Total Hip Replacement: http://orthoinfo.aaos.org/topic.cfm?topic=A00377
You will routinely be given 3 doses of antibiotics 8 hours apart, the first dose is just before the skin incision.
A total hip replacement puts you at risk of having a blood clot in the calf, which can go to the lung causing a PE (pulmonary embolus) and can make you very sick. There is a large debate that has been going on for many years about what is the best way to prevent blood clots. The stronger the medication, there is less likely to be a clot, but much higher chance of a complication. With no prophylaxis approximately 37% of people will develop a deep vein thrombosis (clot) in the calf, however most of these will be asymptomatic. There is no difference in fatal PE’s between any of the medications. Warning signs of a blood clot are pain and/or swelling below you knee, unrelated to your incision. Warning signs of a PE are, chest pain and shortness of breath. If these occur immediately seek medical attention. To give the best protection to all my patients, I use the “American Academy of Orthopaedic Surgeons Guideline on Preventing Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty”, for prophylaxis in all joint replacement patients, as can be found here: http://www.aaos.org/research/guidelines/VTE/VTE_summary_of_recs.pdf
- Pain relief
You will start with pain medication, through an IV line in your arm. The pain medication does very well for the pain, however it often makes you feel nauseated and constipated. You will routinely be given stool softeners to help along with anti-nausea drugs. These will then progress to oral medication, which you will go home on.
- Activities in Hospital
The first few days after surgery can be uncomfortable and for some they can feel drained. It is of vital importance that you are mobile both in and out of bed. There are many exercises that you can do whilst in bed, to speed up your recovery. Here is a link to exercises you will do in hospital:
- Discharge home
The average patient stays between 2-5 days. Some people take a little longer which is ok and should not be seen as a cause for concern. The earlier you can get up and become independent the lower your chance of some complications and the better you will feel.
- At home activities
It is important that your home is set up appropriately for your return. Such as having commonly used things in an easily accessible place. The furniture should be moved around so that you can navigate around with a walker if needed. All rugs or throws on the floor that can be tripped on should be removed. Sitting in a higher chair and always using a chair with arm rests. A chair in the shower is also very helpful.
- Resumption of activities
These are common questions I am asked. You can drive again only after 6 weeks, sex should also be avoided for this time. Sleeping is best done on your back with the legs slightly apart with a pillow between them. We encourage walking as much as you like, but we also really like swimming, once the sutures are out and the wound is dry (around 4 weeks) and cycling on a stationary bicycle.
- Do’s and Don’ts
Do be active,
Do kneel on the operated leg if you have to kneel
Do keep your leg in front of you when getting up
Don’t cross your legs at your knees
Don’t bend your hip past 90 degrees
Don’t sit on low chairs
Don’t pick up things off the floor
Don’t stop doing your exercises.
You will be seen at 2 weeks, 6 weeks, 6 months and then every few years as needed. Often a walker or crutches are needed for up to 6 weeks. The first few weeks can be a little daunting. The wound is checked at 2 weeks, at which point it can often be a bit sensitive still. At the 6 week point, pain starts to settle. By the 6 month mark, most people are very close to their best. It is important to understand that there are always outliers. Often people will say they had no pain since straight after surgery and others will still be sore at 1 year. These are all within normal bounds. Pain beyond 1 year needs to be fully investigated. However most people will be resuming all normal activities by 6 months.
Some people are keen to play sports afterwards. It is important to know that it is your hip and you can do what you like with it. However, it is important to know that it is a mechanical device and it can wear out. The more you use it, the quicker it will wear out. Exactly how long this takes is unclear. We introduced a new plastic liner some 15 years ago, which is far superior to old liners. Prior to this most hips last about 10 -15 years. Now however studies have shown little to no wear at 10-15 years, so new hips are lasting longer and longer. I recommend no sports for 6 months and after that it is done patient by patient. I encourage you to tell me what you want to achieve after your joint replacement and we can work together to get you there.
Complications are an inevitable possibility with such a large operation. Thankfully complications are rare. As a surgeon we strive to minimize these risks, but they are still possible. It is through auditing that we are aware of our own complications so that we can be aware of our rate and keep them within or less than international levels. Some complications have accepted numbers others such as leg length discrepancy are harder to define, as usually within 2 cm patients tend not to notice. Others can feel their leg is long even though it is not.
- Infection 0.4 – 1%
- Blood Clot 0.53%
- Fracture 0.1-1%
- Dislocation 1%
- Leg length discrepancy
- Loosening of implant 1% per year
- On-going Pain
- Nerve injury 0-3%
- Vascular Injury 0.2-0.3%.
- Heterotopic Ossification