Total Hip Replacement Exercise Guide

From OrthoInfo &  the American Academy of Orthopaedic Surgeons

Regular exercise to restore strength and mobility to your hip and a gradual return to everyday

activities are important for your full recovery after hip replacement. Your orthopaedic surgeon

and physical therapist may recommend that you exercise for 20 to 30 minutes, 2 or 3 times a day

during your early recovery. They may suggest some of the exercises shown below.

This guide can help you better understand your exercise and activity program, supervised by

your physical therapist and orthopaedic surgeon. To ensure your safe recovery, be sure to check

with your therapist or surgeon before performing any of the exercises shown.

Early Postoperative Exercises

The following exercises will help increase circulation to your legs and feet, which is important

for preventing blood clots. They will also help strengthen your muscles and improve hip


Start the exercises as soon as you are able. You can begin them in the recovery room shortly

after surgery. You may feel uncomfortable at first, but these exercises will help speed your

recovery and actually diminish your postoperative pain.

Ankle Pumps

Slowly push your foot up and down. Repeat this exercise several times, as often as every 5 or 10

minutes. Begin this exercise immediately after surgery and continue it until you are fully recovered.

Illustration of ankle pumps

Ankle pumps

Ankle Rotations

Move your ankle inward toward your other foot and then outward away from your other foot.

Repeat 5 times in each direction.

Do 3 or 4 sessions a day.

Illustration of ankle rotations

Ankle rotatations

Bed-Supported Knee Bends

Slide your foot toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. Hold your knee in a maximally bent position for 5 to 10 seconds and then straighten.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of bed-supported knee bend

Bed-supported knee bends

Buttock Contractions

Tighten your buttock muscles and hold to a count of 5.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of buttock contractions

Buttock contractions

Abduction Exercise

Slide your leg out to the side as far as you can and then back.

Repeat 10 times.

Do 3 or 4 sessions a day

Illustration of abduction exercise

Abduction exercise

Quadriceps Set

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise 10 times during a 10-minute period, rest one minute and repeat.

Continue until your thigh feels fatigued.

Illustration of quadriceps set

Quadriceps set

Straight Leg Raises

Tighten your thigh muscle with your knee fully straightened on the bed. Lift your leg several inches. Hold for 5 to 10 seconds. Slowly lower.

Repeat until your thigh feels fatigued.

Illustration of straight leg raise

Straight leg raises

Standing Exercises

Soon after your surgery, you will be out of bed and able to stand. You will require help at first but, as you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.

Standing Knee Raises

Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 counts and put your leg down.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing knee raise

Standing knee raises

Standing Hip Abduction

Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip abduction

Standing hip abduction

Standing Hip Extensions

Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts. Return your foot to the floor.

Repeat 10 times.

Do 3 or 4 sessions a day.

Illustration of standing hip extension

Standing hip extensions

Early Activity

Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity aids your recovery and helps your hip regain its strength and movement.


Proper walking is the best way to help your hip recover. At first, you will walk with a walker or crutches. Your surgeon or therapist will tell you how much weight to put on your leg.

Illustration of woman using a walker after hip replacement

Early on, walking will help you regain movement in your hip.

Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Advance your walker or crutches a short distance; then reach forward with your operated leg with your knee straightened so the heel of your foot touches the floor first. As you move forward, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step, your toe will lift off the floor and your and knee and hip will bend so that you can reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor.

Walk as rhythmically and smoothly as you can. Don’t hurry. Adjust the length of your step and speed as necessary to walk with an even pattern. As your muscle strength and endurance improve, you may spend more time walking. You will gradually put more weight on your leg. You may use a cane in the hand opposite your surgery and, eventually, walk without an aid.When you can walk and stand for more than 10 minutes and your leg is strong enough so that you are not carrying any weight on your walker or crutches, you can begin using a single crutch or cane. Hold the aid in the hand opposite the side of your surgery.

Stair Climbing and Descending

The ability to go up and down stairs requires both strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember, “up with the good” and “down with the bad.” You may want to have someone help you until you have regained most of your strength and mobility.

Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than the standard height (7 inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.

Illustration of woman climbing and descending stairs using a crutch

Stair climbing and descending using a crutch

Advanced Exercises and Activities

The pain from your hip problems before your surgery and the pain and swelling after surgery have weakened your hip muscles. A full recovery will take many months. The following exercises and activities will help your hip muscles recover fully.

These exercises should be done in 10 repetitions, 4 times a day. Place one end of the tubing around the ankle of your operated leg and attach the opposite end of the tubing to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.

Elastic Tube Exercises

Resistive Hip Flexion

Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight. Allow your leg to return to its previous position.

Illustration of resistive hip flexion

 Resistive hip flexion

Resistive Hip Abduction

Stand sideways from the door to which the tubing is attached and extend your operated leg out to the side. Allow your leg to return to its previous position.

Illustration of resistive hip abduction

Resistive hip abduction

Resistive Hip Extensions

Face the door to which the tubing is attached and pull your leg straight back. Allow your leg to return to its previous position.

Illustration of resistive hip extensions

Resistive hip extensions


Exercycling is an excellent activity to help you regain muscle strength and hip mobility.

At first, adjust the seat height so that the bottom of your foot just touches the pedal with your knee almost straight. Pedal backwards at first. Ride forward only after a comfortable cycling motion is possible backwards.

As you become stronger (at about 4 to 6 weeks) slowly increase the tension on the exercycle. Exercycle for 10 to 15 minutes twice a day, gradually building up to 20 to 30 minutes, 3 or 4 times a week.


Walk with a cane until you have regained your balance skills. In the beginning, walk for 5 or 10 minutes, 3 or 4 times a day. As your strength and endurance improve, you can walk for 20 to 30 minutes, 2 or 3 times a day. Once you have fully recovered, regular walks of 20 to 30 minutes, 3 or 4 times a week, will help maintain your strength.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

A New Hip May Mean a Longer, Better Life

A New Hip May Mean a Longer, Better Life

A hip replacement may help seniors live longer — for at least a decade anyway, a new study from Sweden suggests. “Our study suggests that hip replacement can add years to life as well as adding ‘life to years’ — increasing the chances of longer survival as well as improving the quality of life,” said study author Dr. Peter Cnudde. He’s an orthopedic surgeon with the Swedish Hip Arthroplasty Register in Gothenburg.

Read more

What to Expect After a Hip Replacement

What to Expect After a Hip Replacement

Article Featured on Home Care Assistance

Have You Decided it is Time for Hip Replacement Surgery?

That aching, painful and stiff hip has reduced your quality of life. You can’t enjoy the activities you used to love, like a good golf game, a walk around the block or even playing with the grandkids, without constant pain.

Over 300,000 people have hip replacement surgery each year in the United States. Before you decide to join this group, it is important to know what to expect following surgery. What will you experience after your hip replacement? When will you feel back to normal? What can you do to speed your recovery?

Pain After a Hip Replacement

First things first, hip replacement surgery will hurt. All surgery does! Be prepared that you will experience a significant amount of discomfort in the first three days following surgery. Your mobility will be limited, and you will need to depend on others to help you with your regular activities of daily living. Even simple things like going to the bathroom will require assistance.

On the first day, a significant amount of surgical pain medication will be in your system. You may feel groggy but not as uncomfortable. On the second day, you will likely be able to get out of bed and start moving with assistance. Although you had surgery on the largest joint in your body, you will be walking on it in only one or two days.

Be ready for the third day after surgery. You will probably feel like you got hit by a truck. After surgery, your body sends a large number of inflammatory cells to the injured area in order to help with the healing process. These levels will be at the highest on day three. Inflammation means swelling and swelling means pain. Talk to your doctor their recommendations for using ice and taking an anti-inflammatory medication starting on the day of surgery. But remember, typically, once you get through day three the swelling and pain will get better.

Walking After Hip Replacement Surgery

Most likely, you will be up and walking the day after your surgery. Take it slow and don’t push yourself beyond what you can handle. Getting up and active following surgery is vital to speeding up your recovery after a hip replacement. Try to exercise for 20-30 minutes at a time. The first day that might just mean getting out of bed and to the hallway. Don’t feel discouraged by this!

Moving around will not only speed up your recovery but will also increase the circulation to your legs and feet which will reduce your chance of getting a blood clot. Blood clots are a serious risk following all types of surgery but can be prevented by early movement and exercise.

Getting out of bed will also help to maintain and increase your muscle strength while preventing your new hip from getting stiff. You’ll want to take full advantage of that new level of hip movement. Don’t forget that getting out of bed and being able to walk with a walker or cane is one of the goals you need to accomplish before going home from the hospital.

Your Hip Replacement Recovery Checklist

Typically, after two to four days you will be discharged from the hospital to either your home or to a rehabilitation facility. Here are some goals to use as a checklist when transitioning back to your home. Make sure that:

  • You can get out of bed by yourself.
  • Your pain is adequately under control. This doesn’t mean you’re pain-free but it should be manageable.
  • You can eat, drink, sleep and go to the bathroom.
  • You can walk with a cane, walker or crutches.
  • You’re ready to do home exercises on your own.
  • You know what you need to do to protect your new hip from an injury.

Before you go home, you will need to have someone available to help you at home. This can be a friend, family member or a caregiver. At home, you will want to make sure that your furniture is set up so that you can get around your house easily.

What Will Hip Replacement Recovery be Like?

It’s normal to have questions about what the healing process will look like after surgery. So we’ve gathered the answer to common questions.

When Can I Shower?

You will not be showering until you get the go-ahead from your surgeon because you need to keep the incision dry. But a sponge bath will feel heavenly when you get home! The first two weeks you will be at your highest risk of infection, so report any signs of redness, drainage or fever. Your surgical staples will usually come out on day 10-14 and then you can bathe or shower again.

When Can I Start Walking?

After your surgical staples are removed, you’ll be able to start to work on walking without a walker or cane. Don’t forget to move around as much as you can while at home. Make sure you do the physical therapy exercises you have set up, go for light walks and remember to rotate your ankles, bend your knees and practice leg raises while sitting up or lying down.

When Can I Drive?

You can usually start driving within three to six weeks following hip replacement surgery. However, you will need to make sure that you are no longer taking any pain medication that affects your response time or makes you groggy. Initially, you will likely find that an automatic transmission is easier to drive. Also, make sure you can tip your foot up and down without pain prior to driving. This can depend on which hip is operated on. If you had surgery on the side you use to drive, it may take longer to get behind the wheel.

When Can I Have Sex?

Yes, it is a question every patient has but often hesitates to ask. This can be especially awkward if it is your parent that has had a hip replacement and you are accompanying them to a doctor’s appointment. Check with your doctor to be sure, but it is usually safe to resume sexual activity six weeks to two months following a hip replacement. Remember, as with all activities, to listen to your body! Do not attempt to do more than you feel capable of and to stop or slow down if you notice increased pain.

Dr. Mehran, an orthopedic surgeon, shares this rule of thumb, “If you are still needing to use a walker, you are probably not ready for sex yet.” Still using a walker usually means that you have not yet regained enough strength and balance.

What Should I Eat After Hip Replacement Surgery?

The healthier you eat, the better you heal! The food that you put into your body will provide you with the energy and nutrition needed to fight off infections, accelerate healing, increase your strength and energy and build up your nutrition stores. Speed up the recovery process by eating healing foods like berries and dark leafy greens.

6 Tips for a Successful Hip Replacement Recovery

Along with following your surgeon’s discharge plan for exercise and physical therapy, it’s important to make a few changes to your home.

“Preparing your home with the same care shown to your physical recovery will set you up for success,” says Barbara Bergin, M.D. of Texas Orthopedics, Sports and Rehabilitation Associates. She suggests starting with the following six steps.

1. Remove Tripping Hazards

Slips and falls are common reasons for hip replacement surgeries in the first place. To avoid hospital re-admission with an injury to your other hip, or damaging the replacement, Bergin suggests removing all throw rugs, floor mats, etc. from your home.

“You’ll be shuffling your feet for a while,” says Bergin. As a result, you can trip on throw rugs, including those you use in the bathroom or kitchen. If you prefer to keep the rug where it is, Bergen suggests “fastening them using carpet tape to keep the edges down.” However, she says that the best bet is removing the tripping hazard to eliminate any concerns about a fall.

2. Upgrade the Bathroom

Installing a handicap or comfort height toilet is a better option than a temporary elevated toilets apparatus, says Bergen. “Not only do the temporary appliances get dirty easily, but it’s also recommended to use a comfort height toilet permanently after a total joint replacement.” Doing so, she says, will improve the quality of your life, along with that new joint.

You should also use a shower chair. Make sure that you have a sturdy chair that is higher than average and firm. You will find this easier to get up from. To get in and out of the shower easily, you also might want to consider having a grab bar installed in the bathroom.

3. Raise ‘em up

“Elevating the legs helps get that swelling down,” Bergin says. Swelling can limit your ability to get your life back to normal. She suggests, “Using big pillows or wedges to elevate your legs if recommended.” This includes having a pillow to place in between your legs while sleeping. “A nice, fat body pillow provides comfort and helps promote restful sleep.”

4. Gather the Right Tools

Bergin says over time, you may easily perform many daily activities once again. But in the first days and weeks at home, some of life’s little tasks like getting dressed or feeling steady while retrieving something from a cabinet might be challenging. She encourages people to have a few handy gadgets to make these tasks as stress-free—and safe—as possible.

“Sock donners and handy grabbers that extend your reach are absolute musts,” she says. Other helping hands include leg lifters, bendable bath sponges and a long-handled shoe horn. Many companies sell these items together as a “hip kit” package.

5. Raise Your Seat

If you can afford it, Bergen suggests asking your doctor for a prescription for a lift chair. She says, “Your knees, hips and arms will appreciate it, and that your other bad hip will really appreciate it!” Although insurance doesn’t cover the cost of the chair, having a prescription can avoid the need to pay sales tax in some areas.

6. Borrow, Don’t Buy

Many of the items you’ll need to speed down the road to recovery post hip replacement will only be required for a few weeks or so. Instead of paying the full price out-of-pocket (medical equipment is frequently not covered by many insurance plans) or even your deductible’s portion of these items, check in your area for free or low-cost community resources. These can alleviate the sting of having to outfit your home with several new tools and medical equipment.

“Family members and/or patients may borrow this equipment for little or no cost from community medical equipment lending programs, also known as medical equipment reuse programs or loan closets,” says Janice Selden, Director of Great Lakes Loan Closets.

These organizations accept medical equipment from community members who no longer need it. “They clean the equipment, check to make sure it is safe, and lend it back out to members of the community who need it. Typical equipment includes wheelchairs, walkers, shower aids, and dressing aids,” explains Selden.

Organizations like these usually provide an online directory of locations that provide these services throughout the country and can be very helpful for patients.

Do’s and Don’ts After a Hip Replacement

The dos and don’ts might be different depending on what type of surgical technique your doctor used. Your doctor and physical therapist can give you a specific list to remember. These precautions are pretty standard to prevent your new hip from dislocating and to help with a quick and thorough recovery.


  • Keep your operated leg facing forward.
  • Make sure your operated leg is in front of you as you sit or stand.
  • Use chairs that are high enough that your knee is lower than your hip when bent.
  • Use ice to reduce swelling.
  • Use heat before exercising to warm up the muscles for 15-20 minutes. This will help you to have better movement.
  • Reduce the amount of exercise you do if you are in pain but continue to stay active and resume your exercises as soon as possible.
  • Ask your doctor about safe sleep positions.
  • Limit the amount of weight you carry.


  • Cross your legs for six to eight weeks.
  • Allow your knees to sit higher than your hips.
  • Lean forward while sitting, especially to pick something up off the floor.
  • Turn your foot in or out when you bend down.
  • Bend at the waist beyond 90 degrees.
  • Twist your hips.

How Long Until You Feel Good Again After a Hip Replacement

It will take time before you are out dancing again! Hip replacement is an excellent option to increase your health and quality of life. The American Academy of Orthopedic Surgeons report that 95% of patients who undergo a hip replacement stated the procedure was successful. They reported relief from hip pain and were able to be more active and connected with their loved ones following the surgery.

These results are encouraging but it is not an overnight cure. You can expect it to take 10-12 weeks before you are able to return to all your favorite activities. At some point, you are going to feel like your recovery is taking too long. It’s important to remind yourself that feeling frustrated and limitations to physical ability are a normal part of the healing process.

Take a break and relax from pushing yourself. Do something you can enjoy. Get help if you need it, think about how far you have already come, then get back up, keep on moving and eating healthy. 10-12 weeks will feel like a long time, but once you are enjoying a pain-free stroll or game of golf, that time will be just a memory.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Knee Injuries

What to do if you think your joint replacement is infected

Article Featured on AAOS

Knee and hip replacements are two of the most commonly performed elective operations. For the majority of patients, joint replacement surgery relieves pain and helps them to live fuller, more active lives.No surgical procedure is without risks, however. A small percentage of patients undergoing hip or knee replacement (roughly about 1 in 100) may develop an infection after the operation.Joint replacement infections may occur in the wound or deep around the artificial implants. An infection may develop during your hospital stay or after you go home. Joint replacement infections can even occur years after your surgery.

This article discusses why joint replacements may become infected, the signs and symptoms of infection, treatment for infections, and preventing infections.


Any infection in your body can spread to your joint replacement.

Infections are caused by bacteria. Although bacteria are abundant in our gastrointestinal tract and on our skin, they are usually kept in check by our immune system. For example, if bacteria make it into our bloodstream, our immune system rapidly responds and kills the invading bacteria.

However, because joint replacements are made of metal and plastic, it is difficult for the immune system to attack bacteria that make it to these implants. If bacteria gain access to the implants, they may multiply and cause an infection.

Despite antibiotics and preventive treatments, patients with infected joint replacements often require surgery to cure the infection.

Total knee implants

Examples of total knee implants. Joint replacement implants are typically made of metal alloys and strong, durable plastic called polyethylene.


A total joint may become infected during the time of surgery, or anywhere from weeks to years after the surgery.

The most common ways bacteria enter the body include:

  • Through breaks or cuts in the skin
  • During major dental procedures (such as a tooth extraction or root canal)
  • Through wounds from other surgical procedures

Some people are at a higher risk for developing infections after a joint replacement procedure. Factors that increase the risk for infection include:

  • Immune deficiencies (such as HIV or lymphoma)
  • Diabetes mellitus
  • Peripheral vascular disease (poor circulation to the hands and feet)
  • Immunosuppressive treatments (such as chemotherapy or corticosteroids)
  • Obesity


Signs and symptoms of an infected joint replacement include:

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills and night sweats
  • Fatigue

Doctor Examination

When total joint infection is suspected, early diagnosis and proper treatment increase the chances that the implants can be retained. Your doctor will discuss your medical history and conduct a detailed physical examination.


Imaging tests. X-rays and bone scans can help your doctor determine whether there is an infection in the implants.

Laboratory tests. Specific blood tests can help identify an infection. For example, in addition to routine blood tests like a complete blood count (CBC), your surgeon will likely order two blood tests that measure inflammation in your body. These are the C-reactive Protein (CRP) and the Erythrocyte Sedimentation Rate (ESR). Although neither test will confirm the presence of infection, if either or both of them are elevated, it raises the suspicion that an infection may be present. If the results of these tests are normal, it is unlikely that your joint is infected.

Additionally, your doctor will analyze fluid from your joint to help identify an infection. To do this, he or she uses a needle to draw fluid from your hip or knee. The fluid is examined under a microscope for the presence of bacteria and is sent to a laboratory. There, it is monitored to see if bacteria or fungus grow from the fluid.

The fluid is also analyzed for the presence of white blood cells. In normal hip or knee fluid, there are a low number of white blood cells. The presence of a large number of white blood cells (particularly cells called neutrophils) indicates that the joint may be infected. The fluid may also be tested for specific proteins that are known to be present in the setting of an infection.


Nonsurgical Treatment

In some cases, just the skin and soft tissues around the joint are infected, and the infection has not spread deep into the artificial joint itself. This is called a “superficial infection.” If the infection is caught early, your doctor may prescribe intravenous (IV) or oral antibiotics.

This treatment has a good success rate for early superficial infections.

Surgical Treatment

Infections that go beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.

Debridement. Deep infections that are caught early (within several days of their onset), and those that occur within weeks of the original surgery, may sometimes be cured with a surgical washout of the joint. During this procedure, called debridement, the surgeon removes all contaminated soft tissues. The implant is thoroughly cleaned, and plastic liners or spacers are replaced. After the procedure, intravenous (IV) antibiotics will be prescribed for approximately 6 weeks.

Staged surgery. In general, the longer the infection has been present, the harder it is to cure without removing the implant.

Late infections (those that occur months to years after the joint replacement surgery) and those infections that have been present for longer periods of time almost always require a staged surgery.

The first stage of this treatment includes:

  • Removal of the implant
  • Washout of the joint and soft tissues
  • Placement of an antibiotic spacer
  • Intravenous (IV) antibiotics

An antibiotic spacer is a device placed into the joint to maintain normal joint space and alignment. It also provides patient comfort and mobility while the infection is being treated.

Knee Implant Compressors

(Top) These x-rays show an original knee replacement from the front and from the side. (Bottom) An antibiotic spacer has been placed in the joint during the first stage of treatment for joint replacement infection.

Spacers are made with bone cement that is loaded with antibiotics. The antibiotics flow into the joint and surrounding tissues and, over time, help to eliminate the infection.

Patients who undergo staged surgery typically need at least 6 weeks of IV antibiotics, or possibly more, before a new joint replacement can be implanted. Orthopaedic surgeons work closely with other doctors who specialize in infectious disease. These infectious disease doctors help determine which antibiotic(s) you will be on, whether they will be intravenous (IV) or oral, and the duration of therapy. They will also obtain periodic blood work to evaluate the effectiveness of the antibiotic treatment.

Once your orthopaedic surgeon and the infectious disease doctor determine that the infection has been cured (this usually takes at least 6 weeks), you will be a candidate for a new total hip or knee implant (called a revision surgery). This second procedure is stage 2 of treatment for joint replacement infection.

During revision surgery, your surgeon will remove the antibiotic spacer, repeat the washout of the joint, and implant new total knee or hip components.

An antibiotic spacer in a hip joint.

This x-ray shows knee components used in a revision surgery (stage 2). Note that the stems of the implants are longer to help support bone that has been compromised due to infection and removal of the previous implants.

Single-stage surgery. In this procedure, the implants are removed, the joint is washed out (debrided), and new implants are placed all in one stage.  Single-stage surgery is not as popular as two-stage surgery, but is gaining wider acceptance as a method for treating infected total joints. Doctors continue to study the outcomes of single-stage surgery.


At the time of original joint replacement surgery, there are several measures taken to minimize the risk of infection. Some of the steps have been proven to lower the risk of infection, and some are thought to help but have not been scientifically proven. The most important known measures to lower the risk of infection after total joint replacement include:

  • Antibiotics before and after surgery. Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued at intervals for 24 hours following the procedure.
  • Short operating time and minimal operating room traffic. Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to the decrease risk of infection.
  • Use of strict sterile technique and sterilization instruments. Care is taken to ensure the operating site is sterile, the instruments have been autoclaved (sterilized) and not exposed to any contamination, and the implants are packaged to ensure their sterility.
  • Preoperative nasal screening for bacterial colonization. There is some evidence that testing for the presence of bacteria (particularly the Staphylococcus species) in the nasal passages several weeks prior to surgery may help prevent joint infection. In institutions where this is performed, those patients that are found to have Staphylococcus in their nasal passages are given an intranasal antibacterial ointment prior to surgery. The type of bacteria that is found in the nasal passages may help your doctors determine which antibiotic you are given at the time of your surgery.
  • Preoperative chlorhexidine wash. There is also evidence that home washing with a chlorhexidine solution (often in the form of soaked cloths) in the days leading up to surgery may help prevent infection. This may be particularly important if patients are known to have certain types of antibiotic-resistant bacteria on their skin or in their nasal passages (see above). Your surgeon will talk with you about this option.
  • Long-term prophylaxis. Surgeons sometimes prescribe antibiotics for patients who have had joint replacements before they undergo dental work. This is done to protect the implants from bacteria that might enter the bloodstream during the dental procedure and cause infection. The American Academy of Orthopaedic Surgeons has developed recommendations for when antibiotics should be given before dental work and for which patients would benefit.  In general, most people do not require antibiotics before dental procedures. There is little evidence that taking antibiotics before dental procedures is effective at preventing infection.

    Antibiotics may also be considered before major surgical procedures; however, most patients do not require this. Your orthopaedic surgeon will talk with you about the risks and benefits of prophylactic antibiotics in your specific situation.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.