Time in the hospital and rate of progress are very dependent upon your preoperative health and overall physical condition. The nurses and therapists will likely have most patients out of bed and walking to the bathroom and into the hall the day of surgery. All patients will use a walker at first. If you are in good health with no significant heart, lung, kidney, or other substantial medical illness the anticipated plan will be for discharge home the day after surgery. Some patients will spend 2 nights in the hospital but most will not. By the time of discharge the expectation is that you will be getting out of bed with observation or limited assistance and walking functional household distances—100 feet or more. Depending upon their level of pain and degree of mobility patients discharged to home will either attend outpatient therapy or receive physical therapy at home for 1-2 weeks. Those whose physical condition or personal situation does not allow for discharge to home will usually go to a rehabilitation facility until ready to resume independent living.
Rehabilitation begins in the hospital as discussed above. In almost all situations you will be allowed to put all of your weight on your operated leg. This will put less strain on your arms and prepare you to move quickly from your walker to a cane. My general goal will be to have you using a cane by between 3 and 7 days after surgery and some patients will be totally off their cane by this time. While in the hospital you will begin initial strengthening exercises including heel slides, straight leg raising, and abductor strengthening. You should spend 5-10 minutes 4-6 times per day working on these exercises. Regaining strength is important to reestablishing a normal gait pattern. Most of you probably limped for months or years before your surgery so in addition to the strengthening you will need to mentally focus on recreating a smooth and even walking pattern.
In general, recovery from hip replacement probably requires less dedicated attention to the details of regaining motion than knee replacement does since the hip is naturally placed through a wide range to just accomplish simple tasks like getting out of bed or into and out of chairs. Patients are usually anxious about “popping the hip out of socket.” No matter what technique or “surgical approach” is used there will always be some position that puts the hip “at risk.” With my current “minimal incision” posterior approach that position is the combination of hip flexion, adduction, and internal rotation. Those are medical terms that I don’t expect you understand. First you would not naturally put yourself in this position except in one specific scenario. Imagine yourself sitting in a chair. You bend forward and your hip flexes. You now lean towards your operated hip and reach for the ground. This leaning towards the operated side and reaching towards the ground creates this combination of flexion, adduction, and internal rotation. This really is the single post-operative restriction that I give my patients. Many of you have maybe heard of the “anterior approach” not having restrictions. This is hardly true. The position of risk is just different. With this approach, if you stand with weight on your operated leg and turn to the opposite side to look behind you, this position of extension and external rotation creates an “at risk” situation. Simply put, I tell my patients that there is good “hip hygiene” or care of their hip that they should follow especially in the first 3 months after surgery. Most patients do not find it the least bit restrictive to avoid the type of forward bending and turning to the operated side that I described above.
What is important is regaining the ability to reach your foot. Many of you probably had difficulty putting shoes and socks on for a significant period of time prior to your surgery. The “figure of 4” position is a completely safe position for your hip. You can begin to work on restoring this motion with supine “fall outs” (see drawings). As your pain progressively decreases your cane becomes a very helpful tool. Simply sit in a chair, hold the cane with the hand opposite of your operated hip and place the other hand on the knee of your operated side. Hook the cane around the foot on your operated leg. Now spread your legs apart. With your legs apart you can safely use your cane to pull up on your operated leg bringing it towards the “figure of 4” position. The hand on your knee will work to push the leg into a spread apart position and prevent excessive flexion. With work and time you likely will be able to regain this motion.
Depending upon the extent of your progress, and specific activity desires, you may continue therapy beyond several weeks but many will find that they can continue independently at home or at the gym/health club.
Usually there is no wound care necessary. Your incision will typically be closed with sutures beneath the skin and “skin glue.” An “impervious” or “water proof” dressing is then applied. This combination allows you to shower at any point immediately after your surgery. The dressing typically stays in place with no need to be changed until you are seen in my office for your first post-operative visit which usually is 10-12 days after surgery. Some underlying blood or fluid staining on the bandage sometimes occurs and is not a problem. Should the underlying bandage be saturated with fluid or if fluid is leaking from beneath the bandage you should contact my office for instructions.