5 Things to Know About Hip Replacement Surgery

2. Not everyone with joint damage needs a hip replacement

Pain and inflammation caused by osteoarthritis — sometimes called “wear and tear” arthritis — is the most common reason for a hip replacement, followed by rheumatoid arthritis (a chronic autoimmune disease) and a post-traumatic issue, such as a fall, Summers says. A condition known as osteonecrosis, which is when blood supply to the hip bone is cut off, can also lead to a hip replacement.

With osteoarthritis, which affects roughly 33 million U.S. adults, there’s a genetic component and a use component, Summers says. “In some people, their cartilage is less durable and tends to wear out faster. That’s the genetic component.”

As for use, Summers explains that some people are harder on their hips — they accumulate injuries over time, they may be overweight, and the hip may wear out from more stress going across the joint over a longer period of time. “Eventually arthritis develops, but not in everybody,” he says.

The decision to have hip replacement surgery is different for everyone and requires a conversation with your doctor. If you’re not dealing with an accident or a physical ailment like a tumor, for example, going under the knife will likely depend on your lifestyle and your pain level. For instance, if pain is causing you to lose sleep or is making daily tasks more difficult, you may be a candidate.

Sometimes a person’s imaging tests may look like they’re in pain, but their symptoms don’t match, explains Rishi Balkissoon, M.D., an adult reconstruction orthopedic surgeon at the University of Rochester Medical Center (URMC) in Rochester, New York. “It may be surprising that just because you are bone-on-bone, this does not mean that you need surgery.”

If you don’t opt for surgery, Balkissoon says there are evidence-based, non-surgical treatments that may help with symptoms, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen; cortisone injections; physical therapy; low impact activity and the use of assistive devices such as a cane or walking sticks.

3. Most patients go home the same day as their surgery

Curious what the procedure entails? Here’s a quick snapshot.

There are four main ways surgeons can get to the hip:

• Anterior, where they enter through the front of the upper thigh
• Anterolateral, where they enter from the side and then around the front
• Lateral, where they enter just from the side
• Posterior, where they enter behind the side of the hip bone

While there are pros and cons to each, the “best” method is the one that fits your medical needs and the one that your doctor is most comfortable with, says Summers, who performs approximately 400 hip replacements each year.

Before your operation, discuss with your surgeon whether you’ll be going home the same day or spending the night in the hospital. “The vast majority of patients are candidates to go home the same day as the surgery,” Summers says. You might need to stay over if you have a preexisting condition that needs some extra monitoring.

On the day of the surgery, expect to arrive an hour or two beforehand. You’ll have some paperwork to do, and you’ll meet the various people responsible for your care, such as the anesthesiologist. “Usually, these surgeries are done with a spinal anesthetic, which means they give you one injection in your low back, and you’ll be numb from the waist down,” Summers says.

A general anesthetic can be used, too. Leppla, the patient from Rochester, says his hip surgeries — he’s had both replaced — were done under general anesthesia because he had scar tissue from a previous back surgery. But if you can tolerate a spinal, Summers says, “you can avoid the discomfort of having a tube down your throat and you won’t necessarily be as groggy after surgery.”

The procedure takes about an hour and a half to two hours, and you will likely be walking later the same day. Leppla says his surgery took two hours and then he was in recovery for about two hours. Later that day, he was already starting physical therapy.

4. Full recovery can take a few months  

Consider scheduling your surgery when you have at least a two-month window of time to appropriately recover, Summers says. While you will be up and walking right away, you have to recognize that your body has been through a lot.

It takes time for your bones to adjust to the new hardware, Balkissoon says. “And similarly, the soft tissue around any joint takes about three months to get to approximately 80 percent healed.” His recommendation: Don’t plan on playing golf in the few weeks following surgery. It’s best to minimize the potential for complications, Balkissoon adds, “because early complications can lead to further and more devastating consequences including multiple other surgeries.”

One thing Leppla found helpful and recommends to others: Purchase a few things ahead of surgery that can help with daily tasks while your body heals. Some or all of these may be covered by insurance.

• Sock pullers, so you don’t have to bend more than 90 degrees at the waist
• Long-handled claws to help you reach for things
• Metal clip dressing aid, to help you pull up your pants
• Long-handled shoehorn
• Cane or walking sticks
• Foldable wheeled walker
• Transfer bench to get in and out of the bathtub
• Cold packs or ice machine to help reduce inflammation, pain and swelling after surgery

5. Breakthroughs are helping to lower risks and improve recovery  

One important advance is in “the way we manage blood loss around surgery,” Balkissoon says. Blood loss is a common risk in hip and knee replacement surgeries, but a drug known as tranexamic acid has helped mitigate this risk.

The medication helps provide clot stabilization and reduce blood loss after surgery, and over the last decade or so “has reduced the potential for blood transfusions approximately 60 percent throughout the United States,” Balkissoon says.

The current use of nerve blockers during surgery as well as post-operative pain control medications have improved recovery, Summers says. He also believes that computer-aided navigation tools and other new technologies such as robotic-assisted surgery have helped surgeons “to be more accurate and more precise in hitting our targets during surgery.”