What is Total Joint Replacement Surgery?Total joint replacement surgery is one of the most advanced successful procedures in patients dealing with severe hip and knee pain. The goal of the surgery is to relieve pain and restore the normal functioning of the joint and help patients resume normal activities. Show
Anterior Hip ReplacementOver the past few years, there have been great advances in the treatment options, implants, and minimally invasive techniques. The latest technique in joint replacement such as anterior hip replacement has resulted in a dramatic improvement in outcome. What is Direct Anterior Approach Hip Replacement SurgeryDirect Anterior Hip Replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons. Traditional hip replacement involves cutting major muscles to access the hip joint. Normally, after a traditional hip replacement, your surgeon would give you instructions on hip precautions to allow the cut muscles to heal. However, for anterior hip replacement patients, hip precautions are not necessary as no muscles are cut. Advantages of both anterior hip replacements include:
Timeline for Hip Replacement (What to Expect)Surgery Scheduled with Joshua Hickman, MD
One to Three Weeks Prior to Surgery
Day Before Surgery
Day of Surgery
First Day After Surgery
1-3 Weeks After Surgery
3-6 Weeks After Surgery
3-4 Months After Surgery
12 Months after Surgery
FAQs for Hip ReplacementWhat happens after I schedule surgery? Dr. Hickman's medical assistant will schedule your surgery with the facility you and Dr. Hickman has been selected. The M.A will then authorize this procedure with your health insurance company. Please understand that authorization is not a guarantee of payment and it is always a good idea that you check with your insurance company regarding deductibles, copays, and coinsurance responsibilities. You should also have selected a preoperative appointment in our office. This usually takes place 1-2 weeks prior to your surgery date. How do I prepare for surgery? Have nothing to eat or drink after midnight the night before your surgery. You should also wash your surgical site with an antibiotic soap (which will be given to you at your preoperative appointment). You do not need to shave over your surgical site, this will be taken care of in the operating room. What time will my surgery be? Your surgery time will be set by the hospital or surgical center. They will contact your the last working day before your surgery. They usually call after 1pm. Questions or concerns regarding the time of your surgery should be addressed to the hospital. Should I stop my medications prior to surgery? This will be discussed at your preoperative appointment. If you are taking Ibuprofen, Naproxen, or any other anti-inflammatories you will need to stop these one week prior to the surgery. If you are on Plavix or other blood thinners, please contact Dr. Hickman's office to determine when these should be stopped prior to surgery. If you are diabetic DO NOT take your diabetic medication after midnight on the day of surgery. The hospital or surgery center will instruct you which of your home medications you should take the morning of surgery. How do I care for my wound? Your incision will be closed with dissolving sutures under the skin. There will be no need to remove any stitches. You will go home with two dressings placed on your incision after surgery. The first is directly on the skin and is a clear mesh strip that should be left on for 2-3 weeks. If the strip starts to peel off, trim the edges. The second is an outer brown surgical bandage. The brown bandage should be left on for at least 1-2 days after surgery. Once your surgical bandage is off it is okay to shower and let your incision get wet. Let soap and water run across the incision. rinse clean and pat dry. Do not soak the incision for at least 4 weeks following surgery (no tub, pool, hot tubs, river, creeks, etc.). If you have any concerns about your incision you can email a picture to How will my wound look after surgery? Redness and increased warmth around your incision can be normal. You may continue to note increased warmth for up to one year. If you experience significant drainage from your wound (drainage that soaks through a gauze pad in 5-6 hours), redness extending away from your incision or flu like symptoms, please notify our office immediately. Do I need TED hose (compression stockings)? Most patients do not need compression stockings after surgery. They do not help prevent blood clots, but may be helpful in reducing swelling for select patients. Do I need an ice machine after Surgery? Ice machines can aid in recovery after total hip replacement. Cold Therapy via an intermittent pneumatic compression (IPC) and motorized cold therapy (MCT) machine is very beneficial following a total knee arthroplasty. MCT circulates cold water through a wrap over the injury or surgical site. Some of the benefits of MCT include: decreased postoperative discomfort, swelling, inflammation, and narcotic use, provides a consistent, comfortable and safe temperature for hours, and enables patients to control and self-regulate pain management at home. IPC mimics natural muscle contractions to increase blood flow, oxygen, and mechanically flush edema from the affected site. When combined with cold therapy, IPC has shown to: decrease analgesic drug requirements, improve range of motion (ROM) during post op recovery, provide better pain control and improve post operative recovery. We provide ice machines through our office. Unfortunately, we cannot bill your insurance for this item so it will be an out of pocket expense. Contact Dr. Hickman's office to inquire about purchasing an ice machine. What about dental work after joint replacement? All dental appointments should be avoided for the first 3 months following surgery unless in an emergency. Antibiotics before dental work are not necessary unless a tooth is being extracted for an infection or major periodontal procedures such as gum or bone surgery. They are not necessary for cleanings, cavity fillings, tooth crowns, or other routine exams. How long will I need to take pain medication after surgery? Get off pain pills as soon as possible. You should anticipate discontinuing your pain medication 1-3 weeks after surgery. Will I need home health after surgery? Most patients following hip replacement are able to go home without home health care after surgery. Depending on your personal circumstances, some patients may be released to a rehab center or to home with home healthcare. In either circumstance, it is anticipated that you would complete rehab or home healthcare after 7-14 days. Will I need physical therapy after surgery? Hip replacements rarely need formal outpatient physical therapy. Dr. Hickman recommends short frequent walks as the best therapy after your surgery. I'm having difficulty sleeping after surgery, is this normal? Yes, many patients complain of insomnia and night pain after surgery. This is very normal. Dr. Hickman does not recommend or prescribe sleeping pills. How much will I follow up with Dr. Hickman? Your first postoperative appointment will be 3 weeks after your surgery, then a follow up at 4 months after surgery, and again at 1 year after surgery. Then you will need annual appointments each year. Should you have any questions or concerns outside of those time frames, please contact our office. Physical Therapy After Total Hip ReplacementYour full recovery from your total hip replacement surgery is going to take several months. This website will help you understand your recovery. Guidelines are included which discuss precautions to protect your new joint, exercises that increase you hip strength, and activities of daily living that will help you become an active partner in your care and recovery. Guidelines to Protect Your New Hip JointYour hip surgery did not involve cutting muscles. Motion is usually improved after surgery. Most patients can place all of their weight on the new hip. Having the hip dislocate or "pop out of socket" is almost unheard of with modern implants and surgical techniques. Because of these advances, we are more relaxed in our hip precautions although you may hear of precautions and restrictions in motion that other surgeons use. Below are Dr. Hickman's general guidelines for the first three weeks to help ease recovery of soft tissues.
Our team will teach you in the hospital to use a walker or crutches before you go home. You will quickly progress to a cane. Some patients may not be allowed to put all their weight on the hip immediately. Dr. Hickman will tell you how much weight you can safely put on your new hip. At your three week checkup, Dr. Hickman will tell you if your hip has healed enough to progress to sports or other activities. Your balance might be shaky for a while.
Adaptive Equipment After Total Hip ReplacementMost patients do not require aids postoperatively, but you patients may benefit from several devices to make your daily activities easier and safer. As your soft tissues heal (though preserved they are irritated), these devices may make certain activities more comfortable. Dr. Hickman and your physical therapist will recommend the equipment that best suits your needs. Seat / Shower Bench: This seat allows you to sit while bathing and provides you safety while you are in the shower. Seat Cushion: Cushions are used to elevate the seat height of a chair, couch, car, or other surfaces. Elevated Toilet Seat: This device is attached to your toilet seat to elevate its height. Reacher: A reacher is used to pick up items off the floor and help you with dressing. Dressing Stick: This device has a hook on one end and a pusher on the other end. It is used to help put on pants, skirts, pull up zippers, etc. Sock Aid: This aid helps you safely put on your sock. Long-handed Bath Sponge: This sponge helps you clean hard to reach areas while bathing. Long-Handled Shoe Horn: This shoe horn is attached to long stick and allows you to put on your shoes while sitting or standing. Managing Activities of Daily Living Following SurgeryWalking with CrutchesCrutch Safety
You may place as much weight on your operated leg as you can tolerate, if told so by Dr. Hickman. Use the crutches to improve your balance and safety, as well as to favor the operated leg when it is painful. Always use a handrail if one is available for stairs and curbs. Going up with Handrail
Going Up without Handrail
Going Down with Handrail
Chair TransferAvoid recliners and soft couches until otherwise told by Dr. Hickman. Stiff-backed chairs with armrests are ideal to sit in. If the seat is low, you may place 1 or 2 pillows in the chair to elevate the seat and facilitate transfers
Car TransfersThe front seat is preferable because it generally has more leg room, can be adjusted for comfort, and can allow the rider to more easily wear a seat belt.
Putting on Pants
Putting on ShoesWear slip-on shoes or shoes with Velcro straps so that you will not have to bend over to put the shoes on and tie the laces. If you are having difficulty, use the long-handled shoe horn or reacher to put on and take off your shoes. ExercisesMost patients after a hip replacement do not require formal physical therapy. Walking is the best exercise after surgery, beginning with short, frequent walks. The day of surgery, the physical therapist will get you out of bed for the first time. The therapist will help you walk with a walker or crutches as you are able. Each day the amount of walking will increase as you can tolerate. Before you go home, the physical therapist will teach you how to climb stairs safely to protect your new hip. Additional exercise can help you regain the strength in your hips and legs so you can walk more easily. Below are some basic exercises that should be performed until you can do 3 sets of 10 repetitions very easily. Your therapist at the hospital will also review a home exercise program with you before you are discharged. Ankle Pumps: This strengthens your calf muscles in your lower leg.
Quad Setting: This exercise helps your upper leg or thigh muscles.
Gluteal Setting
Avoiding Problems After SurgeryBlood Clot Prevention: Follow your Dr. Hickman's instructions carefully to minimize the potential of blood clots which can occur during the first several weeks of your recovery. Warning signs of possible blood clots in your leg include:
Warning signs that a blood clot has traveled to your lung include:
Notify Dr. Hickman immediately if you develop any of these signs. Preventing Infection: The most common causes of infection following total hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your hip replacement and cause an infection. Following your surgery, you should take antibiotics prior to major dental work or any surgical procedure that could allow bacteria to enter your bloodstream. Warning signs of a possible hip replacement infection are:
Notify Dr. Hickman immediately if you develop any of these signs. How far can you bend after anterior hip replacement?Hip precautions after surgery (no bending greater than 90 degrees, no crossing legs, no excessive rotation) are generally required for this reason. Direct anterior hip replacement is a minimally invasive surgical technique.
What are anterior hip precautions?Hip precautions are very restrictive and usually include the following: Avoid the combined movement of bending your hip and turning in your foot. You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle. Avoid low chairs.
Can I sit cross legged after anterior hip replacement?Motion: You need to maintain hip precautions in order to avoid dislocation. These precautions include: not bending at the hip more than 90 degrees, sleeping with a pillow between your legs, not turning the toes inward, not pivoting at the hip, and not crossing your legs.
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