Hip Replacement Surgery

In traditional hip replacement surgery, the doctor makes a 15- to 25-centimetre cut (incision) on the side or the back of your hip. Some muscles and other soft tissues, such as ligaments, are cut so the doctor can get to the hip joint.

Hip replacement can also be done with one or two smaller incisions. This is called minimally invasive surgery. It may cause less blood loss and leave a smaller scar but it can also mean a longer time in surgery, because the surgery is harder to do. And if the new hip can't be fitted properly through the smaller incision, the doctor may have to make a larger cut.

A newer type of surgery is done through a small incision in the front (anterior) of the hip. Anterior hip surgery causes less disruption to muscles than getting to the hip joint from the side or the back. It may help you heal faster and return to activity sooner.

Anterior surgery and minimally invasive surgery require special training and equipment. Your doctor can explain your options and help you understand the risks and benefits of each type of surgery.

Total hip replacement surgery is usually done when hip pain and loss of function become severe and when other treatments no longer relieve pain. Hip replacement is sometimes done after a hip fracture.

Surgery usually works well. You will probably have much less pain and be able to do most of your daily activities more easily but recovery does take time and patience.

Most artificial hip joints will last for 10 to 20 years or longer. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra kilogram of body weight adds 3 kilograms of stress to your new hip joint. Controlling your weight will help your new hip joint last longer.

The risks of hip replacement surgery can be divided into two groups:

1. Risks of the surgery and recovery period. These risks include:
   • blood clots
   • infection
   • fracture (crack in the bone)
   • bleeding (a small number of patients require blood transfusion)
   • nerve injury
   • problems with wound healing
   • problems with anesthesia
   • limp (usually goes away with physiotherapy but may persist in a small number of patients)
   • hip dislocation after surgery
   • difference in leg length. Usually very small and corrected by using a shoe insert
2. Long-term risks that may occur months to years after the surgery. These risks include:
   • loosening of the hip implant in the bone.
   • infection in the joint.
   • a reaction to the metal in the new hip joint. As metal connections in the artificial joint wear, tiny particles of metal can wear off and sometimes this causes problems such as loosening of the hip prosthesis or issues with the soft tissues (tendons and muscles) around the hip

Most hospitals will ask you to come in several weeks before your joint replacement surgery to review your situation and talk about what will happen. It’s a good idea to bring a family member or friend to this visit to take notes and ask questions. You will be given lots of information, and this can be overwhelming and difficult to remember if you don’t have someone with you.

During the pre-operative visit, the team will talk about what kind of anaesthesia is best for you. This depends on many things, including your age and general health and preference. The team may suggest a regional anaesthesia so you don't feel the area of the surgery, with this option you'll also have medicine that makes you relaxed or lightly asleep but you will breathe on your own. Alternatively, your team may suggest a general anaesthesia that puts you completely asleep during the surgery, with a breathing tube down the throat and attached to a breathing machine.

Physical activity

The best way to strengthen your legs in preparation for surgery is to walk regularly. Don’t be afraid to walk while waiting to have your surgery – it won’t harm your knee or hip joint. Follow the “two hour” pain rule: If your joint hurts for longer than two hours after your walk, you have done too much. Do what you can to manage the pain and walk a bit less the next day.

Besides walking, your surgeon may recommend that you do some regular pre-operative exercises. Some are aimed at strengthening your arms and shoulders, which will help you cope with crutches or a walker after surgery. Others will help maintain the strength of your leg muscles. The exercises should take about 20 minutes to complete, and if possible, you should do them twice a day.

Your home

Your house or apartment may need certain changes to meet your needs after your operation. Look around and see what can to be done.

• Arrange or remove furniture so that you have a clear path around your home wide enough for a walker (on average you'll need about 76 centimetres or 30 inches of clear space).
• Remove small mats and area rugs. Tape down the edges of larger rugs so you won’t trip over them.
• During recovery use armchairs because you’ll need the arms to help you sit down and stand up. Make sure you have at least one chair with a strong seat (not too low), a backrest and sturdy arms. Avoid chairs that rock, roll or glide.
• You can raise chair heights either by using lifts under the legs or by placing a firm pillow on the seat.  
• Keep rooms and hallways well lit so you can see obstacles.
• Make sure all stair railings in and outside your home are secure.
• Keep cords out of the way.
• Getting in and out of bed can be difficult after joint replacement surgery. It’s important that your bed isn’t too low.
• The edge of the mattress should be no lower or higher than the backs of your knees. If your bed is too low, you may need to raise it to a better height by having someone place it on sturdy blocks. If it's too high, you may need to adjust the height by adjusting the bed frame.
• If there is no bathroom nearby or it is on a different level, you may need to purchase or borrow a bedside commode (a chair with a built-in bed pan) for use at night.
• Install a raised toilet seat
• Get a rubber (non-skid) mat for your bathtub or shower stall so you don’t slip while bathing. A tub bench is also helpful. Purchase a long, handheld sponge to help you wash your feet without bending over.
• Even with assistive devices, it’s hard to get into the shower, turn on the water, and adjust the temperature without bending. Plan to have someone help you shower when you first come home.
• If grab bars around the toilet, tub or shower are necessary, make sure they are installed before your surgery.
• Put all your bathroom utensils, such as toothbrush, comb, hair dryer, make-up, and razor in a single area so you can reach them without moving around.
• Organize your kitchen so that items are close by and at waist level – you won’t be able to bend down right after your operation.

Right after surgery

Your pain will be controlled with intravenous (IV) medicine. You will probably also have medicines to prevent infection, blood clots, and nausea. If you had regional anaesthesia, you may have little or no feeling below your waist for a while.

You may have a cushion put between your legs. It helps keep your new hip in the correct position. To help prevent blood clots, you may be wearing compression stockings. And you may have compression sleeves on your legs. These squeeze and release your lower legs to help keep the blood moving.

Lack of activity following surgery and the use of pain medication can cause constipation. If needed, laxatives may be prescribed.

Moving around

On the day of surgery or the day after, you'll get out of bed with help. You will learn how to walk with a walker or crutches. By the time you leave the hospital, you will be able to safely sit down and stand up, dress yourself, use the toilet, bathe, and use stairs.

Within a couple of weeks, you will start physiotherapy. You'll learn exercises to help you get stronger. You will also be shown how to move your body without dislocating your hip. Sometimes you will be asked to limit certain movements, follow the instructions provided by your surgeon.

Leaving the hospital

You will probably stay in the hospital for 1 to 4 days after surgery. You can go home from the hospital if you have care at home and your recovery is going well. It will be very helpful to have someone stay with you for the first few days and you will likely need help with cooking, cleaning and other chores for the first couple of weeks after surgery.

You may go to a rehabilitation centre if you need extra care and are not able to move around safely enough to look after yourself shortly after surgery. You can go home when you've recovered enough to move around safely and care for yourself.

Call your surgeon or family doctor if:

• you develop a temperature higher than 38 C. (101 F.)
• you notice any change in the amount, colour or odour of drainage from your incision or a sudden increase in pain around the incision
• you notice increased pain, swelling or tenderness in the calf or thigh of either leg
• you notice that either leg appears pale or bluish in colour
• you notice that either leg feels unusually cool to the touch
• you suddenly have trouble walking

During the few weeks after surgery, you will need less and less pain medicine. For several weeks after surgery, you will probably take medicine to prevent blood clots.

You may need a walker, crutches, or a cane for a few weeks or months. As you get your energy back, work up to taking a short walk a few times each day. If you feel any soreness, try a cold pack on your hip.

Don't drive until your doctor says it is okay for you to drive.

Rehabilitation continues after you go home from the hospital. You will get rehabilitation until you are able to function on your own and you get back as much strength in your hip as you can. You will keep working on building strength and endurance. Rehabilitation after surgery will take several months and you may continue to improve (especially strength and endurance) for up to one or one and a half years after surgery. Early recovery may be faster after anterior hip surgery.

For most people, it is safe to have sex about 4 to 6 weeks after a hip replacement. Talk to your doctor about when it is okay to have sex and what positions are safe for your hip. Some positions could increase the risk of dislocating your hip. That means that your doctor may want you to avoid certain positions, especially for the first few months.

Exercise (such as swimming and walking) is important for building your muscle strength. And it helps you feel better overall. Discuss with your doctor what type of exercise is best for you. You probably will be able to return to most activities that you did before surgery, such as golfing, biking, swimming, or dancing. Your doctor may want you to avoid running, playing tennis, and doing other things that put a lot of stress on the joint.

Your doctor will probably want to see you at least once every few years to check your hip.

In most healthy patients the guidelines from the Canadian Dental Association for antibiotic use after joint replacement surgery will be followed. 

In some circumstances, for example, if you are immunocompromised or have other risk factors for infection, your surgeon may recommend taking antibiotics before any dental work or invasive medical procedure after your joint replacement surgery. It is important to let your dentist, and any medical professionals involved in your care, know that you have had joint replacement surgery so that they can provide you with the most appropriate treatment.