After Hip Replacement Surgery

What can I expect During Recovery?

Postoperative care begins with a team approach of heath professionals within the hospital. Those closely involved with the postoperative total knee patient are:

  • The nursing staff
  • Respiratory Therapists
  • Physical Therapist
  • Occupational Therapists

The Nursing Staff

After surgery, vital signs and sensation in the lower extremities are observed and checked by the nursing staff and documented for the physician. Antibiotics are administered according to the physicians preference to reduce the risk of infection.

The surgical incision is observed closely for:

  • Excessive drainage

  • Proper initial healing

  • The need for changing of sterile dressings


The Respiratory Therapist

The respiratory therapist is essential at this stage for:

  • Instruction for coughing and deep breathing exercises to help prevent complications, such as congestion or pneumonia.

  • Instruction in the use of a bedside device called an incentive spirometer to assist in deep breathing exercises. Use of this device and deep breathing exercises are important in minimizing the risk of lung complications by removing excess secretions that may settle in the lungs during surgery.

The Physical Therapist

Shortly after surgery the physical therapist addresses:

  • Circulation - The acute care physical therapist in the hospital instructs the patient in early stage exercises such as moving the ankles up and down to promote circulation and prevent clots.

  • Range of motion - The physical therapist will instruct the patient to perform exercises to improve upon hip range of motion.

  • Mild strengthening - Following surgery, the total hip patient will work with the hospital physical therapist to improve range of motion to the hip as well as initiate muscle strengthening. This will progress the patient into becoming independent in walking, going up and down stairs, getting in and out of bed, and doing exercises to improve the range of motion and strength of the hip. This initial rehabilitation generally takes 5-7 days. During this time, patients may experience discomfort may be experienced while walking and exercising. To address this problem, pain medication will be ordered by the doctor as needed.

  • Gait training - The physical therapist assists the patient in walking short distances using walker initially followed by elbow crutches. This not only promotes range of motion and strength but is also important for endurance and stamina.


The Occupational Therapist

The occupational therapist is involved in evaluating and addressing how well the patient with the new knee replacement functions with activities of daily living. Issues such as how safely and independently the patient is able to dress, bathe, and care for his or herself following total knee replacement are evaluated.

The occupational therapist is involved in evaluating and addressing how independently and safely the patient functions in activities of daily living such as dressing, bathing, and caring for his or herself following hip surgery. Issues such as how safely and independently the patient is able to care for himself is evaluated. The occupational therapist teaches patients how to use equipment that prevents excessive bending of the new hip.

Dr. Vaidya’s team will explain you, in detail with pictures, how to perform these activities.

Standard exercises that are used for early postoperative hip replacement are:

Heel Slides (Knee Flexion) -

This exercise promotes muscle activity of the hamstrings as well as help increase the amount of knee flexion. The patient is lying in bed on his or her back, with legs straight and together and arms at the sides. The patient slides the foot of the surgical limb toward the buttock to a point where a mild stretch is felt. The patient holds this position to a count of 10 then slowly returns to the starting position. The physical therapist will record the amount of flexion and extension for a daily report on the patient's progress to be reviewed by the physician.

Active Abduction -

The patient places a smooth surface such as a plywood sheet under his or her legs. The patient begins with the legs together then moves the operative leg out to the side as far as tolerated keeping toes pointed toward the ceiling. The patient then returns to the starting position, progressing to 20 repetitions, 2 times a day.

Quadriceps Setting -

The patient is lying in bed on his or her back, with legs straight and together and arms at the side. The patient tightens the quadriceps muscles while pushing the back of the knee downward into the bed. This is a good beginning exercise as it not only initiates the needed muscle contraction but also is helpful in increasing extension of the knee. The patient holds this muscle contraction for 5-10 seconds, relaxes for a short period of time and repeats 10-20 times for each leg. It is optimal to exercise both legs as both legs will be in a weakened state after surgery. The patient is encouraged to do this exercise several times every hour, however, the amount of discomfort will determine how many repetitions each patient can perform.

Terminal Knee Extension -

This exercise also helps promote muscle activity and increases knee extension. The patient is lying in bed on his or her back, with a pillow or towel rolled up into a bolster under the surgical knee to place the knee joint at approximately 40 degrees from full extension. The patient is then instructed to tighten the quadriceps muscle and straighten the knee by lifting the heel off the bed. The patient is instructed to hold this muscle contraction for 5-10 seconds, then to slowly lower the heel to the bed. This exercise is to be repeated 10-20 times.

Gluteal Setting -

The patient lies either on his or her back or sits with legs straight and in contact with the bed. The patient is then asked to tighten the buttocks in a pinching manner and hold the isometric contraction for 5 seconds, relax 5 seconds. The exercise is repeated 20 repetitions, 2 times a day.

Isometric Hip Abduction -

The patient is instructed to keep the legs straight, together, and in contact with the bed. Next a loop or belt is positioned around the thighs just above his or her knees. The patient then slowly spreads their legs against the belt. This is held for 5 seconds, followed by relaxing for 5 seconds. The patient progress to 20 repetitions, 2 times a day.

Precautions After Surgery

General rules of total hip replacement that the patient needs to follow are:

  • In the first six to eight weeks after the operation, the individual receiving a total hip needs to avoid bending the hip beyond 90 degrees. This can be achieved by keeping knees below the hips when sitting. Sitting on a small pillow can help with this positioning. Avoiding sitting in sofas or couches which may cause excessive bend at the hip.

  • Avoid bending over from the hip to reach the floor.

  • Avoid crossing the surgical leg over the non-surgical leg. When sitting, it is good advice to keep the legs three to six inches apart.

  • Avoid turning the operated leg inward, i.e. pigeon-toed.

  • To use elevated commode seat

  • To use wedge pillow while sitting

Going Home

In general, most individuals after hip surgery are discharged after 4 to 10 days providing there are no complications and particularly if there are family members to assist with daily activities. In some cases, the social service department at the hospital will find a temporary nursing home or intermediate stay facility until returning home is a viable option.

Home Health

Once discharged from the hospital, a physical therapist appointed by Dr. Vaidya will likely see for in home treatment. This is to ensure that the newly discharged individual is safe in and about his or her home. The number of home health care visits range from one to several. These are carried out for safety checks and reviews of the exercise program. In some cases, up to three visits home care visits before individuals can begin outpatient physical therapy. In other cases, the individual may be functioning adequately and may not require outpatient therapy.

The home exercise program for hip replacement is often similar to the regimen used in the hospital. It will progress with resistance and repetitions of strengthening exercises and increased distance and independence of ambulating. The individual continues to adhere closely to the weight bearing status assigned following surgery.

The occupational therapist involved in the home health care of the postoperative hip patient closely examines how safely and independently the patient is able to dress, bathe, and care for his or herself within the home environment. The occupational therapist can also determine the need for home medical devices such as elevated commodes.

Utpatient Physical Therapy

If additional rehabilitation is needed, a new evaluation is generally conducted at an outpatient physical therapy facility.

In an outpatient physical therapy clinic the physical therapist may use the following methods of treatment to help reduce persistent swelling or pain and promote mobility:

  • Thermotherapy or cryotherapy (use of heat or ice)

  • Electrical stimulation

  • Ultrasound

  • Soft tissue mobilization

  • Joint mobilization

Progression Of Ambulating And Exercise

Continued use of a walker or crutches is commonplace for the individual progressing to the outpatient setting. However, the goal is generally to progress each person with hip replacement to ambulating without an assistive device when possible.

Once initial hip precautions are no longer a concern, increasing the postoperative individual's endurance can be addressed through walking, swimming, bicycling, and upper body exercises which is usually between 6 weeks to 3 months. The physical therapist will select a group of exercises that can be used to simulate day-to-day activities, like going up and down steps and raising up on the toes. Once the goals have been met in an outpatient setting regarding range of motion, strength, endurance, and ambulating, the person is ready for discharge with an independent program or possible exercising at a fitness center.

What Can I Expect After A Hip Replacement?

New technology involving implants for artificial hip replacement and advances in surgical techniques has improved the immediate and long-term outcome of the surgery. Generally today's artificial hips can last a lifetime. However, if the person is very young, the plastic can wear out. Fortunately, with the new socket implants for the pelvis, the socket can be changed without removing the other portions of the hip joint.

The person with a hip replacement may be able to take part in physical activities that were impossible before surgery.

Some additional tips and precautions for recreational activities include the following: (Please consult Dr. Vaidya, before starting these !)

  • Stress from rotation on the lead leg and hip in golf may be minimized by use of a smooth spikeless shoe.

  • Because bicycling introduces risk factors related to the resistance (such as from uphill inclines), avoid heavy pedaling when riding.

  • Although skiing on smooth groomed slopes in proper light is relatively safe, falls can have serious effects.

  • The surgeon will review x-rays and scans and can advise about current risk factors that may affect the life of the implant.

Your Future Activities

Most individuals following hip replacement surgery are able to return to work within a month or two of surgery. Yet, some individuals that are exposed to work requiring a great deal of repetitive climbing or crawling, may find it necessary to change jobs. Overall, many find that the activities that were once painful such as climbing up and down stairs, sitting for extended periods of time, and getting in and out of cars can now be performed with less pain.

What If The Hip Replacement Fails?

Loosening of the implant is the most frequent cause of failure of a total hip replacement. If that happens, revision surgery may be needed.

The extent of a revision surgery depends on the complexity of artificial implant removal along with restoration of bone. Revision of a surface replacement is likely to be less involved because the intact femur or thigh bone is still present. Revision surgery is technically more difficult although quality results can be achieved. Third and fourth revisions have been performed with each revision having a special and more difficult challenge for the surgeon and patient.