WHITE ROCK ORTHOPEDIC ASSOCIATION

EAST LAKE MEDICAL BUILDING

                                                  MARC S. GOLDMAN, M.D.                              10611 GARLAND ROAD, SUITE 110                   ROBERT A. GOLDBERG, M.D.

DALLAS, TX  75218

214.660.0505 Telephone               www.whiterockorthopedic.com                            214.660.4484 Facsimile

 


Activities after a Hip Replacement

If you are a candidate for hip replacement surgery, you probably anticipate that life after the surgery will be much like life before it, only without the pain. In many ways, you are correct. But change doesn’t happen overnight and your active participation in the healing process is necessary to ensure a successful outcome.

Although you will be able to resume most activities, you may have to change how you do them. For example, you will have to learn how to bend to avoid putting stress on your new hip. The following suggestions will help you adapt to your new joint and resume your daily activities safely.

Activities in the hospital

Joint replacement is major surgery and, for the first few days, you’ll probably want to take it easy. But it’s important that you start some activities immediately to counteract the effects of the anesthesia, encourage healing and help prevent blood clots from forming in your leg. Your doctor and a physical therapist will give you specific instructions on wound care, pain control, diet and exercise. Ask specifically about how much weight you can put on your operated leg.

Proper pain management is important in your early recovery. Although pain after surgery is quite variable and not entirely predictable, it can be controlled with medication. Initially, you will probably receive pain control medication through an intravenous (IV) connection so that you can regulate the amount of medication you need. Remember that it is easier to prevent pain than to control it. You don’t have to worry about becoming dependent on the medication; after a day or two, injections or pills will replace the IV.

In addition to pain medication, you will also have to take antibiotics and blood-thinning medication to help prevent blood clots from forming in the veins of your thighs and calves.

You may lose your appetite and feel nauseous or constipated for a couple of days. These are normal reactions. You may be fitted with a urinary catheter during surgery and be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery. You will be taught to do breathing exercises to prevent congestion from developing in your chest and lungs.

Usually a physical therapist will visit you on the day after your surgery and begin teaching you how to use your new joint. It is important that you get up and about as soon as possible after joint replacement surgery. Even as you lie in bed, you can "pedal" your feet and "pump" your ankles on a regular basis to promote blood flow in your legs. You may have to wear compression stockings and or a pneumatic sleeve to help keep blood flowing normally.

Discharge

Your hospital stay may last from 3 to 10 days, depending on how well you heal after surgery. You will need help at home for several weeks. If you do not have sufficient help at home, you may be temporarily transferred to a rehabilitation center. The following tips can make your homecoming more comfortable.


 

 
  • In the kitchen (and in other rooms as well), place items you use regularly at arm level so you don’t have to reach up or bend down.
  • Rearrange furniture so you can maneuver with a walker or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
  • 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.
  • Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Install a shower chair, gripping bar and raised toilet 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 too far over. A footstool is useful for keeping your operated leg straight out in front of you when you sit. Wear a big-pocket shirt or soft shoulder bag for carrying things around.
  • Set up a "recovery center" in your home, with the phone, television remote control, radio, facial tissues, wastebasket, pitcher and glass, reading materials and medications within reach.

Activities at home

  • Keep the area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing if you are not sure.
  • Sutures will be removed in 2 to 3 weeks and X-rays will be taken to ensure that the joint is healing properly. Until then, do not shower or bathe; instead, do a simple sponge bath.
  • Notify your doctor if the wound appears red or begins to drain.
  • Take your temperature twice daily and notify your doctor if it exceeds 100.5°F.
  • Swelling is normal for the first 3 to 6 months after surgery. Elevate your leg slightly and apply an ice pack for 15 to 20 minutes at a time.
  • Wound care: General guidelines for wound care include: Calf pain, chest pain or shortness of breath are signs of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms.

Medication. Take all medications as directed. You will probably be given a blood thinner to prevent clots from forming in the veins of your calf and thigh, because these clots can be life-threatening. If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.

Because you have an artificial joint, it is especially important to prevent any bacterial infections from settling in your joint implant. You should get a medical alert card and take antibiotics whenever there is the possibility of a bacterial infection, such as when you have dental work. Be sure to notify your dentist that you have a joint implant and let your doctor know if your dentist schedules an extraction, periodontal work, dental implant, or root canal work.

Diet. By the time you go home from the hospital, you should be eating a normal diet. Your physician may recommend that you take iron and vitamin C supplements. Continue to drink plenty of fluids and avoid excessive intake of vitamin K while you are taking the blood thinner medication. Foods rich in vitamin K include broccoli, cauliflower, Brussels sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage and onions. Try to limit your coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming normal activities: Once you get home, you should continue to stay active. The key is not to overdo it! 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:

  • Weightbearing: Be sure to discuss weightbearing restrictions with your physician and physical therapist. Their recommendations will depend on the type of implant and other issues specific to your situation. Revision hip surgery (replacing a previously implanted prosthesis) may require an extended period of time without putting weight on the leg.
    • Uncemented hip replacement: For the first 6 weeks, use crutches and do not put any weight on the leg. Then gradually begin to put weight on the leg, using a cane or walker. By 12 weeks, you can begin weightbearing. This protects the joint and gives the bone time to grow into the porous coating of the implant.
    • Cemented or hybrid hip replacement: Using a cane or walker, you can put some weight on the leg immediately, but should continue to use an assistive device for 4 to 6 weeks.
  • Driving: You can begin driving an automatic shift car in 6 to 8 weeks, provided you are no longer taking narcotic pain medication. If you have a stick shift car and your right hip was replaced, do not begin driving until 12 weeks. The physical therapist will show you how to slide in and out of the car safely. Placing a plastic bag on the seat can help.
  • Sexual relations can be safely resumed 4 to 6 weeks after surgery.
  • Sleeping positions: Sleep on your back with your legs slightly apart or on your side with a pillow between your knees. Be sure to use the pillow for at least 6 weeks, or until your doctor says you can do without it.
  • Sitting: For at least the first 3 months, sit only in chairs that have arms. Do not sit on low chairs, low stools, or reclining chairs. Do not cross your legs. The physical therapist will show you how to sit and stand from a chair, keeping your operated leg out in front of you. Get up and move around on a regular basis, at least once every hour.
  • Going up and down stairs: Stair climbing should be avoided if possible until healing is complete. If you must go up stairs,
    • The unaffected leg should step up first.
    • Then bring the affected leg up.
    • Then bring your crutches or canes up.

To go down stairs, reverse the process.

    • Put your crutches or canes on the lower step.
    • Next, bring the affected leg forward.
    • Finally step down on the unaffected leg.
  • Return to work: Depending on the type of activities you perform, it may be 3to 6 months before you can return to work.
  • Other activities: Walk as much as you like once your doctor gives you the go-ahead, but remember that walking is no substitute for your prescribed exercises. Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed, approximately 6 to 8 weeks after surgery. Acceptable activities include dancing, golfing (with spikeless shoes and a cart), and bicycling (on level surfaces). Avoid activities that put stress on the joint such as tennis or badminton, horseback riding, contact sports (football, baseball), squash or racquetball, jumping, badminton, or jogging. Do not do any heavy lifting (more than 40 pounds) or weight lifting.

Do's and Don'ts

Your doctor and physical therapist will provide you with a list of do's and don'ts to remember with your new hip. These precautions are necessary to prevent the new joint from dislocating and to ensure proper healing. Here are some of the most common precautions.

  • Don’t cross your legs for at least 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.
  • Do keep the leg facing forward at all times.
  • Do keep the operated leg in front as you sit or stand.
  • Don’t reach down to pull up blankets when lying in bed.
  • Don’t bend at the waist beyond 90 degrees.
  • Don’t stand pigeon-toed.
  • Do use a high kitchen or bar stool in the kitchen.
  • Don’t use pain as a guide for what you may or may not do.
  • 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!

April 2001