Total Hip Replacement Recovery Guide

Hip Replacement Recovery Tips to maximize healing

Following your total hip replacement, it is important to adhere to the instructions that your physical therapist, surgeon or healthcare provider has given you as part of your discharge information.

Many patients wish to maximize the healing process as much as possible and although there is no universally accepted way to increase the speed of your recovery, there are a number of steps that you can take in order to ensure that your recovery is uneventful and as planned.

It is important to always adhere to the instructions that your surgeon or healthcare provider has given you with regards to the dressings or bandages over your hip replacement incision. Removal of your hip replacement dressings too early can expose the surgical incision to the outside environment before it has fully healed and this puts you at risk of a surgical infection which could potentially progress to a periprosthetic joint injection and this must be avoided at all costs. As such, do not remove any dressings unless you have been instructed to do so and do not remove them before you have been instructed to do so.

Total Hip Replacement on X-ray in frog legged lateral view.

We encourage you to ambulate regularly. If this requires the use of a gait aid then this is perfectly acceptable and should not be avoided. Although there is no limit that your surgeon or healthcare provider will place on the amount that you can ambulate, you will find that your hip and general fatigue will limit you in the early postoperative period and this is normal.

You will also have performed some recovery exercises with your physical therapist after the surgery and it is important to comply with your postoperative rehabilitation instructions as closely as possible. This will include doing some home exercises and performing these on a daily basis will increase the speed of your recovery and decrease the soreness in the hip early on.

Broached proximal modular femoral component

Distal femoral component (modular)

The images above show a modular femoral component used in revision hip replacement. The modular structure allows for intraoperative adjustment of the anteversion and firm fixation in the femoral canal. The fully porous coated surface allows for bone ingrowth and a long stem ensures a stable fixation in the femoral canal.

Pain after Total Hip Replacement

Most patients agree that their postoperative pain is more manageable after a total hip replacement than compared to a total knee replacement. With that being said, you should expect some soreness in your hip for up to 2 to 3 weeks following the surgery and that this should have dissipated almost completely by 6 weeks following the surgery. You will be prescribed a pain medication regimen when you leave the hospital and these pain medications are designed to help control your pain in the postoperative period, but you should aim to wean off these within 2 to 3 weeks of the surgery if not sooner.

Hip Replacement Recovery Timeline

Following your hip replacement surgery, you will be bought to the recovery room and you will recover from the surgery in the immediate postoperative period for an hour or so there. Depending on the type of anesthetic that you have for your hip replacement, you may still be numb from the waist down if you had a spinal anesthetic; however, if you have had a general anesthetic, as you wake up you will notice that you will have no numbness and you may notice that your hip is sore from that point onwards.

You will have a dressing or bandages on or around the hip and it is important not to touch these or try to remove them.

You will then be taken to a ward where you will begin your postoperative pain medication regimen and during your hospital stay, you will have a physical therapist, nurses and other healthcare professionals help you ambulate, usually with a gait aid such as a rollator walker and the frame or cane.

After a short hospital stay (how long will depend on the type of hip replacement that you have had as well as the surgical approach), you will be discharged home when it is appropriate to do so. You will take home similar postoperative pain medications as you have been taking in the hospital as well as some discharge instructions for caring for your surgical dressing as well as exercises to continue doing at home.

You should notice that your pain subsides within 2 to 3 weeks of the surgery if not sooner and as such you should aim to be weaning off the narcotic analgesic pain medications as you can tolerate.

About 6 weeks after the surgery, you should have recovered most of the strength back in your hip and the pain should be significantly diminished. This will continue to diminish up until 3 months and your strength will also increase up until around 6 months after the surgery. This is usually the point of which you are considered to be at your baseline, although this will depend on if you experienced complications after the surgery or not.

Most patients from 6 months almost find that they are fully recovered from the hip replacement and most patients also feel that they are able to have no restrictions in the activities that they cannot do from this point onwards.

Hip Replacement Recovery Timeline in the Elderly

Hip replacement surgeries are a very common surgery in the elderly population and although the steps for the recovery are no different than patients who are younger, it may be the case that the elderly patient takes longer to recover from the hip replacement due to them having a decreased physiological reserve as compared to a younger patient. This is normal and should be stressed to elderly patients who are to undergo hip replacement surgery that they may take longer to recover from this and that this is perfectly normal and does not indicate that the hip replacement has failed.

Life after Hip Replacement

Hip replacement surgery is the most successful surgical procedure across all the subspecialties of surgery and patient’s satisfaction is consistently reported as being 95% or higher. Patients are able to live active and healthy lifestyles with a hip replacement and it is known to improve people’s quality of life significantly.

The only limitations that your surgeon may advise you of living with a hip replacement will be related to the range of motion that you can be expected to experience after the surgery. Although most people they do not notice any limitations in their range of motion in activities of daily living, certain activities that rely on extremes of range of motion in the hip should be avoided. This includes some of the more complex and advanced yoga poses or gymnastic activity that would place the hip at extremes of range of motion. These activities should be discouraged as they can lead to complications including hip dislocation.

However, that certainly does not mean that patients are not able to do these activities, moreover that they should be counseled that, when performing these activities, they should maintain a slightly decreased range of motion of the hip than they would have otherwise done without a hip replacement. For example, yoga poses that do not put the hip in adduction or external rotation are perfectly acceptable for patients who have received a hip replacement through a lateral approach, and ones that do not put the hip in abduction or internal rotation are perfectly acceptable for patients who have received a hip replacement through a posterior approach.

How much walking should I do after Hip Replacement?

Your surgeon or healthcare provider will not place any limitation on the amount of walking that you can do following a hip replacement. We would certainly encourage ambulation, as this is one of the best activities that you can do to help you recover from the hip replacement surgery. It is important to remember that if ambulation necessitates the use of the gait aid, this is entirely acceptable and should not be seen as a sign of slow progress or failure. Using a cane even up to the 6-week point is perfectly reasonable and although we would want you to eventually to progress to ambulating without the gait aid in the early postoperative phase, these are commonly used and can help facilitate good outcomes.

Hip Replacement Recovery Exercises

Although ambulating uses all of the muscles that we aim to strengthen after a hip replacement, there are certain exercises that will help your hip muscles recover strength quicker.

Straight leg raises with the leg out straight will help strengthen hip flexors and is a low impact exercise that can be done anywhere without any special equipment. This involves the patient lying on their back and raising the leg straight up in the air and holding it against gravity for a count of 8 seconds before allowing it to gently come back down to the flat surface. Repeating this 8 times twice a day will help strengthen the hip flexors.

Active abduction, particularly in patients who may have had a lateral approach hip replacement, will help strengthen the abductor muscles. This involves standing with the contralateral side against the wall and moving the leg to the side and holding it against gravity for kind of 8 seconds and allowing it to come back down to neutral carefully. As with the straight leg raises performing this for a count of 8 seconds 8 times in a row twice or even three times a day will help strengthen the abductors. This exercise can also be performed lying in a lateral position with the nonoperative side being laid on and the operative side being pointed towards the ceiling. Raising the leg to the side against gravity as with the standing portion of the exercise will also help strengthen the abductors.

Hip Replacement Exercises to avoid

Any exercises that place the hip in positions that are considered unsafe should be avoided. These positions include pushing the hip to the extremes of its range of motion. Depending on your surgical approach, your surgeon may also had given you hip precautions to follow which include not crossing your legs, not externally rotating your leg beyond 90 degrees and not extending your hip beyond the neutral position. These restrictions are usually discontinued after 6 weeks or even earlier for a subset of patients that have received the hip replacement surgery through a lateral approach.

What not to do after a Hip Replacement?

Aside from the aforementioned exercises performing activities that are exceptionally jarring or put a high amount of strain across the hip should be avoided. These include jumping either from a height or from a standing position. Sporting activity should also be avoided in the immediate postoperative period, particularly sports that put a great deal of stress across the hip including tennis, soccer and weight lifting.

What type of pain medication will I take after my Total Hip Replacement?

You will usually be started on a narcotic analgesic to control your pain after your hip replacement surgery. Each patients’ postoperative analgesic regimen is tailored to their specific needs and so different drugs are used for different patients. It is also important to mention if you have taken any of these drugs in the past and reacted badly to them. This will help your surgeon decide the most appropriate pain medication for you. First line pain medications include hydromorphone and oxycodone and these can be used in conjunction with Tylenol. These should be weaned off after 2 to 3 weeks following the surgery if not sooner. By the 6-week period ideally, the patient would only require Tylenol occasionally to control that pain or a lower potency analgesics such as codeine or tramadol.

How long will I be on pain medication after my Hip Replacement surgery?

Each patients’ experience of pain after the hip replacement surgery is different and therefore, every patient should expect to be on pain medication for a different amount of time. With that being said, we usually aim to have you weaned off your narcotic analgesic by 2 to 3 weeks after the surgery if not sooner. Usually by 6 weeks, patients will have well controlled pain and are seldom requiring lower potency analgesics or Tylenol and by 3 months, the patient is not usually requiring any pain medications at all.

Conclusion

Hip replacement surgery is known to be the most effective surgical procedure across all the surgical specialties. The patient consistently reports positive outcomes and over 95% of patients are satisfied with the surgery and would, and frequently do, undergo the surgery again should they develop arthritis in the contralateral hip. If you feel that you may be a candidate for hip replacement and are experiencing hip pain, speak to one of our surgeons who will assess you and advise if you are a candidate for hip replacement.

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