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Total Hip Replacement
What you need to know about total hip replacement (THR):
THR is surgery to replace a hip joint damaged by wear, injury, or osteoarthritis. It is also called total hip arthroplasty. The hip joint is where the top of your femur (thigh bone) sits in the socket of your pelvic bone. The joint is held together by ligaments and muscles. The top of your femur is shaped like a ball and covered with cartilage. Cartilage is a tissue that helps joints move.
How to prepare for THR:
- Your healthcare provider will check your overall health. He or she will ask about your current hip pain or stiffness. Tell your provider how pain or stiffness affects your daily activities or ability to play sports. He or she may also ask about fatigue, anxiety, or depression you may have.
- Some medicines will need to be stopped weeks before surgery. These medicines include blood thinning medicine, such as aspirin and ibuprofen. It also includes some antirheumatic medicines. Make sure your healthcare provider knows all medicines you are taking. Also ask how long before surgery to stop taking them.
- The week before surgery:
- Ask a family member or friend to drive you home when you are discharged from the hospital. Ask someone to stay with you for 1 to 2 weeks after surgery, in case you need help.
- You may need to move furniture around to make room for assistive devices that will be used after surgery. You may need a cane or a walker to get around safely.
- Keep all self-care items and most commonly used items within your reach. After surgery, you will need to avoid bending down or reaching over your head.
- You will not be able to sit or get up from low seating after surgery. Check to see if your chairs and toilet seats are too low.
- Ask your healthcare provider about other things you can do to make your home safer.
- Your healthcare provider may tell you not to eat or drink anything after midnight on the day of your surgery. He or she will tell you what medicines to take or not take on the day of your surgery.
What will happen during THR:
- You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given regional anesthesia, such as spinal or epidural anesthesia, or a peripheral nerve block. Regional anesthesia keeps you numb from the waist down, but you will be awake during surgery.
- Your healthcare provider will talk to you about which of the following procedures is right for you:
- The conventional hip replacement involves 1 incision. Your healthcare provider will make the incision along the front, side, or back of your hip.
- The minimally invasive hip replacement surgery involves a smaller incision that is about 4 to 8 inches in length. Your healthcare provider may make an incision along the front, side, or back of your hip. He or she will use fluoroscopy (a type of x-ray) as a guide during the surgery.
- The ball of your femur and the socket of your pelvis will be removed. A hip implant will replace the bones that were removed. Your healthcare provider may use medical cement to secure the implant parts. He or she may use an implant that has a porous surface. This surface allows your own bone to grow and fill the pores of the implant. Your healthcare provider may use both cement to hold the ball in place, and a porous socket implant. A drain may be placed to remove extra blood and fluids from the surgery area. Your incision will be closed with stitches or staples and covered with a bandage.
What will happen after THR:
- It is normal to have increased stiffness and pain after surgery. Your pain and stiffness should get better with exercise.
- Do not get out of bed until your healthcare provider says it is okay. Healthcare providers will teach you how to sit up and move without causing damage to your hip. A physical therapist will help you walk after your surgery. When you walk the same day after surgery, it helps decrease pain and improves the function of your hip. You may use crutches or a walker.
- You may be in the hospital for up to 5 days, or you may go home shortly after surgery. Your healthcare provider may talk to you about rehabilitation you can do at home. A physical therapist can teach you exercises to help strengthen your hip and prevent stiffness. You may also need occupational therapy to teach you the best ways to bathe and dress.
Risks of THR:
- You may have more hip pain, or your hip joint may become stiff or numb. Your joint movement may not be as stable as it was before your surgery. You may have bone loss, or the bones near the implant area may break or crack. You may bleed more than expected or get an infection. Your nerves, blood vessels, ligaments, or muscles may be damaged during surgery.
- Your implant may become loose or move out of place. If this happens, you may need another surgery to replace the implant. You may need surgery to remove your implant if you have an allergic reaction to the materials. You may get a blood clot in your limb. This may become life-threatening.
Call 911 for any of the following:
- You have chest pain when you take a deep breath or cough. You may cough up blood.
- You suddenly feel lightheaded and short of breath.
- You have a seizure or feel confused.
Seek care immediately if:
- Your leg feels warm, tender, and painful. It may look swollen and red.
- Your incision comes apart.
- You urinate less than usual or not at all.
Contact your healthcare provider if:
- You have a fever or chills.
- Your wound is red, swollen, or draining pus.
- Blood soaks through your bandage.
- You have nausea or are vomiting.
- You have more pain and swelling in your hip joint, even after you take pain medicine.
- You have questions or concerns about your condition or care.
- Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
- Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
- Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
- Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
- Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
- Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
- Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
- You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
- Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
- Use your assistive devices as directed. Examples include a walker, cane, and a reacher. These devices will help decrease your risk for falls.
- Do your exercises several times each day. The physical therapist will teach you exercises to build strength and prevent blood clots.
Prevent dislocation of your hip implant:
Do the following for up to 8 weeks after your hip replacement:
- Sit in a straight-backed chair. Use armrests to help you rise from a seated position. Do not sit in low chairs, sofas, rocking chairs, or stools.
- Use assistive devices to put on socks and shoes. Do not lean forward to put on pants, socks or shoes. Do not lean forward or twist to pick items up.
- Keep your knees apart. Do not cross your legs. You may need to put a pillow between your knees to remind you.
Follow up with your healthcare provider as directed:
You will need to have your stitches or staples removed. Your healthcare provider may contact you weeks after your surgery. He or she may ask if surgery helped relieve your pain or stiffness. Tell your provider how well you are able to do your daily activities after surgery. Also tell him or her if you are having any problems with mobility or range of motion. Write down your questions so you remember to ask them during your visits.
Care for your incision area as directed:
Do not get the area wet until it is completely healed. Ask your healthcare provider when it is okay to get the area wet. Change your bandage as directed and if it gets wet or dirty.
A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. If you are not able to be safe at home, you may be admitted to a rehabilitation facility.
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