Your Guide to a Total Hip Replacement

Ouida Dickey, 90, likes to stay active. "I don't sit home in the rocking chair," says Dickey, a retired college professor and former academic dean at Berry College in Rome, Georgia. But after retiring she found "great pain" in her hips from osteoporosis was making it hard to walk and putting a damper on life. In 2011, after weighing her options, she had a total right hip replacement.

When your bad hip -- from a medical condition, trauma or the wear and tear of aging -- is threatening to bring on constant pain and disability, hip replacement may be on your radar. "You don't have to be totally incapacitated to need a hip replacement," says Dr. Mark Zawadsky, an orthopedic surgeon at MedStar Georgetown University Hospital. "If you're not happy with your level of functioning, that's a good time to start thinking about getting a hip replacement."

How to Choose a Surgeon for Hip Replacement Surgery

If you're choosing a surgeon, consider his or her experience, level of specialization and outcomes (such as infection rates and need for surgical revision), and how well patients function soon after surgery and months and years down the road. Some orthopedic surgeons are generalists, while others specialize in areas like joint replacement. When deciding on a surgeon, don't hesitate to ask these questions:

-- How many of these procedures have you done in the past year? Overall?

-- What were complication rates? What post-operative infection rates did you see?

-- What if I need a revision surgery? How often does that happen?

-- Six months after surgery, how is hip function for most of your patients?

-- How are patients doing five years later?

-- Have you measured patient satisfaction? How is it?

-- Which approach do you specialize in?

You can also research your surgeon's background on independent sites like SurgeonRating.org and ProPublica's " Surgeon Scorecard." U.S. News also ranks the best hospitals for hip replacement surgery using data on patient survival, nurse staffing, volume and more.

[See: 10 Questions Doctors Wish Their Patients Would Ask.]

Look for a high-volume facility -- one that regularly performs these procedures. Depending on your location, choices can range from major medical centers to facilities that concentrate on hip and knee conditions. "You want to make sure you go to a surgeon that's comfortable doing the procedure and does a lot of them," Zawadsky says. "It's a routine procedure that should be done in a routine manner, and you should have systems set up to handle the pre-op clearances and the anesthesia and the pain management protocols and the physical therapy."

Cost may be a consideration, too. The average cost of a hip replacement for someone without insurance is close to $40,000, reports CostHelper.com, a consumer information startup. And while most insurance companies cover the procedures, patients who have a hip replaced may still pay several thousand dollars in out-of-pocket expenses.

Posterior Versus Rear Approach

As you go online to research surgeons, you'll notice many describe their surgical "approach" -- using either a traditional posterior (rear) approach to reach the hip joint, or an anterior (frontal) approach, which is now common as well. "Ten years ago it was about 5 percent (of surgeons who used it) and now it's probably 40 percent," Zawadsky estimates.

While both approaches, when done well, are "life-changing" in terms of alleviating pain and improving function and mobility, Zawadsky says, there are important differences to understand. "One of the big differences [with anterior] is all of the muscles are still intact. We stretch them and pull them out of the way as opposed to cutting the tendons and repairing them to bones," he says. "So when we do the replacements [posteriorly], we have to allow six weeks for the tendons to heal back to the bones -- and that's where your ultimate stability of the joint comes from."

[10 Ways to Prepare for Surgery.]

In his research comparing the experiences of his earlier patients who underwent a posterior approach to his more recent patients who've undergone the anterior approach, he's found the latter have better short-term outcomes: Patients had shorter hospital stays by about a day, reported less pain, used less narcotic pain medicine and relied less on walkers or canes. Similar advantages were seen when Zawadsky compared his anterior-approach patients' with a colleague's who uses the posterior approach. His research has also found that obese patients -- who are sometimes turned down for hip replacements and other surgeries due to the relatively high rate of complications -- can benefit from the anterior approach.

The biggest plus of the anterior approach, though, might be not having to worry about dislocation precautions after surgery -- things like not bending your hips more than 90 degrees or moving your knee a certain way, using an elevated toilet seat, sleeping with a pillow between your knees and not driving for several weeks. Zawadsky says with an anterior approach, these restrictions aren't needed. That's why Dickey opted for the anterior approach. "My concern was finding the approach that was the least confining and wouldn't keep me out of operation very long," she says.

And, while early research suggested that the anterior approach raises the risk of wound complications after surgery, different wound closure techniques "have greatly reduced this risk," says Cale Jacobs, assistant professor in the University of Kentucky's department of orthopedic surgery who's conducted studies comparing the approaches.

Longer-term outcomes for both approaches, however, appear to be the same, Zawadsky says, and choosing a surgeon who's skilled and experienced in either technique is more important than the approach itself. Your personal characteristics matter too: How your body fat is distributed, for example, can affect which approach is preferable for you. And, if you've had a prior posterior surgery, you'll likely need to use that approach again in any follow-up surgery.

Preparing for Your Hip Replacement Surgery and Recovery

After you choose a surgeon, the National Library of Medicine suggests questions to ask about hip replacement and how it will affect you, including, "How well does this surgery work for someone my age and with any of the medical problems I may have?" Make sure your surgeon and other health care providers are up-to-date about health status -- medical conditions, complete list of medications, allergies and other precautions -- in advance.

[Read: Exercising After You've Gone Under (the Knife, That Is).]

Find out how side effects will be managed in your case, and what precautions you'll need to take post-surgery. For instance, ask how long you'll wear compression stockings after surgery to prevent embolisms (blood clots) and what sort of anti-clotting medicine you'll receive.

Ask about activities -- such as golf, tennis or hiking -- and when you can resume them. (Most activities are fine after hip replacement, but many surgeons advise against running.) Also, ask how you can prepare before surgery to make the outcome more successful -- such as learning to use crutches or a walker before you actually need them, and how to manage stairs. And talk to your doctor or physical therapist about how to get in the best possible shape before surgery, to make recovery easier.

Also ask about your surgical wound care and supplies. For instance, experts may recommend you don't immerse yourself in water -- a Jacuzzi, bathtub or pool -- during the first few weeks until the wound is healed.

Life After Surgery

Following her hip surgery and three days of recovery in the hospital, Dickey was transferred to a rehabilitation center for physical therapy. When she left two weeks later, she says she was walking "very well." (Some patients go straight home after discharge and get outpatient physical therapy.)

Within a month, Dickey was walking around the house without a cane, although she would use one outdoors if "surfaces were questionable." After a month, she was cane-free and today, she frequently walks up and down her three-block street, "using a cane as the street curves slightly on the sides," she says. Dickey also occasionally joins a friend for a walk on a nearby college's indoor track and grooms the flowers around her yard. "Both hips are doing well," she says. "I'm happy to have had the surgery when I did."