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Wound Care
Wound Care
You will have a Mepilex surgical dressing. The wound itself is usually closed with absorbable suture and special surgical tape. It is normal that there are no staples or sutures visible.
You will have a Mepilex surgical dressing. The wound itself is usually closed with absorbable suture and special surgical tape. It is normal that there are no staples or sutures visible.
This dressing is water resistant. You can shower at any time. Do not submerge the dressing.
This dressing is water resistant. You can shower at any time. Do not submerge the dressing.
You can leave the dressing on until your first clinic visit. It is normal to have some spotting of blood on the dressing.
You can leave the dressing on until your first clinic visit. It is normal to have some spotting of blood on the dressing.
If it becomes saturated with fluid such that the dressing is no longer flat you should remove the dressing. Spotting is normal. If it is loose, dirty, or annoys you it can be removed at any time.
If it becomes saturated with fluid such that the dressing is no longer flat you should remove the dressing. Spotting is normal. If it is loose, dirty, or annoys you it can be removed at any time.
You may replace it with anything that is clean and dry as a covering, or leave your wound open to air. The dressing is not necessary. The wound does not need to be covered.
You may replace it with anything that is clean and dry as a covering, or leave your wound open to air. The dressing is not necessary. The wound does not need to be covered.
Activity
Activity
We recommend simple walking with a walker for the initial 3-5 days after surgery, followed by transition to a cane or nothing as your pain and stability allow. Everyone is different, and your requirements will change throughout the day and week. You may need a walker for nighttime, or first thing in the morning, and then be able to complete your day with minimal assistance.
We recommend simple walking with a walker for the initial 3-5 days after surgery, followed by transition to a cane or nothing as your pain and stability allow. Everyone is different, and your requirements will change throughout the day and week. You may need a walker for nighttime, or first thing in the morning, and then be able to complete your day with minimal assistance.
By the first clinic follow up at 2 weeks, most patients are completing most of their walking without an assistive device or jsut a cane. There are certainly patients who will require a walker or cane for longer than this.
By the first clinic follow up at 2 weeks, most patients are completing most of their walking without an assistive device or jsut a cane. There are certainly patients who will require a walker or cane for longer than this.
During the second week, activity outside the house and non-essential walking may be pursued. You will likely notice increased pain and swelling afterward or the next day. This is normal and not typically a concern.
During the second week, activity outside the house and non-essential walking may be pursued. You will likely notice increased pain and swelling afterward or the next day. This is normal and not typically a concern.
There are no formal activity restrictions. There are also no useful restriction on your range of motion. We ask that you use your judgment. Avoiding falls is the primary concern during this time. If pain is increasing day after day, you are unable to bear weight, or your pain is uncontrollable, you should contact us.
There are no formal activity restrictions. There are also no useful restriction on your range of motion. We ask that you use your judgment. Avoiding falls is the primary concern during this time. If pain is increasing day after day, you are unable to bear weight, or your pain is uncontrollable, you should contact us.
If you are highly active during the first two weeks, you may create more inflammation and swelling. We ask that your activity be moderate. Allow your body time to heal.
If you are highly active during the first two weeks, you may create more inflammation and swelling. We ask that your activity be moderate. Allow your body time to heal.
Therapy
Therapy
There is no formal therapy or specific exercises that are recommended outside of short-distance walking during the first two weeks mostly for functional purposes (bathing, eating, toilet). While sitting or laying down, gentle movement of the ankles, knees, isometric contraction of the calves, thighs, and buttocks (firing muscles without movement). Walking and weight bearing uses all of the muscles about the hip.
There is no formal therapy or specific exercises that are recommended outside of short-distance walking during the first two weeks mostly for functional purposes (bathing, eating, toilet). While sitting or laying down, gentle movement of the ankles, knees, isometric contraction of the calves, thighs, and buttocks (firing muscles without movement). Walking and weight bearing uses all of the muscles about the hip.
During the first two weeks, hip-specific movements and exercises may be painful and unhelpful. Short walks to the kitchen or bathroom are enough. More than that is up to you, and dictated by your own pace, but increased activity frequently results in increased swelling and inflammation that can unexpectedly lead to an overall slower recovery. Hips do best with a slow launch. This is counter to many beliefs and expectations and different from the recovery typical of other joints in the body.
During the first two weeks, hip-specific movements and exercises may be painful and unhelpful. Short walks to the kitchen or bathroom are enough. More than that is up to you, and dictated by your own pace, but increased activity frequently results in increased swelling and inflammation that can unexpectedly lead to an overall slower recovery. Hips do best with a slow launch. This is counter to many beliefs and expectations and different from the recovery typical of other joints in the body.
The new prosthetic hip rarely has issues with long term stiffness or weakness/atrophy after replacement. It is not helpful to worry about this. You will be walking the day of your surgery, so any down time or atrophy is minimized. The hip does not stay stiff, and you will obtain full range of motion by resuming your regular activities.
The new prosthetic hip rarely has issues with long term stiffness or weakness/atrophy after replacement. It is not helpful to worry about this. You will be walking the day of your surgery, so any down time or atrophy is minimized. The hip does not stay stiff, and you will obtain full range of motion by resuming your regular activities.
It is NORMAL to have weakness with flexing the hip/raising the thigh for 1-3 weeks after surgery. The hip flexors run in front of the hip near the operative site, and are reflexively weakened by the inflammation and trauma of surgery to the local tissue. It is not helpful to attempt repeated use of these tissues during recovery.
It is NORMAL to have weakness with flexing the hip/raising the thigh for 1-3 weeks after surgery. The hip flexors run in front of the hip near the operative site, and are reflexively weakened by the inflammation and trauma of surgery to the local tissue. It is not helpful to attempt repeated use of these tissues during recovery.
Need for formal therapy will be assessed during the subsequent clinic visits. The vast majority of patients at this time do not wish to pursue formal physical therapy as they see daily improvement and generally have a gait that becomes normal with the passage of time and healing of the tissue. If there is a specific issue or deficit, we will engage therapy as needed.
Need for formal therapy will be assessed during the subsequent clinic visits. The vast majority of patients at this time do not wish to pursue formal physical therapy as they see daily improvement and generally have a gait that becomes normal with the passage of time and healing of the tissue. If there is a specific issue or deficit, we will engage therapy as needed.
Pain Management
Pain Management
Pain after your hip replacement can be highly variable.
Pain after your hip replacement can be highly variable.
The most common site for pain is the groin and front of the thigh. The wound itself is commonly tingly, hot, numb, or burning for a few days. It is common to also have some numbness in the region of the incision and on the outside of the thigh that can last for several weeks.
The most common site for pain is the groin and front of the thigh. The wound itself is commonly tingly, hot, numb, or burning for a few days. It is common to also have some numbness in the region of the incision and on the outside of the thigh that can last for several weeks.
After 3-5 days, the pain typically migrates to the musculature of the front of the thigh and around the top of the knee. This can be dominant for 2-3 weeks and is improved with continued use of anti-inflammatories and compression.
After 3-5 days, the pain typically migrates to the musculature of the front of the thigh and around the top of the knee. This can be dominant for 2-3 weeks and is improved with continued use of anti-inflammatories and compression.
Pharmaceutical management of pain is based upon continuous use of oral anti-inflammatory medication, such as Celebrex (Celecoxib), Ibuprofen, or Aleve (Naprosyn), in addition to continuous use of Tylenol (Acetaminophen). In addition many patients typically use 1-3 days of oral narcotics. Narcotics are usually used just at night time, but in some cases significantly more use may be required. Read more about pain management here: Medical Management of Pain
Pharmaceutical management of pain is based upon continuous use of oral anti-inflammatory medication, such as Celebrex (Celecoxib), Ibuprofen, or Aleve (Naprosyn), in addition to continuous use of Tylenol (Acetaminophen). In addition many patients typically use 1-3 days of oral narcotics. Narcotics are usually used just at night time, but in some cases significantly more use may be required. Read more about pain management here: Medical Management of Pain
There are some other considerations to mitigating pain post-operatively including activity modification, cold therapy, and compression that are important. Please continue reading below.
There are some other considerations to mitigating pain post-operatively including activity modification, cold therapy, and compression that are important. Please continue reading below.
Activity
Activity
We ask that activities for at least the first week are minimal. Do just what you need to do to take care of yourself. No exercises, repetitive focused movements of the hip, or hip focused stretching. If you feel your pain is increasing, you may need to scale back your activity. Increased tissue movement will increase inflammation, swelling, and fluid production. Patients may initially feel like moving and walking freely without the previous pain of arthritis, and may wish to engage in the activities they have not been able to do. Early activity will not cause a long term problem, but it may come with significant delayed discomfort and inflammation that may take up to a week to fully manifest.
We ask that activities for at least the first week are minimal. Do just what you need to do to take care of yourself. No exercises, repetitive focused movements of the hip, or hip focused stretching. If you feel your pain is increasing, you may need to scale back your activity. Increased tissue movement will increase inflammation, swelling, and fluid production. Patients may initially feel like moving and walking freely without the previous pain of arthritis, and may wish to engage in the activities they have not been able to do. Early activity will not cause a long term problem, but it may come with significant delayed discomfort and inflammation that may take up to a week to fully manifest.
Ice/cold/cryo therapy
Ice/cold/cryo therapy
We highly recommend nearly continuous use of cold therapy for the first 48-72 hours after surgery. We utilize simple flat Gel packs or freezer bags of ice sandwiched between two pairs of compression pants. If gel packs are selected, at least 3 should be purchased before surgery. These can be rotated out to your freezer every 45 minutes. Usually at least a 10 inch square will provide adequate coverage
We highly recommend nearly continuous use of cold therapy for the first 48-72 hours after surgery. We utilize simple flat Gel packs or freezer bags of ice sandwiched between two pairs of compression pants. If gel packs are selected, at least 3 should be purchased before surgery. These can be rotated out to your freezer every 45 minutes. Usually at least a 10 inch square will provide adequate coverage
Alternatively, a circulating cryotherapy device can be used. This is the most effective but has additional cost. Please see below.
Alternatively, a circulating cryotherapy device can be used. This is the most effective but has additional cost. Please see below.
If purchase of a circulating compression cryotherapy device is selected, these can be found online or by referral from our office to a local supplier. This device is particularly useful in patients who wish to avoid narcotics, those who cannot take regular anti-inflammatory medications (NSAIDS), or in other cases where an atypical response to surgery is anticipated. These devices can cost $300 or more and may not be needed in every case, but it is very helpful in maintaining consistent cooling over a wide area with the added benefit of cyclical compression for control of local swelling. The unit I recommend is the Breg Polar Care Wave. It can be purchased anywhere or we can assist in connecting you with a local distributor. I have no financial interest in any devices.
If purchase of a circulating compression cryotherapy device is selected, these can be found online or by referral from our office to a local supplier. This device is particularly useful in patients who wish to avoid narcotics, those who cannot take regular anti-inflammatory medications (NSAIDS), or in other cases where an atypical response to surgery is anticipated. These devices can cost $300 or more and may not be needed in every case, but it is very helpful in maintaining consistent cooling over a wide area with the added benefit of cyclical compression for control of local swelling. The unit I recommend is the Breg Polar Care Wave. It can be purchased anywhere or we can assist in connecting you with a local distributor. I have no financial interest in any devices.
Compression
Compression
Swelling of the hip, thigh, calf, and foot is always present. At times it can be significant. Aggressive elevation and wearing compression pants with or without compression socks can be very helpful. We ask patients obtain two pairs of waist-to-ankle compression pants prior to surgery. They can be worn one over the other to increase compression.
Swelling of the hip, thigh, calf, and foot is always present. At times it can be significant. Aggressive elevation and wearing compression pants with or without compression socks can be very helpful. We ask patients obtain two pairs of waist-to-ankle compression pants prior to surgery. They can be worn one over the other to increase compression.
This is usually only needed for 2-3 days but in some patients several weeks are required to prevent return of swelling in the leg. They are available at any athletic store or online.
This is usually only needed for 2-3 days but in some patients several weeks are required to prevent return of swelling in the leg. They are available at any athletic store or online.
Infection
Infection
Infection is extremely rare.
Infection is extremely rare.
Elevated temperatures are common postoperatively and can be related to many perioperative normal biologic processes and common drug reactions. Narcotics, antibiotics, and inflammation can all cause elevated temperatures above normal. We do not recommend routinely following your temperature after surgery.
Elevated temperatures are common postoperatively and can be related to many perioperative normal biologic processes and common drug reactions. Narcotics, antibiotics, and inflammation can all cause elevated temperatures above normal. We do not recommend routinely following your temperature after surgery.
Temperatures above 101.4 consistently for greater than 24 hours may represent an infection of some nature, but it is most likely not related to your hip. Common colds and urinary tract infection are far more likely. Surgical infections are very rare, take weeks to months to evolve, and frequently do not have elevated temperatures. Increasing, unrelenting pain over several days is the first sign of infection.
Temperatures above 101.4 consistently for greater than 24 hours may represent an infection of some nature, but it is most likely not related to your hip. Common colds and urinary tract infection are far more likely. Surgical infections are very rare, take weeks to months to evolve, and frequently do not have elevated temperatures. Increasing, unrelenting pain over several days is the first sign of infection.
We do not recommend routinely checking temperatures.
We do not recommend routinely checking temperatures.
We maintain 24 hours of antibiotic coverage per standard of care, usually oral Keflex (Cephalexin).
We maintain 24 hours of antibiotic coverage per standard of care, usually oral Keflex (Cephalexin).
In some patients with history of infection, immune compromise, or complicated cases this may be extended with another antibiotic.
In some patients with history of infection, immune compromise, or complicated cases this may be extended with another antibiotic.
We recommend avoiding elective dental cleaning or procedures until 8 weeks after your hip replacement.
We recommend avoiding elective dental cleaning or procedures until 8 weeks after your hip replacement.
DVT/Blood Clot Prophylaxis
DVT/Blood Clot Prophylaxis
Aspirin 81m tablets twice daily for a total of 2 weeks post-operatively is prescribed as medical prophylaxis against blood clots. In patients who have risk factors for blood clots, history of blood clots, or other indications for anticoagulation, we may use other medications for longer duration.
Aspirin 81m tablets twice daily for a total of 2 weeks post-operatively is prescribed as medical prophylaxis against blood clots. In patients who have risk factors for blood clots, history of blood clots, or other indications for anticoagulation, we may use other medications for longer duration.
By far the most effective way to avoid blood clots is to have regular movement of the muscles of the legs, avoiding long periods of not moving, and maintaining adequate fluid intake to avoid dehydration. This does not necessarily require walking or moving the hip. Simply flexing the muscles of the calves, thighs, and buttocks against the opposing muscle groups (isometric contraction) is an effective measure to accomplish this.
By far the most effective way to avoid blood clots is to have regular movement of the muscles of the legs, avoiding long periods of not moving, and maintaining adequate fluid intake to avoid dehydration. This does not necessarily require walking or moving the hip. Simply flexing the muscles of the calves, thighs, and buttocks against the opposing muscle groups (isometric contraction) is an effective measure to accomplish this.
Vitamin D Replacement
Vitamin D Replacement
Continue taking 5,000 IU Vitamin D3 daily for 6 weeks after surgery. We also recommend a daily multivitamin.
Continue taking 5,000 IU Vitamin D3 daily for 6 weeks after surgery. We also recommend a daily multivitamin.
Stool Softeners
Stool Softeners
Narcotics are constipating. You should take a stool softener while taking narcotics. It is normal to not have a bowel movement for up to 5 days. Stool softeners can be stopped when you are no longer using narcotics or when regular bowel movements have resumed. Drinking adequate fluids, a high fiber diet, and using minimal narcotic medications are helpful in avoiding constipation.
Narcotics are constipating. You should take a stool softener while taking narcotics. It is normal to not have a bowel movement for up to 5 days. Stool softeners can be stopped when you are no longer using narcotics or when regular bowel movements have resumed. Drinking adequate fluids, a high fiber diet, and using minimal narcotic medications are helpful in avoiding constipation.
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