Total Hip Replacement (THR)

Total hip replacement is a surgery to replace your damaged hip joint. Your hip joint is replaced with a man-made (artificial) hip joint. This man-made hip joint is called a prosthesis. This surgery is done to lessen pain and to help your hip move better.

What happens before the procedure?

Staying hydrated

Follow instructions from your doctor about drinking fluids. This may include:

• Up to 2 hours before surgery – you may keep drinking clear liquids. These include:
  • Water.
  • Clear fruit juice.
  • Black coffee.
  • Plain tea.

Eating and drinking restrictions

Follow instructions from your doctor about eating and drinking. These may include:

• 8 hours before surgery – stop eating heavy meals or foods. These include meat, fried foods, and fatty foods.
• 6 hours before surgery – stop eating light meals or foods. These include toast and cereal.
• 6 hours before surgery – stop drinking milk or drinks that have milk in them.
• 2 hours before surgery – stop drinking clear liquids.

Medicines

Ask your doctor about:

• Changing or stopping your normal medicines. This is important if you take diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These can thin your blood. Do not take these medicines unless your doctor tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• You may have a physical exam.
• You may have tests, such as:
  • X-rays or MRI.
  • Blood or urine tests.
• Plan to have someone take you home.
• Plan to have someone you trust take care of you for at least 24 hours after you leave the hospital or clinic. This is important.
• Prepare your home so you can be safe and have easy access to what you need.
• Have teeth cleanings or any dental work done weeks before your surgery, or wait until a few weeks after your surgery.
• Avoid shaving your legs just before surgery. If any shaving is needed, it will be done in the hospital.
• Ask your doctor how your surgical site will be marked or identified.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV tube will be put into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine to numb your body below the waist (spinal anesthetic).
• Your doctor will make a cut (incision) in your hip. The place where the cut is made will depend on the approach used by the doctor:
  • Posterior approach. The cut will be at the back of the hip.
  • Anterior approach. The cut will be at the front of the hip.
• Then, your doctor will:
  • Use his or her hands to move your hip out of position (dislocate it).
  • Cut and take out damaged parts of your hip joint.
  • Put a man-made hip joint into place.
  • Do an X-ray of the hip joint to make sure it is in the right place.
  • Place a drain to remove extra fluid, if needed.
  • Close the cut and place a bandage (dressing) over it.

The procedure may vary among doctors and hospitals.

What happens after the procedure?

• Your health care team will:
  • Monitor you until you leave the hospital.
  • Check your blood pressure, heart rate, breathing rate, and blood oxygen level.
  • Check if you can move your foot and can feel sensations in it.
  • Give you pain medicine.
• Your doctor will tell you to take actions to help prevent blood clots and reduce swelling in your legs. You may need to:
  • Wear a type of socks that are tight (compression stockings).
  • Take medicines to thin your blood (anticoagulants).
• You will do exercises (physical therapy) until you are doing well. Your doctor will tell you when you are well enough to go home.
• You may need to use a walker or crutches.
• You may need to use a wedge pillow (hip abduction pillow) when you are in bed. This pillow will keep your legs from turning in ways that may cause your new hip joint to move out of place.

Summary

• Total hip replacement is a surgery to replace your damaged hip joint. Your hip joint is replaced with a man-made (artificial) hip joint.
• Follow instructions from your doctor about eating and drinking before the procedure.
• Plan to have someone take you home from the hospital.
• You may need to use a walker or crutches after surgery.

Total Hip Replacement, Anterior, Care After

This sheet gives you information about how to care for yourself after your procedure. Your doctor may also give you more specific instructions. If you have problems or questions, contact your doctor.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Stiffness.
• Discomfort.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your doctor.
• If you were prescribed a medicine to thin your blood (anticoagulant), take it as told by your doctor.

Surgery cut care

• Follow instructions from your doctor about how to take care of your cut (incision) from surgery. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If you cannot use soap and water, use alcohol-based hand sanitizer.
  • Change your bandage as told by your doctor.
  • Leave stitches (sutures), skin glue, or skin tape (adhesive) strips in place. They may need to stay in place for 2 weeks or longer. If tape strips get loose and curl up, you may trim the loose edges. Do not remove tape strips completely unless your doctor tells you to do that.
• Check your surgical cut every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your doctor says it is okay.
• Keep the bandage dry until your doctor says it can be removed.

Managing pain, stiffness, and swelling

• If directed, put ice on the hip area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your leg above the level of your heart while you are sitting or lying down.

Activity

• Rest as told by your doctor.
• Do not sit for a long time without moving. Get up to take short walks every 1–2 hours. This is important. Ask for help if you feel weak or unsteady.
• Do exercises as told by your doctor or physical therapist.
• Use a walker, crutches, or a cane as told by your doctor.
  • You may use your legs to support (bear) your body weight as told by your doctor. Follow instructions about how much weight you may safely support on your affected leg (weight-bearing restrictions).
  • A physical therapist may show you how to get out of a bed and chair and how to go up and down stairs. You will first do this with a walker, crutches, or a cane. Then you will do it without any of these devices.
  • Once you are able to walk without a limp, you may stop using a walker, crutches, or cane.
• Return to your normal activities as told by your doctor. Ask your doctor what activities are safe for you.

Safety

• To help prevent falls:
  • Keep floors clear of objects you may trip over.
  • Place items that you may need within easy reach.
• Wear an apron or tool belt with pockets for carrying objects. This leaves your hands free to help with your balance.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Ask your doctor when it is safe to drive.

General instructions

• Wear compression stockings as told by your doctor. These help to prevent blood clots and reduce swelling in your legs.
• Keep doing breathing exercises as told by your doctor. This helps prevent lung infection.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your doctor may suggest that you:
  • Drink enough fluid to keep your pee (urine) pale yellow.
  • Eat foods that are high in fiber. These include fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and sugar. These include fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that have nicotine or tobacco in them, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your doctor.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have a fever or chills.
• You have a cough.
• You feel short of breath.
• Your medicine is not helping your pain.
• You have any of these at or near your cut from surgery:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • An area that feels warm when you touch it.
  • Pus or a bad smell.

Get help right away if:

• You have very bad pain.
• You have trouble breathing.
• You have chest pain.
• You have redness, swelling, pain, and warmth in your calf or leg.

Summary

• Follow instructions from your doctor about how to take care of your surgery cut (incision).
• Do not take baths, swim, or use a hot tub until your doctor says it is okay.
• Use crutches, a walker, or a cane as told by your doctor.
• If you were prescribed a medicine to thin your blood (anticoagulant), take it as told by your doctor.

Total Hip Replacement, Posterior, Care After

This sheet gives you information about how to care for yourself after your procedure. Your doctor may also give you more specific instructions. If you have problems or questions, contact your doctor.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and swelling.
• A small amount of blood or clear fluid coming from the cut that was made during surgery (incision).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your doctor.
• If you were prescribed a medicine to thin your blood (anticoagulant), take it as told by your doctor.

Activity

• Ask your doctor what activities are safe for you.
• Do exercises as told by your doctor or physical therapist.
• Rest often, but move around as much as you can. Movement helps you heal and helps prevent problems.
• Do not use your legs to support (bear) your body weight until your doctor says it is okay. Follow instructions about how much weight you may safely support on your affected leg (weight-bearing restrictions).
• Use crutches or a walker as told by your doctor.

Movement restrictions

• To keep from dislocating your hip, follow instructions about movement restrictions as told by your doctor. For example:
  • Do not cross your legs at the knees. To remind yourself about this, you may keep a pillow between your legs while lying in bed.
  • Do not bend farther than 90 degrees at the hip and waist. To keep from bending this far:
    • Do not bring your knees higher than your hips.
    • Do not pick up something from the floor while sitting in a chair.
    • Avoid sitting in low chairs.
    • Use a raised toilet seat.
    • When standing up from a seated position, keep the injured leg out in front of you.
  • Avoid twisting at your waist and reaching across your body to the side of the affected leg.
  • Avoid rotating your toes inward on the affected leg.
• When getting into a car:
  • Raise the seat as high as you can.
  • Move the seat as far back as it will go.
  • Recline the upper part of the seat slightly.
  • Sit down into the seat with your injured leg extended out of the car.
  • Scoot back in the seat as you move the lower half of your body into the car. Try to avoid bumping your foot or leg as you bring it into the car. To make this motion smooth and easy on a cloth seat, try placing a plastic bag on the seat.

Surgery cut care

• Follow instructions from your doctor about how to take care of your cut from surgery. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If you cannot use soap and water, use alcohol-based hand sanitizer.
  • Change your bandage as told by your doctor.
  • Leave stitches (sutures), skin glue, or skin tape (adhesive) strips in place. They may need to stay in place for 2 weeks or longer. If tape strips get loose and curl up, you may trim the loose edges. Do not remove tape strips completely unless your doctor tells you to do that.
• Do not take baths, swim, or use a hot tub until your doctor says it is okay.
• Check your surgical cut every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on the hip area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your leg above the level of your heart while you are sitting or lying down.

Driving

• Ask your doctor when it is safe to drive. This may not be recommended for up to 6 weeks after surgery.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• Do not use any products that have nicotine or tobacco in them, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your doctor.
• Tell your doctor before you have any dental procedures done, including teeth cleaning.
• Wear compression stockings as told by your doctor. These help to prevent blood clots and reduce swelling in your legs.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your doctor may recommend that you:
  • Drink enough fluid to keep your pee (urine) pale yellow.
  • Eat foods that are high in fiber. This includes fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have trouble breathing.
• You have either of these at your surgery site:
  • Any signs of infection.
  • Bleeding that will not stop.
• Your surgical cut opens up after stitches or staples are taken out.
• You have a fever.

Get help right away if:

• You have more redness, swelling, or pain in the leg you had surgery on.
• You have pain or swelling in your thigh or on the back of your lower leg.
• You have shortness of breath.
• You have chest pain.
• You have pain that is not helped by pain medicine.

Summary

• Do not use your legs to support your body weight until your doctor says it is okay. Use crutches or a walker as told.
• To keep from dislocating your hip, follow instructions about movement restrictions as told.
• If you were prescribed a medicine to thin your blood (anticoagulant), take it as told by your doctor.
• Keep all follow-up visits as told by your doctor. This is important.