Hip Replacement

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Preoperative Procedures

Before total hip replacement surgery, patients undergo a complete physical examination, a dental evaluation, and a number of tests (e.g., blood tests, chest x-ray, EKG, urinalysis). Patients who are overweight may be advised to lose weight to reduce the risk for complications during and after surgery. In some cases, patients are advised to donate blood prior to surgery in case a blood transfusion is necessary during the procedure.

Prior to surgery, patients should follow their health care provider's directions for eating, drinking, and taking medication. In most cases, patients are advised not to eat or drink after midnight the night before the procedure.

Postoperative Care

After surgery, patients are taken to the post-anesthesia care unit (PACU) and are closely monitored by the nursing staff until they are awake and coherent. Once the anesthesia wears off, the patient is transferred to his or her hospital room.

Following hip replacement surgery, patients usually remain in the hospital for 3 to 7 days. The length of recovery depends on the type of surgery performed (e.g., traditional, minimally invasive), the patient's overall health, and the success of rehabilitation.

After the procedure, patients must limit movement and the hip usually is braced in the correct position. In most cases, a drain is inserted near the incision site to excess drain fluid and patients continue to receive intravenous (i.e., through a vein; IV) fluids. Patients who experience difficulty urinating may have a catheter in place to drain the bladder. Prescription pain relievers are used to reduce discomfort.

Patients usually are required to do simple breathing or coughing exercises to reduce the risk for fluid in the lungs. Physical therapy often begins the day after surgery. Within 2 days, most patients are able to sit up, stand, and walk with assistance. Stitches (sutures) or staples are usually removed in about 2 weeks.

Complications

Advances in surgical methods have reduced the risks involved with total hip replacement. Studies have shown that this type of surgery is successful in more than 90% of cases; however, complications can occur. In some cases, the artificial hip becomes dislocated. This occurs because the prosthesis is smaller than the normal hip joint and the ball can come out of the socket if the hip is moved in a certain way (e.g., by sitting too low, crossing the legs, pulling the knees to the chest).

Other complications include the following:

• Blood clot
  
• Excessive bleeding (may require blood transfusion)
  
• Excessive bone growth around the prosthesis
  
• Infection
  
• Nerve damage
  
• Pulmonary embolism (blood clot that obstructs an artery in the lungs)
  
• Reaction to anesthesia
  

Following hip replacement surgery, inflammation can result when particles from the prosthesis wear off and are absorbed by surrounding tissue. Severe inflammation can result in further damage to the bone, which may cause the artificial parts to become loose. Inflammation is treated using anti-inflammatory medications. In some cases, revision surgery (i.e., replacement of the joint) is necessary.

Recovery

Following hip replacement surgery, patients may need help with everyday tasks, such as bathing and cooking, for a couple of weeks. Physical therapy can help patients strengthen muscles that support the artificial hip, and can teach proper techniques for bending, reaching, and sitting to reduce the risk for injury.

High-impact activities (e.g., jogging, basketball, tennis) usually are discouraged following total hip replacement because they increase the risk for damage to the artificial hip. Types of exercise that may be recommended include walking, swimming, and bicycling.

Following hip replacement surgery, patients are at increased risk for infection from bacteria that enter the bloodstream. Patients are advised to take antibiotics before dental procedures (e.g., cleaning) and surgical procedures.

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