One way to control the pain following the surgical procedure is with a patient controlled anesthesia pump (PCA pump). This hand controlled pump will allow you to have pain medication delivered when you need it. This device will be used for 2-3 days following the surgical procedure to provide adequate pain relief. When the PCA pump is stopped, oral pain medication will be prescribed. You should expect some pain following any type of surgery, but the pain can be well controlled with appropriate techniques. Please be sure to notify your physician if the pain is not being controlled so that arrangements can be made for alternative treatment.
How Long Are Recovery and Rehabilitation?
On the day after surgery or sometimes on the day of surgery, therapists will teach the patient exercises that will improve recovery. A respiratory therapist may ask the patient to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
A physical therapist may teach the patient exercises, such as contracting and relaxing certain muscles, that can strengthen the hip. Because the new, artificial hip has a more limited range of movement than an undiseased hip, the physical therapist also will teach the patient proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip.
Usually, people do not spend more than 6-7 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 9-12 weeks depending on the type of surgery, the overall health of the patient, and the success of rehabilitation.
What to expect the days following surgery?
- The day following surgery, you will be encouraged to sit up, out of bed, in a chair. Remember, although your hip may be painful, the artificial joint is very stable and strong and can be walked on immediately the day following surgery. A Physical Therapist will come by to help you out of bed and encourage walking.
- The therapist will also instruct you is proper care of your new hip to prevent a dislocation.
- Medications - You will be given a dose of antibiotics immediately prior to the surgical incision and antibiotics every 8 hours for 24 hours following the surgery. This regimen of antibiotics has been found to be the most effective in the prevention of infection following total joint replacement.
Blood thinners - You will need medication to prevent the formation of blood clots in the legs. In general, we want the blood to be thin, but not too thin as excessive bleeding may occur. Aspirin has shown efficacy in prevention of clots. It can be dosed twice a day in 1 tablet for up to 6 weeks following the surgery. In addition you will receive small dose heparin injections while you are an inpatient.
You will also be asked to wear special stockings for up to six weeks after surgery.
You will be on a patient controlled analgesia pump (PCA) which enables you to self inject a predetermined safe dose of painkiller with the click of a button. This machine will come down after 48 hours when you should not be in severe pain and should ask for painkilling tablets. The medication is there for your comfort, so please don't be bashful to ask the nurses for these.
- Blood draws - Nurses will draw your blood the days following surgery. If a blood transfusion is needed, it will be given.
- Fever - It is normal for a patient after a major surgical procedure to run some temperature. In fact, a temperature of 102° or 103° on the first or second day following surgery is not unusual. If this were to occur, it is extremely important that you drink plenty of fluids. A high fever 3-4 days following surgery could be an indication of infection. If this occurs, appropriate measures will be taken.
- Clinic Visits: Your first return visit to the clinic will be approximately 2 weeks from the date of your discharge from the hospital. At this time, the doctor will examine your incision and remove the staples. You will be asked to continue your physical therapy routines and continue your walking activities. The next follow-up visit will be in the 3-4 weeks at which time another physical examination will be performed in addition to x-rays.
- Incision: The incision is to be kept clean and dry till the staples come out If redness or drainage from the wound is noted, please notify your physician immediately.
- Infection: An infection can occur in an artificial joint at any time, even years after the surgical procedure. If any signs of infection occur, notify your doctor. Prior to any dental or urological procedures, consult your dentist or physician as to appropriate medications to help prevent infection.
Will I need anything special at home?
You will need an elevated toilet seat, and crutches or a walker. Optional things include handrails around the toilet, bath areas and stairwells. Any scatter rugs should be removed and torn areas in carpet or tile tacked down to prevent falling. It will be helpful to have someone stay with you for a week or two after you get home. The Occupational therapist will assist you with any special needs.
Will I need more therapy once I am home?
Most patients are independent with their exercise program at discharge and do not require additional therapy, however, if you do require additional therapy this will be arranged prior to your discharge.
How long will I be on crutches?
You will be on 2 crutches for 3 weeks after which you may go on to one crutch held in the hand opposite to the operated hip. At that time you will be permitted to advance to a cane. Once you are comfortable with the cane, have regained your confidence and balance you may discontinue it's use.
What about driving and sex?
You will generally be permitted to resume both of these activities at 6 weeks.
Is there life after a total hip replacement?
Of course, but it will take approximately 3 months before you will feel like your old self. You may continue to get minor aching for up to 3-4 months. When you resume your activities it is recommended that you avoid jarring or stop/start sports such as jogging, singles tennis, soccer and basketball. Activities that are generally well tolerated include bicycling, walking, swimming and golf.
Are there certain things I need to avoid after my total hip?
Yes, there are a number of things you need to be aware of . Following is an outline of the precautions you should follow during the first 6 weeks after surgery.
- Riding in a car is permitted as long as you make frequent stops, once hourly, to get out and walk around.
- Avoid sitting on low chairs or sofas. Instead sit in a high chair or place a firm cushion on your furniture. Use the arm rests on the chair to assist you getting up.
- Avoid crossing your legs. Have a pillow between your legs when turning in bed.
- Avoid low or conventional toilet seats. An elevated toilet seat should be used. When using a public restroom, you should use the handicapped facilities to ensure adequate toilet height.
- Sitting in the bottom of your bathtub is forbidden. You may want to get a shower seat for your tub. Do not shower until you have been given permission by your doctor.
- Do not reach down to put on shoes and socks. You may want to get a long handled shoehorn.
- Avoid stooping, squatting or bending forward excessively for the first 6 weeks. Use a reacher if you need something very low.
- When visiting other physicians and dentists, let them know you have a total hip prosthesis. You will need antibiotics for certain dental and medical procedures, ask your doctor for a letter outlining this, if you don't already have one. This precaution will be in force forever.