Total hip replacement (THR) is a common procedure that resurfaces the damaged hip joint, often due to arthritis. The first week following surgery is a foundational period that dictates the pace of early recovery. Modern surgical techniques, such as the anterior approach, minimize muscle disruption, often leading to a faster initial recovery and a shorter hospital stay. Understanding the immediate aftermath and the milestones of this initial week can help manage expectations.
The Immediate Aftermath and Pain Management
Upon waking from anesthesia, patients are transferred to a recovery area for close monitoring of vital signs. It is common to experience a temporary feeling of grogginess or “surgical fog” as the anesthesia wears off. Nausea is also a frequent complaint, which nurses manage with anti-emetic medications.
Managing pain is a primary focus during the first 48 hours to allow for early mobilization. Many patients benefit from a multimodal pain management approach, which may include a nerve block administered before or during the procedure. This nerve block provides localized numbness that can last for several hours to a couple of days, reducing initial post-operative discomfort.
Some facilities utilize a Patient-Controlled Analgesia (PCA) pump for a short time, allowing the patient to self-administer intravenous pain medication as needed. As surgical pain subsides, the care team transitions the patient to an oral regimen. This typically combines scheduled non-opioid medications and an as-needed opioid for breakthrough pain. Effective pain control permits participation in physical therapy.
Regaining Movement and Independence
Physical therapy (PT) begins quickly, often on the same day as the surgery or the morning after. The initial goal is to promote blood circulation and prevent complications like blood clots. This is achieved through simple exercises such as ankle pumps and gentle leg movements while still in bed. The therapist’s first major task is to guide the patient from lying to sitting at the bedside, and then to standing.
Within the first one to two days, the patient is encouraged to walk short distances using a walker or crutches, bearing weight on the operated leg as directed. This early weight-bearing is safe and stimulates bone healing around the implant. Occupational therapy (OT) simultaneously teaches adaptive techniques for daily activities, which helps maintain required hip precautions.
OT instructs on safe methods for pivoting and transferring, and using adaptive equipment like a long-handled reacher or dressing stick. They also focus on the safe use of a raised toilet seat, which prevents excessive hip flexion that could strain the joint. The ability to independently navigate short distances and perform basic self-care tasks are the primary criteria for hospital discharge, typically achieved between one and four days post-operation.
Managing Incision Care and Monitoring for Safety
The surgical incision is typically covered with a specialized, sometimes waterproof, dressing that must be kept clean and dry. Depending on the surgeon’s preference, the incision may be closed with dissolving sutures, surgical glue, or thin adhesive strips. Staples or non-dissolvable sutures are also used and are usually removed at the first follow-up appointment, about 10 to 14 days after the surgery.
Patients must closely monitor the incision for signs of localized infection. These signs include increasing pain, excessive warmth, spreading redness beyond the edges, or thick, foul-smelling drainage. Bruising down the leg and mild swelling around the hip are normal and expected, often worsening slightly before resolving.
Beyond the incision, recognizing systemic warning signs is a major safety concern during the first week. A sudden, severe pain or swelling in the calf that does not improve with elevation could signal a deep vein thrombosis (DVT), or blood clot. A sudden fever above 101.5°F, especially when accompanied by chills or shortness of breath, requires immediate medical attention. This can indicate a serious infection or a pulmonary embolism.
Transitioning Home and Daily Life Adjustments
Upon discharge, often on day three or four, a profound sense of fatigue is a near-universal experience due to the trauma of surgery, anesthesia, and the body’s healing response. This tiredness is normal and necessitates frequent, planned rest periods throughout the day. Patients should prioritize short, restorative naps and use the early days at home to recover energy.
The change in activity, combined with the use of opioid pain medication, often leads to gastrointestinal issues, most commonly constipation. Taking a prescribed or over-the-counter stool softener is recommended to manage this discomfort and prevent straining. Appetite may also be reduced temporarily, so focusing on small, frequent, and nutritious meals is advised.
Preparing the home environment is crucial for safety and independence during the first week. This includes setting up a temporary recovery station on the main living level to avoid stairs and ensuring necessary items are within easy reach to prevent excessive bending or twisting. Placing grab bars in the shower, securing any loose rugs, and using a firm chair with a high seat are small adjustments that improve safety and comfort.