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 pre-operative 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, your family and friends will be provided an update. To maintain patient privacy, as well as to reduce the risk of infection, PACU visits are limited, but will be facilitated through the Family Atrium patient liaisons.
When the anesthesiologist determines that you are sufficiently recovered, approximately 4 to 5 hours 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 close monitoring and observation.
Hip replacement recovery takes some time, and starts with detailed care while still at the hospital. An ace-bandaged dressing will be applied around 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 hip. The tube and drain are removed the day after surgery, and the bandage is removed the first or second post-surgical day.
Members of the nursing staff will position you in bed and help you turn until you are able to move on your own. A pillow between your legs will help maintain the proper position of your hip. 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.
Do not get out of bed by yourself. Always ask for assistance. HSS has developed a Safety and Falls Prevention pamphlet that you should read…if you don’t already have one, ask your nurse or therapist for a copy.
In collaboration with you and your support system, the hospital staff, including a physician, physician assistant, nurse, physical therapist, and social worker will plan, provide, and monitor your care.
Your rehabilitation program will begin once you are medically stable and there are orders from your doctor to begin post-operative mobility. For some patients, rehabilitation will begin the day of surgery, for others it will start the day after surgery. 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 or crutches within a few days after surgery.
Always make sure to ring your call bell for nursing or physical therapy staff for assistance getting in and out of bed.
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 (ferrous sulfate) after your discharge.
Recovery from surgery takes time. You will likely feel tired and fatigued for several weeks and this is a normal response. It is important to plan periods of rest throughout the day. You may experience skin numbness around your incision and hip stiffness. This is normal. At times, you may notice clicking. This is common and is due to the plastic and metal implant surfaces rubbing together. These symptoms will gradually improve over several weeks and months. The benefits of THR usually become fully evident 6 to 8 months after surgery.
After full hip replacement recovery, some patients enjoy light sports activities. Activities you can enjoy after THR include walking, bicycling, bowling, swimming, golf, and doubles tennis. Skiing may be allowed, but likely on green and blue trails only. Avoid high-impact activities, such as jogging, running, or jumping. Please check with your surgeon about specific sports activities.
After full recovery, some patients enjoy light sports activities. Activities you can enjoy after THR include walking, bicycling, bowling, swimming, golf, and doubles tennis. Skiing may be allowed, but likely on green and blue trails only. Avoid high-impact activities, such as jogging, running, or jumping. Please check with your surgeon about specific sports activities.
Please note: Patients and their partners may have concerns about sexual relations after hip surgery. This information is available on pages 53-54 in the printed booklet received in the physician’s office or in the pre-op class. If you would like to receive this material electronically, please feel free to contact the Patient Education staff at 212.606.1263.
Reviewed and Updated: 3/2/2016