Introduction to Total Hip Replacement
Total hip replacement (also known as a total hip arthroplasty or THA) surgery consists of replacing worn-out or damaged portions of the hip joint with a prosthetic joint connection.
A total hip replacement consists of replacing both primary components of this ball-and-socket joint with artificial versions: namely the femoral head (the ball) and the acetabulum (the hip joint socket on the pelvis). A successful hip replacement surgery should reduce pain and improve function of the hip joint resulting in a better quality of life.
Who Is a Good Candidate for a Total Hip Replacement?
A hip replacement surgery may be a viable option for people experiencing pain in their hip joint, groin, or frontal thigh on a regular basis. This pain may be caused by certain conditions that cause hip joint damage like osteoarthritis, rheumatoid arthritis, osteonecrosis, or bone tumors. Hip joint damage caused by a fall or high-impact collision could also warrant a hip replacement. This could present itself later on in the form of post-traumatic arthritis. If a person is having discomfort during their everyday life during simple activities, or cannot sleep consistently because of pain in their hip, they should see a health care provider to help consider their options.
Since most hip replacement prosthetics last between 15-20 years, an ideal candidate would be between 50 and 80 years old. Still, an orthopaedic surgeon should always evaluate the need for a hip replacement procedure based on the individual rather than their specific age.
In most cases, a patient should attempt a more conservative approach before considering a surgical option such as a hip replacement, such as physical therapy, exercise, walking aids, weight loss, or medications.
Is a Hip Replacement a Major Operation?
Yes, a hip replacement surgery is a major operation that, while effective, is often only considered after other treatment options have been exhausted. Given that your body is integrating brand new components in an area that is integral for movement, a hip replacement surgery should not be taken lightly. As this surgical procedure is invasive, patients must be asleep under general anesthesia or sedated with the use of spinal anesthesia during the operation.
During the procedure, a patient will receive both an artificial hip-socket and a connecting ball at the top of the femur. Your surgeon will cut away or reshape a section of the femur, making room for a supportive stem to be placed within the bone. This stem is the structure that attaches the femur to the artificial ball, which is typically made of either metal or ceramic materials. Any damaged cartilage from the socket is removed and replaced with a metal socket that is stabilized with either screws or cement. The lining of the new hip socket is made of ceramic or polyethylene plastic, providing a smooth articulation with the ball in a well-functioning new joint.
Although this surgery is significant, it does have a high success rate with more than 95% of patients experiencing relief from hip pain. Even 20 years later, more than 80% of those with replacement hips still consider their surgery a success.
Recovery Time for a Hip Replacement Surgery?
Every patient that undergoes hip replacement surgery will have a unique recover process. Timeframes can vary based on many variables from your surgery, including your age and overall health, your mindset, and commitment to physical therapy. In most cases, patients are ready to resume most normal activities within four to eight weeks after the surgery. Between three and six months after surgery, the majority of the surgical pain around your new joint will be gone and at this point you can confidently return to all normal activities. It is important to note that it is fairly common for patients to deal with some mild swelling after more intense activities for up to one year after a total hip replacement.
What to Expect After Hip Replacement Surgery
After concluding your hip replacement surgery, the road to recovery begins.There are three key components of rehabilitation that will help you on your way to returning to normal activities: rest, recovery, and self care.
Rest:
Rest is the primary form of rehab you must focus on after your surgery is completed. Rightfully so, as your body has just gone through a major procedure and needs to mend itself and adapt to its new structure. After you come home from the hospital it is imperative that you follow the post-discharge instructions. One of the places we regularly see this slip is in ‘rest’. Keeping this in mind, it is important that prior to your surgery you arrange to have help lined up to assist you with everyday tasks including errands, shopping, and even rides to and from follow-up appointments.
Recovery:
In as little as one day after your total hip replacement surgery, you will meet with a physical therapist that will create a recovery plan that encompasses your specific needs within the guidelines provided by your surgeon. At Keystone, we have spent years developing unique and personalized relationships with our surgeons. Each surgeon is unique with small variations in the technique, procedure, and their desired rehabilitation process. For the patient, it is equally important to work with therapists that have open lines of communication with your chosen surgeon and their team.
Your therapist will teach you exercises to be performed several times each day to help strengthen the muscles around your new hip, get accustomed to it, and reduce the amount of discomfort over time. Movement after surgery also plays a role in helping to prevent blood clots. You may be able to walk with the assistance of crutches or a walker as soon as one to two days after your surgery. Still, it is important to follow your recovery plan and take your rest seriously when you are not working on assigned exercises.
Self Care:
Although you will be under the supervision of the hospital staff initially, many THA patients are going home same day or next day after surgery. Some will need to stay for 2-3 days depending on how the recovery from surgery is happening.
- Caring for your surgical incision: Your surgical incision will either be stitched or stapled closed following your hip replacement surgery. The primary recommendation for taking care of your incision and the surrounding area is to keep it dry and to change your bandages as directed or if it gets dirty or wet. However, many surgeons are using dressings that stay on for 7-14 days. These do not need to be changed unless saturated or experience a loss of integrity. This style of dressings has served to greatly reduce surface infections in the surgical incision. Please consult your surgical team about dressing needs and changes.
- Avoid lotions and skin-care creams around the incision. An icepack or Iceman can be used for 20-30 minutes at a time to help ease the pain.
- At around two weeks your surgical team will remove the staples, if you have them (many surgeons are now using a subcutaneous glue, eliminating the need for staples.
- Medication: To help manage your pain and prevent post-surgery complications, you may be prescribed a variety of different medicines. You should expect to be using prescription pain medicine for up to two weeks after your surgery. You will likely also be prescribed a blood thinner to help prevent blood clots. The risk of blood clots should be taken seriously, as they can be responsible for strokes, heart attacks, and even death.
- Follow-ups: You will likely have follow-up visits with your doctor throughout the first year after your total hip replacement surgery. These are crucial for monitoring progress, troubleshooting issues, making modifications to your treatment plan, and ensuring that your hip joint health and overall health are in a good place. It is important to clearly communicate to your doctor if you are experiencing any significant issues with pain or having problems with range of motion or mobility. The information you receive during these follow-ups can also help inform the physical therapy approach and any adjustments needed in your lifestyle.
Standard Precautions for Posterior Total Hip Replacements
- Do not cross your legs and keep your knees apart when seated.
- Do not sleep on your side, as this increases the risk of your legs crossing. Special orthopedic pillows or foam wedges can be purchased to place in-between your legs if you are concerned about crossing your legs while asleep or if you want to sleep on your side safely.
- Do not bend your surgical leg beyond 90 degrees
- Do not sit on soft sofas, low chairs, stools, or rocking chairs, and utilize armrests to help you stand up whenever possible.
- Use assistive devices (such as a reacher) or ask for assistance when possible. Even simple tasks like putting on socks, shoes, or pants can put you at risk for a joint dislocation as you lean forward.
*If you have an Anterior Approach, your surgeon will have specific recommendations and precautions for you to follow.
How Painful Is a Hip Replacement Surgery?
Total hip replacement surgery itself will not be painful, as your surgeon will administer a general anesthesia or sedation prior to the operation. However, pain will be present in the weeks and months that follow the surgery, but to varying degrees as each person and each operation is different. After the surgery, it is common to experience hip pain along with groin and thigh pain as your body gets acclimated to its new hip joint. Pain is generally a less-significant issue at the site of the surgical incision itself, which is only about three inches long.
In some cases, your hip replacement surgery may result in a slight change in the length of your leg. While patients will adapt to their new leg length over time, it can cause pain in the knee and thigh. Discomfort associated with this issue can be improved through physical therapy and mobility exercises.
While some patients may be able to manage their hip pain with over-the-counter medications (such as Tylenol), others may need a prescription for a stronger pain-killer. Regardless of the medications recommended or prescribed to you, it is important for you to adhere to your doctor-advised schedule and communicate with them if the current dosage or medication is not sufficient to manage your discomfort. It is possible that there can be underlying causes (such as infection, fracture, or a loosening joint) that could be contributing towards any lingering pain, which should be addressed by your medical team.
The good news is that the pain you might experience should be temporary, manageable, and improving week after week as your body gets used to your new hip joint and you continue to work on your mobility.
How Much Does Hip Replacement Surgery Cost?
Once it has been determined that hip replacement surgery is your best course of action to solve ongoing issues in their hip joint, you must consider the costs associated with the procedure. Because this is an essential health procedure, most hip replacements are covered by insurance companies - however the amount that you would have to contribute to the costs is dependent on your specific health insurance plan. It is not unusual for patients that do have health insurance to pay up to several thousands of dollars (or their policy maximum) for out-of-pocket expenses.
Check with your insurance company about covered and non-covered costs related to your planned surgery.
Conclusion
For some, a total hip replacement procedure may be the best approach to regain their health and independence and improve their overall quality of life. For those suffering from arthritis in the hip, a hip replacement surgery can fully alleviate the discomfort associated with it. Even though a hip replacement surgery should not be the first treatment option considered, for some it truly is the best long-term option.
If you or someone you love is planning on having a hip replacement, you will be in good hands with Keystone managing your physical therapy recovery plan. We can also bring our physical therapists to your home, reducing the need for you to rely on others to assist you with transportation. Contact us today for a free consultation.
