What happens after the surgery? What are dislocation precautions?

Patients wake up in the recovery room after total hip replacement surgery. Pain is minimized using a combination of a local or regional anesthetic agents (such as spinal or lumbar plexus blocks) and intravenous pain medication controlled by the patient (PCA-“patient controlled analgesia”). Intravenous fluids are given to replace fluids lost during surgery. Once fully awake and comfortable, the patient is transferred to the patient care floor of the hospital. Often, the patient is allowed to sit on the edge of the bed for dinner and get up with physical therapy to begin walking on the new hip.

Physical therapy continues the first day after surgery. Most patients are quite comfortable, even on the first post-operative day. Often the pain from the new incision is less than that of the arthritis that has been alleviated by the surgery. The patient is allowed to place full weight on the new hip and will begin strengthening the muscles and work on getting in and out of bed, in and out of a chair, and will begin walking with the aid of a walker or crutches, or even a cane.

Walking, stair climbing, and exercises to strengthen the muscles of the hip are taught to the patient over the next day or two. Most patients are able to get up and around well with the use of crutches, walker or a cane within 2-3 days. At this point, the patient can usually be discharged home with visits from a home nurse and physical therapist 3 times per week for a week or two. Rarely, a patient may need to go to a rehabilitation hospital for several days after leaving the surgical hospital. This only happens if your walking or general mobility is not considered safe for discharge home by the 3rd or 4th post-op day.

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 mind at all times. 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. (Note: these rules apply only to Dr. Swanson’s mini-incision technique with the capsular noose repair. If you have had a total hip replacement by another surgeon using a different technique, please follow their post-operative precautions.)

Before you go home, you will be seen by an occupational therapist who will provide you some assistive devices such as a reacher/grabber, a long-handled shoehorn, and a sock applicator to assist with these functions during the first few weeks. The therapist will also teach you some tricks for caring for yourself during the first weeks of recovery. You will be discharged with a walker, crutches or cane and an elevated toilet seat for temporary use.

You will be discharged with a pair of elastic stockings to minimize swelling in your legs and pooling of blood in your veins. You will also be instructed to take one coated aspirin twice daily (or in some cases, a stronger blood thinner), iron supplements each day, a non-steroidal anti-inflammatory drug such as Motrin, Advil or Aleve, and pain pills when you need them. You will continue the exercises you were taught in the hospital on a daily basis and continue working on your walking.

Surgery Preparation Tips

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