After hip replacement surgery you will be moved into the recovery room, where you will stay for several hours. During this time, you will be monitored until you awaken, at which time you will be taken to your hospital room. Typically, you will stay in the hospital for three to four days, but this varies depending on how quickly you progress. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs. The rate of medical complications following hip replacement surgery is extremely low. Serious infections, such as a hip joint infection, occur in less than 2 percent of patients. The most common cause of infection occurs when bacteria enter the bloodstream during dental procedures, urinary tract infections or skin infections. After your surgery, you should take antibiotics before having any dental work or surgical procedure performed.
Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. These clots can become life threatening if they move to the brain, lungs or heart. However, your orthopedic surgeon will have a blood clot prevention plan that includes medication and support stockings. If you do experience any symptoms of blood clots, you should call your surgeon immediately. Your doctor and nurse will discuss what symptoms to look for. To help strengthen your hip joint, it is recommended that you do small exercises such as contracting and releasing the muscles in your legs and buttocks, and ankle pumps. Also, it is very important that you restrict movement in your hips. Your surgeon and physical therapist will discuss these movements with you. Usually, you will begin to work with a physical therapist the first day after surgery. The physical therapist will teach you specific exercises to regain full hip movement. During your hospital stay, you will work with a physical therapist one to two times per day.
An occupational therapist and nurse discharge planner also will help you prepare for your discharge from the hospital. After you return home, you will work with a physical therapist three to four times a week. If you are having the minimally invasive two-incision hip surgery, you will stay at least one day in the hospital. You may stay in the hospital up to three days if you are having a primary total hip replacement. If you are having a revision hip replacement, you may be in the hospital four to five days. Most patients after joint surgery go home after leaving the hospital. You should plan ahead and arrange for family or friends to drive you home from the hospital. You will be most comfortable in a sedan-type car. You may need help from family and friends with cleaning, shopping and other errands for a week or two. You will not be allowed to drive for 3-6 weeks or longer so you may want to plan transportation to and from your doctor’s appointment. It is most important for you to consider the kind of help you will need and mobilize your friends and family to assist you (with shopping, cleaning, errands, transportation, etc.).
Find a family member, or friend who is willing and able to take time off work to assist you for the first 4 or 5 days that you are home. (family medical leave forms can be obtained from employers and submitted to the surgeon's office for signature). Stock up on easy to prepare foods: frozen, canned, etc. Set up the telephone, or cellular phone in the area where you will spend most of your time. Insurance very rarely, if ever, will cover help at home for bathing, dressing, cooking or cleaning. It is best to plan ahead and see if you can get assistance from family or friends, church groups or social clubs. There are homecare agencies that provide "home health aides" for this kind of help, but it runs upwards of $22 per hour (we can provide you with a list of agencies). The physical and occupational therapists will evaluate you post-operatively and help the doctors to determine what level of therapy you will need after you leave the hospital. There are three options: Home with physical therapy (PT) specialist coming to your home two to three times a week (until you are able to go to an outpatient PT clinic facility).
The vast majority of our patients go home after joint replacement. Rehabilitation Hospitals are for those who the therapist and doctors feel require three hours every day of physical therapy (PT) and occupational therapy (OT). If you are able to get out of bed without hands-on help and walk with walker or crutches then it will be unlikely that you will qualify for inpatient rehabilitation stay. Skilled nursing facilities (also called nursing or convalescent homes) are for those who need PT, are still unsafe to go home, but no longer need to be in the hospital and do not qualify for inpatient rehabilitation. At most skilled nursing facilities the patient rooms are shared and there are usually no televisions, sometimes no bedside phones. There are certain conditions that may increase the likelihood that you may qualify for a short stay in an inpatient rehabilitation facility. These include having a history of stroke, bilateral (both side) joint replacement, arthritis in more than two joints or a spinal disorder.
Once you have returned home, it is very important to follow your orthopedic surgeon's instructions during the first few weeks after surgery. Your incision is closed with staples, which will be removed around 14 days after your surgery. This area will be bruised for a while and may itch, pull or feel numb. You also may experience a burning sensation, which can be relieved by using an icepack for 10 to 15 minutes. Avoid using creams, lotions or ointments on the hip area. You may want to put a bandage on your hip area, although be sure that you do not soak it. Keep the area dry until your staples are out. Avoid showers until forty-eight hours after your staple have been removed. Being physically active is an essential part of recovery. Within three to six weeks, you should be able to resume most normal physical activities of your daily routine. During the first few weeks of recovery, a physical therapist may teach or help you perform specific exercises to strengthen your hip.
Other recommended physical activities include graduated walking and normal household activities to increase your mobility. However, it is important that you do not push yourself and avoid falling, which can damage your hip and require further surgery. Stairs are particularly hazardous and should be avoided if you do not have the help of an assisting device or caregiver. Recommended devices include a cane, crutches, walker and handrails. Six weeks after surgery, when you regain full hip movement, you can probably resume driving. At this time, your surgeon also may allow you to return to work, depending on how much physical activity is involved in your occupation. Sexual activity can be resumed at this time as well. During the first year following your surgery, routine follow-up visits are scheduled with your orthopedic surgeon. Your follow-up appointments will be at three weeks, six weeks, three months, six months and 12 months after your surgery. You will be asked to return for annual visits thereafter to assess the status and function of your implant.
Rehab Goals for Patients with Total Hip Replacement *Note: These goals reflect the typical progression for a patient after a total hip replacement. Your personal goals may vary. You will be introduced to hip precautions and weight bearing status. Learn two to three bed exercises. You may sit at the edge of the bed, stand with a walker, or transfer to and from a chair or toilet with assistance. You may begin walking with assistance, but do not attempt to climb stairs. Recite hip precautions and weight bearing status independently. Learn one to two more exercises and perform them all with supervision. You may sit at the edge of bed and stand with a walker or crutches with assistance or supervision. You may transfer to and from a chair with assistance or supervision. You may transfer to and from a toilet with assistance, supervision, or independently. You may walk to the door, bathroom or into the hall with assistance and a walker or crutches. You may attempt stairs with crutches or handrails with assistance.
You will be assessed for the type of assistive walking device (walker or crutches) if going home. If needed, you will be introduced to the use of lower body dressing equipment. You may practice grooming and hygiene standing or sitting at a sink with assistance. Maintain precautions and weight bearing status independently with function. You may perform exercises and sit at the edge of the bed independently. You may stand independently with a walker or with crutches. You may transfer to and from a chair or toilet independently. You may walk in the hallway with a walker or crutches, either with supervision or independently. You may attempt stairs with crutches or handrails, with supervision or independently. You may receive an assistive walking device and lower body dressing equipment for home use. You should practice using lower body dressing equipment to achieve independence. You may also practice grooming and hygiene independently. Reviewed by health care specialists at UCSF Medical Center.