Your Pathway to Recovery: A Patient's Guide to Total Hip Replacement Surgery (THR)

Patient Education Council and Adult Reconstruction and Joint Replacement (ARJR) Service
Hospital for Special Surgery

The information below is excerpted from Your Pathway to Recovery: A Patient's Guide to Total Hip Replacement, which can be found in it's entirety at the bottom of this page.

About Total Hip Replacement Surgery

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.

Illustration of a healthy hip joint
Illustration of a hip showing signs of arthritis
Illustration of a total hip replacement

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.

Things to Do Before Total Hip Replacement Surgery at Hospital for Special Surgery

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.

  1. Before your surgery, the surgeon’s office staff will make an appointment for you with an internist at HSS who will:
    • Review and/or perform any necessary diagnostic tests.
    • Perform a medical exam to make sure you are safe for surgery.
  2. Unless you are told otherwise, continue to take medicines already prescribed by your own physician.
    Extremely Important: Always have a list of your current medications and the dosages, so that the correct medication and dosage can be prescribed for you while you are in the hospital. You should also have contact information for your local physician, and any details on medical information, allergies, or past reactions to anesthesia.
    • Fish oils should be discontinued 7 days prior to surgery.
    • Anti-inflammatory medications, nutritional supplements (vitamins, herbals, minerals, iron, and calcium) should be discontinued 7 days prior to surgery.
    • Consult your physician regarding aspirin products. Patients with cardiac stents should continue to take their aspirin (81 mg).
  3. The surgeon’s office staff will also make an appointment for you for pre-surgical testing approximately 1 to 3 weeks prior to surgery where:
    • The pre-surgical screening staff will perform routine diagnostic testing to be sure you are ready for surgery, including taking a blood sample for testing, a urine specimen, and an electrocardiogram (EKG).
    • You should bring a list of current medications and a detailed account of prior medical, surgical, and family health history.
    • The nursing staff will request information as part of a comprehensive medical history to add to your patient database profile.
    • The nursing staff will provide instruction on preparation for surgery.
  4. The surgeon’s office staff will make an appointment for you to attend the pre-operative patient education class. The class is approximately 60 to 90 minutes long. During the class, patient educators will:
    • Review the surgical process.
    • Discuss setting realistic expectations, patient safety, mobility, pain management and the prevention of complications (infection and blood clots).
    • Provide instruction on bowel and skin preparation.
    • Provide information about:
      • nutrition and diet restrictions before surgery;
      • the preoperative patient phone call and how patients obtain general pre-surgical information;
      • the staff phone call to the patient the day before surgery with detailed and specific preparation instructions;
      • the time and place to arrive for surgery; and
      • discharge planning
  5. You may be asked to donate your blood for the surgery. If a donation is recommended, the surgeon’s office staff will provide information and schedule one for you, usually 1 to 2 weeks prior to date of surgery. It is important to drink plenty of fluids before and after you donate and be sure to eat a substantial meal prior to your donation.
  6. You may wish to review and plan your post-hospital care with Case Management Services (212.606.1271) before admission. The Pre-Admission Program offers patients and their families the opportunity to receive assistance before the patient is admitted for surgery. This program enables you to begin understanding and planning your hospitalization and your discharge needs in a timely, comprehensive manner. It helps you maximize your options and make decisions in a more relaxed way.
  7. Prepare for your return home from the hospital.
  8. Before your admission, please complete the Health Care Proxy form authorizing another person, designated by you, to make decisions with your physician about your care, should this become necessary.
  9. A nurse from the Same Day Surgical (SDS) unit will contact you one business day prior to your surgical date (Friday for Monday surgical cases) with more detailed instructions.
    All patients must call the hospital’s pre-surgical information line at 212.606.1630 and listen to a pre-recorded message within 48 hours of your scheduled surgery for general instructions and a review of the pre-hospital process.
  10. The night before your surgery and 2 hours after your dinner, administer your Fleet enema.
  11. The surgical area from waistline to knee (front side and back) should be washed with the antiseptic soap solution at the end of your last bath or shower before surgery. Do not shave your legs during this last shower. The solution should be rinsed and removed after application. Specific instructions will be provided through the pre-surgical screening appointment, the pre-operative education class, and preoperative phone call.
  12. The Call Center nurse will review when you should stop eating and drinking, but realize that it is likely that only clear fluids (no milk products) after midnight (i.e., water, ginger ale, black coffee or tea) will be allowed on the day of your surgery and nothing should be consumed 3 hours prior to your surgical time. A detailed pre-operative nutritional guideline is described in this booklet and will be reviewed during the pre-operative education class.
  13. For patients who have Sleep Apnea and use a Sleep Apnea device, please bring your mask attachment and a record of the settings you normally use. Please DO NOT bring the Sleep Apnea machine. Patients with Sleep Apnea are generally required to stay overnight in the Post-Anesthesia Care Unit (PACU) to be monitored and observed.
  14. The use of nicotine products (i.e., cigarettes, cigars, gums, or patches) has been shown to increase risk of complications following surgery. They can inhibit bone and wound healing by decreasing blood flow to the surgical site. They can also increase the risk of deep vein thrombosis (DVT, a.k.a. blood clots). Please discuss smoking cessation with your doctor.
  15. You and your support system will be instructed to go to the Family Atrium on the 4th Floor of the hospital.

After Total Hip Replacement Surgery at Hospital for Special Surgery

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.

Recovering from Total Hip Replacement Surgery at Hospital for Special Surgery – The Beginning of Hip Replacement Recovery

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.

Hip Replacement Rehabilitation in the Hospital for Special Surgery

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:

  • Sitting at bedside with your feet on the floor
  • Transferring in and out of bed safely
  • Walking with the aid of a walker or cane
  • Climbing stairs

Beginning to Walk

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.

What to Expect During Hip Replacement Recovery at Home

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.

Your New Hip Is Different

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.

Sports Activities

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.

The Total Hip Replacement Guidebook

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.


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