Q&A: What to Know Before Your Hip Replacement

Replacing a joint? This sounds scary right? While a total hip replacement can be scary, it is considered one of the most successful surgeries done in the United States today. Before you consider having a total hip replacement, here are some answers to frequently asked questions, as well as how physical therapy can help to prolong the need for a hip replacement.

What is a Hip Replacement?

A total hip replacement (also known as a total hip arthroplasty) is when a surgeon replaces both surfaces that make up the hip joint – the acetabulum (the socket portion of the hip that is attached to the pelvis) and the head of the femur (the long thigh bone). Each surgeon will have their preferences and equipment used for surgery, so be sure to ask and understand what components and approach will be used. The socket portion of the replacement is typically made out of a strong metal. The liner will fit in the inside of the socket. A metal stem, is used to attach the “ball” into the joint. The stem is typically made of a metal and the ball can be made of metal or ceramic.²

When Do I Need a Hip Replacement?

A hip replacement is performed when a joint has significant/severe arthritis AND the joint pain limits a patient’s independence and function in day-to-day life. Pain from the hip joint can occur in the front or back of the hip, as well as the groin.

Approaches to Hip Replacements:

• Posterior: This type of total hip replacement is performed along the back of the hip. This technique does a great job of preserving the integrity of the hip abductor muscles, the muscles that sit around the side of your hip, which are major hip stabilization muscles.³ Following any hip replacement, the patient will have what is called “hip precautions.” These precautions are motions the patient is not allowed to perform to allow for muscular healing and joint stability. With a posterior hip replacement, the patient is not allowed to flex the hip past 90 degrees, turn their toes inward, or even cross their legs.
• Anterior Lateral: This approach spares cutting any major muscles. The hip joint is accessed through the tensor fasciae latae and the gluteus medius. The tensor fasciae latae and the gluteus medius are rubber-band like muscles that help to stabilize the hip. This is a great choice if possible due to muscle integrity preservation.³ The hip precautions for an anterior lateral hip replacement are extending the hip behind you and externally rotating the hip in this extended position.
• Lateral: When accessing the hip joint, this technique requires dissection through the hip abductor muscles.³ This is the least common hip replacement performed at this time.

What is Required Following Surgery?

Immediately following surgery, expect to stay overnight in the hospital for observation. You will need a ride home upon discharge. Following a total hip replacement, the patient may be allowed to bear weight as tolerated without an assistive device as long as it is deemed safe by the physician.

In many cases, however, balance, strength, and motion become limited initially following surgery, where use of an assistive device may be necessary. Falls should be avoided at all costs. A patient should expect to adhere to their hip precautions as indicated by their physician for several weeks to months, depending on the individual protocol. The precautions will be dependent on the type of hip replacement as described above.

What Should I Watch for Following a Hip Replacement?

Following any major leg surgery, there are risks and complications that can occur. These things can be very serious or even life threatening. Be on the lookout for:

• Blood loss
• Deep vein thrombosis (DVT)/ blood clot
  • This can be indicated by warmth of the back of the leg, redness, swelling, and pain of the calf
• Pulmonary embolism
  • This is typically a progression of a blood clot and can be more serious, causing chest pain and shortness of breath
• Hematoma (bruising)
• Infection
• Dislocation

Is the Pain Actually Coming from My Hip?

Pain in the hip can come from the pelvis, low back, hip, knee, and ankle. A thorough evaluation is important prior to having a hip replacement to ensure the pain is coming from the hip joint. A physical therapist or orthopedic physician can help you determine this as hip joint pathology does not always correlate with the source of pain.

Can Physical Therapy Help to Prevent a Total Hip Replacement?

Physical therapy may help to prolong a hip replacement through improving core and hip stability along with lower extremity strength and mobility. As stated about, even if a hip has arthritis, it does not always mean it is beyond help. By working towards restoring normal range of motion and strength, you can improve function and prolong a major surgery like a total hip replacement. Here at Athletico Physical Therapy, we offer a hip preservation program to do just that. Our therapists are specifically trained to help preserve the hip joint and prolong the need for a total hip replacement.

If you’re experiencing hip pain contact Athletico for a free assessment. Free assessments are available both in-clinic and virtually through our Telehealth platform. Our experts will take a look at your pain or condition and provide next steps as well as recommendations for a treatment plan.

Request a Free Assessment

If you are interested in learning more about Athletico’s Hip Preservation Program, including hip arthroscopy risk assessment, please email hip@athletico.com.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Crawford R, Murray D. Total hip replacement: indications for surgery and risk factors for failure. Annals of the Rheumatic Diseases 1997;56:455-457.
2. Hip joint replacement: Medlineplus medical encyclopedia. (n.d.). Retrieved January 08, 2021, from https://medlineplus.gov/ency/article/002975.htm
3. Beagan, C. (2010, June). Physical therapy.
4. Foran, J. (2017). Total hip replacement exercise guide. American Academy of Orthopaedic Surgeon.
5. Madara, K. C., Marmon, A., Ajehani, M., Hunter-Diordano, A., Zeni Jr, J., & Raisis, L. (2019). Progressive rehabilitation after total hip arthroplasty: A pilot and feasibility study. International Journal of Sports Physical Therapy, 14(4), 564-581.
6. Physical therapy guide to total hip replacement (arthroplasty). (2020, August 20). Retrieved January 08, 2021, from https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to- total-hip-replacement-arthroplasty