Total Hip Replacement Q & A
Am I too old for hip replacement surgery?
Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. You may ask Dr. Bhushan Naiani for an opinion about your general health and readiness for surgery.
How much time will my surgery take?
We reserve approximately two to two-and-a-half hours for surgery. Some of this time is taken by the operating-room staff to prepare for the surgery.
How long will my new hip last?
This varies from patient to patient. For each year following your hip replacement, you have a 1% chance of requiring additional surgery. For example, at 15 years postoperatively, there is a 90% success rate without the need for further surgery. However, with continued improvements in the technology of the articulating surfaces, it is hoped that durability will continue to improve.
When can I shower or get the incision wet?
If your dressing has been unstained for a 24-hour period and there is no drainage, then you can shower. You should avoid immersing your incision under water. When drying the incision, pat the incision dry, do not rub it.
Will I need blood?
You may need blood after the surgery. You may donate your own blood, if able, or use the community-blood-bank supply.
How long will the surgery take?
We reserve approximately two to two-and-a half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery. However, it is not uncommon for some surgeries to take over 3 hours.
What are my anesthesia options?
You may have a general anesthetic, which most people call "being put to sleep," or a spinal anesthetic. The choice is between you and the anesthesiologist.
Will I have pain after surgery?
Yes, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. The day of surgery, most patients control their own medicine with a special pump that delivers the drug directly into their IV. Dr. Nariani will discuss with you what pain control option is best for you.
How long, and where, will my scar be?
The scar will be approximately 6–8 inches long. It will be along the side of your hip.
Will I need a walker, crutches or cane?
Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or crutches. Your equipment needs will be determined by the physical therapist and ordered for you by the us and delivered to you before you leave the hospital.
Will I need any other equipment?
After hip-replacement surgery, you will need a high toilet seat for about three months. If needed, you will also be taught by the physical therapist to use adaptive equipment to help you with lower body dressing and bathing. You might also benefit from a bath seat or grab bars in the bathroom. Your home equipment needs will be arranged while you are in the hospital.
Will I need physical therapy?
Formal physical therapy doesn’t play as significant a role in hip replacements as in knee replacements. A physical therapist may visit you 2-3 times /week and review some simple strengthening exercises with you. However stretching and range of motion exercises are typically avoided. Specifically, patients should avoid hip flexion (the act of bending or the condition of being bent) of more than 90 degrees and rotation of more than 35-40 degrees in either direction as well as avoid crossing the midline of the body for approximately 12 weeks. We find the best therapy for our patients initially to be walking. Dr. Bhushan Nariani may recommend formal physical therapy on an outpatient basis following your initial post-operative visit.
Will I need help at home?
Yes. In the first several days or weeks after surgery, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. Family members or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single-portion frozen meals will reduce the need for extra help.
Will I need physical therapy when I go home?
Yes. Physical therapy will continue after you go home with a therapist in your home or at a physical therapy facility. The length of time required for this type of therapy varies with each patient. We can help you with these arrangements before you go home.
Can I go up and down stairs?
Yes. Initially, you will lead with your un-operated leg when going up stairs, and with your operated leg when coming down. As your muscles get stronger and your motion improves, you will be able to perform stairs in a more normal fashion, usually in about one month. A good rule of thumb to remember when deciding which leg to lead with is “up with the good, down with the bad.”
I feel depressed. Is this normal?
It is not uncommon to have feelings of depression after hip replacement surgery. This may be due to a variety of factors such as limited mobility, discomfort, increased dependency on others, and medication side effects. Feelings of depression will typically fade as you begin to return to regular activities. If your feelings of depression persist, consult your primary care physician.
I have insomnia. Is this normal, and what can I do about it?
Insomnia is a very common complaint following hip replacement surgery. Some over-the-counter remedies or sleep aid may be effective. If this continues to be a problem, prescription medication may be necessary.
What do I do about post-operative constipation?
It is very common to have constipation post operatively. This may be due to a variety of factors but is especially common when taking narcotic pain medication. A simple over the counter stool softener is the best prevention for this problem. In rare instances, you may require a suppository or enema.
How much range of motion do I need?
Most patients note an improvement in the range of motion of their hip following hip replacement. However some patients may always have some difficulty with certain movements such as shoe and sock application and foot care due to the long standing contractures of the soft tissues about the hip. Initially patients should avoid hip flexion (the act of bending or the condition of being bent) of 90 degrees or more, hip rotation of more than 35-40 degrees, and crossing the body’s midline with the affected leg for approximately 12 weeks in order to avoid a dislocation of the hip joint. Do not force a body position past a feeling of stiffness. This feeling of stiffness often improves over the course of a year.
I think my leg feels longer now. Is this possible?
Most patients have a sense that the operated leg feels longer early in their recovery and this may initially feel awkward. This is due to the fact that the affected leg is usually shorter than the unaffected leg prior to surgery. Arthritis is the process of the protective cartilage covering wearing away from the bone. As the cartilage in the hip joint is destroyed, this results in the leg becoming shorter. Eventually, patients become accustomed to their “new anatomy” following surgery, and do not have any long lasting sense of a leg length discrepancy. Occasionally, some patients choose to wear a small shim in a shoe. At times, the leg is intentionally lengthened at the time of surgery in order to tighten the surrounding soft tissues of the hip and prevent/limit the risk of dislocation. In the majority of cases your leg length will essentially be unchanged.
How long will I limp?
It varies from patient to patient and typically improves over the course of a year. Most patients limp prior to surgery. As one’s strength, conditioning and endurance improve the limp lessens. Some patients will always have some degree of a limp. Larger patients may tend to limp for a longer period of time.
How soon after surgery will I be able to drive?
The ability to drive depends on whether surgery was on your right hip or your left hip and the type of car you have. If the surgery was on your left hip and you have an automatic transmission, you could be driving within two weeks. If the surgery was on your right hip, your driving could be restricted as long as six weeks. Consult with your surgeon for advice on your activity. You should not drive if you are taking narcotic pain medicine.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, even if your job allows you to sit frequently. More strenuous jobs will require a longer absence from work.
How soon after surgery can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with Dr. Nariani.
When do I need to follow-up with my surgeon?
Follow-up appointments are usually made postoperatively at 4-6 weeks after surgery followed by yearly and then every other year visits. These appointments are necessary to monitor the fixation of the prosthesis and evaluate the potential wearing out of the plastic articulation.
My hip makes an intermittent clicking or bumping noise. Is this normal?
Yes. This is normal as the metal ball is contacting the plastic or metal liner. The weight of the leg may slightly distract the ball from the socket during the swing phase of gait leading to this sensation. This is not a harmful situation and some patients do experience this.
Why does the skin around my hip feel numb?
This is a normal and expected finding. The sensory nerves are interrupted with the incision and this results in an area of numbness around the hip. Often, this improves over the course of one year, but may always feel somewhat different.
How will my physical activity be restricted after surgery?
High-impact activities such as contact sports, running, and singles tennis are not recommended. Injury-prone sports are also dangerous for your new joint. You will be restricted from crossing your legs. Your surgeon and therapist will discuss further limitations with you following surgery. You are encouraged to participate in low-impact activities such as walking, dancing, golfing, hiking, swimming, and gardening.
Will I set off the security monitors at the airport?
You will probably set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a hip replacement and will most likely set off the alarm.
Will I notice anything different about my hip?
In many cases, patients with hip replacements think that the new joint feels completely natural. However, we recommend always avoiding extreme positions or high-impact physical activity. The leg with the new hip may be longer than it was before, either because of previous shortening due to the hip disease, or because of a need to lengthen the hip to avoid dislocation. Most patients get used to this feeling in time or can use a small lift in the other shoe. Some patients have aching in the thigh when bearing weight for a few months after surgery.
What should I be worried about?
There are issues that are abnormal and require a call to your personal physician. These include:
Increasing redness about the wound.
Increasing pain and swelling, though it is normal to have increasing swelling following activity. It is also normal for the operated hip to feel warmer than the un-operated hip.
A temperature of more than 101.0F as well as drainage from the incision should prompt a call to your personal physician.
Leg or foot pain and swelling that does not resolve with overnight elevation and use of compression stockings as well as bleeding gums or blood in one’s stool or urine should prompt a call to the physician’s office.