Total Hip Replacement

Total hip replacement is the surgery where we replace the damaged hip joint by a metal or plastic. We fix the implant either by cement or by bone ingrowth. This procedure will alleviate the pain and will help to restore patient activities with some limitation.

• Risks in surgery:
  • Infection: 1%. If it happens we need to remove the prosthesis then put a spacer with IV antibiotics for 6 weeks then revise the joint with new implant
  • DVT: 1%. We give anticoagulation after surgery for 2 weeks
  • Neurovascular injury: rare
  • General anesthesia risks
• Admission Procedure:
  • At Physician office: the patient will get full explanation about the procedure and it complications. The patient will be signing an operative consent afterward. He will be provided with papers for his third party payer.
  • At PAU: a complete physical exam will be provided and labs will be taken include: CBC, ESR, CRP, Cr, TXM, PT, PTT, and ABG. Urine analysis and culture. Two unit of blood will be prepared. CXR will be taken. EKG.
• Before Surgery:
  • It is advised not to eat or drink after midnight the night of surgery
  • A shower with antibiotics soap
  • Anesthesia team will insert IV and will give medication to relax
• During Surgery:
  • Surgery will last around 2 hours
  • Patient will have a suction drain from beside the wound
  • After surgery is over patient will be transferred to recovery room. Patient physician will contact your relative
  • Patient will have a pillow between the leg
• Recovery after surgery:
  • Patient need to take deep breaths for thier lungs
  • He/She will be given antibiotics and anticoagulation
  • Pain medications will be provided on demand
  • Nurse in charge will be there for any assistance
  • Foley Cath will be applied just in one condition, if patient fail to void 8 hours after surgery
  • Drain will be removed the second day
  • Physiotherapist on day 2 will be ready to do some exercises and ambulation
  • Day 3, if patient OK will be discharged home
  • Physiotherapist will visit at home for exercises
  • Dressing will be changed every 3 days
  • Prescription will be provided upon discharge
  • Dressing will be changed every 3 days
  • Sutures to be removed in 3 weeks
  • Discharge will be with an ambulance
• Hip precautions:
  • Leg should be abducted, no leg crossing
  • No hip flexion beyond 90° unless you told are so
  • No rotation is allowed first 3 weeks
  • Ambulation using walker partial weight bearing
  • Patient should not sit on low seat chair
  • During sleep keep a pillow in between the legs
• Accessories:
  • Toilet seat raise
  • Walker
  • Cane
• Rehabilitation:
  • The physical therapist will see the patient the second day after surgery. He will teach gentle exercises and ambulation.
  • The patient will be scheduled for physical therapy visit directly after discharge on a daily basis until he has full control of ambulation.

Exercises at home will include Hip and Knee ROM strengthening exercises for the quadriceps muscle. The patient will ambulate using walker first 10 days then shifted to cane as he progress with therapy.

• Questions at home
  • Watch for any drainage from the wound, Redness or unusual sore
  • Significant swelling in the leg
  • Change in length with pain
  • Difficulty in breathing