Patient Information An
Overview of Total Hip Replacements
HISTORY
OF THR
Joint replacement surgery has been popular since the 1960s. Sir
John Charnley was the father of successful total hip replacement
surgery. Several advances in design as well as materials used in
the hip replacement have given us the current state of hip replacement
surgery. 90 to 95 percent of patients have a good or an excellent
result with this type of surgery. Total hip replacement is generally
recommended when patients have unacceptable levels of pain with
everyday activities, increasingly severe deformity or unacceptable
function. Current hip replacement design consists of two components.
The femoral component fits in the canal or marrow space of the femur
bone, the acetabular component fits in the socket of the pelvis.
The combination of components is frequently referred to as a prosthesis.
TOP
INDICATIONS
FOR SURGERY
The main indication for a total hip replacement arthroplasty is
arthritis of the hip accompanied by considerable pain and loss of
function that does not respond to conservative treatment. Pain from
arthritis of the hip is a personal experience-your friends, family
and Dr. do not know how much pain you have. The decision regarding
proceeding with surgery is ultimately the patient's decision. Arthritis
of the hip is not a malignant condition nor is it life-threatening.
Quality of life is the main consideration in the decision-making
process. The operative goals are to relieve pain, improve function
and restore strength to the hip.
TOP
THE
PROCESS
Total hip replacement surgery can be divided into phases.
Phase
1-Presentation
This is the phase in which the patient presents to the physician.
It is in this phase that the patient comes to see the physician
for their arthritic joint. At this time after a variable length
of time it is determined that the patient needs surgery. In addition
the patient has had a workup by the surgeon consisting of an interview,
physical exam and x-rays. After it has been decided that surgery
is to be performed we enter into the next phase of treatment.
TOP
Phase
2-Immediate Preoperative/Prehospital
Phase 2 involves all work that is done to prepare the patient for
surgery up until the time that they are actually admitted to the
hospital for the procedure. This is a very labor-intensive parlor
workup as we are trying to identify reasons for this patient to
vary from their pathway or have complications. Prior to admission
to the hospital you will be required to have laboratory studies,
electrocardiogram, chest x-ray and a urine analysis and culture.
This would include workup to eliminate any active infections in
our patients. The cardiac and pulmonary status of our patients should
be optimized. Vascular surgery problems such as arterial or venous
insufficiency should be addressed. Dr. Bertram will do a nutritional
screen on his patients. This consists of an albumin level, transferrin
level and a total lymphocyte count. This will help to identify patients
that may be at risk for either delayed wound healing or increased
risk for infection postoperatively. This is particularly important
for larger procedure such as revision total joint surgery. This
phase requires careful integration of the primary care physician
and the orthopedic surgeon. It is their important that the patients
be honest with or surgeon regarding their medical conditions and
social habits. Unrecognized alcoholism and the development of postoperative
delirium tremens is a serious complication which has as high as
a 50 percent post operative mortality rate. Also during this phase
the physician will review the x-rays of the operative joint and
plan for appropriate prosthesis selection and sizing. If your surgeon
prefers that you donate your own blood in preparation for the surgery
it will be done at this time. For a routine primary joint arthroplasty
procedure two units of autologous blood will be sufficient. For
a revision joint arthroplasty are three to four units of blood are
needed. Any type of blood thinner medication needs to be stopped
at least two weeks prior to surgery. These medications include Coumadin,
Aspirin or Persantine. Anti-inflammatory medication such as Motrin,
Advil, Aleve, Indocin, Feldene, Naprosyn and Clinoril should also
be stopped two weeks prior to surgery. Use only Tylenol as your
pain medication. You will also be enrolled in patient education
classes that will teach you as much as possible about joint replacement
surgery during the hospital stay. We feel that if our patients know
what to expect they will have a better outcome and a better hospital
experience.
TOP
Phase
3-Preoperative /In Hospital
Once you present to the hospital, everything is geared toward getting
you ready for surgery. Do not bring any valuables or jewelry to
the hospital. You will wear a hospital gown into the operating room.
Jewelry, wigs or nail polish are not allowed. Glasses and dentures
will be secured for you and given back to you when you are awake
after surgery. You will be given medication prior to surgery to
help relax you. The medication may cause drowsiness or dry mouth.
Your family should wait in the family waiting area during your surgery.
The doctor will call the waiting room to talk with your family or
come over to talk with them. If we need to call someone outside
the hospital, let us know.
TOP
Phase
4-Surgery
As you enter the operating room you will be impressed by the brightness
of the lights, the number of people busily preparing for your operation,
and your anesthesiologist who will be immediately attentive. Your
name, age, and operative site will all be verified to ensure proper
identification. An intravenous line will be started at this time
if not done previously to provide a route for your fluids and antibiotics.
A blood pressure cuff and EKG electrodes are routinely applied to
monitor your blood pressure and heart beat during surgery. Your
anesthetic is administered and the surgery will begin. You will
be given medication through your IV before you receive any gases
through a mask. If your doctor prefers that you have a catheter
in place after surgery, it will be placed in the operating room,
after you are asleep. A total hip replacement usually takes approximately
two hours. In the event that both hips are being done at the same
time, the operative time will be approximately four hours. The doctor
will do the surgery, and he will be assisted by another physician
or a physician's assistant. You may receive a bill from an assistant
surgeon or physicians assistant. The surgery will usually be done
through an incision along your buttock and upper lateral thigh.
The skin is usually closed with metal staples. A drain may be used
or it may not, at the discretion of the surgeon. Upon leaving the
operating room you will have a very dressing on your leg. From the
operating room you will be transferred to the recovery room.
TOP
Phase
5-Postoperative/In Hospital
You remain in the recovery room until your blood pressure is stable
in you are alert enough to return to your room to. This usually
takes approximately 1 to 1 1/2 hours. In the recovery room your
vital signs will be monitored and you will have oxygen delivered
through a plastic tube which will be on your nose. This helps to
rid the body of the anesthetic agents used during surgery. If your
doctor orders a PCA (Patient Controlled Analgesia) Pump, it may
be started in the recovery room. You will have your IV in place
for several days until you are eating and drinking well, and all
your antibiotics have been administered. Oral pain medication is
available after one to two days and may be given every four hours
upon request. If you had a Foley catheter in place at the time of
surgery, it will be removed on the second day after surgery. If
you have problems voiding after that, you may have to be catheterized
intermittently. The incidence of this is greatly decreased when
we place a catheter in your bladder in the operating room. To prevent
the development of respiratory problems, you will be asked to use
your incentive spirometer every hour while awake. You will be instructed
in the use of this device. Depending upon the preference of your
surgeon, you may be placed in a traction type of device to help
balance your leg. This is actually both more comfortable and more
physiologic than other methods. Your diet will be advanced from
clear liquids to a regular diet the first postoperative day. You
are encouraged to take liquids by mouth to maintain normal body
temperature and an adequate intake and output level. The plastic
drain in your knee will usually be removed on the first or second
day postoperative. There is minimal discomfort from removing the
drain. During your hospital stay you may be given medication that
contains iron. This may make your bowel movements very dark. This
is normal. Physical therapy is under the control of your physician
and your therapist. You will be visited by your physical therapist
on the first day post op. You progress to sitting and standing usually
on the first or second post op day. You will ambulate with crutches
or a walker once you do get up. If your prosthesis was put in with
cement you may bear weight right away. We usually cement the components
in place. An occupational therapist will teach you how to perform
activities of daily living after hip surgery.
Phase 6-Discharge from the Hospital. Most patients leave the hospital
after 3-4 days. Upon leaving the hospital you will either go home,
to a rehab facility, or to a facility that specializes in caring
for patients after surgery until they can return home. When you
leave you will go home with instructions regarding your therapy
at home, prescriptions for pain medication, iron supplements and
blood thinners. Arrangements for your follow up visit with the surgeon
should have been made prior to your hospital stay, but if not you
can call to arrange this.
TOP
ADDITIONAL
GUIDELINES TO FOLLOW:
 Remain on your
crutches or walker at all times during the first 4-6 weeks until
you are told otherwise.
Only take a shower or sponge bath, not a bath during
the first 6 weeks to avoid excess strain on the hip. You may get
in a whirlpool if supervised by a therapist after 5 days if your
incision has no drainage.
Driving a car is usually not allowed for 4-6 weeks
after surgery but is at the discretion of your surgeon.
Even after your crutches or walker are discontinued you may never
lift heavy objects.
Sports
allowed 4-6 months after surgery are golf, swimming, bicycling,
bowling and doubles tennis.
Activities not allowed are contact sports,
running, jogging, racquetball, football and skiing.
For information regarding antibiotic prophylaxis
see the portion of our web page devoted entirely to that subject.
TOP
CALL
FOR ANY OF THE FOLLOWING:
Sudden and extreme hip pain
Fever greater than 101.5 degrees
Unusual redness, swelling or drainage around the incision
Sudden chest pain, shortness of breath or
coughing up blood.
Any sudden onset of increased swelling in either
leg
For more detailed information on each part of this process, look
under our "Medical Library" portion of this WebSite, and
you can learn even more.
Good Luck and Call us if you have any further questions.
TOP
<<RETURN TO PREVIOUS PAGE
|
