what to expect after HIP Replacement

---

   With arthritis, the weight bearing surfaces of the hip joint become worn away. They are no longer smooth and free running and this leads to stiffness and pain as the bone of the thigh bone (femur) grinds on the socket in the pelvis. 

A total hip replacement replaces these surfaces with plastic and metal. The hip end of the femur is replaced with a smooth metal component, which fits into the end of the thigh bone. This articulates with a cup which replaces the socket in the pelvis.

 The surgery is performed via an incision (cut) down the side of the hip of about 15cm in length. The hip joint is dislocated and the round head on the top of the thigh bone is removed and replaced with the metal component. The cup in the pelvis is replaced with a new cup lined with either plastic or ceramic. When your surgeon is satisfied with the position and movements of the hip, the tissue and skin are closed with stitches (sutures). 

 You are usually admitted to hospital on the morning of surgery. The hospital staff at the will call to advise your admission time. You need to take relevant x-rays, current medications and their prescriptions. 

On the day of surgery you will see your surgeon and anaesthetist before your operation. An anaesthetic will be administered in theatre. This may be a general anaesthetic (where you will be asleep) or a spinal block (where the area to be operated is completely numbed). 

 You will wake up in the recovery ward and then be transferred back to your room. 

   You will be encouraged to stand and take a few steps on the same day as your surgery with the use of a walking frame.  

 You will go for an X-ray the day after the operation. 

Your physiotherapist will assist you to get out of bed and walk a short distance. This will be progressed over a few days, till you are independently mobile. 

You will be encouraged to get up and out of bed as much as possible, and shown exercises to improve the strength and regain the range of motion of the hip. 

   In most instances you can take as much weight on your leg as comfortable. The exercising will cause some discomfort and swelling, however this is a normal part of the healing process. 

An ice pack can be used regularly to help reduce the pain and swelling. 

After a few days you should be walking reasonably comfortably for short distances, be able to manage stairs, and dress and care for yourself independently.   

We encourage you to take all of your meals sitting out of bed and dress in normal loose fitting comfortable day clothes.

Immediately after surgery some hip discomfort and swelling is normal, and is just part of the healing process. Ice packs should be used regularly to help reduce the pain and swelling around your hip. You will be given regular pain relief. 

The hip wound sutures are dissolvable and do not need to be removed but the wound will remained covered until healing is complete (around 10 days).  When you leave hospital your hip wound will be covered with a waterproof dressing.  

 Once the dressings are removed the wound may appear slightly red and raised with small scabs which are normal. It will slowly heal usually to a fine white scar over about a year.

Most patients stay in hospital for 3-5 days, and then go home. Wherever possible we encourage you to go home to continue your rehabilitation. Current evidence including our published research suggests that routine prolonged stay in rehabilitation hospitals is not beneficial. 

The hospital staff will guide your ongoing treatment in the form of either home visits, outpatient rehabilitation classes or a self directed exercise program. 

You will be provided with medications to take home to manage your pain.  You should schedule an appointment with your GP for a check up within the first week of going home.  

Most patients will be walking with crutches or a walking stick and be able to manage stairs, and dress and care independently. 

Once home we encourage you to perform your exercises regularly and commence a walking program. 

Activity trackers such as an apple watch or fitbit can be useful to track your activity level. In general aim for 1000 steps per day in week one and increase your goal by 1000 steps each week.

We recommend you follow the following hip precautions for six weeks to reduce the risk of dislocation. 

1. YOUR HIP SHOULD NOT BE FLEXED MORE THAN 90 DEGREES 

Chair seat height should be knee height or higher, with arm rests to enable you to get out of it easily. Deep lounge chairs should not be used.

Don’t bend forward to pick up items and don’t lean forward to put on your stockings/socks and shoes

2. NO CROSSING OF YOUR LEGS

Do not cross your legs when you are sitting down, standing up or lying down. 

Keep your knees apart when bending to reach between your legs, rather than reaching to the outside of your leg.

3. NO TWISTING OF YOUR LEG

Keep feet facing the direction you are going, rather than feet planted and then twisting

4. SLEEPING:  You should sleep on your back, or on the side that is not operated on, with a pillow between your legs 

5. Avoid LIFTING or carrying anything heavy

 It is common to have some soreness, stiffness and some swelling around your hip for 3 months after surgery, especially with activity. 

Local numbness around the wound is expected. The hip may also feel slightly warm for this period. 

Pain medication should be tailored to the individual symptoms. Narcotic medications should be ceased as soon as tolerated. 

Sleep disturbance in the first few months is common.  

Walking is encouraged as exercise, and an excellent goal is about 7000 steps per day for healthy adults over 65 years.     

Return to work depends on the type of work you do and your ability to travel. 

 Most people can usually return to driving after a hip replacement once they can safely control the car—particularly being able to do an emergency stop without hesitation or pain.

Right hip: Because the right leg controls the accelerator and brake, you’ll generally need 4–6 weeks before reaction times return to safe levels. 

Left hip(automatic car): You may be able to drive sooner, often at around 2–3 weeks, since the right leg is used for braking and accelerating.

Key factors before resuming driving:

No longer taking strong painkillers (like opioids) that impair reaction or judgment.
Able to walk comfortably and bear weight on the leg.
Good control and strength in the hip, with adequate range of motion.
Practice in a safe setting first, such as an empty car park, before going on the road.

It is usually safe to take a short flight a week after surgery as long as you do not have blood clots in your legs. Long flights are best avoided during the first few months after surgery, as there is a risk of deep vein thrombosis (blood clots in the legs).

If you must travel, we recommend you wear TED stockings, mobilise throughout the flight as much as possible and if possible keep your legs elevated when seated during the flight. If it is necessary to travel long distances, then speak to your GP or surgeon prior to doing so. They may recommend you take some preventative medications.

You should not plan significant travel which would involve a lot of daily walking for at least 3 months after hip replacement surgery.

Swimming, golf, walking, cycling, lawn bowls, gardening and social tennis are examples of excellent options to explore to keep fit after hip replacement. However, you should plan to refrain from exercises such as pilates, golf and social tennis until 2-3 months after surgery. 

With all sporting activities it is advised to  progressively increase intensity as your hip symptoms tolerate. For example for golf get comfortable at the driving range or putting green, and plan to use a cart initially. For tennis practice with a friend and start with doubles format.  For cycling, start on a stationery bike.  

High-impact sports involving jumping, running, and quick pivoting, such as basketball and football, should generally be avoided.   Activities which put your body into extreme poses at end of range, such as yoga, are not recommended at any time after hip replacement.  

If you are enthusiastic about a particular sport, please seek instructions from your surgeon.   

After joint replacement current evidence suggests that routine use of antibiotics for all dental procedures is not

indicated. Rather this decision should be based on the expected associated risk of infection associated with the

procedure. For routine non surgical dental treatments, including extractions no antibiotics are required, unless

otherwise indicated.   

Prophylactic antibiotics may still be considered for patients with high risk such as 

Immunocompromised status: Patients with weakened immune systems are at a higher risk.

Recent surgery: A dental procedure within the first three months after a joint replacement is a higher-risk situation.

Infection from a dental problem: Dental treatments for established tooth infections are more likely to require antibiotics.

You should arrange to attend the Mater Hospital preadmission clinic before surgery to be meet with an Anesthetist and hospital staff. If you live remotely this can be organised over the telephone. You can discuss your medical history and options for your anaesthetic. This should be scheduled for 2-4 weeks prior to your surgery. Phone: (02) 9900 7494 

Prior to you appointment  complete the online admission and registration form, and have your pre-operative blood tests. If your Surgeon has asked for a review with a cardiologist or Physician, have this prior to your Pre-Admission appointment.  

You should also contact the Mater Continuous Care Team who can assist in your preparation for surgery and discharge to home.

 You should disclose to your anaesthetist if you are taking any blood thinners, hormone tablets, diabetes or weight loss medications. Your anaesthetist will give you individual advice, but in general you should stop arthritis medications such as anti-inflammatories for one week prior to surgery as they increase bleeding. Take only panadeine or paracetamol for pain relief during this period.  GLP-1 receptor agonists (such as semaglutide [Ozempic, Wegovy], dulaglutide [Trulicity], liraglutide [Saxenda/Victoza])  Tirzepatide (Mounjaro®) are being used more widely for both diabetes and weight management.  GLP-1 medications slow down stomach emptying. This can increase the risk of vomiting or aspiration (food or fluid going into the lungs) during anaesthesia. To keep you safe, these medicines are usually paused a few weeks before surgery.  Your anesthetist will give you specific instructions for your individual case. 

Eating well rounded meals in the weeks before surgery emphasizing complex carbohydrates and especially high quality proteins which will support recovery and strength. Protein intakes of 1.2-2.0g/kg/day is recommended in the weeks before surgery. Supplements can be helpful in achieving these goals.  If you have diabetes, it is important to keep blood sugar under good control — this lowers risk of infection and helps healing. 

Alcohol increases bleeding risk and may interact with anaesthetic so is best avoided in the week before surgery. High-salt foods may increase swelling and blood pressure.

Eat a balanced meal the night before: lean protein, vegetables, and whole grains, and avoid alcohol and heavy, fatty, or spicy meals that can upset your stomach. 

You will usually be asked to fast from midnight the day before surgery which means you should have no food, and drink clear fluids only.   

Make Moving Around Safer

Clear walkways: remove loose rugs, cords, and clutter to prevent tripping. Ensure hallways, stairs, and bathrooms are well lit. Check that any stair rails and grab bars are secure.
 

Set Up Comfortable Living Spaces

Make sure you have a firm, supportive chair with arms that is not too low, to make standing up easier. Chair seat height should be knee height or higher, with arm rests to enable you to get out of it easily. Deep lounge chairs should not be used. 

 Bed height – Your mattress should be high enough that you can sit without your hips bending past 90°.
A raised toilet seat makes it easier to sit and stand without bending too much.
 

Plan for Meals & Essentials

Stock up on groceries: freeze easy meals or prepare healthy options ahead of time.  

Keep essentials handy: place frequently used items (phone, TV remote, medications, water bottle) within easy reach at waist level. 

In the kitchen move frequently used items out of low or high cupboards so they can be easily accessed. 

Consider help: arrange for family, friends, or community services to assist with shopping, cooking, or cleaning in the first few weeks.

Ensure you have supportive and comfortable shoes, with a flat grip sole that fully enclose your feet 

Walking aids: you will likely use crutches or a stick when you return home. These can be purchased or hired  before surgery. Before surgery, practice and get comfortable using these aids around your home. 

Bathroom aids: a raised toilet seat, shower chair, and non-slip mats can make bathing safer and can be hired.

Pet care: make arrangements if you have pets that may get underfoot or need walking. 

Transport: arrange who will drive you home from hospital and to follow-up appointments (you won’t be able to drive for several weeks).

Some simple exercises can be beneficial in improving the strength of your leg before surgery which may assist your post operative recovery. 

Use of a stationary exercise bike is encouraged. 

Some other simple exercises are

1. Wall squats from 0-90 degrees of knee flexion.

2. Side Leg Lift. Lying on your side with the bottom knee bent, slowly raise and lower your leg

3. Hip Extension. In a standing position, slowly lift your leg back-ward, keeping your knee straight.

4. Bridging. Lying on your back with your knees bent, slowly raise your buttocks from the bed, keeping your stomach muscles tight.

You may benefit from an appointment with a physiotherapist if you would like a more personalized program. 

Walking is encouraged as exercise, and an excellent goal is about 7000 steps per day for healthy adults over 65 years.  

This video available on the Mater Hospital website may also be a useful guide.