Typical hospitalization times usually range from three to four days for most total hip replacement surgeries and hip resurfacings, with younger patients often needing less time in the hospital. The events leading up to and surrounding the surgery are similar for all joint replacement surgeries and are detailed in a later chapter, including information about preoperative testing, blood donation, anticoagulation, etc.

In general, most of the patients treated in our practice can expect a general timeline similar to the one presented here, although there certainly can be variability depending on other medical issues and the exact type of surgery performed.

Day of Surgery

Most patients arrive at the hospital early on the morning of total hip replacement or resurfacing surgeries. This process is detailed in a later chapter because the process is the same for both hip and knee replacement surgeries. The surgery usually takes about 60 to 90 minutes for routine primary (first time) surgeries, although it certainly can take longer if the patient has had prior surgery, is very muscular or obese, is having more than one procedure performed, etc.

The time in the operating room for most hip surgeries is actually longer than the hour to hour and a half needed for the procedure, because the anesthesiologist needs time to perform the spinal or general anesthesia, the patient needs to be positioned and prepped with antiseptic scrub, and sterile drapes have to be placed.

Most patients are in the recovery room for two or three hours after the surgery, at which time routine xrays are taken to check on the implants and surrounding bones. Patients also need to be fully awake and have a stable blood pressure before being transferred to their hospital room upstairs. However, most hip replacement and resurfacing surgery patients can actually get up with assistance that first evening.

First Day After Surgery

Physical therapy starts in earnest on the second day of hospitalization. Most patients are allowed to fully bear weight on the affected hip(s), but it is important to work with the physical therapist to ensure that there is no dizziness from medications or anesthesia. We typically allow most patients to fully bear weight right away if the postoperative x-rays show everything to be in good position and there are no special circumstances.

Some surgeons will routinely limit weightbearing for noncemented prostheses, with the idea being that the bone needs time to adequately grow into the porous coating. However, many surgeons (as in our practice) would prefer to start full weightbearing as soon as possible by "press-fitting" the prosthesis tightly at the time of surgery. Your surgeon and physical therapist will let you know your weightbearing status after surgery.

Most patients use a walker at first, and when they are ready and steady enough, they progress to a cane. There is a great deal of variability in how long the process takes, because everyone has different levels of physical stamina, balance, muscle strength, etc. As a general rule, younger and more active patients and thinner patients will graduate to using a cane quicker than their older or heavier counterparts.

Most IV lines, urinary catheters (if you have one - not all patients require this), and surgical drains (again, many patients do not have any drains, depending on the size of the patient and surgical factors) are removed on the first or second day after surgery. Although many patients may be apprehensive about removal of drains or catheters, most are somewhat surprised to find that this is not usually as uncomfortable as they expected and literally takes only seconds.

Second And Third Days After Surgery

There are typically daily blood tests to monitor hemoglobin levels and metabolic parameters, and patients are monitored to make sure that they do not have any complications after surgery such as a blood clot or a serious hematoma (more on this later). Blood thinners of some sort (either aspirin, heparin / enoxaprin injections, or warfarin) are usually started the day after surgery also (the exact regimen depends on the patient, surgeon, and medical factors).

Total hip replacement patients have a list of precautions to follow so that the hip does not dislocate in the initial weeks while the soft tissues are healing. The exact precautions depend on the surgical approach used, but generally it is advisable not to flex the hip beyond 90º (or level with the pelvis while sitting), cross the legs, or pivot on a planted foot on the affected side. Anterior hip resurfacing patients, on the other hand, do not have these precautions because it is very difficult to dislocate those prostheses. The physical therapist works with you to practice your recommended exercise regimen and learn what you should and should not do after leaving the hospital.

After three or four days in the hospital, most patients are ready to graduate either to home with visiting nurses/physical therapy or to a short term rehabilitation facility. This depends on how well the patient is able to get around on their own and their age, but most often the need for a rehabilitation center is dependent on social factors. If a patient lives alone or does not have adequate help, or if the living arrangements cannot be changed to accommodate staying on one level, then a short stay at a rehabilitation center is more likely.

Discharge

The first post-operative visit in our practice is usually between 3 and 6 weeks after surgery. If there are staples or non-absorbable sutures, these are usually removed by the visiting nurse at 2 weeks after the surgery. Most patients undergoing joint replacement surgery in our practice today have absorbable sutures with a type of surgical "glue" for the skin, which does not require any suture/staple removal.

Patients are discharged with a detailed list of instructions on what to do, what not to do, and what to call about (such as fevers, wound breakdown, calf swelling, etc.). These are described in greater detail in a later chapter.

If patients are going to a rehabilitation facility, then instructions and detailed dictations on the hospital course are provided to the facility. If they are going home, then the discharge planner usually coordinates for visiting nurses, home physical therapy, and any necessary equipment (such as a raised toilet seat if needed, walkers, etc.).

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.