Total Hip Replacement FAQ’s

What is a total hip replacement?

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components.

How long is the hospital stay?

In recent years, the average length of a hospital stay for hip replacement surgery has decreased significantly. The average hospital stay is around 3 to 4 days after a hip replacement.

How long will it take to recover from a hip replacement?

Recovery from a total hip replacement generally occurs within six weeks. In most cases, however, you will be restricted to using a walker for few weeks after the surgery. You will gradually return to normal activities with no assistive devices at six weeks.

What Are Possible Complications of Hip Replacement Surgery?

Hip replacement surgery is generally a safe procedure. But as with any major surgery, there are potential risks involved. Complications can be general (medical) or specific to hip replacement. Certain medical conditions may increase the risks of surgery. Before the surgery, ask your surgeon the potential risks and complications associated with the hip replacement surgery.

What are the benefits of hip replacement?

The benefits of hip replacement include:

  • Relief from pain
  • Improved movement and strength
  • Restore function
  • Give a better quality of life
How long does a hip replacement last?

Longevity of Hip Replacements varies from patient to patient. Hip implants generally last more than 20 years.

What is the future of hip replacement surgery?

It is likely that we will see further development of resurfacing the joint biologically rather than replacing.

How does hip replacement surgery works?

When hip implants are inserted, new bone will grow onto the components to achieve fixation.

What is anterior hip replacement?

In anterior hip replacement we go from the front, absolutely no muscles are cut at all. We go between the muscles and do the hip replacement.

After getting anterior hip replacement, a major risk factor is the wound issues, which can happen especially in the proximal part of the wound. I do not do hip replacements on patients who have skin fold, which can interfere with the wound healing in the upper part of the wound, and on clinical examination I’m able to mind that.

The procedure itself takes a little longer than the classic posterior approach. In patients who have significant cardiac problems or significant medical problems in which expeditious surgery is very important, I do not use the anterior approach, because it takes more time to do.

What is direct anterior approach hip replacement surgery?

Direct Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons.

Traditional hip replacement involves cutting major muscles to access the hip joint.

Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions such as not bending over or crossing your legs to allow the cut muscles to heal.

However, for Anterior Hip Replacement patients, hip precautions are not necessary as no muscles are cut to gain access to the joint.

What are the advantages of anterior hip replacement?

The main advantage of the anterior hip replacement is the initial rehabilitation is much faster. Patients can let go of their assistive devices very, very quickly and they rehab pretty fast.

However, anterior hip replacement is not a panacea. It is not for all patients. You have to realize that there are certain risks that are associated with anterior hip replacement that are not associated with a posterior hip replacement. Patients with anterior hip replacements sometimes can get numbness on the outside of the thigh. That can sometimes be permanent. Most of the time patients do not notice this.

What are the advantages of anterior hip replacement?

The main advantage of the anterior hip replacement is the initial rehabilitation is much faster. Patients can let go of their assistive devices very, very quickly and they rehab pretty fast.

However, anterior hip replacement is not a panacea. It is not for all patients. You have to realize that there are certain risks that are associated with anterior hip replacement that are not associated with a posterior hip replacement. Patients with anterior hip replacements sometimes can get numbness on the outside of the thigh. That can sometimes be permanent. Most of the time patients do not notice this.

Are there any dislocation precautions after hip replacement, especially after anterior hip replacement?

After anterior hip replacement, there are really no dislocation precautions. But it is important that you do not arrange your hip through extreme motion. What we really don’t want is hyper-extension of the hip. Apart form that, there are really no dislocation precautions after a hip replacement, using the anterior approach.

What is Posterior Hip Replacement?

Posterior approach is an approach that has been used for many years. It is something which is familiar to most surgeons. I use it mainly if there are significant medical problems in which expeditious surgery is necessary.

I use it if there is posterior hardware in the hip, which means if the patient has had earlier surgery and there is hardware in the hip which has been placed through a posterior approach.

However, in the long term, after three months the results are similar for both anterior and posterior hip replacements. Posterior hip replacement is something that is still not thrown out of the window. There are very, very selective criteria that I use for patients who get anterior hip replacement from me.

What does hybrid fixation mean in total hip arthroplasty?

Hybrid fixation means that the one component of total hip arthroplasty is fixed without bone cement and the other component is fixed with bone cement.  In the early days of total hip replacement, both the cup and the stem were cemented into place.

The trend later moved to cement-less fixation of the cup and with stem being cemented this is called a “hybrid” fixation. Hybrid fixation in total hip arthroplasty means that the cup is fixed without cement while the femoral component is cemented into position.

Currently, I very rarely use cement for component fixation in total hip arthroplasty. Most of my total hip cases are non-cemented on both sides.

What cementation techniques do you use for fixation of the implant with bone cement?

When cement is used, we use modern cementation techniques for fixation of the cement into the canal.  The femoral canal is thoroughly cleaned and the cement is then pressurized into the femoral canal.  The femoral component is then placed into the femoral canal and the excess cement is removed.  The cement then cures and after the cement is hardened, the prosthesis is firmly secured.

How common is urinary retention after hip and knee replacement surgery?

Urinary retention can happen after hip and knee replacement surgery.  It is more common in males than in females.  If urinary retention occurs, the patient is given a “trial” to urinate where the patient is helped to a bathroom and the patient attempts to urinate.

If the patient is still unable to urinate, the patient gets a “straight catheter”, which means that the catheter is inserted into the bladder the urine is drained and the catheter is immediately removed.  If the urinary retention recurs after straight catheterization, it is possible to place the straight catheter again to drain the urine.

It is rare that the urinary retention continues and if it does, then the patient can be placed on a “continuous catheter” and discharged home or to a rehab place to be followed up with a urologist.  There are drugs like Flomax, which are started in the hospital to help with urinary distress in males.  Urinary retention occurs typically in males who have had prostate trouble in the past.  It is rare in male patients who have not had prostate trouble before the surgery.

What precautions should I take after a posterior hip replacement?

After getting a posterior hip done, after doing artificial hip replacement, using a posterior approach, the patient has to follow something called posterior hip dislocation precautions. What does this exactly mean?

After getting posterior hip replacement, the patient should not be crossing their legs. The patient should not be bending their hips beyond 90 degrees. The patient mainly should not be crossing their knees. It’s okay to cross the ankles, but not the knees.

What I tell my patients is that after the surgery, you should keep your knees separated. If you keep your knees separated, the possibility of dislocation is very, very low.

What are the things that you do not tell the patient when you see the patient in the office?

There is one very important thing that I evaluate when I see the patient in the office.  I determine if the patient in front of me will be a happy patient at the end of the procedure.  I question- is this a relationship I would want for the rest of my life?  If I operate on a patient, I consider it as a life-long relationship.  In certain ways it is much stronger than a marriage because you can divorce your married partner, but once joint is in a patient there is no way to reverse the operation!

What would you be doing if you are not an orthopedic surgeon?

I have been scrubbing in the operating room with my father (who is also a practicing operating surgeon as on 2018) ever since I was a teenager.  I have never considered any other career choices.  Orthopedics is a field of medicine where a surgeon can dramatically improve the life of patients.  The satisfaction is overwhelming and extremely humbling.  I have been drawn towards orthopedics because of the excellent patient satisfaction that I can provide.

Do you do customized hip replacements?

Customized hip replacement would imply that the CT scan of the hip was performed preoperatively and the hip joint was made very specifically for the patient.  In 2018, we do not have a customized hip.

For a variety of other reasons, we have customized knee implants but we do not have customized hip replacements. Customized knee implants are an attempt to improve the satisfaction scores after total knee replacement surgery. As against knee replacement surgery the outcomes after hip replacement are excellent and is one of the reasons why there has been little effort to develop customized hip implants.

All the hip replacements are over the shelf.  The surgeon sizes the hips intraoperatively and based on the preoperative templating and the surgeon uses “off the shelf” implants.

During surgery, the surgeon measures the size of the implant, places the trials into the hip, trials the hip through a physiological range of motion and then makes the final selection. The final implants are taken from the shelf, the implants are then opened and placed into the hip by the surgeon.

When can sex can be resumed after a total hip replacement?

There have been numerous studies that have been done specifically addressing sexual function after a total hip replacement surgery. Studies have reported that after a successful total hip replacement there is improved sexual satisfaction and performance in most patients. Total hip replacement surgery has shown to improve the sexual quality of life after surgery, both in terms of physical function, both in terms of functional well-being and psycho-social well-being.

The majority of patients with hip arthritis suffer some sort of dysfunction during sexual activity, and studies have shown that most patients do not ask questions and most orthopedic surgeons do not specifically counsel the patients about the improvement that can happen after a total hip arthroplasty. Irrespective of the sexual position, most patients are able to resume sexual activity at around six weeks. At around three months they are able to perform sexually without significant issues related to the hip.

When it is safe to resume driving after total hip arthroplasty?

I tell my patients that the time to return to driving has to be individualized. This time depends on the patient’s recovery, confidence level, strength in the affected extremity amongst numerous factors. It is important to work with the physical therapist to determine the strength and the patient’s reaction times for driving. It is important to look at the operative total brake response time.

Most patients who have left side hip replacements are able to drive sooner and are able to return to driving faster than patients who have had a right sided hip replacement. Operative total brake response time means the time that a patient who has a hip or a knee replacement is able to press on the brakes for safe driving.

I tell my patients who have had a right hip replacement that they can drive at around two to four weeks. Patients who have had a right knee replacement are able to drive at around four to six weeks after total knee replacement.

It is also important to ensure that the car seat is high and the hip dislocation precautions are followed when patients start driving after surgery. It’s very important to keep the knee separated after the posterior approach in the approach has been done for the hip to decrease the possibility of dislocation.

It is especially important to be aware of the hip dislocation precautions when patients get in and out of the car. Again, it’s important that patient’s advice be individualized. For a minority of patients after a right hip replacement or a right knee replacement it takes more than three months to return to driving.

Is the skill and experience of the orthopedic surgeon more important than the device used in the procedure?

The skill and the experience of orthopedic surgeon is far more important than the device or the procedure. The procedure maybe done using different approaches, the anterior and posterior approach, etc. The device that is the total hip replacement part may be from a variety of implant manufacturers. Most of the implant manufacturers have implants that are equal in quality.

It is very important to select orthopedic surgeon who does joint replacement surgery on a regular basis and we strongly recommended that the orthopedic surgeon be fellowship trained in the joint replacement surgery.

If I do not have surgery what is the risk?

The patients who do not want surgery or who want to defer surgery have only one downside- suffering with the pain. For patients who can never have hip replacement surgery (terminal illness, multitude of medical issues etc.) there are options including injections in the hip joint that can decrease the pain. It is important to realize that the patients who have injections in the hip joints should not be getting hip replacement surgery for at least three months after the injection in the hip.

The patients who are candidate for getting hip replacements are strongly advised not to have the injection because of the increased risk of infection in the joint after hip replacement surgery.

This is the day before surgery and I am unable to sleep, what can I do?

It is understandable that there is significant anxiety around surgery and my advice is to use general measures that help you sleep.  I do not advocate using sleep medication preoperatively or postoperatively unless you are already on sleep medication.  Sleep medications can cause drowsiness.  They can cause imbalance of gait and falls.

Waking up after a posterior hip replacement surgery, why is there pain in my shoulder on the other side?

In the posterior approach, the patient lays on their side and especially if the patient has had prior shoulder pain on the other side this pain can be aggravated.  This is because of positioning.

Intraoperatively we provide adequate cushioning, we place axillary support to prevent compression of the nerves in the axilla, but occasionally a patient may wake up with pain in the other shoulder after a hip replacement.  If the left hip is done, then the patient may wake up with pain in the right shoulder.  This pain, which is positional, is expected to go away unless there was an underlying issue with the shoulder before the surgery which will need to be addressed separately.

Would you operate on your own family members?

I mean it when I say that I treat patients like family.  I have operated on family members and will continue to do so if they need orthopedic surgery.  I operated on my mother who had left hip replacement done by me.

I also operated on my brother who needed open reduction and internal fixation of his forearm after he was in a very serious vehicle accident. I treated my kids when they had orthopedic injuries. I tried my cousin brother and sister when they had orthopedic issues. I injected cortisone into knees of my relatives who had arthritis.

American Medical Association (AMA) advises against treating your own family except in case of an emergency. The AMA feels that if a physician treats his or her own patients, the physician’s objectivity maybe compromised, personal feelings may influence medical judgement, physicians may not probe into the accurate sexual history etc.

AMA feels that the patient as well as the physician maybe uncomfortable undressing the patient adequately as needed if the patient was the surgeons relative. If there is a negative medical outcome, the personal relationship maybe affected. Will the surgeon obtain the informed consent in the proper manner? They wonder is patient autonomy truly be respected by the physician.

Nevertheless, I feel that my reasons for operating on my relatives if they need surgery are very well justified. Most importantly, why should I deny good care to my own relatives?  If complication happens, it would be hard to reconcile that I did not operate on my relative myself. I would always wonder about possibility of that complication not happening had I done the surgery myself.

As of 2018, my father is a practicing orthopedic surgeon.  He also operated on his mother-in-law when she needed hip surgery.  Among the many things that I learned from him is excellent patient care. Patient care that should not exclude your own family members.  There is no reason for the surgeon to exclude his or her own family from getting the same unsurpassed care the surgeon provides to his or her other unrelated patients.

Post Operative Issues

Post Operative Total Hip Questions

will be added to their own section of the total Hip Replacement stand alone  FAQ page.

How long will I have swelling in the affected extremity after hip replacement surgery?

Swelling in the lower extremity after hip replacement surgery is very common in the postoperative period. The swelling usually lasts for four to six weeks after the surgery.

What can I do to decrease the swelling in the lower extremity after hip replacement surgery?

I advise patients to use sequential compression devices when the patient is in the hospital. When the patient is discharged from the hospital, I advise them to wear compression stockings in both lower extremities.

Use of compression stockings and sequential compression devices not only help decrease the swelling in the lower extremity but they also help decrease the risk of blood clots in the lower extremity after hip replacement surgery.

How will I know if I have a blood clot after the hip replacement surgery?

Blood clot after hip replacement surgery usually manifests itself as tenderness in the calf muscle. Swelling by itself does not mean existence of a clot.

When should I get an ultrasound after hip replacement surgery?

Orthopedic surgeons do not advise routine ultrasound for screening of blood clots after hip replacement surgery. Ultrasound after hip replacement surgery routinely show small blood clots that are insignificant. If you suspect a clot, it is important to get advice from your orthopedic surgeon and get a clinical examination done.

We have found that rehabilitation facilities and primary care providers order ultrasound quite unnecessarily. A small clot is seen on ultrasound and then the patient is rushed to the hospital and given blood thinners for treatment for the clot. This excessive treatment is unnecessary and may actually harm the patient. The harm from potent anticoagulants has been clearly noted in literature.

They can increase the risk of bleeding in the operated joint. They can increase the risk of bleeding elsewhere including the bleeding in the brain. They can be the cause of increase drainage from the wound, which leads to increase possibility of infection in the joint in the future.

What is the preferred method of preventing blood clot in the lower extremity after hip replacement surgery?

Our approach for preventing blood clot is multimodal. Pharmacology is small part of this multimodal protocol. We use minimally invasive surgery, we use regional anesthesia, and we use sequential compression devices on the other extremity during the surgery. After the surgery, both lower extremities get sequential compression devices as well as compression stockings.

I use Aspirin for pharmacological prophylaxis (prevention of blood clots) in majority of my patients. Among other indications, the patients who have past history of clot that has lodged into the lung are candidates for getting very strong anticoagulant medications. Sometimes, we place a filter in the blood vessels so that even if a patient develops a clot, the filter prevents the clot from traveling to the lung.

How long does it take to recover from total hip replacement surgery?

After hip replacement surgery, the patients are usually walking the same day of surgery. Patients then progress to walking with support using a walker, to walking with a walker on their own and then walking with a cane in one hand. The pain that they had before the hip replacement surgery from arthritis is gone after hip replacement surgery. The patients have surgical pain, which only gets better with time. Most of the discomfort from the surgery is gone at four to six weeks’ time. Most patients are almost back to normal at three months. Minority of the patients are still recovering after three months of surgery.

Is it normal for the affected extremity to feel heavy after hip replacement surgery?

It is not uncommon for the patients to complain of heaviness in the affected extremity after hip replacement surgery. This heaviness is because the muscles are weak after hip replacement surgery. It is not because of the weight of the artificial hip joint. The weight of the artificial hip joint is not the reason for the heaviness after hip replacement surgery.

What exercise can you do after hip replacement?

After hip replacement surgery, I advise the patients to walk as much as they can. Walking is the most strongly recommended exercise. Depending upon the progress of the patient, several physical therapists push the patients to do squats and active straight leg raise exercises of the affected extremity.

I tell my patients that this is not necessary. Most primary hip replacement surgeries are done in a very minimally invasive manner and the patients regain the ability to squat and to do straight leg raise with time. The patients do not need to push to achieve straight leg raise very early in the postoperative period. Active straight leg raise is among the last items that a patient can do after hip replacement surgery because this activity requires significant strength.

When can you lay on your side after hip replacement surgery?

The patients can lay on the side of the hip replacement surgery whenever they are comfortable. After a posterior hip replacement surgery, they should be careful when laying on the other side because it may compromise the stability of the hip joint because the patient may not be following hip dislocation precautions.

The patients who lay on the other side should keep a wedge between their thighs so that the possibility of the hip dislocation is minimized. To decrease the risk of hip replacement surgery, most patients sleep with a wedge between the two thighs to prevent a hip dislocation. However, laying on the affected side is possible whenever the patient is comfortable so long as the hip dislocation precautions are followed.

How long before you can drive after a hip replacement surgery?

The patients who have had a left-sided hip replacement are able to drive sooner than the patients who have had a right hip replacement for automatic cars. For cars with a clutch, the time is the same after left and right hip replacement surgery.

The patients with right hip replacement are able to drive in about two to four weeks’ time. The patients with left hip replacement are able to drive as soon as they are off pain medications. It is critically important for the patients to follow hip dislocation precautions, especially when they get in and out of the car. In order not to dislocate the hip, it is also critically important for the vehicle to have a high seat so that the patients do not bend the hip beyond 90 degrees following a posterior hip replacement surgery.

How should you sit after hip surgery?

The patients should sit with their knees separated after hip replacement surgery on a high chair. Orthopedic surgeons advise not to bend the hip beyond 90 degrees after hip replacement surgery after a posterior hip replacement. It is a common misunderstanding of the patients that they should not be crossing their ankles. After posterior hip replacement, it is absolutely okay for the patients to cross their ankles so long as they are keeping their knees separated.

I give advice that is very easy to follow- patients should be looking at the inside of the knees and they should “not” be looking at their outside of the knees. If patients keep their knees separated, they are looking at the inside of their knees and that is a very safe position for a patient to sit after hip replacement surgery. The worst position is for the patient to bend their hip beyond 90 degrees be looking at the outside of your knee because this is a position that the hip is most prone for dislocation.

Is having hip replacement surgery a disability?

The goal of hip replacement surgery is to take away the pain from the arthritis. I give a temporary disability sticker for a few months after hip replacement surgery for public parking. For patients with workers’ compensation injury, I follow the New York State Guidelines for determining permanent impairment and loss of wage earning capacity for determining disability.

Total hip replacement according to the 2012 guidelines of workers’ compensation schedule has 60 to 66 and 2/3% loss of use of the leg. Excision of head and neck of the femur without prosthetic replacement equals 50% loss of use of the leg for anatomical loss, but that is without replacing the excised head and neck of the femur. If there is thigh muscle atrophy and weakness, there could be an additional 10% award.

How long do you have to wait before flying after hip replacement surgery?

The patients can fly within a few days of having hip replacement surgery. When the patients fly, they are at increased risk of developing blood clots esp. in long flights. I strongly advise them to take their blood thinner. Additionally, it is very important to keep themselves hydrated during the flight.

Additionally and most importantly, I advise them to walk as much as possible inside the aeroplane to decrease the risk of formation of blood clots in the calf muscles. The patients should also follow hip dislocation precautions by keeping their knee separated when they fly after hip replacement surgery. The patients who travel to me internationally or from other states are usually fly back after the staples are removed within about 10 days of surgery.

How long does the patient have to wear compression stockings after hip replacement surgery?

I advise the patients to wear compression stockings commonly called “TED stockings” till the swelling in the extremity has completely subsided. There are two types of anti-embolism stocking available after hip replacement surgery- below knee and above knee. The patients are encouraged to wear stockings to decrease the swelling and to decrease the risk of blood clots after the surgery.

If the patients are wearing above knee stockings, it is important to make sure that the stockings are worn properly. For above knee stockings it is important to make sure that the stocking does not roll behind knees and compress the soft tissues around the knee, which will actually cause stagnation of blood and may increase the risk of blood clots.

Can the patients drink alcohol after an operation?

We strongly advise against drinking alcohol after the surgery for a variety of reasons. The patients may be getting narcotic medication and combination of narcotics and alcohol can be disastrous. The combination may slow down breathing and may even result in death.

Additionally, alcohol may create balance issues that may result in the patient falling and fall can cause fracture around the hip joint and may lead to a hip dislocation. After consumption of alcohol, the patients may forget to follow hip dislocation precautions after the surgery and may sustain dislocation of the hip joint. Patients may also forget to take their medications including blood thinners. Therefore, for a variety of reasons it is best to avoid alcohol after hip replacement surgery.

Is it normal to have bruising after hip replacement surgery?

The patient may have bruising around the incision or in the lower part of the incision after hip replacement surgery. Sometimes bruising may even track down to the calf. If not excessive, this bruising is considered normal. It is due to the blood that accumulates in the soft tissues after hip replacement surgery.

The patients who are on blood thinners before the surgery (example for atrial fibrillation who were taking Coumadin) may notice additional bruising after hip replacement surgery on that extremity. The patients who have had bruising in their upper extremity from taking blood thinners may notice slightly more bruising in the lower extremity than the patients who are not taking blood thinners.

How much do the hip replacement surgery weigh?

Hip replacement artificial parts are made from metal and plastic and weight of the part is insignificant. The patients may feel heaviness after hip replacement surgery in the affected extremity but that feeling is because the muscles are weak.

The weight of the hip replacement surgery artificial parts depends on the size that the patient received. The size that the patient received depends on the preoperative templating as well as the anatomy of the hip. Most artificial hip replacements weigh less than 5 pounds.

How long do you have to wait to take a bath or a shower after hip replacement surgery?

I encourage my patients to shower the next day after the surgery with the dressing on. I use a dressing that does not allow the water to seep into the wound. If the dressing is saturated, I change the dressing. The patients can take some dressings from the hospital or they can buy dressings from a surgical supply store.

I feel that the patients have a much better sense of well being after showering soon after surgery. The patients can get into the water and take a bath after the skin has healed which is about a week or 10 days after the surgery provided there is no drainage from the incision and provided the incision looks good. A visiting nurse, by the rehab physician or the orthopedic surgeon or a physician assistant who is experienced with surgical wounds, can assess the incision.

If the patient is taking a bath in a tub, it is critically important to follow hip dislocation precautions. Additionally it is important to have a handle to hold for entering and exiting the tub. I also encouraged having an assistant and bell for more help if needed. Before sitting down in tub or pool the patient should be comfortable siting and getting up from a chair as well as from a toilet commode.

Do you advise a high toilet seat for the patients after anterior hip replacement surgery?

Yes, I have found that the patients feel much more comfortable using a high toilet seat even after anterior hip replacement surgery even though the posterior hip dislocation precautions do not have to be followed. Additionally a handle for getting up is extremely useful for patients who have had hip replacement surgery irrespective of the approach. The muscles around the hip after hip replacement surgery are weak and a toilet seat helps.

How long do you have to stay in the hospital after hip surgery?

The hospital stay is about one or two nights. Most patients after hip replacement surgery go home the next day after a one-night stay.

Depending upon the time of the day the patient undergoes surgery, they may need to stay one additional night if they get out of the operating room late during the day.

Orthopedic surgeons have now started doing hip replacements on an ambulatory surgery centers. However, it is critical to have the right patient selected for a procedure to be done in an ambulatory surgery center. Before the patient is discharged from the ambulatory surgery center or from a hospital the patient is evaluated by case management as well as physical therapist to ensure it is safe for the patients to be going home. We ensure patients can safely do the activities that they do at home.

Patients, who have no help or who are unable to do the activities of daily living, go to a rehab facility. Patients after hip replacement surgery going to rehab facility has significantly decreased over the past several years.

What does it feel like when you have had a hip replacement surgery?

Immediately after a hip replacement surgery, the pain from the arthritis is gone. The only discomfort that remains is from the surgical procedure and is mainly around the incision. The first time the patient places their foot on the floor and bears weight, they realize that the pain from the arthritis has changed to postoperative pain that should be within tolerable limits for most patients.

The patients may complain of groin pain after hip replacement surgery. This groin pain persists for several months. This pain is present mainly when the patient gets up in the morning and gets up after being seated for a long time or if sleeping for a long time. This pain is called “startup pain” and it goes away with time.

What kind of pain medication will I have to take after the procedure?

Orthopedic surgeons use a combination of medications after hip replacement surgery. We have decreased the use of narcotics because of the side effects that include nausea, vomiting, constipation as well as altered gait. The patients gets premedicated even before the procedure and in the postoperative period narcotic medications are now being replaced more and more with anti-inflammatory medication.

Will my postsurgery pain be manageable?

We have made tremendous advances in the management of postoperative pain. We give medication for postoperative pain even before the surgery starts. Intraoperatively we use injections into the body part for postoperative pain relief. This injection lasts several hours after the procedure. Postoperatively we use a combination of medications to keep the pain down. Most patients should have pain level of less than five on a scale of 1-10 after the surgery (0 being no pain and 10 being the worst pain you have experienced in your life).

When is my first postoperative visit?

Patients visit their orthopedic surgeon at about six weeks after the surgery with an x-ray. If the patient has staples or sutures, the visiting nurse removes them if the visiting nurse is comfortable removing the staples. If the visiting nurse is not comfortable removing the staples and if the patient is at home, then the first postoperative visit to the surgeon is in about two to three weeks for removing the staples. If the patient is at a rehab facility, the rehabilitation physician removes the staples and the orthopedic surgeon sees the patient in about six weeks’ time.

What should I expect to be feeling immediately after the surgery?

Immediately after the surgery, the patient is in the postoperative care unit and is cared by the postoperative team. The pain levels are carefully attended to. If needed, IV pain medications are given to the patient to control the pain. Patients are started on sips of water with ice, then they progress to fluids and then to a light diet and then to a full diet. The patients occasionally feel that the pain on the second day is more than the first day because the injections given in the surgery have worn away. They may need additional medications during the second day for control of pain.

How active should I be after the surgery?

We want the patients to be active and we want the patients to be completely pain free after the surgery. The only activity I advise against after any artificial joint replacement of the hip and knee is “impact” type of activity. I have patients who play golf, who ski, who dance, patients also play doubles tennis, etc. The patients should be advised that the artificial joint replacement surgery entails having artificial parts that have no ability to heal themselves. If the artificial joint is damaged, then the patient can have pain due to loosening and may require a revision joint replacement surgery in the future.

When will my sutures or staples be removed?

Sutures or staples after hip replacement surgery can be removed as early as one week to 10 days after the surgery if incision looks good. Stiches and staples can be kept for long time after the surgery, however, if kept for several weeks skin grows around the staples and the sutures and removal becomes more painful.

Will I have pain when my stiches or sutures are removed?

Pain during removal of stiches or staples is minimum. Having said that, occasionally I have had patients who joke and tell me that that is the worst pain that I have had during the whole procedure including the hip replacement surgery. I spray a numbing medication before taking the sutures and staples out to make the patient more comfortable during the procedure.

How long do I need to keep a bandage/dressing on my incision?

I advised to keep the bandage or the dressing on the incision until the sutures or the staples are removed if the patient has sutures and staples. If the patient does not have sutures or staples, I advise the dressing to be kept on the wound for about two weeks’ time. The dressing should not interfere with showering. If the water soaks the dressing, the dressing can be removed and another dressing can be applied.

It is not a worry if clean water runs over the incision. I advise my patients to “gently dab” the incision with a clean towel and then place another dressing on. I advise the dressing to be placed on the incision in the presence of sutures or staples because patients complain of discomfort because of the staples and sutures rubbing against their clothes.

How long will I be on the pain medication after hip replacement surgery?

Every patient’s pain tolerance is different. Most patients are off pain medications within a few weeks after hip replacement surgery. They taper their medications to a point that they do not need the pain medications anymore. The patients who are on pain medication prior to the hip replacement surgery need larger dose of medications as well as they stay on medications for a longer period. Eventually after the pain in the hip has completely subsided, they go back to their baseline medication that they were taking. In my experience, patients are taking chronic pain medications for their back.

Will I go to a rehabilitation facility or home after hip replacement surgery?

Most patients after hip replacement surgery go home. Fewer and fewer patients are going to a rehabilitation facility after hip replacement surgery. If the patient is unable to do activities of daily living at home and if they are not cleared by the physical therapist and case manager, then patients go to a rehab facility.

I strongly advise patients against going to a rehab facility because I feel I lose control of the patient, I feel that the care is much better if the patient goes to clean familiar environment at home. I have had rehab facilities refuse my recommendations. As an example, I have had patients complain that they do not get adequate physical therapy at the rehab facility. Some facilities will not allow the patient occasionally to walk on their own even if they are able to walk.

The rehabilitation facilities sometimes do not follow through on my protocols for prevention of blood clots after surgery. There have been times that the rehab facility sends the patient to ER for unnecessary reasons. Coordination of care has been an issue with some rehabilitation facilities and literature has shown that the patients going home do better. I therefore prefer the patients to go home rather than to a rehab facility.

Do I need a physical therapist after hip replacement surgery?

The patients going home after hip replacement surgery have a physical therapist who visits them at home after the procedure. This is organized by home health and it is set up before the patient leaves the hospital. After they are cleared by home physical therapy, patients may choose to do outpatient physical therapy.

How long will my new hip last and can a second hip replacement be done?

I tell my patients getting a new hip done is like buying a brand new car! It depends on how well you treat it. The patients who abuse their artificial joint, do not have enough longevity in the joints.

Most hip replacement surgeries last for a long time. There is data that shows that 95% of hips done 20 years ago are still in and are doing well. If there is a fracture, if there is infection, if there is loosening of the joint or if there is a dislocation, the patient may need a second hip replacement. The second or “revision” hip replacement is performed depending upon the circumstances that are needed for doing hip replacement surgery.

Why do total hip replacements fail?

Total hip replacements fail for a variety of reasons. Total hip joints may loosen because of wear and tear and because of the wear particles arising from the plastic. This was thought to be “cement disease” several years ago because it was felt that the particles from the cement caused loosening. However, literature is now clear that the plastic wears away and the wear particles from the plastic eat the bone and that is called “osteolysis”.

The pumping action from the movement of the joint causes the particles to go beyond the constraints of joint and the loosening can happen in the bone adjacent to the joint replacement surgery. Additional causes for revision of the hip are recurrent dislocation of the hip, breakage of the bone around the hip that can cause loosening of the hip and infection of the hip joint amongst other causes.

How long are patients in rehabilitation centers following joint replacement surgery?

Our strong preference is for patients to go home after joint replacement surgery. Patients who live alone, who are unable to do their activities of daily living at home are candidates to go to rehabilitation facilities. Patients who go to acute rehab facilities are limited in their stay to about 10 days. Patients who go to long-term rehab typically are patients who require long-term care. Patients who have had major revision joint replacement surgeries are patients who commonly go to rehab facilities.

As an example, patients who have had a spacer for infected joint replacement have difficulty placing weight on the affected side and their rehab facility stay could be 6 weeks or longer. These are patients who are undergoing a “staged reconstruction” for their infected joint. The first stage is the stage where the rehab stay is long. After the second surgery when the spacer is removed and revision hip replacement is performed, patients typically go home.

Insurances including Medicare typically cover the stay at rehab facilities for several days. For patients where they run out of days covered by commercial insurance or Medicare, there are other options including changing to Medicaid or alternative private insurances. Very rarely patients need to pay “out of pocket” to stay at rehabilitation facilities.

How soon can patients resume sexual activity after hip and knee replacement surgery?

Numerous studies have shown that both sexual satisfaction as well as performance are improved in most patients after a hip replacement surgery. Most patients resume sexual activity at around 6 weeks after the surgery. At around 3 months, there are hardly any sexual issues attributed to the hip joint. Patients can resume sex even before 6 weeks, but they have to follow hip dislocation precautions.

Are hip dislocation precautions for life?

Not at all! Hip dislocation precautions are required only for about 6 weeks after hip replacement surgery. After hip replacement surgery, the patient slowly should led go their hip dislocation precautions. In the long-term, the patient should be able to function and carry on their life without any hip dislocation precautions.

Precautions are permanent only if the patient continues to dislocate their hip after surgery is already done for recurrent dislocation and the patient still continues to dislocate the hip. This is an extremely rare scenario.

What are good and bad positions for my hip during recovery?

These positions depend upon what approach to the hip was used for doing the hip replacement. If the patient has an anterior hip replacement, they should not be hyperextending their hip and turning their toes outward because this is a position where the hip is most unstable and prone for dislocation. After posterior hip dislocation precautions, the patient should not be bending their hips beyond 90 degrees and twisting their hip in a manner that they are looking at the outside of the knee (internal rotating their hip).

For posterior as well as anterior hip dislocation precautions, patients should not be going to extremes of any position. Patients after posterior hip replacement should be sitting in a high chair, should be keeping their knees separated (it is okay to cross the ankles). Patients after anterior hip replacement surgery find it more comfortable to sleep with the pillow under their knee. Patients with posterior hip replacement, sleep with wedge between their thighs as a reminder to follow the hip dislocation precautions.

How much range of motion do I need?

Total joint replacements today allow much better range of motion at the hip than needed for most activities of daily living. Most patients do not need range of motion more than 90 degrees after hip replacement surgery. A 90-degree motion at the knee and 90-degree motion at the hip are enough for patients to carry on their activities of daily living including walking up and down stairs, including sitting on chairs and sitting on a toilet seat. Patients need about 20 degrees internal and external range of motion for activities of daily living. Today’s implants allow much better range of motion.

My leg feels longer after the total hip replacement surgery, is it possible?

Patients may feel that their affected extremity is longer after hip replacement surgery. This feeling most commonly goes away after a few weeks. Patients who have a low BMI are especially prone to feel this limb length discrepancy. We use a variety of techniques for accurate planning of the surgery, which include numerous preoperative and intraoperatively techniques to ensure that the length of the extremity is the same as the other side.

However, occasionally patients may have “true” lengthening after hip replacement surgery that maybe permanent. If patients feel the leg is longer or shorter several weeks after the surgery, a “lift” in the other extremity under the shoe maybe used for balancing the gait.

How long will I limp?

Depending upon how patients rehab their muscles, they may limp for 4 to 6 weeks after the surgery. Most patients do not have any limp at all after 3 months.

Can I use weights when I exercise after hip replacement surgery?

Patients should be cognizant of how well their muscles have rehabbed after hip replacement surgery and they should slowly increase their weights if they use weights to exercise. Strengthening of the quadriceps while sitting and using weights is safe. However, if they use weights and squat, they have to make sure they follow the hip dislocation precautions in the post-operative period. I strongly encourage them to wait for up to 3 months for using heavy weights. Patients should work closely with a physical therapist to exercise and use weights cautiously.

My hip has intermittent clicking or pumping noise, is this normal?

Intermittent clicking noise may occur in the immediate postoperative period after hip replacement surgery. Most commonly, this noise goes away. If a patient has had a constrained liner and if there is breakage of the ring around the constrained liner, then the patient may start getting clicking several months or years after the surgery has been done for recurrent dislocation. If the patient develops clicking after several months or years, it is important to have the hip evaluated by an orthopedic surgeon along with radiological studies (which is an x-ray as a starting point).

When should you call your surgeon or your primary care provider?

I encourage my patients to use common sense. The risks of the surgery are elaborately discussed before the surgery. If the patient develops sudden onset pain, is unable to walk, it may suggest dislocation or a fracture and should contact their surgeon immediately.

If there is sudden onset swelling in the lower extremity, if there is trouble breathing, it may be a sign of blood clot going to the lung and this is an indication to contact their surgeon or their primary care provider or go to the nearest emergency room as soon as possible. If the patient develops fever, it may be a sign of infection and they should contact their provider as soon as possible. Infection is accompanied with spiking fever and inability to bear weight and severe pain in the joint.

What are the signs and symptoms of infection in the hip joint?

Infection in the immediate postoperative period presents as suddenly increased pain, swelling and redness in the hip joint. The patient is unable to bear weight. On examination, there is redness, increased warmth and the rotations of the hip are painful.

X-rays are normal in an infection because the infection is not seen on an x-ray. If the patient has an infection, depending upon the time of the onset, the patient may need irrigation and debridement and exchange of the head in the plastic in the artificial hip joint. If the infection appears several months or several years after a hip replacement surgery or if the infection has been ongoing, patients may need removal of the hardware and a stage reconstruction in which the hardware is removed, antibiotic spacer is placed and after 4 to 6 weeks, the antibiotic spacer is removed and the revision hip replacement is performed.

What are the signs and symptoms of a blood clot?

A blood clot manifests as swelling in the lower extremity accompanied with pain over the calf muscles. If a patient suspects a blood clot, it is important to get himself or herself evaluated by an orthopedic surgeon. Orthopedic surgeons do not routinely advise surveillance by ultrasound for a blood clot. However, if the patient is symptomatic, ultrasound with Doppler is performed for a blood clot and the patient is treated accordingly.

What are the signs and symptoms of pulmonary embolism?

Pulmonary embolism is a serious condition that can happen from the blood clot in the calf muscle lodging into the pulmonary system. The patient presents in acute respiratory distress. On examination, the oxygenation may be low and studies including VQ scan are performed for diagnosis of pulmonary embolism. Patients with pulmonary embolism need blood thinners for several months.

Can I bend over to tie my shoes after hip replacement surgery?

Patients should be able to bend their hip as well as externally rotate their hips after total hip replacement surgery. Flexion and external rotation are necessary for patients to be able to tie their shoes. If patients have back issues and unable to bend their back, they may not be able to tie their shoes.

If patients have trouble with their shoes, they may use shoes that they were using prior to getting their hip replacement surgery including shoes without a shoelace. Shoe inserters may also be used for assistance to wear shoes. Some patients bend their need on the side of the hip replacement.

Can I cross my legs after hip replacement surgery?

Crossing the legs requires good external rotation and flexion and most patients have significantly better external rotation and flexion after hip replacement surgery compared to their flexion and external rotation prior to total hip replacement surgery.

In the short term, for about 6 weeks after surgery, patients should not be crossing their knees especially with the hip bent beyond ninety degrees.

Can I sit on the floor cross-legged if it does not hurt?

In the long term after the hip dislocation precautions are weaned, patients should be able to sit on the floor cross-legged. Sitting cross-legged on the floor is important function of several eastern cultures and most patients are able to do it without any issues.

Do you have any restrictions about lifting objects?

Patients have no restrictions in their long term for lifting. We have several grandparents and parents who want to pick up their baby and their toddler after hip replacement surgery. Patients should follow general ergonomic considerations for lifting. As an example, it is important to bend the hip and keep their spine straight before picking up objects to avoid injury to the back.

Are there any restrictions that are permanent after total hip replacement surgery?

There are no permanent restrictions after hip replacement surgery. The only precaution I advise is to avoid impact type of activity. The artificial joint replacement surgeries have artificial parts and patients who abuse their joints are at a risk of loosening their joint, which may need a hip revision.

Is there anything I should add to my daily or weekly routine after hip replacement surgery that would help?

I strongly advise my patients to be active. The goal of hip replacement surgery is to take away the pain from the hip. We strongly advise daily and weekly exercise schedule for general fitness.

When can I start hydrotherapy after hip replacement surgery?

I advise patients to start hydrotherapy about 2 weeks after hip replacement surgery. Certain centers have allowed patients to start hydrotherapy immediately after the surgery. However, I worry about the contamination of water and seepage of water into the wound that may lead to infection. If the wound is covered and if the water is clean and the dressing does not allow seepage of water into the incision, the hydrotherapy may be allowed sooner.

How soon can patients go to the beach after total hip replacement?

In the immediate post-operative period, patients have to be cautious when they go to the beach and into the water because waves may cause falls and injury to the hip in the postoperative period. Patients can get into a pool in their backyard and into water if the water is clean and if the dressing makes the incision water resistant. I have had patients go to the beach without getting into the water within days of having hip replacement surgery.

Is there is a particular time of the year that you advise hip replacement surgery?

There is no time of the year that is worse or better. It does not matter whether it is summer, spring, winter or fall for having hip replacement surgery. I tell my patients that hip replacement surgery is “elective” and not “emergency” surgery and they can decide when they want to have it. They should get all the help they can when they have surgery. I tell my patients they should feel as if they are “the center of the world” when they have any elective surgery. Travel, vacation and other requests by patients and their friends and relatives should be in place well before the procedure.

Given my pain medication, when can I drink alcohol again?

Combining pain medications and alcohol can lead to fatal outcomes. We do not advise drinking alcohol while the patient is on pain medication. Additionally, there may be gait disturbances that can cause falls. Patients may forget to follow their hip dislocation precautions after drinking alcohol. It is best to use common sense before starting to drink after total hip replacement surgery. Think of drinking after all pain medications are stopped and after the limb and use of assistive devices is gone!

What symptoms should worry me if they occur after total hip replacement?

If the patient is unable to bear weight, if there is sudden increase in pain, if there is fever, if there is sudden shortening of the extremity, if the patient is suddenly unable to ambulate after hip replacement surgery, the patient should contact their provider because these are worrisome symptoms suggestive of a complication.

Do I have a reason to be concerned about my other hip?

Patients occasionally have arthritis in both hips. If one hip is replaced, then they become symptomatic for the other pretty soon because the pain in the operated hip is gone. If patients have no pain in the other hip, they do not need to be treated for the other hip. If patients have pain in the other hip, they can be evaluated by the orthopedic surgeon, but in the absence of pain, they do not need to be concerned or to be treated for the other hip.

I still have swelling in the extremity after hip replacement surgery, is that a concern and what should I do about it?

Swelling in the affected extremity remains for several weeks after hip replacement surgery and is generally not a concern so long as the swelling keeps decreasing. Patients can elevate the extremity, they should be using compression stockings and in the hospital, we use sequential compression devices. If the swelling suddenly increase and is accompanying by pain in the calf muscles, the patient should seek the advice from their provider.

There are big indentations around my incision, is this normal? What is the meaning of these indentations?

Big indentations around the incision after total hip replacement surgery is rare. The patient should seek advice and show these indentations to their provider. Especially if these indentations are red and are accompanied with pain, they should immediately seek attention of their orthopedic surgeon because it may be a sign of infection around hip joint.

Occasionally, patients have noticed indentations around the incision that have been present previously and are present on their other hip. However, if there is concern or if these indentations are associated with pain, swelling and redness, they should immediately seek the advice of their orthopedic surgeon.

What are the pros and cons of minimally invasive surgery?

The term “Minimally invasive surgery” is used very widely and means different to different people. I like the term “less invasive surgery”. If the surgeon is in his learning curve for minimally invasive surgery and if the surgeon has never used less invasive approaches before, there have been studies that showed that the stability of the implant as well as the position of the implant have been compromised.

The “invasiveness” of the procedure depends on what is done inside the scar and not necessary the length of the scar. In my opinion, the length of the scar matters significantly less than how “invasive” the surgery was inside the scar.

Does it really make a meaningful difference in the results after minimally invasive surgery or does minimally invasive surgery pose increased risk of the surgery?

The advantages of “minimally invasive surgery” are only in the first few weeks after surgery. The results in literature show that even for surgeons who do minimally invasive surgery and who are experts in doing that, the results are normalized in or around 3 months. This means that the results in patients who have “not” had minimally invasive surgery and who had minimally invasive surgery are the same at around 3 months.

Since every patient is different, stratification in studies is difficult. It is difficult to differentiate which patients have done better and in which patient minimally invasive surgery really worked. I tell my patients that my incision “is as small as possible and much as is needed”. If required, I extend the incision as much as is needed to ensure a good long-term result. Generally patients who are younger and who have better muscle bulk do better in their immediate postoperative period irrespective of whether the surgery was “minimally invasive”.

Will I able to contact a surgeon after the surgery if I have a question or a problem?

Orthopedic surgeons should be available all the time after the surgery if the patient has a problem. In the hospital, most orthopedic surgeons have physician extenders and nurses available to help patients with their pain requirements. Hospitals that do a good volume of joint replacement procedures have most questions answered by in-hospital staff while patients are in the hospital. If the patient needs to reach me, they call the service and are able to reach me emergently.

If the patient is in the hospital it is better for the nurse to reach me so that the relevant clinical information is conveyed and if any medication changes need to happen, they can be conveyed to the nurse directly. For medical issues in the postoperative period we usually have a medicine doctor on board who takes care of the medical issues including nausea, giddiness, asthma, drop in hemoglobin level, abnormal potassium levels, etc.

I get itchy when I take pain medications after total hip replacement, am I allergic?

We have numerous medications available for treatment of pain and we sometimes have to juggle with them to ensure that the patient remains pain free and gets the correct medication. Some patients are allergic to pain medications and this allergy may present as itchiness. If patient feels itchy after getting pain medications, we have medications available to decrease that itchy feeling. The itchiness may mean that the patient is allergic to that medication.

The determination then is made to continue the pain medication with the medication that decreases the itch or to change the pain medication all together. Allergy may manifest itself as little itchiness at one end of the spectrum to a severe anaphylactic reaction at the other. I use medications which the patient has used in the past and which have worked on the patient to ensure that the possibility of side reactions from medication are minimized.

How do I get a medication refill after hip replacement surgery?

If patients are at home, they usually are able to call their orthopedic surgeon to get a medication refill. Today we are able to pull up what the patient has been prescribed in the past. We can easily pull up what medication the patient got from the pharmacy, which pharmacy the patient got it from, what was the dose, how many pills were given and which provider gave the medication. I run this history and then depending up on the physical examination and days after the surgery, the patient is given a medication refill.

Will I get hooked on to pain medication after hip replacement surgery?

We have strict criteria for giving pain medication after the surgery. Patients who are taking pain medications prior to the surgery usually go back to the pain medication that they were taking before. The pain management person who was giving them the pain medication in the first place before the surgery provides this pain medication.

Patients who take medications as prescribed in the postoperative period do not get “hooked” onto pain medications. The pain after hip replacement surgery continues to improve and the need for pain medication decreases. I have seen patients who are very concerned about being “hooked onto pain medication” and they do not take pain medications at all which I feel is a mistake. We want the pain to be well controlled, so that the patient cooperates with physical therapy and there is a feeling of well being in the postoperative period.

When do you cement to fix hip components?

Bone cement is rarely used today for fixation of hip components. My preferred method is to use “uncemented” stems and cups for replacing joints. I use cement only if the structure of the bone does not allow placement of an uncemented prosthesis in an acceptable manner.

Additional circumstances where I may consider the use of cement is for pathological fractures of the hip that are seeded with metastasis from a primary source elsewhere in the body. For pathological fractures with metastasis, I use zoledronic acid with bone cement. This technique of mixing a drug with bone cement has provided excellent pain relief after pathological hip fractures that are treated with hip replacement surgery.

The reason for using uncemented prosthesis are numerous. The long terms result of uncemented hip prosthesis are excellent. Uncemented prosthesis are little more forgiving for “varus placement” in the hip joint which means that the prosthesis is more tilted when placed into the hip joint. Additionally cement has been associated with embolism, which means that the cement when pressurized into the bone can leak into the blood vessels and can go into the cardiovascular system causing issues.

Which company do you use for hip replacement surgery?

I use implants that have excellent track record. I do not use implants that are in a post marketing phase or in the research phase of the life. Occasionally a patient requests certain company. I caution them that there are many companies pushing to consumer products but I only use implants that have a good record of accomplishment irrespective of direct patient to consumer marketing by joint replacement companies. Joint replacement surgery is doing the same procedure repeatedly in a consistent manner and I do not change the implant company that I use based on individual patient requests. I use the implant company I know well and that has provided good results in my hands.

Implant companies have used celebrities to promote hip replacements. The results of companies pushing their own product as compared to their competitors has not been substantiated on scientific basis for the most part. Several implant companies have several models and designs that defer from each other. Some designs are better for the unique anatomical fit of the patient. I look carefully at the bony anatomy of the patient and the templating of the hip Xray that is done preoperatively. My implant choices occasionally change depending on the individual bony anatomy of the patient.

For the patients getting robotic hip replacement surgery, the implants used have to be compatible with robotic platform. Some implants that are not compatible with robotic platform cannot be used if the patient is getting a robotic hip replacement.

For the most common type of hip replacement surgery there is very little difference in the implants offered by most manufacturers. I personally do not get paid by any company to promote or use any of his products.

Can I go up and down stairs after hip replacement surgery?

The patients are able to stand up and walk the same day of surgery depending upon how the patient’s rehab. They may be able to go up and down stairs even the first day of surgery. Most patients are able to go up and down stairs within a few days of having surgery. When walking up and down, my advice is- “good goes to heaven and bad goes to hell!” This means that while walking upstairs patients should use the nonoperative extremity and while walking downstairs they should put their operated extremity forward.

Can I kneel after hip replacement surgery?

The patients are able to kneel after hip replacement surgery without any issues. In the postoperative period, they should be following hip dislocation precautions. Additionally it is strongly advised to have handle or some sort of support to help them get up from the kneeling position. Most patients who kneel in the post-operative period use some sort of support and with good upper extremity strength, they are able to stand up from a kneeling position.

When can I discontinue using a raised toilet seat after hip replacement surgery?

The patients should stop using a raised toilet seat six to eight weeks after posterior hip replacement surgery. The raised toilet seats accommodates two things. Firstly, the patient can easily follow the hip dislocation precautions. The raised toilet seat prevents the patient from bending the hip beyond 90 degrees. Secondly, with a raised toilet seat it is easy for the patient to stand up after using the toilet. In addition to raised toilet seat, I always advise having a handrail or a walker to help them get up from the seating position.

What should I expect my range of motion at six weeks and at one year after hip replacement surgery?

The patient’s range of motion should be terminally restricted at around six weeks of surgery. Most patients gain full range of motion. After hip replacement surgery at one year, most patients do not feel any restriction. Occasionally the patients may feel restriction in rolling their legs outward causing some difficulty in tying shoelaces.

Do I need antibiotics before dental work or any invasive procedure?

It is absolutely critical to take antibiotics before any dental work. Most dentists are cognizant of the fact that the patients having knee artificial joints need antibiotics. Most dentists prescribe 2 grams of amoxicillin before any dental procedure. Antibiotic prophylaxis before dental procedure has to be followed for the rest of the patient’s life after any artificial hip or knee replacement surgery.

Some surgeons advise use of antibiotics only for two years after surgery and I am strongly against use only for two years. I have seen infections occur several years after hip replacement surgery if dental prophylaxes are not followed. Alternative antibiotics can be chosen by the dentists if the patient is allergic to amoxicillin.

Will I set off machines at airport security after hip replacement surgery?

Security machines at most airports will go off after hip and knee replacement surgery. There have been some rare occasions where the patients told me that they did not set off the airport security (which makes me worry about the quality of the machines at those airports!).

A doctor’s note about hip or knee replacement surgery will not help because anybody can carry that note. If you set off alarm set airport security, the security personnel will usually use a “wand” to ensure safety of the airport. In the earlier days we used to give a card with the patient’s name and the name of the joint that was replaced. However, carrying operative note or this card or a doctor’s note is not helpful. Although if the patients wanted one, we will be happy to give it to them.

How long will my incision be after hip replacement surgery?

I tell my patients the “incision is as short as possible as long as is needed”. Incisions heal side to side not end to end. “Minimally invasive surgery” entails what is done inside the hip and ironically, this does “not” depend on the length of the incision. Orthopedic surgeons are cognizant of the length of the incision. However, the length of the incision is as much as it needs to be to ensure proper placement of the prosthesis so that the long-term results of the hip replacement are not compromised.

What is the rate of infection after hip replacement surgery?

The risk of infection after hip replacement surgery is typically less than 1% in the immediate postoperative period. The risk of infection depends on the immunity of the patient. It depends on the hospital. It depends on the aseptic technique used during the surgery among various factors.

How do I take care of the incision after hip replacement surgery?

After the hip replacement surgery, there is a dressing over the incision. On discharge from the hospital, notes are given to the patient on the care of that incision. I allow my patients to shower over the dressing and the dressing is changed as needed. The dressings stays on till the sutures or the staples are removed or for about two weeks after the surgery. Placing antibiotic cream over the incision is not needed and is not recommended.

What do I do about postoperative constipation after hip replacement surgery?

Narcotics and anesthesia do give rise to postoperative constipation. I advise improved diet, plenty of water intake and over the counter medications. In the hospital, patients get medications like Colace, Miralax or an enema if they are significantly symptomatic for constipation.

Should I use ice or heat over the incision after hip replacement surgery?

The patient should use ice over their incision after total hip replacement surgery. Certain insurance companies allow a cold therapy pack that helps with the pain after hip replacement surgery.

Is it normal to have insomnia after hip replacement surgery? What can I do about it?

Some patients are very anxious and may get insomnia after hip replacement surgery due to anxiety. Other reasons for difficulty falling asleep are if patients were taking sleep medications before the surgery and are discontinuing them afterwards. Additional reasons include worry about hip dislocation precautions and inability to fall asleep in the supine position.

Pain is rarely a cause of inability to fall asleep after hip replacement surgery. The patients who are uncomfortable laying supine with their hips straight are advised to use a pillow underneath the knee after hip replacement surgery. This bends the hip a little and makes the patient more comfortable. I do not advise taking sleeping pills after hip replacement surgery because of the increased risk of falls after taking sleeping pills. Patients who are unable to fall asleep in the supine position should use a wedge between their thighs to sleep on the side.

What precautions should I keep in mind?

Apart from just following common sense, the most important precautions to follow after hip replacement surgery are following the “hip dislocation precautions”. Other precautions are to take your medications properly, especially the blood thinners. It is important to keep the incision dry and intact.

Will I be provided with a list of rehabilitation centers after hip replacement surgery?

If the patient is not able to go home, the case manager provides a list of rehabilitation centers. I generally do not recommend any rehabilitation center because most rehabilitation centers have problems. There are variety of problems including unsatisfactory nursing care, unsatisfactory food to actual medical care. I encourage the patient to do the own research to look at rehabilitation facilities.

I do give the patients a list of rehabilitation facilities that I do “not” want them to go because these are the centers which are associated with very poor medical care which can compromise long-term results of the hip replacement surgery.

Will my insurance cover the cost of going to rehabilitation center?

Joint replacement surgery is elective surgery and the patients should know their exact out of pocket expenses for the surgery and for rehabilitation after the surgery whether it is inpatient or outpatient. The patient should be aware of their copay or their deductible and coinsurance for any of the treatments they undergo in and outside the hospital.

Labral Tear

What does a labral tear in the hip feel like?

A labral tear will manifest as pain in the groin. It will present as sharp pain, worse with activity.

Can hip labral tear heal on its own?

A labral tear of the hip does not heal on its own, just like the meniscus tear in the knee joint. However, with some therapy, some anti-inflammatory medication a labral tear can become asymptomatic. Not all labral tears are indications for surgery. As I always say, I treat patients not MRIs or x-rays. Labral tears seen on the MRIs and therefore is not asymptomatic and does not need to be treated.

Are hip labral tears common?

Hip labral tears are part of hip degradation. They are a precursor for hip arthritis. Hip labral tears are especially common where patients are predisposed to hip arthritis like patients who have hips dysplasia.

Can a labral tear in the hip cause back pain?

By itself, a labral tear in the hip will not cause back pain. It will present as pain in the groin; however, if the patient is walking with a tilt it can cause secondary back pain. Once the hip pain from the labral tear is resolved, the back pain should go away.

How do you fix a torn hip labrum?

A torn hip labrum is fixed using arthroscopy techniques. It’s very minimally invasive procedure; however, it’s particularly important to carefully select patients who are candidates for labral tear versus patients who are candidates for hip replacement surgery. With significant arthritis in the hip joint, patients are not candidates for labral repair.

Hip Dysplasia

What are the symptoms of hip dysplasia?

Hip dysplasia by itself is asymptomatic; however, there’s increased stress on the cartilage because of the shallow cup. That is a precursor for arthritis, so ultimately with hip dysplasia patients can develop hip arthritis.

To prevent hip arthritis in the early stages of hip dysplasia, there are certain osteotomies that can be done by highly specialized surgeons and those can avoid the need for hip replacement surgery. The other advantage of these osteotomies is that when the hip replacement is needed there is better coverage of the bone on the cup side.

Is hip dysplasia permanent?

Yes, hip dysplasia is something that presents in a child and it is a permanent condition. It means that the hip cup is shallow and there is concentration of stresses on the cartilage or the hip joint. This condition is a precursor for arthritis.

Is hip dysplasia disability?

Hip dysplasia by itself it not a disability; however, when it leads to arthritis the pain from the arthritis can be a disability. What is the cause of hip dysplasia? There are numerous causes of hip dysplasia. Some of them are preventable, most of them are not preventable and there is also a genetic cause for hip dysplasia.

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