What is arthritis and why does my hip hurt?
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.
What is a total hip replacement?
A total hip replacement is an operation that removes the arthritic ball of the upper thigh bone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic liner that is usually fixed inside a metal shell. This creates a smoothly functioning joint that does not hurt.
What are the results of total hip replacement?
Ninety percent to 95 percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, and x-rays. Your orthopedic 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
Am I too old for this 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 be asked to see your personal physician for his/her opinion about your general health and readiness for surgery
How long will by new hip last and can a second replacement be done?
We expect most hips to last more than 10 - 15 years. However, there is no guarantee and 10 percent to 15 percnet my not last that long. A second replacement may be necessary.
Why do they fail?
The most common reason for failure is loosening of the artificial ball 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.
What are the major risks?
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are one percent or less. Dislocation of the hip after surgery is a risk. Your orthopedist will discuss ways to reduce that risk.
Should I exercise before the surgery?
Yes. You should follow the exercises you receive in your notebook. These will be reviewed with you during your scheudled pre-op education class. You also have the opportunity to participate in our Joint Camp strenth and conditioning program, with an exercie specialist, at the Wellness Center. Please all (423)431-5386
Will I need blood?
You may need blood after surgery. Bank blood is considered safe, but we understand if you want to use your own. For more information, read "What I Need to Know About Blood Transfusions" in your notebook appendix.
How do I donate my own blood?
If you wish to donate blood for yourself, contact your orthopedic physician to see if you meet the requirements for donating your own blood. Your orthopedic physician's office will make arrangements through the American red Cross if you meet the requirement.
How long am I incapacitated?
You will probably stay in bed the day of your surgery. However, the next morning you will get up, sit in a chair or recliner and will be walking with a walker or crutches.
How long will I be in the hospital?
Most hip patients will be hospitalized for three days after their surgery. There are several goals that you must achieve before you can be discharged.
What if I live alone?
Two options are usually available to you. You may either stay at a sub-acute facility (skilled nursing) following your hospital stay, or a home helath nurse and a home physical or occupational therapist may assist you at home for two or three weeks.
Will I need a second opinion prior to the surgery?
Your physician's office will contact your insurance company to pre-authorize your surgery. If a second opinion is required, you will be notified.
How do I make arrangements for surgery?
Your surgeon's office has scheduled you for your surgery and your pre-admission testing (PAT). They should have also given you a schedule of dates available to attend a pre-operative education class. You may choose which ever date is most convenient for you to attend this class; however, we do recommend you attend a class at least 3 to 4 weeks prior to your surgery. There is no need to call and register, just come to the 6th floor of JCMC at the appropriate time on the date a class is being held. If you have questions you may call the Joint Replacement Center at (423)431-6937.
How long does the surgery take?
We reserve approximately one to two hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people call "being put to sleep," or a regional anesthetic. The choice is between you and the anesthesiologist. You will discuss this with your anesthesiologist prior to your surgery. For more information, read "Basics of Anesthesia" in your notebook appendix.
Will the surgery be painful?
You will have discomfort following the surgery, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. You may receive pain medication by injection or by a special pump (PCA) that delivers the drug directly into your IV.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An assistant often helps during the surgery.
How long, and where, will by scar be?
The scar will be approximately six inches long. It will be along the side of your hip.
Will I need a private nurse?
No. You do not need a private nurse, but if you want one, we can provide a list of agencies for you.
Will I need a walker, crutches or a cane?
Yes. For about six weeks we do recommend that you use a walker, a cane or crutches. The case manager can arrange for them if necessary.
Will I need any other equipment?
After hip replacement surgery, you will need a high toilet seat for about three 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. This will be reviewed at your pre-op education session, and can be discussed with your occupational therapist during your hospital stay.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after discharge. Some may transfer to a sub-acute (skilled nursing) facility. Stays there are from three to five days long. Your case manager will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you ahve sub-acute benefits.
Will I need help at home?
Yes. The first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. Family or friends need to be available to help if 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 singleportion frozen meals will reduce the need for extra help. Home health nursing and phsycial therapy will be arranged if ordered by your physician.
Will I need physical therapy when I go home?
Yes. You will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. The case manager will help you arrange for an outpatient physical therapy appointment. If you need home physical therapy, we will arrange for a physical therapist to provide therapy at your home. Following this, you will go to an outpatient facility three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.
How long until I can drive and get back to normal?
Do not drive until you return to your surgeon for your first post-op visit. Your surgeon will instruct you on when you are cleared to drive. The ability to drive depends on whether surgery was on your right leg or your left leg, and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right leg, your driving could be restricted as long as 6 weeks. Getting "back to normal" will depend somehwat on your prgress. You will not be able to drive while you are taking narcotic pain medications.
When can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with your orthopedic surgeon.
How often will I need to be seen by my doctor following the surgery?
Seven to 10 days after discharge, you will be seen for your first postoperative office visit. This appointment will be scheduled for you before you are discharged from the hospital. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, 12 weeks and then yearly.
Do you recommend any restrictions following this surgery?
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 replacement patients will be restriced from crossing their legs or bending their hips more than 90 degress for three months.
What physical/recreational activities may I participate in after my recover?
You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.
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 acitivity. 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 lenghten 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 on weight bearing for a few months after surgery.