Prior to release from the hospital you will be contacted 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) and a bedside commode. The bedside commode can also be used as a raised toilet seat by placing it over the commode and removing the bucket. It can also serve as 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, 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 limited in your activities. You may go out for short walks using a walker or crutches (less than a block) and short rides in the car, but most of the time you should spend indoors recuperating. You will not have fully regained your strength until approximately six to twelve weeks after surgery and it is unwise to plan any large trips or outings during this period of time.

Riding in the car presents some difficulties. For the first six weeks after surgery, you should restrict the amount of bending at the hip to less 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. I would suggest if you have a large vehicle, you should 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, the amount of bending allowed is increased to 90 degrees and this usually allows easier exit and entrance to a vehicle. You should not plan on driving until at least four weeks after surgery for a left hip replacement, six weeks after surgery for a right hip replacement.

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. Usually, at this time, the pillow between the legs which you will be using at home in bed can be discontinued. The elevated toilet seat, however, is still helpful although not required.

By three months after surgery, you will usually be strong enough to resume most normal 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 some lifelong restrictions 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. Exercises such as swimming and bicycle riding are encouraged. Walking is also a good exercise. You should wear shoes that have a cushioned heel to avoid impact loads on the hip while walking. Sports such as tennis, racketball, jogging, jumping or lifting heavy objects 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. NOTE:For dental procedures not involving an active infected area, you do not need to take prophylactic antibiotics after 2 years from your surgery.

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. Remember that the goal of the surgery is to relieve pain and to restore function so that you should be able to perform the routine activities of daily living. Your hip will never be "normal" again but it should give you a significantly improved level of function and pain relief as compared to your preoperative status.