John D. Burrow, DO
Hip replacement surgery is one of the most common procedures that I perform as an Orthopaedic surgeon, especially as my specialty is revision and reconstruction of joint replacements that have failed, worn out or need fixing for some other reason. I treat patients in all age groups and categories, so I’m knowledgeable about the recovery process everyone must go through after their hip replacement surgery. In this article, I want to discuss the recovery period after surgery, what to expect and how to judge your progress based on our partnership together with your Physical Therapist.
Hip Replacement today typically is an outpatient procedure, although for some patients, it may require an overnight stay, due to insurance or health concerns. After surgery and spending an hour or so in recovery, having something to eat and drink and awakening fully, patients are gotten up and assisted with walking and going up and down a set of stairs by Physical Therapy staff in the ambulatory surgery center. At that point, they are released to go home, with pain medication and orders for in-home physical therapy and nursing care. At home, the patient will be able to recover in their own surroundings, with their own bed, food, TV, family, etc. We find that patients tend to be more comfortable in this setting versus a busy, noisy hospital.
When being sent home from the hospital, the patient must also first walk well and go up and down stairs before being discharged and will receive compression stockings to take home to wear during recovery. Patients will be sent home from the surgery center (CVSC) with rechargeable compression sleeves to be worn on their calves to help prevent blood clots (DVTs) after surgery. Whichever option you are given, these should be worn as specified for your safety. Your incision will be glued, and covered with a bandage. I recommend that you not get this bandage wet until after your two-week follow-up visit, in order to reduce the chance of infection.
With today’s advanced pain control methods, including nerve blocks, most patients do not experience severe pain during their recovery, and find they are surprised at how good they feel after surgery. Sometimes, this can be misleading and cause them to want to overexert themselves. However, we encourage our patients to rest and recover after this major surgery, allowing their bodies to heal. Elevation of the leg of your operated hip and intermittent ice will be your best bet to reduce swelling and assist with pain relief. You’ll be using a walker to ambulate at this point in your recovery, and I recommend that you get up and walk every few hours as you regain your strength.
An unfortunate side effect of opioid pain medication is constipation, so it is advised you immediately address this with stool softeners, Miralax, prune juice or the laxative of your choice upon your arrival at home.
A home health nurse will typically come to your home to check your vital signs, your incision, change your dressing and make sure you are doing well the day after surgery. A Physical Therapist will also visit your home to start you on an exercise regimen to improve your strength and range of motion. You will be expected to continue your exercises and stretches on days when your Physical Therapist doesn’t come to your home.
Depending on your fitness level, you may start using a cane after a few days or a week, instead of your walker, to provide you with stability while walking. Your Physical Therapist can advise you on when to make this transition. You will also notice that your discomfort level will have decreased significantly when resting and that you may only experience pain when exercising. You will be decreasing the amount of pain medication you take, except it is a good idea to take your pain medication an hour before doing your Physical Therapy. You may find that taking Tylenol only is enough to cover any discomfort you may have.
In two weeks, I will see you for your post-surgical follow-up visit at my office where we will look at your incision, watch you walk, and do some tests to ascertain your progression. When you are in the office, it’s a great time to ask me any questions you may have about living with your new hip, now that you have been getting accustomed to it for two weeks. Make sure you write them down and bring them with you on your appointment day.
After two-three weeks, you will be released to outpatient Physical Therapy, which means you will go to a free-standing clinic to be seen by your therapist. You will be able to use all of the exercise machines and therapeutic modalities at the clinic to advance your rehabilitation even further. Depending on your job, lifestyle and how well you progress, therapy may continue for a few more weeks or even months.
Driving is a very individual activity. Some of my patients are off pain medication, are physically fit, and their affected hip is not on their driving and braking leg, so they are driving in two weeks or less. Others may require a month or six weeks before they feel comfortable driving again. You’ll know when you are ready and feel confident in your ability to drive.
Now that you have a replaced hip, you will need to take a prophylactic antibiotic anytime you go for a dental cleaning or procedure. Why? Because the mouth is full of bacteria and is very vascular, and bacteria can be released into the bloodstream during a cleaning or procedure. Unfortunately, those little critters like setting up house in replaced joints, so we want to make sure that the environment for them is inhospitable, so that your replaced hip joint remains healthy.
You’ll be seen again in my office at the one-year mark for another check-up. We’ll do x-rays of your hip and give you a complete examination to make sure that your replaced hip is functioning properly. I will continue to see you yearly thereafter or sooner, if needed. Working together, we’ll ensure that your replaced hip serves you well and lets you participate in the activities you enjoy for many years to come.