Before a surgery can be planned a couple of preoperative checks must be completed.

• Preoperative consultation with the anaesthetist: Surgery is performed under general anaesthesia. The anaesthetist will review any current medication. Routinely an ECG and a blood analysis will be performed. If necessary additional investigations may be required.
• Preoperative templating radiograph: A pelvic X-ray with a calibration marker is used to digitally template the correct size of the hip replacement.
• In case of dental problems it is important to have this treated before hip surgery. During dental procedures, bacteria may enter in the blood and potentially cause an infection of the hip replacement, which can lead to complications.

Every month information sessions are organised at the Gasthuisberg Hospital. The entire team (surgeon, nurse, physiotherapist, social worker) will explain the procedure extensively and describe the rehabilitation after surgery. These sessions are held in Dutch language. The dates can be found here.

Infection of a hip prosthesis can be caused by bacteria that can commonly be found on the skin. To decrease the risk of infection, you will have to use a decontaminating soap starting 5 days prior to admission. The prescriptions and instructions for use will be provided during the preoperative clinic.

Smokers have a strongly increased risk of complications after surgery: E.g. wound problems, infection of the prosthesis, ingrowth problems, pulmonary embolism, venous thrombosis, myocardial infarction. It is absolutely necessary to quit smoking at least 2 months before surgery.

Obesity is a also strong predictor of postoperative complications (specifically infection and wound healing problems).  Other complications such as pulmonary embolism and thrombosis can also occur much more frequently. It is important to achieve a healthy weight before surgery. Ideally the Body Mass Index would be less than 40.

It has been recognized that patients tend not to lose weight after surgery, even if activity is generally increased. Therefore a healthy weight must be achieved before surgery.

 Get in touch with a physiotherapist of your choice who can treat you after surgery.

 Practice how to walk with crutches and how to do transfers before your surgery. A link to the instructional videos can be found here.

You will be able to leave the hospital on average 3 to 4 days after surgery. Plan in advance where you will be staying for your rehab. If you decide to stay in a rehab center, this needs to be planned well in advance. Please get in touch with the social worker if you need any assistance: contact social worker.

Admission is at 7 am the day of surgery. Patients who are planned to be operated first in the morning may be admitted on the evening before surgery. You have to be nil-by-mouth (no food/milk) from midnight before surgery. Drinking of water only is allowed until 4 hours before surgery.

The procedure routinely takes place under a general anaesthetic. If this is contraindicated, a locoregional anaesthesia (spinal) can alternatively be used.

At the end of the surgery additional local anaesthetic agents are injected into the wound for pain control during the first hours after surgery.

First you will enter the preparation room, where an intravenous line will be put in. After completing all the checks, you will be transported to the operating theatre. The anaesthetist will take care of the general anaesthetic and monitor you throughout the surgery. The procedure normally takes 1h to 1h15 on average. After surgery you will be woken up and monitored in the recovery room for 2 hours.

• A local anaesthetic will be administered in the wound at the end of the surgery. This decreases the pain during the first hours after surgery. However, towards the end of the day, the local anaesthetic may wear off. It is therefore very important not to skip any painkillers, even if the pain is well controlled at that specific moment.
• Drink plenty of water
• Move your feet and legs. A pillow will be placed in between the legs until the morning after surgery. However, you should not keep your legs still during that time. Move both your feet and bend your knee till your foot is flat on the bed.
• If you feel well enough the physiotherapist will get you out of bed in the afternoon and help you to take the first steps on your new hip.

• Blood analysis to control blood loss (haemoglobin)
• Removal of intravenous line after administration of last dose of antibiotics
• If a drain was used, this will be removed in the morning.
• The dressing stays on.
• Swelling around the wound is normal.
• You will walk in your room or the corridor with a walking frame or with 2 crutches
• Ice application and rest after the exercises will reduce pain and swelling.
• In men the entire thigh can often feel very stiff.
• A slight increase in temperature (up to 38.5°) is normal the first 2 or 3 days after surgery.
• In the evening, you will receive a subcutaneous injection for thrombosis prophylaxis. This is changed to oral medication on discharge.

• An x-ray of the hip and pelvis is performed to check the position of the replacement.
• Physiotherapy: walking with crutches in corridor and exercises in the physio room.
• Men can often still suffer from pain and stiffness in the thigh: maintaining enough movement and physio is crucial.
• Continue ice applications and rest after the exercises.
• Return to home is possible if all discharge criteria have been fulfilled.

• The wound is dry and clean.
• The pain is well controlled on oral medication.
• The physiotherapy goals have been achieved: Safe walking with crutches, transfers & using stairs.

The exact day of discharge strongly varies from person to person and depends on your age, general health, the severity of the arthrosis and the preoperative muscle status. The average length of stay in the hospital is 3 to 4 days.

Your physiotherapist will follow you up during your rehabilitation at home. Specific instructions regarding mobilisation and weight-bearing will be found on the physiotherapy prescription. Usually 2 crutches have to be used for 4 weeks postoperatively to reduce the risks of falling.

It is normal to have some muscle pain the first weeks after surgery. Remember to rest after the exercises and take a pain killer if necessary.  Do not forget to apply ice 3 times daily.

Swelling of the leg is normal and will gradually migrate toward the knee. This will then disappear after a couple weeks.

In up to 30% of the cases, a numb feeling might be present on the lateral (outer) side of the leg. This will slowly decrease, but it may take several weeks or months.  

If there are any problems with the wound (discharge, bleeding, redness) you should immediately contact the hospital.

• Blood thinning medication will be prescribed to prevent deep venous thrombosis (DVT). This can consist of daily injections or, in most cases, oral medication (Xarelto ™), for 30 days after surgery.
• Anti-inflammatory drugs are prescribed during 2 weeks to prevent calcifications in the muscles and to decrease pain and swelling. These should always be taken with a meal and must be stopped in case of gastrointestinal intolerance.
• As mentioned previously, pain is normal the first weeks after surgery. Take enough painkillers so it remains possible to do all of the exercises.

Compression stockings are not necessary after an anterior hip replacement. They are only prescribed if you have a history of thrombosis or an otherwise increased risk. Swelling of the leg is normal after surgery, but remaining active will help to increase circulation and decrease the swelling.

• A transparent and water-resistant dressing will be applied on the wound before discharge. This dressing does not need to be changed daily. If the dressing comes loose, a nurse should be asked to reapply this. The sutures are reabsorbable and only the knots on the side have to be removed by your GP 2 – 3 weeks after surgery. The suture itself does not have to be removed.
• If necessary a nurse can offer daily help with getting dressed or washing. A prescription will be provided by the assistant on the ward.

• At 6 weeks: Clinic with radiographic control (x-ray). The position of the components and wound healing are checked.
• At 1 year: Clinic with X-ray control. Assessment of bony ingrowth of the hip replacement.
• Further follow-up depending on the symptoms.

Monitoring the quality of our care is one of the priorities of the University Hospitals of Leuven. You will be asked to fill out questionnaires on a regular basis. This will help us to follow your rehabilitation process and allow us to improve the care for our future patients.

At the moment we our using the online MoveUp Platform for data collection. Please find more information here.