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Adam S. Bright, MD

Hip Replacement: Hip FAQ's

When do I need a hip replacement?

On the end of your bones, you have cartilage. The cartilage is smooth and frictionless, allowing your hip to move freely. The cartilage has no nerves in it, so the pain free function of our hip is something we take for granted until the cartilage wears out and becomes thin. When the cartilage is too thin, we start feeling pain from the exposed nerves in our bone and we also start to limp due to loss of range of motion and weakness from favoring it. It is even possible to lose so much bone and cartilage that your leg can become shortened. Exercise and medications can relieve pain. However, when the pain is uncontrolled, then you probably need a hip replacement. When your walking and exercise start to become limited, you should have a hip replacement. If you wait too long, then research has shown that you might not ever be able to regain the strength and flexibility of your hip and might continue to limp even after your hip replacement.

How does a hip replacement work?

A hip replacement removes the diseased and worn out ball on the end of your thigh bone and replaces it with a ceramic or metal ball attached to a stem which fits inside your thigh bone. The socket is resurfaced with a metal shell and a plastic, metal, or ceramic liner. The surfaces of the metal are roughened so that your own bone can grow into the metal and allow it to integrate with your own bone. Because the hip replacements are shaped like a normal hip, patients can return to an active and healthy lifestyle with a dramatic reduction in their pain. To see a video of a hip replacement, click here.

How long will the hip replacement last?

Hip replacements usually last more than fifteen years. Patients who are overweight or are very active may wear out their replacement faster. Also, despite the newest advances in technology, a very small number of hip replacements do fail very early.

How long will I be in the hospital?

My patients nearly always stay for three days, which means a Monday surgery goes home on Thursday, and a Thursday surgery goes home on Sunday. Patients who experience some difficulties, such as fever or pneumonia or other complications, sometimes need to stay longer in the hospital.

How long will it take to recover?

Generally, most patients experience an improvement in the pain within the first one to two months. Patients continue to get stronger and improve their walking for nearly a year after the surgery.

Do I need to go to a rehabilitation hospital after my surgery?

Patients who live alone, or who have other medical problems such as obesity or severe heart disease frequently benefit from going to a rehabilitation hospital for a few weeks after they leave the hospital. Patients who are more active and have someone at home to help them for the first week or two usually go home. Overall, about 80% of my patients go home. Research has proven that there is no statistical benefit to going home and having home physical therapy (which is cheaper) than going to a rehabilitation hospital. The decision is mainly based on medical need, and patients who can get out of bed and walk several feet without help are usually able to go home where they are more comfortable.

How can I keep my replacement working well and lasting long?

Staying thin and exercising will likely make the replacement last longer. Following up with Dr. Bright every few years for a checkup can also help to avoid any long term problems, and allow you to keep informed of any changes or advances in hip replacements.

What can I do to avoid a complication with my surgery?

See your medical doctor for a complete physical exam to make sure you are as healthy as possible. Do not take any herbal remedies the week before and after your surgery since they might interfere with your anesthesia or even cause excessive bleeding. See a dentist before your surgery for a cleaning and checkup to make sure there are no infections that could spread from your mouth to your hip replacement. Smoking increases the chances of blood clots and infection, so plan to stop smoking now. For women, avoid hormone replacement therapy for one to two months after your surgery to decrease your chances of a blood clot. Lastly, begin a modest exercise program for both your arms and your legs, such as going for a short walk or bike ride and lifting small hand weights. After your exercise, stretch your joint gently to improve its flexibility.

What sports will I be able to do with a hip replacement?

Speed walking, cycling, elliptical trainer, golf, horseback riding, skiing, and many other sports are healthy for you after your hip replacement. Contact sports such as basketball, football, lacrosse, and soccer should be avoided since these sports carry significant risk of injury, and an artificial hip replacement would not be able to heal like a normal hip might.

How can I avoid dislocation of my hip?

Women, the elderly, patients with Parkinsons, patients with a previous stroke affecting the same leg as their arthritic hip, and patients with very flexible hips are at the highest risk of dislocation. I use the largest size hip ball that is possible, and also repair the hip capsule after the surgery, which limits the chance of dislocation. However, some patients can still dislocate their total hip. To avoid dislocation of your total hip, you should avoid flexing your hip more than 90 degrees or crossing your legs for the first month after your surgery. After the first month, you may return to all physical activities but should continue to avoid hyperflexion of your hip.

Will my hip replacement set off the airport metal detector?

Yes, almost certainly. The new transportation safety administration guidelines require very sensitive metal detectors which will detect the titanium hip replacement that I use. I used to give all of my patients plastic cards to hand to security. However, since security personnel are now required to perform a secondary screening with a metal detecting wand, the card is completely unnecessary and will only result in a further delay to you in security since the TSA official will then pause to look at your card. My advise is to simply be courteous as your explain that you do have an excellent hip replacement from Dr. Bright, and it will probably set off the metal detector.

Am I too old for a hip replacement?

Only your medical doctor can determine if hip replacement surgery is safe for you. Your physician can inform you of your risk of a complication, but unfortunately there is no guarantee that something cannot go wrong. As we age, so does our heart and lungs, and with our aging our risk of surgery increases. However, hip replacement is still just as rewarding and successful for a ninety year old patient as it is a forty year old patient. The main difference is that the 90 year old patient has a greater risk of medical complications, such as heart attack or stroke. In the end, it should be your personal decision if you can accept the risk of the surgery and a month or two for recovery for the reward of pain relief and improved function.

How do I avoid MRSA infection?

Patient's who smoke and patients who are overweight are at higher risk, so stopping smoking and losing weight helps. I also screen my patients before surgery for MRSA, and if you are one of the 10% of Americans who is a carrier, we pre-treat you before your surgery to kill the MRSA bacteria. I also preform my joint replacement surgeries in a glass chamber called a laminar flow room with highly filtered air, and I and my surgical team wear space suits so we cannot breath near the replacement. The custom guide that I use also eliminates 22 steps of the surgery. Because my surgeries are faster and take slightly less than an hour, there is statistically a lower chance of infection.

How do I avoid a blood transfusion?

Dr. Bright's research has shown that using a custom guide to perform the knee replacement diminishes the blood loss. Having surgery under spinal anesthesia has also been shown to lower blood loss. My patient's are not given blood unless their blood count is very low AND my patient has symptoms. Research has shown that patients who are arbitrarily given blood transfusions for an arbitrary number when they are NOT symptomatic gain no benefit from the blood transfusion. Receiving someone else's blood affects their immune system. Although blood transfusion do not have bacteria, simply receiving someone else's blood during a major surgery affects us and increases the chances we will develop infection at our surgery site, or pneumonia or urinary tract.