1

Case 10: Hip Replacement Surgery

60-year-old man, with arthritis of right hip. Wants to get total hip replacement. Wanted it last
year but the GP said the symptoms weren’t bad enough.
Tasks: Take history.
Explain in general terms the process of total hip replacement, its risks and benefits.
Hello, I am Dr…. I can see from the note that you are interested to get hip replacement. Can I ask
you few questions regarding that?

History:

I can see that you have arthritis in the right hip.

Well controlled questions of Osteoarthritis-

§ Since when you have been diagnosed with arthritis?
§ Are you taking any medication for that?
§ Have you done any physiotherapy for improving your condition? Like Stretching,
strengthening exercises?
§ Are you in regular check up with your specialist regarding arthritis?
§ How well controlled is your arthritis?

Osteoarthritis symptoms questions-

§ Do you have any symptoms now?

§ Like pain, restriction of movement or stiffness in the joint?
§ Pain Questions- SORTSARA/SIQORRA (Site, Intensity, Quality, Onset, Radiation,
Relieving, Aggravating factors of pain) (Pain for 1 year)
§ Any joint swelling or tenderness?
§ Any locking/ sticking feeling in the joint with movement?
§ Do you hear a grinding noise (crepitus) in the joint with movement?
§ Any Limping? Do you use cane for walking? (Limping +ve)
• How is it affecting your life? Does your hip pain limits your everyday activities like walking,
bending? (Has some problem taking the dog to the park for a walk, Daily life is affected)

Associated Symptoms:

§ Any fever, rash?

§ Any LOW, LOA, Lumps and bumps anywhere in the body?

Risk factors for osteoarthritis questions-

§ Do you consider your weight to be overweight?

§ What is your occupation?
§ Any positive family H/O Osteoarthritis?
§ Do you do any activities that involves overactive hip movements?

Questions for indications of hip replacement surgery-

• Do you have pain even after taking pain medication, physiotherapy or walking support?
• Does it get worse with walking, even with a cane or walker?

Dr. Anika Hossain’s Note

 2

• Does your hip pain continue while resting, either day or night?
• Do you have stiffness in the hip that limits your ability to move or lift the leg?
• Does it interfere with your sleep? Sleep disturbances?
• Does it make difficult for you to get dressed?
• Does it affect your ability to go up or down stairs?
• Do you have difficulty to rise from a seated position?

Complications of osteoarthritis questions-

§ Any tingling, numbness weakness in the legs? (Pinched nerve)

§ How is your mood? Do you still enjoy things that you used to enjoy before? (depression)
§ Do you experience recurrent fall?

General Questions-

§ SADMA (smoking, alcohol positive)

§ Family situation? Do you live alone? (Lives with wife)
§ Past Medical and surgical History?

PEFE card-gait antalgic, restricted movement all direction

Process of hip replacement surgery:

Hip replacement surgery is one of the most successful operations in all of medicine.
Anatomy:

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by
the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the
upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue
that cushions the ends of the bones and enables them to move easily.

A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this
membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all
friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide
stability to the joint.

Description:
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage
is removed and replaced with prosthetic components.

The damaged femoral head is removed and replaced with a metal stem that is placed into the
hollow centre of the femur. The femoral stem may be either cemented or "press fit" into the
bone.
A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged
femoral head that was removed.
The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a
metal socket. Screws or cement are sometimes used to hold the socket in place.

Dr. Anika Hossain’s Note

 3

A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for
a smooth gliding surface.

We will order some blood tests and an X-ray for you before surgery. The surgical procedure
usually takes from 1 to 2 hours. You'll be given either a spinal block, which numbs the lower half
of your body, or a general anesthetic. After, surgery you will be moved to the recovery room
where you will remain for several hours while your recovery from anaesthesia is monitored.
After you wake up, you will be taken to your hospital room. You will likely stay in the hospital
for four to six days and may have to stay in bed with a wedge-shaped cushion between your legs to
keep the new hip joint in place. A tube will likely be placed in your bladder to help you go to the
bathroom. Physical therapy usually begins the day after surgery and within days you can walk with
a walker, crutches, or a cane. You will continue physical therapy for weeks to months following the
surgery.

Risks of surgery:

The complication rate following hip replacement surgery is low. Serious complications, such
as joint infection, occur in less than 2% of patients. Major medical complications, such as
heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the
potential for complications. Although uncommon, when these complications occur, they can
prolong or limit full recovery. The orthopaedic surgeon and the team will take every measure
to prevent the complications from happening.
Infection may occur superficially in the wound or deep around the prosthesis. It may happen within
days or weeks of surgery. It may even occur years later.
Blood Clots in the leg veins or pelvis are one of the most common complications of hip replacement
surgery. These clots can be life-threatening if they break free and travel to your lungs.
Leg-length Inequality happens sometimes after a hip replacement, one leg may feel longer or shorter
than the other.
Dislocation occurs when the ball comes out of the socket. The risk for dislocation is greatest in
the first few months after surgery while the tissues are healing. Dislocation is uncommon.

Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity.
Other Complications could be nerve and blood vessel injury, bleeding, fracture, and stiffness can
occur. A small number of patients continue to experience pain after surgery.

Benefits of surgery:

Hip replacement surgery is a safe and effective procedure that can relieve your pain. Freedom
from pain is often the main benefit of surgery. Increase motion and getting back to enjoying
normal, everyday activities are other benefits. Most people who have hip replacements notice an
improvement in their overall quality of life and mobility. Although a hip replacement may not give
quite as much mobility as a healthy natural hip joint. You may find it easier to move simply because
there’s less pain.

You will probably experience much more benefit if you take physical therapy and do exercises
recommended for you.

Dr. Anika Hossain’s Note

 4

28th April 21

PILOT 1 – Total hip replacement counselling

60-year-old man, with arthritis of right hip. Wants to get total hip replacement. Wanted it last year
but the GP said the symptoms weren’t bad enough.
Tasks: Take history.
Explain in general terms the process of total hip replacement, its risks and benefits.
Otherwise, healthy man with painful hip. Getting worse. Disturbing his lifestyle.
Even though I didn’t really know much about total hip replacement, this one was somehow an easy
one to explain. I didn’t know the prosthesis was made of metal, but I explained about how we
remove both the ball and the socket and use artificial ones instead. Risks of anaesthesia, surgery,
post-op. Benefits of better mobility.
28th April 21 Another Feedback

PILOTS
HIP REPLACEMENT

60-year-old man, with arthritis of right hip. Wants to get total hip replacement.
Wanted it last year but the GP said the symptoms weren’t bad enough.
Tasks: Take history.
Explain in general terms the process of total hip replacement, its risks and benefits.

Hx, PEFE card-gait antalgic, restricted movement all direction

Has some problem taking the dog to the park for a walk

Daily life is affected

Limps

Pain since 1 year

Lives with wife

[don’t need to tell technical part of hip replacement]

smoking, alcohol positive

I told him we use implants and replace the joint , it is a long procedure that requires
hospitalisation for prolonged period of time, has infection risk, bleeding, blood clot
formation,
and longer time for recovery
Pros are you will be good to go for ten twenty yrs and will be followed up

Dr. Anika Hossain’s Note

 5

Reading Material:
https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
https://www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042
https://www.webmd.com/arthritis/hip-replacement-surgery

https://www.versusarthritis.org/about-arthritis/treatments/surgery/hip-replacement-surgery/

https://www.orthobethesda.com/blog/8-signs-to-know-if-you-need-hip-replacement-surgery/
When it is recommended:
• Hip pain that limits everyday activities, such as walking or bending
• Hip pain that continues while resting, either day or night
• Stiffness in a hip that limits the ability to move or lift the leg
• Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking
supports
You might consider hip replacement if you have hip pain that:

§ Persists, despite pain medication

§ Worsens with walking, even with a cane or walker

§ Interferes with your sleep

§ Makes it difficult to get dressed

§ Affects your ability to go up or down stairs

§ Makes it difficult to rise from a seated position

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, and it may be hard to put on your shoes and socks. You may even feel uncomfortable
while resting.

If medications, changes in your everyday activities, and the use of walking supports do not
adequately help your symptoms, you may consider hip replacement surgery. Hip replacement
surgery is a safe and effective procedure that can relieve your pain, increase motion, and help
you get back to enjoying normal, everyday activities.

Hip replacement surgery is one of the most successful operations in all of medicine. Since the
early 1960s, improvements in joint replacement surgical techniques and technology have
greatly increased the effectiveness of total hip replacement.

Recommendations for surgery are based on a patient's pain and disability, not age. Most
patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons
evaluate patients individually. Total hip replacements have been performed successfully at all
ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative
arthritis.

Dr. Anika Hossain’s Note

 6

Anatomy:

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by
the acetabulum, which is part of the pelvis bone. The ball is the femoral head, which is the
upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue
that cushions the ends of the bones and enables them to move easily.

A thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, this
membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all
friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide
stability to the joint.

Description
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage
is removed and replaced with prosthetic components.
§ The damaged femoral head is removed and replaced with a metal stem that is placed into
the hollow centre of the femur. The femoral stem may be either cemented or "press fit" into
the bone.
§ A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the
damaged femoral head that was removed.
§ The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a
metal socket. Screws or cement are sometimes used to hold the socket in place.
§ A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow
for a smooth gliding surface

Procedure
The surgical procedure usually takes from 1 to 2 hours. Your orthopaedic surgeon will remove
the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to
restore the alignment and function of your hip.
After surgery, you will be moved to the recovery room where you will remain for several hours
while your recovery from anaesthesia is monitored. After you wake up, you will be taken to
your hospital room or discharged to home.

The Orthopaedic Evaluation

An evaluation with an orthopaedic surgeon consists of several components.
• Medical history. Your orthopaedic surgeon will gather information about your general
health and ask questions about the extent of your hip pain and how it affects your ability
to perform everyday activities.
• Physical examination. This will assess hip mobility, strength, and alignment.
• X-rays. These images help to determine the extent of damage or deformity in your hip.
• Other tests. Occasionally other tests, such as a magnetic resonance imaging (MRI) scan,
may be needed to determine the condition of the bone and soft tissues of your hip.

Dr. Anika Hossain’s Note

 7

Possible Complications of Surgery

The complication rate following hip replacement surgery is low. Serious complications, such
as joint infection, occur in less than 2% of patients. Major medical complications, such as
heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the
potential for complications. Although uncommon, when these complications occur they can
prolong or limit full recovery.
Infection
Infection may occur superficially in the wound or deep around the prosthesis. It may happen
within days or weeks of surgery. It may even occur years later.

Minor infections of the wound are generally treated with antibiotics. Major or deep infections
may require more surgery and removal of the prosthesis. Any infection in your body can
spread to your joint replacement.

Blood Clots
Blood clots in the leg veins or pelvis are one of the most common complications of hip
replacement surgery. These clots can be life-threatening if they break free and travel to your
lungs. Your orthopaedic surgeon will outline a prevention program which may include blood
thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early
mobilization.

Leg-length Inequality
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your
orthopaedic surgeon will make every effort to make your leg lengths even but may lengthen or
shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some
patients may feel more comfortable with a shoe lift after surgery.

Dislocation

This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the
first few months after surgery while the tissues are healing. Dislocation is uncommon. If the
ball does come out of the socket, a closed reduction usually can put it back into place without
the need for more surgery. In situations in which the hip continues to dislocate, further
surgery may be necessary.

Loosening and Implant Wear

Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It
can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a
second surgery called a revision may be necessary.

Other Complications
Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. A small number of
patients continue to experience pain after surgery.

Dr. Anika Hossain’s Note

 8

How Your New Hip Is Different

You may feel some numbness in the skin around your incision. You also may feel some
stiffness, particularly with excessive bending. These differences often diminish with time, and
most patients find these are minor compared with the pain and limited function they
experienced prior to 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.

Protecting Your Hip Replacement

There are many things you can do to protect your hip replacement and extend the life of your hip
implant.
• Participate in a regular light exercise program to maintain proper strength and mobility of your
new hip.
• Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may
require more surgery.
• Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic
surgeon about whether you need to take antibiotics prior to dental procedures.
• See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if
your hip replacement seems to be doing fine.

Advantages/Benefits of the surgery:

Most people who have hip replacements notice an improvement in their overall quality of life and
mobility.
Freedom from pain is often the main benefit of surgery. You should expect to have some pain from
the surgery to begin with, but you’ll be given medication to help with this. Pain from the surgery
itself should start to ease within the first two weeks after the operation. However, some people will
have longer-term pain, and, in some cases, this may need further treatment.

You can expect to have some improvement in mobility as well, although a hip replacement may not
give quite as much mobility as a healthy natural hip joint. You may find it easier to move simply
because there’s less pain. But you’ll probably have a greater improvement if you take an active part
in your recovery – for example, by regularly doing the exercises recommended for you.

Some people find that one leg feels longer than the other after the operation. Sometimes this may be
because you’ve become used to walking in a way that eases the load on your painful hip. If this is the
case, physiotherapy should help. If there is a real difference in leg length, this may need to be
corrected with a shoe insert or insole.

What Happens After Hip Replacement Surgery?

You will likely stay in the hospital for four to six days and may have to stay in bed with a wedge-
shaped cushion between your legs to keep the new hip joint in place. A drainage tube will likely be
placed in your bladder to help you go to the bathroom. Physical therapy usually begins the day after
surgery and within days you can walk with a walker, crutches, or a cane. You will continue physical
therapy for weeks to months following the surgery.

Dr. Anika Hossain’s Note

 9

What Activities Should I Avoid After Hip Replacement Surgery?

For anywhere from six to 12 months after hip replacement surgery, pivoting or twisting on the
involved leg should be avoided. You should also not cross the involved leg past the midline of the
body nor turn the involved leg inward and you should not bend at the hip past 90 degrees. This
includes both bending forward at the waist and squatting.
Your physical therapist will provide you with techniques and adaptive equipment that will help you
follow any of the above guidelines and precautions while performing daily activities. Remember, by
not following your therapist's recommendations you could dislocate your newly replaced hip joint
and may require another surgery.
Even after your hip joint has healed, certain sports or heavy activity should be avoided. The
replacement joint is designed for usual day-to-day activity.

What Can I Do at Home After Hip Replacement Surgery?

There are a few simple measures that you can take to make life easier when you return home after
hip replacement surgery, including:
There are a few simple measures that you can take to make life easier when you return home after hip
replacement surgery, including:

• Keep stair climbing to a minimum. Make the necessary arrangements so that you will only have
to go up and down the steps once or twice a day.
• Sit in a firm, straight-back chair. Recliners should not be used.
• To help avoid falls, remove all throw rugs and keep floors and rooms clutter free.
• Use an elevated toilet seat. This will help keep you from bending too far at the hips.
• Keep enthusiastic pets away until you have healed completely.

Recovery After the operation

When you leave the operating theatre, you’ll be given any fluids and drugs you need through a tube
and a needle in your arm, sometimes called a drip. You may also have plastic tubes in your hip to
drain away any fluid produced as your body heals.
You’ll be taken to a recovery room or a high-care unit until you’re fully awake and your general
condition is stable. Then you’ll be taken back to a ward, which may be a different one from the
admission ward, often with a pad or pillow strapped between your legs to keep them apart.
You’ll need painkillers to help reduce pain as the anaesthetic wears off. These may include:
• painkilling liquids or tablets to swallow
• a local anaesthetic given around the joint during the operation
• patient-controlled analgesia (PCA) – a system where you can control your own supply of
painkiller going into a vein by pressing a button
• a nerve block injection or epidural.
The hospital team will try to get you walking as soon as possible, often on the same day as your
operation. To begin with, you’ll be using a walking frame, followed by elbow crutches or sticks.
The drip and any drains are usually removed within 24 hours.

Physiotherapy and occupational therapy

A physiotherapist will see you in hospital after the operation to help get you moving and advise you
on exercises to strengthen your muscles. They’ll also help you to learn how to walk on your crutches
and use stairs safely before you go home.

Dr. Anika Hossain’s Note

 10

A physiotherapist or an occupational therapist may offer advice on how best to get in and out of a
bed, a chair, the shower etc. They may also offer advice on things to avoid.
Before you leave hospital, an occupational therapist will assess your physical ability and your
situation at home, and they may arrange special equipment for you, such as a raised toilet seat or
gadgets to help you dress.

Going home
How soon you can go home depends on how well the wound is healing and whether you’ll be able
to get about safely. Most people will be ready to leave hospital within four to eight days.
If the surgeon feels it’s right for you, they may include you in an enhanced recovery programme
(ERP). The enhanced recovery programme focuses on making sure you take an active part in your
own recovery. It aims to get you walking and moving within 12–18 hours and home within one to
three days.
Once you’re back at home you’ll have a routine check-up, usually six to 12 weeks after the
operation, to make sure your recovery is going well. You may also be offered follow-up
physiotherapy if your doctors feel that this will help your recovery.
The district nurse will change your bandages and take out any stitches. If you have any problems
with your wound healing, then you should tell the hospital staff straight away.
If you were told to stop taking or change the dose of any of your regular drugs before the operation,
ask your healthcare team when you should restart your medication.

Looking after your new hip joint

You need to take care, especially during the first eight to 12 weeks after the operation, to avoid
dislocating the hip. You may not be able to bend your leg towards your body as far as you’d like to.
Your therapist will advise you about any movements that you need to take special care with. Don’t
be tempted to test your new joint to see how far it will go.
However, it’s important to continue with the programme of muscle-strengthening exercises
recommended by your physiotherapist.

Getting back to normal

How quickly you get back to normal depends on many different things including your age, your
general health, the strength of your muscles and the condition of your other joints.
You may need to sleep on your back at first, with a pillow or support between your legs to keep
them stable. You may need a walking aid for the first few weeks, but this varies from one person to
another. Your surgeon or physiotherapist will be able to advise how well you’re progressing.

Driving
You can expect to drive again after about six weeks, as long as you can safely control the vehicle
and do an emergency stop. It’s important to check with your insurance company whether you’re
covered during your recovery, and you need to be sure that you can safely control the vehicle in all
situations.
Getting in and out of a car can be difficult – your therapist may suggest sitting sideways on the seat
first and then swinging both your legs around together. Some people put a plastic bag on the car
seat to make it easier to swivel round.

Working
You could return to work after about six weeks if you have a job that doesn’t involve too much
moving around. If you have a job that involves a lot of walking, you may need three months or

Dr. Anika Hossain’s Note

 11

more to fully recover before returning to work. If you have a very heavy manual labour job, then
you may want to think about changing to lighter duties.
Sex
You’ll probably be able to have sex after about six to eight weeks. Many people find it more
comfortable to lie on their back when having sex, but don’t feel awkward about asking for advice on
suitable positions.

What about sport and exercise?

Regular exercise will help with your recovery. Walking is fine, and so is swimming once your
wound has been checked and is healing well. Cycling is also good, though it may be difficult at first
to get on and off the bike. Dancing or sports like golf or bowls that involve bending or twisting at
the hip may also be difficult at first but should be fine after about three months.
Some surgeons and therapists suggest avoiding extreme hip movements and activities with a high
risk of falling, such as skiing. Others may advise against running on hard surfaces, jumping, or
sports that involve sudden turns or impacts, such as squash or tennis. If in doubt, ask your surgeon
or physiotherapist for advice.

Avoiding Problems After Surgery

Recognizing the Signs of a Blood Clot

Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots
developing during the first several weeks of your recovery. He or she may recommend that you
continue taking the blood thinning medication you started in the hospital. Notify your doctor
immediately if you develop any of the following warning signs.

Warning signs of blood clots. The warning signs of possible blood clot in your leg include:

• Pain in your calf and leg that is unrelated to your incision

• Tenderness or redness of your calf
• New or increasing swelling of your thigh, calf, ankle, or foot
Warning signs of pulmonary embolism. The warning signs that a blood clot has travelled to your
lung include:
• Sudden shortness of breath
• Sudden onset of chest pain
• Localized chest pain with coughing

Preventing Infection
A common cause of infection following hip replacement surgery is from bacteria that enter the
bloodstream during dental procedures, urinary tract infections, or skin infections. Following
surgery, patients with certain risk factors may need to take antibiotics prior to dental work,
including dental cleanings, or before any surgical procedure that could allow bacteria to enter your
bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics
before dental procedures is needed in your situation.

Warning signs of infection. Notify your doctor immediately if you develop any of the following
signs of a possible hip replacement infection:

• Persistent fever (higher than 100°F orally)

• Chills
• Increasing redness, tenderness, or swelling of the hip wound

Dr. Anika Hossain’s Note

 12

• Drainage from the hip wound

• Increasing hip pain with both activity and rest
Avoiding Falls
A fall during the first few weeks after surgery can damage your new hip and may result in a need for
more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a
cane, crutches, a walker, or handrails or have someone help you until you improve your balance,
flexibility, and strength.

Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be
required following surgery, and when those aides can safely be discontinued.

Other Precautions
To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take
special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery.
These precautions will vary from patient to patient, depending on the surgical approach your
surgeon used to perform your hip replacement.

Your surgeon and physical therapist will provide you with any specific precautions you should
follow.

Why Hip replacement surgery is done

Conditions that can damage the hip joint, sometimes making hip replacement surgery necessary,
include:

§ Osteoarthritis. Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick

cartilage that covers the ends of bones and helps joints move smoothly.
§ Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces
a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in
damaged and deformed joints.
§ Osteonecrosis. If there isn't enough blood supplied to the ball portion of the hip joint, such as
might result from a dislocation or fracture, the bone might collapse and deform.

Procedure:

§ Before surgery you'll meet with your orthopedic surgeon for an exam. The surgeon will:
§ Ask about your medical history and current medications
§ Examine your hip, paying attention to the range of motion in your joint and the strength of the
surrounding muscles
§ Order blood tests, and an X-ray. An MRI is rarely needed
§ You'll be given either a spinal block, which numbs the lower half of your body, or a general
anesthetic.Your surgeon might also give you a nerve block by injecting an anesthetic around
nerves or in and around the joint to help block pain after your surgery.
§ The surgical procedure takes a few hours. To perform a hip replacement, your surgeon:
§ Makes an incision over the front or side of your hip, through the layers of tissue
§ Removes diseased and damaged bone and cartilage, leaving healthy bone intact
§ Implants the prosthetic socket into your pelvic bone, to replace the damaged socket
§ Replaces the round ball on the top of your femur with the prosthetic ball, which is attached to a
stem that fits into your thighbone

Dr. Anika Hossain’s Note

 13

After the procedure

§ After surgery, you'll be moved to a recovery area for a few hours while your anesthesia wears off.
Medical staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your
need for medications.
§ Some people can go home the same day, while others may need to stay a day or two in the
hospital. You’ll be asked to breathe deeply, cough or blow into a device to help keep fluid out of
your lungs.
§ Cushion. between your legs to keep the new hip joint in place.
§ A drainage tube will likely be placed in your bladder to help you go to the bathroom.
§ Moving early. You'll be encouraged to sit up and walk with crutches or a walker soon after
surgery. This will likely happen the same day as your surgery or on the next day.
§ Applying pressure. Both during and after surgery, you might wear elastic compression stockings
or inflatable air sleeves similar to a blood pressure cuff on your lower legs. The pressure exerted
by the inflated sleeves helps keep blood from pooling in the leg veins, reducing the chance that
clots will form.
§ Blood-thinning medication. Your surgeon might prescribe an injected or oral blood thinner
after surgery. Depending on how soon you walk, how active you are and your overall risk of
blood clots, you might need blood thinners for several weeks after surgery.

Physical therapy.

Home recovery and follow-up care

§ Before you leave the hospital, you and your caregivers will get tips on caring for your new hip.
For a smooth transition:
§ Arrange to have a friend or relative prepare some meals for you
§ Place everyday items at waist level, so you won't have to bend down or reach up
§ Consider making some modifications to your home, such as getting a raised toilet seat if you
have an usually low toilet
§ Put things you need, such as your phone, tissues, TV remote, medicine and books near the area
where you'll be spending most of your time during recovery
§ 6 to 12 weeks after surgery, you'll have a follow-up appointment with your surgeon to make sure
your hip is healing properly. If recovery is progressing well, most people resume at least some
version of their normal activities by this time. Further recovery with improving strength will
often occur for six to 12 months.

Dr. Anika Hossain’s Note