What to Do Before and After a Hip Replacement

Chronic hip pain can be frustrating or even debilitating for people experiencing it, keeping them from doing the things enjoy most.

There are a range of non-operative treatments and therapies available to reduce hip pain caused by osteoarthritis or other conditions, but when those have reached their limits, a hip replacement may be the best option available. More than 450,000 hip replacement surgeries are performed in the U.S. each year, according to the Agency for Healthcare Research and Quality.

Thomas Kneifel, MD, is a board-certified orthopedic surgeon and serves as chair of orthopedic surgery for Rochester Regional Health’s St. Lawrence region. As someone who has performed thousands of hip replacement surgeries, he explains what patients can expect before and after surgery, how each patient’s surgical team helps them prepare for recovery, and common questions patients have about the process.

What happens before hip replacement surgery

Similar to other joint replacement surgeries, a meeting with an orthopedic surgeon does not mean a patient must have hip replacement surgery. Other non-operative treatments and therapies are available to treat hip pain.

Once a patient and orthopedic surgeon decide together that other treatments have reached their limits and a replacement is right for them, the patient discusses with a surgical scheduler who walks them through to set a date for a pre-admission & testing appointment, as well as a date for surgery.

Between their scheduled pre-admission appointment and surgery date, patients will undergo:

• medical clearances
• a pre-operative joint replacement class
• pre-operative educational literature & resources

The pre-operative joint replacement class helps to prepare patients mentally and physically for their surgery. At the class, each patient learns what their hospital stay is like and how they can prepare at home for the post-surgical experience.

Preparation at home means having:

• you must have a support person (family, friends, or neighbors) who can help for the first 1-2 weeks after surgery
• strengthening exercises to do as the patient is able
• home environment modifications

By educating patients as much as possible before their surgery, patients often feel more at ease and can ask more informed questions of their orthopedic surgery team.

“If you are preparing for a bigger surgery like a hip replacement, you want to know what the surgery can and cannot do for you,” Dr. Kneifel said. “By understanding those benefits and drawbacks, you understand what you are getting into and, in my experience, are happier with the outcome.”

What happens after hip replacement surgery

On the day of the surgery, patients arrive at the hospital to be prepared for surgery ahead of time. Between anesthesia and the procedure itself, hip replacement surgery takes about 2 hours.

After surgery, patients will be assessed by the same physical therapists who helped with pre-operative physical therapy at the hospital. They will recommend the best course of PT and OT and go over precautions such as:

• being safe while using a walker
• navigating in and out of home
• using the restroom/stairs/bedroom
• other activities of daily living (ADLs)

Following consultation with the rest of the patient’s care team, most patients will be approved for discharge the following day. Within 48 hours of a patient being discharged, a member of the home care physical therapy team will meet with them to ensure they have what they need to recover. Patients can expect to transition from a walker to use of a cane at approximately 4 weeks post operatively. After in-home physical therapy is complete, the patients will slowly return to their normal daily activities.

Follow-up visits are scheduled for two weeks, six weeks, 3 ½ months, and 12 months.

What to expect with pain relief and movement restriction

Typically, patients start to notice having less pain within 2 weeks of the surgery, with more significant pain relief coming 4-6 weeks after surgery. Patients start to return to more regular movement around 10-12 weeks after surgery.

Hip replacement patients are advised to avoid certain types of movement following their surgery, such as crossing your legs.

This type of motion can lead to dislocations, which can lead to an increased risk of additional hip surgeries.

For some patients, their hip pain may have led to overcompensation with other joints, which may have caused additional pain.

“Everything is connected. Having a hip replacement may allow you to not only regain the function of your hip, but also have less joint pain – particularly in the back,” Dr. Kneifel said.

“The vast majority of people who have a hip replacement are happy with them eventually. It’s a dramatically life-changing surgery. People's lives really change once they have their hip replacement because they have had to restrict themselves many times for many years prior to having it done.”