Total Hip Replacement 2023. Your Journey Begins With The Right Start.
The first 2 weeks are key!
As in any journey, the road to recovery following hip replacement is simple if you have a map and a good plan. Keep in mind, the first two weeks after surgery may be the most important period as you launch your recovery. Accordingly, your physical therapist will be your coach and your tour guide rolled into one. Their primary role is to guide you to perform the right activities, and to coach you when you may need to slow it down. Use this guide to help you get started in the right direction.
Physical therapy exercises and joint protection
The goal of your physical therapy during the first two weeks after your hip replacement is to promote normal muscular activity of the muscles around the hip joint while simultaneously protecting the hip from excessive forces. Most surgeons agree that this is best accomplished by simply “walking”. It will also help to prevent blood clots forming in your lower legs therefore most surgeons recommend taking a short walk around your home as much as every hour during the daylight hours.
Joint protection techniques after hip surgery are commonly known as “total hip precautions” and vary depending upon the surgical approach and other factors related to surgeon preferences. These precautions may last between 2 weeks and 3 months after surgery. Adherence to your hip precautions is critical because it allows the tissues around your hip heal without excessive stress, thus helping decrease the risk of hip dislocation after surgery.
Below, is a common and effective home exercise routine to help you reach your goals.
Perform this exercise routine three times a day.
Warm-up: Begin with a four to five minute walk around your home. A rolling walker or crutches are highly recommended. Walk softly. Dedicate this time trying to normalize your gait as your pain decreases.
Simple exercise routine: Perform each of these exercises 10 times each: Standing heel raise: Standing knee flexion, Sitting knee extension , Ankle pumps, Ankle circles, Quadriceps sets, and Gluteal sets.
Cool down: Apply a cold pack or cryotherapy unit for 15 minutes.
This routine is designed to be simple and gentle. It should only take about 25 minutes in total. To ensure best results, initial performance should be under the guidance of your home physical therapist. This routine may be adjusted by the therapist to better meet you changing needs.
Stay ahead of the pain
The most common advice given by the surgical team is to “stay ahead of the pain”. Staying ahead of the pain following hip replacement simply means this: take your oral pain medicines on a regular basis so that it does not get out of control. Early on, you will have to be regular with your pain medicine, taking it as prescribed on the label. When your pain level is consistently low, you can begin to extend the times between doses to start your weaning process. Most patients are off major pain medicine between two to four weeks after surgery.
A quick note about pain medicine. Many medical professionals including doctors, nurses, and therapists have instructed patients to take their pain medicine one hour prior to physical therapy. The author of this article does not endorse that suggestion. Consider this approach: pain medicine should be taken to maintain a level of comfort / tolerance regardless of the activities or therapeutic exercises being performed with the therapist or by the patient alone. Exercises should be performed gently with or without the therapist present. Therefore, if pain medicine is taken regularly and appropriately, there is no need to take timely pain medicine prior to the physical therapist’s session.
Diet, hydration and nutrition
The healthy diet that you started prior to surgery should continue following surgery. If you have not done this or have questions about your diet, seek the counsel of a registered dietitian or nutritionist. A healthy diet will strengthen your immune system and help you heal. Your diet should include green leafy vegetables, bright-colored fruits and berries, and easily digested protein from fish and eggs, and plenty of water.
Whether or not you have diabetes, it is important to maintain proper blood glucose levels. Diabetic patients will have the assistance of their glucose monitors. Non-diabetic patients should continue their normal healthy diet while avoiding foods with a high glycemic effect. Simply stated, avoid anything with excessive sugar. It is very common for patients to look for satisfaction through eating their favorite comfort foods. Don’t do it. Avoid the temptation to binge on the bad! Both your immune system and your healing process/system will perform optimally when you maintain a healthy diet without excessive sugar.
Stay properly hydrated to prevent constipation and help improve the effectiveness of your pain medicine. Keep a bottle of water next to you and continue to hydrate throughout the day. Hydrating frequently will make you urinate frequently. This is good. It will help flush your system of the anesthesia, and also help maintain proper blood pressure. With your doctor’s permission, resume any vitamins and supplements you were taking prior to surgery. These were likely stopped approximately two weeks before your surgery but can now be resumed.
Positioning and Swelling
Swelling, know as edema, will develop in your lower leg and foot within a few days after surgery. To address this normal response, you will need to elevate your lower extremity. The sitting position with your feet rested on the ottoman does not count. The operative leg should be elevated in bed so the foot and lower leg is positioned above the level of the heart. This is recommended twice per day for the first two weeks.
Getting good sleep
Proper sleep after surgery is critically important. Many patients are challenged with both their sleep duration and frequency. You are allowed to sleep in any position of comfort that does not put pressure on the incision. These positions tend to be variations of side-sleeping. Best tolerated is sleeping on the opposite side of the surgery with pillows between your thighs and lower legs. Pillows keep your legs from crossing preventing excessive pressure on the repairing surgical tissues. When allowed, you are may sleep on the operated side as well with a similar setup. Avoid long and frequent naps during the day as these will play a role in sleep disturbance at night.
There are two additional tips that correspond to the surgical approach used by the surgeon:
Patients with anterior hip replacement surgery should avoid sleeping on your stomach for 4-6 weeks as this position may put pressure on the incision.
Patients with posterior-lateral replacement surgery should avoid sleeping on the operative side for about 2-3 weeks as that may put pressure on the incision.
Final Words
As you journey through the first two weeks following your hip replacement, you may feel that your progress is slow. Keep in mind that during this time, aided by proper diet and exercise activities, you are both healing and recovering from surgery. Joint protection and general mobility are the most important outcomes during this phase.
Here is a summary of what is happening during this time:
Your pain and swelling are decreasing.
You are transitioning from using a walker/crutches to using a straight cane.
Your limp is beginning to improve.
You have begun to wean off the stronger pain meds (opiate/narcotic meds).
If you have staples or sutures, those will be removed approximately 2 weeks after surgery. Your physician / surgeon will recommend outpatient physical therapy to help guide you toward success. This usually begins between two to four weeks after surgery. Start slow with your outpatient physical therapy being cautious not to overdo it. Tissue remodeling and strengthening will continue for at least six months after surgery.
After a smooth and easy recovery during these first 2 weeks, your outpatient physical therapy can begin between 2-4 weeks after surgery.
Enjoy the rest of the journey!
