Hip Replacement Surgery: What to Expect on the Day of Surgery

When hip replacement surgery is performed, the damaged bone and cartilage of the hip joint are removed and replaced with prosthetic parts made of some combination of metal, ceramic, or plastic. These prosthetic parts recreate a healthy ball-and-socket hip joint that is painless and allows for normal hip function after proper recovery and rehabilitation.

Before the Surgery

On the day of your hip replacement surgery, you will first go to a pre-operative room where you will change into a hospital gown. An operating room nurse will then check your vital signs and place an IV in your arm. This IV is used to give you fluids, an antibiotic, and anesthesia medications prior to/during the surgery.

Next, your orthopedic surgeon and anesthesiologist will come to say hello and briefly review the surgery with you. You may need to sign additional consent forms at this time.

Lastly, you will be wheeled into the operating room on a gurney where the anesthesia process will start.

The types of anesthesia that may be used for hip replacement surgery include:

• General anesthesia: An anesthesiologist will give you intravenous or inhaled medication that will render you temporarily unconscious. After you are asleep, the anesthesiologist will insert an endotracheal tube and deliver oxygen to assist in breathing.
• Regional anesthesia: An anesthesiologist will inject a numbing medication into a part of your body, usually your lower back (called a spinal or epidural block), or around the nerves in your hip (called a peripheral block). You will be conscious, but you will not feel any pain or other sensations in the numbed part of your body. Oftentimes, a small catheter is also placed at the injection site so that more local anesthetic can be infused after the surgery to help control your pain. In order to feel relaxed or even fall asleep, most patients are given a sedative when undergoing regional anesthesia.

The type of anesthesia that will be used during your procedure is usually chosen ahead of time. The choice is based on your preference and whether you have any underlying health conditions.

Surgeons tend to prefer regional anesthesia, as it is associated with less blood loss, less nausea and sedation, and improved pain control after the surgery.

During the Surgery

Hip replacement surgeries are traditionally performed by the surgeon making a large incision over the hip joint. This approach is sometimes replaced by a minimally invasive approach, which instead requires one or two smaller incisions. Research suggests no major benefit to using one approach versus the other.

A traditional hip replacement surgery takes around one to two hours and generally proceeds in the following fashion:

• Once anesthesia is administered, a member of the surgical team will clean the skin over your hip with an antiseptic solution to kill any bacteria. Sterile drapes will also be applied around the surgical site, both to keep you warm and prevent infection.
• Your surgeon will make an incision either behind (posterior), to the side of (lateral), or in front of (anterior) your hip. The muscles attached to the hip are then split or detached, exposing the joint.
• The surgeon will then cut and remove the damaged ball of the joint (the femoral head).
• The damaged cartilage and bone of the socket (part of the pelvic bone called the acetabulum) are then scraped away, leaving a smooth, perfectly rounded surface. A metal cup is then inserted to serve as the new socket. Screws or bone cement may be used to keep it in place.
• A liner made of plastic, metal, or ceramic is then pressed into the cup to create a smooth surface so the hip can move freely.
• Next, the surgeon focuses on the thighbone (femur). After hollowing out the end of the femur, a long metal stem is placed into the hollow space. This stem can either be fixed into the femur with cement or press-fit (wedged tightly) into the bone. Over time, bone grows into the implant, further securing it.
• A metal or ceramic ball is then tightly fit on top of the metal stem. The ball is placed into the cup.
• Once the prosthetic parts are placed, the incision site is closed with stitches or surgical staples. A bandage is then placed over the surgical wound.
• Finally, the anesthesia medication is stopped and the breathing tube (if one was used) is removed. You will then be taken to a recovery room.

After the Surgery

In the recovery room, you will wake up from the anesthesia or sedating medication. A nurse will monitor your vital signs and manage common post-operative symptoms like pain and nausea.

Once you are alert and your symptoms are under control, you will be taken to a hospital room to recover for approximately one to three days. If your hip replacement is performed in an outpatient surgical center, you will be discharged home to recover.

During your hospital stay you can expect the following:

• If you do not have a Foley catheter, you will use the bathroom with the assistance of a nurse right after surgery. (A Foley catheter may have been placed in the operating room and is usually removed by the first day after surgery).
• Your pain will be initially controlled with intravenous (IV) pain medication and pain medicine administered through a catheter (if regional anesthesia was given). You will be switched to all oral medications prior to discharge.
• Ice packs will be placed over your hip to minimize swelling and pain.
• You will wear compression devices on your legs and be given a blood thinner (an anticoagulant) to prevent blood clots.
• To prevent pneumonia, you will use a breathing device called an incentive spirometer at least 10 times per hour when awake.
• Within a day after your surgery, you will meet with a physical therapist who will help you perform bedside exercises and eventually, assist you out of bed.
• Usually the day after surgery, you will begin eating meals, as tolerated, while sitting up in bed.
• Prior to being discharged, you will be able to walk with a walker and climb stairs with your new hip.

As you recover at home, you will have various post-operative instructions to follow, such as:

• Taking your medications as prescribed, which will include pain medication and an anticoagulant.
• Following up with your surgeon as instructed for stitches or staple removal (usually around two weeks after the surgery).
• Engaging in at-home exercises and using a walker (for the first two to four weeks) followed by a cane, as advised by your physical therapist. Rehabilitation is an essential part of your recovery. Exercises will focus on increasing your new hip's range of motion and strength.

A Word From Verywell

Most patients are very satisfied with the outcome of their hip replacement surgery, relishing in their restored ability to participate in both routine and pleasurable activities again without pain. That said, everyone's post-operative experience is a bit different.

To ensure you are not disappointed in your surgical outcome, it's important to discuss realistic expectations of the procedure with your surgical team before proceeding.