Orthopaedic Specialists of Conneticut

Joint Replacement

Instructions after Total Hip Replacement

Weight Bearing Status

Put as much weight as you can on your operated leg with the help of the walking aid provided by the physical therapist. Initially you start with a walker, with time you will progress on to crutches and then on to a cane. If using a cane, use it on the opposite side as your knee replacement. Use the most appropriate walking aid until 6 weeks. This prevents you from tripping and falling over while your muscles around the knee recover

Anticoagulation

Anticoagulation helps to prevent phlebitis, pulmonary embolism, and blood clots. Please be sure you understand the type of anticoagulation you must take. You started the anticoagulation while in the hospital. The medication sheet which is completed by the MD/PA when you are discharged will list the anticoagulation medicine which you are taking.

If you are on Coumadin, the dose will be ordered either by your Primary Care Physician or your Orthopedic MD. Make sure you understand this prior to discharge.

Once you are home, you have arrangements made for blood draw twice a week to know the level of the blood thinner following which the above doctor would prescribe you further doses of Coumadin.

If you are on Aspirin, you need to take 325 mg of Aspirin twice a day for a total period of 6 weeks. You can buy this over the counter as prescription is not required for Aspirin.

If you are on Lovenox, you need to have an injection as directed by your Orthopaedic MD.

Diet

You need to eat to gain back your strength. You should resume your pre-hospitalization diet unless otherwise instructed.

Dressing and Incision care

You can shower when you get home. The dressing provided is water proof. If the central pad of the dressing appears soaked from underneath then inform us and come and see us in the office immediately. Make sure you do not immerse the incision in a bath tub. If for any reason the water runs into the incision site, remove the dressing and apply a fresh one. The dressing applied in the hospital (if not soaked by leakage from the wound) can be left on until removed by us in the office.

Pain Medicine

You have been given a prescription for pain medication. Please remember the following:

  1. Take only what is prescribed by your doctor.
  2. Take your pain medicine 45 minutes prior to exercise.
  3. Try to take the medicine before it becomes severe.
  4. If the medicine does not reduce your pain, call your surgeon.
  5. If you are taking pain medicine, you MUST avoid alcohol, and illicit or illegal drugs.

Home Recovery Program

Our specially-designed Home Recovery Program, a series of basic instructions and exercises, will help you regain your mobility and, thus, speed your recovery. Tested and refined at the Orthopaedic specialist, the program is straightforward and effective. You do not have to do every exercise at each session. Though you do not have to follow a particular order, doing the lying exercises in sequence is easier and more convenient.

The Home Recovery Program allows you to choose from the four exercises you were taught in the hospital. The number of times you do each exercise depends on your capacity, which will increase as you progress towards recovery. Recovery doesn't happen overnight, so don't be discouraged, and don't try to do too much too soon. The exercises should not cause pain. If they do, eliminate them from your program.

Continue to follow precautions outlined by your physical therapist until told otherwise by your surgeon.

Climbing Stairs

The following are instructions (NOT exercises) for climbing and descending stairs.

If you have one (1) total hip:

UPSTAIRS

  • The non-operated leg goes first.
  • The operated leg goes second.
  • The crutches go last (at the same time as the operated leg).

DOWNSTAIRS

  • The crutches go first.
  • The operated leg goes second.
  • The non-operated leg goes last.

If you have two (2) total hips:

UPSTAIRS

  • The stronger leg goes first.
  • The weaker leg goes second.
  • The crutches go last (at the same time as the weaker leg).

DOWNSTAIRS

  • The crutches go first.
  • The weaker leg goes second.
  • The stronger leg goes last.

Putting on Socks and Stockings

During your recovery, many otherwise ordinary tasks, such as getting dressed, will require special attention. One of the most difficult is putting on socks and stockings; this simple activity normally requires you to bend past a 90-degree angle, which can dislocate your new hip. Men should use knee-high socks, and women, knee-high socks or stockings. For your comfort, your physical therapist can order a sock aid, a device that has two cords which you hold in your hands and pull up to put on a sock or stockings.

To put on a sock or stocking, place sock around rim of sock aid. Slide sock up halfway so that the toe of sock is secure against the sock aid. Stick foot in so that toe is making contact with the toe of the sock. Pull up on the cords of the sock aid to pull on sock. You may put the sock on your non-operated foot in your usual manner. To take off a sock or stocking, use either your reacher or your long handled shoehorn to push sock off foot.

Homemaking Tips

Use an apron with several pockets.
Carry hot liquids in containers with covers.
Slide objects along the countertop, rather than carry them.
Sit on a high stool when doing countertop tasks.
Use a reacher for objects on the floor. DO NOT bend down to pick up objects.
If you are discharged with a walker, a walker bag is available. The bag fits in your walker and can be used to carry items including plates, silverware and food in sealed containers.
Remove scatter rugs from the floor to avoid tripping over them.

Home Recovery Exercise Program

Quad Set
Lying on your back:

  1. Tighten thigh muscles by pressing knees down into the bed.
  2. Hold for a count of 6. Do not hold your breath.
  3. Relax.
  4. Repeat.

Gluteal Set
Lying on your back:

  1. Squeeze buttocks together.
  2. Hold for a count of 6. Do not hold your breath.
  3. Relax
  4. Repeat

Ankle Pumps
Lying on your back:

Keeping legs flat on bed, move both your ankles up and down.

Leg Rotation
Lying on your back:

  1. Roll your operated leg inward so that your kneecap and foot are pointed toward the ceiling. Do not internally rotate your operated leg past this neutral point.
  2. Relax
  3. Repeat

Heel Slides
Lying on your back:

  1. Bend hip and knee of operated side to about 40-45 degrees.
  2. Hold for a count of 6. Do not hold your breath.
  3. Relax
  4. Repeat

Advanced Exercises

These exercises place slightly greater demands on your hip. Progress to them only after you are seen by your surgeon on your first post-op visit.

Straight Leg Raise

To build muscle strength perform this exercise twice each day. Work up to 20 lifts each time.

Lying on your back with your non-operated leg bent and your foot flat on the bed:

  1. Raise your operated leg 12-18 inches.
  2. Hold for 2 counts
  3. Lower leg slowly.
  4. Repeat

Side Leg Raise

To improve your hip's range of motion, perform this exercise twice each day. Work up to 20 lifts each time.

Lying on your non-operated side

  1. Raise your operated leg 12-18 inches
  2. Hold for 2 counts.
  3. Lower leg slowly.
  4. Repeat

Stationary Bicycle

If you have a stationary bicycle, use it at no resistance for 15-20 minutes each day.

Swimming

Swim as much as you like. It is an excellent exercise and will help in your recovery.

You must call your physician if you experience any of the following problems

  1. Drainage from the incision
  2. Increasing redness of the suture line.
  3. Temperature over 101 degrees
  4. Sudden shortness of breath or chest pain or difficulty in breathing.
  5. Increasing tenderness of thigh or calf or increasing pain.
  6. Swelling of the knee, calf, or ankle that does not respond to elevation for one hour. The leg and ankle must be elevated above the level of the heart.

Frequently Asked Questions:

How long should I use the pain medication? This is different for each patient. Some are able to use Tylenol or Advil after you leave the hospital and others require narcotic pain medications for two to three weeks. Generally, you should try to decrease the use of medications as time passes.

When should I go to outpatient therapy? If you are going home or to a rehab centre, in either case you should have PT within a few days following your release from them. If you do not have a prescription for PT, please call your surgeons office and they will provide a prescription and list of places.

When can I go to the dentist? Not for three months after surgery. As the hip is gently healing and there is increased blood flow to this area, there is a higher risk of infection.

You must take prophylactic antibiotics if any of the following things pertain to you for the next two years.

  1. Another operation anywhere on your body
  2. Any dental procedure
  3. Lung, bladder, or colon scope or procedure
  4. If you develop an infection anywhere in your body

Immuno compromised patients with Rheumatoid Arthritis, Lupus, Insulin Dependent Diabetes, chemical or radiation induced immuno-supression need to take prophylactic antibiotics for life.

Total hip replacement patients who require dental work on gums or roots must adhere to the following antibiotic procedure:

For patients not allergic to Penicillin: Cephalexin, Cephradine or Amoxicilin: 2 grams orally 1 hour prior to the dental procedure

For patients allergic to Penicillin: Clindamycin: 600mg orally 1 hour prior to the dental procedure.

Patients should adhere to this regimen for the first two years following joint replacement. Immunocompromised patients, including those with inflammatory arthropathies, rheumatoid arthritis, drug or radiation-induced immunosuppression, insulin-dependent diabetes or any other major medical problem should follow this antibiotic routine indefinitely.

Antibiotics can reduce the risk of infection but cannot completely eliminate that risk. Preventing infection must be the concern of all the healthcare professionals who treat you. MAKE SURE YOU INFORM YOUR PHYSICIAN AND DENTIST THAT YOU HAVE HAD A TOTAL HIP REPLACEMENT.

When can I drive? You should not drive as long as you are taking narcotic pain medications. If it is your left hip, you can resume driving when you feel you actually return back to normal in about three weeks. If it is your right hip I would like to evaluate you at 6 weeks-hence no driving before 6 weeks in cases of surgery to the right hip.

My hip clicks after surgery. Usually clicking after surgery is normal. The clicking is a result of soft tissue moving across the front of the hip or the metal parts coming into contact with one another. This sensation usually diminishes, as your muscles get stronger.

I am experiencing a lot of swelling, is it normal? Fluid can accumulate in the legs due to the effects of gravity. Usually it is not a problem in the hospital, but it gets worse when you go home or rehab because you are doing more. To reduce this you should elevate your legs at night. Lie on the back and place pillows underneath the legs so that they are above the heart.

How long do I have to wear the stockings? You should wear the stockings in both legs. Have someone help you with them in the morning, wear then throughout the day and then take them off at night. If you did not get the stockings from the hospital you can purchase knee height, medium, compression, surgical stockings from any pharmacy shop. Try to wear them for 6 weeks if possible. This helps to reduce leg swelling and prevent blood clot formation in your legs.

When can I return to work? It depends on your occupation. It’s never a mistake to take more time off in the beginning of the recovery. That way you can focus on your hip. I recommend taking at least three weeks following your surgery. Keep in mind that you need to be using crutches.

Can I travel? In general, I would like to see you before you fly. If you are traveling by car you should be sure to take frequent breaks so that you do not feel too stiff in getting up; or in airplane, I would like you to wear compression stocking and take couple of walks during the flight. Having aisle and/or bulk head seat will help you get more space.

Leg Swelling

Following hip replacement, most patients develop swelling in the operated leg. Although the amount of swelling can vary from patient to patient, the swelling itself in the leg, knee, ankle or foot is normal, and will usually resolve gradually over several weeks.

For the first month after your operation, the amount of time spent in a sitting position should be 30 TO 45 MINUTES ONLY, as sitting tends to worsen the swelling. Periods of walking should be alternated with periods of elevating the swollen leg. When elevating the leg, the ankle should be above the level of the heart. You should lie with one pillow under your head and four to five pillows under your foot and leg to elevate your leg above your chest.

Do's and Don’ts after Your Total Hip Replacement

Below is a general list of precautions to follow after your total hip replacement. If additional precautions are necessary, the staff will provide instructions.

Lying Down

Keep the abductor pillow between your knees when you lie on your back.
Keep the bed flat when you exercise or get out of bed.
You may turn on the non-operated side with the help of your nurse.
Avoid crossing your legs.

Sitting

Your surgeon or therapist will tell you when to start sitting in a high chair.

Do:
Keep your knees lower than or equal to your hips.
Use a high toilet or a raised toilet seat on a standard toilet.
Sit on a firm chair (preferably) using two firm pillows.

Don't:
Sit in low, soft chairs such as sofas.
Bend to pick up any objects from the floor.
Bend to clean or dry your feet.

If you leave the hospital by carpenter the car from street level to avoid bending your hip too far; sit in the front seat, making sure the car seat is all the way back and in an upright position. Sit on two pillows.

DO NOT ELEVATE YOUR FEET while sitting in a chair.

It is often helpful to spend an hour in this elevated position in the early afternoon to help diminish the swelling which may have developed during your morning walks.

To prevent or reduce leg and ankle swelling:
Elevate the operated leg
Avoid sitting for more than 30 to 45 minutes at a time
Perform ankle exercises
Use elastic compression socks

Sports Activities

After full recovery, some patients enjoy light sports activities. Activities you can enjoy after total hip replacement include walking, bicycling, bowling, swimming, golf and doubles tennis. Avoid high impact activities, such as:

  • Jogging
  • Running
  • Jumping
  • Skiing

Other positions to avoid following Total Hip Replacement

Sexual Relations

The following questions, answers and illustrations respond to the common concerns of patients and their partners after hip replacement surgery.

Will I be able to resume sexual relations now that my hip has been replaced?

The vast majority of patients are able to resume safe and enjoyable sexual intercourse after hip replacement. Patients whose sexual function had been impaired by preoperative hip pain and stiffness welcome their new pain-free mobility. However, gaining full confidence with your new hip may take several weeks.

When can I resume sexual intercourse?

In general, intercourse can be resumed safely approximately eight weeks after surgery. Though individual recovery time varies greatly, this timeframe allows the incision and the muscles around the hip to heal. If you recuperate rapidly, you will be able to resume sooner, as long as you are free of pain.

What positions are safe during intercourse?

Total hip replacement precautions need to be observed during all activities, including sexual intercourse. In general, follow the do's and don'ts on pages 26-27 and the positions illustrated on page 29. As advised in the discharge instructions, you should avoid excessive hip flexion (knee toward chest), adduction (leg towards center of body), and internal rotation (toes turned inward).

Most patients, male and female, prefer 'passive' intercourse in the 'bottom' position, an option some find less fatiguing. As your hip heals, you may resume a more active role. After a few months, patients can resume sexual activities in any comfortable position.

What should I tell my partner?

As good communication is essential, you may want to share information in this booklet with your partner. In addition, you can discuss the hip precautions that the hospital staff reviewed with you.

Sexual Positions Recommended Following Total Hip Replacement

Pillows placed under your knees can provide extra support and comfort

Sexual Positions to avoid Following Total Hip Replacement

Sanjay Gupta, M.D.

Office Telephone number: 203-775-6205
Office Fax number: 203-775-2373

Ps: Some content and diagrams are taken with Permission from Ranawat Orthopaedics, New York.

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