TOTAL HIP REPLACEMENT AUTHORS: Scott S. Kelley, MD; Paul F. Lachiewicz, MD; Frank C. Wilson, MD CONTENTS Introduction Pre-Admission Information Admission Information Day of Surgery Following Surgery Physical and Occupational Therapy Summary of Hospital Stay Going Home Infection Prevention Results of Surgery Bilateral Operations Complications Reoperation  Introduction Total hip replacement is an operation that was developed in England in 1963 in which the diseased ball and socket of the hip joint are replaced with an artificial device. The ball is made of metal, while the socket is made of plastic. At the present time, the femoral component is usually inserted into the thigh bone with bone cement, while the socket is usually inserted without bone cement. The operation with bone cement has been performed in the United States since the early 1970s and the operation without bone cement has been performed at UNC since 1984. Total hip replacement has proven to be highly successful in a large number of patients, and is now a widely accepted procedure for patients suffering from a variety of hip disorders, arthritis in particular. Pre-Admission Information Patients contemplating this surgery are encouraged to see their private physician (internist or family practitioner) to be checked medically before surgery. If you have not seen a dentist in the past year, this examination is also recommended prior to surgery. Blood Transfusion Patients usually require a blood transfusion after total hip replacement. Bloodborne diseases (AIDS, hepatitis, etc.) and allergic reactions are the major complications of a transfusion. Because our blood bank screening procedures are as thorough as possible, this risk is exceedingly small. However, even this small risk can be eliminated with autologous (self) transfusions. It is recommended that all patients 75 years of age or younger (if medically capable) donate two to four pints of blood in the four to six week period prior to surgery. You must take iron supplement pills during this time. Pre-operative Evaluation You should come to the Ambulatory Care Center (or UNC Hospitals) seven to ten days prior to surgery for outpatient tests to see that your general health is satisfactory. You will have blood drawn and a urine specimen will be obtained. X-rays of your chest and an electrocardiogram (to check your heart) will also be performed if recommended by your surgeon. X-rays of your hip will be made if we do not have films taken within the past 6 months. You will be seen by an orthopaedic resident and your surgeon during this visit. A consent form for surgery will need to be signed. You may also receive preoperative instructions from a physical therapist and an occupational therapist. You will be measured for a pair of white compression stockings and pneumatic sleeves (boots) to wear during and after surgery. The stockings improve circulation and help prevent blood clots in the legs. The anesthesiologist will meet with you during this preoperative visit to discuss the type of anesthetic you will receive. Spinal anesthesia is recommended because there are fewer complications. Less bleeding and fewer blood clots occur with spinal anesthesia. The nurse will give you an antiseptic soap before you leave. It is very important that you take a thorough shower with this antiseptic soap the morning of surgery. Admission Information You should not eat or drink after midnight the night before surgery. It is most practical to bring pajamas, short gowns and robes, shorts, or sweat pants to the hospital. Long gowns and robes interfere with walking. Bring a pair of shoes (or sneakers) that you are accustomed to wearing; bedroom slippers usually do not give the foot enough support. Any lifts on the heel or sole will need to be removed. This is not a good time to "break in" new shoes.

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For questions or comments, please contact msmiller@med.unc.edu October 2004