What Should I Expect from a Double Hip Replacement?

During a hip replacement surgery (also called hip arthroplasty), your surgeon works to remove parts of your hip joint that have been damaged, then replaces them with new, artificial parts.

Most of the time, hip replacement surgery is performed on one side of the hip (unilateral). But sometimes, hip replacements are done on both sides of the hip (bilateral).

Double hip replacements are less common than unilateral hip replacements. And there are different ways that a double hip replacement can be performed.

Read on to learn more about double hip replacements, what the procedure is like, and what to expect afterward.

Why is a double hip replacement done?

A hip replacement surgery is often done to:

• improve the function of the hip joint
• relieve pain

Hip replacement surgery is typically considered for individuals who have hip pain that:

• interferes significantly with mobility and the ability to perform daily activities
• hasn’t responded to nonsurgical treatments, such as medications and physical therapy

What leads to deterioration of the hip joint?

There are several conditions that can lead to damage or deterioration of the hip joint and give rise to pain and reduced joint function, including:

• osteoarthritis
• rheumatoid arthritis (RA)
• osteonecrosis
• developmental dysplasia
• injuries, such as hip fractures

Sometimes, these conditions can affect both hip joints. For example, it’s estimated that in 42 percent of people with osteoarthritis, both hip joints are affected — and 25 percent of these individuals will eventually need both joints replaced.

In people with damage or deterioration in both hip joints that significantly affects daily life, a double hip replacement can help alleviate pain and improve function.

But double hip replacements are rare, according to a 2015 report from the Centers for Disease Control and Prevention (CDC).

 

What are the types of double hip replacement?

Typically, a double hip replacement involves something called total hip replacement. This is when both the femoral head (ball on top of your thighbone) and the acetabulum (socket in your hipbone) of the hip joint are replaced with artificial parts.

These artificial parts, or implants, can be made of materials like metal, ceramic, or a combination of the two. They’re held in place with a special type of cement or by letting bone tissue naturally grow around them.

There are two different types of double hip replacement: staged and simultaneous. Staged double hip replacements are done more commonly than simultaneous double hip replacements.

Staged double hip replacement

In a staged procedure, the double hip replacement occurs in two distinct steps:

1. Surgery is performed to replace one hip joint.
2. After about 3 to 6 months, the second joint is replaced.

Simultaneous double hip replacement

During a simultaneous double hip replacement, both joints are replaced during the same surgery.

It’s believed that a simultaneous procedure can have the following advantages over a staged procedure, including:

• decreased cost
• less time spent in the hospital
• shorter rehabilitation period

But the use of the simultaneous procedure is controversial due to conflicting evidence about the risk of complications.

A 2018 review of the safety of the simultaneous procedure found that it may not be recommended for those who:

• are aged 75 or older
• have RA or underlying cardiovascular disease
• have a high risk of an adverse reaction to anesthesia

It may also be more difficult to rehabilitate and follow safety precautions after a simultaneous procedure. Because both hips are operated on, this surgery takes longer, which means there may be a higher risk of a transfusion or medical complication.

 

How do I prepare for a double hip replacement?

Prior to your surgery, you’ll meet with your orthopedic surgeon. During this appointment, they’ll:

• Evaluate your medical history.
• Take note of any medications you’re taking and advise you as to whether you need to stop taking them before your procedure.
• Examine your hip joints with imaging tests like X-rays.
• Order laboratory tests, such as blood and urine tests, to assess your overall health before surgery.
• Answer any questions or concerns that you may have about preparation, the procedure itself, or recovery.

Other important things to consider as you prepare for your double hip replacement include:

• Smoking. Smoking can interfere with the healing process. If you do smoke, try to cut back or quit. Talk to your doctor about ways to help quit smoking.
• Transportation. Make sure to arrange for transportation to and from the hospital. Note the dates of your follow-up appointments and arrange transportation for those as well.
• Exercise. Working to strengthen your upper body, core, and legs prior to surgery can aid in recovery. Additionally, if you have overweight, losing weight can help reduce stress on your joints during the recovery process.
• Meals. It may be helpful to prepare and freeze meals prior to your surgery so that you have them on hand when you arrive home.
• Home preparation. Designate an area where you’ll spend most of your recovery time, making sure that things you may need are within arm’s reach. Acquire a comfortable chair that provides firm support for your legs, back, and arms.
• Assistive devices. Consider asking about assistive devices that may be helpful with your daily activities as you recover, including handrails for stairways, a safety bar in your shower, or a raised toilet seat.
• Household help. You’ll likely need additional help around the house during recovery. Talk to someone you trust about helping out with activities like cleaning, laundry, and cooking.

Your orthopedic surgeon will give you more specific instructions on things to do and things to avoid prior to your procedure. Be sure to follow their instructions carefully.

 

How does the double hip replacement procedure work?

Hip replacement procedures are performed using anesthesia. Two different types may be used:

• General anesthesia. This type of anesthesia will cause you to go to sleep while your procedure is performed.
• Nerve block. A nerve block numbs your body from the waist down. You’ll be awake during the procedure but may be given a sedative to help you relax.

The specific technique that your orthopedic surgeon uses may vary. Generally speaking, the following steps occur during a total hip replacement:

1. An incision is made at the front or side of your hip.
2. The orthopedic surgeon works to remove the damaged tissue from the joint, including the removal of the upper part of your thighbone that contains the ball part of your hip joint.
3. A cup-shaped implant is placed into the socket part of your hip joint.
4. A second implant is fitted to replace the ball portion of the joint at the top of your thighbone, which consists of a smooth ball attached to a shaft.
5. The incision is closed with sutures or staples.

The length of the procedure depends on the type that you’re having.

In a staged procedure, only one joint is replaced at a time. This typically takes 1 to 2 hours. Having a simultaneous procedure may take twice as long.

 

What can I expect after a double hip replacement?

You’ll be taken to a recovery room in the hospital right after your procedure, where staff will monitor your vital signs while the anesthesia wears off.

You may go home the same day, but you’ll likely need to stay at the hospital for a few nights, particularly if you’ve had a simultaneous procedure.

It’s also possible that you may be admitted to an inpatient rehabilitation facility as part of your recovery.

Blood clots are a common concern with hip replacements. You may be encouraged to start moving around in the day or two following your surgery by sitting up or walking with the assistance of a walker or crutches.

You’ll likely also be given a blood thinner to prevent clots, such as aspirin, warfarin (Coumadin), Lovenox (enoxaparin), or Xarelto (rivaroxaban).

When you’re ready to go home, hospital staff will give you instructions on how to care for yourself, including:

• when and how often you can perform certain activities such as standing, walking, or climbing stairs
• how to care for your incisions and how to recognize signs of infection
• how and when to take your medications, including blood thinners, antibiotics, and medications to manage pain
• exercises that you can do to strengthen the muscles in your torso, hips, and legs
• types of activities you should avoid

Physical therapy will also be an important part of your recovery. A physical therapist will teach you exercises and stretches that will help to increase strength, mobility, and flexibility in and around your hips.

In the weeks after your procedure, your surgeon will see you for a follow-up appointment to remove stitches and evaluate your progress. Follow-up appointments are typically scheduled 2 to 12 weeks after your surgery.

 

 

What outcome can I expect from a double hip replacement?

The overall recovery time for a double hip replacement can depend on your:

• age
• overall health
• general fitness level

As you recover, you can expect to experience improved function and less pain in your hips. It’s normal for your new joints to feel strange or stiff, but this feeling often goes away with time.

Staged versus simultaneous procedures

A 2010 study assessed over 1,800 people that had had a double hip replacement.

In this study, the lowest walking ability was found for those receiving staged procedures that had a long length of time (6 months to 5 years) between joint replacements.

The study found that walking ability was most improved in those having a simultaneous procedure, compared with those who had a staged procedure.

Tips for living with a double hip replacement

Follow the tips below to protect your new hip joints:

• Exercise. Maintaining strength and flexibility is important for your joints. Talk to your doctor or physical therapist about low-impact exercises that will be beneficial.
• Avoid high-impact activities. Vigorous activities like running, jumping, and some types of sports can increase the wear and tear of your new joints.
• Reduce the risk of falls. Falling onto your hip can damage your implants. Eliminate trip hazards in your home, avoid walking on slippery surfaces, and use assistive devices to maintain balance.

Are there any risks or complications with double hip replacements?

Complications due to hip replacement surgery are typically rare.

According to the American Academy of Orthopaedic Surgeons, serious complications happen in less than 2 percent of individuals.

The complications associated with hip replacement surgery include:

• a bad reaction to the anesthesia
• infection at the incision site or in the area around your hip joint
• blood clots that form in the legs or hips and potentially travel to your lungs (pulmonary embolism)
• different leg lengths
• dislocation, where the ball portion of your new joint pops out of its socket
• implants loosening from the bone over time
• damage to surrounding nerves or bones

Research into complications in staged versus simultaneous double hip replacement procedures has produced conflicting results.

Studies from 2010 and 2019 have found that complications were lower in those receiving a simultaneous double hip replacement.

But a 2020 study suggests that the simultaneous procedure may be associated with a higher rate of complications, particularly those involving the cardiovascular system.

When to see a doctor

If you’ve had a double hip replacement, see your doctor promptly if you experience warning signs of complications, such as:

• hip pain that worsens, regardless of if you’re resting or active
• pain that’s not related to your procedure or that comes on suddenly, particularly if it’s in your legs or chest
• redness, pain, or swelling around the incision site
• drainage of blood or pus from your incision
• swelling of your legs
• fever or chills
• shortness of breath

A double hip replacement is when both of your hip joints are replaced. People that have a double hip replacement often have damage or degeneration that severely affects both sides of their hips.

Double hip replacements can be either simultaneous or staged.

During a simultaneous procedure, both joints are replaced. A staged procedure is when one joint is replaced at a time. In this case, there are typically months between surgeries.

Recovery time following a double hip replacement depends on factors like age, overall health, and type of procedure. Be sure to follow all instructions during and after recovery to help ensure your new joints stay healthy

Source: Healthline

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