Joint Replacement Institute

Postoperative Course: Hip

Your postoperative course of treatment and recovery begins immediately following surgery and it is important that you comply with established prophylactic protocols and dislocation precautions. These procedures and precautions are described below.

Hospital Stay

Immediately following surgery, you will be taken to the recovery room where you will stay for 1 - 2 hours. Your blood pressure, circulation, respiration, temperature, and wound drainage are carefully monitored. Patients generally are transferred to an intensive care unit (ICU) for the first night if epidural anesthesia is used of if close monitoring is needed. Other patients may be transferred directly to their own room. Private duty nurses are generally unnecessary.

Through an intravenous (I.V.) tube which was placed in your arm vein during surgery, you will be given antibiotics and fluids. After 1~2 days the I.V. will be disconnected and if antibiotics are still needed, they can be given to you orally. Because you will probably feel some discomfort after surgery, pain medication will be given to you every three or four hours as needed. A special machine called P.C.A. is available in order for you to self-medicate, but it is rarely needed. A tube (Foley catheter) may have been inserted into your bladder during surgery to keep it empty and this is usually removed in 1-2 days. If you have difficulty in voiding, then the tube can be kept in longer but an antibiotic will be continued to avoid possible infection.

Several measures are used to help prevent the formation of blood clots in your legs which can become dangerous. TED stockings are placed on your legs after surgery and will remain on, day and night, during your hospital stay except for a short period twice a day. You will be encouraged to do bed exercises (isometrics and ankle circles) which the nurses and physical therapist will teach you. Elevation is also important and is accomplished with sling suspension. Blood thinning drugs (Warfarin - Coumadin) or other agents that provide chemical prophylaxis are recommended. Blood is drawn daily to determine the appropriate dosage of Coumadin. Other chemical anti-coagulants may be used such as Lovenox (low-molecular-weight heparin), Fragmin, or children’s aspirin (the latter is generally used after 3 weeks of Warfarin for an additional 3 weeks.)

In order to prevent respiratory complications you will be asked to breathe into "blow bottles" and cough several times a day. You may also be asked by an inhalation therapist to breathe with an assistive positive pressure machine.

To prevent heterotopic bone from forming in the soft tissues around the hip, Indocin is prescribed beginning the night before surgery and for four days, postoperatively. 700 rads of radiotherapy (a low dose) may be indicated and administered preoperatively in patients undergoing bilateral procedures or those who are deemed to be at high risk.

The wound dressing is usually changed on the second day after surgery, or as indicated by the physician.

Each day you should feel a little more comfortable as your hip heals and becomes stronger. Usually on the second day after surgery you will be seen by a physical therapist to begin using a walker or crutches to walk with partial weight bearing.

During Your Hospital Stay

During your hospital stay, the therapist will visit you daily and gradually your activity level will be increased. They will also help you in determining what type of equipment you will need to use at home. Some of this equipment includes a reacher which enables you to pick up things without bending past the 90-120 degree restriction, a sock cone which assists you in putting on nylons and socks, a long shoehorn to help put on shoes, and equipment for bathing. The therapist will also discuss safety procedures for various activities with you. Prior to discharge, a set of instructions with diagrams will give you specific guidance on how to sit, use a walker, get into or out of bed, position a chair correctly, etc… Since you will not be allowed to bend your hip more than 120 degrees, special instructions for entering a car will be given to you as well. Every program is designed specifically for each patient and only equipment that will be useful to you will be suggested. If you have any questions, please ask your therapist and/or nurse.

The programs discussed above are for more "routine" first-time THR and hip resurfacing surgeries. They may be altered for complex revisions. In these cases, ambulation may be delayed, and an abduction brace or cast may be required to minimize the risk of dislocation. The typical length of hospital stay for THR and hip resurfacing is three days although it can be shorter or longer depending upon the patient’s specific situation.

Visitors are welcome during your hospital stay. However, they should be kept at a minimum especially during the first 1~2 days while you are recovering from surgery and need your rest.

Dislocation Precautions and Activities to Avoid

Lying Down Correctly

You will also be taught specific precautions to follow in order to minimize the risk of dislocating your new hip joint.

Sitting Correctly

On postop day one, you will be instructed in the proper way to sit in a chair. You should be in a high chair with your torso reclined and your knees placed lower than your hip joint to avoid bending your hip past 120 degrees (See figures below). (Note: Special "high chairs" are available during your hospital stay which will help you avoid sitting incorrectly. If you are interested in renting a chair during your recuperation at home, please ask the hospital’s discharge planning nurse for assistance. These chairs are available from certain medical equipment suppliers.)

You will also be instructed in toilet transfers using a raised toilet seat (until then it will be necessary for you to use the bed pan). You may be taught how to roll on your side with pillows between your leg if cleared by your physician. Face down exercises may be done at this time to avoid future problems of your hip not fully extending.

Activities to Avoid

It is important to remember the types of activities to avoid, particularly if you have a conventional total hip replacement with a small ball: