Total hip replacement surgery is a common and effective procedure performed to alleviate chronic pain and restore mobility, often necessitated by severe arthritis or injury. The first week of recovery is the most intense period of healing and adjustment, setting the trajectory for long-term success. This initial seven-day span demands careful attention to medical instructions and physical limitations. This article details what you can expect during the first week following your total hip replacement.
Immediate Post-Operative Period in the Hospital
The initial hours after the procedure are spent in a recovery room where medical staff closely monitor your vital signs, including heart rate, blood pressure, and oxygen saturation. You may have various lines, such as an intravenous line for fluids and medication, and potentially a drain near the surgical site to remove excess fluid or blood, though these are often temporary. The goal of this immediate period is to manage the acute effects of surgery and anesthesia.
Mobilization begins surprisingly quickly, often within hours of the procedure, with the help of medical staff. Early movement is strongly encouraged to promote circulation, reduce stiffness, and prevent the formation of blood clots. A physical therapist will guide you through your first steps, typically using a walker or crutches, for short walks around your room or the hallway.
During your hospital stay, which usually lasts between one and three days, physical and occupational therapists work intensively with you. The physical therapist focuses on strengthening exercises and safe walking techniques. The occupational therapist assists with adapting daily activities like dressing and bathing. Discharge depends on achieving specific milestones, such as safely getting in and out of bed, managing pain with oral medication, and walking a short distance with an assistive device.
Controlling Pain and Medication Management
Pain management in the first week follows a strategic progression, often beginning with regional techniques like nerve blocks or local anesthetic injections administered during the surgery. This initial pain relief is designed to be sustained, allowing for comfortable participation in early physical therapy. As the local anesthetics wear off, the focus shifts to a regimen of oral medication to control the discomfort.
Pain is most intense in the first few days post-surgery, presenting as a deep ache or sharp sensation around the new joint. The pain management plan involves a combination of opioid medication for breakthrough pain and non-opioid options like acetaminophen or NSAIDs, if approved by your surgeon. The strategy is to utilize narcotic medication sparingly, transitioning to non-opioids as soon as the worst pain subsides.
A frequent side effect of opioid pain medication is constipation, which must be proactively managed to avoid straining and discomfort. Your care team will often prescribe a stool softener or laxative to be taken regularly alongside the narcotic medication. Applying ice packs to the surgical site for 15 to 20 minutes at a time can also significantly reduce localized swelling and pain without requiring additional medication.
Maintaining a schedule for pain medication, rather than waiting for the pain to become severe, helps keep discomfort manageable and facilitates better participation in therapy. Communicate openly with your healthcare providers about your pain level and any side effects you experience. Your pain medication regimen will be tapered down over the course of the week as the intensity of the post-surgical pain decreases.
Navigating Mobility and Physical Restrictions
Protecting the new hip joint from dislocation requires strict adherence to specific movement restrictions known as hip precautions. These precautions vary depending on the surgical approach used, but aim to prevent extreme movements that could pull the prosthetic joint out of its socket. Common restrictions involve avoiding bending your hip past 90 degrees, such as when sitting down or leaning over.
You must also avoid crossing your legs or ankles, whether sitting, standing, or lying in bed. Do not internally rotate your hip; keep your toes pointed forward or slightly outward and avoid twisting your body to reach something. These limitations are non-negotiable because the muscles and tissues surrounding the joint need time to heal and strengthen to provide natural stability.
Using an assistive device, such as a walker or crutches, is mandatory for all walking during the first week to ensure partial weight-bearing and stability. A physical therapist will teach you the correct technique for using your device, emphasizing the importance of keeping your weight balanced and your steps controlled. To safely get in and out of bed, you should lead with your operated leg when getting out and lead with your non-operated leg when getting in, keeping the operated leg straight to avoid excessive flexion.
Sitting and standing must be done carefully to maintain the 90-degree restriction, often requiring the use of an elevated toilet seat or firm chair cushions. When sitting down, back up until you feel the chair against the back of your legs, then extend your operated leg forward before slowly lowering yourself. These careful mechanics of movement are central to preventing injury and promoting a stable recovery during this initial phase.
At-Home Care and Recognizing Complications
Once discharged, focus shifts to managing recovery at home, requiring vigilance for warning signs. Incision care is important, generally involving keeping the wound clean and dry, often with a waterproof dressing for showering. You will receive specific instructions on changing dressings, and you must avoid soaking the incision in a bath until it is fully healed.
Preparing your home environment beforehand aids safe mobility by removing tripping hazards like loose rugs and ensuring frequently used items are within easy reach. Sleeping on your back is recommended for the first weeks, often with a pillow placed between your legs. This helps maintain necessary hip precautions and prevents accidental crossing or rotation of the operated hip while resting.
Monitor for signs of potential complications that require immediate medical attention:
- Infection is signaled by increasing redness, warmth, or tenderness around the incision, persistent fever higher than 100.4 degrees Fahrenheit, or unexpected drainage from the wound.
- Symptoms of a deep vein thrombosis (DVT), or blood clot, include severe calf pain, tenderness, or swelling in the leg unrelated to the incision, and should be reported to your surgeon immediately.
- A sudden, severe increase in pain accompanied by an inability to bear weight may indicate a serious complication like a dislocation.