5 Tips to Make Your Hip Replacement Successful

If you’re scheduled for total hip replacement surgery, you want to make sure that everything goes smoothly and that you come out feeling better than you did when you went in.

“While each patient’s experience will be a bit different, there are some things every patient can do to ensure they have a successful outcome,” says Geoffrey Westrich, MD, an orthopedic surgeon specializing in hip and knee reconstruction at HSS. Here are five guidelines that Dr. Westrich suggests you heed to have the best outcome possible.

1. Go to a center that specializes in joint replacement. 

While many surgeons do hip replacements, data suggests that the outcomes are better and risk of complications lower if you go to a top joint replacement center that does a high volume of joint replacements, says Dr. Westrich, who does about 250 hip replacements and 250 knee replacements every year. Experience is critical, he adds, and surgeons at top joint replacement centers will have seen every type of hip problem, so they’ll be ready to handle whatever issues may arise. 

Top hospitals also utilize state-of-the-art technology, such as robotic-assisted hip replacement, which enhances your surgeon’s skills for an even more precise procedure. “Robotic-assisted hip replacement can reduce the risk of complications, optimize the implant placement, and is more accurate at making the leg lengths perfectly equal,” he says. 

Before you settle on a surgeon, ask plenty of questions, such as:

• Are you fellowship trained in joint replacement? 
• How many knee and hip replacements do you do per year?
• What is the risk of infection at your institution?

2. Go into surgery in the best shape possible. 

“We call these ‘modifiable risk factors,’ which are risk factors you can change,” says Dr. Westrich. While some risk factors are set, like your age, others can be altered. These include:

• Your smoking status. It’s important to try to quit before surgery. Research shows that stopping tobacco use (which includes cigarettes, marijuana, cigars, pipes, etc) six weeks before surgery can help lower your risk of complications. Long-term success usually involves a combination of medication and counseling. “At HSS, we have a formal smoking cessation program run by our nurse practitioners,” says Dr. Westrich. You can also visit https://smokefree.gov for dozens of ways to help you quit.
• Your weight. Many studies show that obesity increases the risk of complications during and after surgery. See if your institution has a wellness center to help you lose weight before surgery. Many, including HSS, do. 
• Chronic health conditions. Before surgery, visit your primary care physician to get any chronic conditions, like diabetes, high blood pressure, or high cholesterol, under control. “Diabetes in particular substantially increases the risk of infection,” says Dr. Westrich. 
• Your physical activity. Condition the muscles in your lower body as much as you’re able to, says Dr. Westrich.  “Most arthroplasty joint replacement surgeons recommend non-impact exercises to the extent that the patients can tolerate them, such as a walking, cycling on a stationary bike, using an elliptical trainer, and swimming and aqua programs.” 

3. Ask plenty of questions. 

Your surgeon should provide reading material that covers everything you need to prepare for surgery, what to expect after the surgery, as well as post-operative care. If they don’t, make sure to ask every question that comes to mind. A few things you should make sure to know include: 

• Can you explain the dos and don’ts following surgery, to make sure I don’t injure myself or dislocate the new hip?
• How should I care for my wound and when can I take off the dressing? “Most of today’s surgeons use skin glue, so you shouldn’t have any stitches to remove at home,” says Dr. Westrich. 
• When can I shower and/or get the area wet?
• Will I be able to walk up and down stairs? If not immediately, then when?
• When can I drive? “Typically, if you’ve had your left hip replaced it will be two weeks until you can drive, and four weeks if it was your right hip,” says Dr. Westrich. 

4. Keep in mind that some level of pain is normal after surgery.

“Most state-of-the-art pain management includes different strategies, which will be available at top joint replacement centers,” says Dr. Westrich. That means that you’ll be given a combination of regional anesthesia, anti-inflammatory medication, non-narcotic pain medication like Tylenol, and narcotics only if you need them, which research has shown is the best way to manage pain.  

However, your pain should get better, not worse, as the days progress, and the swelling should be going down. “If your pain worsens, you develop any redness in your leg that’s not near the incision, or you develop a fever, call your doctor right away,” says Dr. Westrich. 

5. Go to physical therapy as directed. 

Exercise may feel a bit rough after surgery, but lying on the couch all day will make things worse and more painful overall. If needed, a physical therapist can come to your home to help you with exercises designed to strengthen the muscles around the hip and help you to navigate activities of daily life, like getting in and out of bed, climbing and going down stairs, and getting in and out of the car. 

Once you’re able to drive, you’ll move to in-office PT to continue to work on strength, endurance, range of motion, and balance, so you can get back to regular life as soon as possible. And while PT is important, doing the proper exercises on the days you’re not in therapy is just as imperative, says Dr. Westrich. 

PTs typically give patients a home exercise program, which they should do on days off from PT as well as after they’re finished with PT, says Dr. Westrich. Instructions come in the form of worksheets, pictures, apps and videos that detail exactly how to do each exercise and how many times per week. “Continuing to exercise is crucial, even after physical therapy ends,” stresses Dr. Westrich.