Total Hip Replacement Surgery: The Process

Replacing the worn out ball and socket joint of the hip with a metal stem/ball and socket. This is done to relieve the pain associated with arthritis of the hip. These components are fixed to your body with bone ingrowth or cement fixation. The type of fixation is determined by your bone quality, activity level, and weight. The procedure is done as an inpatient requiring a hospital stay of 2 to 4 days. The procedure takes approximately 60 to 90 minutes to perform. It is done through an incision which is as small as possible to allow adequate visualization for your surgery. A walker or crutches are used for approximately 2 to 4 weeks, then a cane for 1 to 3 weeks. Ninety to 95 percent of patients are happy with the results after surgery.

What is the Process?

• Make the decision to have surgery.
• Pick a date for your procedure.
• Pre-op medical evaluation with a primary care physician and consults as needed.
• Pre-op labs and tests within 3 weeks of surgery.
• Attend informational seminar at the Center for Joint Replacement.
• Donate blood as indicated 3-4 weeks prior to surgery.
• Arrange for family and/or friends to assist you after you go home from the hospital.

The Day of Surgery

What to Bring

• Walking shoes with rubber soles or tennis shoes. No house slippers.
• Pen and pad of paper to write down questions you may have.
• Personal care items.
• Women: Gowns and robes; knee length only. Bring panties. May wear shorts, sweatpants, and T-shirts, or a hospital gown with a robe, if you prefer.
• Men: Short pajamas or exercise shorts and T-shirts. May prefer hospital gown with a robe. Bring underwear.
• Do not bring over $5.00 or jewelry, credit cards or other valuables.

Report to

The outpatient surgery area of the hospital at the time designated on your surgery checklist. A nurse will review your medical history.

The Preoperative Area

You will meet the anesthesiologist, and he/she will discuss the type of anesthesia to be used. There are two options: A spinal anesthetic, which numbs you from the waist down. Sedation will also be given with a spinal, so you won't hear the sounds of surgery. The other form is a general anesthetic, which involves a breathing tube placed through your mouth.

You will be dressed in a hospital gown, and an IV will be started in your arm. You will receive a preop dose of antibiotics. Your family/friends may wait with you, until you are taken to the Operating Room.

Arrival at the Center for Joint Replacement

• After you spend 1-2 hours in the Recovery Room, you will be transferred to the Center for Joint Replacement, where your family and friends can visit you.
• The nurses will check your vital signs and pain control. If you are uncomfortable or have nausea, medications will be given to help.
• A therapist will evaluate you and begin therapy, including sitting, standing, and walking. Patients who return to the Joint Center in the late afternoon will begin therapy the next morning.

The staff at the Center for Joint Replacement specialize in the care of patients with joint replacement surgery. They will make sure your recovery goes as smoothly as possible.

Waking Up After Surgery

You will wake up in the Recovery Room, and then will be taken to your room. There will be several things connected to you.

• IV (intravenous line): This is a tiny catheter which is inserted into a vein in your hand or arm. It will be connected to a tubing and a bag of fluids.
• OXYGEN: You will have oxygen through a tubing with two small prongs into your nose. This doesn't mean that you are not breathing well. The oxygen may be discontinued the evening of surgery or the following morning.
• FOLEY CATHETER: A catheter may be inserted into your bladder during surgery. It will stay in for approximately one to two days.
• ABDUCTION PILLOW: This is a soft foam triangular-shaped pillow that fits between your legs and is secured with Velcro straps. If your doctor feels that you need it, it will be used to keep your legs in the correct position when you are turning in bed or sleeping. If it is ordered for you, it will be discontinued as you gain muscle control of your leg, and you will then use a fat pillow between your legs at all times when turning, even after you return home.
• DRAIN: You will have a drain tube into the hip after surgery. This removes excess blood from the hip after surgery. It will be removed the second day after surgery.
• P.C.A. (Patient Controlled Anesthesias) MACHINE: This is a machine which may be used for your pain medication. It connects by tubing to your IV line. Attached to a small IV pole is the machine which contains a syringe of pain medicine. There is a button on a cord from the machine that will be within your reach. When you are having pain, push the button, and the medicine will deposit directly into your vein. This is a small dose. Therefore, you may have it often, if you need it. The machine is programmed so that you cannot give yourself too much medicine. You may take pain pills along with using the machine. This machine will be disconnected when the pain pills will relieve your pain.
• BREATHING: The nurse will be asking you to take deep breaths and to use your spirometer, which is a small machine that you breathe into in order to clear your lungs.
• DIET: You will be on a regular diet after surgery.

The Remainder of Your Hospital Stay

Day 1 (the day after surgery)

• You will get up to a chair with the assistance of the nursing staff.
• You will begin physical therapy. The therapists will help you walk with a walker.
• Your exercise program will begin to help you to gain strength in your new hip.

Day 2:

• You will have physical therapy twice daily, doing your exercise program and walking further each day with your walker.
• The drain and Foley catheter will be removed by the nursing staff.
• Your IV will probably be discontinued, and the needle will be capped for a few days.

Days 3-4:

• You will continue physical therapy twice daily. When you can get in and out of bed alone, walk safely with your walker, and you have shown that you can climb stairs, you will be able to leave the hospital. This is usually the third or fourth day after surgery.

YOU are the most important player on your team of caregivers. Your doctor, or one of his assistants, will see you daily, and your nurses and therapists will play their roles in supporting your care. Only YOU can do what needs to be done to make your new hip its best.

Your hard work will be worth it!