Hip Replacement

Preparation

If after undergoing an orthopedic evaluation, you and your surgeon decide that hip replacement surgery is the best possible treatment for you, our team of medical experts will provide you with information on how to prepare for the procedure.

Medical Preparations

A few weeks before your procedure, you will need to have a complete physical by your primary care physician to rule out any other medical problems that may interfere with your surgery. At this time, your doctor also will take your medical history and order various tests that must be performed before surgery, such as blood tests, urinalysis, chest X-rays and electrocardiograms (EKG or ECG).

Be sure to tell your orthopedic surgeon about all medications that you are taking. They will then advise you on which medications you should continue or stop taking prior to surgery. In addition, if you develop any kind of infection prior to surgery, such as a cold or the flu, notify your surgeon immediately.

You should be in the best possible health before your surgery. If you are overweight, your doctor may suggest that you lose weight. If you smoke, it is highly recommended that you stop prior to your surgery because smoking can change blood flow patterns and delay healing and recovery.

Seven days prior to surgery, you should stop taking all aspirin or other non-steroidal anti-inflammatory drugs, such as NSAIDS like Aleve, Motrin, Ibuprofen, Advil and Naproxen. You may continue taking Cox-II inhibitors such as Vioxx, Celebrex and Bextra. You may take Tylenol for pain and discomfort.

Blood Donation

Total hip replacement surgery can result in blood loss that may require a blood transfusion. Therefore, it is suggested that you donate your own blood before surgery. If you are unable to donate blood for yourself, your family or friends may donate for you. They must have the same blood type and meet criteria for donation. Otherwise, banked blood is available. Banked blood, which is from volunteers, is screened for viral diseases and is matched to your blood type.

If you are having surgery due to an infected prosthesis, you are not allowed to donate your own blood for surgery. In these cases, you must have family or friends donate blood or receive blood from a volunteer.

Dental Evaluation

Significant dental conditions and problems should be treated prior to surgery. Although uncommon, an infection can occur as a result of these dental procedures if bacteria enter your bloodstream. If necessary, be sure to schedule an appointment with your dentist before your joint replacement surgery to treat any problems you may have.

Artificial Implant

When planning your hip replacement surgery, you will discuss the many options available for the design and materials of your artificial implant, or prostheses, with your orthopedic surgeon. An implant is designed to replicate the action of a healthy ball-and-socket hip joint. It consists of three parts: the stem, the ball or head, and the shell and accompanying liner.

Eventually, due to continuous movement and friction between the different parts of your implant, certain surfaces may wear out and need replacement. The vast majority of total hip replacements are performed using a metal ball and a plastic socket made of an ultra-high weight polyethylene material. However, in certain circumstances depending on your age, bone quality and activity level, your surgeon may recommend an alternative bearing surface. These bearing surfaces, in some cases, could provide increased resistance to wear of your total hip replacement. UCSF Medical Center is one of several medical centers in the country that are studying the potential benefits of these new implants.

Insurance

Once your surgery has been scheduled, call your insurance company and inform them of your upcoming procedure. You will need to provide them with the date of your surgery, procedure type and the phone number for our office. You should also discuss what type of post-surgery services, such as rehabilitation hospital care and home physical therapy, as well as equipment, such as a commode and walker, your insurance carrier covers.

Home Preparations

It is recommended that you plan for your return home prior to your admission to the hospital so that you are as comfortable as possible. We recommend a family member or friend be with you twenty-four hours a day for the first week. In addition, make sure you have rides planned from the hospital and to all follow-up visits, which will be at three, six and 12 weeks after surgery.

If you have crutches or a walker, bring them to the hospital. If you don't already have walking aids, let us know and we will help you to either rent or purchase these and other recommended devices, such as a raised toilet seat, bedside commode, tub chair and stock aid, at the hospital.

After surgery you will need help caring for yourself at home. Figure out ahead of time who will be able to assist you and talk with them about your concerns. If no one is available to care for you, please let us know and a discharge-planning nurse can help make arrangements for skilled nursing or caregivers to help you at home.

In addition, arranging meals that can be stored and frozen and stocking up on prepared foods will eliminate extra work for your caregiver. It also is highly recommended that you organize your home with safety features to prevent accidents. These include making pathways in crowded areas, eliminating all throw rugs, securing extension cords and telephone cords strung across the floor, securing handrails in your bathtub and stairways, and placing all needed items at a level so that you can easily reach them. You also should be sure that your house is equipped with the following:

• Raised toilet seat
• Stable shower bench or chair for bathing
• Long-handled sponge or shower hose
• Reaching device that will allow you to grab objects without bending your hip
• Firm pillows to sit on that keep your knees lower than your hips

Pack a small suitcase for your hospital stay that includes a list of all medications you are taking, personal hygiene items, comfortable and loose clothing, a knee-length robe and slip-on shoes. Please leave all of your valuables, including jewelry, wallet and watches, at home. It is not necessary to bring your actual medications, however do bring a list of your medications and their dosages. The hospital will provide you with your medications. Also, we recommend you to bring a phone card.

The Day Before Surgery

Our hospital staff will call to notify you of your surgery and scheduled admission times. You may not eat or drink anything after midnight the night before your surgery. Please take a shower or bath and wash your body thoroughly. Try to rest and go to bed early.

Procedure

In total hip replacement surgery, the damaged ball and socket are removed and replaced with a new set that is made of metal and a durable plastic material. These artificial parts are called implants, or prostheses. There are three different types of prostheses: cemented, uncemented and custom. Based on your age, activity level, bone shape, size and strength, your orthopedic surgeon will decide which prostheses is best for you. This will be discussed with you at your pre-op visit.

The surgery usually takes two to four hours, although this depends on the severity of the arthritis in your hip. In the operating room, a urinary catheter will be inserted and left in place for one or two days. Compression stockings will be put on both of your legs. For a complete overview of your procedure, please see Total Hip Replacement.

You will be admitted to the hospital on the day of your scheduled surgery. You will be asked to arrive to the hospital two hours before the start of your surgery. After admission, you will move into the pre-operative area where you will be evaluated by an anesthesiologist. The most common type of anesthesia is general, in which you are given anesthesia through an intravenous (IV) drip that keeps you asleep for the entire surgery. Your anesthesiologist also may offer you an epidural or spinal injection or a combination of the above. You will discuss this with your anesthesiologist prior to your surgery.

Computer Assisted Surgery

Our experts are trained in computer-assisted orthopedic surgery, which uses special cameras and intra-operative imaging tools that project images of the area being operated onto a television screen. On-screen prompts help guide surgeons to the ideal alignment of the implant and provide real-time vision of the surgical site. High-precision alignment may extend the long-term survival of the implanted artificial hip or knee, thus reducing the need for future corrective surgeries. UCSF Medical Center surgeons are currently involved in studying these new technologies to determine their impact on total hip replacement.

Recovery

After surgery you will be moved into the recovery room, where you will stay for several hours. During this time, you will be monitored until you awaken, at which time you will be taken to your hospital room. Typically, you will stay in the hospital for three to four days, but this varies depending on how quickly you progress. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.

Possible Surgical Complications

The rate of medical complications following hip replacement surgery is extremely low. Serious infections, such as a hip joint infection, occur in less than 2 percent of patients. The most common cause of infection occurs when bacteria enter the bloodstream during dental procedures, urinary tract infections or skin infections. After your surgery, you should take antibiotics before having any dental work or surgical procedure performed.

Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. These clots can become life threatening if they move to the brain, lungs or heart. However, your orthopedic surgeon will have a blood clot prevention plan that includes medication and support stockings. If you do experience any symptoms of blood clots, you should call your surgeon immediately. Your doctor and nurse will discuss what symptoms to look for.

Physical Therapy

To help strengthen your hip joint, it is recommended that you do small exercises such as contracting and releasing the muscles in your legs and buttocks, and ankle pumps. Also, it is very important that you restrict movement in your hips. Your surgeon and physical therapist will discuss these movements with you.

Usually, you will begin to work with a physical therapist the first day after surgery. The physical therapist will teach you specific exercises to regain full hip movement. During your hospital stay, you will work with a physical therapist one to two times per day. An occupational therapist and nurse discharge planner also will help you prepare for your discharge from the hospital. After you return home, you will work with a physical therapist three to four times a week.

Length of Stay

If you are having the minimally invasive two-incision hip surgery, you will stay at least one day in the hospital. You may stay in the hospital up to three days if you are having a primary total hip replacement. If you are having a revision hip replacement, you may be in the hospital four to five days.

Post-Hospital Care

Once you have returned home, it is very important to follow your orthopedic surgeon's instructions during the first few weeks after surgery.

• Caring for Your Incision -- Your incision is closed with staples, which will be removed around 14 days after your surgery. This area will be bruised for a while and may itch, pull or feel numb. You also may experience a burning sensation, which can be relieved by using an icepack for 10 to 15 minutes. Avoid using creams, lotions or ointments on the hip area. You may want to put a bandage on your hip area, although be sure that you do not soak it. Keep the area dry until your staples are out. Avoid showers until forty-eight hours after your staple have been removed.

• Physical Activity -- Being physically active is an essential part of recovery. Within three to six weeks, you should be able to resume most normal physical activities of your daily routine. During the first few weeks of recovery, a physical therapist may teach or help you perform specific exercises to strengthen your hip. Other recommended physical activities include graduated walking and normal household activities to increase your mobility. However, it is important that you do not push yourself and avoid falling, which can damage your hip and require further surgery. Stairs are particularly hazardous and should be avoided if you do not have the help of an assisting device or caregiver. Recommended devices include a cane, crutches, walker and handrails.

  Six weeks after surgery, when you regain full hip movement, you can probably resume driving. At this time, your surgeon also may allow you to return to work, depending on how much physical activity is involved in your occupation. Sexual activity can be resumed at this time as well.

• Follow-Up -- During the first year following your surgery, routine follow-up visits are scheduled with your orthopedic surgeon. Your follow-up appointments will be at three weeks, six weeks, three months, six months and 12 months after your surgery. You will be asked to return for annual visits thereafter to assess the status and function of your implant.