Total hip arthroplasty (total hip replacement) is a common surgical procedure used to treat a damaged hip joint. Proper post-operative care is mandatory for optimal recovery and function. Elevating the leg is a frequent instruction given to patients to manage swelling and discomfort. Patients must follow the specific instructions provided by their surgeon and physical therapist, as individual needs and surgical approaches vary.
Why Elevation is Crucial for Recovery
The surgical process causes inflammation and trauma to the surrounding tissues, leading to an accumulation of fluid known as edema in the lower limb. While swelling is the body’s protective response, excessive fluid buildup increases pain and slows healing. Elevation directly counters this fluid pooling by leveraging gravity to assist the body’s circulatory systems.
Elevating the leg improves venous return, reducing pressure within the leg veins and preventing fluid from leaking into soft tissues. It also aids lymphatic drainage, moving excess fluid and waste products out of the area more efficiently. Minimizing swelling reduces tension around the incision site and helps manage pain, making it easier for patients to participate in physical therapy exercises.
Specific Guidelines for Elevation Duration
The duration and frequency of leg elevation depend on the individual’s rate of edema reduction. In the initial acute phase (typically the first one to two weeks), elevation is most frequently required. A common instruction is to elevate the leg for 30 to 45 minutes, three to five times per day. The goal is to interrupt periods of sitting or standing, which allow fluid to pool, with periods of drainage.
As recovery progresses into the transition phase (generally weeks three through six), the frequency of elevation gradually decreases. Patients may only need to elevate the leg two to three times a day, or after periods of increased activity. Scheduled elevation requirements usually taper off significantly after the first six weeks. However, intermittent elevation may still be necessary for several months if significant swelling persists, especially at the end of the day or after long walks.
Technique for Safe and Effective Elevation
For effective elevation, the leg must be raised above the level of the heart. This position optimizes the gravitational assist for fluid return. Achieving this height often requires stacking three or four pillows or using a specialized foam wedge.
It is crucial to support the entire length of the leg, from the calf to the heel. Avoid placing a pillow directly behind the knee, as support only under the knee can lead to excessive knee flexion and restrict circulation. Patients must also maintain hip precautions while positioning themselves for elevation, such as avoiding bending the hip past 90 degrees or crossing the legs.
Signs That Elevation Needs Are Changing
Patients can monitor their progress to determine when they can safely reduce the frequency of elevation. A primary sign of successful recovery is a noticeable reduction in visible swelling, often assessed by comparing the operative leg to the non-operative leg. Decreased pain and improved ease of movement also indicate that the body’s inflammatory response is subsiding.
If the leg no longer feels heavy, tight, or throbbing after a period of activity, it suggests the circulatory and lymphatic systems are managing fluid effectively. Reduced reliance on elevation should be a gradual process, coordinated with guidance from the physical therapist. Conversely, if the leg shows new or worsening swelling, or if the calf develops new pain or redness that does not resolve with elevation, this should be reported to the surgeon immediately as it could indicate a complication.