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Patients have asked many questions about total hip replacement surgery. Below is a list of the most frequently asked questions along with their answers. If you have additional questions, remember to write them down and discuss them with your Orthopaedic surgeon. Click here for a printable Hip Replacement Preperation Kit.

1. What is arthritis and why does my hip hurt?
2. What is a total hip replacement?
3. What are the results of total hip replacement?
4. When should I have this type of surgery?
5. Am I too old for this surgery?
6. How long will my new hip last and can a second replacement be performedifneeded?
7. Why do they fail?
8. What are the major risks?
9. Should I exercise before the surgery?
10. Will I need blood?
11. How long am I incapacitated?
12. How long will I be in the hospital?
13. What if I live alone?
14. How long does the surgery take?
15. Do I need to be put to sleep for this surgery?
16. Will the surgery be painful?
17. Will I need a private nurse?
18. Will I need a walker or crutches or cane?
19. Will I need any other equipment?
20. Where will I go after discharge from the hospital?
21. How long until I can drive and get back to normal?
22. Will I need help at home?
23. Will I need physical therapy when I go home?
24. When will I be able to get back to work?
25. When can I have sexual intercourse?
26. Do you recommend any restrictions following this surgery?
27. What physical/recreational activities may I participate in after myrecovery?
28. Will I notice anything different about my hip?
29. What are the risks associated with total hip replacement surgery?
30. What are the risks of general anesthesia?
31. What are the risks of the surgery and recovery period?

In the hip joint there is a layer of smooth cartilage on the ball of the upper end of the thigh bone (femur) and another layer within your hip socket. This cartilage serves as a cushion and allows for smooth motion of the hip. Arthritis is a wearing away of this cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.

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A total hip replacement is an operation that removes the arthritic bone which makes up the ball of the upper thigh bone (femur) as well as damaged cartilage from the hip socket (acetabulum). The ball is replaced with a metal or ceramic ball that is fixed solidly inside the femur atop a stem. The socket is replaced with a liner that is usually fixed inside a metal shell. Various articulations are currently available including metal, ceramic and/or plastic. This new articulation creates a smoothly functioning prosthetic joint that does not hurt.

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More than 90-95 percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.

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Your Orthopaedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, and x-rays. Your surgeon will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There is no harm in waiting if conservative, non-operative methods are controlling your discomfort.

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Age is not a problem if you are in reasonable health and have the desire to continue living an active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.

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It is expected that most traditional metal on plastic hip systems to last more than 10-15 years. Continuing technological advancements in material sciences have surfaces (metal on metal and ceramic on ceramic) which do not show evidence of significant wear in simulation for almost 25 years. However, there is no guarantee on the longevity of any total hip replacement. Many factors influence how long a prosthetic implant may last.

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The most common reason for failure is loosening of the artificial stem where it is secured in the femur,or loosening of the socket. Wearing of the plastic spacer may also result in the need for revision.

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Most surgeries go well, without any complications. Infection and blood clots are two serious surgical complications. To avoid these complications, your surgeon may use antibiotics and blood thinners. Special precautions are taken in the operating room to reduce risk of infections as well. The chances of this happening in your lifetime are one percent or less. Dislocation of the hip after surgery is a risk.

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Yes. You should either consult an outpatient physical therapist or follow an exercise program outlined byyour surgeon.

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You may need blood after the surgery. You may donate your own blood, if you are able, use the community blood supply or have your relatives donate for you. Bank blood is considered safe, but we understand if you want to use your own.

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You will probably stay in bed the day of your surgery. However, the next morning you will get up, sit ina chair or recliner and should be walking with a walker or crutches later that day.

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Most hip patients will be hospitalized for 3-4 days after their surgery. There are several goals that you must achieve before you can be discharged.

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Two options are usually available to you. You may either stay at a sub-acute facility following your hospital stay, or a home health nurse and a home physical or occupational therapist may assist you at home for two or three weeks.

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Your surgeon will reserve approximately one and a half to two hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.

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You may have a general anesthetic, which most people call "being put to sleep." Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you and the anesthesiologist.

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You will have discomfort following the surgery, but your surgeon will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. Some patients control their own medicine with a special pump that delivers the drug directly into their IV.

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No. You do not need a private nurse, but if you want one, you can make those arrangements.

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Yes. For about six weeks your surgeon will recommend that you use a walker, a cane or crutches. The physical therapist will assist in guiding you as to which devices you will need to use. The nursing staff will assist in ordering and have the items delivered to you during your hospital stay.

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After hip replacement surgery, you will need a high toilet seat for about two months. You will also be taught to use assistive devices to help you with lower body dressing and bathing. You may also benefit from a bath seat or grab bars in the bathroom. The nursing staff will assist you with these arrangements during your hospital stay.

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Most patients are able to go home directly after discharge. Some may transfer to a sub-acute facility. Stays there are from three-seven days long. The Total Joint Coordinator in the hospital will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have sub-acute benefits.

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You can probably drive after the third week from surgery if you feel safe and confident. We encourage you to practice in a parking lot first.

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Yes. The first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. If you go directly home from the hospital, the Total Joint Coordinator will arrange for a home health care nurse to come to your house as needed. Family members or friends need to be available to help if at all possible. 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.

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Yes. The Total Joint Coordinator will assist in arranging for a physical therapist to provide therapy atyour home. On occasion, some patients who do not have insurance benefits for such care may not have this as an option. Following this, you may go to an outpatient facility two to three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient but on average is 12 weeks.

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This varies a great deal depending upon the patients' goals and the work environment. We recommend that most people take at least one month off from work, unless their jobs are quite sedentary and they can return to work with crutches. Some patients who have strenuous or physically demanding positions may be off of work as much as for 12 to 16 weeks.

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Do not have sexual intercourse for at least six to eight weeks. Sexual relations must not compromise your hip precautions. Your physician will advise you.

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Yes. High-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also restricted. Hip patients will be restricted from crossing their legs or bending their hips more than 90 degrees. For sport specific restrictions please ask for our activity guideline handout.

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You are encouraged to participate in low impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.

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In many cases, patients with hip replacements come to think that the new joint feels completely natural.However, we recommend always avoiding extreme position or high impact physical activity. Some patients may have aching in the thigh with weight bearing for a few months after surgery while to body adjusts for the new prosthesis.

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The risks of potential complications range from less than 1% to about 10% (less than 1 in 100 to about 1in 10).

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The risks of general anesthesia vary according to the person's state of health, age, and many other factors. We encourage you to discuss these issues with your anesthesiologist.

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• Blood clots and/or Pulmonary Embolus. People may develop a blood clot in a leg vein after hip joint replacement surgery. Blood clots can be dangerous if they block blood flow to the leg or move to the lungs (pulmonary embolus). A blood clot that travels the lungs (pulmonary embolus) can be fatal. Blood clots may develop in association with injury and other common medical conditions not related to orthopaedic surgery. Blood clots generally affect less than 5% of people (less than 1 in 20) but are more common in older patients, those who are very overweight, those who have had blood clots before, and those who have cancer. Prevention in the form of exercise, mobility, stockings, foot pumps and blood thinning medications are all utilized to minimize the risk of developing a blood clot. Despite all of these measures, blood clots may occur which will require treatment.
• Infection in the surgical wound or in the joint. Infection is rare (less than 1 in 100) in people who are otherwise healthy. People who have other health problems, such as diabetes, obesity, rheumatoid arthritis, chronic liver disease, or those who are taking corticosteroids are at higher risk of infection after any surgery. Infections in the wound usually are treated with antibiotics. Infections occurring deep in the joint are even rarer and may require intravenous antibiotics, more surgery, and in some cases the artificial joint must be removed. Deep joint infections that are not responsive to treatment can potentially become limb threatening.
• Deposits of bone in soft tissues around the hip joint. This is called heterotopic ossification(HO). The incidence of this condition ranges from 0.6% to 6%. This condition is most common in healthy young males who have arthritis in more than one joint. It usually doesn't affect how well the hip works, but in some people, it may decrease the range of motion at the hip. The condition needs treatment only if it causes significant pain or greatly limits motion. Treatments such as pre-operative irradiation and medications may be used to decrease the risk of developing this potential complication.
• Hip dislocation after surgery. The incidence of dislocation following hip replacement surgery varies (0.5% to 9%). Hip precautions are instituted and are a set of rules used to significantly reduce the risk of having a dislocation following surgery. Some patients may still have a hip dislocation after hip replacement surgery. This usually is treated by having a doctor put the hip back into place after giving you medications or anesthetic. You may be required to wear a brace for a while (8-12 weeks). In very few cases, surgery may be needed to put the joint back in place. Patients undergoing revision total joint surgeries have the highest risk of dislocation. Chronic and recurrent hip dislocations may require surgery to correct the problem.
• Neurovascular injury. In rare cases, a nerve or blood vessel may be injured around the site ofthe surgery. This is more common (but still unusual) if the surgeon is also correcting deformities in the joint. A nerve injury (0.6% to 3.7%) may cause tingling, numbness, or difficulty moving a muscle. A vessel injury (0.2%) may result in significant blood loss requiring transfusion. These injuries usually get better over time and in some cases may go away completely.
• Intra-operative Fracture. Due to the fact that contemporary hip replacements are placed into the bone in a very tight fit fashion, it is possible to cause a small crack or fracture in the bone during the surgical procedure. If this occurs, it may be necessary to stabilize the fracture during the surgery. Patients undergoing revision hip surgeries are at the highest risk for intra-operative fracture.
• Problems with wound healing. Wound healing problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.
• The usual risks of anesthesia (mentioned above). Risks of any surgery are higher in people whohave had a recent heart attack and those who have long-term (chronic) lung, liver, kidney, or heart disease.
• Death from the surgery. About 0.1% to 0.3% of people die from total joint replacement surgery.Most deaths occur in older people who have other serious medical problems before surgery such as heart or lung disease.

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Copyright 1998 Michael C. Welch, M.D.