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After hip replacement, your lifestyle should improve and your hip should be without pain. This can take a year or more for complete recovery. You need to be a partner in the healing process to ensure a successful outcome. You will be able to resume most activities; however, you may have to change how you do them. You will have to learn new ways of bending down that keep your new hip safe.
What happens in the hospital?
Hip replacement is major surgery and, for the first few days, you will need to take it easy. However, it is important that you start some activities immediately to offset the effects of the anesthetic, help the healing, and keep blood clots from forming in your leg veins. Your doctor and physical and occupational therapists will give you specific instructions on wound care, pain control, diet, and exercise.
Pain after surgery is quite variable and not entirely predictable. It does need to be controlled with medication. Initially, you may get pain medication through an IV (intravenous) tube. It is easier to prevent pain than to control it and you do not have to worry about becoming addicted to the medication; after a day or two, injections or pills will replace the IV tube.You will also need antibiotics and blood-thinners to help prevent blood clots from forming in the veins of your thigh and calf.
You may lose your appetite and feel nauseous or constipated for a couple of days. These are ordinary reactions to anesthesia and surgery. Initially you will have a urinary catheter inserted during surgery and be given stool softeners to ease the constipation caused by the pain medication. Breathing exercises keep your chest and lungs clear.
A physical therapist will visit you, usually on the day after your surgery, and teach you how to use your new joint. It is important that you get up and about as soon as possible after hip replacement surgery. Even in bed, pedal your feet and pump your ankles regularly to keep blood flowing in your legs. You have to wear elastic stockings and/or a pneumatic sleeve to help keep blood flowing freely.
When will I be discharged?
Your hospital stay will usually last from 1-2 days. Then many people will go to a rehabilitation center for a short while for extra assistance. If you go straight home, you will need help at home for several weeks.
Make your homecoming easier by preparing before your surgery.
- In the kitchen (and in other rooms), place items you use frequently within reach so you do not have to reach up or bend down.
- Rearrange furniture so you can get about on a walker or crutches. You may want to change rooms (make the living room your bedroom, for example) to stay off 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 rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
- Install a shower chair, grab bar, and raised toilet in the bathroom.
- Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool to avoid bending too far over. Wear a big-pocket shirt or soft shoulder bag for carrying things.
- Set up a “recovery center” in your home, with a phone, television remote control, radio, facial tissues, wastebasket, pitcher and glass, reading materials, and medications within easy reach.
What will it be like when I leave the hospital? What should I keep in mind?
- Keep the skin clean and dry. The dressing applied in the hospital should be changed as necessary. Ask the nurse for instructions on how to change the dressing if you are not sure.
- If you have stitches or staples that need to be removed, a visiting nurse will do this. You can shower once the wound has healed or is covered with a waterproof dressing. You cannot soak in a tub, Jacuzzi or go in a sauna for 4 weeks. Notify your doctor if the wound appears red or begins to drain.
- Take your temperature if you feel you have a fever and notify us if it exceeds 101°F. You must use a thermometer!
- 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, a few times a day.
- Calf pain, chest pain, and shortness of breath are signs of a possible blood clot. You may need to go to the Emergency Room if this occurs.
Take all medications as directed. Aspirin or a blood thinner can prevent life-threatening clots from forming in the veins of your calf and thigh. If a blood clot forms and then breaks free, it could travel to your lungs (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 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 procedure. The American Academy of Orthopaedic Surgeons has prepared recommendations about using antibiotics to prevent joint infection when you must have dental work.
By the time you leave the hospital, you should progress toward eating your normal diet. You may take iron and vitamin supplements. Continue to drink plenty of fluids and avoid excessive intake of vitamin K if you are taking the blood-thinner medication Coumadin (Warfarin). 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. Limit your intake of coffee and alcohol. Do not smoke.
[yellowbox]Resuming Normal Activities[/yellowbox]
Once you get home, you should 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:
With un-cemented hip replacement, the use of crutches or a walker protects the joint and gives the bone time to grow into the porous coating of the implant. By 8 weeks, you should be weight bearing with only a little support (cane).
You can put some weight on the leg immediately using a walker, and you should continue to use some support for 6 weeks to help the muscles recover.
You can begin driving an automatic shift car in 4 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, consider renting or borrowing an automatic until you have completely recovered. The physical therapist will show you how to slide in and out of the car safely.
Some form of sexual relations can be safely resumed 4 to 6 weeks after surgery. Some positions can lead to a hip dislocation (see below).
Sleep on your back with your legs slightly apart or on your side with an abduction pillow, a regular pillow between your knees, or a knee immobilizer at night. Be sure to use the pillow for at least 6 weeks. Sleeping on your stomach should be all right.
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.
Stair climbing should be limited until healing is far enough along. If you must go up stairs:
- The unaffected leg should step up first.
- Then bring the affected leg up to the same step.
- Then bring your crutches or canes up.
To go down stairs, reverse the process as below:
- Put your crutches or canes on the lower step.
- Next, bring the affected leg down to that step.
- Finally step down with the unaffected leg.
[yellowbox]Return to Work[/yellowbox]
Desk work can usually be resumed in a week or two. Travel should be limited in the first 6 weeks and you may have to take an injection blook thinner before each flight. Depending on the type of activities you perform, it may be as long as 3 to 6 months before you can return to work.
Walk as much as you after the first 8 weeks, but remember that walking is not a substitute for your prescribed exercises. Walking with a pair of trekking poles is helpful and adds as much as 40% to the exercise you get when you walk.
Swimming (after the wounds have completely healed) is also recommended; approximately 6 to 8 weeks after surgery. Using a pair of training fins may make swimming a more enjoyable and effective exercise. Do not do the breast-stroke kick.
Most patients can get back to activities they could not do before because of their hip include dancing, golfing (with spikeless shoes and a cart), and bicycling (on level surfaces).
To get the most years and fewest complications from your new joint avoid activities that involve impact stress (such as contact sports like football and baseball. Professional athletes have returned to baseball, triathlon, and cycling but these activities may decrease the number of years your joint will last and can lead to fracture around the implant or dislocation. Use your best judgement.
Lifting weights is not a problem, but carrying heavy, awkward objects that cause you to stagger is not advised. Plan ahead to have a cart, dolly, or hand-truck available.
Do’s and Don’ts
These precautions will help 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 at the knees.
- 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 when you bend down.
- Don’t reach down to pull up blankets when lying in bed.
- Don’t bend at the waist beyond 90°.
- Don’t stand pigeon-toed.
- Don’t kneel on the knee on the unoperated leg (the good side).
- Do keep the leg facing forward.
- Do keep the affected leg in front as you sit or stand.
- Do use a high kitchen or barstool in the kitchen.
- Do kneel on the knee on the operated leg (the bad side).
- 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 towel. Don’t exceed 30 minutes at a time.
- Do apply heat before exercising to assist with range of motion. Use a heating pad or hot, damp towel for 15 to 20 minutes.
- Cut back on your exercises if your muscles begin to ache, but don’t stop doing them!
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