After Hip Replacement
After a hip replacement, you may expect your lifestyle after the surgery to be a lot like the way it was before, but without the pain. In many ways, you are right, but it will take time. You need to be a partner in the healing process to ensure a successful outcome.
You will be able to resume most activities; however, you may have to change how you do them. For example, you will have to learn new ways of bending down that keep your new hip safe. The suggestions you find here will help you enjoy your new hip while you safely resume your daily routines.
Activities in the hospital
Hip replacement is major surgery and, for the first few days, you’ll want to take it easy. However, it’s important that you start some activities immediately to deal with the effects of the anesthetic, help the healing and keep blood clots from forming in your leg veins. Your doctor and physical and occupational therapists can give you specific instructions on wound care, pain control, diet and exercise. Ask how much weight you can put on your affected leg.
Pain management is important in your early recovery. Although pain after surgery is quite variable and not entirely predictable, it does need to be controlled with medication. Initially, you may get pain medication through an IV (intravenous) tube that you can control to get the amount of medication you need. It is easier to prevent pain than to control it and you don’t have to worry about becoming addicted to the medication; after a day or two, injections or pills will replace the IV.
Besides the pain medication, you will also need antibiotics and blood-thinners to help prevent blood clots from forming in the veins of your thigh and calf.
You may lose your appetite and feel nauseous or constipated for a couple of days. These are ordinary reactions. You may have a urinary catheter inserted during surgery and be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery. You will be taught to do breathing exercises to keep your chest and lungs clear.
A physical therapist will visit you, usually on the day after your surgery, and teach you how to use your new joint. It is important that you get up and about as soon as possible after hip replacement surgery. Even in bed, you can “pedal” your feet and “pump” your ankles regularly to keep blood flowing in your legs. You may have to wear elastic stockings and/or a pneumatic sleeve to help keep blood flowing freely.
Your hospital stay may last from 3 to 10 days, until you can perform certain skills you’ll need to use at home. If you go straight home, you will need help at home for several weeks. If going straight home is too difficult, you may need to spend some time at a rehabilitation center.
The following tips can make your homecoming easier.
- In the kitchen (and in other rooms as well), place items you use frequently within reach so you don’t have to reach up or bend down.
- Rearrange furniture so you can get about on a walker or crutches. You may want to change rooms (make the living room your bedroom, for example) to stay off the stairs.
- Get a good chair, one that is firm and has a higher-than-average seat. This type of chair is safer and more comfortable than a low, soft-cushioned chair.
- Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Install a shower chair, grab bar and raised toilet in the bathroom.
- Use assistive devices such as a long-handled shoehorn, a long-handled sponge and a grabbing tool or reacher to avoid bending too far over. Wear a big-pocket shirt or soft shoulder bag for carrying things.
- Set up a “recovery center” in your home, with a phone, television remote control, radio, facial tissues, wastebasket, pitcher and glass, reading materials and medications within easy reach.
Activities at home
“ Take your temperature twice daily and notify your doctor if it exceeds 100.5 F. ”Keep the skin clean and dry. The dressing applied in the hospital should be changed as necessary. Ask for instructions on how to change the dressing if you are not sure.
If you have stitches that need to be removed, your surgeon will give you specific instructions about the incision and when you can bathe. X-rays will be taken later to ensure that the joint is healing properly.
Notify your doctor if the wound appears red or begins to drain.
Take your temperature twice daily and notify your doctor if it exceeds 100.5�F.
Swelling is normal for the first 3 to 6 months after surgery. Elevate your leg slightly and apply an ice pack for 15 to 20 minutes at a time, a few times a day.
Calf pain, chest pain and shortness of breath are signs of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms.
Medication: Take all medications as directed. You will probably be given a blood thinner to prevent life-threatening clots from forming in the veins of your calf and thigh. If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.
Because you have an artificial joint, it is especially important to prevent any bacterial infections from settling in your joint implant. You should get a medical alert card and take antibiotics whenever there is the possibility of a bacterial infection, such as when you have dental work. Be sure to notify your dentist that you have a joint implant and let your doctor know if your dentist schedules an extraction, periodontal work, dental implant or root canal. The AAOS and the American Dental Association have prepared guidelines that say when you should get antibiotics to prevent joint infection if you must have dental work. You’ll find a link to these guidelines at the end of this article.
Diet: By the time you leave the hospital, you should be eating your normal diet. Your physician may recommend that you take iron and vitamin supplements. Continue to drink plenty of fluids and avoid excessive intake of vitamin K while you are taking the blood-thinner medication. Foods rich in vitamin K include broccoli, cauliflower, Brussels sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage and onions. Try to limit your intake of coffee and alcohol. You should watch your weight to avoid putting more stress on the joint.
Resuming normal activities: Once you get home, you should stay active. The key is not to overdo it! While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:
Weight bearing: Be sure to discuss weight bearing with your physician and physical therapist. Their recommendations will depend on the type of implant and other factors in your situation. Revision hip surgery (replacing an artificial joint that fails) may require you to wait a longer time without putting weight on the leg.
Uncemented hip replacement: Your surgeon will give you specific instructions about the use of crutches or a walker and when you can put weight on the leg. By 8 weeks, you should be weight bearing with only a little support. This protects the joint and gives the bone time to grow into the porous coating of the implant.
Cemented or hybrid hip replacement: Using a cane or walker, you can put some weight on the leg immediately, but should continue to use some support for 4 to 6 weeks to help the muscles recover.
Driving: You can begin driving an automatic shift car in 4 to 8 weeks, provided you are no longer taking narcotic pain medication. If you have a stick-shift car and your right hip was replaced, do not begin driving until your doctor says you can. The physical therapist will show you how to slide in and out of the car safely. Placing a plastic bag on the seat can help.
Sex: Some form of sexual relations can be safely resumed 4 to 6 weeks after surgery. Ask your doctor if you need more information.
Sleeping positions: Sleep on your back with your legs slightly apart or on your side with an abduction pillow, a regular pillow between your knees or a knee immobilizer at night. Be sure to use the pillow for at least 6 weeks, or until your doctor says you can do without it. Sleeping on your stomach should be all right.
Sitting: For at least the first 3 months, sit only in chairs that have arms. Do not sit on low chairs, low stools or reclining chairs. Do not cross your legs at the knees. The physical therapist will show you how to sit and stand from a chair, keeping your affected leg out in front of you. Get up and move around on a regular basis, at least once every hour.
Going up and down stairs: Stair climbing should be limited if possible until healing is far enough along. If you must go up stairs:
- The unaffected leg should step up first.
- Then bring the affected leg up to the same step.
- Then bring your crutches or canes up.
- To go down stairs, reverse the process.
- Put your crutches or canes on the lower step.
- Next, bring the affected leg down to that step.
- Finally step down with the unaffected leg.
Return to work: Depending on the type of activities you perform, it may be as long as 3 to 6 months before you can return to work.
Other activities: Walk as much as you like once your doctor gives you the go-ahead, but remember that walking is no substitute for your prescribed exercises. Walking with a pair of trekking poles is helpful and adds as much as 40 percent to the exercise you get when you walk. Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed, approximately 6 to 8 weeks after surgery. Using a pair of training fins may make swimming a more enjoyable and effective exercise. Acceptable activities include dancing, golfing (with spikeless shoes and a cart) and bicycling (on level surfaces). Avoid activities that involve impact stress on the joint such as tennis or badminton, contact sports (football, baseball), squash or racquetball, jumping, or jogging. Lifting weights is not a problem, but carrying heavy, awkward objects that cause you to stagger is not wise, especially if you must go up and down stairs or slopes. Plan ahead to have a cart, dolly or hand-truck available.
Do’s and Don’ts
Do’s and don’ts (precautions) vary depending upon the surgeon’s approach. Your doctor and physical therapist will provide you with a list of do’s and don’ts to remember with your new hip. These precautions will help to prevent the new joint from dislocating and to ensure proper healing. Here are some of the most common precautions.
- Don’t cross your legs at the knees for at least 8 weeks.
- Don’t bring your knee up higher than your hip.
- Don’t lean forward while sitting or as you sit down.
- Don’t try to pick up something on the floor while you are sitting.
- Don’t turn your feet excessively inward or outward when you bend down.
- Do keep the leg facing forward.
- Do keep the affected leg in front as you sit or stand.
- Don’t reach down to pull up blankets when lying in bed.
- Don’t bend at the waist beyond 90 degrees.
- Don’t stand pigeon-toed.
- Do use a high kitchen or bar stool in the kitchen.
- Don’t kneel on the knee on the unoperated leg (the good side).
- Do kneel on the knee on the operated leg (the bad side).
- Don’t use pain as a guide for what you may or may not do.
- Do use ice to reduce pain and swelling, but remember that ice will diminish sensation. Don’t apply ice directly to the skin; use an ice pack or wrap it in a damp towel.
- Do apply heat before exercising to assist with range of motion. Use a heating pad or hot, damp towel for 15 to 20 minutes.
- Do cut back on your exercises if your muscles begin to ache, but don’t stop doing them!