What can I expect during the hospital stay?
You can expect to see several people who will help with your recovery. A physical therapist will assist with hip exercises and walking. An occupational therapist will assist you with learning everyday activities, such as dressing and bathing, while your hip is healing. Your surgeon, his associates, medical doctors, and nursing staff will see you daily. A nursing assistant will help with bathing and activities that you are unable to do yourself.
The first night or two may be hard considering that you will have an unfamiliar bed, diet, and medications. Ask for a sleeping pill or anti-anxiety medication if that will help. Anticipate several weeks before your normal sleeping, eating, and resting patterns are restored.
How long will I stay in the hospital?
The average hospital stay after surgery is one or two days. The day after your surgery, you will be helped into a chair and you may be able to walk limited distances. Your activity will increase with each day that follows.
Recovery time varies from one patient to another. Much depends on other existing medical conditions. For example, arthritic disease in other major joints, heart disease, diabetes, obesity, depression, and other related conditions will affect recovery.
Most people return to their own place of residence after a hip replacement. Some elderly or debilitated patients may need to go to a nursing home to recuperate.
Preventing blood clots
What measures are taken to reduce the risk of blood clots?
For routine hip surgery, we use the blood-thinning medicine for about 4 weeks after surgery. In addition to a blood thinner, we also use early mobility, spinal anesthesia, leg exercises, foot pumps, and efficient surgery as adjunctive measures to minimize the risk of blood clots.
Why is a blood thinner needed after surgery?
This is to reduce the risk of a blood clot. Hip surgery is associated with a risk of blood clots developing in the calf, thigh, or pelvic veins. These clots often do not have any obvious symptoms or signs. Clots can cause chronic swelling of the legs, pain, and circulation and skin problems. In rare instances, a clot can break off and travel to the lungs, which can sometimes be fatal. This is why blood clots and blood-thinning medications are taken so seriously.
The risk of clots greatly decreases when the blood is thinned after surgery. Therefore, we use a blood thinner in every patient following hip surgery.
If you have ever had a blood clot before, or have ever had an adverse reaction to a blood thinner, please let us know so we can plan and prepare accordingly.
What sensations can I expect right after surgery?
Typically, patients have little to no pain, but nausea is more common. This nausea can come from the anesthetic drugs or from pain medicines and we can help control it by changing pain medicines and prescribing anti-nausea agents if necessary. If you have pain, nausea, or any other disagreeable sensation, let the nursing staff know. They are very knowledgeable in controlling such symptoms. Usually, an adjustment of medications is all that it takes to address any disagreeable sensations.
Why do I have a popping sensation in the new hip?
This can happen from a tendon, called the psoas tendon, rubbing against the new hip. With exercise and time, this sensation will disappear, assuming that it ever manifests in the first place. Usually this popping sensation occurs while the hip is healing, and during turning the leg side to side.
Why is the outside of my thigh numb?
This is normal after most anterior approaches to hip replacement or hip resurfacing. The incision cuts small nerve fibers that run from inside to outside of the hip, so the skin to the outside of the cut always feels numb after hip surgery. Usually, this sensation will resolve over time and is not a major problem for patients. Most patients will not notice that the outside of the scar feels numb.
Is it normal for the muscles to spasm and tighten after surgery?
Yes. Sometimes unexpected spasms of the leg muscles occur after surgery, usually as the person is healing from the operation. These spasms will go away. If they are particularly troublesome, we can prescribe a muscle relaxant medicine, which can help.
Why are my appetite, mood, food-taste, and sleep different after surgery?
Altered appetite, bowel habits, depression, and mood swings are common after surgery. This is very important to know, understand, and anticipate. In some cases, medications might be necessary to control such symptoms.
All surgery elicits powerful psychosocial and physiological responses, which vary from one person to another. These responses are normal, and we will help you get through them. It takes time for the body, mind, and soul to recover from any invasive operation.
Caring for your incision
Should I keep the incision covered?
Yes. Covering daily with a gauze dressing is best. You can shower with the dressing on, protecting it as much as possible, and then changing with a new dressing after the daily shower. Avoid touching the incision; the skin around the scar should be kept clean with soap and water. No antibiotic ointments are necessary. Alternatively, you can remove the dressing, wash around the incision with soap and water, pat dry, and cover with a new dressing. Showering is safe at any time after surgery, but immersing the incision in a bathtub should wait until the stitches/staples are removed.
Can I put any lotion on the scar?
While stitches or staples are still in, avoid applying anything to the incision; simply keep it clean and dry. Once stitches or staples are out, you can use Vitamin E cream to massage and loosen the scar. Massaging the thigh area with an anti-inflammatory or cortisone cream can reduce skin inflammation and tenderness; many such ointments are available over the counter.
What if I am allergic to the adhesive used in the dressing?
If your skin cannot handle the adhesive or tape, or if there is drainage from the incision, a useful tip is to use feminine hygiene pads as a dressing. These are self-adhesive, comfortable, very gentle on the skin, and very absorbent; this is a practical tip offered by our patients.
Who will remove stitches and when?
Usually the home health nurse will remove stitches or staples, no earlier than 21 days after surgery. In some cases, the stitches may be left in longer, depending on the rate of healing. Home health nurses should take a digital photo of the incision if there is a concern and send it to us via e-mail.
When can I shower, take a bath, or swim?
Shower anytime after the surgery, if you can sit or stand safely with help. The incision can be covered with a plastic wrap. A new, dry dressing should be used to cover the incision after the shower.
Tub baths and immersion into water, such as a swimming pool, should be delayed until the stitches or staples are out and the skin has sealed completely. This takes at least a couple of weeks after surgery.
How long will I have swelling and warmth in the surgical site?
Swelling and warmth around the scar are common after a hip replacement or hip resurfacing operation. The ankle may also swell on the operated leg. This represents the normal process of healing and can last for several weeks to months, depending on factors such as circulation, body weight, diabetes, and other variables.
Obesity, diabetes, poor circulation, poor muscles, varicose veins, high activity, heart disease, and swelling before surgery will usually result in a longer period of swelling and heat in the operated leg. Elevating your leg at night and wearing compression stockings during the day will help.
Deep aches and swelling in the hip can persist for a long time because bone, a living tissue, continues to re-model and adapt around the metal implants. This increased metabolic activity can lead to lingering soreness and swelling after heavy activity, all of which will disappear with time. .
When can I stop wearing the compression stockings after hip replacement?
Compression stockings may be applied to both legs after surgery to control swelling, and many patients inquire when these can be discontinued. The answer is that if swelling is not a concern, you can stop wearing the stockings at any time.
These stockings are prescribed to control one of the most common nuisances after any hip operation, namely, swelling in the leg and ankle. The stockings have nothing to do with preventing blood clots; for that problem, we give you a blood thinner, and use other strategies discussed elsewhere in this guide. .
How do you prevent infections during hip replacement?
Some of the key factors in reducing the risk of infection involve scrubbing of the skin with an antiseptic, antibiotics given before surgery, surgeon experience, a team-approach designed to promote efficiency, and standardized protocols. It is impossible to completely eliminate this risk, but we can get the risk down to nearly zero. It is very rare to have an infection after routine hip replacement. .
Is there a long-term risk of infection in an artificial hip?
Yes, there is a lifetime risk of infection with any artificial implant in your body, whether a hip joint, heart valve, or other synthetic component. As long as you maintain good health and appropriate body weight, avoid smoking, maintain proper hygiene, keep diabetes under control, and promptly address even minor infections in your body, the risk of infecting an otherwise well-functioning hip implant is essentially zero. .
What if an infection does develop?
An early infection shows up as redness and pain around the healing incision. This can generally be treated with oral antibiotics alone, usually taken for 5 to 10 days. Very rarely, the hip joint has to be opened and washed out to clean the tissues and effectively treat an early infection.
A late infection that happens months or years after surgery is more serious, and will require additional surgery. Such infections occur because the immune system can be weakened by age, infirmity, tobacco use, heavy alcohol use, cancer, and other conditions. In these cases, the infected prosthesis is removed and a temporary antibiotic-loaded hip is implanted. After three or more months, a new hip joint is implanted. Six weeks of antibiotics and these two operations will effectively treat an established deep infection in the hip. Fortunately, such cases are very rare, and late deep infections usually occur in immune-compromised patients with other serious medical problems.
Leaving the hospital
How will I manage at home?
If help from an adult family member or friend is not possible, it may be necessary to stay at an inpatient rehabilitation facility. You will not be able to drive for the first couple of weeks after surgery. If you go home, a home health agency will check on you at home, about three times a week or more, to help with walking, exercise, incision checks, medications, and communication with the doctor.
The home health agency will send a nurse to do blood draws and follow-up care, a physical therapist to continue therapy, and possibly an occupational therapist. The nurse also communicates with our office to regularly update us on your progress.
How is my hospital discharge handled?
Our social worker will visit with you after surgery and work with the therapists and nurses to formulate a discharge plan. The social worker will assist in coordinating discharge to your home, a skilled nursing facility, in-patient rehabilitation facility, or nursing home.
What determines when I can go home after surgery?
You can go home when you can ambulate safely with a walker, go up and down stairs, and get to the bathroom. Typically, you will have had a bowel movement before discharge, and will be able to take a shower. Your doctor is the one making the ultimate decision about the safety and timing of your discharge. You will need someone to drive you home from the hospital.
When must I come back for a visit?
You will return for a visit about one month after surgery; call or e-mail if you have questions before that time. This guide and your home health nurse can be helpful resources. Long-distance patients use e-mail, and have sent us digital photos of their incisions, and digital X-rays; this works very well and saves time and travel expense.
When should seek medical help?
Contact us if you have any of the following: persistent drainage from your incision; excessive redness around the incision; increase in the incision pain; increased leg swelling; pain and swelling in the calf of the leg; temperature above 101 degrees; numbness or tingling down the back of the operative leg; chest tightness; new cough; difficulty breathing; or any related concern.
Your family doctor is a good resource if you develop a cold, flu, nausea, vomiting, diarrhea, or constipation. If you are unsure, please contact us. If unable to reach a doctor, and you feel there is a problem, please go to the local emergency room.
Can I place full weight on the operated leg after surgery?
Yes. But, use some form of assistive device for at least a month after surgery, to avoid a sudden twist and fall. Hip implants are loaded in torsion (a rotational stress is placed on the implant each time you get up, turn in bed, or go up or down stairs), as well as loaded in compression (your weight pressing down). Putting full weight on your hip right after surgery is never a problem.
About a month after surgery, if you feel confident and balanced, you can walk without a cane, but if there is any question, stay with a cane until you feel safe.
In complex, repeat hip implant surgery, these instructions will be more specific to each unique situation. In almost all cases, however, at 12 weeks after such surgery, patients can resume all activities.
Can I kneel down after hip replacement surgery?
Yes. As soon as you're comfortable, kneeling is safe, as is crossing our legs and lifting weights by bending the knees or back. It is not possible to damage the implants.
How soon can I drive after surgery?
With a left hip replacement, an automatic transmission, and a healthy right leg you can drive any time after surgery that you are comfortable. Typically this time is about two weeks from surgery, but sometimes longer.
If the right leg is operated on, you can drive in 3 to 4 weeks after surgery. If you feel sleepy or sedated because of pain medications, then should avoid driving until you are alert and can concentrate on driving.
How much therapy will I need?
You need four weeks of therapy, usually at home, with a visiting home health nurse. Some patients need therapy after this four-week period, and others are already independent. If you need outpatient therapy, usually 4 to 6 weeks will suffice. Once you learn basic hip exercises, you will be able to do them at home.
How much movement can I expect in the new hip?
The amount of movement you achieve should be close to that of a normal hip. That said, existing scar tissue, contractures of the hip joint, severity of arthritis, pain tolerance, motivation for exercise, body size, and other variables profoundly affect how much mobility a person will get. For most patients, the amount of hip movement gained after replacement allows them to engage in all activities of daily life.
Should I exercise after surgery?
Yes. A regular program of light aerobic exercise is beneficial from many standpoints, and will optimize the outcome of your hip replacement. After your six- week post-operative appointment, recommended exercises include walking, swimming, golf, hiking, treadmill walking, stair climbers, light aerobics, weight training, and elliptical exercise equipment.
How active can a person be after a total hip replacement?
You can be as active as you want, and lift as much weight as you desire. Heavy impact exercises, such as basketball, football, soccer, and tennis are probably best avoided, since they contribute to increased prosthesis wear. Low-impact aerobics, bicycling, treadmills, swimming, and similar exercises are fine. Climbing, hiking, and other outdoor activities can be performed as tolerated.
Strength and endurance will build up over time. Modern total hip implants are very durable and designed to take repetitive impact loading for many decades, even in active and heavy patients.
When can I ride a lawn mower, tractor, horse, bicycle, or ATV?
Defer these things for one month after hip implant surgery. You may feel like you can handle such activities sooner, but there is no point in rushing things.
When can I go back to work after surgery?
It depends on the type of work. If you are in hard labor, it is best to wait for three months before swinging into full action. Prior to that time, you can return to some light duty work if this is possible.
For jobs that require some standing, sitting, and walking, it is possible to return earlier. It really depends a lot on the individual and the job. Typically, most people will give themselves at least 3 to 4 weeks after joint replacement before returning to work in some capacity, but some people have returned to work after just two weeks.
When can I drink alcohol after surgery?
Moderate, social alcohol use can be resumed anytime that you wish. Avoid alcohol while you are on any blood thinner or pain medication.
When can one resume sex after a hip replacement or resurfacing?
You can resume sex as soon as comfortable, and in any position that does not cause discomfort. With earlier hip replacement methods, certain restrictions and precautions applied, but these do not apply to modern hip replacements.
How soon can I travel?
As soon as you are comfortable with sitting down, you can travel by airplane or car; there is no specific time period. If you travel, be sure to exercise your calf muscles and ankles frequently. Also, get out of the car or walk the aisle of the airplane frequently to avoid the possibility of blood clots. Continue taking blood thinners while you travel during the first month after surgery.
How long does it take to feel normal after surgery?
A great deal of the recovery takes place in the first two months, but complete return to normal takes longer. Bone around the metal parts keeps changing and remodeling for 1 to 2 years after surgery, which is why you can feel deep aches and can tell when the weather changes. After that time, the hip will feel normal.
Do you use a machine to move the hip after surgery?
No benefit has been shown from the use of continuous passive motion (CPM) machines in hip replacement. Some surgeons use such machines after knee replacement, but they are not needed.
How much can I lift after hip replacement?
You can lift as much weight as you can comfortably tolerate. Once tissues have healed, lifting, climbing ladders or stairs, getting up on roofs, and related activities are safe. Avoid these things for about three months after surgery, until we are sure that your bone has healed into the implants.
Tips on walking
The therapist will demonstrate proper and safe walking after a hip replacement, with the use of crutches or walker. The purpose of the walker or crutches is to avoid a fall or sudden twist. Weight-bearing is safe immediately after surgery. But until the implants have grown into the bone, a process that takes 4 to 6 weeks, a fall or other sudden twisting force on the leg can risk implant loosening or injury to the leg. Reflexes take time to return, and narcotic pain medications can further dull the senses. That is the reason for learning to use an assistive device as long as necessary after surgery.
The assistive device can be a walker, crutches, or a cane in either hand; as long as you feel confident and safe in balancing yourself and minimizing the risk of a fall. When using a walker, lean forward, and lead with either leg. When using crutches, avoid putting weight into the armpits; the proper technique is to load the arms as much as needed for a comfortable stride. When using a cane, the most bio-mechanical advantage comes from holding the cane on the side opposite the replaced hip.
Assistive devices can be discarded anywhere from 1 to 4 weeks after surgery, depending on a number of factors, such as narcotic use, return of strength, confidence in walking, return of reflexes, and patient preference. Patients recover differently from each other, and there is no harm in using an assistive device to help in walking for a longer or shorter duration. Because the hip replacement components are designed to heal directly to bone without use of bone cement, the skeletal stability of the implants is assured by 4 to 6 weeks, at the minimum. Around that time, the assistive devices can be discarded, in favor of normal walking in nearly all cases
Tips on stairs
The ability to go up and down stairs requires strength and flexibility. At first, you will need a handrail for support and will be able to go only one step at a time. Always lead up the stairs with your good knee and down the stairs with your operated knee. Remember, up with the good and down with the bad. In other words, going up stairs, lead with the good (non-surgery) leg, and coming down stairs, put the bad (surgery) leg down first.
You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity.
Do not try to climb steps higher than the standard height (seven inches) and always use a handrail for balance. As you become stronger and more mobile, you can begin to climb stairs foot over foot.
Managing pain & discomfort
Should I apply ice or heat to the hip as it is healing?
After surgery, and for the first two weeks, ice is more effective in reducing swelling and pain. After complete healing of the skin has occurred, you can use a moist heat pack if it feels comfortable. Soaking in a hot tub at this point may also be helpful.
Whom should I call for pain pills?
Please call our office for pain medicines. State regulations allow some medicines to be phoned in; others require a written prescription. Please plan ahead, since narcotic prescriptions on weekends or Friday afternoons can be difficult to call in, mail in, or otherwise get filled.
How long can I have pain medications refilled?
Most patients will taper off the use of narcotic pain medications very quickly. Be aware that some narcotics cannot be phoned into pharmacies. If you will need refills over a weekend or holiday, be sure to contact our staff during regular office hours.
Some patients require pain medications for a longer time, while others do not need them at all. We individualize treatment for every person.
How long should I take pain pills?
Most patients use pain medication for anywhere from 1 to 3 months. After three months, you should taper off and begin anti-inflammatory medicines and other non-addictive medicines for pain.
When taken over a long period of time, narcotic drugs create a tolerance that makes them less effective. That is why it is preferable to taper off narcotic drugs quickly after surgery, unless there are compelling reasons to continue use.
What if I need narcotics three months after surgery or if I have been taking them before surgery?
In such cases, the doctor who was filling the prescriptions prior to surgery may resume dispensing the medication. Very rarely, referral to a pain specialist is necessary for patients who are dependent on long-term narcotics.
If you were taking narcotics regularly before surgery, pain control is usually more difficult and complicated since the body is desensitized to the pain control medicines we use after surgery. In such cases, let us know what you are taking before surgery so that we can adjust pain medicines accordingly.
Life with an artificial hip
How long will the artificial hip last?
In most cases, the hip replacement should outlast your lifespan. The 15-to-20-year data on the longevity of hip replacement components is excellent, with more than 90 percent of the implants still functioning well in many studies. But, this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.
Many factors affect the future of a hip replacement or resurfacing, such as accidents, fractures, late infections, and deterioration in your overall health. How well you take care of yourself down the road is something the surgeon cannot control.
The longevity of a hip replacement thus depends on many factors, including the following:
- Surgeon skill in implanting the components
- Known history or track record of the implants
- How well you take care of yourself and your health
- Understanding and respecting the limitations of a prosthetic lifestyle
- Your activity level and body weight
- Avoiding high-impact or extreme sports
How do I know if I have a metal allergy to the hip part?
Orthopaedic implants are made of alloys of cobalt-chrome and titanium that have been implanted in millions of patients over the past several decades. Most instances of a persistently painful hip after replacement have to do with a problem related to the surgery, or possibly an infection. A true metal allergy is extremely rare, and seldom encountered in clinical medicine.
What will weather changes feel like in the hip?
Some patients report increased pain and stiffness, or can feel changes in the weather after hip surgery. These sensations are not common though, and usually will disappear over 1 to 2 years after surgery. For the first couple years, the bone adapts and grows around the metal prosthesis, and this bone activity probably leads to sensitivity to weather and pressure changes.
How about future dental work and other surgery?
Because you have an artificial hip joint in place, you must take care to protect it from infection. The same applies to any artificial implant in your body. Before having dental work (teeth cleaning, fillings, extraction or root canals) or certain medical procedures (colonoscopy, biopsy, endoscopies, etc.), you must take an antibiotic.
The antibiotic will help prevent bacteria from getting into the blood stream and thus into your hip. The odds of this happening are very rare, but the antibiotic can reduce this already small risk.
For routine dental prophylaxis following surgery, antibiotics are recommended for your lifetime after the surgery.
In what other situations will I need antibiotics after the surgery?
Antibiotics given for other medical procedures may vary. Contact us for advice if there is any doubt. Antibiotics are needed if you develop an infection such as an abscessed tooth, pneumonia, bronchitis, and skin or urinary infections.
If you have a cut anywhere that develops an infection, conditions like a tooth abscess or ingrown toenail developing, seek medical attention urgently. Ignoring a festering sore means that there is a risk the bacteria could migrate to the hip, resulting in a serious deep infection, even though it happens rarely.
Will the new hip set off a metal detector at the airport?
Most likely, it will. Tell airport personnel that you have an artificial joint prior to entering the metal detector. Metal detection sensitivity at airports is highly variable, and it is impossible to say if a certain detector will set off the equipment. We will supply you with an implant identification card that you can carry to prove that you have metal hip replacement parts.
Can I have a MRI scan after hip replacement?
Yes. MRI scans of other parts of your body are safe after hip replacement. Although some old MRI scanning equipment may not be compatible with your prosthesis, the majority of MRI scanning equipment today is safe and compatible with hip replacement parts. You may also have a CT scan of any part of your body after a hip replacement.
How will I know if my hip implants are recalled?
In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please let us know.
Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.
Is there a long-term risk of failure of hip implants?
Implants are engineered to withstand your body weight and activity level, but the moving parts of a hip replacement do wear over a period of several decades. A properly aligned hip replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.
Subtle component mal-positioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the hip is implanted in your body is a critical determinant of durability.