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. If you have had a spinal anaesthetic you will not be able to move your legs at that stage. Your legs will be loosely supported and kept in position by a foam wedge with straps. This should not be uncomfortable.
Sometimes patients will have had a catheter inserted into the bladder. This will have been done either before or immediately after surgery in the recovery area.
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.
After your return 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 to help control post-operative pain. All the potential options will be available. The various options will have been discussed with the 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 until you are moving comfortably and the spinal anaesthetic has ‘worn off’.
While previously patients were kept in the hospital for a few days following surgery, we now appreciate that with careful surgery, modern anaesthetic techniques and local anaesthetic infiltration into the wound, we can mobilise patients more rapidly. Getting up and mobile is a very important part of the rehabilitation.
Soon after your surgery you will be encouraged to move your foot up and down and gently to bend and straighten your knee and, indeed, your hip. Once the muscles and nerves are working well and you are comfortable, it is likely that the physiotherapists will start getting you out of bed with gentle mobilisation on the afternoon or early evening of your surgery .
Post-operative day one
On the first day after surgery 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. Your rehabilitation will continue. The physiotherapists will visit and supervise exercises in bed and continue with your mobilisation out of bed.
Initially the physios will help you to walk using a frame or crutches to start off with so that you have plenty of support and feel confident as you get used to your new hip.
Unfortunately, particularly after regional anaesthesia, some patients can have difficulty passing water and a catheter can be required a few hours after the procedure. Whether it has been inserted before or after surgery, the plan will be to remove the catheter as soon as you are more mobile.
An x-ray will be performed to ensure that the components implanted in your hip are sound. Over time, you will require more ‘formal’ x-rays, from the front and indeed the side of the hip, to monitor progress and to ensure that the components remain solid and secure as you progress through your rehabilitation.
The physiotherapists will visit regularly during your initial mobilisation. 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 website 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 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 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.
It is important to reassure you that there are plenty of options in terms of painkillers, injections and tablets available to keep your pain under control. Again, these are dealt with elsewhere in the site. Post-operative pain relief following your hip operation should not be something to concern you.
You will be asked to wear thromboembolic 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 following surgery 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. The injections will be started immediately after your surgery once the risk of any acute bleeding has reduced and will be continued for four 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 typically this would be on the first or second post-operative day. This will all be 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 be available while you are on the ward and will help 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.
In preparation for your return home
With regard to your hip wound, I use an occlusive dressing at the time of surgery. This covers a single suture and Steristrips in the wound that should leave you with a very neat and tidy scar. The dressing should be left intact until the suture is removed at two weeks post-surgery. The dressing itself should be checked prior to your discharge but typically the wound will remain covered unless there are any specific concerns
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.