What is the recovery time?
Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted to using a walker or crutches for one month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This usually takes about three months but can take longer.
What is a dislocation of the hip?
A dislocation of the hip occurs when the femoral head (ball) comes out of the acetabulum (socket). While the risk is very small, typically less than 2 percent, you are given dislocation precautions to help prevent this from happening.
What are the dislocation precautions for my hip (positions I should avoid)?
You should avoid flexing (bending) at the hip more than 90 degrees. Avoid low chairs and furniture because they require too much bending at the hip in order to get up. If you must reach to the floor when seated, always reach between your legs, not to the outside. Use an elevated toilet seat to avoid excessive bending of the hip. If possible, use a chair with arms. The arms provide leverage to push you up to the standing position. When sitting, position your legs so that you can see your inner thigh, calf and foot (not the outside). If your physician orders different precautions, you will be instructed on them by your physical therapist.
How long do I need to follow my dislocation precautions?
Follow your precautions very carefully for the first six weeks. You should avoid extreme positions of the hip flexion (bending) forever.
Can I sleep on my side?
You may sleep on your operative side whenever you feel comfortable. You may sleep on your nonoperative side at four weeks with a pillow between your knees.
When will my stitches be removed?
Your stitches are absorbable and do not need to be removed. The Steri-Strips can be kept in place until they fall off on their own. They will help keep the skin edges together. If they have not fallen off after two weeks, it is OK to remove them.
How long do I need to keep a bandage on my incision?
Approximately one week or until there is no drainage from the incision. This should be changed daily to a new, dry sterile gauze. If desired, you may continue to wear a bandage to protect the incision from irritation.
When can I shower (get the incision wet)?
Five days after your operation, as long as there is no drainage present at the incision. (Initially, try to keep the incision dry with plastic wrap.) If it gets wet, pat it dry.
When can I immerse my hip in water (e.g., bath, swimming pool, ocean, hot tub)?
Typically, you should not swim or get in a hot tub for six weeks. However, some surgeons allow their patients to do so after two weeks if there is no drainage. Check with your surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication for about three months. Initially, you will be on a strong oral pain medication (such as a narcotic). Most people are able to wean off their strong pain medication after one month and are able to switch to an over-the-counter pain medication (such as Tylenol or ibuprofen). If you are on Coumadin (warfarin), avoid taking any NSAIDs (e.g., aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn) without first consulting with your internist.
Will I go to a rehabilitation facility or a home?
It depends. Most people are able to go home after their operation. However, you may go to a rehabilitation facility in order to gain the skills you need to return home safely. Many factors will be considered in this decision. These include availability of family or friends to assist with daily activities, home environment, safety considerations, postoperative functional status as evaluated by a physical therapist in the hospital and overall evaluation by our hospital team.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. If you go home, you will likely have a therapist come to visit you (usually two to three times a week). Sometimes you will be referred to an outpatient physical therapist. If you go to a rehabilitation facility, you will receive therapy there. Your therapist will keep your surgeon informed of your progress.
What exercises should I do?
You will be instructed by your physical therapist on appropriate exercises and given a list to follow. In general, swimming and stationary bicycles are good exercise options. These should be continued indefinitely even after your recovery is complete. Do not begin using a stationary bike or swimming until four weeks after your surgery or until you have been seen by your surgeon.
I think my leg lengths are different. What should I do?
It is not uncommon to feel as though your leg lengths are different. Your leg was most likely slightly shorter to begin with as a result of the loss of cartilage. Your surgeon has restored the natural height of your hip during the surgery. In the operating room, leg lengths are accessed very carefully, and an attempt is made to make them as equal as possible. Sometimes, the new hip has to be lengthened in order to obtain proper muscle tension (to help avoid hip dislocation). Wait three months before making any final judgments about your leg length. Your muscles and body take time to adjust to a new hip. In rare cases, a shoe lift may be prescribed for a true difference in leg lengths. In most cases, however, no treatment is necessary.
Can I use weights?
Generally not for the first two months. However, as everyone's strength varies, consult with your physical therapist before using weights. Use light weights to begin with and gradually progress from 1 pound to a minimum of 5 pounds.
How long will I be on a blood thinner?
Typically, you will be on Coumadin (warfarin) as a blood thinner. This medication is used to help prevent blood clots. Some surgeons may order a dose of Coumadin the night before surgery and continue you on Coumadin while in the hospital. At the time of your discharge, you will be enrolled in our Coumadin Clinic. They will arrange for you to have blood draws at home. They will then adjust your Coumadin dose for you by phone. You will normally need to be on a blood thinner for four to six weeks. This will be decided prior to your discharge from the hospital. Some surgeons prefer to use an injectable blood thinner. This is something that you will administer yourself at home. Your surgeon will discuss the specifics of this with you prior to your discharge.
How long should I take iron supplements?
Four weeks is usually sufficient. These supplements help your body replenish its iron stores, which may be depleted postoperatively.
When can I drive?
If you had surgery on your right hip, you should not drive for at least one month. After one month, you may return to driving as soon as you feel comfortable. If you had surgery on your left hip, you may return to driving as soon as you feel comfortable as long as you have an automatic transmission. Be careful getting into and out of a car, and avoid crossing your operated leg over the other. DO NOT DRIVE IF TAKING NARCOTICS! Some surgeons do not allow their patients to drive until they have seen them back in their office four to six weeks after surgery. Check with your surgeon.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return after approximately one month. If your work is more rigorous, you may require up to three months before you can return to full duty. In some cases, more time may be necessary.
When can I travel?
You may travel as soon as you feel comfortable. It is recommended that you get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.
Will I set off machines at airport security? Do I need a doctor's note about my surgery?
You may set off the machines at airport security depending on the type of hip implant you have and the sensitivity of the security checkpoint equipment. At your follow-up visit you may ask to have a wallet card to carry with you for travel.
What activities are permitted following surgery?
You may return to most activities as tolerated, including walking, gardening and golf. Some of the best activities to help with motion and strengthening are swimming and a stationary bicycle.
What activities should I avoid?
You should avoid impact activities, such as running, downhill skiing on expert slopes and vigorous racquet sports, such as singles tennis or squash. In addition, you should avoid any activity that may put your new hip at risk for dislocation.
Can I have sex?
You should wait several weeks postoperatively before resuming sexual intercourse. Follow your hip dislocation precautions. Having your legs apart is a safe position.
Can I drink alcohol?
If you are on Coumadin, avoid alcohol intake. Otherwise, use in moderation at your own discretion. You should avoid taking narcotics or other medications.
How long should I use compression stockings (TEDs)?
These should be used for the first several days, particularly if you have a lot of swelling or discomfort. Some surgeons allow the use of heat. Once the initial swelling has decreased, you may use ice or heat. Check with your surgeon.
Can I go up and down stairs?
Yes. Initially, you will lead with your nonoperated leg when going down stairs. You can use the phrase, "Up with the good, down with the bad" to help you remember. As your legs get stronger, you will be able to perform stairs in a more regular pattern (about one month).
Can I kneel?
Yes, after six weeks. To kneel, touch down with the knee of your operative leg first. To arise from kneeling, use your nonoperative leg first.
When can I discontinue using a raised toilet seat?
Six to 10 weeks after your operation.
What should I expect for my range of motion at six weeks? At one year?
Everyone's range of motion varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have enough motion to put on socks and tie your shoes. Clipping toenails may be difficult.
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given a letter explaining this in detail at your first follow-up visit. Avoid any dental cleaning or nonurgent procedures for six weeks postoperatively.
I feel depressed. Is this normal?
It is not uncommon to have feelings of depression after your hip replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.
I have insomnia. Is this normal? What can I do about it?
This is a very common complaint following hip replacement surgery. Nonprescription remedies such as Benadryl or melatonin may be effective. If this continues to be a problem, medication may be prescribed to you.
How long will my total hip replacement last?
This varies from patient to patient. For each year following your hip replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate. Newer implants and technologies may have even better success rates.
When do I need to follow up with my surgeon?
Follow-up appointments should be made postoperatively at four to six weeks, one year, two years, five years, seven years and ten years.
Normal things about your new hip:
- Clicking noise with hip motion
- Skin numbness near or around your incision
- Swelling around hip, knee or lower leg
- Warmth around hip
- “Pins and needles” feeling at or near your incision
- Dark or red incision line
- Increased bruising if on Coumadin
Abnormal things about your new hip (call tour surgeon if you experience any of these):
- Increasing redness, particularly spreading from incision
- Fevers (above 101 degrees)
- Persistent drainage from your wound
- Calf swelling or pain, particularly associated with ankle motion
- A sudden "giving way" of your hip with inability to bear weight
- Ankle swelling that does not resolve or decrease overnight
- Bleeding gums or blood in urine/stool