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Lymphedema and Total Hip Replacement


Related Terms:  TKA, Arthroplasty, hip arthroplasty, hip prosthesis


From time to time there have been numerous questions posted on the lymphedema boards regarding complications involved with total hip replacement for those with lymphedema. There is only a limited amount of information available and only one published report of follow up with lymphedema patients undergoing a major joint replacement and it is on knee replacement.

In that report the overall total complication rate was 31% in a group of  63 lymphedema patients.  There were ten superficial wound infections, six deep infections and three deep venous thrombosis.  The report does also conclude that despite the complications there was a significant improvement in joint  function and patient mobility. 

This is apparently further verified by the random discussions of list members who have undergone the surgery.  The other most commonly mentioned complications or set backs include an increased time of post surgical rehabilitation and a temporary increase in the lymphedema as a result of not being able to undergo decongestive massage therapy.

Since this page was first published, the report continues to be quite good for lymphedema patients in our groups that have had hip replacement.  Infection continues to be the biggest problems and foremost complication. 

There is also documentation in the medical literature of lymphedema being triggered by joint replacement, but it is quite rare.

Anatomy of the Hip

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

See the entire article on total hip replacement  in the OrthoInfo page link below.


May 4, 2008

Preoperative Considerations for Lymphedema Patients:

1.   For the prevention of infection and/or to lower the risk of infection it may be necessary for you to be on a preventative therapy of antibiotics BEFORE surgery.

2.   For the prevention of blood clots (venous thrombosis) and based on any additional underlying medical conditions, you should also discuss the possibility of being on blood thinners before the surgery.

3.   Make arrangements and plans for the scheduling and/or resumption of decongestive massage therapy for the lymphedema after the surgery.

4.   Be sure to have your PCP, surgeon and lymphedema therapist working together to design a treatment/therapy modality that is best for you.

5.   Familiarize yourself with the hip replacement surgery so that you will know what to expect.  There are also support groups of patients undergoing this that you may want to participate in. What type of surgery will the doctor do? The standard THR procedures or any of the less intrusive methods?

6.   Before the final decision to have a hip replacement discuss alternatives. It is possible for non-steroidal anti-inflammatory drugs (NSAIDs) to help or COX-2 inhibitors. With consideration of surgical complications, it is important to try all methods of treatment before a surgery is planned.

7.   What happens if the hip wears out? Hip  replacement have an average usage expectancy from between eight to twenty years.  What are the considerations of the need for a future second surgery affect your lymphedema.

8.   If you are obese or morbidly obese discuss how the added strain of the surgery will affect your lymphedema.

9.  Be sure to understand the specifics of what you can or can't do, how long you will be off work, financial arrangement and the need for personal assistance you may have.

10. Discuss lymphedmea self care before the surgery. Your lymphedema therapist will, based on your personal situation let you know when you will be able to resume bandaging, wearing compression garments and/or use compression sleeves.

Possible Complications of Hip Replacement Surgery

The most common complication is blood clots in the legs. The most serious complication is infection. The most important long-term complication is loosening or wear.
Bloodclots in the veins of the legs are the most common complication of hip replacement surgery. As long as the clots remain in the legs they are a relatively minor problem. Occasionally they dislodge and travel through the heart to the lungs (pulmonary embolism). This is potentially serious, since (very rarely) death can result from embolism. The chances of embolism are one out of several hundred. The internist will prescribe Coumadin (a blood thinning drug) to help prevent clots from forming after your surgery. Additionally, compressive calf pumps are used and leg exercises are encouraged to prevent blood clots. Blood clots can occur despite all these precautions. They are usually not dangerous if appropriately treated, but may delay your discharge from the hospital by two to three days.

Infection. Pioneer surgeon John Charnley found that the risk of infection after joint replacement was much greater than with most other operations, unless special precautions are taken. Since bacteria can enter the open wound at the time of the surgery in a regular operating room, he invented the laminar flow operating room in which special filters provide clean air, free of most bacteria. In addition, Charnley devised a sterile space suit for the surgeon and his attendants. The suite encloses the entire head and body, and includes a sterile face mask. Antibiotics given to you before, during and after the operation further help to lower the rate of infection. The risk of an infection in first-time hip replacement is currently reported as being about 0.5%.

The artificial joint can become infected many years after the operation. The bacteria travel through the bloodstream from a source elsewhere in the body, such as from an infected wound, or a gall-bladder infection. Even regular dental work can release bacteria into the blood. Infections of the bladder, teeth, prostate, kidneys, etc. should be cleared up by appropriate treatment well before the day of surgery. Patients who have had joint replacements must take antibiotics by mouth before and after any dental work and must have all infections vigorously treated.

Loosening of the prosthesis from the bone is the most important long-term problem. How long the bond will last depends on a number of factors.
  1. How well the surgery is done. This is by far the most important factor. Choose a surgeon who has had a great deal of experience with hip replacement, and preferably one who restricts his practice to joint replacement surgery.
  2. The quality of your bones. The harder your bones are, the better the bond will be, and the longer the replacement will last. Osteoporosis is a factor of age, as well as the type of arthritis you have. People with rheumatoid arthritis have especially soft bones.
  3. How active you are. Excessive force on the implant can cause the bond to loosen. If you stayed in bed for the rest of your life the implant will probably never come loose! Activities such as running and heavy lifting should be avoided. The key thing is to use common sense. .
  4. Your weight. You should also keep your weight down because every pound you gain adds three pounds to the force on the hip.
  5. Whether or not the implant is cemented. At present it is believed that uncemented implants will last longer than cemented ones. We are not certain that this will be the case, even though the results so far are extremely good and promising with cementless implants.
  6. The design of the implant. Small abrasion particles from the implant may play a role in implant loosening. Plastic surfaces shed more particles than metal or ceramic ones.
Wear of the Plastic Polyethylene Socket starts from the day of surgery. The plastic socket is the weakest link in the implant. The rate of plastic wear against a metal ball is about 0.1 millimeters per year, but is more rapid in very active patients. “Cross-linked” polyethylene promises a wear rate about half that of regular poly. Plastic wear against a ceramic ball is much less in the lab, but this has not yet been shown to be true in the human body. Metal-on-metal bearings will never wear out. Nor will ceramic-on-ceramic implants, but there is a 1/20,000 risk of fracture of the ceramic ball. Many doctors use and recommend metal on metal implants, or ceramic on ceramic implants for those patients who want them, and have a life expectancy of more than fifteen years. In all others cross-linked polyethylene may be recommended. (“Marathon” Polyethylene from Johnson & Johnson).

Dislocation of the hip replacement occurs in a small percentage of patients regardless of how good your surgeon is (some surgeons report as high as 4%). Dislocation means that the metal ball slips out of the plastic socket. In the first six weeks after the surgery, the ball is only held in the socket by muscle tension. During this time, before scar tissue forms around the ball, and before muscle strength returns, the hip is more likely to dislocate.

The physical therapist will teach you what positions to avoid, and how to safely use your hip replacement during this early phase of your recovery. If the hip does dislocate, it is usually a simple matter for the physician to pull on the extremity and “pop” the hip back into place . Revision hip replacements, replacements in people who are grossly overweight and replacements in people with poor muscles are more likely to dislocate. Occasionally patients develop repetitive dislocations, requiring a brace to be worn for several months to prevent further dislocation. Sometimes further corrective surgery is needed to solve the problem.

Extra bone formation (ectopic bone) around the artificial hip develops less than 1% of the time. It causes the hip to be stiffer than desired. This is more likely to occur in younger males with severe osteoarthritis. Small amounts of ectopic bone appear frequently around hip replacements but do not cause a problem. Very large amounts causing severe stiffness is rare. It can be treated by surgical removal of the bone once it is “mature.” Radiation therapy may be recommended by Dr. Huddleston to try and prevent ectopic bone formation if he believes a particular patient is likely to develop it. Such radiation treatment is administered during the first 2 or 3 days after surgery, or on the day before surgery. If you need radiation, the risks will be discussed with you by the radiotherapy doctor. The risks are negligible.

Fracture of the femur can occur during hip replacement. This can be a small crack or a major fracture. It is more common during revision hip surgery, but can occur with first time hip replacement. Occasionally the femur may be accidentally perforated during first time or revision hip surgery. It can also fracture later from any trauma, such as falling down stairs. If your femur is accidentally cracked during surgery, you may have to remain on crutches for up to 3 months to allow healing to occur. You may have to remain in the hospital with traction for several weeks. Complete fracture may require separate surgery for fixation. Small cracks may need to be treated with “circlage” wires.

Residual pain and stiffness can occur. In virtually all cases hip replacement will make a significant improvement in your pain and mobility. In most cases, you will have no pain at all, and the hip will feel “normal.” The completeness of the pain relief, and the degree of mobility is partially determined by your hip problem before surgery. Rarely, patients have pain after surgery which cannot be explained. Some patients with un-cemented hip replacements develop mid thigh pain. The pain is usually mild, and almost always resolves after 18 to 24 months. It has been found that the larger the diameter if the implant installed the more likely “thigh pain” will develop. 

The length of the leg may be changed by the surgery. Getting leg lengths exactly right can be very difficult. Some leg length difference may be unavoidable. Sometimes the leg will be deliberately lengthened in order to stabilize the hip or to improve muscle function. Shoe lifts may be necessary if the difference is more than a quarter of an inch. When the leg is more than an inch short to begin with, it may be impossible to equalize the legs for fear of damaging the nerves to the legs. In the first weeks after surgery, most patients complain that the operated leg feels “too long” even when the legs are perfectly equal in length. This is an artificial sensation which will resolve itself after a few months 

Injury to the arteries or nerves of the leg is an exceedingly rare but possible complication. The major arteries of the leg lie close to the front of the hip joint. The damaged vessel can usually be repaired by a vascular surgeon if recognized in time. If the nerves to the leg are injured, they usually recover; but it may take 6 months or more. Occasionally, they don’t recover at all. Most patients have some numbness around their wounds which may be permanent.

Bleeding complications.

  1. Sometimes bleeding can occur into the wound in the days after surgery (“hematoma formation”) as a result of the use of blood thinners. It may distend the hip and cause dislocation. If it is excessive, it may require re-opening the wound under anesthesia to let the blood out.
  2. Occasionally the blood thinners may cause bleeding into the urine (or elsewhere), but this is usually temporary, and not of serious consequence.
Anesthetic complications can occur, and very rarely even death can occur from the anesthesia. Your anesthesiologist will see you before surgery and explain the risks involved.

Allergy to the metal parts About 15% of the population has skin sensitivity to some metals. All metal implants release some metal ions into the body. However, reports of proven allergies to metal implants are surprisingly rare. You should notify Dr. Huddleston if you believe you have a metal allergy. People who know they have metal allergies should be tested with extracts of the various metal components of the implant prior to surgery. The tests are not reliable, so they are only performed if a metal allergy is suspected. Allergy to the plastic parts has never been reported. Small particles of plastic or metal from the implant may cause a “foreign body” reaction in the bone, but this is not a true allergy. Some patients with metal implants have had temporary, mild skin rashes, while some have had severe rashes that resolved only with removal of the implant. If you are known to be sensitive to nickel, chromium or cobalt you should probably have a titanium implant, even though there have been reports of allergy to titanium as well. There is no evidence that metal-on-metal implants are harmful in any way, or are more likely to cause metal sensitivity, or that implants are more likely to fail in patients allergic to metals.

Complications From Blood Transfusions. The risks of getting AIDS from banked blood is believed to be about 1 in 2,000,000. The risk of Hepatitis B is estimated to be approximately 1 in 550 units, and Hepatitis C is 1 in 100. The risk of disease transmission from directed blood  may be the same a the risk from ordinary banked blood. The risk of an allergic reaction (hives) is 1 in 500. You can have an allergic reaction to donor blood even though it has been properly cross matched. The risk of a Hemolytic Transfusion Reaction is 1 in 10,000. The risk of a Fatal Hemolytic Transfusion Reaction is 1 in 100,000.

All blood intended for transfusion (including your own) is screened by the blood bank for Hepatitis B virus, Hepatitis C virus, syphilis, Human T Cell Leukemia virus, and the AIDS virus. If cadaver bone is used as part of revision hip replacement, there is some risk of transmitting disease, just as with blood transfusion. The bone is screened for 6 months before being used.

Fat Embolism. Fat from the bone marrow can get into the circulation and cause lung or neurological symptoms. This is a very rare complication. In very rare cases it can be fatal.

Other minor complications can rarely occur, such as tape allergies, allergies to medications, skin rashes and so on. You should keep in mind that the chances of any significant complication that permanently affects the overall result and your satisfaction with the joint replacement are very small.

Special thanks to the Hip and Knee Institute - Tarzana, California


Revision Hip Surgery

Cemented hip replacements may fail after 10 to 15 years, or occasionally sooner. The parts may come loose or wear out, or they may break. In some patients with cementless implants, the porous surfaces may not bond properly to the bone. Loose, worn or broken parts may need to be replaced (“revision surgery”).

It involves longer operating time and increased blood loss, and may require an increase in the length of the hospital stay. A mini-incision operation is not possible for revision surgery, even though some revision cases are relatively straightforward. Much depends on how difficult it is to remove the prosthesis, and on the quality and quantity of bone left behind after the implant has been removed. The trochanter bone may need to be cut to remove the implant. Wires may be needed to hold the parts together until the bone has healed. Bone grafts from your pelvis and/or from a bone bank may be needed if defects need to be filled with bone. With bank bone, infections can be transmitted in the same way as with blood transfusions.

There is a chance that your leg may be shorter or longer than it was before the operation. The femur bone can be fractured during surgery, requiring extra repair procedures. The range of motion may be less than after first-time hip replacements. There is a high risk of dislocation for 12 weeks after revision hip surgery, and restrictions must be continued for at least that long to prevent dislocation. Patients who have revision operations are frequently advised to use a cane full-time, in order to protect the replacement from re-loosening.

These complex operations are much riskier than first-time hip
replacement surgeries. All the risks associated with first-time hip replacements are present, but the chances of complications occurring are greatly increased. These are among the most difficult procedures performed in orthopedic surgery.


Commonly Asked Questions After Hip Replacement

How long will I be in the hospital? 3 - 4 days

Can a family member stay with me in the hospital? Only if you are in a private room.

How long is the incision? 10 - 12 inches long, located more to the back of your thigh

How long does the surgery take? Approximately 2 ½ hours

What time will my surgery be? You will be notified the day before surgery by the operating room as to the time to report to the hospital for surgery. The orthopaedic staff has no control over this.

What is the implant made of? Metal and plastic

Will it set off alarms? Yes, if more than one joint. Especially in the areas where the technology is more sensitive (i.e. larger airports)

When will I get out of bed? You will get out of bed the day after surgery.

How long will I need to follow hip precaution? The minimal time is 6 weeks. However, your doctor will provide you with more information at your follow-up appointment. It will be based on results from the x-rays, physical therapy and your activity level.

How long do I have to use the abductor pillow (blue wedge pillow provided on day of surgery?) 6 weeks

When can I drive? We request that you not drive for 6 weeks. If you have an automatic, and the surgery has been on your left hip, please discuss with your doctor at your 2-week follow-up appointment.

When can I shower? 24 hours after the staples have been removed. Staples are usually removed 12 - 14 days from the day of surgery.

Why can't I move my operated leg? Many muscles were cut to put in the artificial hip joint. These muscles are very weak and you will need assistance and training on how to properly move your leg after surgery.

What time do I need to leave the hospital? We strive to have patients discharged by 11:00 a.m. on day of discharge.

May I use ice packs to help decrease pain and swelling? Yes, ice is very useful in helping to relieve these symptoms. It may be used immediately after surgery and until your pain and swelling decrease. (DO NOT get the wound or dressing wet; use a water tight ice pack.)


From the British Lymphoedema Support Network (LSN) Newsletter.

Questions and Answers

The LSN's Chief Medical Adviser, Professor Peter Mortimer, MD, FRCP
Professor of Dermatological Medicine attended a meeting in March 2001 at the
Royal Marsden Hospital Chelsea and answered members' questions.

Question: Do you recommend hip or knee replacements?

Answer: My attitude has changed somewhat. Previously I was hesitant to
recommend joint replacements for patients with lymphoedema because of the
problems of poor healing, seepage or infection. But now that the replacement
operations are more generally performed, I have begun to see lymphoedema
patients who have successfully had it done. And, after all, if your mobility
deteriorates, your lymphoedema will get worse, so it's a Catch 22 situation.

The big enemy is the danger of infection in the prosthesis. Many orthopaedic
surgeons write and ask me what I would recommend at the time of the
operation to prevent problems. I say that the antibiotics are crucial and
obviously trying to reduce the swelling both before and after the operation
minimises problems.

We have been trying to audit lymphoedema patients who
have had a hip or knee replacement and we would like to know through the LSN
of patients who have had this done successfully.

Question: I have had lymphoedema for 35 years and it does not get any
better..... and have now developed arthritis of the knee.

Answer:  As far as joint replacements are concerned, which is of course an
option, I used to say "If you cannot walk very well, it does not help the
lymphoedema and you are probably in pain". More and more lymphoedema
patients are having joint replacements and in general if we have managed to
avoid infection and look after the lymphoedema, the likelihood of problems
seems to be small. More mobility afterwards means that exercise will help to
keep the lymph moving, but make sure the orthopaedic surgeon is fully aware
of lymphoedema and what should be done.


Hip joint replacement

Questions and Answers about Hip Replacement

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Publication Date: January 2001

Questions and Answers about Hip Replacement

What Is a Hip Replacement?

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery are to improve mobility by relieving pain and improve function of the hip joint.

Who Should Have Hip Replacement Surgery?

The most common reason that people have hip replacement surgery is the wearing down of the hip joint that results from osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

Before suggesting hip replacement surgery, the doctor is likely to try walking aids such as a cane, or non-surgical therapies such as medication and physical therapy. These therapies are not always effective in relieving pain and improving the function of the hip joint. Hip replacement may be an option if persistent pain and disability interfere with daily activities. Before a doctor recommends hip replacement, joint damage should be detectable on x rays.

In the past, hip replacement surgery was an option primarily for people over 60 years of age. Typically, older people are less active and put less strain on the artificial hip than do younger, more active people. In recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain. A more important factor than age in determining the success of hip replacement is the overall health and activity level of the patient.

For some people who would otherwise qualify, hip replacement may be problematic. For example, people with chronic diseases such as those that result in severe muscle weakness or Parkinson's disease are more likely than people without chronic diseases to damage or dislocate an artificial hip. Because people who are at high risk for infections or in poor health are less likely to recover successfully, doctors may not recommend hip replacement surgery for these patients.

What Are Alternatives to Total Hip Replacement?

Before considering a total hip replacement, the doctor may try other methods of treatment, such as an exercise program and medication. An exercise program can strengthen the muscles in the hip joint and sometimes improve positioning of the hip and relieve pain.

The doctor also may treat inflammation in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen. NSAIDs also include Celebrex* and Vioxx, so-called COX-2 inhibitors that block an enzyme known to cause an inflammatory response. Many of these medications are available without a prescription, although a doctor also can prescribe NSAIDs in stronger doses.

* Brand names included in this booklet are provided as examples only and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. Corticosteroids are not always a treatment option because they can cause further damage to the bones in the joint. Some people experience side effects from corticosteroids such as increased appetite, weight gain, and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter the body's natural hormone production, patients should not stop taking them suddenly and should follow the doctor's instructions for discontinuing treatment.

If physical therapy and medication do not relieve pain and improve joint function, the doctor may suggest corrective surgery that is less complex than a hip replacement, such as an osteotomy. Osteotomy is surgical repositioning of the joint. The surgeon cuts away damaged bone and tissue and restores the joint to its proper position. The goal of this surgery is to restore the joint to its correct position, which helps to distribute weight evenly in the joint. For some people, an osteotomy relieves pain. Recovery from an osteotomy takes 6 to 12 months. After an osteotomy, the function of the hip joint may continue to worsen and the patient may need additional treatment. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.

What Does Hip Replacement Surgery Involve?

The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This "ball and socket" arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities.

During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours.

Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a "cemented" procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient's own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a "hybrid" replacement, which consists of a cemented femur part and an uncemented acetabular part.

Is a Cemented or Uncemented Prosthesis Better?

Cemented prostheses were developed 40 years ago. Uncemented prostheses were developed about 20 years ago to try to avoid the possibility of loosening parts and the breaking off of cement particles, which sometimes happen in the cemented replacement. Because each person's condition is unique, the doctor and patient must weigh the advantages and disadvantages to decide which type of prosthesis is better.

For some people, an uncemented prosthesis may last longer than cemented replacements because there is no cement that can break away. And, if the patient needs an additional hip replacement (which is likely in younger people), also known as a revision, the surgery sometimes is easier if the person has an uncemented prosthesis.

The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, people with uncemented replacements must limit activities for up to 3 months to protect the hip joint. The process of natural bone growth also can cause thigh pain for several months after the surgery.

Research has proven the effectiveness of cemented prostheses to reduce pain and increase joint mobility. These results usually are noticeable immediately after surgery. Cemented replacements are more frequently used than cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis.

What Can Be Expected Immediately After Surgery?

Patients are allowed only limited movement immediately after hip replacement surgery. When the patient is in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. The patient may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid and a tube (catheter) may be used to drain urine until the patient is able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.

How Long Are Recovery and Rehabilitation?

On the day after surgery or sometimes on the day of surgery, therapists will teach the patient exercises that will improve recovery. A respiratory therapist may ask the patient to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.

A physical therapist may teach the patient exercises, such as contracting and relaxing certain muscles, that can strengthen the hip. Because the new, artificial hip has a more limited range of movement than an undiseased hip, the physical therapist also will teach the patient proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. As early as 1 to 2 days after surgery, a patient may be able to sit on the edge of the bed, stand, and even walk with assistance.

Usually, people do not spend more than 10 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, the overall health of the patient, and the success of rehabilitation.

How to Prepare for Surgery and Recovery

People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.

Before Surgery

  • Learn what to expect before, during, and after surgery. Request information written for patients from the doctor or contact one of the organizations listed near the end of this document.
  • Arrange for someone to help you around the house for a week or two after coming home from the hospital.
  • Arrange for transportation to and from the hospital.
  • Set up a "recovery station" at home. Place the television remote control, radio, telephone, medicine, tissues, waste basket, and pitcher and glass next to the spot where you will spend the most time while you recover.
  • Place items you use every day at arm level to avoid reaching up or bending down.
  • Stock up on kitchen staples and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.

After Surgery

  • Follow the doctor's instructions.
  • Work with a physical therapist or other health care professional to rehabilitate your hip.
  • Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
  • Use a long-handled "reacher" to turn on lights or grab things that are beyond arm's length. Hospital personnel may provide one of these or suggest where to buy one.

What Are Possible Complications of Hip Replacement Surgery?

According to the American Academy of Orthopaedic Surgeons, approximately 120,000 hip replacement operations are performed each year in the United States and less than 10 percent require further surgery. New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.

The most common problem that may happen soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.

The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation.

Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone).

When Is Revision Surgery Necessary?

Hip replacement is one of the most successful orthopaedic surgeries performed--more than 90 percent of people who have hip replacement surgery will never need revision surgery. However, because more younger people are having hip replacements, and wearing away of the joint surface becomes a problem after 15 to 20 years, revision surgery is becoming more common. Revision surgery is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.

Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the hip show that damage has occurred to the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts, and infection.

What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?

Proper exercise can reduce joint pain and stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most exercise programs begin with safe range-of-motion activities and muscle strengthening exercises. The doctor or therapist will decide when the patient can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are cross-country skiing, swimming, walking, and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.

What Hip Replacement Research Is Being Done?

To help avoid unsuccessful surgery, researchers are studying the types of patients most likely to benefit from a hip replacement. Researchers also are developing new surgical techniques, materials, and designs of prostheses, and studying ways to reduce the inflammatory response of the body to the prosthesis. Other areas of research address recovery and rehabilitation programs, such as home health and outpatient programs.

Where Can People Find More Information About Hip Replacement Surgery?

National Institute of Arthritis and Musculoskeletal and
Skin Diseases Information Clearinghouse

NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366

The clearinghouse provides information about various forms of arthritis and rheumatic disease and bone, muscle, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.

American Academy of Orthopaedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663) (free of charge)

The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist's scope of practice includes disorders of the body's bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.

The Hip Society
c/o Karen Andersen
951 Old County Road, #182
Belmont, CA 94002
Phone: 650-596-6190
Fax: 650-508-2039

The society maintains a list of physicians who are specialists in problems of the hip and provides physician referrals by geographic area.

American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 703-684-2782 or 800-999-2782, ext. 3395 (free of charge)

This national professional organization represents physical therapists, allied personnel, and students. Its objectives are to improve research, public understanding, and education in the physical therapies.

Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or 800-283-7800 (free of charge)
or call your local chapter (listed in the telephone directory)

This is the major voluntary organization devoted to arthritis. The foundation publishes pamphlets on arthritis, such as "Arthritis Answers," that may be obtained by calling the toll-free telephone number. The foundation also can provide physician and clinic referrals. Local chapters also provide information and organize exercise programs for people who have arthritis.


The NIAMS gratefully acknowledges the assistance of Charles A. Engh, M.D., of the Anderson Orthopaedic Research Institute, in Arlington, Virginia; James Panagis, M.D., M.P.H., of the National Institutes of Health; and Clement B. Sledge, M.D., of Brigham and Women's Hospital, in Boston, Massachusetts, in the review of this booklet.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at

NIH Publication No. 01-4907


Hip Replacement Surgery


Total Hip Replacement Illustration



Pelvic lymph tissue



External Links For further information on hip replacement


Total Hip Replacement: A Guide for Patients

University of Iowa Department of Orthopaedics
Peer Review Status: Internally Peer Reviewed

University of Iowa


Total Hip Replacement


My Bad Hip A Melodrama in Three Acts With Additional Notes

by Jim Kunstler


Hip Replacement

Last Updated: June 20, 2002

Author: Jon A Jacobson, MD, Clinical Associate Professor, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan


Preparing for Joint Replacement Surgery

American Academy of Orthopaedic Surgeons


Total Hip Replacement  

American Academy of Orthopaedic Surgeons


Hip Implants

American Academy of Orthopaedic Surgeons


Hip replacement: Relieve pain, improve mobility

Mayo Clinic


New Hip Implants No Better Than Older Ones, Study Finds 

Medline Plus


Procedural Codes ICD-9-CMV3


Abstracts and Studies


Individuals' expectations and challenges following total hip replacement: a qualitative study. Jan 2012

McHugh GA, Luker KA.


School of Nursing, Midwifery & Social Work, University of Manchester , Manchester , UK.


Purpose: Hip replacements are one of the most common operations for individuals with hip osteoarthritis. There have been numerous quantitative studies investigating the recovery from joint replacement surgery and these show how effective and satisfied patients are. However, little qualitative work has been conducted to explore patients' actual experiences. Therefore, this study aimed to detail the experiences of individuals undergoing a total hip replacement (THR) to determine whether their expectations were met. Method: The qualitative study was nested within a longitudinal study (n = 215) that was investigating biomedical and psychosocial outcomes from THR. We interviewed a purposive sample of individuals (n = 25) 6 months after THR to explore their experiences of having a THR. Findings: Participants were aged 48-82 years. They felt disabled following the THR and some had unrealistic expectations of recovery. Most of them received minimal information and health professional support. Participants had to overcome a number of challenges such as diminished confidence, frustration over slow progress and reduced physical functioning. Conclusion: Individuals undergoing THR need to have the opportunity to discuss their expectations of THR, so there is no "false optimism". Support requirements, following THR, need to be reviewed as they were often underestimated by patients and health professionals.


Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature. 

Jan 2012

Thabet AM, Catagni MA, Guerreschi F.


Orthopedics Department, Benha Medical School, Benha, Egypt,

Keywords  Pelvic support – Ilizarov – Arthroplasty – Lengthening


Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome. 



Scientists Identify Two Key Risk Factors for Hip Replacement in Women

Researchers funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases have determined that excess body weight and older age increase a woman's chances of needing a total hip replacement to treat osteoarthritis.

Matthew Liang, M.D., M.P.H., Elizabeth Karlson, M.D., and Lisa Mandl, M.D., M.P.H., and their colleagues at Harvard Medical School studied 568 participants from the ongoing Nurses Health Study who received a hip replacement to treat hip osteoarthritis. The researchers examined risk factors--including body mass index, use of hormones after menopause, age, alcohol consumption, physical inactivity and cigarette smoking--for hip replacement. Of these potential risk factors, only body mass index and age were associated with needing a hip replacement. Body mass index is a standard measure of weight in relation to height and is used to estimate body fat. Participants with a high body mass index showed double the risk of having a hip replacement compared with low body mass index participants. The risk from obesity appeared to be established early in life. Participants who had a high body mass index at age 18 showed five times the risk of receiving a hip replacement to treat hip osteoarthritis later in life. Women age 70 and older were nine times more likely to have a hip replacement compared with those under age 55.

According to the authors, this is one of the first long-term prospective studies to show an association between a modifiable risk factor and osteoarthritis. Results suggest that reducing weight may improve quality of life and decrease health care costs related to osteoarthritis.

The Nurses Health Study, from which data were drawn, is one of the largest studies of risk factors for chronic diseases in women. Over 116,000 women are enrolled.

Osteoarthritis is a degenerative joint disease in which cartilage, the slippery tissue that covers the ends of bones in a joint, wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Osteoarthritis is one of the most frequent causes of physical disability among adults. It mostly occurs in older people but can also affect younger men and women.

Support for this study was also provided by the National Cancer Institute and the Arthritis Foundation. NIAMS and the National Cancer Institute are part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services

National Institutes of Health


Social Experience Seen to Influence Joint Replacement Decisions

By Katie Lai

When people think about having a hip or knee replaced, knowing someone who's had the surgery may influence their decision.

Past studies have shown that in certain minority populations, joint replacement is underutilized for treating pain and improving function. Now, a recent study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the Robert Wood Johnson Foundation has shown that one reason African Americans may be less likely than Caucasians to seek joint replacement surgery is because they know fewer people who have had the procedure.

Mary Charlson, M.D., and her research team at Cornell University conducted a 30-minute telephone survey of hip and knee pain and joint replacement surgery in 515 African Americans and 455 Caucasians. According to the results, 42 percent of African Americans and 31 percent of Caucasians reported pain. However, 42 percent of African Americans--compared with 65 percent in the Caucasian group--knew someone who had surgery for the pain. This racial difference in personal contacts with joint surgery recipients may contribute to underutilization of the procedure in African Americans.

For many people, joint surgery helps relieve the pain and disability of severe osteoarthritis. This is the most common type of arthritis that affects millions of people in the United States. In osteoarthritis, the surface layer that cushions cartilage in a joint breaks down and wears away, allowing bones under the cartilage to rub together, resulting in pain, swelling, and loss of joint motion.

Blake VA, Allegrante JP, Robbins L, Mancuso CA, Peterson MGE, Esdaile JM, Paget SA, Charlson ME. Racial differences in social network experience and perceptions of benefit of arthritis treatments among New York City Medicare beneficiaries with self-reported hip and knee pain. Arthritis & Rheumatism 2002;47(4):366-371.

National Institutes of Health


Knee Malalignment is Risk Factor for Knee Osteoarthritis Progression

By Elizabeth Freedman

Researchers funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have found that knee malalignment is a key risk factor in the progression of knee osteoarthritis (OA), a degenerative joint disease that is a major cause of disability in people 65 and over.

The alignment of the hip, knee, and ankle influences how the knee responds to loads, and a knee turned inward or outward is subject to additional stress. Participants in the Mechanical Factors in Arthritis of the Knee (MAK) study with more severe malalignment when the study began showed greater decline in physical function after an 18-month period, according to Northwestern University investigator Leena Sharma, M.D., and her colleagues. The scientists also found that more severe malalignment was associated with greater subsequent loss of knee joint space. Bow-legged knee alignment was associated with a significantly greater chance of OA progression in the inner side of the knee, while knock-kneed alignment increased the chance of OA progression on the outer side of the knee.

According to the authors, the MAK study is the first of its kind to demonstrate knee alignment as a factor in the progression of knee osteoarthritis over an 18-month period. It suggests a potential benefit of future interventions to reduce stress caused by knee malalignment.

The risk of disability attributable to knee OA alone is greater than that due to any other medical condition in people age 65 and over. As the U.S. population swells with graying baby boomers, vast numbers of people will experience pain and decreased function associated with osteoarthritis. Today, 35 million people--13 percent of the U.S. population--are 65 and older, and more than half of them have evidence of osteoarthritis in at least one joint. By 2030, 20 percent of Americans (about 70 million) will have passed their 65th birthday, and will be at risk  for OA.

Sharma L, Song J, Felson D, Cahue S, Shamiyeh E, Dunlop D. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001;286(2):188-95. Functional Recovery After Hip Resurfacing and Rehabilitation

National Institutes of Health


Hip resurfacing: not your average hip replacement

Jan 2012


Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report. 

Jan 2012


Functional Recovery After Hip Resurfacing and Rehabilitation 

Dec 2011


Navigated non-image-based registration of the position of the pelvis during THR. An accuracy and reproducibility study.

Comput Aided Surg. 2008 May



External fixator-assisted acute shortening with internal fixation for leg length discrepancy after total hip replacement

Strategies Trauma Limb Reconstr. 2008 Apr



Prevalence and functional impact of patient-perceived leg length discrepancy after hip replacement.

Int Orthop. 2008 Apr

Springer Link


The phan-thien and tanner model applied to thin film spherical coordinates: applications for lubrication of hip joint replacement.

J Biomech Eng. 2008 Apr



Cemented and cementless total hip replacement. Critical analysis and comparison of clinical and radiological results of 182 cases operated in Al Razi Hospital, Kuwait

Med Princ Pract. 2008



Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement

Rev Chir Orthop Reparatrice Appar Mot. 2007

Keywords: Posterior approach , minimally invasive surgery , total hip arthroplasty , prospective study , comparative


Is a dorsal access associated with an elevated luxation rate following total hip replacement?

Orthopade. 2007 Oct

Springer Link


Less invasive posterior surgical approach for hip joint replacement--complications and limitations

Ortop Traumatol Rehabil. 2007 Jan-Feb

Index Copernicus


Minimally invasive total hip replacement: the posterolateral approach.

Am J Orthop. 2006 May



Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. Surgical technique.

J Bone Joint Surg Am. 2006 Sep

Journal of Bone and Joint Surgery


See also:


Edema and Chronic Venous Insufficiency

Edema and Deep Venous Thrombosis

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

Edema and Venous Pooling


Edema of the Neck

Edema and Nephrotic Syndrome

Edema of the Face


Edema and Diabetes


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