When is time to have a THA?
When you are physically and psychologically ready to have your hip fixed. There is no magic time: assuming you have severe arthritis in your hip, and the pain and stiffness has reached a point where you’re very unhappy and can’t enjoy the activities as you should, it’s time to consider surgery.
Is there anything that can be done other than surgery to fix my hip?
Once the cartilage in the hip has been destroyed from arthritis, there is no way to grow it back. There are things you can do to stay comfortable, like take anti-inflammatory medication or even a cortisone injection into the hip joint. This can palliate some of the pain to make you more comfortable, but there is no way to make a hip normal again without surgery.
If I need a hip replacement but am not ready yet, what can/should I do in anticipation of surgery?
It is important to stay fit and active to the best of your ability prior to surgery. The better shape you’re in before surgery, the better shape you’ll be immediately after surgery. I encourage my patients to exercise and stay as strong and flexible as possible in anticipation of hip replacement surgery to ensure a more speedy recovery.
Should I do physical therapy prior to surgery?
Physical therapy will not fix your hip, but I think it is helpful for many patients to have some structure and guidance to their strengthening and stretching prior to surgery. This also enables patients to get to know their therapist prior to surgery and practice some of the exercises they will be doing in the postoperative period.
If I like to exercise in the gym, what can I do to stay in shape?
Basic low-impact cardio exercises are good, such as the elliptical machine, the recumbent or upright bicycle. or walking on the treadmill. Also useful are basic lower extremity exercises with lighter weights focusing on the muscles around the hip: i.e., hip flexors and abductors. Upper body strength will help in the immediate post-op period when you will be using an assist device to learn how to walk again.
How long will I be in the hospital?
For a single hip replacement, most patients are in the hospital for two-to-three days. More than 80% of the patients under the age of 65 go home after surgery and start therapy either at home (a physical therapist is sent to the house) or as an outpatient.
What happens if I don’t want to go home or I live alone?
Some patients who are de-conditioned, elderly or live alone elect to spend time in an inpatient rehabilitation facility until they feel comfortable enough to be in their home environment. Such arrangements are made in the hospital by the case managers, and patients are sent to facilities based on where they live and what their insurance will cover. Most in-patient therapies last anywhere from five days to two weeks.
What type of anesthesia will I get?
The vast majority of my patients receive a spinal anesthesia with no narcotics. This is typically better for the cardiovascular system, and patients experience little or no nausea and vomiting (which is common with general anesthesia). Our goal is to keep you alert and feeling well so you can participate with therapy following your surgery. For the bilateral patients (both hips at the same time), an epidural catheter is added which we leave in overnight for post-operative pain relief.
When can I return to work?
Well, this obviously depends on your occupation. I do recommend patients take at least a month off from work if possible, and I advocate as much time as patients need to return safely and comfortably to their workplace. In the first four-to-six weeks after surgery, patients are usually fairly fatigued from the stress of surgery, requiring frequent naps during the day and needing to lay down and elevate their leg so it doesn’t swell. If you are your own boss or have the ability to take some time at work to rest, it is possible to return to work sooner. With patients who have more of a white-collar or sedentary job, many are back at work in a week, however, I do recommend at least a month off. Certainly going back part-time to check in on things is reasonable if you feel up to it. For patients with more labor-intensive jobs, or occupations requiring they be on their feet for the majority of the day, a month is the minimum I would recommend and, again, would advocate as much time as necessary to feel comfortable performing their job.
When can I resume my normal activities?
Well, first of all, it’s important to remember that what’s normal for some is outlandish to others. However, in general, you can resume activities as soon as your hip is comfortable and off narcotic medication. I recommend refraining from any high-impact/cutting sports for at least six-to-eight weeks after surgery. No golf for six weeks (you can chip and putt, but no swinging the big bertha). No swimming for a month until the wound is sealed. You can return to the gym when you are comfortable, then ease back into your pre-op routine. The implants must have time and rest so the bone can grow into them and achieve long-term stability.
Am I a candidate for anterior total hip replacement?
In my practice — with very little exception — everyone is a candidate for anterior total hip replacement. Since I’ve been practicing in New York, I have performed 99.9% of my primary total hip replacements anteriorly. I believe it is the best way to perform hip replacement surgery and, in my hands, the patient’s recovery is faster and pain is less than any other method. Just as important, in my hands, this approach offers a significantly lower risk of routine complications.