Getting a Total Hip Replacement with RA
Every year, 200,000 people in the U.S. have a hip replacement. It’s one of the most common and often most successful surgeries. Advanced rheumatoid arthritis (RA) can damage joints to the point that limited mobility and extreme pain make a hip replacement necessary.
What happens in a total hip replacement?
There are different types of hip replacement surgery, but this article will focus on total hip replacement. A total hip replacement replaces two parts of the hip joint: the ball at the top of the femur (thigh bone), as well as the socket on the pelvic bone in which the ball moves. In the surgery, the top part of the femur is removed and the joint replacement is inserted into the femur. It consists of a long stem attached to the ball. A plastic cup is attached to the pelvic bone with cement or screws. Then the surgery site is closed, most likely with staples, and a dressing is put on the wound. On average, hip replacements last 10-20 years, although yours may last even longer.
Your surgeon may suggest you watch a video of a hip replacement. Dan Malito, blogger of Dan’s du Journal at CreakyJoints and the raconteur of TalkingJoints, had both hips replaced in the late 1990s, when he was 19 and 21 years old. He says, “I implore you, do not watch the video! A large part of recovery is your mental state. Thinking about what the surgeons have done is tough to get out of your mind.”
Preparing for the surgery
Getting ready to have hip replacement surgery involves some planning. Your surgeon’s office will most likely give you a list of items you’ll need during recovery, as well as where you can buy or rent them. They usually include a wedge cushion to sit on and a cushion to put between your knees when you sleep. You’ll also need a long shoe horn, a reacher — get several for different rooms — a walker, and a raised toilet seat. Also, make sure that you have lots of freezer meals that are easy to heat up.
When you go into the hospital, bringing toiletries and loose clothing that is easy to put on with limited mobility. Dan recommends you bring a couple of things that you may not think of. “Two things that I always bring with me to the hospital are my backscratcher, because lying in that bed makes your back itch all the time. And two, a fan — there is no greater torture than to be covered in IVs, bandages, and to be sticky with sweat.”
You also need to plan for the recovery process. If you live alone, ask family and friends to take turns to help you for the first several weeks. Depending on how physically able you are, you may need someone to stay with you when you first come home.
You can make your recovery easier by being in as good a physical shape as possible before the surgery. If you need a hip replacement, your hip is in bad shape, causing pain that can make it difficult to move. Try to build up the muscles in your arms and legs as much as you can. Ask your doctor for suggestions or for a referral to a physical therapist who can show your exercises that will build strength, without hurting your joints.
Surgery and the hospital
Surgery is no one’s idea of fun. After the operation, you will be in quite a lot of pain, but for the first few days also have access to a morphine pump that can help you get through it. Expect the physical therapist to get you out of bed the day after surgery. “That was unexpected,” Dan said. “They come in the day after your surgery and kick you out of bed twice a day to walk and walk and walk.”
They will also take you through the precautions you need to follow for the next three months. For instance, not to bend your hip more than 90°, and don’t cross your legs. The two cushions you got ahead of time are to help prevent you from doing that. Make sure you follow these precautions until your doctor gives you the green light. They will prevent your brand-new hip joint from dislocating, an experience that would require you to get anaesthesia in order to have the hip popped back in or maybe do the surgery over again. Dan’s left hip dislocated three times. “By the third time, I asked my mom, ‘Do we have to go to the hospital — can’t we just check on YouTube and do it ourselves?’” Given time, usually about three months, the muscles and bone grow back to hold the new joint in place.
After a few days in the hospital, you’ll be sent home with a prescription for blood thinners and pain killers. Make sure you take these medications. The blood thinners can help prevent blood clots — important when you’re not moving much — and the pain medication will help you do the work you need to recover.
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Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.