In this section we will discuss a few things you need to know in regard to surgery and recovery. We will cover some common hospital protocols as well as precautions your doctor and staff will be taking to avoid complications which can result from surgery.
Surgery and recovery
After surgery, you will be taken to the recovery room for a period of observation. The staff will monitor your blood pressure, heart rate, respiration and body temperature. Special attention will be given to your circulation and sensation in your feet and legs. When you awaken and your condition is stabilized you will be transferred to your room.
While protocols differ from hospital to hospital, here is a list of things you may see when you wake up:
- A large dressing applied to the surgical area
- A drain tube leading into the surgical area
- An IV will continue to be used to provide adequate fluids and administer antibiotics and other medication
- A catheter may have been inserted into your bladder as the side effects of medication often make it difficult to urinate
- A V-shaped wedge pillow may be inserted between your legs to keep your new hip in the best position
- A patient-controlled analgesia (PCA) device connected to your IV for pain relief
Post-operative care and precautions
As with any major surgical procedure, hip complications can occur following hip replacement surgery. The following is a list of some of the complications with a brief description of each.
Deep vein thrombosis
Deep vein thrombosis occurs when blood clots are formed in the larger veins of the legs. In some cases, these clots may dislodge from the veins, travel through the circulatory system and become stuck in critical arteries of the lungs. The following precautionary steps may be taken by you and your physician to prevent deep vein thrombosis:
- Blood thinning medication, such as aspirin or anticoagulants
- Support stockings (TED hose)
- Foot elevation to prevent swelling
- Pneumatic devices placed on the feet to improve circulation
Infection
In a small percentage of patients undergoing hip replacement surgery infection can occur. Your physician will be able to minimize the risk of infection by closely monitoring the incision and looking for any signs of redness, swelling or other indications. Always remember to wash your hands after any contact to the incision site, especially when the sutures are still in place.
Pneumonia
A possible side effect of surgery is the development of pneumonia. The following steps may help minimize this risk.
Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to “Smell a Rose and Blow Out the Candles.” In other words, inhale slowly and deeply through your nose and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises eight to 10 times every hour.
Coughing: This activity helps to loosen the secretions in your lungs and excrete them from your pulmonary system.
Incentive spirometer: This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique.
Rehabilitation after hip replacement surgery
Your own diligence regarding physical rehabilitation is one of the most critical factors in achieving successful hip replacement surgery. You must actively participate in the rehabilitation process, working on your own as well as with your physical therapist to achieve optimal results.
The physical therapists will begin working with you as early as a day or two after surgery. They will teach you simple exercises that can be performed in bed to strengthen the muscles in the hip and lower extremity. These exercises may include:
- Gluteal sets: Tighten and relax the buttock muscles
- Quadricep sets: Tighten and relax the thigh muscles
- Ankle pumps: Flex and extend the ankles
Your physical therapist will also teach you the following proper techniques. Although these activities may seem simple, you must learn to do them safely so that the hip does not dislocate or suffer other injury.
- Moving up and down in bed
- Going from lying to sitting and vice versa
- Going from sitting to standing and vice versa
Another important goal for early physical therapy is for you to learn to walk safely with your walker, crutches or other assistive device. Your orthopaedic surgeon will determine how much weight you can bear on your new hip and the therapist will teach you the proper techniques for walking on level surfaces and stairs with your assistive device. Improper use of the assistive device increases the chance for injury or an accident.
An occupational therapist will teach you how to safely perform activities needed in daily life and will also provide you with a list of hip precautions that are designed to protect your new hip during the first eight to 12 weeks following hip surgery. The occupational therapist will also instruct you in the proper use of various long-handled devices that will assist you in your daily life activities. These devices may include the following:
- A reacher to dress and pick things up off the floor
- A sock-aid to assist in putting on socks
- A long-handled sponge to wash your legs and feet
- A leg-lifting device to move the operated leg in and out of the car or bed
- An elevated toilet seat for using the bathroom
- An elevated bathtub chair to fit in the shower or tub
Hospital discharge and home instructions
Before leaving the hospital, your doctor and staff will help you adjust to recovery in everyway possible. They will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
Progress varies from patient to patient, so discharge instructions may also vary. You will receive specific precautions from your orthopedic surgeon, nurse and physical therapist.
- You will be using a walker or crutches to assist with walking. Ask your surgeon how much weight you can put on your operated leg.
- Wear your TED hose.
- Your surgeon will talk to you about when you can drive; generally it is four to six weeks after surgery.
- Continue the exercise program you learned while in the hospital. Walking is the most important exercise you can participate in.
Life after hip replacement surgery
You should have a near-normal range of motion and adequate strength in your hip to perform most daily activities after completing the post-operative hip rehabilitation process. After hip replacement surgery, patients have effectively returned to walking, driving, swimming, golf, doubles tennis, stationary cycling and gardening.
However, care should always be taken. You should generally avoid high-impact activities such as running, vigorous walking and downhill skiing. Remember to listen to what your body tells you. If you begin to have pain or swelling, contact your physician for advice.
