What A Modern Hip Replacement Really Involves And How To Prepare

How Do You Prepare And Assist Patients With Hip Replacement Surgery?  

Pain that steals your stride doesn’t get the last word. We take you inside a modern hip replacement—what truly fails with end-stage arthritis, how the implant restores smooth motion, and the practical steps that make recovery safer and faster. With Dr. Noelle DiGioia Guthrie and PA Tiffany Belculfine, we get specific about materials like ceramic heads and porous coatings, the differences between cemented and cementless fixation, and why many patients find hip rehab more straightforward than knee rehab.

We walk through smart preparation: targeted prehab for hips, core, and the joints above and below; realistic timelines for walkers, therapy, and milestones; and the role of a dedicated support coach who attends visits and practices transfers and stairs. We also break down surgical approaches—posterior, anterolateral, and direct anterior—and the simple, approach-based precautions that cut dislocation risk. If fear of pain or the unknown has kept you on the sidelines, you’ll hear how education, expectation setting, and a responsive care team turn anxiety into action.

Finally, we map out a safer home: clear paths, no loose rugs, nightlights, and essentials within easy reach. You’ll learn how compensations from a painful hip can strain your back and opposite knee, and why gait retraining matters as you reclaim your routine. The goal is not just a new joint—it’s a return to confident movement, from daily errands to long walks and travel. If this guide helps, subscribe, share it with someone who needs clarity, and leave a review telling us what you want to tackle next.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit:  https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St. 
Pittsburgh, PA, 15213 
412-683-7272  

To learn more about The Wellness Center for Bone and Joint Health visit:  https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601 
Pittsburgh, PA, 15213 
412-641-8594  

Transcript

Welcome And Hosts Introduced

SPEAKER_00 0:04

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your host, Dr. Noel DeJoy Guthrie of the Ponent Joint Center of the Key Women's House, and Tiffany Belkafine, position assistant at the Wellness Center of the Ponent Joint House, serving the dogs across Western. If you're like putting on your side eye stairs, you're in the right place. Every day, they'll break it down and build you back up with a personalized plan for real life. The show is information without a substitute clinician. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_01 0:54

Hip replacement can be life-changing. Today we're breaking down the prep, the procedure, and the support that helps patients thrive. Welcome. I'm Julie Schwenzer, co-host and producer with Dr. Noel DeJoy Guthrie of the Bone and Joint Center at McGee Women's Hospital, and Tiffany Belkafine, physician assistant at the Wellness Center for Bone and Joint Health. Ladies, again, it's a pleasure to speak with you. We love learning from you.

SPEAKER_02 1:18

Hi, Julie. Good morning. Thanks for having us again.

SPEAKER_01 1:21

Yes. So, Dr. Noelle, let's begin with you. Will you describe what exactly hip replacement surgery is and why it's needed in general?

How A Modern Hip Is Built

SPEAKER_02 1:30

Sure, absolutely. And um, you know, I'm referencing one of our past um podcasts when we talked about arthritis because people have hip replacements because they have arthritis that's gotten so bad that we call it end stage arthritis. And, you know, a lot of patients know it as bone-on-bone arthritis, where basically all of the cartilage within your acetabulum, which is the cut part, and the top of your ephemeral head, which is the head part, has basically worn away just from wear and tear of, you know, using your hips to walk how many times in your life until you get a certain point. Um, so when that their bones start to rub, that generates pain and inflammation. And that's a reason to have a hip replacement. We always try conservative management, you know, and try to see if we can modulate your pain that way. But then at some point, you know, those don't work. And that's when we start to talk about surgical options, meaning a hip replacement. Um so hip replacement's a little similar to knees, but a little different because obviously it's a different joint. It's a ball and socket joint, so different from the knee joint. Um, basically, we resurface the inside of your acetabulum part and place a metal, a metal cup, kind of a hemispherical cup. Within that goes a little plastic piece that acts as your new cartilage. And then talking about the femoral side, so on your leg, your femur part, um there's a stem that goes down your femur that has a new neck and then a head on it, usually made of ceramic these days. You know, back when not that long ago, but you know, 10, 15 years ago, they used to use metal heads. Um, but mostly these days we use ceramic heads. Um, and then we put your hip back together, so relocate it, and then you know, close everything up, and that's your hip replacement. That femoral stem can be uncemented or cemented, kind of depending on the patient, um the surgeon's preferences and whatnot, and meaning cemented using cement like a grout that we talked about with the total knees, or it can be cementless, meaning that there's a porous substance around the stem that actually grows into your bone. That one's the the cementless one, is usually more common for hips. And then that cement also on the acetabular side, there's a porous substance on the the back side of the cup that grows into your bone. So that's um how we that's the generalized um total hip replacement. Um yeah.

SPEAKER_01 3:44

Well, thank you for explaining all that. And Tiffany, in our past podcast on the knee replacement, the whole operation and the prep and stuff. How similar is it with this operation for the the prep for the patients and how you assist patients uh physically and mentally with getting ready for surgery?

SPEAKER_03 4:04

So definitely when they're doing their prehab exercises, those are going to be a little bit of a different setup of exercises that they would have to do compared to a knee because it is a different joint. It moves in a different way. But we always want to think about the joints above and below the joints that we're trying to improve. So when people have a knee replacement, they do have some exercises for their hip and for their ankle to keep things in line and keep those muscles strong all throughout. So there are definitely some slight differences there. Um, and there are also some things that may be a little bit different for women compared to men for their preparation. Um, and then certainly mentally, you know, making sure that people understand the procedure, understand who their support people are going to be to help them when they're recovering at home, how long they're going to need physical therapy for, how long they're going to need a cane or a walker, you know, using those information that they'll get from their physician's office to let them know these are the things to expect. This is what we hope to have happen. This is what'll happen the day of your surgery. This is what'll happen a week after surgery or two weeks after or a month after or a year after, so that they know what their expectations are and those are all lined out very clearly for them. And then making sure they're at their very best so that they have their very best outcomes. So if they have other complications that could be a concern, something like smoking or not being at a good body weight, where they're actually putting too much pressure on that joint to relieve some of the pressure on that joint, they sometimes need to pursue some weight loss options. So talking through all of that with them to make sure that they understand why all of that's important.

Safety, Clearance, And Timing

SPEAKER_01 5:39

Yeah. And then with Dr. Duel, with the surgical approach, how do you decide what's safest and most effective for each patient? Because, you know, you both have mentioned each patient is so different and might be in a different um condition in their life. And like you said, age is just a number.

Rehab Differences: Hips Versus Knees

SPEAKER_02 5:56

Yeah, no, very similar to, you know, total knees. We make sure everyone's number one healthy medically, as far as, you know, your heart, your lungs, your brain. If you've had any issues in the past, we make sure that you're seeing your that that physician, making sure they're clearing you for surgery. And we do our own history and physical too to make sure that um you're safe for surgery. And obviously, knowing, you know, patients who have a that degree of arthritis where you're basically bones are touching. Um, also making sure you've tried other things before surgery to make sure that, you know, you're doing the right thing. Because it's always an elective surgery. So it's not a surgery that we have to do. So we want to make sure we're doing it for the right reasons and at the right time. Um, so definitely that approach of making sure that we were doing it for the right reasons is very, very important. Um, prehab for the hips. So hips in general, because they are a different joint, they don't get as stiff as knees. So knees, we kind of really hit home working on your range of motion. So doing therapy, doing a lot of prehab, a lot of rehab post-operatively, moving, moving. And the hips don't get as stiff, I should say. It's definitely still important to move. You know, joints, either non-replace joints or replace joints, like to move. So the more you move, the better you'll feel. Um, but you know, and we like you to do therapy and more so to keep moving, kind of strengthening your muscles. A lot of patients with hip problems sometimes have low back problems. So therapy will help that afterwards too. Um, so therapy is definitely important, but you know, we don't really emphasize the range of motion part of it like we do with the knees. And I think in that way, sometimes hips, you know, talking to lots of patients and just what I've seen in my clinical practice, hips tend to be a little bit easier to rehab from for that reason. Um, I think the rehabs just a little bit less painful, a little bit easier as far as um what you do. So I do think, you know, and you'll read that a lot of places, and we I've seen that a lot in my practice. And um so yeah.

SPEAKER_01 7:58

And for both of you, what is the the safety precautions you're looking at at home? Do they always need a walker after? And like you you both had mentioned about making sure the house is clear and to look for obstructions and that you have help. Do you still need to coach everything the same?

Home Setup And Support Coaching

SPEAKER_03 8:14

Or so yes, people still need that support person um to help them, you know, after surgery. In I know in the Bone and Joint Center in Dr. Guthrie's practice, they do have requirements that people have to have a coach. They have to have someone there to come to their appointments and learn about the whole process and help them through. And then also we just want to make sure that their home environment is going to be safe. Um, you know, that they are going to learn the skills that they need through physical therapy or occupational therapy, you know, before or after surgery. They're going to learn how to do things like going up and down the steps the right way and making sure that their balance is good, making sure that they know how to use a walker. So they're going to be as well prepared for that as they can be, but also their physical environment at home definitely needs to be a consideration. You know, they need to make sure that they know how to navigate from their bedroom to the bathroom. They need to know how to, you know, open the door and, you know, do all the things that we tend to take for granted.

Surgical Approaches And Precautions

SPEAKER_02 9:08

And there's one thing with hips that is different for me. So there's uh different approaches, surgical approaches to the hip that you've, you know, patients hear about a lot. And that certain, you know, surgeons. I think it's most common surgeons who trained in one way and learned that way, they do that way. The posterior lateral approach, the anterior lateral approach, and then the direct anterior approach, which is in the front of the hip. Um, so three different approaches to the hip that you can have. Sometimes there might be certain precautions that you have postoperatively to prevent dislocation. So that's one of the big risks from hip surgery, is where your hip pops out after having surgery. So sometimes we'll tell patients to not move their leg in a certain position, depending on which approach they they underwent in surgery. So that's one thing different that um from knees that we always talk about with patients.

How One Joint Affects Another

SPEAKER_01 9:55

Do you see a lot of patients that have undergone both replacements? And if so, which one came first, the knee or the hip? In general, mostly.

SPEAKER_02 10:05

Yeah. Um, there's a lot of patients, uh, a lot of patients who've had two hips and two knees, you know, one knee, two hips. Um I and there's not I'd say there's not really a rhyme or reason. I think, you know, some patients have worse knee arthritis and then it goes to your hip. It it I would say you can't really, there's not one more than the other.

SPEAKER_03 10:26

And I think it's also important for patients to realize that sometimes the way that they move their body to kind of get away from something that hurts can affect other parts of their body too. Um, you know, if their their left knee hurts, their right knee might be taking more of the brunt of that. So they might be, you know, shifting their posture a little bit. And then when that left knee gets fixed, then the right knee is kind of like, well, wait a minute, where do I fit in this, you know, this realm now? Um, and the same thing can happen with hips that, you know, if people are walking a little differently, like she said, that can affect their back. And, you know, they they might have different posture and they might walk differently, and that's a whole thing that they have to figure out. And sometimes people go, I don't know, it just hurts. I don't know where it's coming from, and then they don't know if it's their hip or their knee. And it's very hard to figure out sometimes.

SPEAKER_01 11:11

And any words of advice for patients that are considering either replacement, knees or hips, but they feel nervous about the pain and the movement restriction, but they know that they're not enjoying how they're living because of the pain from those areas.

SPEAKER_02 11:28

Yeah. And I think, you know, patients we have a lot of patients say, I'd wish I'd done this sooner, because they were, you know, they were nervous about it. And then, you know, you do go through a few months of pretty intense pain and rehab, but then down the line they're so happy. They're able to do things that they wanted to do before that they couldn't. Um, so I think being prepared is huge. I would say, you know, find a surgeon who you you like and trust and can talk to and who listens to you. I think that's important because that's that person's, you you marry them when you have surgery with them. You, you know, you'll be with them for a while and you want to be able to um know that person, trust that person, um, trust their team. Their team, you know, uh medicine in general, especially orthopedics, is very team-oriented. Surgeons cannot do everything. You know, they're physicians, assistants, nurse practitioners, uh, you know, any part of the team is helpful and you have to really be able to trust them, you know, communicate with them easily. Um, you know, I think being educated is huge too. You know, learn, learn the details of every step of the process, pre-op, intra-op, post-op. Um, I think that's huge in our program is education from every step of the way and having support every step of the way. Um so I think when you find those things and prepare yourself, you can feel more confident in the process. I think you're it knowing realistically, you're gonna have pain. Yeah, you're having surgery. You know, surgery is a big deal. Um, but having people behind you who can support you and help modulate and and help you through the process is really important. Um, so I think that's the biggest words of wisdom I can give somebody, you know, whether it be our practice, whether it be somebody else, I think, you know, that's something to look for and and um will help you through the process.

Closing Thoughts And Patient Resources

SPEAKER_01 13:17

Well, thank you both. And I mean, I can sense that you guys provide support like a family would for your patients, and that is really awesome. And I'm sure very um helpful to many people considering this. So thank you for breaking down the operative side and the prep side and the post-op side of a hip replacement. We really appreciate it.

SPEAKER_03 13:35

Of course. Thank you.

SPEAKER_00 13:41

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272, or visit PGHPJC.com. Or if you are looking for lifestyle changes that are not surgical, contact Tiffany Belcovine. Call 412-641-8594, or visit bone at jointhealth.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.