What is partial hip replacement surgery?

A partial hip replacement removes and replaces the ball of the hip joint. It does not replace the socket. This surgery is most often done to repair certain types of hip fractures.

The ceramic or metal ball is attached to a metal stem. This is called a hip implant. The stem is set down into the core of the thighbone (femur). It is firmly fixed in the femur in one of two ways. It may be:

• Cemented to the bone.
• Uncemented. This kind of stem has a porous coating that the bone grows into.

Your doctor may use regional anesthesia. This means you can't feel the area of the surgery. You'll have medicine that makes you unaware and lightly asleep. Or a doctor may use general anesthesia. This means you'll be asleep during surgery. Which type of anesthesia you get depends on your doctor and on your overall health. Your doctor might also ask what you prefer.

Activity

• Your doctor may not want your affected leg to cross the center of your body toward the other leg. If so, your therapist may suggest these ideas:
  • Do not cross your legs.
  • Be very careful as you get in or out of bed or a car. Don't let your leg cross the imaginary line in the middle of your body.
• Rest when you feel tired. You may take a nap, but don't stay in bed all day.
• Work with your physical therapist to learn the best way to exercise. You will probably have to use a walker, crutches, or a cane for a few weeks.
• Try not to sit for too long at one time. You will feel less stiff if you take a short walk about every hour. When you sit, use chairs with arms. Don't sit in low chairs.
• Do not bend over more than 90 degrees (like the angle in a letter "L").
• Sleep on your back with your legs slightly apart or on your side with a pillow between your knees for about 6 weeks or as your doctor tells you. Do not sleep on your stomach or affected leg.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.

Diet

• By the time you leave the hospital, you will probably be eating your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Your doctor may recommend that you take iron and vitamin supplements.
• Eat healthy foods, and watch your portion sizes. Try to stay at your ideal weight. Too much weight puts more stress on your new hip joint.
• If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Your doctor may give you a blood-thinning medicine to prevent blood clots for a few weeks after surgery. Be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems. This medicine could be in pill form or as a shot (injection). If a shot is needed, your doctor will tell you how to do this.

Incision care

• If your doctor told you how to care for your cut (incision), follow your doctor's instructions. You will have a dressing over the cut. A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
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• If you did not get instructions, follow this general advice:
  • If you have strips of tape on the cut the doctor made, leave the tape on for a week or until it falls off.
  • If you have stitches or staples, your doctor will tell you when to come back to have them removed.
  • If you have skin glue on the cut, leave it on until it falls off. Skin glue is also called skin adhesive or liquid stitches.
  • Change the bandage every day.
  • Wash the area daily with warm water, and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing.
  • You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing.
  • You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks, or until your doctor tells you it is okay.

Exercise

• Your rehab program will include a number of exercises to do. Always do them as your therapist tells you.

Ice and elevation

• For pain, put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. If your doctor recommended cold therapy using a portable machine, follow the instructions that came with the machine.
• Your ankle may swell for about 3 months. Prop up your ankle when you ice it or anytime you sit or lie down. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

• Continue to wear your compression stockings as your doctor says. These help to prevent blood clots. How long you'll have to wear them depends on your activity level and the amount of swelling you have. Most people wear these stockings for 4 to 6 weeks after surgery.
• Preventing falls is also very important. To prevent falls:
  • Arrange furniture so that you will not trip on it.
  • Get rid of throw rugs, and move electrical cords out of the way.
  • Walk only in areas with plenty of light.
  • Put grab bars in showers and bathtubs.
  • Try to avoid icy or snowy sidewalks. Choose shoes with good traction, or consider using traction devices that attach to your shoes.
  • Wear shoes with sturdy, flat soles.

Surgery usually works well. But recovery does take patience and time. Your hip will likely be able to do most, if not all, of what it used to do.

Because of the way the hip is structured, every added pound of body weight adds 3 pounds of stress to the hip. Controlling your weight will help your new hip joint last longer. Your hip should also last longer if you don't do hard physical work or play sports that stress the joint.

Surgery may take 1 to 3 hours.

The risks of hip replacement surgery can be divided into two groups.

• Risks of the surgery and recovery period. These include:
  • Blood clots. These can be dangerous if they block blood flow from the leg back to the heart, or if they move to the lungs.
  • Infection. Infection in the wound is usually treated with antibiotics. Infection deep in the joint may need more surgery. In some cases, the hip implant has to be replaced with another one.
  • Nerve injury. This is rare. It can cause tingling, numbness, or difficulty moving a muscle.
  • Problems with wound healing.
  • Problems with anesthesia.
  • Hip dislocation after surgery.
  • Difference in leg length. Any difference is usually very small and can be corrected by using a shoe insert.
• Long-term risks. These risks may occur months to years after the surgery. They include:
  • Loosening of the hip implant in the bone.
  • Infection in the joint.

During partial hip replacement, your doctor replaces the ball of your hip joint, but not the socket. The artificial part is made of metal, ceramic, or plastic. This type of surgery is done to repair certain types of hip fractures.

When you wake up from surgery, your pain will be controlled with intravenous (I.V.) medicine. You will also likely have medicines to prevent infection, blood clots, and nausea. If you had regional anesthesia, expect to have little or no feeling below your waist for a while.

Coming out of surgery, you may have a cushion between your legs. This is to keep your new hip in the right position. To help prevent blood clots, you'll likely be wearing compression stockings. And you may have compression sleeves on your legs. These squeeze and release your lower legs to help keep the blood moving.

On the day of surgery or the day after, you'll get out of bed with help. You will learn how to walk with a walker or crutches. By the time you leave the hospital, you will be able to safely sit down and stand up, dress yourself, use the toilet, bathe, and use stairs.

During the first week or so after surgery, you will need less and less pain medicine. For a few weeks after surgery, you will likely take medicine to prevent blood clots.

As soon as possible, you will be taught how to move your body without hurting your hip. Until your hip is fully healed, you will need to follow "hip precautions." Your doctor and physical therapist will tell you how to do this.

Many artificial hip joints last for 10 to 20 years. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra pound of body weight adds 3 pounds of stress to your new hip joint. More weight may cause it to wear out sooner.

At home

When you go home, you will be able to move around with crutches or a walker. But you will need someone to help you at home for the next few weeks until your energy returns and you can move around better.

You'll be able to drive when your doctor says it's okay. You may be able to go back to work in 4 weeks to 4 months.

For most people, it's safe to have sex about 4 to 6 weeks after a hip replacement. Talk to your doctor about when it's okay to have sex and what positions are safe for your hip.

Be sure you go to all of your follow up appointments.

Rehabilitation

You will be in a rehab program. Your physical therapist will get you started and teach you exercises. Then you will do them on your own.

Rehab often lasts 6 months or more. It's not easy, and it takes time. Many people say that it's like "having a second job."

Exercise

Exercise (such as swimming and walking) is important for building your muscle strength. And it helps you feel better overall. Discuss with your doctor what type of exercise is best for you.

• You probably will be able to do most of the activities that you did before surgery, such as golf, bike, swim, or dance.
• Your doctor may discourage you from running, playing tennis, and doing other things that put a lot of stress on the joint.

After surgery to replace the ball of your hip joint, you will probably be walking with crutches or a walker. You may be able to climb a few stairs and get in and out of bed and chairs. But you will need someone to help you at home until you have more energy and can move around better.

You'll go home with a bandage and stitches, staples, skin glue, or tape strips. You can remove the bandage when your doctor tells you to. If you have stitches or staples, your doctor will remove them about 2 weeks after your surgery. Glue or tape strips will fall off on their own over time. You may still have some mild pain and the area may be swollen for 3 to 4 months after surgery. Your doctor may give you medicine for the pain.

You will keep doing the rehabilitation program (rehab) you started in the hospital. The better you do with your rehab exercises, the sooner you will get your strength and movement back. Most people are able to go back to work 4 weeks to 4 months after surgery.

Partial hip replacement surgery is done through one or two cuts (incisions). The cuts are often on the side or toward the back (posterior) of your hip. You may have anesthesia to block pain and medicine to make you drowsy. Or you may get medicine to make you sleep. Your doctor will then:

• Remove the damaged bone tissue and cartilage from the hip joint.
• Replace the ball at the upper end of your thighbone (femur).

A partial hip replacement surgery is most often done to repair certain types of hip fractures. It's an option when the socket of the hip joint is healthy.