Q. Am I too old for this surgery?

Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. Take Dr. Riddhivardhan opinion about your general health and readiness for surgery.

Q. How much time will my surgery take?

The surgery takes approximately two to two-and-a-half hours for surgery. Some of this time is taken by the operating-room staff to prepare for the surgery.

Q. Will I need blood?

You may need blood after the surgery. You may donate your own blood, if able, or use the community-blood-bank supply.

Q. What are my anesthesia options?

You may have a general anesthetic, which most people call “being put to sleep,” or a spinal anesthetic. The choice is between you and the anesthesiologist.

Q. Will I have pain after surgery?

Yes, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. The day of surgery, most patients control their own medicine with a special pump that delivers the drug directly into their IV. Dr. Riddhivardhan will discuss with you what pain control option is best for you.

Q. What are the risks involved with this surgery?

Risks include infection, blood loss, blood clots, and damages to nerves and arteries. Every precaution is taken to minimize these risks, including the use of pre and post surgery antibiotics, short term use of anticoagulants or compression devices and careful surgical technique.

Q. How long, and where, will my scar be?

The scar will be approximately 6–8 inches long. It will be along the side of your hip.

Q. Will I need a walker, crutches or cane?

Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or crutches. Your equipment needs will be determined by the physical therapist and ordered for you by us and delivered to you before you leave the hospital.

Q. How long will I be in the hospital?

You will be discharged home when you are medically stable, you pass physical therapy, and your pain is controlled. For most patients this is 2-3 days following surgery.

Q. How soon can I take a bath or shower?

You can shower as soon as you feel comfortable doing so. You will have a waterproof bandage will need to stay on until your first visit to the clinic. Do not take a bath until your surgical incision is well healed.

Q. How do you take care of your incision?

You will have a waterproof bandage that will be put on before you leave the hospital.

Q. What to do about post-operative constipation?

It is very common to have constipation post-operatively. This may be due to a variety of factors but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener is the best prevention for this problem. In rare instances, you may require a suppository or enema.

Q. Will I need any other equipment?

After hip-replacement surgery, you will need a high toilet seat for about three months. If needed, you will also be taught by the physical therapist to use adaptive equipment to help you with lower body dressing and bathing. You might also benefit from a bath seat or grab bars in the bathroom. Your home equipment needs can be arranged while you are in the hospital.

Q. Will I need physical therapy?

Formal physical therapy doesn’t play as significant a role in hip replacements as in knee replacements. A physical therapist can be arranged to visit you 2-3 times/week and review some simple strengthening exercises with you. However stretching and range of motion exercises are typically avoided. Specifically, patients should avoid hip flexion (the act of bending or the condition of being bent) of more than 90 degrees and rotation of more than 35-40 degrees in either direction as well as avoid crossing the midline of the body for approximately 12 weeks. We find the best therapy for our patients initially to be walking. Dr. Riddhivardhan may recommend formal physical therapy on an outpatient basis following your initial post-operative visit.

Q. Can I go up and down stairs?

Yes. Initially, you will lead with your un-operated leg when going up stairs, and with your operated leg when coming down. As your muscles get stronger and your motion improves, you will be able to perform stairs in a more normal fashion, usually in about one month. A good rule of thumb to remember when deciding which leg to lead with is “up with the good, down with the bad.”

Q. How much range of motion do I need?

Most patients note an improvement in the range of motion of their hip following hip replacement. However some patients may always have some difficulty with certain movements such as shoe and sock application and foot care due to the long standing contractures of the soft tissues about the hip. Initially patients should avoid hip flexion (the act of bending or the condition of being bent) of 90 degrees or more, hip rotation of more than 35-40 degrees, and crossing the body’s midline with the affected leg for approximately 12 weeks in order to avoid a dislocation of the hip joint. Do not force a body position past a feeling of stiffness. This feeling of stiffness often improves over the course of a year.

Q. I think my leg feels longer now. Is this possible?

Most patients have a sense that the operated leg feels longer early in their recovery and this may initially feel awkward. This is due to the fact that the affected leg is usually shorter than the unaffected leg prior to surgery. Arthritis is the process of the protective cartilage covering wearing away from the bone. As the cartilage in the hip joint is destroyed, this results in the leg becoming shorter. Eventually, patients become accustomed to their “new anatomy” following surgery, and do not have any long lasting sense of a leg length discrepancy. Occasionally, some patients choose to wear a small shim in a shoe. At times, the leg is intentionally lengthened at the time of surgery in order to tighten the surrounding soft tissues of the hip and prevent/limit the risk of dislocation. In the majority of cases your leg length will essentially be unchanged.

Q. My hip makes an intermittent clicking or bumping noise. Is this normal?

Yes. This is normal as the metal ball is contacting the plastic or metal liner. The weight of the leg may slightly distract the ball from the socket during the swing phase of gait leading to this sensation. This is not a harmful situation and some patients do experience this.

Q. Why does the skin around my hip feel numb?

This is a normal and expected finding. The sensory nerves are interrupted with the incision and this results in an area of numbness around the hip. Often, this improves over the course of one year, but may always feel somewhat different.

Q. Will I set off the security monitors at the airport?

You will probably set off the alarm as you progress through the security checkpoint. Be proactive and inform the security personnel that you have had a hip replacement and will most likely set off the alarm.

Q. Will I go to a rehabilitation facility or home after a total hip replacement?

It depends. Many people are able to go home after their total hip replacement operation. However, you may go to a rehabilitation hospital in order to gain the skills you need to safely return home. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, post-operative functional status as evaluated by a physical therapist in the hospital, and overall evaluation by your hospital team.

Q. Should I use ice or heat after total hip replacement surgery?

Ice should be used for the first several weeks after total hip replacement surgery, particularly if you have a lot of swelling or discomfort. Once the initial swelling has decreased, you may use ice and/or heat.

Q. I have insomnia after total hip replacement surgery. Is this normal? What can I do about it?

Insomnia is a common complaint following hip replacement surgery. Nonprescription remedies may be effective. If insomnia continues to be a problem, medication may be prescribed for you by your primary care physician.

Q. When can I drive a car?

• You should wait to drive a car until after your first follow up appointment after surgery.
• Do not drive while taking narcotic pain medicine because it can impair your judgment and ability to operate the car safely.
• If it is your right hip that is replaced you may start driving as soon as you are not taking narcotic pain medication during the day and walking with a cane.
• If it is your left hip it will be around 4-6 weeks before you will be able to drive.
• Do not use your involved leg to operate machinery until at least 6 weeks after surgery.

Q. When can I return to work or hobbies?

Discuss returning to work or hobbies with Dr. Riddhivardhan or his team. Ask your occupational therapist how your activity restrictions will affect your hobbies.

Depending on the job (manual labor or sedentary work) some will get back to work in 4 weeks. Usually you will begin to go back gradually, half days for example. Normally by 8-12 weeks you can be full time and effort.

Q. When will I be able to walk after surgery?

You will be able to put full weight on your new hip the day of surgery. You will probably need a walker or crutches at first but should be able to progress to walking without any assistive devices, usually at 4-6 weeks after surgery. This is directed by a patient’s confidence and comfort.

Q. What are my restrictions after surgery?

You will need to keep your knee and hip flexion around 90 degrees and do not cross your legs for 6 weeks after surgery. You will need to sleep with a pillow between your knees for that time period as well.

Q. Is swelling of my knee, leg, foot and ankle normal?

Yes, for three to six months. Typically swelling becomes most significant 7-10 days post op. To decrease swelling, elevate your leg and apply ice for 20 minutes at a time (3-4 times a day). If swelling is unresponsive to ice/elevation and /or associated with calf pain or shortness of breath contact Dr. Riddhivardhan or his staff immediately.

Q. What precautions should I keep in mind?

Inform doctors and dentists of you hip replacement before having any surgery, podiatry procedures, dental work, or other tests or procedures. You may need to take antibiotics.

Q. When can I resume sexual activity?

You can resume sexual activity after 2-3 weeks, but on a firm mattress. Be the passive partner for the first 6 weeks after surgery or use a less dominant position.

Q. When do I follow up with Dr. Riddhivardhan and his team?

• 10-14 days post operative for wound check, x-ray, removal of staples, discussion of pain management and DVT management
• 6 weeks post op for wound check, discussion of any problems and activities
• 6 months post op for X-ray and evaluation
• 1 year post op for X-ray and evaluation
• 2 years post op for X-ray and evaluation
• 5 years for x-ray and evaluation

Q. When should you call Dr. Riddhivardhan office?

• Your surgical leg is cool to the touch, dusky in color, numb or if it tingles
• You develop a temperature of 101.6 degrees Fahrenheit or higher
• Your incision is red, tender, has drainage, or signs of infection: pain, swelling, redness, odor, warmth, and/or green or yellow discharge
• You develop bright red bleeding from your incision
• You have nausea and vomiting that won’t stop
• You have severe pain that cannot be relieved with typical pain mediation dose
• You have signs/symptoms of a stroke
• You have sudden onset of difficulty breathing at rest

Q. How long can I expect the new hip to last?

Current studies show that 5% of hip replacement patients are reoperated on before 10 years for a variety of reasons, such as infection, loosening, or fracture. With current technology it is extremely rare for a knee replacement to “wear out”. We would expect you to have a 95% chance of being satisfied with you knee in 10 years and a 90% chance of being satisfied in 20 years