How Painful is hip replacement surgery and how long does it last?

• June 9, 2020
• teamhri

When Steve woke up from his superPATH hip replacement surgery he felt absolutely no pain. His journey to this bed started the year before when he realized he wasn’t going to be able to continue to fish unless he had his hip replaced. As his eyes regained focus, Steve looked around the recovery room and saw Tammy, his nurse, watching over him. He tried to smile.

“Surgery is over,” Tammy said.

Everything seemed perfect. Except for one thing. He couldn’t move his legs. Tammy saw him looking down at his feet and reassured him right away.

“Remember, you had the spinal?”

Steve nodded. In fact, both Tammy and the nurse anesthetist warned him ahead of time that he would be having a spinal anesthetic during the surgery. The block was placed carefully in the operating room after Steve was sedated. He didn’t remember it at all. Tammy and the nurse anesthetist warned Steve that he wouldn’t be able to move his legs until the medicine in the spinal wore off; most of the time that’s before the patient even wakes up after hip replacement surgery. But people are different. Some people wake up faster than others. A few minutes later Steve was wiggling his toes, and an hour after that Tammy had him standing up and walking around the Ambulatory Surgery Center with a walker on his brand-new hip. Steve was sporting a grin from ear to ear. He felt absolutely no pain. Including the pain, he had before surgery, which was completely gone.

Legacy hip replacement surgery using the posterior approach was so painful it required general anesthesia, which caused pneumonia and urinary tract infections. In general anesthesia, a breathing tube is inserted down your throat, and a ventilator machine breathes for you. Both the breathing tube and the ventilator require a level of sedation which is so deep it can only be achieved with high doses of potent drugs. If you are so sedated that you can tolerate a tube in your throat, then you are so sedated that you cannot protect your own airway. If you were to throw up while sedated and you are not able to protect your own airway, then there is a risk the vomit will go into your lungs. Aspiration of vomit into the lungs can cause pneumonia after surgery. Deep sedation can also cause urinary retention and the need for another tube in your bladder. Placing a tube in the bladder can lead to urinary tract infection. The superPATH and Anterior approaches are so much less painful than the legacy posterior approach that they do not require general anesthesia. That substantially lowers the risk of aspiration or urinary tract infection following surgery.

Today’s minimally invasive approaches, like superPATH and the Anterior, are so much less painful they can be done with a spinal instead of general anesthesia. Most people think of spinal anesthesia associated with having a baby. The patient is positioned bent over in a sitting position. By delivering the medications directly into the spinal canal there is little or no risk of stopping breathing and patients wake up faster and much fresher than they do with a general anesthetic. Pain relief with a spinal anesthetic is so strong a breathing tube and traditional general anesthesia are not necessary.

In rare cases, a spinal fluid leak causes headaches after spinal anesthesia. “It seems like every time they get a fluid leak doing obstetric anesthesia it’s significant, and requires a blood patch,” explained Chad Peterson, CRNA. Chad has extensive experience providing anesthesia for total hip replacement surgery. “The injection for the spinal block we do for joint replacement surgery is totally different. It takes only 30 to 60 seconds, and the needle we use is just thicker than four human hairs put together. The needle is so thin we almost never have fluid leaks.“ In the unlikely event, a fluid leak does occur, it can be controlled with a blood patch.

By the next day after surgery Steve’s spinal wore off, and he took medication to blunt the pain of surgery. Narcotics, non-steroidal anti-inflammatory drugs, and medical marijuana are all useful after hip replacement surgery because they work in different and complementary ways. Each has its own possible complications as well so that taking them requires specific precautions. Narcotics like Percocet, which Steve found very helpful off and on for a month after surgery, make pain feel much less severe. Narcotics are also highly constipating, so you must take a laxative with any narcotic pain medication. Non-steroidal anti-inflammatory drugs (NSAIDs), like Aleve and ibuprofen, reduce the inflammation which causes pain. For most patients, NSAIDs are the workhorse of pain relief after hip replacement surgery. NSAIDs also produce acid in the stomach, so you must take an acid blocker like Prilosec with them to avoid developing an ulcer. Narcotics and NSAIDs have been used by surgeons to control pain after hip replacement surgery for decades; more recently medical marijuana has emerged as a potent pain and anxiety reliever after hip replacement surgery as well. Today some hip replacement surgeons offer their patients medical marijuana to relieve the pain and stress of surgery.

The new superPATH and Anterior hip replacement approaches are less pain because they are less invasive. No muscles are taken down with the anterior approach. Most of us have experienced the pain of a muscle cramp; imagine the pain of having several muscles, tendons and ligaments cut and sewn back together. In the legacy posterior hip replacement surgery, the gluteus maximum, gluteus Medius, and tensor fascia Lata are often disconnected and moved to provide the surgeon access to replace the hip joint. Studies have shown significant weakness in the hip which may take two years to improve. If you’ve ever had it, you know hip dislocation is extremely painful. SuperPATH avoids hip dislocation entirely; the goal is to not only reduce the risk of hip dislocation after hip replacement surgery but to also make the surgery itself less painful. Surgeons who perform minimally invasive hip replacement surgery believe a less painful surgery leads to a quicker and better recovery.

Steve made a swift recovery with the help of the medications. He was up and walking right after surgery, ditched the walker after the second day, and continued to increase his walking every week after the procedure. He is hiking and fishing again and looking forward to hunting again when the season arises. Steve’s experience is typical.

The hip and groin pain people experience before hip replacement surgery is usually gone by the time they wake up. Surgery will always be painful, but with the minimally invasive superPATH and Anterior approaches, the pain is bearable and decreases dramatically over the first three days after hip replacement surgery. Most people report their pain is easily managed with the medications their surgeon prescribes and is largely resolved by two weeks afterward.