Part of planning hip replacement surgery involves choosing the surgeon. The surgeon will determine where your surgical incision is located, how big it is, and what type of artificial hip is implanted. The surgeon may also influence factors that affect your recovery, such as where you go for physical therapy.
Patients are encouraged to ask their prospective surgeons:
1. Where will the surgical incision be? How much experience do you have with this approach?
Traditional hip replacements involve a surgical incision at the back of the hip, called the posterior approach. Other possible incision sites include the side of the hip (lateral approach) and the font of the hip (anterior approach).
Don’t be afraid to ask for specific information about your surgeon’s experience, including how many times they perform the approach in a year and what their success and complication rates are. Research 1 Katz JN et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population*. J Bone Joint Surg 83. (2001 Nov);11:1622-1629. suggests that surgeons who do more than 50 hip replacements a year have the lowest complication rates.
2. What results should I expect after this surgery?
Discuss any specific goals and expectations you have with your surgeon. For example, you may want to know if surgery will:
- Eliminate a limp
- Eliminate the need for pain medications
- Enable you to put on socks and cut your toenails
- Allow you to participate in certain sports
- Make sex more comfortable
Expected results can vary from person to person, depending on anatomy and overall health. Discussing and understanding individual expectations early can lead to greater post-surgical patient satisfaction.
3. What type of implant do you recommend for me?
The ball-and-socket components of a hip replacement can be metal, plastic (polyethylene), ceramic, or a combination of these materials. Some components are attached to bone with bone cement. Others, called “cementless” prosthetics, are designed to allow bone tissue to grow into them over time.
Each type of prosthetic comes with certain advantages and risks. There is no definitive scientific evidence showing certain hip prostheses are better than others for all patients. 2 Rajan Anand, Stephen E. Graves, Richard N. de Steiger, David C. Davidson, Philip Ryan, Lisa N. Miller, Kara Cashman, What is the Benefit of Introducing New Hip and Knee Prostheses? The Journal of Bone & Joint Surgery (Am.), Dec 2011; 93 (Supplement_3); 51-54. doi: 10.2106/JBJS.K.00867 , 3 Harkess, JW and Crockarell, JR Jr. Arthroplasty of the Hip. Campbell’s Operative Orthopedics, 13th edition. Philidelphia, PA. Elsevier, 2017: 167-321. A surgeon will make a recommendation based on their experience and your unique situation.
4. What are the possible complications of this procedure? What are your complication rates for people like me?
Hip replacement is major surgery, and like any surgical procedure, it carries potential risks, such as infection and deep vein thrombosis (DVT). Serious complications are uncommon but can be life threatening. Understand your risks, and ask if any preexisting conditions, such as diabetes, may raise your risk for certain complications.
5. Who will be in charge of answering my questions before and after surgery?
You want to be able to communicate with your surgeon clearly and honestly. In addition, a good surgical team will provide you with detailed written or online materials that you can refer to at home. You should know what number to call if you have questions or concerns between appointments.
6. What will physical therapy involve?
Physical therapy is an essential part of recovery. In the weeks after surgery, stretches and exercises must be done at home periodically throughout the day.
In addition to doing physical therapy at home, you will probably also have one-on-one appointments with a physical therapist. How many times you see a physical therapist each week depends on several factors, including the surgeon’s preference, where you live, and your insurance coverage. A surgeon may prefer that you work with a specific physical therapist or leave the choice up to you.
After asking these questions, you should feel very comfortable with—and confident in—the surgeon who will perform your hip replacement surgery. If you don’t, feel free to get a second opinion.
- 1 Katz JN et al. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population*. J Bone Joint Surg 83. (2001 Nov);11:1622-1629.
- 2 Rajan Anand, Stephen E. Graves, Richard N. de Steiger, David C. Davidson, Philip Ryan, Lisa N. Miller, Kara Cashman, What is the Benefit of Introducing New Hip and Knee Prostheses? The Journal of Bone & Joint Surgery (Am.), Dec 2011; 93 (Supplement_3); 51-54. doi: 10.2106/JBJS.K.00867
- 3 Harkess, JW and Crockarell, JR Jr. Arthroplasty of the Hip. Campbell’s Operative Orthopedics, 13th edition. Philidelphia, PA. Elsevier, 2017: 167-321.