Total Hip Replacement

Total Hip Replacement is recommended for patients suffering from Arthritis, extreme pain and limited function.


To understand hip replacement surgery it is important to understand how your hip works. Your hip is essentially a ball and socket joint that allows movement in many different directions. The ball is your upper end of the thigh bone that fits into the socket of your pelvis. When your hip joint is healthy you can walk and move your leg easily and without pain. When the cartilage wears away, the bones rub together, causing pain, stiffness and limited mobility.


An artificial joint can relieve your pain and improve your mobility.









An artificial joint is a metal ball and stem that replaces the worn head of the thigh bone and a metal cup and plastic liner replaces the worn socket of your pelvis. There are two types of total hip replacements-cemented and cementless. Cemented total hip replacements use a bone cement called polymethylmethacrylate to hold the implants in place. A cementless total hip replacement uses an implant that has a rough surface which will allow your own bone to grow into them. Your doctor will choose the best type of hip replacement for you.

Before hip replacement surgery you will need the following:


  1. You will need a thorough dental examination to ensure you do not have any dental problems and infections which could travel through your bloodstream and infect your hip replacement. Any infection needs to be treated before your surgery.
  2. You will need an examination by an internist to specify any medical problems you may have that may interfere with your hip replacement surgery.

Your doctor will schedule a preadmission evaluation which may include some or all of the following.

  • Medical history
  • Anesthesia interview
  • Blood and urine tests
  • Electrocardiogram
  • X-rays

During the first six weeks after surgery, while the muscles and tissues around your hip are healing, you will need to follow certain activity restrictions. To help you during your recovery SSI can arrange the following.

  • A bi lingual nurse
  • A physical therapist
  • An apartment/house or hotel with easy access
  • Cleaning and laundry services
  • Food shopping and preparation
  • Massage therapists
  • Tours of the island

What’s Wrong with my Hip?

Joint replacement procedures (also called arthroplasties) are done when a patient experiences severe, incapacitating hip pain due to osteoarthritis, rheumatoid arthritis or injury. The old joint is replaced with a new mechanical joint called a prosthesis.

A healthy hip consists of a smooth ball on the end of the thigh bone which fits into the end of the hip socket to form the “ball and socket” joint. A layer of cartilage cushions the ends of these bones, allowing the ball to glide easily within the socket.

A problem hip can be the result of wear and tear to the cushion of cartilage in the hip joint due to osteoarthritis or other diseases. Without the cushion of cartilage, the joint surfaces become irritated and pitted as bone rubs against bone.

The hip prothesis consists of a specially designed ball and socket that replace your worn hip joint. The ball and stem replace the worn ball of your thigh bone. A cup replaces the rough hip socket. The prosthesis has smooth surfaces that fit together and allow the ball to move easily and painlessly within the socket, much like a healthy hip.

What are the risks involved in having a total hip replacement?


We want you to understand the benefits and risks of hip replacement surgery.  The ultimate goal is for you to regain function of your knee with minimal pain and discomfort.


Most people recover smoothly from surgery. However, complications are possible. These occurrences are rare and are almost always treatable.


Complications you should be aware of:



Blood clots may occur when blood flow is slowed due to the break in activity you will experience after your surgery. The following measures are helpful in preventing this condition:

  • Ankle pump exercises after surgery
  • Elastic stockings or foot pumps to improve circulation
  • Medication to thin your blood
  • Getting out of bed several times each day starting either the day of surgery or the next day

Even with the best of care, it is still possible for blood clots to form. It is important that you watch for any signs of blood clots and let medical staff know immediately if you experience any of the symptoms listed below:


  • Swelling
  • Redness
  • Pain
  • Tenderness and warmth in the calf or lower leg

Infection is a possibility with any surgery.

  • With joint replacement surgery, infection may be at the incision (the
    surface) or inside your body around your prosthesis. To help prevent
    infections, you will be given IV antibiotics after surgery.
  • It is also possible to get an infection at home, after you leave the hospital.
    Again, antibiotics generally take care of these types of infections, but in
    rare cases, additional surgery may be needed to remove an infected prosthesis
    for replacement with a new one.

Dental Injury

  • Teeth may become chipped, loosened or dislodged during your surgery and recovery period. Please let your anesthesia team know of any dental problems you may have.

Reactions to anesthesia or pain medication are other types
of complications that can occur.

  • Please let your doctor or anesthesiologist know if
    you have ever experienced a reaction during a previous surgery.

Nerves close to the joint replacement may be damaged.

  • Over time, these nerves may improve, or completely recover.
    Please let your doctor or anesthesiologist know if
    you have ever experienced a reaction during a previous surgery.

Hip Prosthetic wear

  • Some wear is common on all joint replacements, but if this wear is severe, surgery may be needed to revise the joint replacement.

Hip Prosthetic breakage

  • While very rare, the metal or plastic joint in a replacement may break. Again, surgery would be required to revise the joint if this occurs.

Hip Prosthetic loosening

  • Many years after your joint replacement, your prosthetic hip can loosen from the bone. Surgery may need to be performed to revise the joint replacement.

Other possible risks include:

  • Chills
  • Fever
  • Rash, itching or hives
  • Infection
  • Trouble breathing and a fast heart beat
  • Chest pain

Blood donors are routinely screened for:

  • Blood type
  • Infections
  • HIV (the AIDS virus)
  • Hepatitis B and C: an infection of the liver and the blood
  • Syphilis: a sexually transmitted disease that is also carried by blood
  • HTLV: a virus that causes certain infection
  • Other testing
  • Jaundice (yellowing of the skin due to liver problems)


A positive approach
Preparing mentally for your hip replacement surgeryis just as important for you and your family or support person as it is for your surgeon and the rest of the medical team involved in your hip replacement procedure. Because of medical advancements, total joint replacement surgery is possible to relieve your pain and discomfort and improve your activity level.


It is important to remember that the pain and activity limitations after hip replacement surgery will be different than what you are experiencing now, and they will be short term. A significant portion of the recovery process is using your new joint by walking and doing the exercises that your doctor orders.


Depending on your condition, your recovery and exercise plan will be tailored to meet your needs. Each patient recovers differently and joint replacement revisions often progress at a slower pace than the initial surgery.


Your stay in the hospital will be short and your recovery will be continued after discharge in your home, with family or at an extended care rehab center. It is important for you to make a commitment to follow your doctor’s instructions and work on your exercise plan after surgery in order to benefit most from the joint replacement. If you or your family need support, either physically or emotionally, coping with surgery and recovery, please talk with the staff.


*The improved life-style after recovery is worth the risk and stress of surgery!



The family’s role in your recovery

Your family and friends are very important in helping you during your recovery yourhip replacement surgery. They can help:

  • Stock up on canned and frozen or packaged food
  • Move food to cabinets between your waist and shoulder level, helping you avoid reaching and bending
  • Prepare a room with all the needed supplies so that you can rest during the day
  • Remove rugs and other clutter for safe walking
  • Run errands, grocery shop, and drive you to follow-up doctor’s appointments
  • Arrange for needed equipment

*Surgery is your primary path toward getting yourself back to being the person you want to be , so don’t let any unnecessary delays stand in your way!



Going Home after Hip Replacement


Discharge Instructions

  • You will be given written discharge instructionsand prescriptions for any medications needed after discharge.
  • We will go over these instructions with you. If there is any information that you do not understand, please ask the staff before you leave.



  • The past few weeks have been full: you have prepared for your hip replacement surgery, waited to enter the hospital, undergone surgery, learned to walk with your new joint, and made plans for going home.
  • You are stable enough to be discharged from the hospital.
  • For the next six to eight weeks, you will continue to heal and recover from surgery. You should balance periods of activity with periods of rest. Do not try to overdo or push yourself to the point of pain or exhaustion.
  • Resume medications that you were taking before surgery unless instructed otherwise by your doctor.
  • You will be given a prescription for pain medication.
  • Your doctor may prescribe medication to prevent blood clots from forming, such as aspirin or Warfarin® (Coumadin®). If you are on Warfarin®, it is important to closely follow instructions that your nurse or doctor gives to you.


  • Follow the activity guidelines and exercises as instructed by your doctor or physical therapist.

Hip precautions

  • Do not cross your legs
  • Do not bend your hip to more than a 90o angle
  • Do not lean forward more than 90o (such as reaching your feet/covers, or picking up an object on the floor)
  • Keep legs 6-10 inches apart
  • Use an elevated toilet seat
  • Use a cushion for all low chairs



  • Use your walker or crutches for each step when walking. Progress to use of a cane when directed by your therapist or physician.
  • You may feel that you can walk without an aid, but the bones take six to eight weeks to heal.
  • Walk daily for increasing distances, allowing for rests between activities.


  • Do not sit longer than 30 minutes at a time. Get up, walk, and change positions.
  • Use a pillow or chair cushion on all low chairs.
  • Use a raised toilet seat.
  • On long car trips, stop at 30 minute intervals. Get out and move around.
  • With lack of movement, your hip may become stiff, swollen, and you are more prone to blood clots.
  • Do not rest in recliners. The reclining position does not aide circulation or help reduce swelling.


  • If you need to use stairs, we recommend making only one trip up and down each day. Be careful and hold onto the railing or another person for support when using the stairs.


  • Do not participate in sports during the first three months after your hip replacement surgery.
  • Do not use exercise equipment, whirlpools or spas until your doctor tells you it is okay. Please talk with your doctor about the type of sports you like to do.
  • You may eventually resume some sports that do not put your hip at risk, such as golfing,
    swimming, bicycling and dancing.


  • Avoid sleeping on your side until your doctor okays it. If (when) you sleep on your side, sleep on your non-operative side, placing a pillow between your knees to keep your operative side from crossing midline.

Water beds

  • If you have a water bed, tell your physical therapist.

Sexual Activity


After hip replacement surgery, many people are worried about resuming sexual activity. The following guidelines are designed to address some of the more common issues.


Please speak with your physician if you have any specific questions or concerns.


Resuming sexual activities
It is generally safe to resume sexual activity 6 – 8 weeks after post hip replacement surgery as long as you are not having significant pain or stiffness in your hip joint.


Effect of hip replacement on sexual relations


In reality, the pain and stiffness associated with your bad hip before surgery probably already interfered with intercourse.


Since your surgery will help decrease most of that discomfort, you may now be more comfortable during sexual activity.
Safe positions and precautions
There are certain guidelines to follow:

  • Do not bend at the hip more than 90°
  • Do not move the leg toward the midline
  • Do not rotate the leg inward
  • Combination of the above activities


  • Do not drive until your doctor tells you it is okay.

Care of your wound

  • If your wound was closed with staples, arrangements will be made to remove the staples that hold your incision together.
  • Wash your incision gently with soap and water and pat it dry.
    You may shower if you have a walk-in shower.
  • Do not take a bath.
  • Do not use lotions on your incision until your doctor okays it.


  • An infection in another part of your body (lungs, kidneys, mouth, skin, etc.) could possibly spread to your new joint. Contact your family doctor and orthopaedic surgeon with any type of infection.
  • To protect your joint you may need to take antibiotics before certain procedures, such as dental care or a surgical procedure.
  • Swelling (also called edema) is common after surgery. Swelling may or may not occur in the hospital or after you are home and more active. The most common areas for swelling are the foot, ankle, knee, and at times, the thigh.
  • To decrease swelling, lie with your operative leg elevated so that your foot is higher than your heart. This can be done during your rest periods for at least 45 minutes, 2-3 times during the day.

Compression stocking (if ordered) and foot pumps

  • Foot pumps will be ordered for you after your surgery and must be on at all times while you are in bed.
  • Wear your white compression hose during the day for two weeks. Wear them as much as possible, especially during the day.
  • Compression hose should be removed at nightas they can cause pressure sores on heels.


  • If staples were used to close your incision, an appointment for staple removal will be made for you prior to discharge.
  • Continue using your medical equipment and doing your exercises until your doctor evaluates you and gives you new instructions.


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