You've been grappling with hip pain, stiffness, and reduced mobility that is affecting your daily life. Despite exploring nonoperative treatment options, you've reached a point where you can no longer take part in the activities you cherish. Whether you’re still exploring treatment options or have already decided to undergo hip replacement surgery, you’re probably thinking – Now what? What can I expect? What happens next?
First, take a deep breath. You’re not alone.
Annually, more than 450,000 individuals in the United States choose to undergo total hip replacements. This surgical intervention removes the arthritic portion of the hip joint and replaces it with an implant. Generally, people who choose hip replacement surgery experience a notable reduction in hip pain and a considerable improvement in their ability to engage in daily tasks. This frequently leads to enhanced mobility and the ability to resume cherished activities such as sports, gardening, hiking, and more.
If you haven’t already, schedule a consultation with an orthopedic surgeon.
Orthopedic surgeons dedicate years to mastering the intricacies of bone and joint repairs. During your consultation, you and the surgeon will explore your symptoms and desired outcomes, before collaboratively deciding whether hip replacement surgery is the right choice for you. During this appointment, you should feel comfortable asking any questions you may have about the procedure. No question is too small! An orthopedic surgeon knows how to repair bones and joints, but you know your lifestyle and what matters most to you.
Common questions that patients ask me during consultations include:
What exactly is a hip replacement?
The hip joint is often described as a “ball and socket.” The “ball” part of the socket is the femoral head. The “socket” is the acetabulum. During hip replacement, the damaged femoral head (ball) and cartilage on the acetabulum (socket) is removed.
The “ball” is recreated by inserting a metal stem into the hollow center of the femur and attaching a metal or ceramic ball at the upper end of the stem. A metal socket is used to replace the arthritic acetabular surface, sometimes secured in place using screws or cement. To facilitate a smooth gliding surface, a plastic, ceramic, or metal spacer is introduced between the new ball and the socket.
I keep hearing about “minimally invasive” hip replacements. What’s that?
Traditionally, total hip replacement surgery has involved a relatively long incision. This allows a surgeon to see and access the hip joint. However, there is an alternative method called a minimally invasive procedure, where the surgeon employs one or more shorter incisions or adjusts the location of the incision. The goal of this type of procedure is to minimize pain and expedite the recovery process.
Minimally invasive approaches can be done from a posterior, lateral, or a direct anterior surgical approach. Over the last decade, the direct anterior approach has gained popularity due to its reduced impact on underlying tissues and muscles. A direct anterior approach, where the surgeon makes the incision on the front of the hip, requires cutting less muscle and recovery has been reported to be faster. However, both anterior and posterior approaches have similar long-term positive effects. Not all techniques are suitable for every patient. Your orthopedic surgeon will discuss various surgical options, and how they specifically apply to you.
What results can I realistically expect from having hip replacement surgery?
Typically, individuals who choose hip replacement surgery witness a remarkable decrease in hip pain and a significant improvement in their ability to perform common daily activities. Overall, hip replacement surgery boasts a high success rate, with approximately 95% of patients finding relief from hip pain.
Am I too young/too old for hip replacement surgery?
The typical age range of patients opting for total hip replacement falls between 50 and 80, however, orthopedic surgeons assess each patient on a case-by-case basis. Successful total hip replacements have been carried out across all age groups, from adolescents grappling with juvenile arthritis to older individuals contending with degenerative arthritis.
How long will my hip replacement last?
Research indicates most total hip replacements last for a minimum of 15 years. Given recent advancements in implant materials, this time is expected to increase, possibly reaching 20 to 30 years or even more. In general, the risk of failure and the necessity for subsequent surgeries are low.
What are some of the risks associated with total hip replacement?
The chances of complications after hip replacement surgery are low, and the risk of a serious complication, like infection, is less than 2%. Complications are rare but can include blood clots, infection, dislocation, fracture, change in leg length, loosening and/or implant wear, bleeding, stiffness, or nerve damage. A small number of patients continue to have hip pain after surgery.
How soon can I go back to work after surgery?
The timeline for returning to work varies based on the nature of your job. For desk jobs, a return to work is often possible after 2 weeks. However, if your job involves heavy lifting, a recovery period of approximately 6 weeks may be necessary.
How do I prepare for surgery?
A medical clearance is typically required before proceeding with elective hip replacement surgery. There may be additional requirements such as dental clearance, a CT scan, or scheduling physical therapy. Your surgeon will discuss these requirements with you at your appointment.
But preparing for hip replacement surgery involves more than just the procedure. Some patients return home the same day, while others may spend a night in the hospital. Either way, you will be walking with a cane, crutches, or a walker shortly after surgery. The amount of time you will need assistance in walking is different for everyone. To ensure a smooth recovery after you go home, it's crucial to plan for how you will handle tasks such as cooking, shopping, and transportation. You may also want to rearrange your living area to make it easier for you to walk between your bedroom, bathroom, and kitchen.
What can I expect on the day of surgery?
Your surgical coordinator will furnish you with the details regarding the location, time, and date of your scheduled surgery. On the designated day, follow instructions and arrive at the assigned hospital or ambulatory surgical center as directed. Generally, you'll need to refrain from eating or drinking after midnight on the night before surgery. However, you'll receive specific time frames and preoperative instructions tailored to your surgery schedule. Adhere to the guidance provided by the care team.
To ensure your comfort throughout the surgery, anesthesia will be administered. The exact type of anesthesia, whether spinal or general, will be determined by your anesthesiologist and tailored to what is best for you.
How long does the surgery last? How long will I be in the hospital?
The typical duration for a hip replacement procedure is approximately 1-2 hours. In this timeframe, your orthopedic surgeon will remove the damaged joint and cartilage in your hip, replacing it with an implant. Following the surgery, you'll be transferred to the recovery area, where you'll be closely monitored as the effects of the anesthesia wear off. Once you're ready, you'll be reunited with your chosen family member or friend.
Your ability to go home on the same day depends on your recovery progress and the preoperative discussions and plans. If your doctor recommends an overnight stay, arrangements will be made to transfer you to a designated room.
What is recovery going to be like?
You should ease into the first days and weeks after surgery. Recognize that surgery of any type is difficult on your body and while you'll be encouraged to start walking at the earliest opportunity, complete recuperation will require time. You can typically return to most light, daily activities within 2 to 6 weeks post-surgery. It's common to experience some discomfort during activities and at night for a few weeks, and medication is often part of your recovery plan. In addition to the potential use of narcotic painkillers, you may also incorporate Tylenol, NSAIDs, and/or anticoagulants into your recovery routine. Follow the post-surgery guidelines, which include not immersing yourself in water (i.e., using bathtubs, swimming pools, etc.) until your incision is totally healed, which usually takes at least three weeks.
Lastly, remember …
In most cases, hip replacement is considered elective surgery. The choice to undergo hip replacement surgery should be a collaborative decision involving you, your family, your primary care doctor, and your orthopedic surgeon.
The ultimate decision to proceed with surgery lies with the patient and is based on your symptoms, pain levels, and ability to function. Patients opting to move ahead with surgery often tell me that their hip symptoms keep them from participating in regular or favorite activities.
Hip replacement surgery is typically a very positive and successful treatment for hip arthritis, bringing relief to approximately 95% of folks dealing with hip pain. So, postoperatively, you can look forward to enjoying your newfound hip functionality and returning to the activities that bring you joy!