Total Hip Replacement Patient Information Handout
Dr. Steven A.T. Krywulak, M.D., FRCS(C)
Which patients are considered candidates for total hip replacement?
Hip replacements are most commonly performed on patients with osteoarthritis. Less
commonly, they are done for patients with rheumatoid arthritis, post-traumatic
arthritis, or avascular necrosis.
Regardless of the diagnosis, all patients will have
severe disabling hip pain that interferes with their quality of life and activities of daily
living. Such patients will often have pain at rest or at night that interferes with sleep.
Walking tolerance will be reduced from previous levels. If symptoms are not all that
severe, non-surgical treatments are attempted before considering major hip
replacement surgery.
What factors might exclude a patient from being scheduled for a hip replacement?
All patients must be fit medically for a major surgery. For example, a patient having a
heart attack in the 6 months prior to surgery would not be a suitable candidate.
Patients with other serious medical conditions may be excluded. Any patient with an
active infection in the hip or elsewhere in the body would not be an appropriate
candidate. Many patient factors must be considered and ultimately the surgeon
must use his or her judgment as to whether to proceed forward with knee
replacement.
What kind of results can I expect from my hip replacement surgery?
The goal of this procedure is to produce a pain free hip joint that functions well for
activities of daily living and results in a meaningful improvement in patient quality of
life. This result is achieved in 95% or more of cases. Some patients may have some
minor aching in the hip after surgery but most patients are greatly improved from their
pre-operative status. It often takes a full 3 to 6 months to fully see all of the benefits
from this surgery due to variable recovery between individuals. Some patients
continue to improve for up to a year following the procedure.
What are the risks and complications associated with hip replacement surgery?
Hip replacement is not without risk. A patient must carefully consider the risks and
benefits of surgery prior to giving informed consent. The following list includes the
most commonly encountered complications of hip replacement surgery. They are
divided into major and minor complications. Major complications can result in loss of
life or limb. Minor complications can vary in severity from those causing significant
difficulty to those causing minor inconvenience to the patient.
No list of
complications can include every known possible adverse event. If you have any
further questions or concerns, be sure to ask your surgeon.
Major Risks
- heart attack
-stroke
-pulmonary embolism
- infection
- bleeding requiring transfusion
- allergic reaction to the anesthetic/antibiotics
Minor Risks
- nerve injury causing numbness or weakness in the foot
- fracture of the femur
-blood clots in legs
- post-operative confusion
-pneumonia
- dislocation of the hip after surgery (rare)
- leg length discrepancy
Most complications can be successfully treated with little or no impact on the final
result for the patient. Patients are routinely given antibiotics to prevent infection and
blood thinners to help prevent blood clots/pulmonary embolism. It is important to
stop your anti-inflammatory medication a week prior to surgery to prevent increased
bleeding unless you are taking Celebrex. If you are unsure, about this, simply ask your
doctor.
Note: Most patients can expect swelling in the knee and foot for 3-6 months after
surgery.
Is it possible that my legs might not be the same length after surgery?
Unfortunately the answer is yes. Every effort is made during the operation to even out
leg lengths equally. This is not always as easy as it sounds. Many patients note that
their arthritic leg is shorter before surgery. This happens when the cartilage of the joint
wears out and can be worsened if bony collapse occurs. When the hip replacement
is done, bone is taken away from the ball and socket portions of the joint. This bone is
replaced with the metal and plastic components. A surgeon must then alter the
femoral component length to obtain stability and sometimes the leg is lengthened to
keep enough soft tissue tension in order to prevent the hip from dislocating. Most
patients who have leg length discrepancies after surgery have minor ones of about 1
cm. This is usually not noticeable for the patient. Rarely a patient will have up to two
centimeters difference and may require a shoe lift on the non-operative side to
balance the pelvis.
Will I be getting a cemented or uncemented hip replacement?
When it comes to the cup (socket) portion of the replacement, all of these are
uncemented components placed in with a press fit. The sockets are placed in fairly
tightly, but in some cases a few screws may be used to secure the cup. Your own
bone will eventually grow into the rough surface of the implant to secure it
permanently. Most of the femoral components in Kelowna are also placed in without
cement. In certain rare patients with poor bone quality, a smooth femoral
component will be used with bone cement at the surgeon’s discretion.
How painful is this procedure?
Most patients find hip replacement to be moderately painful, especially for the first
week. Some patients have very little pain after surgery. You will receive long and
short acting narcotics along with Tylenol and an anti-inflammatory immediately postop. By the third or fourth day, patients are typically on milder pain killers in pill form,
and most will go home on these pills. Many patients will have the majority of their
pain resolve by 12 weeks post-operatively. Rarely, some patients may take a full six
months or more before their comfort level plateaus. Each individual responds
differently and sometimes a little patience is required.
How long will I be in hospital after surgery?
Typically, most patients are in hospital for 2-4 days. If a patient requires a longer stay
to recover, they may be transferred to a rehabilitation or transitional unit for further
care. Due to hospital bed shortages, stays longer than 5 days are avoided whenever
possible so that other patients do not have their surgery cancelled due to lack of
beds on the ward.
Will I need physiotherapy after surgery?
Yes, all patients will be seen by the physiotherapy team while in hospital. You may
be up walking the same day as your surgery. On discharge, patients are encouraged
to see a physiotherapist to assist with their leg exercises. Outpatient physiotherapy is
somewhat limited at the hospital but enquiries can be made to access this service.
Many patients will choose to see a physiotherapist in the community, but this service is
not covered under the provincial health plan and is prohibitively expensive for some
patients. Patients who can’t make it out of their home may arrange to have a home
physiotherapist visit them postoperatively. This is covered under provincial health
care but the number of visits you will receive is also limited.
What restrictions will I have after hip replacement surgery?
You will be permitted to shower over the wound by the second day in hospital.
Bathing is not permitted until 5 days after the staples have been removed as long as
the incision is full healed over. Staples come out on Day 10 typically. Keep the wound
clean and dry. Most patients are allowed to take full weight through the hip
immediately, but usually require crutches or a walker until more stable. You may
want to rearrange furniture or sleeping arrangements in your home to accommodate
a walker and avoid stairs. You may require a chair in the shower or other assistive
devices. A raised toilet seat is important to avoid excessive bending of the hip that
may cause hip dislocation. A pillow between the legs during sleep is suggested for 3
months, also to prevent dislocation. Driving is not permitted for 6-9 weeks if the right
hip is done. You should be confident in using the leg to brake in an emergency. If
you use a car with an automatic transmission, and the left hip is replaced, driving
may be permitted by 2-6 weeks post-operatively. Return to work depends on the
type of work done. Six weeks for return to a desk job and 3 months for other types of
employment are general guidelines. Mobility will be restricted after surgery and
arrangements for personal care, bathing, meals etc. should be made before surgery
if possible. You can walk as much as you like. Sexual activity is permitted at 6 weeks
or thereafter depending on patient comfort. It is possible that airport metal detectors
will sense your hip prosthesis. There is no documentation for security and this should
pose no issue in most cases.
What activities can I do once I am fully recovered from surgery?
The purpose of this procedure is to help patients become more active, therefore we
do encourage activity. However, high impact activities are not recommended as
they may significantly decrease the lifespan of the implant, necessitating revision
surgery. The following list serves as a guideline, but each case must be individualized
to the patient. If you have questions, ask your surgeon.
How long will my hip replacement last?
No one can predict this for sure. Individual patients vary in size, weight and the
demands they place on their implants. Certainly, patients under the age of 65 will
place increased demands on their implants creating concerns about longevity.
Typically, a total hip replacement can be expected to last 15 years minimum. In
lower demand patients, they may last 20 years or longer. X-ray follow-up may be
required in younger patients who are more likely to wear out their hip in their lifetime.
Some newer implants are available for younger or higher demand patients that may
improve survivorship in the long run. The use of these “premium” implants will be
discussed with you prior to surgery if you are a candidate. In certain cases, there will
be a charge to the patient for upgraded or premium implants. If you have any
questions regarding these implants, you can make an appointment to discuss them
with your surgeon.
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Dr. Steven Krywulak