What to Expect: Total Hip Replacement

Hip replacement is gaining increasing acceptance, which is one of the reasons why the surgery will become only more prevalent in the decades ahead.

An aging population with arthritis, increasing obesity putting stress on hip joints, and baby boomers wishing to remain physically active are other significant factors, according to a 2006 study presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

What follows are answers to questions that many hip-replacement candidates are likely to have.

How should I prepare?

First, research orthopedic surgeons in your area and consider second opinions as the norm. Hospitals and surgical groups often provide pre-surgical seminars which will prove to be helpful in meeting local surgeons and expectations.

Second, pre-surgical outpatient rehabilitation (“prehab”) is usually beneficial in maximizing range of motion and strength before surgery as well as gives the patient a good sense of the type of exercises necessary after surgery.

How soon until rehab post-surgery? How long will I have rehab?

Your rehab will begin within 24 hours of surgery, while in the hospital, with the primary emphasis on weight-bearing, moving and understanding range-of-motion restrictions.

Depending on the surgeon and patient’s pre- and post-surgical health status the patient may then be admitted to a skilled facility or rehab center and/or home health care for a couple weeks.

Outpatient physical therapy may begin as early as two weeks after surgery but depends on the surgeon’s protocol and surgical procedure. Some surgeons prefer to wait up to six weeks post-op to begin outpatient physical therapy services (although home therapy would be performed in the meantime).

Once in outpatient physical therapy, anticipate sessions three times per week for at least six weeks. Depending on the patient’s current activity level and specific goals, therapy may take as long as 12 weeks. The length of your physical therapy program/process has to do with achieving your specific goals relative to range of motion, walking without a limp or assistive device, strength and activity level.

What will my rehabilitation include?

Treatments will include exercises to help with balance, gait (to help reduce your limp and the need for a walker or cane), range of motion, strength and flexibility. Manual or “hands-on” treatment techniques, such as scar massage and stretching, also will be incorporated to assist with your incision scar healing, sensitivity, flexibility and tenderness. Each session may take one to two hours and usually conclude with ice and/or electrical stimulation to keep swelling and soreness to a minimum. Therapy may be exhausting at times, so getting plenty of rest and using ice at home will be helpful.

What can I do on my own to progress?                         

Your therapist will teach and prescribe a home exercise program to assist with range of motion, flexibility, balance and swelling. It usually is encouraged that the patient perform these activities three times per day, each time icing afterward for 15 to 20 minutes.

How long until I am pain-free post-surgery?

Some patients say they are sore but that the pain is gone within two weeks; others say it takes six weeks for the pain to go away. However, others have some soreness and pain for three months.

Will this procedure last a lifetime or will it need to be re-done after a period of time?

There are cases of hip replacements lasting a couple decades. The key to making a new hip last long is the patient’s ability to adhere to a consistent exercise program at least three times per week. The program should be taught by a physical therapist and should focus on maintaining appropriate strength, range of motion, flexibility and body weight, thus decreasing the stresses on your new hip joint so you can live an active lifestyle.