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Whether you have just begun exploring treatment options or

have already decided with your orthopaedic surgeon to undergo
hip replacement surgery, this booklet will help you understand
the benefits and limitations of this orthopaedic treatment. You’ll
learn how a normal hip works and the causes of hip pain, what
to expect from hip replacement surgery, and what exercises and
activities will help restore your mobility and strength, and enable
you to return to everyday activities.

If your hip has been damaged by arthritis, a fracture, or other
conditions, common activities such as walking or getting in and
out of a chair may be painful and difficult. Your hip may be stiff
tiff
and it may be hard to put on your shoes and socks.
ocks. You may even
feel uncomfortable while resting.

P
If medications, changes in your everyda
everyday
ay activities, and the
t use
of walking aids such as a cane are nnot helpful, you may want to

M
eplacement surgery. By replacing
consider hip replacement eplacing your diseas
diseased hip
joint with an artificial joint, hip replace
ement surgery
replacement surg can relieve
your pain, increase motion, and help yyou ou gget back to enjoying
al, everyday activit
normal, activities.

First performed in 196
1960, hip replacement surgery is one of the
most important
impo surgical advances of the last century. Since
then, improvements
im in joint replacement surgical techniques and
technology have greatly increased the effectiveness of this surgery.
Today, more than 230,000 total hip replacements are performed
each year in the United States. Similar surgical procedures are
performed on other joints, including the knee, shoulder, and
elbow.

smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. E A thin. this membrane mbrane makes a small embrane L amount of fluid that lubricates and almostt eliminates friction in your hip joint. our hip work in harmony. P Normally. The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily. allowing you SA Acetabulum cetabulu Femoral head Femur Normal hip 3 . In a healthy hip. all of these parts to move easily and M rts of your d without pain.How the normal hip works The hip is one of your body’s largest weight-bearing joints. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

PL Traumatic arthritis. The ion articular cartilage becomess damaged and stiffness. Th aged and.Common causes of hip pain and loss of hip mobility The most common cause of chronic hip pain and disability is arthritis. This can follow a serious hip injury or fracture. Osteoarthritis. causes hip pain SAM Hip osteoarthritis 4 . rheumatoid arthritis. Osteoarthritis. This is an autoimmune disease in which the E synovial membrane becomes inflamed. the articular cartilage cushioning the bones of the hip wears away. It may be caused or accelerated by subtle irregularities in how the hip developed. Rheumatoid arthritis. causing hip pain and stiffness. leading g to pain and stiffness. In this form of the disease. over time. produces too much ch synovial ovial fluid. and damages the articular cartilage. and traumatic arthritis are the most common forms of this disease. A hip fracture can cause a condition on known as avascular necrosis. This usually occurs after age 50 and often in an individual with a family history of arthritis. The bones then rub against each other.

orthopaedic surgeons evaluate patients individually. Although many patients who undergo hip replacement surgery are age 60 to 80. E disability. our le S • You have littlee pain nflammatory drugs infl sulfate. your family. • Other treatments. your primary care doctor. n M • Hip p pain cont continues tinues while resting. L You may benefit from P hip replacement surgery if: • Hip pain limits yourr everyday yday activities. not solely on age. either day or night.Is hip replacement surgery for you? The decision whether to have hip replacement surgery should be a cooperative one between you. A • Stiffness tiffness in a hip hip limits l its your ability ab bility to move or lift your yo our leg. restin ng. 5 . activitie activities. such as walking ng or bending. don’t relieve hip pain. such as physical therapy or the use of a cane. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation. Recommendations for surgery are based on the extent of your pain. ulfat d n relief rre from anti- or glucosamine • You have harmful or unpleasant side effects from your hip medications.in. n. and general health status. and your orthopaedic surgeon.

• A physical on This will assess your hip’s mobility. and streng an alignment. scussed later in this b The orthopaedic icc evaluation evaluattion consists consissts of several components: • A medical history. blood tests or other tests. Your edicall history.. such as an magnetic resonance imaging (MRI) scan or a bone scan. Occasionally. also may be considered. may be needed to determine the condition of the bone and soft tissues of your hip. T These images help determine the extent of damage or deformity in your hip. These risks and complications are discussed iscussed booklet. d def • Other tests. hysiccal examination examinatio examination. edi Yo our oorthopaedic hopaedic surgeon will gat gath gather mation about your general infomation health ealth and ask questions gene al he q qu about the extent nt of your yo our hip painn and h ow it affects your ability to perform how everyday yd ac activities. Other treatment options. physical therapy. 6 . strength. or other types of surgery. nd align • X-rays. including ng g those related to the surgery itself and those that can occur over ver time after your surgery. Your orthopaedic surgeon will explain the potential riskss and complications of hip replacement surgery.The orthopaedic evaluation Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. activit ctivities. such as medications.

Following surgery. including jogging and high-impact sports. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. of the joint that could lead to dislocation. 7 . Medical evaluatio evaluation. contact your orthopaedic surgeon for a program to improve your skin before your surgery. you u may be aasked to have a complete physical by your primary care doct before your surgery. L You may be asked to avoid specific positions ion. an Even with normal use and activities. a cardiogram. However. This is needed to assess your health and find doctor conditions that could interfere with your surgery or recovery. chest x-rays. verweight. If either is present. Your orthopaedist or your primary care doctor will advise you about which medications you should stop or can continue taking before surgery. Tests. p S Preparing aring for surgery evaluation If you decide to have hip replacement surgery. hip replacement surgery will not enable you to do more than you could before your hip problem developed. It will be stored in case you need blood after surgery. Tell your orthopaedic surgeon about the medications you are taking. and urine samples may be needed to help plan your surgery.What to expect from hip replacement surgery An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and can’t do. Several tests such as blood samples. you will be advised to E avoid certain activities. Blood donations. esis) develops some wear artificial joint (prosthesis) over time. You may be advised to donate your own blood prior to surgery. Medications. tivities. P ctivities. Preparing your skin. If youou u participate in high-impact M activitiess or are overweight. for the rest of your life. on. Your skin should not have any infections or irritations before surgery. this wear may m ccelerate ate and cause the prosthesis to loo accelerate loosen A and become come painful.

ck. ck. and car • Removal of all loose carpets and electrical cords from the areas where you walk in your home 8 . two overy arms. The following items may help with daily activities: • Securely fastened safety bars or handrails in your shower or bath • Secure handrails along all E stairways • A stable chair hair air for your early recovery very with a firm back. Home modifications can make your return home easier during your recovery. and a firm seat se cushion hat allows your knees that kne to emain lower than your hips remain • A raised toilet seat • A stable show shower bench or chair bathing for bathi bath • A lo long-handled ong-hand ng-handled dled d spongee and sho sshower how hose • Addressing ressing essi stic stick. a sock aaid. sofas.Weight loss. and possibly decrease the risks of surgery. and a long-handled shoe horn for puttting on and putting nd taking off shoes and socks without excessively d ta tak nding your ben bending y new hip • A reacher that will allow you to grab objects without excessive bending of your hips • Firm pillows to sit on that keep your knees lower than your hips for your chairs. If you are overweight. Home planning. your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip.

P alone. and laundry. Individuals with a history of recent or frequent urinary infections. bathing. your surgeon’s office. A short stay in an extended care facility during duri durin M your recovery y also lso may be arranged. The anesthesia team will discuss these choices with you and help you decide which type of anesthesia is best for you. or a discharge planner at ial a the hospital can help you make advance arrangements to have someone assist you at your home. Routine cleaning of your teeth should be delayed for several weeks after surgery. a member of the common types of anesthesia for most co t the will evaluate you. you should consider getting treatment for significant dental diseases (including tooth extractions and periodontal work) before your hip replacement surgery. hing. you will need somee help for several weeks L with such tasks as cooking. Although you will be able to walk with th crutches or a walker soon after surgery. hospital on the day of your su surg Prior to admission. 9 . Because bacteria can enter the bloodstream during dental procedures. ome. E Social planning. The hip replacement surgery are general anesthesia (which puts you to sleep throughout the procedure and uses a machine to help you breathe) or spinal anesthesia (which allows you to breathe on your own but anesthetizes your body from the waist down). an infection can occur if bacteria enter your bloodstream.Dental evaluation. If you live athing. and older men with prostate disease should consider getting a urological evaluation before surgery. shopping. Urinary evaluation. Your surg surgery S h A You will ll most likely be admitted to th nesthesia team anesthesia surgery. a social al worker. Although infections after hip replacement are not common.

prosthesis and the rem 10 . and then position new metal. All of them consist of two basic components: compon compo the ball all component mponent (made of a highly polished strong m metal or ceramic me A material) durabl cup of plastic. Your orthopaedic surgeon will remove the damaged cartilage and bone. plastic. ceramic l) and the socket component (a durable or metal. or ceramic joint surfaces to restore the alignment and function of your hip.. met S be used to fill the gap between the Special surgical cement may b remaining natural bone to secure the artificial joint. PLE Individual total hip components Many different types Components merged into implant ypes of designs and materials are currently used in i M artificial hip joints. which may have an outer me metal shell).Surgical procedure The surgical procedure takes a few hours.

and malposition of the implants—that can contribute to the fe premature wear. less painful A recovery very and more rapid return to normal aacactivities. A combination of a cemented ball and a noncemented socket may be used. orthopaedic surgeons have been developing M new techniques. Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs. Your orthopaedic surgeon can talk to you about his or her experience with minimally invasive hip replacement surgery. more active patients with strong bone. dislocation. PL A special note about minimally hip replacement lly y invasive total to Over the past severall years. wound healing problems. but not yet proven. rapidly evolving area. infection. known as minimally invasive hip replacement su ssurgery. It is used most often in younger. appear to be at higher risk of problems. you will be taken to your E hospital room.A noncemented prosthesis has also been developed. Patients who have marked deformity of the joint. 11 . those who are heavy or muscular. which allows bone to grow into the prosthesis. After you awaken fully.. you will be moved to the recovery room where you will remain for 1 to 2 hours while your recovery from anesthesia is monitored. After surgery. S Minimally invasive and small incincision total hip replacement surgery is a incis While certain techniques have proven to be safe. fracture of th femur. It is incisio hoped. that this may allow for q quicker. and those who have other health problems. The prosthesis may be coated with textured metal or a special bone-like substance. and the possible risks and benefits of minimally invasive hip replacement surgery. and loosening of your hip replacement.es. Whil associated with an increased risk of complications—such others may be associa assoc as nerve and aartery injuries. for inserting rting total hip replacements through smaller incisi erting incisions. which can contribute to wound healing problems.

you will be asked to breathe deeply and cough frequently. ankle pump exercises. such as a V-shaped pillow placed between your legs. inflatable leg coverings. a positioning splint. Your orthopaedic surgeon will take this into account. in addition to other issues. L Most hip replacement patients begin standing ngg and walking with the help of a walking support and a physical therapist herapist the day after surgery. these complications can prolong or limit your full f recovery when they occur. after hip replacement surgery. S Major medical complications. Blood clots. 12 . M Possible ble complications after surgery A The complication mplication rate following hip replacement replacemen surgery is low. occur even less frequently. cchchronic illnesses may increase the potential for complications. Your orthopaedic surgeon may prescribe one or more measures to prevent blood clots from forming in your leg veins or becoming symptomatic. E Walking and light activity are important to your recovery and nd will be begin the day of or the day after your surgery.Your stay in the hospital You will usually stay in the hospital for a few days. you will feel pain in your hip. However. Leg-length inequality may occur. or may become or seem worse. Serious complications. Blood clots in the leg veins or pelvis are the most common Bloo Blo complication of hip replacement surgery. such as joint infection. such suc as heart attack or stroke. After surgery. Pain medication will be given to make you as comfortable as possible. occur lications. To avoid lung congestion after surgery. The P physical therapist will teach you ou specific exercises to strengthen your hip and restore movement for walking ng and other normal daily activities. may be used. occ oc in less than 2% of patients. including the stability and biomechanics of the hip. Leg-length inequality. These measures may include special support hose. and blood thinners. To protect your hip during early recovery. Some patients may feel more comfortable with a shoe lift after surgery. Although Altho uncommon.

bleeding. You will have stitches oro M staples running along your wound. Your program should also include specific exercises several times a day. Activity. and stiffness can occur. In a small number of patients. Exercise is a critical component of home care. Dislocation.Implant problems. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. nerve and blood vessel injury. bone loss may occur because of the small particles produced at the wearing surface. particularly during the first few weeks after surgery. This problem will likely be less common with newer materials and techniques. The stitches A or staples after aft surgery. You should resume normal household activities. to slowly increase your mobility and endurance. Be sure to drink plenty of fluids. initially in your home and later outside. the hip prosthesis may wear out or loosen. as well as sitting. some pain can continue. standing. often with an iron supplement. balanced diet. This process is called osteolysis. When the prosthesis wears out. Other complications. or a suture beneath your skin. Some discomfort with activity and at night is common for several weeks. Your activity program should include a graduated walking program. Your recovery at home E The success of your surgery will L depend in large measure on how well you follow your orthopaedic surgeon’s P instructions regarding home care during the first few weeks aree ks after surgery. fracture. 13 . clothing or support sst et Some loss of appetite is common for several weeks after surgery. Over years. and walking up and down stairs. A bandage age may be placed o over the wound to prevent irritation from ov stockings. is important to promote A ba b proper tissue healing and restore muscle strength. surge Wound care. Diet. es will be removed about 2 weeks afte S Avoid getting the wound wet unti until it has thoroughly sealed and dried. or new pain can occur after surgery.

ankle. SA Following your surgery. or swelling of the hip wound • Drainage from the hip wound • Increasing hip pain with both activity and rest Notify your doctor immediately if you develop any of these signs. tenderness.Avoiding problems after surgery Preventing blood clots. or foot  Warning signs that a blood clot has traveled to your lung include: PLE • Shortness of breath • Chest pain. you will need to dental work or any surgical p your bloodstream. which can occur during the first several weeks of your recovery. 14 . Follow your orthopaedic surgeon’s instructions carefully to minimize the potential risk of blood clots.  Warning signs of possible blood clots include: • Pain in your calf and leg.org). calf. following M hip replacement bloodstream ent surgery are from bacteria that enter the bloodst bloods duringg dental procedures. Warning signs of a possible hip replacement infection are: • • Increasing pain in your calf Persistent fever (higher than 100 degrees orally) • Shaking chills • Increasing redness. These bacteria acteria can lodge around your prosthesis. or o skin infections. A com the AAOS patient  p t take antibiotics before having procedure that could allow bacteria to enter proc complete discussion of this topic is available on eeducation Website (www. unrelated to your incision • Tenderness or redness of your calf • Swelling of your thigh. urinary tract infections. on. Thee most common causes of infection followin Preventing infection.orthoinfo. particularly with breathing reathing eathing Notify your doctor immediately iff you develop any of these signs.

flexibility. and may result in a need for more surgery. You should use a cane. PL Other precautions To assure proper recovery ry and prevent revent dislocation of the prosthesis. Stairs are a particular hazard until your hip is strong and mobile. a walker. Your surgeon and physical therapist will w M give you more instructions nstructions prior to your discharge from the hhospital. or have someone help you until you improve your balance. crutches. and strength. and when those aids can an safel safely be discontinued. you must take special precautions. or handrails.Avoiding falls. A fall during the first few weeks after surgery can damage your new hip.  A Special precautions include: • Do not cross your legs S • Do not bend yyo your hips more than a right angle (90 0 degrees) degre deg • Do not turn your feet excessively inward or outward ✓ Additional guidelines include: • Use a pillow between your legs at night when sleeping until you are advised by your orthopaedic surgeon that you can remove it • Follow your surgeon’s instructions closely 15 . Your surgeon and physical therapist will help you decide which assistive ssistive E aids will be required following surgery.

How your new hip is different You may feel some numbness in the skin around your incision. even if your hip replacement seems to be doing fine. These differences often diminish with time. You may ask your orthopaedic surgeon for a card confirming that you have an artificial hip. make sure you also do the following: ing: g L • Participate in a regular light exercise program to maintain proper strength and mobility of yourr new hip. • See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays. 16 . Individuals injuries. E After surgery. Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. • Take ke spe special ecial precau precautions precauti utions to av id falls and o avoid njuriies. You will need to take antibiotics before any dental or surgical procedure to prevent possible infection. • Tel Tell your dentist that you have had a hip replacement. and most patients find these are minor compared to the pain and limited function they experienced prior to surgery. Individua who havve undergone ho have undergonne hip replacement replacem placcement ment surgery and an suffer uff a fracture may fracture ma m y qu e more require m moor surgery. You also may feel some stiffness. particularly with excessive bending.

However it does not represent epresent official policy of the Academy and it its text should ld not be construed aas excluding xcluding other acc acceptable viewpoints. © 2009 American Academy of Orthopaedic Surgeons . However.Your orthopaedic surgeon is a medical specialist with extensive education and experience in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system. including bones. muscles. ligaments. tendons. This brochure has been prepared by the American Academy Ac of Orthopaedic Surgeons and is intended to contain curre current information on the subject from om recognized authorities. and nerves. joints.

Return your foot to the floor. Hold for 2 or 3 your knee A S counts and put your leg down. As your thigh muscle tightens. Continue until your thigh feels physical therapist may recommend that you exercise approximately 20 to 30 minutes fatigued. ery It Standing exercises E L may feel uncomfortable at first. and walk 30 minutes. Do not lift lif continue ontinue until you are fully recovered. nee higher than your waist. supervised by your therapist and orthopaedic surgeon. Slowly lower knee and keeping your heel on the bed. . Ankle Rotations inward toward your other foot and Move your ankle in inw S then outward away from your other foot. L P because you may become dizzy the first several times you ou stand. This Standing anding ding Knee Raises M A xercise can begin immediately after surgery aand exercise Lift your ur operated leg toward your chest. Repeat 5 times in tim i each direction three or four times a day. P are holding on to a firm surface such as a bar attached to your bed o or a wall. bending your straight. Regular exercise to restore your knee mobility and strength. As you regain your strength. blood clots. your knee roll inward. Your orthopaedic surgeon and during a 10-minute period. but these exercises will speed your recoveryy and reduce red redu Soon after your surgery. and foot are pointing straight Bed-Supported Knee Bends forward. Keep your body straight. Standing Hip Abduction Repeat the following followin three exercises 10 times. M Ankle Pumpsmps ps Repeat the following exercisess 10 times. These exercises should be done as you lie on your back with h your legs spread th sprea you will be able to stand independently. Try to keep your back straight. Buttock Contractions Tighten buttock muscles and hold to a count of 5. s. you will be out of bed and able to stand. Standing Hip Extensions Lift your operated leg backward slowly. three or four times a day Be sure your hip. three or four times a day Slowly ly push your foot up and down. two or three times a day during your early recovery. lift your leg out to the side. Tighten your thigh muscle with your knee fully straightened on the bed. Do this exercise wly several veral times as often as every 5 or 10 minutes. make sure you slightly apart. While doing these standing exercises. and a gradual return to Hold for 5 to 10 seconds. Repeat this exercise 10 times everyday activities are important for your full recovery. Hold for 5 to 10 seconds. They also are important to strengthen muscles and to improve your hip movement. Hold for 2 or 3 Abduction Exercise counts. two or three times a day. Do not let your leg so your foot is back on the floor.Exercise and Activity Guide Quad Set Tighten your thigh muscle. Slowly lower your leg. You will require help and. nd. The following guide can help you better understand your exercise/activity Straight Leg Raises program. With your knee Slide your heel toward your buttocks. Repeat until your thigh E These exercises are important for increasing circulation to your legs and feet to prevent feels fatigued. You may begin these exercises in the recovery room shortly after surgery. Try to straighten your knee. your postoperative pain. Slide your leg out to the side as far as you can and then back. Early postoperative exercises lift your leg several inches off the bed. knee.

Always lead Exercycling. rned. Then move forward. and you will only be able to go one step at a time. you can walk for 20 to 30 minutes. Alloww its previous position. two handrail for balance. you will need a handrail for support. try to climb steps higher than those of the In the beginning. you will put more and more weight ly. Do not Walking. Don’t hurry. Gradually. walk 5 to 10 minutes. The regain strength and movement. Once you have fully recovered. Adjust the seat height so that the bottom of your foot just touches the pedal with the stairs with your operated leg. A A walker is often used for thee first several weeks to help your balance and to avoid falls. Take a cane with you until you have regained your balance skills. As you complete the E L step. then n flatten your y Stand with your feet Stand and nd sideways from the L P foot. Exercycling is an excellent activity to help you regain muscle strength and hip up the stairs with your good leg and down mobility. Use the cane or crutch in the hand opposite the opoperated hip. Move the walker again and your knee and hip p will Resistive Hip Flexion Resistivee Hip Abducti Abduction again reach forward for your next step. bal Face the door or heavy object to S when your weight is placed fully on both feet. osition. Pedal forward only after comfortable “up with the good” and “down with the bad. You may want to have someone help you slowly increase the tension on the exercycle. Remember. Try to walk as smoothly as you can. four times a day. and when you are no longer leaning on your attached and which the tubing is attac attach hands while using your wal walker. then lift your toes off the floor. gradually building up to 20 to 30 minutes. three to four times a week. Bring door an and extend your your operated leg operated leg out to the side. allow your toe to lift off the floor. As your muscle uscle scle strength and endurance P forward keeping the Allow your leg to return to improve. These exercises should be done in sets of 10 repetitions. you will begin to walk short distances in your hospital room and perform A full recovery will take many months. following exercises and activities will help your hip muscles recover fully. As your standard height of 7 inches and always use the strength and endurance improves.Exercise and Activity Guide Walking and early activity Advanced exercises and activities Soon after surgery. . The pain from your problem hip before your light everyday activities. we M knee straight. As you move. lifting your for balance. Exercycle forward 10 to 15 minutes twice a until you have regained most of your strength day. Remember your knee almost straight.” cycling motion is possible backwards. As you become stronger (at about 4 to 6 weeks). touch your heel fi rst. y. ffa A cane or a crutch is then en used aand balance sed for several more weeks until your full strength an A S skills have returned. ned. three or four times a day. pos posit Stair Climbing and Descending The ability to go up and down stairs requires both flexibility and strength. a stationary object. At first. Hold on to a chair or bar Move your walker or crutches forward a short distance. your leg to return eturn to its M Walking with Cane or Crutch previous ious position. regular walks of 20 to 30 minutes. your knee Elastic Tube Exercises and ankle will bend and your entire foot will rest evenly on the floor. E operated leg so that the heel of your foot will touch the floor first. with one end of the tubing Walking with Walker/Full Weight-Bearing around the ankle of your operated leg and the opposite end of the tubing attached to Stand comfortably and erect with your weight evenly balanced on your walker or crutches. such as a locked door or heavy furniture. This early activity helps your recovery by helping your hip muscles surgery and the pain and swelling after surgery have weakened your hip muscles. three or four times a week. will help maintain your strength. on your leg. or three times a day. You are Resistive Hip Extensions ready too use a cane ane or single crutch when you can stand and babalance without your walker. Stair climbing is an excellent strengthening and endurance activity. slightly apart. straight back. Pedal backwards at fi rst. you may spend more time walking. and mobility. Allow pull your leg straig strai your leg to return r to its previous position.