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Total Hip Replacement Surgery

Replacing the worn out ball and socket joint of the hip with a metal stem/ball and socket. This is done to relieve the pain associated with arthritis of the hip. These components are fixed to your body with bone ingrowth or cement fixation. The type of fixation is determined by your bone quality, activity level, and weight. The procedure is done as an inpatient requiring a hospital stay of 2 to 4 days. The procedure takes approximately 60 to 90 minutes to perform. It is done through an incision which is as small as possible to allow adequate visualization for your surgery. A walker or crutches are used for approximately 2 to 4 weeks, then a cane for 1 to 3 weeks. Ninety to 95 percent of patients are happy with the results after surgery.

What is the Process?

  • Make the decision to have surgery.
  • Pick a date for your procedure.
  • Pre-op medical evaluation with a primary care physician and consults as needed.
  • Pre-op labs and tests within 3 weeks of surgery.
  • Attend informational seminar at the Center for Joint Replacement.
  • Donate blood as indicated 3-4 weeks prior to surgery.
  • Arrange for family and/or friends to assist you after you go home from the hospital.

The Day of Surgery

What to Bring

  • Walking shoes with rubber soles or tennis shoes. No house slippers.
  • Pen and pad of paper to write down questions you may have.
  • Personal care items.
  • Women: Gowns and robes; knee length only. Bring panties. May wear shorts, sweatpants, and T-shirts, or a hospital gown with a robe, if you prefer.
  • Men: Short pajamas or exercise shorts and T-shirts. May prefer hospital gown with a robe. Bring underwear.
  • Do not bring over $5.00 or jewelry, credit cards or other valuables.

Report to

The outpatient surgery area of the hospital at the time designated on your surgery checklist. A nurse will review your medical history.

The Preoperative Area

You will meet the anesthesiologist, and he/she will discuss the type of anesthesia to be used. There are two options: A spinal anesthetic, which numbs you from the waist down. Sedation will also be given with a spinal, so you won’t hear the sounds of surgery. The other form is a general anesthetic, which involves a breathing tube placed through your mouth.

You will be dressed in a hospital gown, and an IV will be started in your arm. You will receive a preop dose of antibiotics. Your family/friends may wait with you, until you are taken to the Operating Room.

Arrival at the Center for Joint Replacement

  • After you spend 1-2 hours in the Recovery Room, you will be transferred to the Center for Joint Replacement, where your family and friends can visit you.
  • The nurses will check your vital signs and pain control. If you are uncomfortable or have nausea, medications will be given to help.
  • A therapist will evaluate you and begin therapy, including sitting, standing, and walking. Patients who return to the Joint Center in the late afternoon will begin therapy the next morning.

The staff at the Center for Joint Replacement specialize in the care of patients with joint replacement surgery. They will make sure your recovery goes as smoothly as possible.

Waking Up After Surgery

You will wake up in the Recovery Room, and then will be taken to your room. There will be several things connected to you.

  • IV (intravenous line): This is a tiny catheter which is inserted into a vein in your hand or arm. It will be connected to a tubing and a bag of fluids.
  • OXYGEN: You will have oxygen through a tubing with two small prongs into your nose. This doesn’t mean that you are not breathing well. The oxygen may be discontinued the evening of surgery or the following morning.
  • FOLEY CATHETER: A catheter may be inserted into your bladder during surgery. It will stay in for approximately one to two days.
  • ABDUCTION PILLOW: This is a soft foam triangular-shaped pillow that fits between your legs and is secured with Velcro straps. If your doctor feels that you need it, it will be used to keep your legs in the correct position when you are turning in bed or sleeping. If it is ordered for you, it will be discontinued as you gain muscle control of your leg, and you will then use a fat pillow between your legs at all times when turning, even after you return home.
  • DRAIN: You will have a drain tube into the hip after surgery. This removes excess blood from the hip after surgery. It will be removed the second day after surgery.
  • P.C.A. (Patient Controlled Anesthesias) MACHINE: This is a machine which may be used for your pain medication. It connects by tubing to your IV line. Attached to a small IV pole is the machine which contains a syringe of pain medicine. There is a button on a cord from the machine that will be within your reach. When you are having pain, push the button, and the medicine will deposit directly into your vein. This is a small dose. Therefore, you may have it often, if you need it. The machine is programmed so that you cannot give yourself too much medicine. You may take pain pills along with using the machine. This machine will be disconnected when the pain pills will relieve your pain.
  • BREATHING: The nurse will be asking you to take deep breaths and to use your spirometer, which is a small machine that you breathe into in order to clear your lungs.
  • DIET: You will be on a regular diet after surgery.

The Remainder of Your Hospital Stay

Day 1 (the day after surgery)

  • You will get up to a chair with the assistance of the nursing staff.
  • You will begin physical therapy. The therapists will help you walk with a walker.
  • Your exercise program will begin to help you to gain strength in your new hip.

Day 2:

  • You will have physical therapy twice daily, doing your exercise program and walking further each day with your walker.
  • The drain and Foley catheter will be removed by the nursing staff.
  • Your IV will probably be discontinued, and the needle will be capped for a few days.

Days 3-4:

  • You will continue physical therapy twice daily. When you can get in and out of bed alone, walk safely with your walker, and you have shown that you can climb stairs, you will be able to leave the hospital. This is usually the third or fourth day after surgery.

YOU are the most important player on your team of caregivers. Your doctor, or one of his assistants, will see you daily, and your nurses and therapists will play their roles in supporting your care. Only YOU can do what needs to be done to make your new hip its best.

Your hard work will be worth it!

Living With Your New Hip

After Discharge From The Hospital

If you live alone or do not have adequate help, you may decide to go to a rehabilitation facility for a while following surgery. We will discuss options for your care prior to your hospital admission. Whether at a rehabilitation facility or at home, the following things will be important for your care.

  • Your Hip Incision: You will have metal skin staples, which will be removed in your surgeon’s office at your first postop visit. Thin steri-strip tape will be applied to the incision. Remaining strips may be removed after one week. If your incision has no drainage, you may shower before the staples are removed.
  • Ice: You may use ice packs to your hip as often as needed following surgery. This may be especially helpful before and after your exercise sessions. Heat is not recommended, as it may increase swelling.
  • Walker/Crutches: A walker or two crutches will be used for walking after surgery. Unless instructed otherwise, you may bear weight as tolerated and use the walker/crutches for 2-3 weeks, then advance to a cane in the opposite hand for 2 weeks or until you can walk without a limp.
  • Physical Therapy: The therapists in the hospital will teach you an exercise program, which you will continue at home twice daily. You will also learn about precautions to take for the safety of your new hip. Much of the success of your new hip replacement surgery will depend upon how you take care of it. Outpatient physical therapy may be prescribed.
  • Coumadin: Most patients will be taking Coumadin for 14-21 days following discharge from the hospital. This blood thinning medication is used to help prevent blood clots. A prescription for a specific dosage and time period is given to you at the time you leave the hospital. Your dose will be adjusted by the Anti-inflammatory medicationscoagulation Clinic at VMC where weekly blood draws will be performed. Aspirin and arthritis medications MAY NOT be taken until 48 hours after the prescription has been completed. If you take aspirin for cardiac reasons, continue to do so while on the Coumadin. Tylenol or Tylenol ES every four to six hours may be used for pain relief in addition to the prescription narcotic analgesics (commonly hydrocodone, Darvocet-N or oxycodone). Following the completion of the prescribed Coumadin, you should take one aspirin each morning for one month. Mark this on your calendar.
  • Driving: You will not be able to drive for four weeks after your surgery. Although you will feel as if you are able, your insurance coverage would be in jeopardy, and your safety is of prime concern during the healing period.
  • Sexual Activity: You may resume sexual activity with caution as desired following your hip surgery. If you have specific questions, please do not hesitate to ask.
  • Sleeping: It is often difficult to get to sleep. We suggest trying Tylenol PM or Benadryl, purchased over the counter, to promote drowsiness.

Follow-Up Office Visits

Most patients are discharged from the hospital on the third or fourth postoperative day. Follow-up office visits are routinely advised for:

1. 1-2 weeks after surgery for staple removal.
2. 4 weeks after surgery for an x-ray and exam of knee motion.
3. 3 months after surgery for exam and assessment of activities.
4. 6 months, 1 year, and annually thereafter for x-ray and exam.

Please call our office appointment desk to schedule appointments: 425-656-5060

Prescription Refills

Refills for pain medicines may be obtained by contacting our office during business hours. It is the policy of our office that narcotic pain relievers will not be refilled or phoned in after hours or on the weekends. Prescription anti-inflammatory medicationsinflammatories may be resumed 48 hours following the last Coumadin dose.

Understanding The Risks of Total Hip Replacement

As with any surgery, there are certain risks. The following are some of the more common complications of which you need to be aware and things that we do to try to prevent them.

  • Infection: There is always a risk of infection with any surgery. You will receive antibiotics in surgery and several doses after surgery to reduce this risk. The risk of infection after Total Knee Replacement is approximately one percent.
  • Blood Clots: When you have surgery on the knee, circulation is impaired during healing. A blood thinner medication will be prescribed for you, which will help to keep your blood a little thinner than normal to prevent blood clots. We begin the first dose on the evening of surgery. Each day in the hospital, blood will be drawn to check your blood thinning level. Another thing that will help to prevent blood clots is to elevate both feet while sitting to prevent blood pooling in the lower legs and perform ankle-pumping exercises.
  • Disloaction of the Prosthesis: There are certain positions and activities which are dangerous to the stability of your prosthesis, especially for the first few months. The therapist will teach you how to sit, rise from sitting, and turn from side to side safely, as well as other precautions. You will be given a sheet of written instructions regarding these precautions.
  • Limb Length Inequality: We make every effort to equalize your leg lengths at the time of surgery. However, at times it is necessary to lengthen your leg to gain better stability after surgery. Occasionally, this will require you to use a shoe lift on your opposite shoe.
  • Numbness: It is important to know that during surgery, trauma can occur to the nerves around the hip, resulting in weakness or numbness in the operated leg.
  • Severe Complications: Again, with any major surgery, there is a possibility that any of the above complications, as well as problems with anesthesia, could be severe enough
    to result in death. If there are any questions or concerns regarding these complications, please feel free to discuss them with your surgeon.

Hip Dislocation Precautions

Do not

  • Cross your legs
  • try to put on your own shoes or socks
  • bend to the floor
  • sit in low chairs or sofas
  • bend your leg so that your knee is higher than your hip
  • turn your knee inward with your hip flexed

Do

  • Turn only with a fat pillow between your legs
  • Continue your exercises as taught by physical therapy 3 times a day

Frequently Asked Questions after Total Hip Replacement

What is the recovery time?

Everyone heals from their surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for 2 to 3 weeks after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices.

What is a dislocation of the hip?

A dislocation of the hip occurs when the femoral head (ball) comes out of the acetabulum (socket). While this risk is small, typically less than 2 percent, you are given dislocation precautions to help avoid this from happening.

What are the dislocation precautions for my hip (positions I should avoid)?

You should avoid flexing (bending) at the hip more than 90 degrees. Avoid low chairs and other low furniture, because they require too much bending at the hip in order to get up. If you must reach to the floor when seated, always reach between your legs, not to the outside. Use an elevated toilet seat to avoid excess bending of the hip. If possible, use a chair that has arms. The arms provide leverage to push you up to the standing position. When sitting, position your legs so that you can see your inner thigh, calf, and foot (not the outside).

How long do I need to follow my dislocation precautions?

Follow your precautions very carefully for the first 8 weeks. You should avoid extreme positions of hip flexion (bending) forever.

When can I discontinue using a raised toilet seat?

Between 6 and 8 weeks after your operation.

Can I sleep on my side?

You may sleep on your operative side whenever you feel comfortable. You may sleep on your non-operative side at 3-4 weeks with a pillow between your knees.

When can I shower (get incision wet)?

Three days after your operation, if no drainage is present at the incision.

How long will I be on pain medications?

You will likely require some form of pain medication for about 4 to 8 weeks. Initially, you will be on a strong oral medication (such as a narcotic). Most people are able to wean off their strong medication after one month and are able to switch over to an anti-inflammatory medicationsthe-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g. aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting your internist. If you take aspirin for medical reasons prescribed by your internist, continue to do so while on Coumadin.

I think my leg lengths are different. What should I do?

It is not uncommon to feel as though your leg lengths are different. At surgery, leg lengths are assessed very carefully, and an attempt is made to make them as equal as possible. Sometimes, the new hip has to be lengthened in order to obtain proper muscle tension (to help avoid hip dislocation). Wait three months before making any final judgments about your leg lengths. Your muscles and body take time to adjust to a new hip. A shoe lift may be prescribed for a true difference in leg lengths. In most cases, however, no treatment is necessary.

Can I use weights?

Generally, but not for the first two months. However, as everyone’s strength varies, consult with your physical therapist before using weights. Use light weights to begin with, and gradually progress.

I am constipated. What should I do?

It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking a narcotic pain medication. A simple anti-inflammatory medicationsthe-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or an enema.

When can I drive?

If you had surgery on your right hip, you should not drive for at least a month. After one month, you may return to driving as you feel comfortable. If you had surgery on your left hip, you may return to driving as you feel comfortable, as long as you have an automatic transmission. Be careful when getting in and out of a car, and avoid crossing your operated leg over the other one.
DO NOT DRIVE IF TAKING NARCOTICS!

When can I return to work?

This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately 3 to 4 weeks. If your work is rigorous, you may require 2 to 3 months before you can return to full duty. In some cases, more time may be necessary.

When can I travel?

You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.

What activities are permitted following surgery?

You may return to most activities as tolerated, including walking, gardening, and golf. Some of the best activities to help with motion and strengthening are swimming and riding a stationary bicycle.

What activities should I avoid?

You should avoid impact activities such as running, downhill skiing on expert slopes, and vigorous racquet sports, such as single’s tennis or squash. In addition, you should avoid any activity that may put your new hip at risk for dislocation.

Can I have sex?

You should wait several weeks postoperatively before resuming sexual intercourse. Follow your hip dislocation precautions. Having your legs apart is a safe position.

Can I drink alcohol?

If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should also avoid alcohol, if you are taking narcotics or other medications.

Can I go up and down stairs?

Yes. Initially, you will lead with your non-operated leg when going up stairs, and lead with your operated leg when going down stairs. You can use the phrase, “Up with the good, down with the bad” to help you remember. As your leg gets stronger, you will able to perform stairs in a more regular pattern (about 1 month).

Can I kneel?

Yes, after 6 weeks. To kneel, touch down with your operated knee first. To arise from kneeling, use your non-operated knee first.

What should I expect for my range of motion (ROM) at 6 weeks? At 1 year?

Everyone’s range of motion (ROM) varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have enough motion to put on socks and tie your shoes. Clipping toenails may be difficult.

Do I need antibiotics before dental work or an invasive procedure?

Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning and non-urgent procedures for 6 weeks postoperatively.

I feel depressed. Is this normal?

It is not uncommon to have feelings of depression after your replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.

I have insomnia. Is this normal? What can I do about it?

This is a common complaint following hip replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.

How long will my total hip replacement last?

This varies from patient to patient. For each year following your hip replacement, you have a 1 percent chance of requiring additional surgery. For example, 10 years post-operatively, there is a 90 percent success rate.

When do I follow up with my surgeon?

Most patients are discharged from the hospital on the third or fourth postoperative day. Follow-up office visits are routinely advised for:
1. 1-2 weeks after surgery for staple removal.
2. 4 weeks after surgery for x-ray exam of your hip.
3. 3 months after surgery for exam and assessment of activities.
4. 6 months, 1 year, and annually thereafter for x-ray and exam.

Please call our office appointment desk to schedule your appointments. 425-656-5060

I’m out of pain medication.

Refills for pain medicines may be obtained by contacting our office during business hours. It is the policy of our office that narcotic pain relievers will not be refilled or phoned in after hours or on the weekends. Prescription anti-inflammatory medicationsinflammatories may be resumed 48 hours following the last Coumadin dose.

Normal things about your new hip:

  • Clicking noise with hip motion.
  • Skin numbness near or around your incision.
  • Swelling around the hip, knee, and/or lower leg.
  • Warmth around the hip.
  • “Pins and needles” feeling at or near your incision.
  • Dark or red incision line. This will gradually fade to lighter color.

Abnormal things about your new hip:

  • Call the office immediately, if you experience any of these.
  • Increased bruising on Coumadin.
  • Increasing redness, particularly spreading from the incision.
  • Increasing pain and swelling.
  • Fevers > 101 degrees F.
  • Persistent drainage from your wound.
  • Calf swelling or pain, particularly associated with ankle motion.
  • A sudden “giving way” of your hip with inability to bear weight.
  • Ankle swelling that does not decrease or resolve overnight.
  • Bleeding gums or blood in urine/stool.

Your new hip is the result of many years of research. But like any other device, its life span depends on how well you care for it. It is important that this care continues for the rest of your life.

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LOCATIONS

RENTON

4011 Talbot Rd S #300
Renton, WA 98055

Phone: 425.656.5060
Fax: 425.656.5047

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27005 168th Pl SE #201
Covington, WA 98042

Phone: 253.630.3660
Fax: 253.631.1591

Maple Valley

24060 SE Kent Kangley Rd,
Maple Valley, WA 98038

Phone: 425.358.7708
Fax: 425.656.5047

Bone and Joint Urgent Care

150 Andover Park W.
Tukwila, WA 98188

Phone: 425.979.BONE

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