Diagnostic work-up of patients needing a total hip
Consider that many patients have more than one diagnosis causing their “hip pain”. Most patients have some degree of back issues. The arthritic hip could have caused the back to become painful! A back with degenerative disc disease can cause hip pain! Many have both issues. Dr. Holmes, many times will want a shot put into the hip. This will tell him and the patient, perhaps, how much of the pain is coming from the hip and how much from the back. In some series of total hip replacements, following surgery, the back pain is DECREASED because the hip now rotates instead of the spine! In some, unfortunately, the back pain is the same or increases probably because of the increased activity of the patient due to the new moving hip.
Once reasonable conservative measures have failed, then, and only then will hip replacement occur. One should consider this if the hip pain is interfering with one’s life and desired activities. Also, consider it while one has their good health to aid recovery.
Who should have hip replacement surgery?
Patients who are losing their health, losing the ability to do the things they want to do, or are losing good insurance should have hip replacement surgery.
“The doctor and his staff are caring professionals who take excellent care of their patients. Several members of my family, besides myself, have entrusted Dr. Holmes with their care. We are completely pleased with our care.” -Debrale G.
What does hip replacement surgery involve?
Hip replacement surgery is a one to two hour procedure during which the ball and cup of the worn out joint is replaced. For more on the surgery, view Sports, Occupational, & Knee Surgery’s 3D animation video of a hip replacement.
How do I prepare for hip replacement surgery?
Exercising as much as possible and taking care of other medical conditions before a hip replacement surgery is suggested.
What can I expect during a hip replacement?
The procedure in Dr. Holmes’ office will be performed ONLY after a preoperative medical clearance is obtained. This allows for the safest, albeit not zero, chances of complications. The procedure WILL be scheduled within 30 days of this clearance.
The procedure itself takes about an hour. The patient will be away from the family for about 4 hours, though. It takes about an hour to start. The procedure is about an hour, then watched in the recovery room (one on one care) for two hours.
Dr. Holmes likes to use the Anatomic sized total hip. This is a very large femoral head about the same size as the original. This requires a large cup. The advantage of this is a VERY LOW dislocation rate! In his hands IF the cup remains fixed then very few future hip precautions are necessary. One can cross their legs and tie their shoes eventually. If the cup is deemed unstable or becomes unstable, then a cup with screws are necessary and this requires a “big head.” Big heads are not as big as anatomic heads and STILL have a low dislocation risk compared to smaller heads but more than the anatomic heads.
The approach, therefore, is usually a small lateral approach because of the anatomic heads. The muscle is split, as much capsule and osteophytes are maintained as possible (It has been found that keeping capsule helps stabilize hips and osteophytes incorporate with the large cup to help stabilize it also!) The approach allows for the repair of abductor muscles that many patients have torn off over the years! In some series the number of femoral fractures, dislocation, and loosening is less than in the anterior approach, in Dr. Holmes’ opinion.
What is recovery like?
The afternoon following the surgery the patient is expected to walk WITH THE ASSISTANCE of Physical Therapy. The hospital stay is two days in which patients are there for physical therapy and under the medical watch of the Hospital assigned internal medicine doctor! After two days, the patient goes home and under an ideal world, starts OUTPATIENT therapy. Most leave on a walker.
At ten days, the patient comes back to the office and is encouraged to go on a cane. The cane is REQUIRED by Dr. Holmes for a month, as is aspirin to prevent blood clots. As far as therapy, total hips require about three weeks in Dr. Holmes’ protocol at which time exercise in the gym, walking at home, swimming, exercise bike, etc. is highly encouraged.
All these times, indications, hip types, approaches, and all other care are of course, tailored to the patient’s individual needs. The recovery time has little to do with the surgery, in the opinion of Dr. Holmes, but is based on the starting point of the patient and how long it takes for the patient to get his body back after waiting for the procedure for varying lengths of time.
How painful is recovery after hip replacement surgery?
Some patients worry about the pain following this surgery with Dr. Holmes, yet they completely forget the pain they’ve been enduring for years leading up to needing hip replacement.
These procedures involve much smaller incisions than they used to, so there is less cutting through muscle and soft tissue. This makes for easier recovery.
You’ll have surgical pain for between 2-4 weeks, and you’ll need some sort of pain medication for up to 3 months. Most patients move off of narcotic pain medication before the end of one month, switching to over-the-counter medication. Other patients never feel the need for prescription pain medication beyond the first few days.
There will be some pain in recovery, but it is manageable and moving forward from there, your pain will be little to none, which will be quite a change from your former condition.
How long will my hip replacement last?
Hip replacement results last depending on age and athletic demands of each patient.
Is there a possibility for failure of a hip replacement surgery?
Hip replacement surgery is among the most common orthopedic procedures, with over 300,000 performed every year in the U.S. It has a very low rate of complications or failure.
Still, the prosthetics used are manufactured, and they will have a lifespan. At some point, all hip replacements will fail, although this isn’t really the applicable word — wear out would be a better term. Today’s hip replacements last an average of 20 to 25 years. Some last longer; others fail much sooner.
Replacement failure is really a term that applies to the initial period after surgery. These are some issues that could be present if a replacement surgery was failing:
- Pain — If pain lingers after the rehabilitation period, or if it arises months after implant surgery, that would be a sign of failure.
- Swelling — There should not be swelling in the area around the hip replacement.
- Metallosis — This is a build-up of metal levels in the blood and/or body tissue. This occurs with metal-on-metal artificial hip cups and balls.
- Loosening components — The ball fits tightly into the cup at first, and it won’t move. But over time, this can loosen. Activity levels (how much impact you’re placing on the prosthesis), age, sex, and weight all play a role in this loosening. Loosening is often the result of weakening of bone around the hip replacement. The weakened bone then allows the hip replacement to become loose and wobble.
- Inflammation of tissue — The hip area becomes swollen, warm, red, and often painful. This could be due to failure and/or infection.
“Dr. Holmes has been an amazing doctor. He helped me with both of my hip surgeries. Without him, his staff and the hospital taking care of me, I don’t know what I would of done. He was very thorough, explained everything that I could understand in latent terms and he made sure that I was doing well. I am so thankful for him and I have recommended him to many people for the wonderful job he has done”- Source: Facebook
Hip Replacement Surgery FAQs
Can physical therapy prepare me for hip replacement surgery?
There are two purposes to having some physical therapy prior to your hip replacement. First, you will record a baseline of information with your physical therapist. This will include measurements of your current pain levels, functional abilities, and the movement and strength of each hip.
Second, you will perform some preoperative therapy to prepare you for your upcoming surgery. You will begin to practice some of the exercises you will use just after your surgery. You’ll be trained on the use of either a walker or crutches, which will be dictated on whether we use a cemented or non-cemented approach.
To avoid dislocation after surgery, we provide guidelines as to which hip positions you’ll need to avoid (called hip precautions). Your physical therapist will walk you through all of these prior to your surgery and be sure you practice them frequently for at least six weeks prior to your surgery. This will strengthen the joint to help prevent dislocation.
Finally, your physical therapist will assess any needs you will have at your home once you’re released from the hospital.
Will I have permanent limitations on physical activity after hip replacement surgery?
The reality is that your hip damage has likely severely limited your physical activities in various ways. That’s why you’re having this procedure with Dr. Holmes. Considering that, you’ll have far fewer limitations on activity than you had with your damaged hip after Dr. Holmes gives you a new artificial hip.
While they are not “totally prohibited,” it’s a good idea not to run long distances. Also, high impact sports, such as basketball and indoor volleyball, should probably be avoided. You can participate in them, but they will lead to faster deterioration of your prosthesis. It’s better to switch to bicycling and swimming, which have little to no impact on your joints. Walking, playing golf, hiking, rowing, doubles tennis, pickleball, and low-impact aerobics are all fine to participate in.
Should I avoid taking baths, hot tubs, and swimming pools during my recovery from hip replacement?
These are not permanent restrictions, but you need to avoid any immersion of your incision in water until it is fully healed. This is usually a period of six weeks. After that, there are no restrictions.
Can I sleep on my side after hip replacement surgery?
You may sleep on your operative hip whenever you feel comfortable. As for your nonoperative hip, you may sleep on that side after four weeks with a pillow between your knees.
How long before I can drive after hip replacement?
If you’re thinking of the “hip precautions” mentioned above, these are things such as crossing your legs, flexing at the hip more than 90 degrees, and the like. These movements cannot be done until your hip is fully healed, but they are not permanently off limits.