Precautions involve movement, nutrition, pain, and frequent follow-up with your doctor. Questions about function, pain experienced, ability to adapt to the new hip and comorbidities are the main concerns.
Ultimately, patients recover from their surgery pretty quickly. Young and active patients recover almost quickly thereafter. But the elderly can have a longer time to adapt.
In recent years, those who have had a hip replacement approximately 5-6 and 12-16 years ago have a good functional outcome according to the Oxford Hip Assessment from a study in 2012. This is in comparison to the patients who didn’t opt for the procedure after the age of 80 years old.
Initially, hip replacement patients are given a long list of things not to do—do not bend the hips or knees further than 90 degrees, do not cross the legs, do not lift the leg to put on socks, and much more.
These movement restrictions protect the new hip from dislocation. Over time, these restrictions are released, especially if the pain is reduced, or weight-bearing is permitted.
Dealing With The Pain
After going home, most of the patients after surgery will experience pain on the site of the surgery. A few days after, the surgical bandage will be removed by a physician or by instructions.
Dealing with wound healing is one, the movement and weight-bearing are another. In the first few weeks, prescribed pain medications, home relief, and therapy are provided.
Firsthand physical therapy is addressing the pain that occurs in the area. You’ll be assessed on your overall function and activities pre-surgery to take note of as a goal.
Coordinating to the occupational therapist of these goals will determine how the interventions will go through the course of weeks.
Some patients complain of pain even after weeks of the surgery. Although intermittent, it can disrupt the overall recovery. Subjective reports of the patient experiencing this are as common, especially during their follow-ups.
Overall, this is not something to worry about. By eliminating other conditions like knee arthritis and back pain, this is a normal response.
Continuous intake of pain medications like NSAIDs and paracetamol is permitted from the physician’s instructions.
Stretching exercises can be provided by the patient from the physical therapist, and use of portable electrical stimulation tailored to pain is used. But most of all, rest from an extensive period of activity is also necessary.
Wound Management, Infection, and Blood Flow
Wound care is one of the mainstays after surgery. By keeping your surgical wound clean, and dry, no infection shall occur.
Most of the patients’ wounds heal easily and in sync with the improvement of movement. You may have to bruise around your wound. This is normal, and it will go away on its own. The skin around your incision may be a little red.
Removal of the staples can occur 10-14 days. Checking of the wound is also needed. Especially if any infection has occurred in the area.
If there is a discharge, foul odor, changes in shape and size of the wound, and appears to be macerated, consult your doctor for immediate action. Infection on the are can affect the healing of the wound, and the surgical area.
Other factors indicate that an infection has already occurred.
- Persistent fever (higher than 101.5 degrees);
- Shaking or chills;
- Increasing redness, tenderness, or swelling of the wound;
- Drainage from the wound; and
- Increasing pain with both activity and rest.
Maintaining good blood flow in the area is almost a must. Especially if you’ve recently gone out of surgery. You’ll be prescribed anticoagulants to prevent clotting in the area, especially if no weight bearing is permitted by that time.
The risks of having swelling on the leg are also a concern. Mainly because of the build-up of fluid from healing. But it can be the least of your concerns.
Nonetheless, it only depends whether the patient has to heart problems, and blood vessel diseases.
You’ll have to check for any redness on the leg, pulsating cramp on the leg, or inability to move the operated leg from pain.
This might be a sign of peripheral vascular insufficiency or deep vein thrombosis. Immediately call an ambulance for more information.
Nutrition and Diet
The role of nutrition and diet plays a role in weight management, strength, and better prognosis for the patient. By having a proper weight, overbearing on the new hip will be prevented.
Optimizing nutritional status pre-operatively may help manage the surgical stress response, with a particular benefit for undernourished, frail, or elderly individuals.
Eating foods rich in the following nutrients are important for your recovery. Here are the following foods you’ll have to eat to maintain a good diet after surgery:
- Protein: Protein helps repair and build healthy tissue.
- Iron: Iron works in each of your body’s cells to help make energy.
- Vitamin C: Vitamin C helps your body repair damaged tissues, keeps your bones and teeth strong, and helps your body absorb iron.
- Calcium: Calcium helps build and maintain your bones, your muscles move, your blood clot and your nerves send messages.
- Fiber: Fiber helps your body produce regular bowel movements.
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Loosening and Displacement Concerns
Even after strength and range of motion have been attained, the patient may have concerns about loosening or displacement of the new hip.
One study in 2013 has detected radiographic component loosening started to increase about 4 years before revision surgery. Two years later, a sharp increase of painful hips from 15% to 80% in the revision year was observed.
Furthermore, walking capacity started to noticeably deteriorate 3 years before revision and in the revision year, about 65% of patients could not walk longer than 30 minutes.
But this is not the case for everyone. There are functional limitations you have to avoid in order to prevent the occurrence of loosening or displacement.
On the other hand, displacement can occur with faulty proper body mechanics, repeated falls, and improper positioning even months after.
Always assure your weight-bearing status with your physician, and follow your precautionary movements to prevent this to occur. Here are the signs to take note of:
- Pain on the hip area, and unable to give weight
- Popping or clicking sound
- The sensation that your joint is moving in and out of its socket
- Partial hip dislocation (subluxation),
- Full hip dislocation,
- The sensation of your knee “giving out” when you put weight on it or swelling in and around your replacement knee joint.
Functional Limitations After Hip Replacement
As mentioned above, precautions and limitations of movement are imposed in order for the operated prosthesis or new hip to heal and to be in place.
These are gradually reduced as time goes by, and from building the strength and increased range of motion imposed through rehabilitation and consulting the physician.
Loosening is the major long-term concern for patients with hip replacement. You should minimize any type of stress on the hip that can cause loosening.
The hip joint bears much of your body weight. Therefore, it is important to control your weight. Excess weight increases stress on the hip and can cause loosening of the hip joint.
Depending on what prosthesis is used, cemented hip replacement is the most common method provided to the patients.
That even the movement is limited, over time, it’s seen with the best results of the return-to function. But with those with uncemented hip replacement (use of plastic), brittleness can occur and has more sensitivity of re-surgery.
On the other hand, strenuous activities like heavy weight lifting, jumping, or diving are prohibited. Displacement and loosening may occur if done without proper body mechanics.
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Use of Assistive Device (Walker/Cane/Crutches)
Initially, assistive devices are provided for the patient’s comfort on pain and weight-bearing restrictions. With comprehensive and continuous therapy visits, strength and mobility are increased.
By that, full weight-bearing status is permitted. Weight-bearing can be gradual, and it only depends on the recovery of the patient.
Most patients use the walker, especially in the older population for assistance. The goal is not using it at all, but sometimes resorting to the use of a cane is needed.
Especially if balance is a concern. On the other hand, young and active patients on the other hand use crutches and eventually don’t even use assistive devices at all.
Follow Up Care
According to surgeons, your hip replacement can last for about 15-20 years, depending on your age, weight, and even activities of daily living.
Appointments to the doctors for a check-up and updating them will help you for a better long-term prognosis. Diagnostic procedures like X-Ray and MRI are necessary to check if loosening or displacement has occurred.
You can contact your doctor if you have any problems with the following: your incision is draining, or any redness appearance on the area, open surgical wound, with a temperature over 101.5, and if you have calf pain that doesn’t improve with elevation.
Furthermore, you can contact them if there are any more concerns that you’d like to know about your case.