I'm currently preparing for my second hip replacement to take place in February, remembering the lessons learned from my first one in April, 2011. My younger brother is also getting a new hip in February, so I'm writing this to help him and other people go through a difficult but worthwhile experience. My replaced right hip works wonderfully, free of the pain that started in 1995 and grew steadily worse. There are many Web pages that provide valuable medical information, but in this post I want to focus on practical advice about getting how to manage the whole process.

For medical advice, let me suggest these pages:
Mayo Clinic: http://www.mayoclinic.com/health/hip-replacement/MY00235
My Joint Replacement: http://www.myjointreplacement.ca/
My goal in this post is to provide practical suggestions to deal with matters that the medical sites don't much discuss. You can also find an informal personal narrative by James Kunstler, author of the terrific post-apocalyptic novel A World Made By Hand, at http://www.kunstler.com/Mags_hip.html. Since the topic of this blog is Hot Thought, let me begin with emotions.

1. Emotion. For me, the most important feelings encountered in the process of hip replacement were fear, frustration, disappointment, hope, relief, and gratitude. Fear and anxiety naturally accompany anticipation of a major operation. The best way to deal with them is to remind yourself that hip replacement operations are now a very successful procedure experienced by hundreds of thousands of people every year. If that cognitive approach doesn't work, try changing your physiological state by techniques such as exercise, deep breathing, or meditation. As I pointed out in a previous post, emotions involve both cognitive appraisals and physiological perceptions, so the best way to manage them combines rethinking the situation with bodily changes.

Frustration is an unavoidable part of the difficult recovery process that I'll say more about below. Disappointment hit me after eight weeks when I still needed a cane because of a persistent lurch in my gait that needed supplemental physiotherapy. To get through the months of recovery, it's crucial to maintain hope that things will get better, optimism that is actually highly rational for the vast majority of people who get their hips replaced. Relief is what comes when you realize after several months that the operation and recovery are in the past and you can walk better than you've been able to in many years. At this point as well as earlier, an appropriate moral emotion is gratitude towards the surgeon, nurses, family members, and friends who got you through the whole thing. Thanks!

2. Hospital. After the operation, you'll need several nights in the hospital as recovery begins. In addition to a major incision, your bones need to heal as well as the muscles and ligaments that were damaged in the process of putting an artificial hip in. You'll get lots of professional advice about how to start moving around. Hospitals are busy and noisy places even at night, and I found it helpful to have the same tools that I use for frequent flights to Europe: ear-covering headphones, iPad, and sleep mask. A good book is also a great help: I'm sending my brother a copy of Jonathan Tropper's hilarious This is Where I Leave You. I hope he doesn't pull out any stitches laughing.

3. Painkillers. Medication is an essential part of managing a major operation, but I really didn't like how oxycodone slowed me down. After less than three weeks I stopped cold turkey, but withdrawal was very unpleasant; so this time I'll taper off gradually.

4. Elevation. I hadn't realized how disabled I would be when I got home: just getting up from a chair was painful and laborious. Make sure that anywhere you sit is at least 6 inches higher than normal, using cushions and raised toilet seats. For many weeks, I took a cushion along for sitting in cars. I didn't use a bed rail last time because I didn't realize how much they can help you get up: this time I have rails on both my sofa and bed.

5. Aids. In addition to the toilet seats and bed rails, you'll need at least the following: a walker to begin, crutches for stairs and when you're moving better, a cane, a device for putting on socks, and numerous reaching tools for picking things up.

6. Exercise. For your muscles to recover, it's crucial that they be worked out several times per day and that you move around as much as possible. I exercised very conscientiously, but discovered with supplemental physiotherapy that I hadn't been properly working my gluteus medius muscle, which is why I was still lurching after eight weeks. Doing exercises right cleared up the problem within a week. By four weeks, I was using my treadmill and exercise bike, starting very slowly but gradually building up over the next few months to 30 minutes of each five days per week.

Today, the only sign that my right hip was replaced is the alarm that goes off at airport security—be prepared for closer scrutiny. I'm hoping for an even smoother recovery this time around, thanks to what I now know about elevation, exercise, diet, and drugs. Because the new operation is on my left hip and my car has an automatic transmission, I hope to be back to driving as soon as I'm off narcotics. Getting a hip replacement is a bit like childbirth: unavoidably difficult but sufficiently rewarding that people sometimes repeat the experience.

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