Dr Philip Allen Orthopaedic Gold Coast

Activities in the hospital

A hip joint replacement is major surgery and, for the first few days, you’ll probably feel fairly drained. It will take you a little while to get back to your normal routine after the surgery. Everyone is different and recovery rates vary.

To get the most out of your new joint and to hasten your recovery, it is important that you start some activities immediately to counteract the effects of the anaesthesia, to encourage healing and help prevent blood clots from forming in your leg. The ward staff and physiotherapist will give you specific exercises to begin after the surgery for your breathing and leg muscles.

Pain after surgery is quite variable and not entirely predictable and is controlled with medication. Initially, you will probably receive pain control medication through an intravenous (IV) drip or pump. If a spinal injection is used to control your pain, this may be continued for the first couple of days. This may cause a “numb” feeling in the legs and some weakness of the muscles. You don’t have to worry about becoming dependent on the medication as, after a day or two, injections or pills will replace the IV.

In addition to pain medication, you may 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. You will be encouraged to do breathing exercises to prevent congestion from developing in your chest and lungs.

Usually the physiotherapist will visit you on the day after your surgery and begin teaching you how to use your new hip 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 will have to wear compression stockings and foot pumps to help keep blood flowing normally and help prevent clots (DVT).

Discharge

Your hospital stay may last from 3 to 6 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 centre. 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 manoeuvre with a walker or crutches. You may wish to 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 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.

Activities at home

Keep the surgical wound 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 or clips (when used) will be removed in about two weeks and the ward staff will discuss the arrangements for their removal.
Notify your GP or Dr Allen if the wound appears red or begins to drain any fluid.
If you feel feverish, take your temperature and notify your doctor or Dr Allen if it exceeds 37.5°C.
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.
If you develop: Calf pain, chest pain or shortness of breath, notify your doctor immediately as these are signs of a possible blood clot or DVT.

Medication.

Take all medications as directed. You will probably be given a blood thinner (aspirin) to prevent 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, 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 from our office 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 plans 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. You may wish to take iron and vitamin C supplements which can be bought from the supermarket to help your recovery. Continue to drink plenty of fluids. 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:

Weight bearing: Be sure to discuss weight bearing restrictions with Dr Allen or the physiotherapist. 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.
Driving: You can begin driving an automatic car in 6 to 8 weeks, provided you are no longer taking narcotic pain medication. If you have a manual car and your left hip was replaced, do not begin driving until 12 weeks. The physiotherapist 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, but please remember about safe leg positioning.
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 Dr Allen 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.

hen 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 3 to 6 months before you can return to work.
Other activities: Walk as much as you like once Dr Allen gives you the go-ahead, but remember that walking is no substitute for your prescribed exercises. Swimming is also recommended; you can begin 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, jumping, badminton, or jogging. Do not do any heavy lifting (more than 10kg) or weight lifting.

Do’s and Don’ts

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!

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Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977 F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au