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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.
Discharge
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.
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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.
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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.
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Install a shower chair, grab bar and raised toilet in
the bathroom.
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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.
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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
-
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.
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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.
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Then bring the affected leg up to the same step.
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Then bring your crutches or canes up.
To go down stairs, reverse the process.
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Put your crutches or canes on the lower step.
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Next, bring the affected leg down to that step.
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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.
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Don't bring your knee up higher than your hip.
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Don't lean forward while sitting or as you sit down.
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Don't try to pick up something on the floor while you
are sitting.
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Don't turn your feet excessively inward or outward when
you bend down.
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Do keep the leg facing forward.
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Do keep the affected leg in front as you sit or stand.
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Don't reach down to pull up blankets when lying in bed.
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Don't bend at the waist beyond 90 degrees.
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Don't stand pigeon-toed.
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Do use a high kitchen or bar stool in the kitchen.
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Don't kneel on the knee on the unoperated leg (the good
side).
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Do kneel on the knee on the operated leg (the bad side).
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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!
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