If your hip is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs.  You may even begin to feel pain while you are sitting or lying down.  If nonsurgical treatments like medications, injections, and walking supports are no longer helpful, you may want to consider total hip replacement surgery.  Joint replacement surgery is a safe and effective procedure to relieve pain and to help you resume normal activities.

WHEN SURGERY IS RECOMMENDED: There are several reasons why Dr. Justin Sherfey or Dr. Alon Antebi may recommend hip replacement surgery.

• Severe hip pain or stiffness that limits your everyday activities such as walking or bending
• Moderate or severe hip pain while resting, either day or night
• Stiffness in a hip that limits the ability to move or lift the leg
• Inadequate pain relief from anti-inflammatory medications, injections, or walking supports

CANDIDATES FOR SURGERY: There are no absolute age or weight restrictions for hip replacement surgery. Recommendations for surgery are based on a patient's pain, x-ray findings, and limitations of daily life & activity. Most common cause of chronic hip pain and disability is arthritis, which can include osteoarthritis, rheumatoid arthritis, and post traumatic arthritis.

NEVER HESITATE to ask Dr. Sherfey or Dr. Antebi any questions you may have about your plan of care.

ADVANTAGES of the ANTERIOR TOTAL HIP over Traditional Hip Surgery

LESS DAMAGE to MAJOR MUSCLES: The anterior approach is referred to as a muscle sparing surgery because no muscles are cut to access the joint. It involves a 3”-4” inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside without detaching any tendons. This minimally invasive approach allows patients to resume their normal activity much quicker than patients that undergo traditional hip surgery.

LESS POST-OPERATIVE PAIN: Because the surgery does not require cutting muscles patients typically experience less pain after surgery and require less pain medication.

FASTER RECOVERY: After surgery, a patient can bend at the hip and bear weight as soon as it is comfortable. Most anterior hip replacement patients stop using their assistive devices sooner than patients who have has a traditional surgery. They have no limitations to their activity or range of motion after surgery.

DECREASED RISK of HIP DISLOCATION: A major post-surgical worry for most hip replacement patients is that the new hip’s ball and socket will dislocate. However, anterior hip replacement surgery does not disturb the muscles and soft tissue structures that could cause the hip to dislocate, therefore anterior surgical patients are less likely to suffer a hip dislocation.

BETTER RANGE of MOTION: Patients may bend over or sit with their legs crossed without risking hip dislocations. Most traditional hip replacement patients are told to avoid sitting with legs crossed for a least 6 to 8 weeks following surgery, and depending on surgeon preference, to avoid deep bending at the hip or extreme internal rotation of the hip for their lifetime. Anterior hip replacement patients DO NOT have these limitations.

Dr. Sherfey or Dr. Antebi will make a 3”-4” inch incision is made in the front of the hip where muscle is moved to expose the bone rather than cut.

1.  The damaged bone and cartilage is removed.
2. The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur.
3. A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
4. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket and sometimes held in place by screw or cement.
5. A plastic spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
6. The surgical procedure takes 45 minutes to an hour.
7. After surgery, you will be moved to a recovery room monitored by nurses where you will remain for several hours while you recover from the anesthesia.
8. You will most likely go home within a few hours after surgery. If needed, you will be kept overnight for further monitoring.

PREPARING FOR SURGERY

FOLLOW ALL PRE-OPERATIVE INSTRUCTIONS given to you by Dr. Sherfey or Dr. Antebi.

 

• Stop all Aspirin, blood thinners, and anti-inflammatory medications (Motrin, Aleve) 10 days prior to surgery as they can cause bleeding during surgery. DO NOT STOP your blood thinners without consulting your primary care physician first.

• Stop any naturopathic or herbal medication 10 days prior to surgery as these can also cause bleeding
• Continue with all other medications unless otherwise specified.
• Bring a list of ALL medication with you on the day of surgery to give to the anesthesiologist.
• You are advised to STOP SMOKING for as long as possible prior to surgery.

REALISTIC EXPECTATIONS: An important factor in deciding whether to have surgery is understanding what the procedure can and cannot do. More than 95% of people who have surgery experience a dramatic reduction of pain and a significant improvement in the ability to perform common activities of daily living. However, surgery will not allow you to do more than you could before you developed arthritis. With normal use and activity, every replacement or implant begins to wear. Excessive activity or weight may speed up this normal wear and may cause the replacement or implant to loosen and become painful.

MEDICAL EVALUATION: Dr. Sherfey or Dr. Antebi may ask you to schedule a complete physical examination with your family physician several weeks before the operation. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist such as a cardiologist before the surgery.

TEST: Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help Dr. Sherfey plan your surgery.

MEDICATIONS: Tell the provider about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.

DIET: Losing weight prior to surgery can help minimize stress on new hip and decrease surgical risks.

DENTAL EVALUATION: Although the incidence of infection after surgery is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your surgery.

URINARY EVALUATION: People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking surgery.

SOCIAL PLANNING: Although you will be able to walk on crutches or a walker soon after surgery, you may need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.

AFTER SURGERY

Patients go home the same day following surgery, but some may go home the following day.

YOUR RECOVERY at HOME: The success of your surgery will depend largely on how well you follow the providers specific instructions at home during the first few weeks after surgery. Some loss of appetite is common for several weeks after surgery. It is important to have a balanced diet (often with iron supplements) to promote proper tissue healing and restore muscle strength. Drink plenty of water!

WOUND CARE: You will be given wound care instructions when discharged home. It is normal to have some blood oozing under the dressing, however if the dressing becomes saturated, you can change the dressing with gauze and tape. Remove the dressing 4 days after surgery. You will have stitches, staples, or a glue sterile mesh (most commonly used) on the skin. The stitches, staples, or mesh will be removed at your follow-up appointment usually 2 weeks after surgery. You can shower after you remove the dressing 4 days after surgery. Wash the wound gently with soap and water while showering. Avoid soaking the wound in water such as a bath or jacuzzi. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

PAIN: Surgery pain is a common concern for most patients. Dr. Sherfey utilizes advanced techniques in treating post operative pain. This includes medications given prior, during and after your surgery. After your surgery, you may experience a minimal amount of pain. Dr. Sherfey will provide medication to make you feel as comfortable as possible. Ice packs should be used regularly to reduce swelling and pain.

ACTIVITY & EXERCISE: This is a critical component of healing, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.

Your activity program should include:

• A graduated walking program to slowly increase your mobility, initially in your home and later outside.
• Resuming other normal household activities, such as sitting, standing, and climbing stairs.
• Specific exercises several times a day to restore movement and strengthen your hip.
• You will most likely be able to resume driving when your hip bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 2 to 4 weeks after surgery

TIME OFF WORK: This depends on your work requirements. Office workers usually require 2 weeks off and manual laborers 2 to 3 months off.

PREVENTING PNEUMONIA: It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed "atelectasis") which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.

AVOIDING FALLS: A fall during the first few weeks after surgery can damage your new hip and may result in a need for further surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, hand rails, or have someone to help you until you have improved your balance, flexibility, and strength.

HOME PLANNING: Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

• Safety bars or a secure handrail in your shower or bath & a stable shower bench or chair for bathing.
• Secure handrails along your stairways & removing all loose carpets and cords.
• A stable chair for your early recovery with a firm seat cushion, a firm back, two arms, and a footstool for intermittent leg elevation.
• A toilet seat riser with arms if you have a low toilet.
• A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery.

POSSIBLE COMPLICATIONS OF SURGERY

INFECTION: Your hip needs time to heal, so be patient. Do not rush the recovery process. It is important to follow Dr. Sherfey’s instructions carefully and make sure your are not pushing yourself too fast or too soon. Although the risk of infection is low, it may occur. Minor superficial wound infections are generally treated with wound cleansing and antibiotics. Major or deep infections may require more surgery and possible removal of the prosthesis.

PREVENTING INFECTION: Keeping your wound clean with antibacterial soap and water is crucial in preventing infection. A common cause of infection following surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your replacement and cause a joint infection. Dr. Sherfey will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.

Warning signs of infection. Notify AVORS immediately if you develop any of the following:

Persistent fever (higher than 100°F orally)

Shaking chills

Increasing redness, tenderness, or swelling of the wound

Drainage from the wound

Increasing pain with both activity and rest

BLOOD CLOTS: Blood clots in veins are one of the most common complications of surgery. These clots can be life-threatening if they break free and travel to your lungs.

PREVENTING BLOOD CLOTS: Follow Dr. Sherfey’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He may recommend that you continue taking the blood thinning medication you started in the hospital. Compression stockings should to be worn for three weeks after surgery. They can be removed for bathing. Notify your surgeon if you develop any of the following

Warning signs of blood clots in leg:

• Increasing pain in your calf
• Tenderness or redness above or below your knee
• New or increasing swelling in your calf, ankle, and foot
• Warning Signs of PULMONARY EMBOLISM:
• Sudden Shortness of Breath or Sudden onset of Chest Pain or Localized Chest Pain & Coughing

IMPLANT PROBLEM: Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Motion may be more limited, particularly in patients with limited motion before surgery.

PAIN: A small number of patients continue to have pain after surgery. However, this complication is rare and the vast majority of patients experience excellent pain relief following surgery.

PAIN MANAGEMENT: After surgery, you will feel some mild pain. This is a natural part of the healing process. Dr. Sherfey and your nurses will work to reduce your pain. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Dr. Sherfey may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Talk to Dr. Sherfey if your pain has not begun to improve within a few days of your surgery.

NEUROVASCULAR INJURY: Although rare, injury to the nerves or blood vessels can occur during surgery.

If you’re not sure whether or not you are a good candidate, you can talk with your doctor about the benefits of a Total Joint Replacement.   Call to schedule an appointment at 661-726-5005.