total hip replacement
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What to Expect: Total Hip Replacement

Surgeons perform an estimated 300,000 total hip replacement surgeries annually in this country. And with an aging population and seniors wishing to remain physically active longer, that number is likely to increase in the years ahead.

Hip replacement is typically recommended when the joint becomes so damaged or worn that it causes pain during movement and while resting. Osteoarthritis, rheumatoid arthritis, and hip fractures are the leading causes of hip joint damage.

If your healthcare provider recommends hip replacement surgery to reduce joint pain and improve function and mobility, you probably have a lot of questions. Keep reading to learn what to expect from total hip replacement and recovery so you can feel confident and prepared for surgery.

How should I prepare for surgery?

First, research orthopedic surgeons in your area and consider second opinions as the norm. The right surgeon has a track record of excellent patient outcomes and a good bedside manner. During a surgical consultation, they take the time to explain the risks, benefits, and alternatives of hip replacement so you can make informed decisions about your own care.

Local hospitals and surgical groups often host pre-surgical seminars which provide useful information about what to expect from surgery. Additionally, pre-surgical outpatient rehabilitation (“prehab”) is beneficial for maximizing range of motion and strength before surgery. It also gives the patient a good sense of the type of exercises that will be necessary after surgery.

You’ll need to complete a series of pre-operative blood tests and other labs to ensure you are a candidate for surgery. It may be necessary to stop taking certain medications (like blood thinners) prior to surgery to reduce the risk of complications. Your surgeon and other medical providers will provide these instructions.
What happens the day of my surgery?
Typically, you’ll check in to the hospital a few hours prior to surgery. You will receive either a general anesthetic or a spinal block, which numbs the lower part of your body.

Your surgeon makes an incision over the side or front of the hip. They remove the damaged cartilage and bone from the hip joint so that only healthy tissue remains. Next, they replace the damaged areas with prosthetic parts made of plastic, ceramic, or metal.

Once surgery is complete, you go to a recovery area where you wait for the anesthesia to wear off. There, medical staff will monitor you for alertness, pain, pulse, and blood pressure.

How soon can I start rehab?

With the aid of your care team and a walker, you may begin walking as soon as the first day post-surgery. Rehab begins in the hospital, with the primary emphasis on weight-bearing, getting in and out of bed, chair transfers, and understanding range-of-motion restrictions.

Even on this first day, you will learn exercises to start getting stronger and restore range of motion to your hip. Depending on the surgeon and patient’s pre- and post-surgical health status, you may then be discharged to a skilled facility, inpatient rehab center, or most likely directly to your home to receive home health care for a couple of weeks.

Is there physical therapy after having total hip replacement?

Every patient’s post-surgical needs are unique. Some surgeons prescribe outpatient physical therapy which may begin between a few days to two weeks after surgery. Others prefer to wait up to six weeks post-op to begin outpatient physical therapy services (although home therapy would be performed in the meantime.)

It is also true that some surgeons do not prescribe physical therapy at all for patients who seem to be progressing well. Some patients may do not have physical therapy initially, but later request a referral after finding they have limited mobility, pain, a limp, or weakness.

If your surgeon does order physical therapy, anticipate sessions three times per week for at least six weeks. Depending on your current activity level and specific goals, therapy may take as long as 12 weeks. The length of your physical therapy program/process depends upon achieving your specific goals relative to range of motion, walking without a limp or assistive device, and your strength and activity level.

What will my rehabilitation include?

Rehabilitative therapy treatments 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 therapy, or “hands-on” treatment techniques, such as scar mobilization and stretching, are also incorporated to assist with incision scar healing, sensitivity, flexibility, and tenderness.

Each session may take one to two hours. Therapy can be physically-demanding at times, so get plenty of rest and use ice at home to reduce swelling and promote recovery. If you are having significant soreness, your physical therapist may also use modalities such as ice and/or electrical stimulation to help with managing symptoms.

What can I do on my own to progress?

Your physical therapist teaches and prescribes a home exercise program to assist with range of motion, strength, flexibility, balance, and swelling. It’s generally recommended to perform these activities three times per day, applying ice after every session for 15-20 minutes.
How long does it take to recover from hip replacement surgery and be pain free?
The timeline for becoming pain-free after hip surgery varies from patient to patient. Most patients find their symptoms are resolved within the first few months post-surgery. Within this time, the body has generally fully healed from the procedure. Of course, always discuss your symptoms and concerns with your surgeon and your physical therapist during every stage of your recovery.

Will I need another hip replacement in the future?

If you are relatively young when you have surgery, you may need an additional joint replacement later in life. On average, hip replacements last 25 years. The key to making a new hip last longer is your ability to adhere to a consistent exercise program at least three times per week and make lifestyle choices that reduce excessive load to the hip.

The exercises prescribed by your physical therapist are beneficial because they 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. To learn more about physical therapy for hip replacement recovery, contact a physical therapy clinic near you.

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