Hip replacement, total: advice and exercises following

Some useful post-operative advice

You have now undergone an operation to remove the worn sections of your hip joint, replacing them with new metal and plastic parts. The advice that is provided for you within this booklet will help you to make a speedy recovery, along with directions provided to you directly by your physiotherapy team and surgeon.

'From Me to You' – A patient testimonial

Dear resident in Ward D8,
You have a beautiful view out to the Gog-Magog Hills. Be nice to your physiotherapists. They are not being cruel to you, although it will definitely feel like it. My physios have excellent patter that take your mind off the exercise pain, which is necessary. The worst day is the second day after your operation and the second night is awful too. The second night you will be awake at dawn. Open the window curtain before dawn (if your roommates are ok with it) and, in the hour before dawn, you will see the planet Venus shining brightly in the predawn sky (planes move and Venus stays still). The Moon will appear, looking beautiful, and then the Sun. Day 3 starts out bad, but improves suddenly and rapidly. By the end of your brief stay, you will feel much better about your operation. Hospitals are positive places – they exist to make you better. There aren't many institutions with so noble an aim.
I hope you get better soon, well, I know you will here.
Best wishes,
Alex

Precautions

Due to the type of operation that you have had, it is important to remember there are certain things that you can and cannot do. Below is a reminder of the dos and don’ts to help to protect and prolong the life of your new hip.

• Don’t cross your legs, knees or ankles.
• Don’t sit on armless chairs; you will need chair arms to help you push into a standing position. When sitting, your knee should be slightly lower than your hip.
• Don’t twist on the operated leg.
• Don’t jump, even low distances.
• Don’t lift heavy objects.

• Do the exercises you have been, and will be taught.
• Do increase your walking distance gently.
• Do make sure you have somewhere to rest if you get tired when walking.
• Do watch your weight.
• Do lie flat for half an hour twice a day to stretch the hip and restore good posture.

Sleeping

Try to lie flat in bed. However, you may lie on your operated side three weeks after the operation (when the wound is fully healed), with two pillows between your knees.

Sitting

Avoid sitting on low chairs or beds. Remember to keep the angle between your body and your operated leg at more than 90°. There are specially designed blocks available to raise beds and chairs. Do not put your operated leg up on a footstool.

Walking

As you become steadier on your feet you can slowly increase the distance you walk. As you progress, you may try general household activities; however, try to avoid prolonged standing. If you wish to resume a particular hobby, please discuss this with your surgeon or physiotherapist.

Post operation

The following information will help you during the first three months following your total hip replacement.

You may experience some initial pain and discomfort from your new hip. This should settle within a few days with the help of pain relieving medication. The stiffness and soreness may last a few months until the muscles and structures around the hip have fully healed and strengthened.

You will be seen by a physiotherapist within 24 hours of your operation, who will encourage you to start exercising your new hip. You will be assisted out of bed, encouraged to walk with aids and helped to sit out in a chair by your bed.

It is important to practise your exercises regularly. The physiotherapist will encourage and help you to become fully independent around the ward and teach you to negotiate stairs.

You will also be seen by an occupational therapist who will advise you on any aids you may require to help you with independence in the home. Expect to stay in hospital for two to seven days.

Healing

It usually takes:

• two weeks for the skin to heal
• six weeks for the ligaments and capsule to heal
• a further six weeks for them to strengthen
• up to six months for the bone to fully heal and strengthen.

Your progress

Everybody recovers at differing speeds, depending upon your age, general health and the nature of your surgery. It is important to understand that your recovery in hospital requires your help as much as that of the hospital staff. Early exercise and mobility are key to a successful and hopefully short hospital stay. Practise your exercises four times a day.

Breathing exercises

Breathing exercises will help you recover from the anaesthetic and make you more alert. If you have chest problems such as asthma or bronchitis, it is even more important for you to do these exercises to reduce the risk of a chest infection.

1. Relax your shoulders and upper chest.
2. Take a deep breath in through your nose.
3. Hold the breath for four seconds, then breathe out through your mouth.
4. Following the fourth breath, cough deeply from the belly (do not just clear your throat).

Try to do this every hour during your stay in hospital.

Circulation and strength exercises

Detailed below are exercises that you can practise with the guidance of your physiotherapist. It is important to keep your circulation moving. Vigorous, rhythmic pumping of the muscles in the lower leg will help you to do this. See in particular the first two exercises below.

• Start by completing five repetitions of each exercise and, as you get stronger, increase the repetitions until you can manage 20 of each.
• Practise all the exercises shown four times a day.
• Once you are independently mobile with the use of walking aids, aim to stand and walk every hour of the day that you are awake.

Exercises following total hip replacement

Please be aware that this leaflet is to be used as a guide. If you find these exercises painful, please seek advice from your physiotherapist or doctor.

If any of the exercises in this leaflet cause you sharp pain, stop that exercise immediately and ask your physiotherapist for further advice, but please continue with all other exercises.

Use of ice

Ice can be used after your surgery to reduce pain and swelling. Wrap an ice pack (or, if not available, ice cubes in a plastic bag) in a tea towel to avoid direct contact with the skin. Apply to the hip for 20 minutes.

Negotiating stairs

The golden rules for walking up or down stairs are one step at a time and hold the rail.

• Going up: step up with your un-operated leg first.
• Going down: move your crutches first, followed by your operated leg and then the un-operated leg.

How to go up stairs

• Hold the hand rail.
• Place your walking aid or aids in the other hand.
• Step up with the strongest leg first.
• Then bring the weaker leg and the walking aid up to the same step that the stronger leg is standing on.

Keep repeating the above for each step.

How to come down stairs

• Hold the hand rail.
• Step down with the weaker leg and the walking aid.
• Bring the stronger leg down one step to join the weaker leg.

Repeat the above until the bottom of the stairs is reached.

Driving

You may travel as a passenger in a car the day after your operation.

You should not drive for at least six weeks, or at your surgeon’s discretion. If you are a passenger, break up long journeys hourly. When you are fit enough to drive again, don’t forget to tell your insurance company you have an artificial hip. It is important that you do not drive until you feel fully in control of the car in an emergency situation.

• Slide the seat back on its runners to give maximum leg room
• sit onto the side of the seat
• slide your bottom back towards the centre of the car
• lift your legs into the foot well one at a time
• re-adjust the seat for comfort.

• Slide the seat back
• turn towards the outside, lift each leg out into the gutter, one at a time
• stand up.

You will be referred to your local physiotherapy service on discharge. They will progress your exercises as and when appropriate.

Pain relief

To help with your treatment, it is important that you have adequate pain relief. If you are suffering high levels of pain following discharge from hospital, please seek advice from your general practitioner (GP).

Anti-embolic stockings

During your stay in hospital you will be wearing anti-embolic stockings. These should be worn all the time for the first four weeks after your operation or until you are back to your normal level of mobility.

They should be removed daily to wash and dry your feet. You may need someone to help you to get your stockings on and off. At the same time, you should check that the skin is in good condition. If the skin is red or sore please contact your practise nurse.

Make sure there are no folds or wrinkles in the stockings when in place.

Contact information

If you have any concerns following discharge from hospital, the inpatient physiotherapy team can be contacted on 01223 216104.