Once you have left the hospital, you will be expected to gently work through the exercises that the physiotherapists have given you. The physiotherapists will have explained exactly how much weight you should be putting through the operated leg. This will differ slightly according to the type of hip replacement that you have had.
You might experience some swelling in the leg but this should not be uncomfortable. Typically, swelling would be expected to settle during the night and perhaps then worsen a little bit during the day as the leg is dependent. For that reason, when you are not actually up and about and mobile, it is often helpful to keep the leg elevated to reduce that swelling. You should continue to take painkillers as required though your requirement for painkillers should settle steadily over the course of the first few days.
It is important that you are active and that you continue to put weight through the leg to encourage the blood to circulate around it and to reduce the risk of clots. You will be giving yourself Clexane injections (or possibly taking tablets) to thin the blood slightly for the first four or five weeks following the operation. You are encouraged to do ‘little and often’ in the first few days to keep the hip mobile but, as things settle and the hip becomes more comfortable, you should be able to progress with your activities.
You will have practised negotiating stairs with the physiotherapists before going home and should find that comfortable.
I am very happy for you to walk outside using support as directed. You should be able to get in and out of the car. I am very happy with you going for short trips and, indeed, to visit friends or perhaps even to go out for dinner as long as you are careful getting in and out of the car and sitting down at a table.
At around two weeks from the operation, arrangements will have been made for your suture to be removed either back at the hospital or by the district nurse.
I have a specific document that I have provided that gives detailed instructions as to how the sutures should be removed and this can be found elsewhere on the website. Once the suture is removed, a simple dry dressing can be put over the scar for another few days to allow things to settle but this should all be completely removed by three weeks and the scar should then continue to improve steadily from there.
With regard to your ongoing rehabilitation, again much will depend on the type of hip replacement that has been performed.
Weightbearing following hip replacement
Typically, when I have used an uncemented titanium-type femoral component, I will protect the patient’s weightbearing a little bit more. This is to reduce any micro-movement (caused by loading) between the thigh bone and the metallic component. As such, with an uncemented hip replacement, we tend to go for a period of three to four weeks on two crutches, moving onto one crutch (on the opposite side) for two weeks to enable you to be full weightbearing through the replaced hip at around six weeks post-surgery. This is the same weightbearing regime that I use for my hip resurfacing patients. If there is any reason why we need to be more protective with your weightbearing as a consequence of a specific situation, then I will have discussed this with you at the time of surgery.
With regard to a cemented femoral component, as the component is solidly fixed at the time of the operation, it is reasonable to weightbear more fully through the hip. As such, we typically use two crutches for the first two weeks, weightbearing as tolerated on the hip replacement during that time. Crutches are used predominantly to ensure that you are comfortable, safe and feel confident. At two weeks from surgery you can, if you feel confident and safe, go down to using one crutch (used on the opposite side) and any time after three or four weeks, as soon as you feel comfortable and confident, I am happy for you to mobilise free of crutches altogether.
Regardless of how much weight you are putting through the hip, it is important that you do the exercises that the physiotherapists have described, bending the knee up, straightening your leg down, moving your hip out to the side and gently bringing the hip towards a normal range of movements over the course of the first few weeks as swelling settles and any discomfort from the wound improves.
Things to look out for following surgery
I would expect you to make sound and steady progress over the course of the first few days after your discharge and indeed over the course of the first few weeks as your rehabilitation proceeds.
I would expect you to feel increasingly comfortable. I would expect your requirement for analgesic medication to settle very steadily. Of course this varies between patients and, to an extent, between the various operations that I perform.
The dressing: With regard to the dressing acutely following surgery, I use an occlusive dressing. There can sometimes be a minimal amount of blood staining on the white dressing though this should not look like fresh bleeding. It should not increase over time. If there is any concern with regard to staining of the dressing that increases or any other concern with the scar, then it is important to get back in touch with the hospital so that we can arrange for this to be reviewed. This would, however, be an unusual situation.
Leg swelling: As I have previously identified, some patients do experience a little bit of swelling following surgery though this should settle steadily as you rehabilitate. It should settle during the course of an evening. If you have painful swelling in the leg, and specifically if the swelling does not settle and becomes progressively worse, it is important that you seek attention as this could be a sign of a clot developing in the leg. If that were to be the case, we would typically arrange an ultrasound scan to investigate this, possibly with a blood test, and we may have to increase the amount of anticoagulation treatment that you are being given.
The reason that we use the injections or tablets for the first few weeks following surgery, and indeed use a spinal anaesthetic at the time of surgery and encourage mobilisation and weightbearing through the hip, is in order to reduce the risk of this potential complication. In essence, if there are any concerns whatsoever in this regard you should be in contact with the hospital so that we can evaluate things more thoroughly.
Pain: Your pain should get steadily better over time but if pain is a major issue and is not improving, then again that is something for which you should contact the hospital so that we can discuss this with you and see if there is anything else that we can do to help.
Other worries or concerns: Some patients can experience a very slight and soft click or unusual sensation of movement in the hip following surgery. This is normal and will settle as the muscles and soft tissues settle around your new mechanical hip. If there is anything more significant than this, again you should be in contact so that we can be sure that there is no cause for concern.
Of course we totally appreciate for many patients the situation following hip surgery is not something that they will have experienced before. If there is any concern or anxiety whatsoever then you should feel very comfortable and confident to be in contact with my secretary or, indeed, with the hospital, so that we can discuss things further, allay any fears and make arrangements for review if that would be helpful.
Driving post-hip surgery
Patients are understandably keen to return to normal function following hip surgery. This is one of the stated aims of the procedure. As part of that, driving is a very important component of a patient’s independence. It is important, however, that when patients return to driving that they are fully safe, able to control the car and to manage and deal with any unexpected situations on the road.
While I suspect that many patients would feel comfortable to return to driving slightly earlier, typically my advice is that patients who have had a right hip replacement should not return to driving for six weeks. Patients who have had a left hip replacement and drive an automatic car, can return to driving at around four weeks. It is important that before you return to driving you are confident that the hip is mobile, independent and comfortable such that you would feel able to deal with any unusual or unexpected concern while driving a car, keeping yourself and others safe. It is probably sensible for a trial to be performed in a quiet car park in the first instance to ensure that you feel able to drive. If there are any concerns with this please do not hesitate to be in contact.