Practice Policy Update regarding COVID-19


What is arthritis and why does it hurt my hip?

The hip joint is aligned with a layer of smooth cartilage which allows the hip ball to move smoothly. Arthritis is due to the wearing down of the smooth cartilage resulting in pain swelling and stiffness.

What does a total hip replacement involve?

A total hip replacement involves the following: The arthritic ball of the femur is removed and replaced with a metal pole that is fixed solidly inside of the femur by a metallic stem attached to the ball. The hip socket is replaced with a plastic liner fixed inside a metal cup. The new parts move freely and smoothly against each other.

When should I get my hip replaced?

For most patients a period of conservative treatment should be tried.

A total hip replacement should be performed when pain is moderate to severe and not relieved with mild analgesics or anti-inflammatory medication, physical therapy, injections, or walking aids.

Am I too old for this type of surgery?

As long as you are in reasonable health and you have the desire to put time and effort into the rehabilitation process, you are a candidate for this type of surgery.

How long will my new hip last and how can a second hip replacement be done?

A number of factors will affect how successful the hip replacement will be. There is no guarantee for a specific length of time for your implant to last. Factors that are under the control of the patient that can affect the life span of your new joint include weight, activity level and medical condition. Statistically, loosening or wear rates requiring repeat surgery are about 2% per year. In other words about 90% will last 10 years and about 80% will last 20 years. With new bearing surfaces we are expecting the hips to last longer in the future.

What causes loosening of the new hip implant?

The most common cause of repair for a hip implant is loosening of the artificial surface from the bone. Wearing of the plastic spacer may also result in the need for a new spacer. Your surgeon will explain these and other possible complications.

What are the major risks with a hip replacement?

Infection and blood clots are to serious complications with any surgery. To avoid complications we start antibiotics just prior to your surgery, and give 3 additional doses 3 after surgery. We also used early mobility, mechanical stockings and blood thinners to minimize the risk of blood clots.

Should I exercise prior to surgery?

Yes, your surgeon can give you recommended exercises and you will also be taught specific exercises by a physical therapist at your preoperative education class. It is important to build up the muscle groups that you can prior to the surgery, this will make it easier for you to mobilize after the surgery.

Will a blood transfusion be required?

There has been a significant decrease in the need for blood transfusion since we have adopted the anterior muscle sparing hip replacement. The reasons for this decreased need for blood transfusion is less operative bleeding, routine use of a Cell Saver, and the use of agents that decrease post operative leading. The risk of requiring a transfusion after the surgery is about 5-10%.

What is a Cell Saver?

During surgery there is normal bleeding from the soft tissues and bone.

The Cell Saver device is a closed system that collects this blood during surgery. The blood is then filtered and washed and then given back to the patient. This recycling of the patients own blood decreases the chance that a blood transfusion will be needed.

Should I give my own blood prior to surgery?

As of this used to be a standard procedure prior to adoption of this new hip replacement, at this time we do not recommend that. This option is still available for those who want it.

How long will I be in bed after surgery?

You will be encouraged to stand on that day of your surgery. If possible you will also be encouraged to walk right after surgery. We have found that early mobilization leads to faster rehabilitation, decreased complications, and decreased time in the hospital.

How long will I be at the joint center?

The average number of days in the hospital is 3 days. For most people receiving a hip replacement at the joint center the length of stay is 2 days and many people are able to leave after one day.

What if I live alone?

Most all of our patients can return home with help from a relative or friend. You will be encouraged to select someone who can help you and assist you at home. Home health is setup for you prior to discharge. They can help with activities of daily living and physical therapy at home. For certain people who need it because of other physical disabilities or advanced age, inpatient rehabilitation is available. There are several excellent centers in our area

How painful is a hip replacement?

For most patients pain following surgery is minimal. They often say that they have less pain after the surgery than they had before. At the end of the surgical procedure local anesthesia is placed into the wound. This reduces immediate pain. After that the patient is placed on an on-demand Hydromorphone drip and is given stong pain pills and anti-inflammatories.

How long will my incision be?

The average length of the surgical incision is 9-10 cm, or about 4 or 5 inches.

Will I have to use a walker after surgery?

We recommend the use of a walker for 2 weeks after surgery. The walker is required to avoid falls or excessive loading of the hip. The use of a walker may be extended to up to 6 weeks in patients with soft or osteoporotic bone. However, this is uncommon. Most patients are walking with no assistance at 2 weeks.

Will I require physical therapy once at home?

Physical therapy exercises will be taught to you during your hospital stay and should be performed twice a day. Additional physical therapy may be ordered by your physician depending on your particular needs. Physical therapy may be done at home through the services of a home health agency or as an outpatient.

How long until I can drive?

Most patients are ready to drive between the second and fourth week following their surgery. Your surgeon will help you determine when it is appropriate to resume driving.

When can I return to work?

Return to work is dependent on the type of job performed.

Typically we recommend that patients take 4-6 weeks off to recover from surgery. Work may be resumed earlier if it is office-type sedentary work. Some people may resume work at home if they can arrange it. Many younger patients can return to the office at 2 weeks.

When do I see the surgeon after I return home?

Your first appointment to see your surgeon at the office will be within 10-14 days. We usually will have you come back at 6 weeks and 3 months. After that yearly visits for a few years.

What restrictions well I definitely have after this surgery?

Until the prosthesis is confirmed to be solidly fixed to the bone we recommend avoiding the following activities: Jumping, running, high impact sports, and repeated lifting of 50 pounds or more. We also recommend avoiding extremes of hip flexion or rotation. After the prosthesis is confirmed to be solidly fixed by x-ray you will then be released to do activities as tolerated.

What activities are encouraged or permitted after a hip replacement?

Cycling, walking, dancing, golfing, swimming, bowling, and gardening are all activities that one can perform without applying extreme forces onto the new hip replacement.

Will my legs be equal in length after surgery?

We aim to make your legs equal during the operative procedure by taking x-rays and adjusting the length of the components. In general leg length is equal for most patients but may vary slightly depending on the particular case.

What are the causes of hip pain?

  • Causes of hip pain:
  • Osteoarthritis
  • Fractures
  • Hip impingement
  • Cartilage tears
  • Hip bursitis
  • Rheumatoid arthritis
  • Avascular necrosis
  • Referred pain from spine

What is a total hip replacement made of?

  • The femoral stem is made from metal usually titanium
  • The femoral head is made of ceramic or metal
  • The cup liner is made out of polyethylene
  • The outer shell of the cup is made of titanium metal
  • The metal components that I use all have a fine coating of hydroxy-apatite, a mineral that allows earlier and stronger bonding of the metal implant to the bone.

Can I treat my hip pain without operation?

  • Yes you should try conservative treatment first
  • Medications: Anti-inflammatories and Tylenol
  • Activity modification: Avoiding activities which cause pain
  • Walking aid: A cane or walker may help alleviate pressure on the hip
  • Weight loss: Losing weight can make you more mobile and help you with your symptoms
  • Changes in your living area: Modifications to your house may help to cope with your symptoms
  • Physical therapy: Exercises in therapy and water exercises are extremely helpful to maintain mobility and decrease pain
  • Injections: Certain types of injections may alleviate or eliminate pain for a variable period of time
  • Nonsurgical treatment is available at our office

Will my hip replacement activate the metal detectors at airports?

Some hip replacements may activate metal detectors at airports and some buildings. Patients have reported mixed experiences at airports: Some detectors go off and some don’t. If you are stopped at an airport just explained that you have an artificial implant. According to a TSA agent who also happens to be my patient, Implant Cards provided by the device manufacturers are not helpful.

Do I need to see a dentist prior to hip replacement surgery?

In general we recommend a dental exam and cleaning before hip replacement surgery. If any dental work needs to be performed we recommend that it be done before surgery. After surgery we recommend avoiding any dental work for a period of 6 months. After surgery when you seen a dentist it is important to let the dentist know that you have a hip replacement. You will need to take antibiotics before any dental procedure to prevent the possibility of an infection to your hip replacement.

How do I know if I need a hip replacement?

If you have difficulty walking or performing everyday activities such as getting dressed it may be time to consider a hip replacement.

In general we recommend less invasive treatments initially such as exercises, medications, walking aids, and possibly injections.

When these less invasive treatments fail we then generally recommend hip replacement surgery.

How do I prepare for hip replacement surgery?

Things to do before surgery include:

  • A physical examination by your primary physician
  • Consultation with a specialist if you are followed by one
  • Weight loss
  • Exercise program
  • Stop or decrease smoking
  • Visit the dentist
  • Blood tests

What happens during hip replacement surgery?

On the day of surgery, the surgeon will see you in the preop holding area and identify the operative site and sign it with a marking pen.

You will then be taken to the operating room and given anesthesia. Surgery takes about 60-90 minutes however you will be in the operating room for about 2-1/2 hours. You will then be sent to recovery room and stay there until you regained complete consciousness.

How is the implant fixed to the body?

The components are placed into the bone and press fitted in place.

Sometimes additional screw fixation of the cup is necessary if the bone is soft.

What if I have osteoporosis?

Some people with loss of bone density may require treatment prior to hip replacement. If we suspect this a series of blood tests and a bone density study will be ordered. Depending on the findings various treatments may be prescribed. For patients with significant osteoporosis we have found that preop treatment with Forteo, a drug that builds up new bone, is very effective.

What about sex?

You may resume sexual activities as soon as you feel able.