“The more you understand about your total hip replacement surgery ahead of time, the better.” Here is a list of questions that were important for my understanding. Look for links at the bottom for more detailed information. These questions are specifically for your surgeon. The surgeon’s assistants will walk you through things like what you need to take with you to the hospital and how and when to schedule the operation, but the questions below are ones to ask your surgeon. Above all, don’t be afraid to ask. No matter who you are talking with, if they do not know the answer, they can direct you to someone who does. Learning as much as you can beforehand makes the whole process less scary.
What “approach” will you be using for the surgery?
– Posterior – an incision is made beside or behind your hip joint
– Lateral – an incision at the side of the hip
– Anterior – an incision at the front of the hip.
– SuperPath – 2-3 cm incision is made on the side of your hip.
– Direct Superior Approach – single small incision on the outside of the hip over the buttock region
Which approach is best for me? Be aware that most surgeons perform only one or possibly two approaches. If you have a preference for a specific approach, you will have to find the surgeon who is right for you.
“What are the restrictions of movement after surgery and how long do the restrictions last?” Surgeons’ restrictions can vary. Usually restrictions are in place for about 6 weeks. Here are common restrictions:
Posterior approach restrictions:
– Avoid inward rotation of the operated leg.
– Do not bend your hip more than 90 degrees.
– Avoid crossing legs or any extreme medial (crossing over your center line) movement of the leg
Lateral approach restrictions:
– Avoid crossing your legs when lying or sitting.
– When standing, avoid pivoting on your operated leg when turning; take small steps instead.
– Avoid sleeping on your operated side for 6-8 weeks to avoid irritating your hip.
– Avoid rotating your operated leg outward.
– Avoid placing the foot of your operated side on your opposite knee.
– Avoid moving your operated leg out away from your body for 6 weeks until your hip muscles are healed.
– Avoid sitting more than 30 minutes
Anterior approach restrictions:
– Avoid outward rotation of the leg.
– Avoid extension of the operated leg.
– Keep your knees apart. Don’t cross your legs.
SuperPath approach restrictions:
– Avoid combined motions of hip – internal rotation and flexion for the first 4 weeks.
– While restrictions are usually not prescribed for this approach, in some cases surgeons prescribe standard posterior hip precautions for 4 weeks.
Direct Superior Approach:
–Usually there are no post-surgical restrictions or hip precautions.
“How long will I be in the hospital?” Some surgeons will perform your surgery as an outpatient procedure, others will keep patients in the hospital for 1 or more days.
“What kind of drugs will I be given for the surgery?” For this question the surgeon might refer you to the Anesthesiologist, but usually you would be given either General Anesthesia or Spinal Anesthesia with sedatives.
“What drugs will I be asked to take before and/or after surgery” – antibiotics, blood thinners, pain killers…?
“What drugs/supplements will I be asked NOT to take before and/or after surgery?” – NSAIDS, supplements….?
“What type of prosthesis will be used? What materials is it made out of? Who is the manufacturer?”
“Will it be cemented in place, not cemented?”
“What size ball and socket will be used?” If the ball of the new prosthesis is too small for the socket, this can raise the risk of dislocation. It’s a good thing to ask your surgeon about.
What are the risks of infection? Infections can be caused because of the surgery. Infections can also happen after you are healed and because bacteria has been introduced into the blood and has traveled to the prosthesis. Your surgeon can explain strategies to avoid infection.
“Leg length?” – Many people have one leg that is naturally longer than the other. If this is true for you, then you want to ask your surgeon about keeping those same proportions because your spine and pelvis are used to them. It’s important to bring up this issue. Some people end up with different leg lengths following surgery which can produce spine and pelvis issues.
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Articles and studies:
“Hip Replacement (Posterior) Precautions: What to Expect at Home”
“REHABILITATION GUIDELINES FOR TOTAL HIP REPLACEMENT(DIRECT LATERAL APPROACH)”
“Hip Replacement (Anterior) Precautions: What to Expect at Home”
“Therapist Overview for SuperPATH THR Protocol”
“Spinal and Epidural Anesthesia”
Study: “General Compared with Spinal Anesthesia for Total Hip Arthroplasty”
“Choosing the Right Hip Prosthesis”
Study: “Materials for Hip Prostheses: A Review of Wear and Loading Considerations”
“What Are the Best Materials for Joint Replacement?”
Study: “The Relative Merits of Cemented and Uncemented Prostheses in Total Hip Arthroplasty”
“Surgical Approaches for Total Hip Arthroplasty” Trigger alert: This link contains images of actual human bodies during surgery.