If you are a candidate for hip replacement surgery, you probably anticipate that life after the surgery will be much like life before it, only without the pain. In many ways, you are correct. But change doesn’t happen overnight and your active participation in the healing process is necessary to ensure a successful outcome.
Although you will be able to resume most activities, you may have to change how you do them. For example, you will have to learn how to bend to avoid putting stress on your new hip. The following suggestions will help you adapt to your new joint and resume your daily activities safely.
Activities in the Hospital
Joint replacement is major surgery and, for the first few days, you’ll probably want to take it easy. But it’s important that you start some activities immediately to counteract the effects of the anesthesia, encourage healing and help prevent blood clots from forming in your leg. Your doctor and a physical therapist will give you specific instructions on wound care, pain management, diet and exercise. Ask specifically about how much weight you can put on your affected leg.
Proper pain management is important to your early recovery. Although pain after surgery is quite variable and not entirely predictable, it can be controlled with medication. Initially, you will probably receive pain control medication through an intravenous (IV) connection so that you can regulate the amount of medication you need. Remember that it is easier to prevent pain than to control it. You don’t have to worry about becoming dependent on the medication; after a day or two, injections or pills will replace the IV.
In addition to pain medication, you will also have to take antibiotics and blood thinning medication to help prevent blood clots from forming in the veins of your thigh and calves.
You may lose your appetite and feel nauseous or constipated for a couple of days. These are normal reactions. You may be fitted with a urinary catheter 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 prevent congestion from developing in your chest and lungs.
Usually, a physical therapist will visit you on the day after your surgery and begin teaching you how to use your new joint. It is important that you get up and about as soon as possible after joint replacement surgery. Even as you lie in bed, you can “pedal” your feet and “pump” your ankles on a regular basis to promote blood flow in your legs. You may have to wear compression stockings and/or a pneumatic sleeve to help keep blood flowing normally.
Your hospital stay may last from 3 to 10 days, depending on how well you heal after surgery. You will need help at home for several weeks. If you do not have sufficient help at home, you may be temporarily transferred to a rehabilitation center. The following tips can make homecoming more comfortable:
- Place items you use regularly at arm level so you don’t have to reach up or bend down.
- Rearrange furniture so you can maneuver with a walker or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using 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 or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Install a shower chair, gripping bar and raised toilet seat in the bathroom. Your occupational therapist can help you choose the best seat for your shower.
- 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. A foot stool is useful for keeping your operated leg straight out in front of you when you sit. Wear a big-pocket shirt or soft shoulder bag for carrying things around.
- Set up a “recovery center” in your home, with phone, television remote control, radio, facial tissue, wastebasket, pitcher and glass, reading materials and medications within reach.
Care at Home
- Keep the area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing if you are not sure.
- Sutures will be removed in two to three weeks and X-rays will be taken to ensure that the joint is healing properly. Your doctor will tell you when you are allowed to shower.
- Notify your doctor if the wound appears red or begins to drain.
- Take your temperature twice daily and notify your doctor if it exceeds 100.5ºF.
- Swelling is normal for the first three to six months after surgery. Elevate your leg slightly and apply an ice pack for 15 to 20 minutes at a time.
- Warning signs – calf pain, chest pain or shortness of breath are signs of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms.
Take all medications as directed. You will probably be given a blood thinner to prevent clots from forming in the veins of your calf and thigh because these clots can be life-threatening. 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 infection from settling into your joint implant. You should get a medical alert card and take antibiotics whenever there is a 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 work. Washing your hands is a vital and easy method of infection control.
By the time you go home from the hospital, you should be eating a normal diet. Your physician may recommend that you take iron and Vitamin C supplements. Continue to drink plenty of fluids and avoid excessive intake of Vitamin K while you are taking blood thinner medication. Foods rich in Vitamin K include:
- Garbanzo beans
- Soybean oil
- Turnip greens
Try to limit your coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.
Resuming Normal Activities
Once you get home, you should continue to 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 restrictions with your physician and physical therapist. Their recommendations will depend on the type of implant and other issues specific to your situation.
- Revision hip surgery (replacing a previously implanted prosthesis) may require an extended period of time to be non-weight bearing.
- Uncemented hip replacement: For six weeks, use crutches and do not put any weight on the leg. Then gradually begin to put weight on the leg using a cane or walker. By 12 weeks, you can begin weightbearing. 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 an assistive device for four to six weeks.
- Driving: You can begin driving an automatic shift car in six to eight 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 12 weeks. The physical therapist will show you how to slide in and out of the car safely. Placing a plastic bag on the seat will help.
- Sexual relations: You can safely resume sexual relations four to six weeks after surgery. Follow your hip precautions.
- Sleeping positions: Sleep on your back with your legs slightly apart or on your side with a pillow between your knees. Be sure to use the pillow for at least six weeks, or until your doctor says you can do without it.
- Sitting: For at least the first three months, sit only in chairs that have arms. Do not sit on low chairs, low stools, or reclining chairs. Do not cross your legs. The physical therapist will show you how to sit and stand from a chair, keeping your operated leg out in front of you. Get up and move around on a regular basis, at least once every hour.
- Stairs: Stair climbing should be avoided, if possible, until healing is complete. If you must go up stairs:
- The unaffected leg should step up first
- Then bring the affected leg up.
- Then bring your crutches or cane up
- To go down stairs, reverse the process:
- Put your crutches or cane on the lower steps
- Next, bring the affected leg forward
- Finally, step down on the unaffected leg.
- Return to work: Depending on the type of activities you perform, it may be three to six 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. Swimming is also recommended; you can begin as soon as sutures have been removed and the wound is healed, approximately six to eight weeks after surgery. Acceptable activities include dancing, golfing (with spike-less shoes and a cart), and bicycling (on level surfaces). Avoid activities that put stress on the joint such as tennis or badminton, horseback riding, contact sports (football, baseball), squash or racquetball, jumping or jogging. Do not do any heavy lifting (more than 40 pounds) or weight lifting.