TOTAL HIP REPLACEMENT: WHAT TO EXPECT AFTER DISCHARGE HOME

DAY 0-1:

REBOUND PAIN WHEN THE SPINAL WEARS OFF. IF you are not having pain, you don’t have to take the narcotics given – stop narcotics if you’re having nausea/vomiting/dizziness/loopiness – i.e. side effects of the narcotics, which your body feels if you don’t have pain.

TOTAL HIP PRECAUTIONS/RESTRICTIONS: AVOID EXCESSIVE WALKING/ACTIVITY FOR 6 WEEKS! – THE SOFT TISSUES TAKE ABOUT 6 WEEKS TO FULLY HEAL, SO ITS IMPORTANT NOT TO OVERDO IT! The hip capsule, the piriformis tendon and the gluteus maximus fascia are sutured/repaired at the end of the surgery and the sutures can break until the soft tissues heal themselves. The tissues take the same time to heal no matter what approach is used – tissue is tissue – your body will take the same amount of time to heal ligament tissue to ligament tissue and tendon to tendon tissue as everyone else….you are HUMAN, not SUPERHUMAN – biology is biology – your cousin or neighbor or friend are not superhuman either.

Its OK TO BEND DOWN BETWEEN the knees – DO NOT BEND OUTSIDE of your knees. It’s OK TO CROSS YOUR LEGS.

THE PROSTHESIS IS WEDGED IN THE FEMUR – IT CAN BEHAVE AS AN AXE BLADE AND BREAK THE FEMUR IF TOO MANY STEPS OR ANY SIGNIFICANT FALL OR IMPACT OCCURS PRIOR TO BONY INGROWTH ON THE IMPLANT. You will want to go-go-go because you feel good and these are the patients that have femur fractures postop—1 to 5 patients a year— please, please, please, do NOT overdo it — once you are 12 weeks postop when bony ingrowth has been certain to occur, its ok to RUN, JUMP, walk a million miles, etc…without the risk of the prosthesis acting like an axe blade – bony ingrowth occurs 6-8 weeks post op so there won’t be any issues if you wait until 12 weeks postop for those kinds of activities.

YOU START THE MULTI-DRUG PAIN PROTOCOL.

YOU START YOUR HOME EXERCISE PROGRAM:

FIRST 2 WEEKS – FOCUS IS LIMITING STEP COUNT and SWELLING MANAGEMENT NOT STRENGTHENING: DON’T OVERDO IT!

EVERY HOUR WHILE AWAKE SHOULD INCLUDE:

30-40 minutes of ICING and LEG ELEVATION.ICING CAN BE DONE 24/7 AS LONG AS THE SKIN IS PROTECTED FROM FREEZER BURN. THIS SHOULD BE DONE 30-40 minutes per hour the first 10-14 days postop.

Flexible ice packs or Ice machines with a bladder are commonly used by patients. They are not covered by insurance and need to be purchased online.

AT HOME EXERCISES:

10 ankle pumps per hour
30 steps per hour of WALKING WITH A WALKER

DAY 1-5:

SWELLING AND BRUISING OF BUTTOCK, HIP, AND THIGH. THE AMOUNT OF SWELLING AND BRUISING VARIES FROM PERSON TO PERSON – EVERYONE RESPONDS DIFFERENTLY – THIS IS NORMAL.

DAYS 5-8:

Pain and swelling are DIRECTLY RELATED TO ACTIVITY LEVEL – 30-40 minutes of ICING and LEG ELEVATION per hour. DON’T OVERDO IT!

DAY 7:

OK to remove dressing and leave open to air. The Steri-Strips (white tape) across the incision will fall off on their own – if still on, they can be removed after 2 weeks postop. OK to shower with the wound uncovered now, using Hibiclens soap over the incision in the showers (NO SUBMERSION OF THE WOUND UNTIL SCAB GONE – USUALLY 3-4 WEEKS POSTOP).

DAYS 7-14:

Depending on fitness level, WALKER is discontinued, continue to use of cane if limp is still present. DON’T OVERDO IT!

AFTER 2 WEEKS, PHYSICAL THERAPY (PT) can either be:

1. SELF-DIRECTED using instructions (Home Exercise Program ie HEP)

Step count LIMITS: DON’T OVERDO IT!

2000 steps/day maximum WEEK 3
2750 steps/day maximum WEEK 4
3500 steps/day maximum WEEK 5
4500 steps/day maximum WEEK 6
progress by 1000 steps/day in each subsequent week letting pain/swelling be the guide.

2. Outpatient PT (OPPT) DON’T OVERDO IT!

ALL STUDIES SUGGEST YOUR HIP FUNCTION/OUTCOME DOES NOT RELY ON FORMAL PT, but on you doing the Home Exercises.

IF YOU BREAK YOUR FEMUR DUE TO OVERUSE/FALLING AND THERE IS NO ROOM ON THE SCHEDULE TO FIX YOUR FRACTURE, YOU MAY NEED TO GO TO A TRAUMA CENTER FOR SURGERY.

RED FLAG SIGNS FOR FEMUR FRACTURE: 1. increase in pain level that does not get better after 1-2 days. 2. inability to bear weight or regression in ability to bear weight 3. shortening of leg or rotation of leg externally (foot facing outward).

WEEK 12:

OK to run (even 7 marathons if you want), jump, ride on a bike in the community, ski (water or snow), play ice hockey (NOT GOALIE! but defence is ok), tennis, pickleball, golf, basketball, soccer, football, baseball, cricket, etc. You are 18 again – enjoy your new hip.

OTHER INFO:

https://orthoinfo.aaos.org/en/recovery/total-hip-replacement-exercise-guide/