HIP REPLACEMENT SURGERY
So you are considering hip replacement surgery! We hope that this page will answer as many of your questions as possible regarding this surgery. Please read through this entire page and watch all the videos. On this page, you will find:
What is hip replacement? How do we do it and why?
What to do before surgery.
What to do the day of surgery.
What to do after surgery.
Commonly asked questions and answers
The physical therapy protocol can be found here.
Hip replacement can be one of the most successful surgeries to restore quality of life…if performed well. We prefer to perform our surgery through a direct anterior approach. This means that the surgical approach to place the replacement is more from the front of the body rather than the back of the body (posterior).
BEFORE SURGERY: There are many tasks that can help your surgery process go smoothly. They include the following:
Medical clearance: some patients have medical issues that may impact the safety and risk of the surgery. If you have any issues that we are concerned about, we will request that you obtain a “medical clearance” from the appropriate physician’s office. This may be a primary care physician, cardiologist, pulmonologist, neurologist, etc. We will not proceed with surgery unless these clearances are in place…even if they are well controlled on medication.
Prescriptions: you will be prescribed several medications for AFTER surgery but you need to pick them up ahead of time. We will prescribe these to your listed pharmacy approximately 1 week before surgery. Pharmacy and insurance companies have become much harder to work with and we strongly recommend getting these in advance of surgery as there will be times when the medications are difficult to get or require more paperwork than is usually necessary.
Pain medication (typically oxycodone or alternative). This is a narcotic and addictive. Please use as little as possible. You should use it ONLY as needed follow the dosing as prescribed.
Stool softener (colace). This helps prevent constipation while you are on the pain medication. Please take it routinely as long as you are on the pain medication.
Blood thinner (Xarelto - also known as Rivaroxaban). This is used to prevent blood clots after surgery. Please take this until completely gone as prescribed. If your insurance company denies this medication or an equivalent medication then we may need to substitute with a blood thinner that is injected under the skin. Aspirin can also be a reasonable alternative.
Nausea medication (Ondansetron). This helps if you are having nausea from the anesthesia or pain medication. Use it as needed.
Muscle relaxant (cyclobenzaprine). This helps if you are having muscle spasms after surgery or during physical therapy. This can cause you to be sleepy and can help at night if you are having trouble sleeping. Use it as needed
Arrange physical therapy. We would like physical therapy to start about 1 week after surgery. This can be done near your home. We have physical therapy in our office two locations for you, if convenient. The referral will be placed but it is still up to you to schedule. Please arrange prior to surgery.
Obtain assistive devices: there are many devices that you may need during your recovery.
Walker: you will start with a walker immediately after surgery for weight bearing. You may end up transitioning to crutches or a cane depending on how physical therapy progresses.
Shower chair: having a shower chair can be helpful for after surgery, but not necessary. If you would like one, we can refer you to an appropriate store. Please give us advanced notice.
Toilet seat riser: having an attachment on your toilet seat to raise the height of it makes it easier to get on and off the toilet. It is not necessary, but if you like one, we can refer you to an appropriate store. Please give us advanced notice.
Food prep: Because your mobility will be less after surgery, we recommend preparing some meals ahead of time and freezing them so that you can simply warm them up when you are recovering. Preparing 3-5 days of meals should get you through the early phase and your mobility will be improved after that time.
Expect a call from the surgery center pre-op nurse who will be reviewing your medical history and medications for your stay. This is part of the pre-anesthesia plan. They will have recommendations regarding any medications that you typically take daily.
Expect a separate call the business day before your surgery from the surgery to communicate your check-in time. This is typically 1-2 hours before the actual surgery time.
For the evening before surgery, have a nice dinner and drink a big glass of water before you go to bed because NOTHING to EAT or DRINK after midnight. If you violate this, the surgery will be cancelled.
DAY OF SURGERY: This is the big day, but relax…all you need to do is show up. The rest is up to us. Please bring the following with you as you will most likely be spending the night recovering.
Insurance card for the surgery center
The surgery will typically be performed at Orthopaedic and Spine Center of Southern Colorado: 4110 Briargate Parkway, Suite 200. This is the second floor of the same building you have been to see me.
A change of clothes, personal hygiene equipment (toothbrush, hairbrush, etc.)
Family and friends are welcome to come and go as they please and I will update the family as soon as the surgical procedure is finished.
AFTER SURGERY: Congratulations! You have a brand new hip. You will want to review the following as it pertains to your hip replacement.
You will be weight-bearing as tolerated. That means you can put as much weight on the leg as tolerated using a walker initially. Expect to work with our physical therapists during your stay to show you how to get up and go. If you have stairs at home, please mention it to them and they will work on the techniques with you. See below for links on appropriate usage of walker.
We placed you hip using an ANTERIOR approach. That means you need to follow ANTERIOR hip precautions. Discuss this with your physical therapist and they can demonstrate the appropriate precautions. If you have any questions about these precautions, we can answer them at our follow up.
You have a sterile waterproof dressing in place. It is somewhat see through. You may shower when you are ready. Please leave the dressing on until your first visit (typically at the office in 1 week). If you see any liquid accumulating under the dressing, please call us and we will bring you in and change it if necessary.
It is common to see bruising surrounding the incision and the bruising and swelling often will spread down the outer thigh. Do not be concerned as this is expected.
Keep up with your fluids and nutrition.
Start physical therapy.
Dental prophylaxis: for my patients, I recommend that you get a single dose of oral antibiotics before any dental procedure (even routine cleanings). The hip replacement can always get infected for the rest of your life. Please notify your dentist and they will typically prescribe the antibiotic. If they do not want to prescribe it, please let me know and I will do it for you.
FREQUENTLY ASKED QUESTIONS:
Will I need a walker after surgery?
Yes. You will be on walker for 2-4 weeks depending on your personal recovery.
Here are a couple useful links on how to use a walker:
Using a walker
Using a walker on stairs
Will I need a hip brace as well?
No.
How often should I ice my hip?
If using ice packs or bags, we recommend putting ice on for about 20 minutes and then removing the ice pack/bag for 20 minutes and then repeating.
If you have a cold compression device, it can be left on for 30-60 minutes
Audubon Orthotics & Prosthetics has a rental unit that provides both cold therapy and compression. Many patients find this to be very helpful after surgery. Please let us know if you would like to see or rent one and we will connect you with them.
I have the sequential compression devices for my legs (calf squeezers). When and how do I use them?
These devices are designed to help circulate your blood when you are less mobile. Please utilize them when you are sitting for more than an hour and at night if possible when you are sleeping
These devices have a battery, but it does not last long. We typically recommend keeping them plugged in.
When you are up and moving around, they are not needed.
Can you explain my medications again?
We give you a variety of medications to try to make the recovery go smoothly. Remember that most of these medications are AS NEEDED. So, if you do not need them, do not use them.
Pain medication (usually oxycodone or alternative). This is the narcotic. It is to take the edge off of surgical pain. It will not eliminate the pain. These are addictive so please use sparingly.
Stool softener (Colace). While taking the narcotic, please take a stool softener to counteract the constipation caused by the pain medication.
Anti-nausea (ondansetron or phenergan). This is provided if you have nausea after surgery.
Muscle relaxant (cyclobenzaprine or other). This is provided to help with muscle spasms that can occur after surgery. This can be taken with the pain medication or all by itself. Please be aware that it makes most patients sleepy.
Blood thinner (Xarelto or other). All surgical patients are at risk for blood clots. Based on your personal risk, we will prescribe one. Duration is based on the complexity of the surgery and the duration of risk.
When can I drive?
You cannot drive while taking pain medications (narcotics)
Driving after surgery is a judgement call. If you can get in and out of the vehicle and feel that you can start and stop the vehicle, then you can start driving.
Patients who have had surgery on the left hip, and who have an automatic transmission may drive when they can comfortably get the leg in and out of the car.
Patients who have had surgery on the left hip and have standard transmissions, should not drive until they have good muscular control of the leg. This usually takes 1-6 weeks depending on what type of surgery was performed.
Patients who had surgery on the right hip should not drive until they have good muscular control of the leg. This usually takes 1-6 weeks depending on what type of surgery was performed.
When can I return to work?
Return to work is based on the type of work you do and the requirements that are necessary for your occupation.
Please discuss return to work with Dr. Huang and his staff as soon as possible. If you have any specific work related paperwork, please provide it as soon as possible.
Dental prophylaxis: for my patients, I recommend that you get a single dose of oral antibiotics before any dental procedure (even routine cleanings). The hip replacement can always get infected for the rest of your life. Please notify your dentist and they will typically prescribe the antibiotic. If they do not want to prescribe it, please let me know and I will do it for you.