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Dr. Jonathon K. Salava

Dr. Felix H. Cheung

Elizabeth Dilley, FNC-P

Jaclyn Kiser, PA-C

Modohipjreplace

HIP_SalavaThe Division is headed by Jonathon Salava, MD, a fellowship trained joint replacement surgeon specializing in the anterior approach to hip replacement surgery​, ​along with Felix Cheung, MD and Tigran Garabekyan, MD. ​ The Hip Joint Replacement Division looks forward to providing you with the latest treatments in total hip joint replacement while providing the caring support you have come to expect from the physicians and staff at Marshall Orthopaedics. Deciding to have a hip replacement procedure can be a long journey, but our staff will be here to guide you every step of the way. Marshall Orthopaedics has developed this webpage to be used as a resource for your pre-procedure and post-recovery concerns. 

Q: What is causing my hip to ache?

A: Hip pain, also described as "groin pain," "groin pull," "fork in my groin" "aching ovaries," or a deep aching pain in one’s hip, can occur from injury to the hip brought on by mechanical dysfunctions in the joint, or the result of trauma from the high impact and deep flexion occurring in sports such as football, downhill skiing, martial arts and wrestling. It also can arise as the result of repetitive motion from certain movements such as golf or soccer. Or, pain can result from a congenital condition that causes wear and tear on the joint. Sometimes the pain is noticed after sitting through a movie or getting in and out of a car.

Q: Is there something I can do while waiting for a diagnosis?

A: If you find yourself with hip pain, it’s important to consult a physician. An examination will help to determine what’s causing the soreness, since hip pain can actually come from the hip as well as the spine, pelvis or leg. While waiting to see your physician, there are activity modifications and exercises that may help to relieve some of the discomfort. View activities and exercises.

Q: How is hip pain treated?

A: Non-surgical treatment should always be considered first when treating hip pain. The discomfort can often be resolved with rest, modifying one’s behavior, and a physical therapy and/or anti-inflammatory regimen. Such conservative treatments have been successful in reducing the pain and swelling in the joint.

If pain persists, it is sometimes necessary to differentiate between pain radiating from the hip joint and pain radiating from the lower back or abdomen. A proven method for differentiating between the two is by injecting the hip with a steroid and analgesic. The injection accomplishes two things:

If the pain is coming from the hip joint, the injection provides the patient with pain relief.

The injection serves to identify the point of origin of the pain. If the pain is a result of impingement, a hip injection that relieves pain confirms that the pain is from the hip and not from the back.

What is the labrum and how does it get injured?

The hip is a ball and socket joint with the femur, or thigh bone (ball) inserting into the acetabulum, or pelvic bone (socket). Both the ball and socket are covered with smooth articular cartilage. The labrum is an additional, specialized piece of cartilage that runs along the rim of the socket to provide a suction seal and stability to the hip joint. The labrum can be torn with a sudden, specific injury or with repetitive motions that cause "wear and tear."

Q: What conditions warrant a hip replacement?

A: There can be many factors to consider when choosing hip replacement but some of them can include:

  • Pain, swelling, and stiffness. If your hip hurts when you walk, climb stairs, or do other daily things, that's a sign you might need a new hip. Your hip may ache at night or even when you're resting. You should think about surgery if you've had the pain for a while and it rarely eases up with nonsurgical treatments.
  • Other treatments didn't help. Surgery shouldn't be your first option. Other non-surgical treatments may include anti-inflammatory drugs like ibuprofen or naproxen, cortisone shots, physical therapy, and crutches or walkers.
  • Bone damage or deformity. Have you noticed that your leg is bowed, or has a doctor found bone damage in your joint? "Those deformities are red flags for the doctor," Lajam says. "That's when the doctor says, 'I don’t know if you're doing yourself a favor by waiting.' The worse the deformity gets, the harder it is to fix it."
  • Quality of life. If constant pain affects your daily activities and mood, it may be time for surgery.

Q: What are the different options I have for Hip Replacement Surgery?

A: Total joint replacement involves surgery to replace the ends of both bones in a damaged joint to create new joint surfaces. Total hip replacement surgery uses metal, ceramic, or plastic parts to replace the ball at the upper end of the thighbone (femur) and resurface the hip socket in the pelvic bone. Total hip replacement surgery replaces damaged cartilage with new joint material in a step-by-step process. Doctors may attach replacement joints to the bones with or without cement.

  • Cemented joints are attached to the existing bone with cement, which acts as a glue and attaches the artificial joint to the bone.
  • Uncemented joints are attached using a porous coating that is designed to allow the bone to adhere to the artificial joint. Over time, new bone grows and fills up the openings in the porous coating, attaching the joint to the bone.

Doctors often use general anesthesia for joint replacement surgeries, which means you'll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can't feel the area of the surgery and you are sleepy, but you are awake. The choice depends on your doctor, on your overall health, and, to some degree, on what you prefer.

Q: How long will the replacement last?

A: Most artificial hip joints will last for 10 to 20 years or longer without loosening, depending on such factors as:

  • Your lifestyle and how much stress you put on a joint.
  • How much you weigh (being very overweight puts extra stress on the joint).
  • How well your new joint and bones mend.

The younger you are when you have the surgery and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Your artificial joint should last longer if you are not overweight and if you do not do hard physical work or play sports that stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint probably will last the rest of your life.

Doctors continue to discover new ways to improve the life span of artificial hip joints. What we know today about the long-term outcomes of hip replacement surgery comes from studies of joints that were replaced 10 to 20 years ago or longer. People who have hip replacement surgery today may expect the artificial joint to last longer than joints replaced 10 to 20 years ago.

Q: What age is it for?

A: Age is not as much a factor as the condition and health of the person considering surgery. However, the younger you are when you have the surgery and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Q: Can I expect a full recovery? What's the recovery time?

A: Your doctor will probably want to see you at least once every year to monitor your hip replacement. Gradually, you will return to most of your presurgery activities. If you drive a car, your doctor will probably allow you to start driving an automatic shift car in 6 to 8 weeks, as long as the seat is not too low and you are no longer taking pain medicine.

Because of the way the hip is structured, every added pound of body weight adds 3 pounds of stress to the hip. Controlling your weight will help your new hip joint last longer.

Stay active to help keep your strength, flexibility, and endurance. Your activities might include walking, swimming (after your wound is completely healed), dancing, golf (don't wear shoes with spikes, and do use a golf cart), and bicycling on a stationary bike or on level surfaces. More strenuous activities, such as jogging or tennis, are not advised after a hip replacement.

Q: What to expect after surgery? Will I have limitations after surgery?

A: Right after surgery, You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you feel ill.

When you wake up from surgery, you may have a catheter, which is a small tube connected to your bladder, so you don't have to get out of bed to urinate. You may also have a compression pump or compression stocking on your leg, which squeezes your leg to keep the blood circulating and to help prevent blood clots. And you may have a cushion between your legs to keep your new hip in the correct position.

Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced. You may also learn to move your feet up and down to flex your muscles and keep your blood circulating. And you may begin to learn about how to keep your hip in the correct positions while you move in bed and get out of bed.

Q: What are some complications that can happen?

A: The risks of hip replacement surgery can be divided into two groups:

  • Risks of the surgery and recovery period
  • Long-term risks that may occur months to years after the surgery

The risks of each complication depend in part on your other health problems and on the surgeon.Risks of the surgery and recovery period

  • Blood clots. People may develop a blood clot in a leg vein after hip joint replacement surgery. Blood clots can be dangerous if they block blood flow from the leg back to the heart or if they move to the lungs. Blood clots are more common in older people, those who are very overweight, those who have had blood clots before, or those who have cancer.
  • Infection in the surgical wound or in the joint. Infection is rare in people who are otherwise healthy. People who have other health problems, such as diabetes, rheumatoid arthritis, or chronic liver disease, or those who are taking corticosteroids are at higher risk of infection after any surgery. Infections in the wound usually are treated with antibiotics. Infections deep in the joint may require more surgery, and in some cases the doctor must remove the artificial joint. If the joint pieces have to be removed, they are usually replaced. But that surgical procedure (revision) is more complicated than the original hip replacement and has a greater risk of problems.
  • Nerve injury. In rare cases, a nerve may be injured around the site of the surgery. This is more common (but still unusual) if the surgeon is also correcting deformities in the joint. A nerve injury may cause tingling, numbness, or difficulty moving a muscle. These injuries usually get better over time and in some cases may go away completely.
  • Problems with wound healing. Wound healing problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.
  • Deposits of bone in soft tissues around the hip joint. This is called heterotopic ossification. It usually doesn't affect how well the hip works, but it may decrease the range of motion at the hip. The condition needs treatment (surgery) only if it causes pain or greatly limits motion.
  • Hip dislocation after surgery. It is rare to have a hip dislocation after hip replacement surgery. Your doctor can usually treat this by moving the hip back into place after giving you pain medicine or anesthetic. You also may wear a brace for a while. In a few cases, surgery may be needed to put the joint back in place.
  • Difference in leg length. Usually, any difference in leg length is very small and does not cause any pain or functional problem. If you have a noticeable difference, it can often be corrected by using a shoe insert.
  • The usual risks of general anesthesiarisks of general anesthesia. Risks of any surgery are higher in people who have had a recent heart attack and those who have long-term (chronic) lung, liver, kidney, or heart disease.

Q: Are there any reasons or conditions that would stop me from having the surgery?

A: General Overall Health and other factors are always considered when having surgery. Your doctor will help you make that decision.


Questions and Answers from American Academic of Orthopaedic Surgeons. For more information visit http://www.aaos.org/home.asp