How long will it take to recover after a hip replacement?
Patients are in hospital two to four nights and are on crutches for three to six weeks. It is normal for the whole leg to swell after a hip replacement, reaching its maximum at seven days. It is also normal for bruising to appear at the back of the knee due to the effects of gravity on the bruise round the hip. Swelling with pain and redness in the calf may indicate a blood clot.
Traditionally patients are advised to take six weeks off work, but clearly this varies between individuals, particularly as working from home in some capacity is possible for many. However, patients may underestimate how much the surgery affects their stamina and there is no doubt that the longer patients take off work, the easier they find it on return. Patients should not do any work at all during the week of surgery and the week after so there are no distractions to recovery. Some gentle work email is reasonable in weeks three and four, with a potential return to the office for the odd half-day from the end of week four onwards, provided the patient is driven to and from work.
Return to full work is usually possible after six weeks but be aware it will initially be tiring being back at work. In addition, physiotherapy will be continuing and setting time aside for exercise is still required. Patients with long or challenging commutes to work should adjust their hours to avoid peak-times to ensure they get a seat. By three months, the hip should function almost normally in day-to-day life and patients should have resumed golf and their usual gym activities, albeit at lower intensity. Hip replacements continue to improve further for up to a year after surgery, and sometimes even longer for very young patients.
What tablets will I need after surgery?
Patients can usually tell the day after surgery that the pain from the arthritic hip has gone and is replaced with a severe stiffness in the buttock from the operation itself. The absence of hip joint pain so soon after surgery gives patients a great psychological boost, as they can already tell that the operation has worked.
Clearly painkillers are required for the surgical pain and initially patients are given slow-release oxycodone (Oxycontin, a synthetic morphine type drug), ibuprofen (Nurofen, the non-steroidal anti-inflammatory drug), and paracetamol. The dose of oxycontin is quickly reduced in hospital and it can even be discontinued prior to discharge in some patients.
Patients are sent home with a reducing dose of oxycontin for seven to ten days, as well as a three-week supply of the blood-thinning capsule, Dabigatran. Patients should also have a supply of the over the counter painkillers Nurofen and paracetamol at home. Both these drugs can be taken together and with oxycontin. After two or three weeks, patients are usually only taking paracetamol tablets occasionally.
When can I drive after my hip replacement?
If patients are confident walking without crutches and able to enter a car unaided then a return to driving is reasonable, provided at least four weeks have elapsed. Advice from the insurance company is recommended if driving before six weeks.
How much physiotherapy will I need after surgery?
Patients are advised to take two walks per day, gradually increasing distance as confidence and strength return. Patients are encouraged to bear full weight on their operated leg. Most patients have discarded their crutches by the six-week follow-up visit. Weekly land-based physiotherapy is essential for successful rehabilitation after surgery. As well as providing appropriate guidance for the hip itself, a visit to the physiotherapist provides an important focus for the week and allows the patient to see real progress at each visit.
Use of an exercise bike is strongly encouraged from two weeks after surgery, initially starting with low resistance for a few minutes. Hydrotherapy can also be helpful in the first six weeks if it is available, but it is not crucial. Modern hip replacements are much less prone to dislocate and there is less reliance on traditional 'dislocation precautions' in the majority of cases.
Patients can sleep on either the operated or non-operated side straight after surgery provided there is a pillow between their knees and flexion beyond 90º is encouraged after two or three weeks to stop the hip getting too stiff and to allow patients to get down to their shoes and socks. Return to swimming varies between individuals and the facilities at the swimming pool. Clearly patients can get back in the pool sooner is there is step rather than ladder access. Crawl kick should be used initially but, as familiarity and fitness return over the first two or three months, breast-stroke kick can be resumed.
Are there any stitches to remove?
No. The stitches are under the skin and dissolvable.
When can I fly after my hip replacement?
The additional risk of blood clots after a hip replacement has almost gone after six weeks. It is for this reason that patients are advised not to fly long haul within this time. Shorter flights to Europe pose little, if any, additional clot risk.
What can go wrong with a hip replacement?
Complications are rare with modern surgical and anaesthetic techniques. Blood clot risk (deep vein thrombosis or DVT) is kept to a minimum with use of a combination of measures. The blood-thinning tablet Dabigatran is given for four weeks after surgery and the patient is advised to wear compression (TED) stockings for six weeks after surgery. In addition, foot pumps are used to enhance blood flow in the legs whilst the patient is in hospital. Infection in a hip replacement occurs in less than 1% of cases, but, whilst the infection can usually be eradicated, it does involve lengthy treatment with antibiotics and surgery.
An unexpected inequality in leg length is also unusual with contemporary implants and templating software. (picture of templated x-ray) This is why it is important that a current x-ray with a calibration marker is available before the operation. Dislocation occurs in approximately 1% of hip replacements and is seldom recurrent. Recurrent dislocation usually indicates malposition of implants. Major nerve injury to either the femoral or sciatic nerves is extremely rare in routine cases; the risk is slightly greater in cases involving deliberate lengthening of the leg or if there has been previous hip surgery. Re-operation on a hip replacement for failure is always a possibility as it would be for any mechanical device, although these risks are greatly reduced with modern un-cemented ceramic on ceramic total hip replacements.