Joint Replacement Institute

Postoperative Course: Hip

Long-term Precautions and Advice

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.

Long-term Precautions and Advice

Postoperative Activity Advice

You may be able to take part in physical activities which before surgery were impossible. There is a difference between patients who have polyethylene bearings and those with metal-on-metal bearings. The problem relates primarily to wear of the plastic bearing which is analogous to tire wear. That is, the more you use it, the more wear occurs. Metal-on-metal devices have considerably reduced wear. Swimming is encouraged. However, very rough or heavy activities may shorten the life of the implant. The rotation stress on the lead leg and hip in golf may be minimized by use of a smooth spikeless shoe. Bicycling risk factors are related to the pedal stress of uphill topography. Skiing smooth groomed slopes in good light is relatively safe, although falls can have adverse effects. It is too soon to assess whether the adverse risks of heavy activity with new metal-on-metal surface replacements(e.g., bump skiing, racket sports, running, heavy lifting) are as minimized as we hope. Your doctor, by serially following your x-rays and scans, can advise you about risk factors which may affect the life of the implant.

Infections

Infection may localize at the site of the artificial implant and can cause major complications. Therefore, if at any time you should contract an infection anywhere in your body, especially those which cause high fever, you should have it treated immediately by your physician. Special precautions should be taken for bladder infections, ingrown toenails, prior to having dental work for tooth and gum infections, and before undergoing surgical procedures. In general, Amoxicillin 3 grams is recommended 1 hour before and 1.5 grams 6 hours after any dental root canal or major dental procedure. If you are allergic to Amoxicillin or Penicillin, Erythromycin stearate is recommended (1 gram 1.5 - 2 hours before and 500 mg 6 hours later). The need for special precaution during routine dental check-ups is controversial. If your gums tend to bleed during the cleaning process, antibiotics are recommended as described above. If possible, all dental work should be delayed until four months following surgery. Antibiotic coverage for other surgical procedures or infections is individualized according to the possible bacterial contamination and, therefore, you should notify the respective physician or surgeon so they can prescribe the appropriate medication.

Although the risk of dislocation is less with hip resurfacing or THR with large femoral head due to their inherent increased stability, it is still advisable that you adhere to the above precautions for four to six weeks when dislocation precautions are generally discontinued depending upon the patient. For conventional THR or after revision surgery dislocation precautions may be minimized or continued depending upon the assessed stability.