Going Home

11. Going Home From The Hospital

Prior to release from the hospital you will be seen by the Home Care Coordinator. Prescriptions will be written for pain medicine and a blood thinner to prevent blood clots (usually Coumadin, also called warfarin). You will be issued either a walker or crutches (whichever you use better).  We recommend a bedside commode which you will need to purchase.  The bedside commode is usually placed over your own toilet.  The bedside commode can be used a shower seat.  Additional items that may be useful are a "reacher", "sock-cone" and a long handled shoe horn. These can be ordered from the Home Care Coordinator, but insurance usually doesn’t pay for them.  You can order these through the home care coordinator before discharge. It may be less expensive, however, if you purchase the bedside commode and the additional items (if needed) prior to your hospitalization.

Although you will be independent with most activities of daily living when you leave the hospital, it is important that you not be alone for the first one to two weeks. During this period of time, it is extremely helpful to have someone help prepare meals, clean the house and give you some of the things that you will need. It is not necessary that this person be medically trained. Physical therapy will be arranged and a therapist will visit your house, usually 3 times a week for three weeks. Also, visiting nurses will be arranged to perform wound checks, remove the staples and draw blood for checking the level of activity of the blood thinner (Coumadin).

For the first two to three weeks, you will be somewhat limited in your activities. You are usually allowed to put as much weight as tolerated on the operated leg, but you will find that it will be uncomfortable to put full weight for 1-2 weeks.  So, plan to use a walker or crutches for 1-2 weeks. As soon as you can comfortably bear full weight, switch to a cane in the opposite hand. We recommend using the cane until you can walk without a significant limp.  This usually takes another 1-2 weeks.  You will most likely find during these first weeks that you easily get fatigued. You can go out for short walks and short rides in the car, but you should not plan any major outings or long walks. 

Riding in the car presents some difficulties initially. For the first six weeks after surgery, you should restrict the amount of bending at the hip to not greater than 90 degrees. Also you must be able to enter the vehicle and exit it without crossing or bending your leg in excess of the recommended position. This will be reviewed with you prior to discharge. We suggest, if you have a normal-size vehicle, that you ride in the front seat with the seat all the way back and have a pillow behind you so that you may semi-recline. An alternative, especially in smaller cars is to use the back seat and sit crossways, with pillows, in a semi-reclining position. After six weeks, you are allowed to bend the hip beyond 90 degrees and this usually allows easier exit and entrance to a vehicle.  The decision of when to drive after surgery is yours. You must decide when you can safely drive the vehicle while still following the bending restrictions and not posing a danger to yourself or others. We generally recommend waiting 4-6 weeks before driving.

Normally, your staples will be removed 7 days after surgery. You should not get the incision wet until 24 hours after the staples are removed. You may then take a shower, carefully patting the operative site dry. The first "official" postoperative visit will be at approximately six weeks from your surgery, at which time you will have x-rays taken. Your surgeon, or his physician’s assistant, will inform you at the six week visit what restrictions can be changed.

By three months after surgery, you will usually be strong enough to resume most normal and recreational activities. Normally, 75% of the strength is gained by three months, 90% by six months and 100% by one year after surgery. You will be required to come for postoperative visits and x-rays at six weeks, three months, six months, one year and then every other year. Routine every other year follow-up is important as it allows your doctor to evaluate x-rays and look for any changes.

Plans to return to work should be made with your surgeon pre-operatively. Your job type will affect this. If you have a desk job with moderate amounts of walking, you can usually return to work 2 – 3 weeks following your surgery, but you may need to use a cane and it may be wise to go back part-time for a week or two. If your job requires more physical activity, you may need to be off work 6-8 weeks.

12. Living With Your New Hip

After you have fully recovered from your surgery, there are still a few lifelong restrictions that we recommend in your activities. When ever you bend more than 90 degrees at the waist, you should keep you knees apart to avoid the risk of dislocation. You should also avoid crossing one knee over the other when sitting. You should avoid extremes of motion of the hip when doing stretching. If you participate in yoga or Pilates, discuss these restrictions with your instructor. Exercises such as swimming, bicycle riding, walking (treadmill or elliptical okay; use shoes with a cushioned heel) are encouraged.  “Low impact sports” like golf, bowling, or doubles tennis are fine. Sports such as racketball, jogging, and skiing are not recommended.  Activities involving jumping at any time or lifting heavy objects (on a routine basis) are to be avoided.

13. Prophylactic Antibiotics

Without appropriate precautions it is possible for bacteria from the blood stream to settle in the hip joint causing an infection after a total hip replacement. Patients with dental infections have been known to have the infection spread to their hip joints. Similarly, infections elsewhere in the body can also spread to the hip. In addition, manipulation of areas that are known to have bacteria can also cause bacteria in the blood stream. Any dental procedure that causes some bleeding of the gum can result in bacteria in the blood stream. The chance of this resulting in an infection is extremely low, but precautions should still be taken. Therefore, it is wise to take prophylactic antibiotics before and after these procedures. Similarly, any procedures on the GI tract or genital-urinary tract also require prophylactic antibiotics. Simply mentioning the fact that you have had a total hip replacement will usually alert your dentist or doctor to these possibilities and they will take the appropriate action. If not, call our office and we will prescribe them.

Summary

A lot of things are going to happen both before and after your surgery. By reading this you will start to prepare yourself and help yourself in recovery. This may generate some questions…please ask your surgeon or any of his staff for answers.  Remember that the goal of hip replacement surgery is to relieve pain and to restore function for the routine activities of daily living. We recommend avoidance of high impact activities (running, jumping, jogging) to allow your hip to last as long as possible.