What to Expect From Total Hip Replacement Surgery How New Advances Have Improved This Joint Pain Treatment

Your doctor says you need total hip replacement surgery – and your painful hip says it too. Worried as you may be, there’s little down side to this common operation: Hip replacements are faster and safer than ever with new materials and surgical procedures. Find out about the recent innovations and what to expect as you recover... When a hip joint is damaged by arthritis, the pain can be unbearable. That’s the time to talk to an orthopedic surgeon about hip replacement, says Geoffrey Westrich, M.D., director of joint-replacement research at the Hospital for Special Surgery in New York City. “Once people have hip pain that affects their daily lives – climbing stairs, getting up from a chair, difficulty walking – it’s time for a consultation,” he says. Close to 200,000 Americans choose this joint pain treatment every year, according to the American Academy of Orthopaedic Surgeons. The success rate is high: Only about 2% of patients have surgical complications such as joint infection. “Hip replacement surgery is one of the safest surgeries we perform,” Westrich says. And now it’s getting even safer. Incisions are smaller, recovery time faster, and there are more surgical options to choose from. The newer operations, called minimally invasive surgeries, no longer require incisions of 6-9 inches, which were necessary in the past, Westrich says. “Now we make relatively small incisions of about 3 inches,” Westrich says. “And we’ve designed [smaller] instruments to use during surgeries.” These techniques cut through less muscle and soft tissue, so recovery time is faster. Not only is the surgery less invasive, but pain-management methods also are safer. More surgeons use spinal anesthesia, which numbs from the waist down, instead of general anesthesia. “Regional anesthetics lower blood pressure, so there’s less bleeding,” says Bradley Gerber, M.D., chief of total joint replacement surgery at South Nassau Communities Hospital in Long Island, N.Y., who does 300-400 joint replacement surgeries a year. “They also reduce the risk of infection or a blood clot in the leg.” Another less-invasive joint pain treatment is hip resurfacing, which has fewer post-operative limits, Gerber says. “We don’t cut away bone,” he says. “Instead, we reshape the head of the femur and place a cap on it.” That fits into a socket, similar to those used with other hip-replacement surgeries. But women, especially those over 55, face a higher risk than men of fracture near the top of the thigh bone from hip resurfacing, according to a 2008 study at Rush University Medical Center in Chicago. The researchers speculate that a bone’s smaller size and quality make it more vulnerable. (Older, female bones tend to be softer.) “Good hip-resurfacing candidates are under 50, have good bone quality and participate in athletic activities,” Gerber says. Special Concerns for Women About the same number of women and men have hip replacements, according to a 2009 report by the Centers for Disease Control and Prevention. But women are more likely to be in severe discomfort by the time they get joint pain treatment, according to a 2011 study Westrich presented to the American Academy of Orthopaedic Surgery. This may be partly because they’re more likely to live alone than men, making them apprehensive about who will care for them after surgery, Westrich says. But it’s wise not to wait. If someone waits and has more pain and disability before surgery, there’s a greater risk for problems later, he adds. Women who had total hip replacement surgery and were more disabled beforehand didn’t recover as quickly as men, according to a 2002 University of Minnesota study of Medicare patients. Types of Hip Replacements In traditional approaches to total hip replacement surgery, a surgeon cuts away damaged bone and cartilage, then places a metal stem with a ball on top into the center of the femur (leg bone). A metal socket fits into the hip bone you were born with, allowing the ball to move. The socket’s liner can be made out of plastic, metal or ceramic. “We typically use metal or ceramic in younger, more active patients – in their 50s and 60s – because those materials are less likely to wear out than plastic,” Gerber says. Metal replacements also may have a porous covering, so that bone can grow into the new hip, naturally holding the parts in place after six weeks. Cement, which doesn’t last as long, is often used for older patients in their 70s and 80s, Gerber says. Cement is less expensive but doesn’t work as well in obese patients. Rehab and Recovery Most hip replacement patients are hospitalized for about three days, says Lisa Konstantellis, section manager of the Joint Mobility Center at the Hospital for Special Surgery. A day after surgery, a physical therapist reviews precautions for the next six weeks. Plan on using a crutch or cane for the first 4-6 weeks, says Charles Kim, M.D., a rehabilitation specialist and clinical instructor at NYU Langone Medical Center in New York City. You may also have to give up work for one month to six months or more, depending on job activity. Most people with desk jobs can return to work in a month or so. “You’re not allowed to bend your hip more than 90°,” Konstantellis says. “That means if you’re sitting in a chair, your knee should be lower than your hip. ” And forget driving, which is one of the worst hip positions, Kim adds. “You should plan to have someone drive you around for several months.” The therapist will also ask you to avoid crossing your legs until the replacement sets solidly in place. Crossing legs “could dislocate the new hip,” Konstantellis warns. From day 1, you’ll be doing a lot of exercises. For example, the therapist will ask you to push the back of your knee into the bed mattress, tightening your thigh muscles. “We ask patients to do 10 repetitions of each exercise every hour they’re awake,” Konstantellis says. Some patients may work with a physical therapist at home. You’ll learn how to use a shower bench and raised toilet seat to make bodily functions easier and safer. A therapist will also teach you how to get in and out of bed, stand and walk. “A lot of these people have been limping for a long time because the hip is in pain from arthritis, so we have to teach them how to stand straight and not favor that leg anymore,” Konstantellis says. At about six weeks, most patients return to the surgeon for X-rays to see how they’re healing. The doctor may prescribe outpatient physical therapy for 6-8 weeks, 2-3 times a week. Kim suggests sleeping with a foam wedge (or adduction pillow) between your legs for three months to stabilize the hip. It’s available online or at surgical supply stores. “Three months is typical for good recovery. But most full recovery takes a year,” Kim says. Managing Pain Your arthritis pain will likely be gone right after total hip replacement surgery, says Kim. But you may have surgical pain for two to four weeks. How bad it will be is tough to estimate. “One person’s pain can be a ‘2,’ while another patient is an ‘8,’” Kim says. Some patients can get by with over-the-counter acetaminophen (Tylenol). The Food and Drug Administration (FDA) regards 2,000 milligrams -3,000 milligrams (mg) per day as safe – but to avoid the risk of overdose, Kim recommends only 1,000-1,300 mg per day. “For those who are elderly or have liver problems, I’d only recommend 1,000 mg a day,” he says. “But most people need something stronger, like Vicodin [acetaminophen and hydrocodone], for about a month afterward,” Kim adds. (For more on acetaminophen, read Pain Medications: Could You Be Overdosing?) How fast you heal depends on your health. “If you don’t have other conditions, like diabetes, recovery is usually quicker,” Kim says. “And as you build new muscle and the replacement area firms up, you can do more.” If you haven’t moved your hips for years before surgery, you may never return to a full range of motion, warns Westrich. “It’s not just the hip but the muscles around it that are affected,” he says. If they haven’t been used, they atrophy. New Hip, New Life Hip replacement is hardly fun. But the results can be. “Most people can’t believe the pain is gone,” Konstantellis says. “They can start doing things that they haven’t been able to do for years. Most people see progress every week after surgery.” Most hip replacement patients can’t return to high-impact sports like running, but they can play golf and do yoga. “And sex is fine,” Konstantellis says. “Just not within the first six weeks.” What’s Your Inflammation IQ? Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life.