When you get home

The first few days

When you are going home the it is important to be careful, make sure you don't fall or have an accident. You should be safe to transfer from bed to chair, chair to the toilet and you be able to wash and cope with meals. In particular for the first few days make sure there are no accidents and be particularly careful with stairs and when reaching for things.

Sleeping

It is fairly common to advise patients to sleep on their back but more frequently we allow patients to lie on the opposite side to their surgery as it can be a lot more comfortable. It is important to place a pillow between your knees to make sure the hip is not abnormally abducted (crossed over the other leg) or moved into a rotation which again may cause a dislocation, but advice does vary quite considerably between surgeons and units. It is fair to say that advice and instruction will be given prior to discharge from therapists and staff as to how you can avoid potential dislocation and that is basically to avoid moving the knee to far up towards the chest and twisting the knee inwards.

How much exercise should I do?

Once you are home, during the day you should keep reasonably active, try and walk two or three times a day with your crutches. Some patients like to get out of the house and walk for 10-15 minutes a day in the first few weeks but others take it a bit more steady and do most exercise inside. There is no set protocol and patients increase their activities at slightly different rates. It is probably inadvisable to try and do too much too soon. We usually advise our patients to take it fairly steady for the first six weeks to allow the repaired muscles around the hip time to heal. You can of course go out and about, travelling in a car as a passenger is normally possible from day one although we wouldn't normally allow you to drive for the first six weeks. Time spent on crutches is quite variable depending on the type of surgery. It may be from as little as three weeks, but many patients feel they need crutches for a lot longer. Sometimes we ask patients to remain partial weight-bearing for up to 6 weeks. This should be discussed with your surgeon. When coming off crutches we recommend using one crutch in the opposite hand to that of your surgery until you feel confident in the house then progress to using only one crutch outside. Some patients move to using a walking stick for a period but eventually you will feel confident enough with your new hip to discard walking aids altogether.

Follow up

Patients are normally reviewed in the outpatient clinic between six and twelve weeks and if all is going well and the wound is fine we normally advise patients that they can drive, lie and sleep on their side and to do light exercise such as on an exercise bike or swimming. This is obviously the chance to talk to your surgeon about any queries or concerns you may have.

Returning to recreational activities

For patients who wish to return to medium level activities such as golf or gentle rambling then this can normally be started gradually at about 12 weeks. For those wishing to get back to higher level activities such as racquet sports, jogging, horse riding or any form of competitive activity then this would not normally be undertaken for six months and should be discussed in depth with your surgeon.

Physiotherapy

Many patients assume that extended or intensive physiotherapy is necessary after a hip replacement but this is often not the case. The main input from the physiotherapist is during the hospital stay to make sure you can use crutches properly and are safe to go home. Often patients do not need any physiotherapy after that period because their recovery is dictated by the general recovery and healing process and their activity and return to normal occurs as a natural process. Furthermore, the muscles around the hip can be exercised just as effectively in normal walking as with specific exercises that may put the hip at risk of dislocation.

Occasionally there are specific indications for physio and of course after knee replacement surgery physio may be required, but again, the knee flexion after knee replacement may occur in any event so it is not always necessary for physiotherapy. There are various exercises which may be supplied to you by the hospital and these are often are grouped into general health exercises to reduce blood clots, breathing exercises, muscle contractions and muscle strengthening and rehabilitation.

Long term follow-up

The British Hip Society recommends that patients be seen at one year and then at five yearly intervals, undergoing x-ray examination on each occasion. The reasons for this are continued post operative surveillance are to ensure the well-being of the patient. It is believed that the surgeon is probably the best person to analyse the x-ray for any adverse signs that there may be in terms of the fixation, performance of the hip component and to make decisions about the action that may or may not be necessary. We frequently use questionnaires to follow up patients and these are sometimes sent in the post in-between follow-up appointments. Some institutions are under pressure to discharge patients back to their GP for follow-up of their hip replacement.

The National Joint Registry (NJR)

Since 2003 the National Joint Registry of England and Wales has been collecting data on patients undergoing total hip and knee replacement. Currently data is being sent in on 80% of patients however the rate of data capture is increasing. The NJR are able to analyse this data to produce information regarding performance of implants and other techniques in relation to hip and knee replacement surgery. (www.njrcentre.org.uk)

(last updated 19/06/08)