In this blog I am going to review the surgical process and recovery of a total hip replacement! This is not a new procedure by any means, but like anything in medicine, there has been some new developments in joint replacement material, and surgical techniques.
The current hip replacement consists of two main components. The femoral component which is placed into your upper leg bone(femur), and the acetabular component, which is placed into you pelvis. The material being used in a total hip replacement is metal, plastic, and usually bone glue(bone cement).
The main difference lies in whether your MD decides you are a better candidate for a cemented or un-cemented hip replacement. If you get a cemented hip replacement you can start rehabilitation right away and there is thought to be less post op pain. In this procedure they use bone cement to help keep the prosthesis in place. In a non-cemented hip placement there is no bone cement being used and it takes some increased time for recovery to allow the bone to fuse to the prosthesis(12 weeks). The main difference between the two is that a cemented hip replacement may not last as long as an un-cemented hip. Typically 10-15 years for a cemented hip replacement and 15-20 years for an un-cemented hip replacement.
In general, older adults may choose to go with the cemented prosthesis to allow a quicker recovery as they generally wont need the hip replacement to last as long. Younger, more active individuals may choose to get an un-cemented hip replacement as they will more easily recover from the time off after the surgery and they need the hip replacement to last longer.
I am going to blog about the cemented hip replacement this week since as that is mostly what we see clinically.
Day 1: The Surgery!
On surgery day they like you to get to the clinic about 1-2 hours before hand to get paperwork done. Then they will take you back and do a spinal block with moderate sedation or a full anethesia(being put to sleep) to get you surgically prepped. The actual surgery takes about 1-2 hours depending on the surgeon and his/her surgical approach preference. The surgeon will decide whether an anterior approach or a posterior approach will be better for you. With the anterior approach you will not be allowed to bend you leg backwards for 6 weeks. With the posterior approach you will not be allowed cross your legs, bend your hip more than 90 degrees, or pivot around you foot with it planted on the ground.
Day 1-2: The Hospital Stay
The minimal amount of time you will spend in the hospital is usually 1-2 nights. During this time they will be monitoring your vitals and pain level to make sure everything is acceptable. Pain wise at this point it usually isn’t too bad because some of the anesthesia from the spinal block can still be in your system. Your physical therapist will becoming in the day of or day after the surgery to get you up and walking! Yes walking! This helps get your blood pressure stabilized, helps with your digestive track to get your bowels moving, and help you get comfortable moving your hip again. The physical therapist will also review your specific surgical precautions depending on the type of hip surgical approach you had done.
Day 2-Week 3: Initial Rehab
From the hospital you will either be sent home or to a rehab center depending on the amount of help you have at home. As long as there is somebody at home to help with bathing/toileting and meal prep you should be able to go home. If you have a driver that can take you to an outpatient physical therapy clinic then you will start physical therapy by usually the 4-5th day post op. If you do not have a driver at home, then you will start with a home health therapist that comes to your house 2-3x a week. During this time your therapist will be working on regaining your ROM, your walking tolerance, and some light strengthening activities. Pain during these three weeks can vary from patient to patient but typically is in the 4-6/10 range. So it’s uncomfortable and swollen feeling, but typically isn’t really all that painful. You should also be doing some light walking of 5-10 minutes everyday, usually 2x a day.
Week 3- 12 weeks: Late Rehab
During this period the hip will really start to improve. Sleeping will become much more comfortable and functionally you will be able to do a lot more. Therapy will consist of strengthening exercises and improving your overall endurance with functional activities. After 6 weeks you will be able to start moving your hip in all the directions without the fear of breaking your surgical hip precautions. Most people will say they turned a corner at 6 weeks and felt like they could do a lot more with less discomfort. By the end of 12 weeks you should be pretty much back to doing all your normal activities of daily life with the exception of some of your more physical endeavors.
Week 12-1 year: Full Recovery
By this point you will be done with physical therapy an on to hopefully an independent gym or walking program. The hip itself will take anywhere from 9 months to a year to really feel normal again. You will continue to get stiff in the hip after sitting for long periods or when you first get up in the morning for about 9 months. But over the span of the year that will eventually fade and you will be so happy with all the things you can now do again with your new hip!
That’s it in a nut shell. Overall I’ve been told by several patients it is a much easier surgery then a total knee replacement or rotator cuff repair. So if you are in need of a total hip replacement don’t despair, get the repair!