WHAT TO EXPECT WITH
A HIP REPLACEMENT

You will need to arrive about two (2) hours before your scheduled surgery time. The pre-surgery registration takes place on the seventh floor at Haywood Regional Medical Center. From there, the staff will escort you to the preoperative area on the first floor.

A spinal block will be performed by the anesthesiologist. Don’t worry, you will still be “napping” during surgery. The spinal block decreases the amount of anesthesia needed, leading to less pain and quicker recovery after surgery.

If you are going home on the day of surgery, you will return to the seventh floor. Our wonderful physical therapists will work with you on safe ambulation after the spinal block wears off. Once you have walked successfully, you will get to go home!

If you are staying overnight, you will have a private room on the fifth floor. The physical therapists will work with you either on the day of surgery or the next morning. Plan to discharge around noon.

Make sure to bring your walker with you to the hospital.

Try to remain as active as you can leading up to the surgery. There are no specific exercises needed.

Make sure that you fill your prescriptions ahead of time. More on this below.

You will need to do a few things before surgery to help reduce your risk of infection.

1. Mupirocin-apply a pea-sized amount to the inside of your nose for the five (5) nights leading up to surgery. This helps decolonize bacteria on your skin surface

2. Chlorhexidine soap-this will be given to you at your preoperative visit.

3. ChloraPrep swab- apply over the surgical site on the morning of surgery

Fortunately, hip replacement is a very common, safe, and successful surgery. It is important to have a fellowship-trained surgeon who regularly performs these surgeries in order to minimize the risk of complications. Below is a list of possible complications following surgery. The chance of any of these happening is less than one percent.

1. Periprosthetic fracture- this is where the bone breaks around the implant

2. Dislocation-this is when the ball pops out of the socket. This is even less common with the anterior approach.

3. Limb length discrepancy-it is possible to still have a very slight (few millimeters) difference between the two legs after surgery. I utilize multiple techniques in addition to preoperative templating to minimize any side-to-side difference

4. Infection-infection of a prosthetic joint is a terrible problem. I use many techniques to reduce the chance of infection. These include: careful soft tissue handling, draping technique, preoperative skin decolonization, betadine lavage, and perioperative antibiotics.

5. Implant loosening or wearing out over time-this is much less common with modern implants

6. Numbness around the incision

7. Medical complications (e.g. heart attack, stroke, blood clots)

**Please note that for patients who are already on narcotic pain medications before surgery, we will create an individualized plan for postoperative pain control. It is often more challenging to control postoperative pain if your body has preexisting tolerance to pain medications.**

1. Oxycodone-take this only as needed. You will almost certainly need this for the first couple of days after surgery. It is important to stay ahead of the pain during this time period, and it is acceptable to take two (2) tablets during this time if needed. After this, you should taper off as quickly as your pain allows.

2. Celebrex-this is a strong anti-inflammatory medication. You will take it twice daily for two (2) weeks. Take this medication regardless of your pain level. Do not take other NSAIDs (Aleve, ibuprofen, naproxen, meloxicam) while using this medication.

3. Tylenol-take two (2) extra-strength tablets every eight (8) hours. This will help cut back on the amount of oxycodone that you need.

All of your medications will be electronically prescribed at the time of your preoperative visit. In addition to the pain medications previously discussed, you will need:

1. Baby aspirin (81mg)-take one tablet twice daily for four (4) weeks after surgery to reduce the risk of blood clots

2. Ondansetron (Zofran)-this is an anti-nausea medication. It is common to have nausea related to anesthesia and/or pain medications. Use this as needed.

3. Senna-this is a stool softener. Constipation is a common issue after surgery. Take this (or another stool softener of your choice) until you have normal bowel movements.

1. Eliquis and Xarelto - stop five (5) days before and resume 6 days after surgery (resume Sunday after Monday surgery, resume Wednesday after Thursday surgery)

2. Coumadin/warfarin - stop five (5) days after surgery, resume 4 days after surgery (resume Friday after Monday surgery, resume Monday after Thursday surgery)

3. Plavix/clopidogrel - stop seven (7) days before surgery, resume 6 days after surgery (resume Sunday after Monday surgery, resume Wednesday after Thursday surgery)

4. NSAIDs (e.g. ibuprofen, Motrin, Aleve, naproxen, meloxicam, Celebrex) - stop five (5) days before surgery; start Celebrex immediately after surgery

5. Blood pressure medications - continue taking per your normal routine

6. Diabetes medications - Metformin should be held on the morning of surgery. With regard to insulin management, please discuss this with your primary care physician and/or endocrinologist to come up with an individualized plan

7. Adderall/Vyvanse/ADHD medications - most of these need to be held the morning of surgery

8. Thyroid medications -continue taking without interruption

9. Cholesterol medications - hold the morning of surgery

You will have Tegaderm (clear plastic film) and gauze covering your incision. It is ok to shower and get it wet, but no soaking in water. No dressing changes are needed. The dressing will be removed at your two (2) week postoperative visit.

**I will occasionally utilize a Prevena wound vac on occasion for patients at increased risk for wound complications. We will discuss this in more detail after surgery if you receive one. There are also additional links included on the website for further instructions.**

The incision will be closed with dissolvable sutures beneath the skin. There are no staples/sutures that need to be removed (aside from tails on either end that will be trimmed at your two-week postop visit).

You will also be provided compression stockings. I recommend wearing these as tolerated for four (4) weeks after surgery. The stockings help reduce postoperative swelling.

You can shower immediately after surgery. However, no soaking (baths, hot tubs, pools, etc) for six (6) weeks after surgery.

**If you have a Prevena wound vac, please do not allow the battery pack to get wet, though the dressing itself is waterproof.**

In general, physical therapy is not as important following hip replacement as it is after knee replacement. However, it certainly can help expedite the recovery process and allow you to return to activities more quickly.

There are two options for therapy: outpatient vs in-home. Outpatient PT involves visits to the physical therapy center, whereas in-home PT is performed in your home. In general, outpatient PT is advisable unless you have restrictions or limited mobility that make it difficult to come to outpatient PT sessions. We aim to begin PT within a few days of the surgery.

The most important exercise is also the most simple one: walking. In general, the more that you walk, the better (within reason).

Here is the recommended rehab protocol from the American Association of Hip and Knee Surgeons:

Home Therapy Exercises After Hip Replacement

Español version

I usually perform hip replacements using an anterior approach (i.e., incision in the front). In these cases, I do not implement formal hip precautions. It is still wise to avoid extreme positions for the first six (6) weeks after surgery.

Following posterior approach hip replacement, you will need to follow posterior hip precautions for six (6) weeks following surgery. Try to avoid sitting on very low seats. If you reach for objects on the floor, try to spread your legs to shoulder-width, and only reach between your legs (i.e., do not bend and twist at the same time).

Once your hip has healed, you can return to essentially all activities that you were doing before surgery. I recommend against long-distance running and black-diamond skiing. You must also exercise caution and avoid certain postures in your yoga practice.

You will come back at two (2) and six (6) weeks after surgery. These visits will be scheduled before the surgery.

The two-week visit will be with our Nurse Practitioner (Crystal Morrow) or Physician Assistant (Maegan Weeks).

At the six-week visit, we will obtain new X-rays to assess the implant position.

I do not give patients a firm timeline, as all patients recover at different rates. However, most patients can drive about 2-6 weeks after surgery. It may take longer after right-sided surgery since that is your driving foot. You will need to be off all narcotic pain medications. I recommend going for a “test drive” around an empty parking lot or another safe area before getting on major roads.

This depends largely on the type of work. For sedentary/desk work, it is often possible to return within one to two weeks, while jobs that require manual labor may take two to three months (or more).

I strongly advise against having dental work (including routine cleanings) performed for the first 6 months following surgery due to the risk of bacteria spreading via the bloodstream to your new joint replacement. It is perfectly fine to have dental work done beforehand as long as it is not within 3-4 days of your surgery.

I recommend using prophylactic antibiotics for the first year following surgery any time that you have dental work performed (including cleanings). After the first year, I only recommend antibiotics when you are having a significant dental procedure (i.e. antibiotics no longer needed for routine cleanings).

The preferred antibiotic regimens are:
Amoxicillin: Four 500mg tablets one hour prior to the dentist OR Clindamycin (for patients with Penicillin allergy): 600mg one hour prior to the dentist

This is a difficult question to answer, as all patients recover at different rates. Much of this is dependent on how healthy and active the patient is beforehand.

With that said, here is a rough timeline:

For the first one to two (1-2) weeks, expect relatively severe pain. You will likely need oxycodone for at least the first few days after surgery. Ideally, you will be off pain medication relatively quickly due to its side effects, but we need to control your pain well enough for you to mobilize and perform physical therapy. The initial intense pain should begin subsiding after a couple of weeks, but there will still be significant soreness for weeks after this as the body continues to heal.

Most patients require the use of a walker/cane for one to four (1-4) weeks following surgery. The goal is for you to have a quick functional recovery. However, it is absolutely imperative to avoid falls after surgery, so continue using your walker until you feel very steady. How quickly you progress off the walker will depend on your preoperative functional level and other medical conditions.

Most patients are able to perform the majority of daily living activities at the six-week mark. There will likely still be soreness, especially if you are particularly active (try not to overdo it!). The joint replacement will continue slowly improving for a full year after surgery, though the progress becomes less rapid as more time elapses.

In almost all cases, you should contact us directly (via the email or phone listed above) so that we can provide appropriate guidance. It is very rarely necessary to go to the emergency room (and in some cases, this can lead to confusion and unnecessary treatment, as well as high medical bills). Unless you are experiencing chest pains, shortness of breath, or a very high fever (above 102 degrees), please contact us first so that we can address your issue.