What to expect after hip replacement

Whether you are just exploring treatment options, have decided to go ahead with the surgery, or have already had the hip replacement without any plans, the following information will help you through your recovery journey.

Although there are average guidelines regarding recovery time, recovery will look different for every hip replacement. Factors such as age, prehab, general health, and well-being can impact the recovery journey—there’s no point in comparing how others are going; it’s your hip, and your goals are most important to you.

It is vital that you take an active role in your recovery journey, working together with your doctors and allied health practitioners to plan and prepare for successful recovery,

Average recovery time

First week
Don’t be surprised if a physiotherapist comes in to help you get out of bed as early as the day of the operation. Physiotherapists will show you ways to get in and out of bed safely and mobilise when safe – usually with a gait aid.
Exercises in the hospital—Depending on your progress, the physiotherapist will prescribe a couple of exercises, ensuring you do them safely and according to the prescription. Having pain relief/medication before Physiotherapy sessions will help you participate better.
When it is safe to go home, you will likely be discharged within a few days, i.e., when you can get around confidently and safely with a walking aid, are mostly independent (not everyone has to be independent to be discharged from the hospital), organised relevant equipment at home, and have no other complications.
Exercises after the hospital: Your physiotherapist will continue to work with you and progress your exercise program to improve your strength and balance.
Ensure swelling and pain are well controlled. It is harder to see swellings in the hip than in the knee; however, there will be swellings there, and they can last up to 3-6 months.

Reaching 6-week mark
You might have gotten rid of the gait aid by six weeks as it feels less painful. However, if you are limping without the aid, you need to practice walking correctly with it.
By six weeks, hip movements would have improved, and you would have started to perform light activities such as preparing meals and other daily tasks.
It will become easier to take care of the hip and able to do stairs
If you have taken a leave from work for the surgery, please seek advice from your treating doctor before returning to work

Another six weeks have passed.
You should be able to feel that swelling has gone down significantly by now.
If you have access to the gym, you might have started using stationary bikes or light weights. If you need help determining which exercises to do and when, please consult the physiotherapist treating you.
You will need clearance to drive from your treating doctor.

Congratulations, you made it to the 3rd month.
If you have a sport to return to or want to start a new sport, please consult the treating doctor and your physiotherapist.
Remember that you have a brand new hip in there, and it can take up to 12 months for a full recovery.

Possible Complications

  • Infections can happen anytime after the surgery or years later. Minor ones are easy to deal with and generally treated with antibiotics. Major or deep infections can be more severe and may result in more surgery or even removal of the hip replacement.
  • Blood clots: blood clots or DVT (Deep vein thrombosis) in the pelvis or leg veins are one of the most common complications of hip replacement. It can be life-threatening if one of those clots breaks off and travels to places like the lungs. There are different ways to prevent this, which include: Blood thinners, Compression stockings, a.k.a. T.E.D stockings commonly used in hospitals, Air pumps for legs, Doing ankle pumps, Early mobilisation > getting you up and walk
  • Difference in leg length: Surgeons will try their best to make your leg length even; however, for mechanical reasons, i.e., stability or biomechanics of the hips, length discrepancies can happen. There can be ways to counter the discrepancy, including a shoe lift.
  • Dislocation: It’s like having a real dislocation of the joint, i.e., the round part on the top of the long bone of the leg coming out of the socket part in the pelvis. The risk is most significant in the first few months when the incision site is healing. Depending on the surgeon and the surgery approach, hip precaution protocol may be prescribed to mitigate the risk.
  • Wearing out and loosening of the prostheses: Like a real joint, your hip prosthesis may wear out or loosen over time. Factors such as the material, activity types, activity load, bone health, and weight can impact the prosthesis’s life span. A revision may be required if the loosening of the prosthesis becomes painful.

Hip precautions?

When getting your hip done, you may have heard from your surgeon and the physiotherapist what movements to avoid with your hips. It’s called a hip precaution, a well-known post-operative protocol designed to mitigate hip dislocations that can occur at an estimated incidence of 1-3%.

There are a few different surgical approaches to hip replacement, i.e., going through the muscles of the buttock (Posterolateral), going from the front (Direct anterior), or going slightly off to the side a bit from the front (Anterolateral). Hip precautions depend on the surgeon and what approach they have used. Depending on the hospital, your doctor, nurse, or physiotherapist will go through this with you before and after the surgery unless you are in for an emergency hip replacement.

The most common approach for hip replacement is the posterior approach – provocative positions for this approach include bending the hips, bringing legs across the body’s midline or twisting the leg inwards. Precautions include:
– Do not bend the hip more than 90 degrees (you may need pieces of equipment at home)
– Do not cross your legs or feet
– Do not roll or lie on your unoperated side for the first six weeks ( this will make the operated leg cross the midline)
– Do not twist the upper body when standing
– Sleep on the back for the first six weeks
– Avoid bathing (you can still shower) and bending down to the tub for 8-12 weeks
(More information available from National Library of Medicine ‘Hip Precautions’)

Ultimately, the surgeon who performed your hip surgery will decide the hip precautions and what you can or are limited to. The nurses and physiotherapists will check the post-operation orders to ensure you comply with the protocol and minimise the risk of dislocation.

Setting up your home

After the surgery, you will notice that seemingly easy-to-do everyday activities like showing or toileting can be challenging, especially when you are in pain, and you are not allowed to bend your hips too much. Here are a few tips to make life easier after hip surgery.
1) If you don’t need to use the stairs, then don’t. If you live in a high-set house, try setting up a room downstairs to minimise going up and down stairs.
2) Over the top, toilet frame- toilets are surprisingly low, and many people can’t sit on them without bending more than 90 degrees.
3) Shower chair for balance
4) For a bit of an extra, there are item pickers, sock aids, etc

Some equipment can be rented; however, not everything will be available for rent, and you won’t likely need much equipment other than major ones like gait aids, toilet frames and shower chairs. Occupational therapists would be the best people to talk to when considering equipment.

Like to know more information?

Reference List
https://www.svph.org.au/services/orthopaedics/knowledge-hub/hip-replacement-surgery-your-recovery
https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
https://www.healthdirect.gov.au/hip-replacement#:~:text=During%20hip%20replacement%20surgery%2C%20damaged,takes%201%20to%202%20hours.
https://www.ncbi.nlm.nih.gov/books/NBK537031/