Hip replacement surgery (total hip arthroplasty) is a successful procedure that relieves pain and restores mobility by replacing the damaged joint with an artificial implant. The long-term success of the new joint depends significantly on strict adherence to post-operative instructions during the initial recovery period. Following these guidelines helps protect the new joint while the surrounding muscles and soft tissues heal, providing a roadmap for a safe and optimal recovery.
Managing Incision Site and Pain
Proper care of the surgical site is necessary to prevent infection and promote healing of the skin barrier. The incision must be kept clean and dry, which usually means avoiding baths, hot tubs, or swimming until the surgeon confirms the wound is completely sealed, often around six weeks post-operation. Patients are typically cleared to shower within 48 to 72 hours, depending on the type of waterproof dressing applied. After showering, gently pat the incision area dry with a clean towel, and avoid applying any lotions, creams, or powders directly to the wound unless specifically instructed by a medical professional.
Managing pain effectively allows for participation in physical therapy and encourages necessary movement. Prescribed pain medication should be taken on a schedule, ideally before the pain becomes severe, to maintain a consistent level of comfort. Patients should never abruptly discontinue prescribed narcotic pain medication without consulting their doctor, as a tapering schedule is often necessary.
Applying ice packs to the surgical area for about 15 to 20 minutes at a time can help reduce local inflammation and provide pain relief. Elevating the leg above the level of the heart also assists in reducing swelling by promoting fluid return. When elevating the leg, a pillow should be placed under the calf or ankle, not directly behind the knee, to avoid putting pressure on nerves or blood vessels.
Crucial Movement Restrictions
Adhering to hip precautions is necessary to prevent dislocation of the new joint. Dislocation occurs when the ball of the artificial hip pops out of the socket, a painful event that often requires further medical intervention. The standard precautions, particularly for the posterior surgical approach, involve three distinct restrictions that must be observed for a period of six to twelve weeks.
The first rule is to avoid bending the hip past a 90-degree angle. This deep flexion places stress on the joint, increasing the risk of dislocation. Patients must avoid bending over to pick up objects from the floor, leaning forward excessively while sitting, and sitting on low chairs or low toilet seats.
The second precaution is the avoidance of internal rotation of the operated leg. The knee and toes must never twist or turn inward. When walking, standing, or lying down, the foot should remain pointed straight ahead or slightly outward. Pivoting on the operated foot is highly discouraged, as this motion can destabilize the joint.
The third major restriction is to never cross the legs or ankles. Crossing the legs forces the hip joint into an unstable position, significantly raising the risk of dislocation. Patients who sleep on their side should always place a firm pillow or an abduction wedge between their knees to keep the legs separated and the hip aligned correctly.
Safe Navigation and Daily Tasks
Applying movement restrictions to everyday life requires specific adjustments and the use of adaptive equipment. When transferring from a seated position to standing, patients should slide their operated leg slightly forward before pushing up with their arms, ensuring the hip does not flex beyond 90 degrees. Similarly, when sitting down, the operated leg should be kept extended slightly in front of the body as the patient slowly lowers themselves into the chair.
Assistive devices like a walker or crutches are initially necessary to maintain stability and control the amount of weight placed on the new joint. These devices should be used until the surgeon or physical therapist clears the patient to progress. To safely navigate stairs, a simple rule is to lead with the non-operated leg when going up, and lead with the operated leg when coming down, a technique often remembered as “up with the good, down with the bad.”
Home modifications greatly enhance safety and independence during recovery. Using an elevated toilet seat ensures the hip angle stays within the safe limit, preventing excessive bending. Firm, high-backed chairs with armrests are better than soft sofas or recliners, as the height allows the hip to remain open and the armrests provide leverage for standing. Long-handled reachers, shoehorns, and sock aids are invaluable tools that eliminate the need to bend over and violate the 90-degree restriction when dressing.
Activities like driving must be postponed until the surgical team gives explicit permission, which typically takes four to six weeks, especially if the right hip was operated on. Patients must not drive while taking narcotic pain medication, as these drugs impair reaction time and judgment. Furthermore, patients should not carry heavy or bulky objects, as this can shift their center of gravity, increase the risk of an accidental fall, and potentially damage the healing hip.
Recognizing Serious Complications
Patients must be vigilant for warning signs that may indicate a serious complication. Infection is a concern, and symptoms include persistent fever above 101.5°F, excessive redness, warmth, or tenderness around the wound, and any drainage that is green, yellow, or foul-smelling. These signs require immediate medical attention.
Deep Vein Thrombosis (DVT), a blood clot in the leg, is a serious risk following joint replacement surgery. The symptoms of DVT include sudden, severe swelling in the calf or thigh that does not subside with elevation, new onset of calf pain or tenderness, and skin that feels warm to the touch. A clot that travels to the lungs, a pulmonary embolism, can cause chest pain and sudden shortness of breath, which is an emergency.
Signs that the new hip joint may have dislocated include a sudden, sharp increase in pain, the inability to bear weight on the operated leg, or the leg appearing noticeably shortened or rotated. If any of these severe symptoms occur, the patient must seek emergency care immediately.