Total Hip Replacement

Preoperative counseling information
Making a decision to have a total hip replacement?

Before you decide to have a total hip replacement, you must be certain you understand the risks and benefits of total hip replacement.

Benefits:

Pain Relief
Greater than 95% of recipients attain excellent pain relief. Although the technology is marvelous, a hip replacement is not as good as a normal 20 year old’s hip.

Many recipients recognize the difference between their native hip and the replaced hip. In large studies, greater than 95% of patients were glad they had the hip replacement and would recommend the operation to a friend. We have many recipients here in Grants Pass who have offered themselves as counselors for people contemplating the surgery. Upon request, we can provide you with names and telephone numbers.

Longevity
Depending upon the stresses placed on the hip prosthesis, it is possible for the hip replacement to last up to 20 years. Considering the fact that our hips cycle over two million times a year, this longevity is amazing. Although undesirable, it is possible to revise a worn hip replacement with a new prosthesis.

Activity
A total hip replacement will allow you to return to most of your daily functions without difficulty or restrictions. Many recipients enjoy an active lifestyle to include golfing, gardening, bowling, swimming and walking. We discourage pivoting sports such as tennis or basketball.

Risks of total hnee replacement:

Infection
In Grants Pass, we have attained an infection rate of one-fifth the national average. The operation will be performed in a specialized joint replacement operating room with specialized air flow. In addition, the operative team will wear “space suits”. Intravenous antibiotics will be administered before and after surgery.

Blood Clots
Blood clots can develop in the calf and thigh during any surgical procedure, but especially orthopedic procedures. They can be life threatening. We utilize state of the art precautionary measures. On the evening following surgery or the first day after surgery, you will be started on a blood thinner which will be continued while at home. In addition, we will encourage you to pump your ankles to promote circulation in the calf. We will place foot or calf compression devices on you as well as thigh high compressive surgical stockings/hose while hospitalized to improve circulation and decrease the chance of developing blood clots.

Hip Dislocations
To insert the prosthesis, it is necessary to incise the ligaments which hold the hip in place. These will need three months to heal. Full healing will take up to one year. Restrictions will be placed on your mobility strictly for the first three months and with precautions for the next three months. A special pillow will be placed between your legs at night to prevent the hip from popping out or “dislocating” during sleep.

Nerve or Blood Vessel Injury
Your nerves and blood vessels lie within one-half inch of your hip joint. Although the risk is less than 1%, it is possible that an injury could occur. A nerve injury could cause loss of sensation or muscle strength temporarily, or permanently below the hip joint. A vascular injury would be repaired. We take every precaution to avoid injury.

Leg Length Discrepancy
Just as all people are individuals, the alignment of their hip is also individualized. Unfortunately, hip prosthetics come in one alignment. At the time of your surgery, it is critical that your prosthesis be aligned so that a hip dislocation will not occur. At times, this alignment adjustment will either lengthen or shorten your leg. All attempts are made to equalize the leg length. If one leg is less than one-half of an inch different in length, the body will adapt. If the discrepancy is greater than one-half of an inch, a lift will typically be needed for one of your shoes.

Blood Transfusion
Typically, total hip replacement recipients pre-donate two units of blood for use after surgery. Occasionally, it is necessary to use additional blood from the community blood bank. The risk of contracting hepatitis is approximately 1 in 63,000 and the risk of contracting AIDS is 1 in 676,000 from the community blood blank. We will make all efforts to avoid its use if possible.

Death
This is an extremely rare occurrence in healthy individuals. If preexisting medical condtions are present, we will obtain the assistance from your regular doctor to assure a safe operation.

Pre-surgical Preparation:

History and physical evalutation
Our Physician Assistant will evaluate your medical history and examine your heart and lungs. At the time of this visit, please bring a record of your medical problems, hospitalizations, surgical procedures, medications and their dosages, and any allergies to medications that you are aware of. This information is very important.

Laboratory Testing
At the time of your visit with our Physician Assistant arrangements will be made for blood tests, heart electrocardiograms and a chest x-ray. Additional leg x-rays will also be arranged, if needed.


Peroperative Clinic
An appointment will be made with the hospital preoperative clinic. At this appointment you will speak with an anesthesia provider, pre-register for your surgery, and have your lab tests completed.

Durable Medical Equipment
At the time of your history and physical examination, you will be provided with prescriptions for walking aids and a raised toilet seat. Please obtain these prior to surgery. Please bring your walker to the hospital prior to your release from the hospital. This will allow the therapist to correctly size the walking aid. Most insurances cover the walking aid and raised toilet seat. You may want to purchase a “grabber” and a long shoe horn at the medical equipment supplier. These are not covered by insurance plans. They will facilitate daily activities while your hip is healing and your mobility is restricted.  You may want to purchase a “grabber” and a long shoe horn at the medical equipment supplier. These are not covered by insurance plans. They will facilitate daily activities while your knee is healing and your mobility is restricted.

Medications
At the time of your appointment with our Physician Assistant you will be provided with a prescription for pain medications and a stool softener for after surgery. Please obtain these prior to your surgery. You may also receive a prescription for a blood thinner called Lovenox or Arixtra. This is an expensive medication. Some insurances will not cover this medication. We will request pre-authorization from insurance. Your pharmacist will assist you with your insurance coverage. Please obtain this medication prior to your surgery. You will be instructed in its use at the time of your hospitalization.

Blood Donation
Arrangements will be made to pre-donate blood before surgery. Please obtain an over-the-counter iron supplement and begin taking iron one month before surgery. Your body needs iron to rebuild it’s blood supply. Normal dosage of iron sulfate is 325 mg twice a day. Be sure to add a stool softener also, since iron can cause some constipation.

Please stop taking aspirin (or arthritis pills), which can thin your blood, five full days prior to surgery. Tylenol is not a blood thinner. Please call us if you have any questions.

Surgery
You will need to come into the hospital on the morning of your surgery.

Hospital Stay
Average hospital stay is approximately three to four days. On the first day after surgery, you will be asked to sit in a chair at the side of your bed. On the ensuing days, we will progressively assist you in walking. When you are safely able to enter and exit your bed and ambulate, you can be released from the hospital.

Pain control will initially be accomplished using a combination of oral or IV pain medicine and “nerve blocks”. Nerve blocks are shots of long acting anesthetics around the nerve that supplies the hip. They can last 6 to 24 hours. Sometimes a tube will be inserted to provide a continuous block for the first couple of days after surgery.

You will be transitioned to pain pills as you become more comfortable. A large bandage will be placed on your hip. This will be changed periodically. The skin clips will be removed by your therapist approximately two weeks after surgery. You may shower 48 hours after removal of the skin clips.

Initially, you will have an intravenous tube, a bladder catheter, a hip drainage tube, and supplemental oxygen tubes to assist your breathing. Each of these tubes will be removed as you recover from surgery.

It is not possible to take your blood thinner in pill form. It will be necessary to place an injection under the skin. This is similar to the injection diabetics perform on a daily basis. You will be instructed on how to safely perform these injections. At first, these injections may seem impossible. With coaching, you will find them to be easy.

After Surgery:

Depending on your desires and your progress after surgery, you may be able to return home directly from the hospital. We will make arrangements for a therapist to come to your house to further assist you in your therapy. You will be taught safe positioning of your hip, as well as exercises for strengthening. Much of this therapy will be self-directed and performed daily for the first three months after surgery. By doing these exercises daily, you will dramatically shorten your recovery time.

Based on your discretion and your progress in therapy, you may benefit from a short stay in a local rehabilitation facility. These facilities include Royale Gardens, Highland House, and Fairview. They are skilled nursing facilities that also have developed specialized rehabilitation units. They allow you concentrated therapy while providing more recovery time prior to returning home. We encourage you to visit these rehabilitation facilities before surgery. The decision on whether to return home or to a rehabilitation facility will be made during your hospital stay. It is helpful to know prior to surgery if you desire a stay in one of the rehab. facilities. The sooner we make these arrangements the better the transition from hospital to the facility. This will be further discussed at your preoperative history and physical examination with our Physician Assistant.

Therapy
Depending on your desires and your progress after surgery, you may return home from the hospital. Outpatient therapy will be arranged. You will be taught stretching and strengthening exercises. Much of this therapy will be self-directed and performed daily for the first three months after surgery. By doing these exercises daily, you will drastically shorten your recovery time.

Based on your discretion and your progress in therapy, you may benefit from a short stay in a local rehabilitation facility. These facilities such a Royale Gardens, Highland House, and Fairview have developed rehabilitation units. They allow you concentrated therapy while providing more recovery time prior to returning home. I encourage you to visit these rehabilitation facilities before surgery. The decision on whether to return home or to a rehabilitation facility can be made during your hospital stay. It is helpful to know prior to surgery if you desire a stay in the

Recovery
Full recovery can take up to one year. Frequently, however the hip will have less pain than prior to surgery within four weeks after surgery. Restrictions on the positioning of the hip are maintained for six months after surgery. If you enjoy walking for exercise, you are encouraged to resume your walking as early as two weeks after surgery. You will be unable to drive for at least six weeks after surgery. Many hip replacement recipients resume social activities at approximately eight weeks after surgery. These include dining out, shopping and visiting friends. It is impossible to outline an exact recovery time because the description of “recovered” and the general health of each individual is extremely variable.

Most Importantly
We are here to assist you. Please do not hesitate to ask for help or ask questions. A knee replacement is a large decision and a large event. Let us assist you through the process.

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