The most common reason patients require hip replacement surgery is for Osteoarthritis. This is a condition where the tough, smooth cartilage which cushions the bones of the joint when they move is worn away. The destruction of this protective layer over time leads to bone rubbing on bone, which is very painful and results in swelling and joint stiffness.
The aim of hip replacement surgery is to both relieve pain and restore function.
A hip joint replacement uses an implant to re-cap the worn, exposed bone ends. The socket (acetabulum) is lined with an uncemented metal cup with a plastic or ceramic liner. The head of the femur is surgically removed and a metal alloy stem with a metal or ceramic ball is then inserted into the femoral shaft. In most cases this is cemented into place. These two components create a smooth surface to restore joint motion.
The majority of surgeries go very smoothly without any major complications.
Serious complications include infection and blood clots. To reduce the risk of infection, Dr Schluter will prescribe antibiotics during your stay, and additionally he and the surgical team take extra precautions in the operating room to reduce your risk of infection. To reduce your risk of clots you will be given blood thinners and compression stockings and a calf compression device may also be used. As you recover, keeping mobile, performing ankle pumps and taking any prescribed blood thinners will also help reduce your risk of clots.
In the first 6 months after your hip surgery, there is a risk of dislocation of the joint. Dr Schluter and your physiotherapist will provide you with information on movements to avoid to reduce the risk of this occurring.
There are also general risks of having a hip replacement that are not orthopaedic related. These risks often relate to your underlying health and your Anaesthetist will be the best person to answer these questions but include:
Not being able to empty the bladder
As a general guide, patients will be in hospital for 3-5 days following a hip joint replacement. Dr Schluter will ensure you have achieved several specific goals before you can be discharged home. These include being safe with mobilising with crutches or a frame, being able to dress shower and access the bathroom, and being able to safely move in and out of bed and a chair.
There are a number of things you can do to make sure you are ready for your surgery.
Stay fit and active leading up to your surgery date – it is important to make sure you are in the best condition possible before undergoing surgery. Eat well and get plenty of sleep. Light walking for 10-15 mins every day and light strength exercises will help your recovery. Remember, don’t do any exercises that are painful for you.
Stop taking herbal medicines (for example St john’s wort, ginger, gingko biloba, ginseng, garlic, echinacea, kava-kava ) 4 weeks before your surgical date as these can interfere with hospital medicines.
Stop Smoking - smoking slows the healing process and can increase blood clotting. Stopping smoking at least 6 weeks before your surgery will increase your ability to heal. You can contact your GP or Quitline 0800 778 778 ( www.quit.org.nz ) for further assistance.
Practice deep breathing exercises – these exercises will keep your lungs healthy and prevent pneumonia after the operation. The nursing staff on the ward will also assist you with these in the days after your surgery.
Make sure you are ready for your trip to the hospital by checking you have your hospital bag packed and have included all your important documentation.
DO NOT EAT OR DRINK after midnight, unless otherwise instructed.
Some patients will be given specific instructions regarding essential morning medications – please follow these carefully. You may brush your teeth and rinse only with water in the morning.
We schedule between two and three hours for your operation. The surgery itself generally takes between 90 mins and 2 hours.
The process starts with the staff preparing you for surgery and completing a series of essential check lists. Dr Schluter will meet with you, cover any further questions you may have, sign the consent form and also mark the operation site.
You will also meet your Anaesthetist (Specialist Doctor) who will review your medical history and discuss with you the type of anaesthesia best suited to you. An IV line (drip) will be inserted, and you may be given some preoperative medications. Once in the operating room, and the final patient check is completed, you will be ready for anaesthesia.
After the operation, you will spend around half to one hour in the recovery room where nursing staff monitor your progress and commence your post operative pain regime before returning to your room in the surgical ward.
Your hip should not be painful due to the anaesthetic and also the injection of local anaesthetic into the joint
There will be a padded dressing the length of the incision
The wound will have been closed with a resorbable suture
You may have a urinary catheter in your bladder
You will have an IV line(drip) going into one of your veins
You will have compression stockings on both legs with mechanical pumps helping blood flow in your calf muscles.
Dr Schluter will call your contact person to let them know you are in the recovery room
During your entire stay, the nursing team will regularly monitor your observations (blood pressure, heart rate, temperature) and track your fluid input and output. They will also monitor your pain score and administer pain medications that have been charted for you.
DAY ONE: You will be assisted out of bed and helped with bathing and dressing and then seated in reclining chair. If there is a urinary catheter, it will be removed. The antibiotics will be stopped but you will continue on blood thinning injection until you go home. You will have a blood test and you may have an xray. You will be assessed by the physiotherapist and given gentle exercises to start with. Dr. Schluter will visit you on the ward.
DAY TWO: The nursing staff will be there to assist you, but it is expected that you do more for yourself each day. You may notice pain in your hip, and though it may be sore, it hopefully will be controlled with regular oral pain medications. Gentle exercises are encouraged, and you may be able to move around the ward for a short time. Some patients progress from a frame onto crutches
DAY THREE: Each day until discharge you will aim to be doing more for yourself and become increasingly mobile.
On discharge, you will be given crutches, a pain relief and blood thinner (generally aspirin) prescription. You will need to make an appointment to see your GP for a wound check at 12 days post op.
Most patients go directly home after their surgery as patients usually prefer to recover in the comfort of their own surroundings. Depending on your progress for the first few days or weeks, you will need some assistance with food preparation and other household tasks. If you live alone, a family member or friend needs to be available to help if possible.
Preparing ahead of time can let you concentrate on your recovery. Before you leave for the hospital, putting clean linens on the bed, doing the laundry and housework, and making some meals for the freezer will reduce your need for extra help.
You can also make sure your house is safe and avoid tripping hazards by
making sure rugs are smooth and secure,
having non-skid matts in the bathroom and kitchen,
removing cables and extension cords from areas you walk
consider putting in night lights in hallways and the bathroom to improve visibility.
and remember to avoid wearing open toe or backless footwear
You can place frequently used items in the kitchen, bathroom and bedroom where they can be easily reached without bending, stretching or having to use a step stool.
Make sure you have arranged for someone to collect you from the hospital (generally late morning) and be aware you may need to stop at a pharmacy on the way home to collect your post-operative medications.
Recovery takes time and everyone progresses at a different rate. You may still need assistance from a partner, friend or relative for several weeks after you return home.
Most patients experience some generalised swelling in the thigh on the side of the operation, and occasionally there may be swelling of the ankle on that same side. This is normal and can take up to 3 months to settle. If there is swelling that is very painful or hot, this may need review – please contact Dr Schluter’s rooms for advice.
It is normal to have a small amount of bleeding into the dressing for up to a week. If there is bleeding that completely soaks the dressing, this will need review – please contact Dr Schluter’s rooms for advice.
Crutches are provided to help you balance when walking. The crutches may be needed for a month or so while you build up muscle strength, and the pain and swelling resolves. As your balance improves and you regain strength, you should use one crutch for support before walking for periods without assistance.
Pain will gradually improve and movement will increase.
You will gain more independence and will start to feel better about having had the replacement performed.
You will need to see your GP at 12 days for a wound check.
An exercise regime provided by the physiotherapist will help strengthen muscles and prevent the joint getting stiff
In general, daily gentle walking on an even surface is excellent for your recovery
The dressing on your wound is waterproof, and it is fine to shower with it
YOU CANNOT DRIVE FOR THE FIRST 6 WEEKS.
It is important to be as active as you can and aim to do a little more each day. Mobilisation and exercises will help strengthen the muscles and prevent the joint form stiffening.
To prevent your hip coming out of the socket (dislocating) there are several movements you should avoid
Do not lie on the operated side for 6 weeks
Do not cross your legs
Do not twist or rotate from the hips
Do not bend at the waist more than 90 degrees
Avoid low seats or toilets that cause you to bend more than 90 degrees
Avoid bending over to pick up items off the floor. If you do need to, keep your legs apart and have the operated leg behind you.
Consider getting a grabber and long shoe horn to prevent excessive bending at the hip.
As a routine, Dr Schluter will see you 6 weeks after your surgery
It is important to follow your progress so we can check the integrity of the prosthesis (implant). A routine xray and consultation with Dr Schluter is recommended at I year and again at 10 years, or sooner if required.
Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:
Temperature higher than 38.5 °C (fever) or chills.
Sudden severe pain or tenderness at the wound site or in the joint.
Significant new swelling in the calf or thigh, especially if associated with pain or heat
Redness around the incision that continues to spreads.
Heavy bleeding from the incision.
Worsening flexibility or an inability to bend the knee.
Loss of mobility after a fall.
Any concerns you may have regarding your knee replacement.