Recovery at Home

Once home you will continue to work on exercises learned in the hospital. You can walk as much as you find comfortable, but should follow the dislocation precautions closely. When able to walk without the use of the walker or crutches you will progress to a cane (used in the hand opposite the side of the surgery). When you are getting around without a limp the cane may be discontinued, particularly for short walks around the house. The home nurse will be available to assist you with your first shower or bath after you arrive home.

The nurse will monitor your wound and change your dressing if needed. You will have a plastic surgery wound closure, so there will be no staples or sutures to remove. The home therapist will monitor your exercises. If all is going well you may not need the services of either one for more than 1-2 weeks.

Dislocation Precautions

Since use of the “Capsular Noose” procedure, developed by Dr. Swanson in 2002, dislocation of the artificial hip is unlikely. However, during the early post-operative period while soft tissues are healing, you should be careful to avoid extreme positions, especially turning the knee inward when your hip is flexed (such as while sitting down). Always remember, as long as you can see the inside part of the operative side knee, dislocation is extremely unlikely, even with bending over.

The physical therapist will teach you stretching exercises to help cross your ankle over the opposite knee for handling shoes, socks, clipping toenails, etc. Always keep the knee rotated outward when you bend the hip past 90 degrees (such as reaching for something on the floor when sitting in a chair).

As a general rule, it is always safe to flex the hip past a 90 degree angle if you have rotated the knee outward enough that you can see the inside part of the knee—keep this rule in your mind at all times; it will eventually become automatic when you bend over.

Additionally, you will be given specific exercises by a Physical Therapist to help strengthen and stretch the muscles around the joint. Do these exercises regularly, at least 3 times daily, during the first 6 weeks after surgery. Stretching exercises are also important, particularly rotating the knee outward. You will be taught to sit in a chair with your feet together and press the knees outward while bending forward a bit. You will also begin to slide the operated ankle up the opposite leg with the knee rotated outward to eventually enable a “figure-4” position to allow easy access to your feet. Remember, as long as the knee is rotated outward, it is very difficult to dislocate the hip.

Blood Clot Prevention

Graduated compression stockings (TED’s is a common name) are used to prevent blood clots in the legs – called deep venous thrombosis (DVT). Patients are required to wear them for 6 weeks post-operatively to keep the blood from pooling in the veins of the legs when inactive. They also help prevent post-operative swelling of the legs. The type that is issued at the hospital has holes at the tip of the stocking to allow staff to check blood circulation in the foot. You may buy additional compression stockings at a medical supply store. You may wish to buy the closed-toe variety, which many patients find more comfortable. Your leg must be measured for correct fit. After hospital discharge, TEDS can be removed a few hours at a time for comfort, but you should try to wear them as much as reasonably possible. At four weeks post-op you may begin to remove your TEDS at night. You will require assistance to put on or remove your TEDS. When planning for help post-operatively, keep in mind that if you plan on removing your TEDS at night you will need someone to help you at least twice daily.

You will also take an adult aspirin twice daily for 6 weeks. Aspirin is a mild blood thinner that helps prevent blood clots in the legs. Patients at higher risk for blood clots may require a stronger blood thinner, sometimes by injection, for 2-4 weeks. You or a family member will be taught how to administer these injections prior to leaving the hospital. Additionally, you should try to move your ankles up and down frequently (“ankle pumps”) as this exercise promotes circulation in the legs.

Weight Bearing Restrictions

Due to excellent primary fixation of the total hip components, you will be allowed immediate full weight bearing as tolerated on your new hip. You will be up and taking a few steps the day of or the day after surgery with a walker or crutches and the help of a hospital physical therapist. Two or three days after surgery, you may find yourself able to do one or two laps around the nurses’ station once or twice daily and work on ascending and descending stairs if necessary. The hospital physical therapist will continue working with you on walking until you are released from the hospital. Once home, you should continue walking and performing the exercises learned in the hospital, initially under the supervision of the home physical therapist. In general, weight bearing “as tolerated” means putting your full weight on the extremity, with or without the use of walking aids (walker, crutches or a cane). Walking should be kept within reasonable limits. You will use a walker or crutches initially and advance to a cane or no support at all when able to walk without a limp. If you are allowed only partial weight bearing, you can walk over a bathroom scale to see how many pounds you are actually bearing. The hospital PT will order a walker for you prior to discharge from the hospital. Most insurance companies will pay for your walker. You may want to check with your insurance company to confirm this. Otherwise, you will have to make arrangements to buy or borrow one to take to the hospital upon discharge and for use at home. Many people attach carrying bags or baskets to their walker to make carrying things with them easier.

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