by Nancy Alexander, PT, CSCS
So, you’re thinking about getting a hip replaced. You’ve had enough of the pain and limitations. Here are some considerations and questions to ask as you research this more. The answers can help you understand the pros and cons of different kinds of procedures and help you know what to expect after surgery.
There are different approaches to this – literally. The more traditional surgery is called a posterior approach. As it sounds, the incision is more towards your backside. More recently, some physicians are using an anterior approach to total hip replacement surgery. This incision is more towards the front of you and often a little to the side. One is different from the other but not necessarily better. The actual replacement of the joint does not change (see picture below). Your surgeon can help you understand the differences.
This picture shows a hip with arthritis on the left, and a replaced joint on the right.
If you have a certain surgeon in mind, then make sure that the physician has done his preferred approach many times. I like my surgeon to have had a lot of experience using a certain method. Leads me to have a certain confidence in the outcome. In recent years, we are seeing more physicians use the anterior approach. It is considered less invasive and some argue their recovery is quicker. With the anterior approach, typically (but not always) there are no “precautions” like that with the posterior approach. This can be very helpful right after surgery. The three hip precautions for the posterior approach are:
1) Don’t flex your hip past 90 degrees
2) Don’t cross your legs
3) Don’t turn the operated leg in toward your other leg
Here are the 7 questions to ask your surgeon:
1) What approach do you use? Will I need to follow hip precautions after surgery? If yes, what are they? And, how long do I need to follow them?
2) How soon can I progress from a walker to a cane?
3) Do you use staples or any specialized dressing? There are some new dressings physicians are using that are left on for a week or so, then removed. They are using these for improved infection control measures.
4) How long do you expect me to be in the hospital? There are some hospitals in my area discharging on day 2… one is trialing same day discharge. It is good to know what to expect both for you and for your family/friends/support system. Ask if you should expect a short rehab stay after surgery before you go home, especially if you live alone.
5) How do you manage anti-coagulation needs (blood thinners)? Prescription meds vs aspirin. Will I need to have blood work done regularly to check levels? Do I need to wear compression stockings? If yes, how long?
6) How soon can I shower after surgery?
7) Lastly, my favorite question for everything… Is there anything else I should know?
Arthritis is the most popular reason people opt for a total joint replacement. When the increased pain and decreased function impact your life, that is when most people seek out a surgeon to perform the procedure. Do your homework and ask lots of questions. Then you will have the faith to do it and be closer to doing the things you enjoy again.