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Dr. John M. Keggi JOHN M. KEGGI
M.D
Dr. ROBERT EDWARD "TED" KENNON ROBERT EDWARD "TED" KENNON
M.D
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Most patients have minimal or no pain by 3 months (or sooner) after hip replacement or resurfacing, and the majority return to our office and report that their discomfort level, activity, and quality of life are all dramatically improved. However, it is not unusual to have occasional muscle aches and persistent (but usually slight) swelling of the thigh and extremity for several months.

Depending on numerous factors, including the surgical approach, amount of surgical work needed, and particularly the state of the musculature around the hip before surgery, some persistent limp is usually expected for a while. In some cases, a limp may be persistent for a long time after surgery (most often for a patient who has had significant muscle atrophy - or wasting - from longstanding disuse of the hip prior to surgery).

Returning To Work

There is a wide variation in how soon patients return to work. It primarily depends on what you do and also on your physical condition before surgery. Obviously, a young person who is in good health aside from a bad hip will be back to work much sooner than a patient who is severely overweight and deconditioned or who has multiple other medical problems, but most patients get there eventually if their health is reasonable and they work at the rehabilitation.

Some patients return to desk jobs within several weeks. Others who have very physical jobs, such as laborers, may need to take 10 to 12 weeks until they are able to meet the demands of their job.

Essentially, we recommend that everyone returns to work when they can function safely and with reasonable comfort. Each patient is responsible for determining if he or she can safely perform the activities of his or her job (no one else knows what the job entails better than the person who has to perform it!). If there is some accommodation by the workplace (e.g., to allow someone who normally works a standing job to do light duty at a desk for a short while), most patients are back to at least some limited work by 6 weeks, and physically demanding duties typically about a month after that.

Every patient is different, and while surgeons can offer some estimation of the average time recovery will take, it may vary considerably.

Activities after Total Hip Replacement

In general it is best to avoid impact activities after hip replacement. Although some patients engage in activities such as jogging or contact sports, they usually do so against medical advice. It is best to avoid situations where repetitive impacts or sudden jolts might occur. Impacts will decrease the life of the replacement and increase the likelihood of early loosening, possibly necessitating revision surgery.

Low impact activities such as walking, golf, cycling, swimming, hiking, or ballroom dancing are good sources of activity and cardiovascular exercise, and these activities are well tolerated by most joint replacements (assuming your general medical condition allows such activities). Skiing on gentle slopes is usually safe, although we recommend against downhill skiing that involves significant twisting and turning. Most joint replacements will last for many years with proper care and low impact activities.

Some patients enjoy yoga or pilates, and these activities are usually fine for routine exercise with some modification to accommodate the range of motion recommended by your surgeon. However, it is best to avoid awkward positions and hyperflexion of the hips. Certainly, touching the toes to the ground over your head is a risky position and may lead to dislocation! In general, it is usually best to try to keep hip flexion limited to 100 degrees or less after total hip replacement. Some types of hip replacements (e.g., large diameter alternative bearing surfaces, such as metal on metal or ceramics) are designed for greater range of motion than this, and it is best to ask your surgeon if you have questions about your specific range of motion limitations after surgery.

Sex After Hip Replacement

Another topic that patients are often afraid or embarrassed to ask about is sex after hip replacement (that's why I put it in the book!). Most patients can resume sexual activity 4 to 6 weeks after routine hip replacement if they are otherwise healthy enough.

Generally, the missionary position is safe for both men and women once they feel comfortable enough to resume activities. One area of caution for women is to not hyperflex the hips too far (usually not greater than 100), but in general, the hips are also abducted (e.g., spread apart) at the same time so that the position tends to be stable.

Straddle position, with the woman on top, tends to be safe for both men and women with hip replacements also (it can be a problem for patients with knee replacements, however, as kneeling is generally uncomfortable).

If you have more creative positions in mind, most things can be accommodated with some common sense and by going slowly. The principal concerns with hip replacements are dislocation by flexing the hips too much or bending over too far to touch the toes. If you have a concern about a particular activity, it is probably best to just ask your surgeon about it rather than do something risky.

Activities After Hip Resurfacing

In contrast to total hip replacements, we do not usually place any specific restrictions on hip resurfacing patients once they are completely healed from the surgery. Although dislocation is possible, it is exceedingly uncommon and difficult. Hip resurfacings can generally tolerate the same types of motion and activity that a native hip can.

One particular area of concern, however, is the possibility of weakened bone in the femoral neck after prolonged inactivity, or particularly in a patient who has had avascular necrosis and possible weakening of the femoral neck. Unlike a total hip replacement, the hip resurfacing keeps the bone of the femoral neck, and if it is substantially weakened there is some reported risk of fracture. In these situations of prolonged inactivity or avascular necrosis, it is best to avoid impact activities for about 1 year after the surgery. Some studies have shown that after a year has passed with restoration of the patient's ability to get around, the bone density in the femoral neck region increases so that weakened bone is no longer as much of a concern. If there is any concern, follow-up bone density scans can be helpful.

Going To The Dentist

In the past, most surgeons have typically recommended the use of prophylactic antibiotics before dental procedures. The reason has been that with dental work, there is often bacteria in the bloodstream for a short while afterwards that (at least theoretically) may lead to infection of the joint replacement. This concept is not limited to prophylaxis after joint replacement surgeries; many cardiologists also recommend antibiotics for patients with heart valve problems for the same reason.

In reality, there are bacteria in the bloodstream on many occasions (such as after brushing your teeth), and the risk of infection of an artificial joint is very low.

There are however some situations in which antibiotics are recommended. The American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) have jointly met and issued some guidelines regarding when antibiotics should and should not be used before dental work. Because this information also applies to knee replacements, there is an appendix with these guidelines at the back of this book.

Longevity of the Implants

Most patients want to have some idea of how long they can expect their hip replacement or resurfacing to last. This is highly variable, however, and there are many factors that contribute to the longevity of the implants used.

Impact activities (running, basketball, and other sports) will increase the likelihood of loosening for a total hip replacement. In addition, most total hip replacements are not designed for these types of sports activities, although hip resurfacings can be. Hip resurfacings can loosen over time, but evidence thus far appears to suggest that they do so less often than hip replacements.

Patient weight has a significant influence over how long the replacements will last. Heavier patients place a larger load on the implants, but conversely, they often are less active (e.g., take fewer steps in a year).

The type of bearing material used factors into longevity. Metal on metal and ceramic on ceramic bearings probably last the longest, followed by hybrid materials, and lastly by traditional metal on plastic bearings. Hip resurfacings are metal on metal bearings and last a long time.

Factors unrelated to the implants may shorten their lifespan, such as infection or trauma. I have treated patients who fell off of ladders or the roof (while cleaning out gutters) who fractured the bone around the implant, necessitating wiring or revision. In general, it usually takes the same amount of energy required to break a bone to damage the replacement, however.

Younger patients wear out their replacements more quickly than older patients. For this reason, many surgeons in the 1980's and 1990's recommended waiting as long as possible before replacing joints in young patients. While we still wait until all conservative (nonoperative) treatments are exhausted, we now recognize that the implants and technology have evolved to the point that even young patients can expect years of use before requiring revision surgery, and hip replacement or resurfacing can now give severely impaired patients their mobility and life back.

Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.