You will gradually take less and less pain medicine. You may continue medicines to prevent blood clots for at least ten days after surgery.
Rehabilitation (rehab) after hip replacement surgery may vary depending on whether the surgeon used cement or cementless methods to attach the joint replacement surfaces. The majority of total hip replacements are porous ingrowth fixation and are not cemented. Whether or not your surgeon used cement also determines how much weight you can put on your leg. Your surgeon will let you and your rehab team know what limitations you have. You'll probably need a walker, a cane, or crutches for several weeks.
In general, most people get out of bed with help on the day of surgery or the next day. Over the next few days, you will learn how to walk with a walker or crutches. Your physical therapist and sometimes an occupational therapist will teach you how to exercise, walk, and do activities such as dressing and cooking while you allow your hip to heal. Depending on the type of surgery you had and your doctor's instructions, you may learn the following precautions to keep your hip from dislocating:
Most people go home within a few days to a week after surgery. Some people who need more extensive rehab or those who don't have someone who can help at home go to a specialized rehab center for more treatment.
After you go home, monitor the surgery site and your general health. If you notice any redness or drainage from your wound, notify your surgeon. You may also be advised to take your temperature twice each day and to let your surgeon know if you have a fever over 100.5°F (38.1°C).
For a while, you may need to sit only in high chairs (not on low seats that flex your hip more than 90 degrees), use a toilet seat raiser, and sleep on your back.
You may need to use a walker or crutches for several weeks after surgery until you can bear your full weight, have less pain, and can safely move around without falling. How long you need to use crutches or a walker depends on the condition of your bones and what type of procedure your doctor used as well as his or her experience working with other people who had similar surgery.
Physical therapy typically continues after you go home from the hospital until you are able to function more independently. Total rehabilitation after surgery will take at least 6 months.
You will have an exercise program to follow when you go home, even if you are still having physical therapy. You should also take a short walk several times each day. If you notice any soreness, try a cold pack on your hip and perhaps decrease your activity a bit, but don't stop completely. Staying with your walking and exercise program will help speed your recovery.
For most people it is safe to have sex about 4 to 6 weeks after a hip replacement. Talk to your doctor about how and when it is safe. And ask your physical therapist or occupational therapist about positions that will not put your new hip joint at risk.
Your doctor will probably want to see you at least once every year to monitor your hip replacement. Gradually, you will return to most of your presurgery activities. If you drive a car, your doctor will probably allow you to start driving an automatic shift car in 6 to 8 weeks, as long as the seat is not too low and you are no longer taking pain medicine.
Because of the way the hip is structured, every added pound of body weight adds 3 pounds of stress to the hip. Controlling your weight will help your new hip joint last longer.
Stay active to help keep your strength, flexibility, and endurance. Your activities might include walking, swimming (after your wound is completely healed), dancing, golf (don't wear shoes with spikes, and do use a golf cart), and bicycling on a stationary bike or on level surfaces. More strenuous activities, such as jogging or tennis, are not advised after a hip replacement.
Your doctor may want you to take antibiotics before dental work or any invasive medical procedure for at least 2 years after your surgery. This is to help prevent infection around your hip replacement. After 2 years, your doctor and dentist will decide whether you still need to take antibiotics. Your general health and the state of your other health conditions will help them decide.
Doctors recommend joint replacement surgery when hip pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use X-rays to look at the bones and cartilage in your hip to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.
Total hip replacement may not be recommended for people who:
But doctors evaluate each person individually.
People who have hip replacement surgery have much less pain than before the surgery and are usually able to resume daily activities. You will probably be able to do your daily activities more easily because the joint moves better.
Most artificial hip joints will last for 10 to 20 years or longer without loosening, depending on such factors as:
The younger you are when you have the surgery and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.
Your artificial joint should last longer if you are not overweight and if you do not do hard physical work or play sports that stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint probably will last the rest of your life.
Doctors continue to discover new ways to improve the life span of artificial hip joints. What we know today about the long-term outcomes of hip replacement surgery comes from studies of joints that were replaced 10 to 20 years ago or longer. People who have hip replacement surgery today may expect the artificial joint to last longer than joints replaced 10 to 20 years ago.
If you wait to have surgery until you have already lost a lot of your strength, flexibility, balance, endurance, and ability to be active, then after surgery you might have a harder time returning to your normal activities.
The risks of hip replacement surgery can be divided into two groups:
The risks of each complication depend in part on your other health problems and on the surgeon.
Continued exercise (such as swimming and walking) is important for your general well-being and muscle strength. Discuss with your doctor what type of exercise is best for you.
You may donate your own blood to use during surgery if needed. This is called autologous blood donation. If you choose to do this, start the donation several weeks before the surgery so that you have time to donate enough blood and rebuild your blood volume before surgery.
If you need more than one joint replacement surgery, such as a knee and a hip, talk to your doctor about guidelines that may help you and your doctor decide in which order to do the surgeries.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Other Works Consulted
American Academy of Orthopaedic Surgeons (2009). Activities after hip replacement. Available online: http://orthoinfo.aaos.org/topic.cfm?topic=a00356.
Imamura M, et al. (2012). Single mini-incision total hip replacement for the management of arthritic disease of the hip: A systematic review and meta-analysis of randomized controlled trials. Journal of Bone and Joint Surgery, American Version, 94(20): 1897–1905.
Rethman MP, et al. (2012). Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Executive Summary on the AAOS/ADA Clinical Practice Guideline. Available online: http://www.aaos.org/research/guidelines/PUDP/dental_guideline.asp.
Pre-Operative Joint Replacement Seminar Video
Cottage Center for Orthopedics - Welcome to Your New Hip
Cottage Center for Orthopedics - Welcome to Your New Knee
Joint Replacement Guide (PDF)
Cirugía de Reemplazo de Articulación (PDF)
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