Hip prosthesis: What to do after surgery?

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

When you have osteoarthritis or hip pain, it is possible that the doctor will offer us a hip prosthesis.

What is a hip prosthesis? When is this operation indicated? How is recovery and rehabilitation going? Are there any risks?

This popularized article explains everything you need to know about the hip prosthesis. If you (or your doctor) ever consider this procedure, you will have your questions answered!

What is a hip prosthesis?

Before talking about hip prosthesis (also called hip arthroplasty), it is worth reviewing the anatomy of the hip to better understand this surgical procedure.

The hip is one of the largest joints in the body. It is formed by the acetabulum (a cavity in the pelvis) and the femoral head (the upper end of the femur, a thigh bone).

In a healthy hip, the cartilage is lubricated by synovial fluid, and helps prevent friction during movement. It also helps preserve the joint space between the 2 bones forming the hip joint.

In some cases, the hip may be the site of pathology. Here is a list of conditions that can lead to a hip replacement. On the other hand, it is crucial to mention that a hip injury does not necessarily lead to surgery.

Potential indication for hip prosthesis surgery

 

• Hip osteoarthritis
• Rheumatoid arthritis
• post-trauma
• Congenital hip injury
• Avascular necrosis

Thus, the hip prosthesis is considered when one of the preceding conditions meets one of the following conditions:

• Hip pathology that does not respond to conservative treatment (medication, physio, physio, osteo, etc.)
• Pathology that persists for several months and does not improve
• Pathology that limits daily life (such as walking, climbing stairs, bending, sleeping, etc.)
• Pain that is often present at rest, and causes morning stiffness
• Patient usually over 50 years old (but there are several exceptions depending on the condition of the problematic hip)

Thus, it is a decision that must be taken jointly with the general practitioner, the surgeon, the patient and his family. This is often the last resort after trying several other approaches.

 

The operation

Now, how do you place a hip prosthesis?

This is an operation where damaged bones and cartilage are removed and replaced with a prosthesis and a rod. The incision is nowadays mainly done anteriorly to preserve the muscles, tendons and nerves. The procedure usually takes 1 to 2 hours.

In the case of total hip prosthesis, the femoral head is removed and replaced by a metal rod which is placed in the acetabulum. This stem embedded in the femur is then cemented into the pelvic bone.

In addition, a metal (or ceramic) "ball" is placed on the upper part of the stem. This replaces the pathological femoral head that was previously removed.

This is a surgery most often performed under general anesthesia. On the other hand, an epidural or a regional nerve block (local anesthesia) is sometimes considered. The medical team decides on the type of anesthesia depending on the patient and his condition.

Today, there are advanced surgical techniques to speed healing and minimize risk. These "new generation" prostheses are often less invasive: The scar measures less than 10 cm vs 20-25 cm for conventional arthroplasties.

New generation prostheses also use better quality materials to increase the life of the prosthesis (such as polyethylene, ceramic, zirconia, etc.).

Sometimes both hips are problematic and require a hip prosthesis. In this case, it will be necessary to decide whether it is preferable to operate bilaterally, or to start with one hip and do the second after a certain time (often, after 6 months).

Note that rehabilitation following bilateral prostheses is more complex because it does not allow any compensation, and begins in a wheelchair.

How long do you keep the hip prosthesis?

When the first hip replacement operations were performed in the early 1970s, the lifespan of a prosthesis was estimated at around 10 years.

Today, nearly 85% of hip replacements last up to 20 years. As mentioned earlier, this is due to improved surgical techniques and materials used for the operation.

If the joint is damaged, a second surgery to repair it is possible, but be aware that it is more complicated than the initial surgery.

This is the reason why we try to delay the hip prosthesis operation as much as possible, especially when the patient is young.

  

Risks

 

The vast majority of people undergoing hip replacement surgery experience a significant reduction in pain, as well as greater ease in carrying out activities of daily living.

 

However, any surgery comes with risks. Although uncommon, these complications can prolong or limit full recovery.

Here is a list of potential complications following hip replacement surgery:

 

Dislocation after a hip prosthesis

To minimize the risks of post-surgery dislocation, the doctor will proscribe certain movements to be made during the first months. Prohibited movements include:

• Adduction
• Hip flexion greater than 90 degrees
• Hip internal rotation

In addition to the prohibited movements, it will be necessary at all costs to avoid falls which could damage the prosthesis. For example, avoiding stairs initially, or even using a cane, can greatly reduce the risk of falling.

Loosening of the hip prosthesis

Fracture

Muscle aches

Nerve complications

Infection

Treatment of the wound will also be important to avoid infections. The stitches or staples will be removed approximately 2 weeks after the operation. In the meantime, avoid wetting and irritating the wound, even if it means using protective bandages.

It will also be necessary to pay close attention to the appearance of the following signs:

• Fever
• Frissons
• Redness, tenderness or swelling of the wound
• Severe pain, even at rest

 

Hematoma

Thrombosis

To avoid the risk of thrombosis, the doctor may prescribe anticoagulant drugs, or even compression stockings. It will also be necessary to pay close attention to the appearance of the following symptoms which indicate a potential vascular attack:

• Calf pain and leg (independent of the operation)
• Calf tenderness or redness
• Edema in the thigh, calf, ankle or foot.
• Sudden shortness of breath
• Chest pain

Difference in length of the lower limbs after the operation

Hip instability (due to surgical material)

Rehabilitation and convalescence

How is recovery and rehabilitation going immediately after the operation?

Immediately after the surgery, the patient is transferred to the recovery room where his state of health is monitored. This is important, especially when general anesthesia was used for the operation.

Medical staff will monitor blood pressure, pulse, alertness, and pain level. Upon awakening, most patients are taken to a hospital room where they will stay between 2 and 6 days. Some establishments offer a same-day return home.

Post-surgery pain

Many people wonder how long it hurts after a hip prosthesis.

Generally, people are able to resume most light activities of daily living within 3 to 6 weeks after surgery without pain. On the other hand, some discomfort during more intense activities (and during the night) is normal, and can last for several weeks.

Precisely, to relieve pain after a hip prosthesis, drugs are often prescribed. Several types of drugs are used, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and/or local anesthetics.

 

Physiotherapy (physiotherapy)

Contrary to what many people think, kinesitherapy (physiotherapy) begins very soon after surgery.

Indeed, the first get up is usually the day after the operation, and walking is allowed in the days that follow (with a technical walking aid such as a cane, crutches, etc.).

The duration of rehabilitation in physiotherapy (physiotherapy), on the other hand, lasts several months after the operation. Moreover, it is said that it is necessary to wait 6 to 12 months before considering an almost normal resumption of activities.

During this time, here are the elements on which it will be necessary to work:

• Control the pain
• Relax and soften tense muscles
• Find the functional amplitudes of movements (respecting the prohibited movements)
• Toning the muscles
• Return to walking without lameness or cane
• Resuming daily activities
• Going back to work

To do this, the physiotherapist (physiotherapist) will use several treatment modalities to relieve pain and correct dysfunctions.

• Application of heat, ice and/or TENS will relieve pain
• Massages will allow muscle relaxation
• Mobilizations will allow you to gain movement and flexibility
• Exercises will strengthen muscles and regain function
• Walking rehabilitation to eliminate lameness

How to sleep with a hip prosthesis?

The question of sleep is also discussed with the physiotherapist (or other health professional). Here are positions to be preferred to relieve pain, as well as reduce the risk of dislocation:

1. Lying on your back with a pillow under your knees

2. Lying on your side with a pillow between legs

Hip prosthesis and sport

During everyday activities, it is normal for the material forming the hip prosthesis to gradually wear out.

Obviously, any excessive activity can accelerate this normal wear and limit the optimal functioning of the hip prosthesis.

For this reason, many surgeons advise against activities involving major impacts, contacts or repeated movements.

On the other hand, the new generations of hip prosthesis are more and more solid, and allow to accomplish more vigorous activities.

The orthopedic doctor is best able to determine the permitted activities, as well as the sports to avoid.

Back to work

For the return to work after a hip prosthesis, this will depend above all on the condition of the patient and the nature of his work.

A sedentary job will be easier to consider, and can be done a few weeks after the operation.

On the contrary, a trade involving gestures like bending or heavy lifting will take longer before recovery.

In addition, there are certain exceptional situations where a degree of invalidity must be discussed with the doctor, especially when returning to work is impossible.

Conclusion

The hip prosthesis is considered following a hip pathology (mainly osteoarthritis) which does not respond to conservative treatment, and which persists over time.

Nowadays, it is a safe and effective operation that allows pain relief and the resumption of activities (especially with the “new generation” prostheses).

A medical team will help you determine the relevance of opting for a prosthesis if you ever suffer from hip pain.

Good recovery !