After the operation you will be taken through to the post-operative recovery area. There your pulse and blood pressure will be monitored carefully. The nurses will make sure that you are breathing comfortably. Typically you will have an oxygen mask over your face and nose to make sure that there is sufficient oxygen circulating around your blood system.
You are likely to have a ‘drip’ going into the back of your hand and indeed there is likely to be a drain coming away from the wound just to ensure that if there is a small amount of bleeding into the soft tissues this is taken away from the wound.
If you have had a spinal anaesthetic you will not be able to move your legs at that stage. Your legs will be supported and kept in position by a foam wedge with straps. This should not be uncomfortable.
The recovery nurses will keep a close eye on you until they are happy that you are sufficiently well to be taken back to the ward.
Back on the ward the observation period continues. You should be allowed to eat and drink as soon as you are more “with it”. Gradually, over time, you will be able to wiggle your toes and move your legs again gently. It is important to keep your toes and legs moving gently to help your circulation and to prevent any concern with pressure areas.
There are plenty of options with regard to helping control post-operative pain. All the potential options will be available and this will have been discussed with your anaesthetist prior to surgery. In essence, post-operative pain is not something that should worry you. There is a section about this elsewhere on the website.
Typically you will be kept lying flat, often with the foam ‘wedge’ between your legs just for support and to reduce any concern with displacement of the prosthesis.
Post-operative day one
On the first day after surgery the drains will be removed from the wound. You will be sat up and blood tests will be taken to ensure that your blood levels are satisfactory. You should by now be eating and drinking well. You will be encouraged to move your foot ‘up and down’ and gently to bend and straighten your knee. The physiotherapists will visit and supervise exercises in bed. If all is well and you are comfortable, it is likely that the ‘physios’ will start to get you out of bed and mobile to get the rehabilitation under way formally.
Typically, the ‘physios’ will help you to walk using a ‘frame’ to start off with so that you have plenty of support and feel confident as you get used to your new hip.
Sometimes patients need a catheter into the bladder. This can be inserted before surgery or immediately after surgery in the recovery area. Unfortunately sometimes, particularly after regional anaesthesia, the patient can have difficulty passing water and a catheter can be required a few hours after the procedure. Whenever it has been ‘put in’, the plan will be to remove the catheter as soon as you are more mobile and will have regained bladder control. You may be given additional antibiotics while the catheter is in place.
Post-operative day two and beyond
Over the course of the next few days the physiotherapists will visit regularly. They will encourage and help you become more mobile and independent. Alongside the nurses, they will work on exercises to ‘build up’ muscle strength around the hip. Again there is a section elsewhere on this site detailing the sort of exercises that you might find helpful.
You should spend increasing amounts of time out of bed, sitting in a chair and mobilising around the ward.
It is very important that you keep your leg mobile to ‘pump’ the blood around. You will be encouraged to put some weight through the leg. The physios will help you to get to know how much weight you are expected to put through the hip as you become more mobile.
The surgeon will visit you on a regular basis to monitor your progress and certainly should be able to answer any of the questions that you have about your rehabilitation. Similarly, you will have an opportunity to go over the details of the operation, exactly what was found and what procedure was carried out.
Within the first few days of surgery you will be taken to the X-Ray Department for a check x-ray to ensure that all is well. In addition, you will require more ‘formal’ x-rays, from the front and indeed the side of the hip, before you go home just to ensure that the components are exactly as planned as you progress through your rehabilitation.
There are plenty of options in terms of painkillers, injections, tablets, ice packs that are available to keep your pain under control. Again, these are dealt with elsewhere in the site. Post-operative pain relief should not be something to concern you.
You will be asked to wear Thrombo Embolic Deterrent (TED) stockings in an attempt to reduce the risk of clots. These can be a little bit uncomfortable but they are important as clots are a major concern following this type of joint replacement surgery. I like to encourage patients to use these stockings for the first six weeks as they become more mobile.
Similarly, we use injections of low molecular weight heparin into the soft tissues of the anterior abdomen to reduce the risk of clots. Often patients are able to self-administer these injections. These injections will be continued for a few weeks after you return home. The nurse will go through this with you before surgery and while on the ward. Again this is not something about which you should have any concern.
Once you are able to mobilise comfortably (usually on crutches) are independent and able to go up and down stairs, take yourself to the bathroom and you are feeling sufficiently confident to go home, you will be discharged from hospital.
Discharge dates are variable but can be anything between three to six days post-surgery dependent on your progress, on the operation that was performed, on any pre-operative medical concern and on circumstances at home.
The occupational therapist will have arranged and supplied a number of pieces of equipment that will help both while you are on the ward and after you go home. These should include apparatus to raise the height of your lavatory seat and apparatus to help you pick up objects from the floor, alongside any other equipment that is felt would be beneficial to you.
The occupational therapist and physiotherapist will have been through this with you at the time of the pre-operative assessment.
Typically the wound will be checked prior to discharge and the dressing changed. You will be discharged with painkillers to ensure that you are comfortable. Arrangements will be made for the sutures to be removed from your wound at two weeks post-surgery, usually at home by the district nurses. You will be given a date for a review appointment in the clinic, normally between four and six weeks after surgery.
© Andrew R J Manktelow – September 2011