Preparing for Surgery
The decisions you make and the
actions you take before your surgery can be every bit
as important as the procedure itself in ensuring a healthy
to arrange to take home any equipment you will need
when you get home from the hospital. This may include
a walker, crutches, ice packs or coolers, or household
items to make movement around the house easier. You
should receive prescriptions for any of these from your
doctor when your surgery is scheduled.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. Try to understand what is
involved and what can be expected with the rehabilitation
process. It can also help to talk to someone else who
has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, discontinue the use of any anti–inflammatory
medicine, especially aspirin, a week prior to surgery,
to prevent excessive bleeding during the procedure.
reduce the risk of infection, try to refrain from smoking
for at least a week prior to surgery.
a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board–certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929–7103.
At most medical centers, you will
go to "patient admissions" to check in for
your open reduction–internal fixation surgery.
There may be a separate department for overnight inpatient
surgery check–in, so be sure to ask your doctor.
After you have checked in to the hospital or clinic,
you will go to a holding area where the final preparations
are made. The paperwork is completed and your hip and
thigh area may be shaved (this is not always necessary).
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or nurse
anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. In general,
you should not eat or drink for eight hours before surgery.
This will reduce the risk of vomiting while you are
under general anesthesia.
a bag for someone to bring you the day after surgery
that contains a full length robe, toiletries, underwear,
personal phone numbers you may need, and any other items
you would like to have around during your hospital stay.
Generally patients wear hospital gowns for the majority
of their stay. Therefore, one change of clothing is
really all that is necessary. Bring a loose pair of
shorts or sweatpants that will fit comfortably over
your hip bandage when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Here is how an osteotomy is performed:
anesthesia is administered, which may be regional, or
general, the surgical team sterilizes the leg with antibacterial
map out (pre–operatively plan) the exact size
of the bone wedge they will remove, either using an
X–ray, CT scan, or 3D computer modeling.
large six– to ten–inch incision is made
along the outside of your thigh.
wires are drilled into the top of your thighbone, usually
below the prominence called the greater trochanter.
The configuration of precisely placed wires guides the
predetermined bone cuts to match the pre–operative
standard oscillating saw is run along the guide wires,
removing most of the bone wedge from underneath the
top of your thighbone, below the femoral neck and greater
trochanter. The cartilage surface on the top of the
thighbone (femoral head) is left intact.
usually refine the exposed thighbone surface with chisels
until it is smooth.
top of your thighbone is then lowered onto the shaft
and attached with surgical screws and a plate. The femoral
head is then tilted in a new position so that healthy
cartilage absorbs more of your body weight when you
layers of tissue in your hip are stapled together and
you are taken to the recovery room.
One of the common complications of an osteotomy is
that your leg's length is slightly shortened. You may
need to wear orthotic devices in your shoes to lift
your heal after surgery. An osteotomy is a complicated
procedure and has a risk of infection (less than one
percent), blood clots (one to five percent), failure
of fixation (screws/plate breakage), nonunion (bones
do not heal), malunion (bones heal in the wrong position).
There also is a slight risk of reduced range of motion,
weakness, and persistent pain.
After an osteotomy, you usually will
stay in the recovery room for at least two hours while
the anesthetic wears off. Your hip will be bandaged
with white gauze pads and tape, and may have ice on
it. You may have lost a significant amount of blood
during surgery and there may be a small amount of bleeding
afterward. Depending on your age and the volume of red
blood cells in your blood stream, blood may need to
be replaced in the recovery room through an IV. To allow
fluid drainage, you may also have a small tube (two
to three millimeters in diameter) inserted in the incision
that usually is removed within 24 to 48 hours after
surgery. Drainage tubes attach to a collection device
and are vacuum operated. You will be given adequate
pain medicine, either orally or through an IV (intravenous)
line, as well as instructions for what to do over the
next couple of days. Antibiotics and blood thinners
(anticoagulants) also may be administered to help avoid
infection and blood clots. You should try to move your
feet, ankles, and knees while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the recovery room and be
admitted for a three to five night stay. The length
of your stay varies depending on your post–operative
pain control, rehabilitation, and absence of complications.
In rare cases, your hip may need to be immobilized in
a spica cast. The spica cast attaches around your lower
torso/waist and to the thigh of the affected leg. It
can be made of casting material (plaster) or as an orthotic
(plastic, metal, and foam), much like a knee immobilizer.
Post-op in Hospital
After an osteotomy, some patients remain in
the hospital for as long as five days. Some patients
may have to stay longer and in rare cases may need to
be transferred to rehabilitation centers or nursing
homes. Nurses typically apply a fresh bandage two days
after surgery. The bandage may need to be replaced once
or twice while at home and the nurses can teach you
to change the bandage yourself. There likely will be
pain, and you can expect to be given pain medication
as needed. Be sure to ask for medication as soon as
you feel pain coming on, because pain medication works
best on pain that is building rather than on pain that
is already present. The nurses will not give you more
than your doctor has prescribed and what is considered
to be safe. Though physicians generally limit weight
bearing on your leg, you will be instructed to sit up
and move around to help circulate blood. Beginning in
the hospital, you probably will need to use a walker
or crutches while the reconstructed bones heal for between
three and 12 months. Your physician, nurse, or a physical
therapist will teach you to use your walker or crutches
and begin gentle rehabilitation exercises to avoid muscle
atrophy. Your physician usually takes X–rays of
your hip before you leave the hospital. Patients usually
visit their physicians two weeks after surgery for an
incision check and removal of sutures. Patients generally
are seen again at six and 12 weeks after surgery. X–rays
usually are taken at the 12 week check unless there
have been prior concerns. You will probably be instructed
to return again at six and 12 months after surgery for
more X–rays. Most patients receive a prescription
for pain medication. You will be unable to drive a car,
so be sure to have arranged a ride home.
what you can expect and how you can cope while recovering
at home from a hip osteotomy:
this procedure, there is usually pain and discomfort
for about two weeks. If needed, take pain medication
as instructed. The pain tends to decrease each day after
surgery. Check with your doctor if unexpected pain arises.
are usually removed about two to three weeks after surgery.
You may need to change your bandage yourself once or
twice during the first week at home after surgery as
instructed by the nurses in the hospital. You can normally
stop using bandages when the wound is dry.
your incision dry when showering. Depending on your
surgeon's advice, the time you are instructed to keep
the incision dry varies, usually from two to three weeks.
full weight bearing on your hip without an assistance
device (a walker or crutches) until X-rays have shown
that your bones have healed. Always use your walker
or crutches when moving around.
physician may prescribe a wedge-shaped pillow to be
worn between your legs that can act as a splint.
move your toes, ankles, and knees as much as possible
to help circulate blood.
balanced diet, iron supplements, and proper hydration
can help restore healthy tissue.
osteotomy can make it difficult to move around your
house and perform even simple household tasks like cooking,
bathing, and laundry. Try to have friends or family
members available to visit you once or twice a day for
several weeks. Generally, most patients are reasonably
mobile and self serving by six to 12 weeks. Most household
duties should be possible within three and six months.
Wheelchairs may be helpful during times of otherwise
prolonged standing or during difficult transfers during
the first few weeks.
you live alone, your insurance company will decide whether
you qualify for a nurse. Otherwise, you can hire help
through a social worker at the hospital who can put
you in contact with nursing and therapy agencies in
to begin non-weight bearing walking exercises within
two days of surgery. You should not remain sedentary
because you run the risk of developing blood clots and
bedsores. Your physician usually refers you to a physical
therapist who can help you learn to walk after surgery.
physician typically evaluates your ability to walk and
prescribes further physical therapy as needed.
Most patients can begin stretching
and strengthening around six to eight weeks after surgery.
Osteotomy relies on bone healing before more vigorous,
weight bearing exercises in the gym can begin. Light
exercise is one of the most effective ways to relieve
arthritis pain by stimulating circulation and strengthening
the muscles around your hip. Strong muscles take pressure
off the bones so there is less grinding in the hip joint
during activities. The key is to work with your therapist
to find a balance between low–impact and weight
bearing activity. Too much weight bearing can damage
your hip, but some weight bearing is needed to increase
bone strength. In conjunction with a healthy diet, exercise
also can help you lose weight, which reduces stress
on your arthritic hip.
Your physical therapist usually helps you stretch
the muscles in your hamstrings, quadriceps, buttocks,
groin, and back while flexing and extending your hip
to restore a full, pain–free range of motion.
Stretching should be continued for the rest of your
life. Many patients receive effective pain relief from
When pain has decreased, physicians generally
recommend at least 30 minutes of low–impact exercise
a day for patients with arthritis. You should try to
cut back on activities that put stress on your hips,
like running and strenuous weight lifting. Cross–training
exercise programs often are prescribed when you have
arthritis. Depending on your preferences, your workouts
may vary each day between cycling, cross–country
skiing machines, elliptical training machines, swimming,
and other low–impact cardiovascular exercises.
Walking usually is better for arthritic hips than running,
and many patients prefer swimming in a warm pool, which
takes your body weight off your hips and makes movement
Strength training usually focuses on moving light weights
through a complete, controlled range of motion. Your
physical therapist typically teaches you to move slowly
through the entire motion with enough resistance to
work your muscles without stressing hip bones. Once
your physical therapist has taught you a proper exercise
program, it is important to find time each day to perform
the prescribed exercises.
After an osteotomy, you can prevent
or minimize recurrent symptoms as well as slow the progression
of osteoarthritis. Until doctors find a cure for osteoarthritis,
you remain at risk of continued hip pain after treatment.
Maintaining cardiovascular fitness has been an effective
method for preventing the progression of osteoarthritis.
Light, daily exercise is much better for an arthritic
hip than occasional, heavy exercise. You should avoid
high–impact or repetitive stress sports, like
football and distance running, that commonly cause severe
hip injuries. Depending on the severity of your arthritis,
your physician may also recommend limiting your participation
in sports that involve sprinting, twisting, or jumping.
Because osteoarthritis has multiple causes and may be
related to genetic factors, no simple prevention tactic
will help everyone avoid increased arthritic pain. To
prevent the spread of arthritis, physicians generally
recommend that you take the following precautions:
anything that makes pain last for more than an hour
controlled range of motion activities that do not overload
heavy impact on the hips during everyday and athletic
strengthen the muscles in your thigh, groin, and back
to help protect the bones and cartilage in your hip.
Non–contact activities and stretching are a great
way to maintain fitness and keep joints and bones healthy
over time. Exercise also helps promote weight loss,
which can take stress off all weight–bearing joints.
| Treatment Introduction
Hip osteotomy is commonly used to
realign your hip structure if you have arthritic damage
in only one portion of your hip. The goal is to shift
your body weight off the damaged area to a different
part of the ball shaped femoral head, where the cartilage
is still healthy. Surgical realignment osteotomy involves
predetermined bone cuts that optimize the distribution
of your body weight over relatively healthy, normal
joint surface. Imagine the ball-shaped femoral head
at the top of your thighbone as the planet earth. Arthritis
may have destroyed cartilage around the North Pole,
where your weight has been pressing it into the hip
joint. An osteotomy can rotate the globe in the socket
so your weight is stressing North America instead of
the North Pole when you are walking. Osteotomy is also
used as a substitute for a total hip replacement in
active patients who are under 65 years old. Prosthetic
hips are known to wear out over time. An osteotomy procedure
can enable younger, active osteoarthritis patients to
continue using the healthy portion of their hip and
can delay the need for a total hip replacement for up
to ten years. There are two general types of osteotomy
procedures. The common method, called a femoral osteotomy,
removes a wedge of bone from your thighbone so that
the top of your thighbone angles differently in the
socket. Depending on the area of damaged cartilage,
the wedge is removed to tilt the ball–shaped femoral
head towards healthy cartilage. A less common osteotomy
procedure, cuts the pelvis so the socket (acetabulum)
can be rotated into a new position. Because this procedure
is rarely performed and its use for arthritis is controversial,
the following discussion deals with the femoral osteotomy.
It is important for physicians to preoperatively asses
your hip range of motion. Poor or reduced range can
prevent a good outcome and must be considered before
embarking on what is considered a major procedure. The
time necessary to perform an osteotomy varies depending
on the complexity of the deformity or correction that
your hip requires. Generally, the operation lasts anywhere
from 1 1/2 to 2 1/2 hours.