A total hip replacement is a procedure where the damaged parts of the hip joint are removed and replaced with prosthetic components made of metal, ceramic, or plastic. This surgery is designed to alleviate chronic joint pain and restore mobility, most often due to severe arthritis. The patient’s diligent adherence to post-operative instructions is necessary to ensure the new joint heals correctly, functions optimally, and provides long-term relief and stability.
Immediate Post-Operative Care and Pain Management
The initial phase of recovery focuses on managing acute discomfort and ensuring the stability of the surgical site. Pain management involves a scheduled regimen of medications to keep discomfort manageable and facilitate early physical therapy. Patients must differentiate between typical surgical site pain and intense, sudden pain, which requires immediate medical attention.
Care for the surgical incision requires close monitoring for complications. The dressing must be kept clean and dry, and patients must avoid soaking the wound in baths, pools, or hot tubs until the incision is completely sealed, often taking at least six weeks. While redness, bruising, and mild swelling are common, increasing drainage, a fever, or pus-like fluid should be reported immediately.
Early mobility is encouraged almost immediately, often starting on the day of surgery. Moving with a walker or crutches helps prevent complications like blood clots and pneumonia. Physical therapists guide patients on the correct use of assistive devices and safe techniques for movements like transferring to a chair. Swelling is managed by elevating the ankle above heart level when resting and applying ice packs to the hip several times a day.
Essential Movement Restrictions and Hip Precautions
Protecting the new hip from dislocation is the most important objective in the early weeks following surgery. Specific movement restrictions, or hip precautions, depend on the surgical approach used. For the traditional posterior approach, which involves a higher risk of dislocation, three main movements must be strictly avoided for about six weeks.
First, the hip should not be bent more than 90 degrees; the thigh should not be brought closer to the chest than a right angle. This restriction applies to leaning forward, sitting in low chairs, or reaching down to tie shoes. Second, the operated leg must not cross the midline of the body or the other leg, meaning patients must avoid crossing ankles or knees. A pillow placed between the legs while sleeping helps maintain separation.
Finally, the operated leg should not be twisted inward (internal rotation), which stresses the joint capsule. Patients must keep their toes pointed forward, especially when turning, by taking small steps rather than pivoting. To comply, adaptive equipment is necessary, including elevated toilet seats, firm chairs, and long-handled tools like reachers and shoe horns. These tools allow patients to perform daily tasks without violating movement boundaries.
The Physical Therapy and Rehabilitation Roadmap
Physical therapy focuses on regaining strength, mobility, and functional independence. Therapy often begins in the hospital, transitions to home-health for the first few weeks, and then moves to an outpatient clinic. Initial exercises are gentle, focusing on muscle activation and circulation, such as ankle pumps, quad sets, and gluteal squeezes. These movements engage muscles without straining the healing joint and help reduce the risk of deep vein thrombosis.
In the acute recovery phase, the physical therapist assists the patient in achieving early functional milestones, including safe walking with an assistive device and mastering transfers. As strength improves, the focus shifts to challenging exercises, such as straight leg raises and standing hip abduction. Exercise progression is carefully managed to ensure soft tissues heal before being subjected to greater load.
Outpatient therapy typically continues for two to three months, focusing on building endurance, improving balance, and restoring a normal walking pattern. A significant milestone is safely climbing stairs, accomplished by leading with the unoperated leg when going up and the operated leg when going down. Consistency is important, as the home exercise program must be performed daily to reinforce gains. Full functional return, such as walking without an aid, is often achieved between six to twelve weeks.
Long-Term Activity Guidelines and Follow-Up Care
After formal rehabilitation, the focus shifts to maintaining joint health and resuming an active life. Driving is safe after about six weeks, provided the patient is off narcotic pain medication and can react quickly. Returning to work depends on physical demands; sedentary roles are possible within three to four weeks, while strenuous jobs may require two to three months or more.
Long-term activity guidelines favor low-impact exercises that minimize stress on the prosthetic joint surfaces. Encouraged activities include swimming, walking, cycling, and doubles tennis. High-impact activities, such as running, jumping, and contact sports, are discouraged because they accelerate implant wear. Long-term maintenance requires regular check-ups with the orthopedic surgeon, starting around six to twelve weeks post-surgery, followed by periodic visits.
A final long-term consideration is the need for prophylactic antibiotics before certain medical or dental procedures, such as extractions or deep cleanings. This practice prevents bacteria from entering the bloodstream and traveling to the new joint, which could cause a deep infection. Patients should also be aware of signs requiring immediate medical attention, such as persistent, unexplained fevers, sudden severe pain, or new significant swelling in the leg.