Post Operative FAQ

This is not well defined but common sense goes a long way.  In general, when you are no longer using a walker or narcotic pain medications, you can begin to drive.  The majority of people can drive themselves to their first post-op appointment at two weeks.  

We suggest that your first return to driving is in a low traffic area and several practice runs at going back and forth between the brake and gas quickly.

Swelling at times can be impressive.  There may also be bruising throughout the leg.  The swelling in the surgical area can obstruct the outflow of lymphatic fluid from the leg, and this is exacerbated by gravity with the leg below the hip. Management is to spend more time with the leg elevated well above the waist.  Typically on a couch or bed with several pillows.  Compression pants over knee high socks are also used in addition.  In addition when needed 6 inch ACE bandage overwrap of the calf and thigh is effective.  Swelling that does not change despite these measures is and issue and warrants contacting me.  DVT/Blood clots may be associated with uncontrollable  and persistent swelling.  

It is NORMAL to have weakness of the hip flexor for 1-3 weeks after surgery.  The hip flexors run in front of the hip and are reflexively weakend by the inflammation and trauma of surgery to the local tissue.  They will return to normal strength as the inflammation resolves.

Showering is permitted at any time after surgery.  The wound dressing is waterproof.  Do not submerge the wound or dressing below water.  

Most patients leave the dressing in place until follow up.  After two days it can be removed if that is your preference.  Any dressing or no dressing is acceptable afterward and is for your comfort only.  Clean water may run over the wound in the shower after two days.

At any time.  There are no restrictions.

Return to function is highly variable and dependent on the individual and their own biology.  There are no formal guidelines or restrictions.

Approximate average:

Walking greater than a mile: 2-4 weeks

Running: 3-6 months

Golf: 2-4 weeks

Hiking irregular terrain/climbing: 4-6 weeks

Swimming: 2-4 weeks

I've never heard a report of a problem or complication with sex.  There are no restrictions.

I get this question a lot and it is hard to answer.  It is variable and dependent on patient, biology, and mindset.  I have had a 74-year-old return to clinic at two weeks who had already gone sky-diving.  That isn't normal and not recommended.  I've also had people take three months to walk well.

On average your expectation should be that you will be independent in your activity within 3-5 days and not requiring routine assistance.  Many are relatively independent at discharge.  A walker is needed for a variable time for each person: as little as a day, to up to 4 weeks.  The average is about 3-5 days.  The use of a walker is self-directed and not a requirement.  

Most people are generally unaware of the hip at 3-6 months. 

There are no restrictions.  I ask people to pay attention to what their bodies are telling them.  If it feels good, its probably OK to return to whatever you like to do.  There is no information that your chosen sport will damage or alter the longevity of your hip.  You can always break a bone with enough energy, but you probably can't break the hip implant itself.

There are no formal restrictions.

Likely longer than you will.  There is always some wear, but with a well-placed prosthesis and modern materials, my experience and our literature says the need for additional surgery for wear with a well-placed implant is exceedingly uncommon.

Yes.  You will be slow and sore for 3-5 days, but with a regular height bed, a walker and some patience you can get in and out of your own bed.   Transitions from bed to chair and standing should be made slowly as you may have some light-headedness for a few days.

This is variable, but it is typically nice to have someone around for the first 3 days.  They don't need to be there 24 hours a day, but some help with meals and transfers during the day can be more comfortable.  

Not usually.  The ability to navigate your home with a walker is helpful, so stairs can be difficult but not impossible for the first 3-5 days.  Commodes, hospital beds, alternate sleeping arrangements are available for unique living areas where access is an issue.

This is rarely needed.  If you are independent in walking before surgery, you should be able to go home afterward.

This isn't something you should worry about.  Your hip is built to be used.  You should try to wear it out.  It is unlikely you can.  I have patients who run marathons and run, ride, hike at high mileages and they do not show wear.   Long-term studies support a modern, correctly positioned hip replacement is unlikely to fail from a wear issue.

Simple walking is ample therapy for the muscles of the hip.  There are no muscles detached during surgery.  The surgical trauma is typically moderate.  Everyone is walking the day of surgery, so atrophy is not a significant issue.

There are innumerable protocols and exercises for hip recovery.  These have evolved at different times with different surgical techniques.  Currently, I don't find any particular exercise to provide an advantage.  In fact, during the first two weeks after surgery, these seem unhelpful in my experience.  Your peak inflammation will be during the first two weeks.  Aggressive exercises during this time can exacerbate the inflammation and are painful.  Simple, careful, frequent walks are enough.  Avoiding DVT/blood clots is the objective.  Isometric (flexing the muscles without moving the legs) exercises of the thighs, buttocks, and calves while in bed are likely beneficial in addition to walking.  These are simple to do.

The ultimate goal is return to the activities you enjoy and keep you fit.  Your therapy should be to add these back as you feel ready.

There is a first post-op visit at two weeks.  We will take x-rays, remove your dressing, and talk about any issues or concerns.  

The next scheduled visit is 6 weeks later.  This visit is optional.  Most people are doing well and don't want to return.

Long-term, I like to check in at 1 year, then every 5 years.  

Simply, no.  This is unfortunately controversial and ultimately you need you do what you, your dentist, and your surgeon are comfortable with.  The American Dental Association and the American Association of Hip and Knee Surgeons agree that this is not universally indicated.  In my practice I do not ask patients to take antibiotics before dental cleaning UNLESS you are immunocompromised, on chemotherapy, have poorly controlled diabetes, or have a history of recurrent infections.  In these cases you should take prophylactic antibiotics before dental work. 

We recommend avoiding all elective dental cleaning or procedures until 8 weeks after your hip replacement.

We recommend avoiding all elective dental cleaning or procedures until 8 weeks after your hip replacement.  Contact us if you are having non-elective dental work.  In these cases we and your dentist will recommend appropriate prophylactic antibiotic coverage.

Many hips will set off a metal detector.  This will prompt a pat-down and/or wand detection of the area.

Your best strategy is to go through the body scanner.  This will identify the implant and will usually not prompt additional screening.

No additional documentation is needed or helpful.  

Yes!  It can take up to a week for normal bowel movements to return.  Don't worry.  Narcotics frequently cause constipation.  If you have a history of constipation, diabetes, or neuropathy this may be a major issue for you.  Stopping narcotics, high volume fluids, fiber, and walking are important to avoid this problem.  You may need over-the-counter magnesium citrate if you have not had a bowel movement by day 5 after surgery.  If you have pain, vomiting, fever, or have not had a bowel movement by the end of day 5, contact me.