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After having a hip replacement, you may expect your lifestyle to be a lot like how it was before surgery—but without the pain. In many ways, you are right, but returning to your everyday activities will take time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.
Even though you will be able to resume most activities, you may have to change the way you do them. For example, you may 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.
Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. Before you are discharged from the hospital, you will need to accomplish several goals, such as:
- Getting in and out of bed by yourself.
- Having acceptable pain control.
- Being able to eat, drink, and use the bathroom.
- Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs.
- Being able to perform the prescribed home exercises.
- Understanding any hip precautions you may have been given to prevent injury and ensure proper healing.
If you are not yet able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.
When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total hip replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.
Warning Signs of Infection
- Persistent fever (higher than 100 degrees)
- Shaking chills
- Increasing redness, tenderness or swelling of your wound
- Drainage from your wound
- Increasing pain with both activity and rest
Warning Signs of a Blood Clot
- Pain in your leg or calf unrelated to your incision
- Tenderness or redness above or below your knee
- Severe swelling of your thigh, calf, ankle or foot
In very rare cases, a blood clot may travel to your lungs and become life-threatening. Signs that a blood clot has traveled to your lungs include:
- Shortness of breath
- Sudden onset of chest pain
- Localized chest pain with coughing
Notify your doctor immediately if you develop any of the above signs.
You will need some help at home for anywhere from several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.
Preparing Your Home
The following tips can help make your return home more comfortable, and can be addressed before your surgery:
- Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to minimize the use of stairs.
- Place items you use frequently (phone, remote control, glasses, pitcher and glass, reading material and medications, for example) within easy reach so you do not have to reach up or bend down.
- Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- 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.
- Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
- Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.
During your recovery at home, follow these guidelines to take care of your wound and help prevent infection:
- Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as often as necessary. Ask for instructions on how to change the dressing before you leave the hospital.
- Follow your doctor's instructions on how long to wait before you shower or bathe.
- Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.
Expect mild to moderate swelling for 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.
Take all medications as directed by your doctor. Home medications may include narcotic and non-narcotic pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.
Be sure to talk with your doctor about all your medications--even over-the-counter drugs, supplements, and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.
It is especially important to prevent any bacterial infections from developing in your artificial joint. Your doctor may advise you to take antibiotics whenever there is the increased possibility of a bacterial infection, such as when you have dental work performed. Be sure to talk to your doctor before you have any dental work done and notify your dentist that you have had a hip replacement. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.
By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin supplements. You also may be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you are taking certain blood thinner medications, such as warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.
Continue to drink plenty of fluids, but try to limit coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.
Once you get home, you should stay active. The key is to not do too much, too soon. 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:
Follow your doctor's specific instructions about the use of a cane, walker, or crutches and when you can put weight on the leg. Full weight bearing may be allowed immediately or may be delayed by several weeks depending on the type of hip replacement you have undergone and your doctor's instructions.
In most cases, it is safe to resume driving when you are no longer taking narcotic pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.
Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.
Depending on your surgery, your doctor may ask you to avoid certain sleeping positions or to sleep with a pillow between your legs for a length of time. Ask your doctor which sleeping positions are safest and most appropriate for you.
Return to Work
Depending on the type of activities you do on the job and the speed of your recovery, it may be several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.
Sports and Exercise
Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your hip flexible.
As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your hip replacement:
- Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
- Swimming is an excellent low-impact activity after a total hip replacement; you can begin as soon as the sutures have been removed and the wound is healed.
- In general, lower impact fitness activities such as golfing, bicycling, and light tennis, put less stress on your hip joint and are preferable over high-impact activities such as jogging, racquetball and skiing.
Pressure changes and immobility may cause your hip joint to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector. You may also wish to carry a medical alert card to show the airport screener.
Dos and don'ts (precautions) vary depending on your doctor's surgical technique. Your doctor and physical therapist will provide you with a list of dos and don'ts to remember with your new hip. These precautions will help to prevent the new joint from dislocating and ensure proper healing. Here are some of the most common precautions:
- Don't cross your legs at the knees for at least 6 to 8 weeks.
- Don't bring your knee up higher than your hip.
- Don't lean forward while sitting or as you sit down.
- Don't try to pick up something on the floor while you are sitting.
- Don't turn your feet excessively inward or outward when you bend down.
- Don't reach down to pull up blankets when lying in bed.
- Don't bend at the waist beyond 90 degrees.
- Do keep the leg facing forward.
- Do keep the affected leg in front as you sit or stand.
- Do use a high kitchen or barstool in the kitchen.
- Do kneel on the knee on the operated leg (the bad side).
- 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!
The American Academy of Orthopaedic Surgeons
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Rosemont, IL 60018