Sometimes the only solution to chronic hip problems, like pain and loss of mobility associated with osteoarthritis, is hip replacement surgery. How does the procedure work and what can you expect in terms of your recovery timeline and post-surgery outlook?
How the Procedure Works
Before any surgery is performed on you, you’ll undergo an evaluation to determine the extent of the damage to your hip, including x-rays. You’ll also get a general medical evaluation including a look at your medical history in order to make sure that you’re a good candidate for surgery. Physical Therapy prior to surgery will help strengthen other areas of the body and better prepare you for the recovery.
The procedure itself generally takes 2 hours, barring complications or in cases where both hips are being operated upon simultaneously. The surgery is performed under anesthesia, either general anesthesia or also epidural, depending on the recommendation of your anesthesiologist and your orthopedic surgeon. The procedure involves several steps including the resurfacing of bones and removal of damaged cartilage, and placing implants to restore smooth hip motion. Typically, a ceramic ball is used to replace the head of the femur (your thigh bone), and a metal cup is used to replace the socket in your hip. The socket implant may either be attached uncemented (which allows bone growth over time to hold the implant in place), or with a cemented prosthesis which is held in place with bone cement.
Your hip can be accessed by the surgeon from one of three angles: From the front (anterior), from the side (lateral), or from the back (posterior). Minimally-invasive techniques are preferred by surgeons these days, with the aim of minimizing the impact on your healthy tissues like muscles and blood vessels. In a minimally-invasive procedure, one or two small incisions are made and muscles are moved aside to make room for the surgeon to work. If a traditional, single-large-incision surgery is required, it can lead to longer recovery time due some muscles and tendons needing to be fully detached prior to placing the hip implants. Your surgeon will discuss which approach is appropriate for your specific case.
You will likely be admitted to the hospital for a few days following your procedure to monitor your condition and start your recovery process, though some patients are discharged after a single night or even the very same day.
Precautions Prior to Surgery
Another component of preparing for the surgery is preparing for life after the procedure. For the first few weeks after the surgery you will very likely need assistance with the activities of everyday life such as bathing and getting dressed, so arranging for help is an important step prior to surgery. For bathing purposes a shower bench or chair is recommended. Other home modifications such as toilet seat risers and safety bars will make it easier to complete everyday tasks safely. A chair with a firm cushion (which keeps your hips above your knees) and arms will be easier to get in and out of than your normal chairs and sofas and should be considered. Special devices to help you reach things, and thus avoid placing extra stress on your hips by bending, are also helpful. In a similar vein, it may make sense to keep frequently-used items in a single area to reduce having to get up and walk excessively.
You’ll also want to remove anything that can pose a falling hazard such as loose cords, rugs, or other objects on your floors. A fall after your surgery could cause severe damage to your hip and require new surgery.
What Post-Op Recovery Looks Like
You’ll be encouraged to sit up and walk with crutches or a walker soon after surgery, in part to help prevent blood clots, which are a temporary risk after the surgery. You may be prescribed blood thinners temporarily to help mitigate the risk or be asked to wear compression garments.
A few weeks after your procedure, any stitches or staples you have will be removed. Your surgical wound should be kept away from water until it has thoroughly sealed. Bandaging the wound to prevent irritation from your clothing is also a smart idea. Certain seated postures (such as crossing your legs) should be avoided, as well as any activity that requires you to raise your knees above your hips.
Long Term Recovery, Physical Therapy, and Long Term Outlook
Part of your long term recovery plan is gradually increasing the amount of walking you do in order to increase your mobility, and slowly resuming household activities. Working with a physical therapist, they can help you with specific mobility exercises to aid in your recovery, including:
Ankle rotations
Straight leg raises (while lying down)
Standing knee raises
Standing hip abduction
Your physical therapist will guide you through implementing these exercises based on your specific needs and recovery timeline. These exercises can help you achieve a more complete recovery more quickly so that you can get back to your daily activities. It’s important to exercise in order to help your hip recover and restore your full range of motion. Be aware that some pain is to be expected when doing exercise during your recovery period, but anything excessive may be a sign you’re pushing yourself too hard. Follow the advice of your physical therapist to get the best short term and long term results!
During the first few months of your recovery, there is some risk of hip dislocation. This is uncommon, and in the event it happens it can often be addressed without additional surgery. That is why hip precautions are put in place for a period of time (usually around 6 weeks) of movements to avoid to decrease the risk of dislocation. Be sure to talk to your physical therapists of how to move safely.
After your recovery is complete you will be able to resume normal daily activities, including recreational activities like sports. This includes high-impact activities like running, but it’s important to note that these can make your implants wear out a little sooner. If you're a dedicated athlete, you may want to try lower-impact sports such as cycling and swimming. Treated well, you can expect your implants to last for up to 20 years, and you’ll be able to enjoy a return to pain free mobility and activity.