The information below is excerpted from Your Pathway to Recovery: A Patient's Guide to Total Joint Replacement Surgery (Hip and Knee), which can be found in its entirety at the bottom of this page.
To understand THR, you should be familiar with the structure of the hip joint, a ball-and-socket joint. The ball component is attached to the top of the femur (long bone of the thigh). The acetabulum (socket) is part of the pelvis. The ball rotating in the socket permits you to move your leg forward, backward and sideways, i.e., in all planes of motion.
With a healthy hip, smooth cartilage covering the ends of the thigh bone and pelvis allows the ball to glide easily inside the socket.
With a problem hip, the worn cartilage no longer serves as a cushion. As the diseased or damaged bones rub together, they become rough, and the resulting pain causes difficulty in walking.
THR consists of replacing the worn out socket with a durable plastic or polyethylene cup with or without a metal titanium shell. The femoral head is replaced with a chromium-cobalt alloy metal ball that is attached to a metal stem of titanium or chromium cobalt metal alloy.
There are several ways to fasten the components (implant to the bone) during the hip replacement procedure. With a cemented THR, the prosthesis is held in place by bone cement. In a non-cemented THR, fixation occurs as the bone grows on and into the implant surface.
Bearing surfaces include metal-on-polyethylene (plastic), ceramic-on-ceramic, and metal-on-metal. The most commonly used FDA-approved bearing surface is metal with highly cross-linked polyethylene. The best bearing surface for you will be decided in consultation with your surgeon.
Clinical and biomechanical research has steadily improved the methods and materials available for THR. Prosthesis durability varies with the usage demands of each patient.
Be sure you understand all preoperative instructions. If you have questions or concerns, please discuss them with your surgeon or call the HSS Patient Education team at 212.606.1263.
In the Post-Anesthesia Care Unit (PACU), also called the Recovery Room, you will be given oxygen, and your vital signs (breaths, heart rate and blood pressure) will be monitored. The team will also focus on managing your pain so you will be comfortable when you begin rehabilitation. Once in the PACU, the person that accompanied you will be provided an update.
To maintain patient privacy, as well as to reduce the risk of infection, PACU visits are limited. These visits will be facilitated through the Family Atrium patient liaisons. One visitor at a time will be allowed during visits. Cell phone use and picture taking is not permitted in the PACU.
When the anesthesiologist determines that you are sufficiently recovered, your vital signs are stable and pain is well managed after surgery, you will be transported to an inpatient unit. While most patients are transferred to inpatient units, some remain overnight in the PACU for additional monitoring and observation.
A dressing will be applied to your hip. You may also have a thin tube inserted at the surgical site attached to a drain to prevent accumulation of blood around the muscles and bones of the joint. The tube and drain will likely be removed the day after surgery, and the bandage is removed the first or second postsurgical day.
Members of the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon. Because anesthesia may temporarily inhibit urination after surgery, a Foley catheter may be inserted into the bladder to remove urine. This catheter is usually removed within 24 hours.
In collaboration with you and your support system, the Hospital staff, including a physician, physician assistant, nurse, nurse practitioner, physical therapist and social worker will plan, provide and monitor your care.
Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles. Very soon after surgery, a physical therapist will teach and review your exercise program.
It is extremely important to perform deep breathing exercises after surgery to rid your airway and lung passages of mucus. Normally, you take deep breaths almost every hour, usually without being aware of it, whenever you sigh or yawn. When you are in pain or are drowsy from anesthesia or pain medication, your breathing may be shallow. To ensure that you breathe deep daily, the nursing staff will provide you with a device called an incentive spirometer, along with instructions on its use.
Your rehabilitation program will begin once you are medically stable and there are orders from your doctor to begin postoperative mobility. Everyone will begin rehabilitation within 24 hours of surgery.
It is critical to understand that motivation and participation in your physical therapy program is a vital element in the success of your surgery and your overall recovery. It is imperative that you play an active role in your recovery and rehabilitation from the start!
The physical therapist will assist you in the following activities:
Your therapist will assist you in sitting up with your feet over the bedside with feet resting on the floor. You will then stand with the use of a walker and the continued help of your therapist.
As the days progress, you will increase the distance and frequency of walking. Most patients progress to a straight cane, walker or crutches within a couple of days after surgery.
Please do not hesitate to contact your surgeon with any questions you have about the following instructions. Consult with your internist about duration and dosage of iron.
Depending on how your incision is closed, your nurse will review care instructions with you.
This guidebook, Your Pathway to Recovery: A Patient's Guide to Total Joint Replacement Surgery (Hip and Knee), is a comprehensive, essential overview of everything having to do with total hip replacement surgery at HSS, from an overview of the procedure and hospital maps to nutrition tips and illustrated physical therapy exercises. Read the guide in the viewer below or download the PDF.