What You Need to Know
About Total Hip Replacement
Steven Heil, MD
Kristine Steele, PA-C
Hip replacement surgeries are one of the great medical advances of the 20th century. It is performed for patients who are experiencing end stage arthritis of the hip. Most patients will have groin and buttock pain with activities. This pain may radiate all the way to the knee. X-rays will show complete loss of cartilage in the hip joint. The usual reason to choose to have a hip replacement is the inability to do normal activities.
Health Care decisions to consider before the Surgery
A hip replacement is a major surgery. People with health issues should first see their primary care doctor and possibly even a specialist such as a cardiologist to make sure they are healthy enough and that all of their medical conditions are optimized. Dental work is discouraged for 6 months after surgery, so we suggest having a dental check-up prior to surgery. The local hospitals have preoperative classes for joint replacements surgery that we highly recommend patients attend. Additionally if you have been inactive we recommend a few sessions of physical therapy prior to surgery to strengthen your muscles and build endurance.
Infection is a feared complication of this surgery. Most infections actually come from bacteria that are growing on the patient prior to surgery. For this reason we have our patients do a special scrub to their surgical site and use an antibiotic nasal gel for several days before the operation. Other things that have been shown to increase the risk of infection are obesity, poorly controlled diabetes and smoking.
Day of the surgery
Patients come in the morning of the surgery to start preparations for the procedure. An IV is started and you will meet with the anesthesiologist. Almost all our patients have a spinal anesthetic. This has been shown to reduce blood clots, bleeding and infections as compared with general anesthesia. During surgery, if your health will allow, the anesthesiologist will sedate you and most patients sleep through the operation.
Components of the Hip Replacement
The surgery takes about one and a half hours. The hip replacement hardware consists of four components. There is a titanium shell that goes into the hip socket, also known as the acetabulum. Then a titanium stem is placed down the femur after the hip ball is removed. This is called the femoral stem. These are both covered with a special porous surface that the surrounding bone can grow into. There is a plastic liner that inserts into the acetabulum shell. It is made out of specially treated polyethylene, the same slippery material that milk jugs are made of. The femoral stem is capped with a ball called the femoral head that articulates with the plastic socket. It is made out of either a super strong steel alloy or ceramic. This allows us to change the liner and ball if they should wear out without removing the parts that your body has grown into.
Method of procedure
Dr. Heil uses a mini posterior approach. This goes behind the major muscles of the hip and only requires detaching one small tendon that is repaired at the end of the operation. This technique allows immediate weight bearing with a very quick recovery. Most patients go home in one to three days after surgery. This technique is used because it allows the doctor to get the components in the right position with minimal bleeding and a very low complication rate. We have a very low dislocation rate. Post operatively we have the patients avoid extreme positions for six weeks after surgery. After that there are no long term restrictions. Dr. Heil has tried other techniques but continues with this approach as the safest most reliable way to do a hip replacement.
After surgery you will go to the recovery room for about an hour prior to going to the orthopaedic floor of the hospital. Most patients are able to get out of bed, walk and go to the bathroom the day of surgery. Oral pain medications are started. All patients will be given medication for the prevention of blood clots. Most patients can just take 325 mg of aspirin daily to prevent blood clots. Patients that are at a higher risk because of prior blood clots or pulmonary embolisms are treated with a stronger oral or injectable blood thinner. A physical therapist will evaluate your needs and design your post-surgical therapy to address your lifestyle when you get back home. If you have stairs or other challenges at home they will make sure you can safely do those things prior to discharge.
Some elderly patients will need more then several days of rehab. One option is having a home health physical therapist come to your house after discharge. Another option, especially for those without much help at home, is going to one of the local nursing homes for rehabilitation. This is usually covered by Medicare.
After surgery the best way to rehabilitate is to walk. Most patients go home with a walker. Most will then transition to a cane in a week or so. Most active patients are able to walk a mile at six weeks after surgery.
Sometime it is hard to find unbiased information. There are two organizations that have excellent information on the internet. Dr. Heil belongs to both of these organizations. They are:
The American Association of Orthopaedic Surgeons located at www.orthoinfo.org, and
The American Association of hip and knee surgeons located at www.aahks.org/care-for-hips-and-knees/.
For more information about Rocky Mountain Orthopaedic Associates Joint Replacement team, go to: www.rmodocs.com