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After You Go Home
Your hospital stay will depend upon the type of surgery and other factors but generally it is a 2-3 days for primary hip replacement and could be longer for revision surgery. Occassionally, insurance carriers deny stays beyond 2 days and the hospital must then obtain authorization for any additional days. You will be discharged from the hospital directly to go home. Patients with medical conditions that require further monitoring or more extensive rehabilitation may be discharged to a rehabilitation or transitional care. Occassionally a home therapist or nurse is needed for a short while. It is very important that you follow the doctor's and therapist's instructions and precautions.
Anticoagulation (blood thinning) Measures:
Post Surgery Diet
You can resume your normal diet. However, if you are taking Coumadin (blood thinner), it is important to avoid excessive intake of vitamin K. Coumadin is an anticoagulant or blood thinner, and vitamin K may counteract its effects. Therefore, if you are taking Coumadin it is recommended that you:
- Avoid foods high in vitamin K, such as: broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil
- Avoid green leafy vegetables such as: spinach, kale, lettuce, turnip greens, cabbage
- Avoid large amounts of onions
- Avoid green tea and herbal teas
- Limit both regular and decaffeinated coffee intake to no more than one cup a day, as they each have a moderate amount of vitamin K
- Avoid alcohol as it can change the way Coumadin affects your body
Medications and Vitamins
After you discontinue taking the Coumadin, your body will need time to recover before your blood clotting ability returns to normal. Use the same caution during this period of time as you did while you were taking the anticoagulant.
Resume your usual medications unless instructed differently. Continue to take iron pills and Vitamin C for one month. If you are taking Coumadin you should avoid drugs which can interact with the Coumadin. The Coumadin (blood thinner) may be continued for three weeks following surgery. A children’s aspirin is recommended for another three weeks. A PT (prothrombin time) blood test may be needed to check on your anticoagulation after discharge. Tables 3 and 4 below indicate which drugs interact with Coumadin by either increasing or decreasing the prothrombin time. Please consult your physician if you have any questions.
Table 3 - Drugs That Increase Prothrombin Time
Oral contraceptives
·Allopurinol (gout medication)
·Anabolic steroids
·Antibiotics
·Thyroxine
·Disulfiram
·Methyldopa
·Methylphenidate
·Narcotics
·Tricyclic antidepressants |
·Diphenylhydantoin
·Quinidine
·Quinine
·Salicylates
·Chloral hydrate
·Nonsteroidal anti-inflammatory medications
·Inhalational anesthetics
·Monoamine oxidase inhibitors
·Oral hypoglycemic agents |
Table 4 - Drugs That Decrease Prothrombin Time
·Corticosteroids
·Antihistamines
·Carbamazepine
·Estrogens
·Griseofulvin
·Vitamin C |
·Antacids
·Barbiturates
·Chlordiazepoxide
·Birth control pills
·Haloperidol
·Rifamycin |
Wearing a TED Hose After Surgery
It is desirable that you continue to wear your TED hose for at least two months following surgery, or as long as swelling is present. During the first month, day and night wear is advised. During the second month, night time wear may be discontinued. You may remove the stockings two months following surgery. However, if swelling develops in your legs, you should elevate them and continue to use your TED hose, until there is no longer any swelling. If the swelling is accompanied by pain or redness, please elevate limb and notify your doctor.
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Activity and Exercise Precautions
Post Surgery Exercise
Gradually increase your activity as is comfortable but be careful not to overdo it! You should use your crutches or walker full-time with continued touchdown weight bearing for at least two months unless special orders have been given. You should not sit in any low chairs or attempt to bend down to put on shoes or socks or cut your toenails. A raised toilet seat should be used for about eight weeks. When you sleep you should keep a pillow between your legs and not lie on either side, unless there are two pillows between your legs and you have been instructed how to roll safely toward your unoperated side.
You may shower and get your incision wet 1-2 days after the stitches or staples are removed but do not soak in a bathtub. If the incision becomes red or starts to drain, you should immediately contact your physician.
The initial exercises should be gentle and low impact. Perform only the exercises taught to you twice a day. Swimming is permitted when the wound completely heals (at approximately three weeks) but avoid vigorous kicking. Assistance is needed to get in and out of the pool.
You may resume sexual intercourse as soon as it is comfortable but as with all activities be careful to observe the hip precautions and don't overdo it!
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Six Weeks After Surgery
Approximately six weeks after your surgery you will return for a follow-up visit with special x-rays. (Patients residing outside the Los Angeles area can mail the x-rays taken by their local physician and further care and treatment will be discussed with the patient by telephone.) The doctor will evaluate your condition and most likely you will begin increased weight bearing (putting more weight on your operated leg and foot) but crutches may still be recommended through the twelfth postoperative week. At this time you will probably be allowed to sit at a 90 degree angle, drive an automatic car (a stick shift car at approximately twelve weeks for right hip surgery), lie on your operated side, sleep without a pillow between your legs, cross your unoperated leg over your operated leg, put on your shoes and socks, and cut your toenails.
Four Months After Surgery
At the fourth month you will generally be re-evaluated and weight bearing further increased depending on your strength. A cane is recommended until you can walk without a limp. A bone densitometry study may be performed. Bicycling may be instituted in certain cases, but pressure is carefully regulated on the operated side during the first postoperative year. At about 6-10 months, as long as you can walk without support and a limp, you may do light recreational activities, such as playing golf and ballroom dancing. Other activities should be cleared with your doctor first. Return to work is also on an individual basis, depending upon your job requirements, type of surgery, and recovery rate.
Each program is tailored to the individual and his/her needs. Your progress may differ as determined by your doctor. If you had a revision procedure or are at risk for dislocation you may need to follow specific precautions for 4-6 months. In order to promote maximum durability it is advisable that you minimize impact as much as possible. It is also recommended that you obtain insoles or heel inserts made of impact absorbing material. Soft cushion or crepe soles are also advisable.
Post Surgery Notes for All Patients
It is essential that a hip replacement be examined by a physician and x-rayed throughout your lifetime in order to determine the response of your bone to the implant and to detect any signs of pending failure. You should be seen at four to six months and then 10-12 months postoperatively and then annually thereafter. The length of time between follow-up visits might be lengthened depending on your condition. Patients should be prepared to have specially positioned x-rays and bone densitometry in certain situations so that the status of bone and fixation can be assessed.
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