How to look after yourself after a hip replacement.

Hip replacement surgery is a short procedure that takes around 90 minutes or less, however, the time taken to recover from it can run into weeks or even months.

To get an idea of why the recovery period takes so long, it might be worth being aware of what happens during the hip replacement surgery. The aim of hip replacement surgery it to remove the problematic hip joint, replacing it with an artificial joint made from metal and plastic materials. The surgery begins with removing the existing hip joint completely and this is achieved by sawing off the head of the femur, and hollowing out the natural socket for the new head of femur. A socket is then fitted into the hollow in the pelvis and the artificial joint is fitted in two sections - a stem and a cup.

Hip replacement surgery is a big deal, and it is important to spend the days in the run-up to surgery preparing as much as possible for your recovery after surgery. Here are some ways you can prepare for the big day:

How to prepare for your hip replacement surgery

• Get informed. Find out as much as you can about the procedure, going through videos and any written information provided by the hospital. Create a list of any questions you may have for your consultant, and keep them ready for your pre-operative appointment.
• Ensure that the floors at home are kept clean, and free from trip hazards such as cords and cables. Also ensure that the rooms you are likely to use often are kept clutter-free. Pack the things you are likely to need, and keep them within reach, as your regular movements might take a few days to return to normal.
• Shop ahead. A large food shop will help to cover you in the event that you are unable to drive or shop after surgery. You might also want to get yourself acquainted with online shopping if you have never tried it, as you may need to shop online for necessities.
• Get some help. You will probably need some support before and after your surgery, so it is a good idea to make arrangements for this. Make travel arrangements to be dropped off and collected from the hospital and give family and friends plenty of notice so that they can make time in their schedules to come and visit.
• Stay active. Strengthening the muscles around your hip will help you recover faster, so start practising some gentle exercises such as walking and swimming in the weeks leading up to surgery.

What should you expect after your hip surgery?

After the procedure, you may wake up from anaesthesia with a triangle-shaped pillow between your legs, used to keep your hip in the correct position. You will also have a large dressing over the wound and the nursing staff will monitor your condition. In the hours following surgery, you will begin to regain feeling in your legs, and you will probably be offered some painkillers to take the edge off the pain.

After an hour, if your condition is stable enough for you to return to the ward, you may be allowed to have something to eat and drink. If your pain is reasonably under control, the staff will try to get you up and walking as soon as possible to help promote blood flow to your legs. You may also be asked to carry out some light exercises under the careful guidance of a physiotherapist with a walking frame or a pair of crutches for support. The physiotherapist’s role is to teach you exercises which would help strengthen your new hip without damaging it.

How soon can you leave hospital following a hip replacement?

With no complications, most hip replacement patients can be discharged within 3 to 5 days if they meet the required conditions according to the recovery program. People who have had more than one joint replaced or who have certain pre-existing medical conditions, uncontrolled pain, or general weakness may be kept in the hospital longer than 5 days.

Usually, the surgeon may give the go-ahead for discharge if you are able to:

• Get in and out of bed and walk short distances (about 50 to 100 metres) with the aid of a walking frame or crutches.
• Eat meals sitting up
• Perform simple exercises
• Follow precautions to avoid dislocating the new hip

There are exceptions, however, as discharge ultimately is determined by the progress made by the patient and what type of surgery they had.

After discharge from hospital

Recovery times differ from person to person and depends on the age, weight, physical condition and the extent of damage to the hip joint. After being discharged from hospital, the rest of your recovery process continues at home. The hospital staff will draw up a care plan and equip you with advice on how to look after your new hip at home.

You will need to ensure that you use any walking aids supplied by the hospital team correctly and that you religiously follow the exercise regimen prescribed by the physiotherapist. The exercises are a crucial part of your recovery, and it is essential that you follow them as instructed when you are at home.

After about six weeks, you will probably start feeling like your old self again. If you had a desk job or light duties prior to surgery, you might be able to return to them after 6 weeks. After your 12-week review with your surgeon, you might be able to resume driving, work and other activities.

While recovering at home, it is important to contact your GP if you notice any red, fluid or increase in pain in the new joint. Avoid extreme movement, sports or heavy lifting during this period until you get the clearance from your doctor.

When should you arrange for home care?

If you find that you need some help around the house or some encouragement/accountability for your exercises, you can get a visiting carer to come and check up on you for a few hours each day. At HP Homecare, we have a team of expert carers who specialise in post-discharge home care. If you are based within or around the London area, contact our team of carers to arrange a care regime based on your care plan to ensure that your loved one has all the assistance and support needed to get back on their feet. If you’re wondering how long it takes to fully recover from hip replacement surgery, look out for our next article, where we will cover this in depth.

How long does it take to fully recover from a hip replacement?

Hip replacement surgery is a major procedure which requires a considerable amount of education beforehand. Education prior to hip replacement surgery is necessary to make sure that any needs of the patient are identified early enough to allow for a detailed recovery plan to be created.

Following hip replacement surgery, the recovery period usually involves many important actions that will determine how well you recover in the long term.

Once you have been discharged from the hospital, most of the hip recovery process should continue at home, and this is why it is important to be organised and put a plan in place beforehand. Your recovery plan is important to make sure that the bulk of your recovery time is actually spent recovering, rather than on essential tasks that could have been completed beforehand such as tidying up, shopping ahead etc. If you do have to arrange for a visiting carer to help with daily tasks after the operation, ensure that you make arrangements before the operation rather than after.

Recovery time varies from person to person and depends on many factors such as age, weight, physical condition and extent of damage to the hip joint. So, when looking after someone who has had hip surgery, it is important to tailor your care to fit the recommendations of the hospital for the patient. To offer good quality care, it is important to first understand the disease as well as the surgical solution.

Understanding the Disease

Hip replacement surgery involves removing the painful hip joint and replacing it with a prosthetic implant made from metal and plastic materials. It is the most recommended treatment for severe osteoarthritis and may also be recommended for fractures of the hip, including those resulting from osteoporosis. Most hip replacement patients are able to walk slowly the day following surgery however, most can resume routine activities within 3 to 6 weeks. Usually, if a patient reaches certain clinical milestones, they can be discharged from the hospital 3 to 5 days after surgery.

Hip replacement recovery timeline

Recovery in hospital

The recovery timeline begins at the hospital following surgery. You might wake up to find yourself flat on your back with a pillow between your legs keeping your hips in the right position. You will have a dressing over the wound, and you may also have a drainage tube to collect any blood that collects around the hip. You will be monitored by the nursing staff and will be allowed to have something to drink at least an hour after returning to the ward. Depending on your condition, you may also be allowed to have some food shortly after. You will be offered an anticoagulant injection through your abdomen to help prevent blood clots from forming in your legs, and you may also be offered some antibiotics if it is thought that you are at risk of developing an infection.

The staff will help you get mobile and walking again as soon as possible, and if your surgery was minimally invasive, you might be allowed to walk on the same day. You will probably feel some discomfort while walking and exercising, and you may get some swelling in your legs and feet. At some point, you will meet with a physiotherapist who will teach you the dos and don’ts involved in caring for your new hip. The physiotherapist will also show you what exercises are best for strengthening your hip, as well as how to bend and sit to avoid damaging the new joint.

Depending on how well you are progressing and what kind of surgery you had, you may spend around 3 to 5 days in the hospital before getting discharged. If your fitness level permits, you might be put on an enhanced recovery programme - which means that you may start walking on the day of surgery with possible discharge from hospital within 1 to 2 days, rather than the regular 3 to 5 days.

You may be discharged with a walking aid - usually 2 walking sticks. Do not feel under pressure to transition from using your aids as there is no set time for which you are expected to use them. When you have gained some confidence, you can rely on 1 stick, using it on the unoperated side until you feel confident enough to progress to not using the sticks anymore.

Recovery at home

One common complaint that most people have after having hip replacement surgery is tiredness and fatigue. This is not unusual, as there are a number of justifiable reasons why you might feel tired following this surgery - anaesthesia, blood loss, pain, and medication. On a positive note, tiredness will slowly resolve over the course of the first 6 weeks following surgery.

It is very important to follow the exercise routine prescribed by the physiotherapist at home, as this is a crucial part of the recovery process. The West Suffolk NHS Trust recommends doing the physiotherapy exercises 3 to 4 times a day, every day for at least 6 weeks in order to strengthen the muscles around the hip to support the new joint. While at home, it is still very important to follow the instructions given by the in-hospital physiotherapist on how best to sit and bend to avoid damaging or dislocating the new hip.

The swelling on the operated leg may take a few months to fully resolve. If for any reason you notice that it is getting significantly worse, visit your GP for advice. As for the dressing on your wound, depending on what kind of dressing is used, you may have a district nurse visit you at home to remove the clips or stitches used for the wound. If you do have any problems with the wound, visit your GP, nurse or contact the ward.

For daily activities such as bathing, cooking, cleaning, running errands etc, you could benefit from getting as much help as you can from friends and family.

Recovery timeline

This timeline is only provided as a rough guide. Before you resume any activity that is new to your recovery routine, ensure that you clear this with your orthopaedic consultant beforehand.

6 weeks after surgery

• Swimming (not breaststroke)
• Water aerobics
• Gentle exercise bike
• Driving

3 months after surgery

• Gentle jogging
• Cycling
• Swimming (breaststroke)
• Aerobics
• Bowls
• Manual work
• Gentle gardening

6 months after surgery

• Racket sports
• Yoga, Tai Chi, Pilates
• Lifting weights

If you are struggling to get active, ring your hospital and ask to speak to the orthopaedic therapist, as they will be able to offer you a lot of guidance.

Protecting your joint

Because the surgeon has to cut through soft tissue and muscle surrounding the hip joint, there is a risk of the new hip dislocating while the soft tissue is still healing. To prevent this from happening, you will need to put certain precautions in place to protect your new hip joint.

The West Suffolk NHS Trust recommends taking the following hip precautions in the first 6 - 8 weeks following surgery to prevent straining the hip and subsequently causing it to dislocate

Meaning:

• Avoid crossing your legs in any position - sitting, standing, lying down, and not even at the ankles
• Avoid bending your hip at less than a 90-degree angle. This includes bending towards your feet or bringing your knees up towards you
• Avoid twisting at the hip or overreaching. Always try to ensure that your body faces whatever you are doing.

Visiting carers for post-surgical care

If you’re struggling to cope after your hip replacement surgery, or perhaps if you happen to have limited access to friends and family, a visiting home carer might be ideal for you. Home care offers you help in your time of greatest need – whether you are looking for someone to visit on set days, or someone to offer you daily assistance with your meals, exercises, shopping, cleaning etc.

At HP Homecare, we specialise in post-surgical home care and provide you with visiting carers who can visit and help you with your recovery, especially if you’re within the London area. Our experienced team of carers have helped post-surgical patients like you get back on their feet for over 20 years, so contact us today to discuss your needs.

Especially in cases where a fall was the predetermining cause for hip surgery, patients might experience anxiety and emotional issues arising from the fear of falling. In our next article, we will cover ways to deal with the fear of falling in patients at risk.