What is a Total Hip Replacement?
Total Hip Replacement (THR) involves the replacement of the hip joint with a manmade prosthesis. The upper end of the thighbone (femur) is replaced by a metal or ceramic component whilst the socket (acetabulum) is replaced by a plastic, ceramic or metal cup. Your consultant will decide the type of prosthesis you will be having. The movement of the ball component of the femoral prosthesis and the socket, provides a low-friction artificial joint that has the potential of lasting for many years.
The components may be fixed in place by various means, often with a special cement. Sometimes a cementless procedure is used and this may affect how much weight you are allowed to put through the leg initially – you will be advised of this by the medical team.
What Should I Expect From My Hip Replacement?
Your new joint will glide smoothly and within a few days after surgery you will notice you have less pain in your hip. The pain should decrease everyday. However, you will have some restrictions with certain movements to prevent your hip from dislocating. Your physiotherapist and nurse will assist you in learning how to take care of your new hip.
Before Coming into Hospital
Start making arrangements for going home after surgery:
- Decide who will take you home from the hospital
- If you live alone or are home alone during the day, plan for family or friends to help you around the house for a week or two after coming home from hospital. You will need help with laundry, cleaning and shopping after you get home. Start getting your home ready. Look around your home and see if there is anything that may be a problem for someone using crutches or a stick
- Take up all scatter rugs and tape down edges of large area rugs
- Keep walkways clear of furniture and electrical/telephone cords.
We recommend that your bed and chair are at a height so that whilst seated and supported your knee is bent at 90 degrees i.e. your upper leg is horizontal. This is dependant on your height.
However, depending on the strength of your non-operated e.g. and your strength in general, you may wish it to be a little higher.
- Obtain a chair with a firm high seat and arms. You will not be able to sit in a recliner, soft low chair, rocking chair, swivel chair or sofa for at least 6 weeks after surgery as these could dislocate your hip
- A handrail is recommended if you have steps into your home
- Stock up on groceries and pre-cooked meals so they can be reheated and served easily
- Place night-lights in dark hallways and have a flashlight at hand for trips to the bathroom at night
- Place items you use everyday at arm level to avoid reaching up or bending down
- If possible, get yourself fit before the operation. Swimming, cycling or doing the exercises described in the booklet, if the pain allows, is a good start.
Arm exercises may also be of benefit. Contact your physiotherapist for advice. Practice your transfers as described in the latter part of this page.
What Happens When I Come into Hospital?
- When you arrive at the admissions office on the ground floor, they will take your details and you will be shown to your room
- You will meet the nurses who will be looking after you. The nurses can answer any questions you may have
- Your physiotherapist will come to see you and discuss your operation, what to expect after the operation and the exercises that you will need to do before and after your operation
- The anaesthetist will visit you before your operation and tell you what will happen when you have an anaesthetic
- It is important you understand what operation you are having and what is written on the consent form before you sign it. If you are unsure about anything, please ask any of the healthcare team
- You will not be allowed to eat or drink anything for six hours before your operation. Your nurse will tell you when you have to stop eating and drinking
- It is important that you bring any relevant scans and equipment, such as your raised toilet seat, when you are admitted.
What Happens When My Operation is Finished?
- After your operation you will be looked after by a nurse in the recovery area near the theatres
- When you wake up your leg may be supported by a pillow. This is to keep your leg in the correct position
- The nurses will measure your blood pressure and pulse while your anaesthetic wears off. As a routine check the nurse will also measure the pulse in your foot
- When you wake up you may have been given some painkillers. If you need anything, or are in pain, please let the nurse know
- When you are resting comfortably a nurse and a theatre technician will take you back to the ward.
What Happens When I am Back on the Ward?
You should commence your chest and circulation exercises immediately (featured later on this page) to prevent any risk of developing a chest infection or blood clot/DVT. You may be seen by a physiotherapist postoperatively on the day of your surgery, and depending on the type of operation you have had, you may get up out of bed or commence bed exercises.
The Day After Your Operation:
- Your physiotherapist will visit you and assess your chest and circulation, check your exercises and assist you out of bed
- You will have a routine x-ray of your hip joint and a blood test
- Depending on your consultant, you may get out of bed on the day of your operation or the following day
- You will be required to sleep on your back for 4 weeks with a pillow, between your legs to remind you not to cross your legs. After 4 weeks you may lie on your operated side with two pillows between your legs
- It is recommended that you alternate between lying in bed, sitting out in the chair, doing your exercises and walking throughout the day as this will help to decrease swelling in your leg and relieve any pressure on your bottom.
1. Deep Breathing Exercises
Take 5 deep breaths in through your nose trying to expand your lower ribs and then breath out completely through your mouth. If this brings up phlegm, cough to clear.
2. Ankle Pumps
Pump your feet upwards and then point them away. Draw circles with your feet. This can be done as often as you wish.
3. Quadriceps & Gluteal Contractions
Tighten your bottom and thigh muscles. Hold the contraction for a few seconds. Repeat 5-10 times.
4. Heel Slides
Bend your unoperated knee up and down by sliding your heel towards you. Attempt this with your operated leg to no further than 90 degrees. Repeat 5-10 times
5. Hip Abduction
Take your operated leg out to the side as far as you comfortably can and then back to the centre, taking care not to take it over the midline (you may need help with this initially). Ensure your toes are pointing out towards the ceiling and do not twist your hip. Keep your trunk straight throughout the exercise. Repeat 5-10 times
Hold onto the back of a sturdy chair/table for support. Repeat each exercise 5-10 times, 4 times per day. Standing on your unoperated leg.
- Lift your operated leg to bend your knee (be careful not to bend the hip beyond 90 degrees). Relax and repeat. Repeat 5-10 times
- Take your operated leg out to the side. Hold out for 2 seconds (move your hips, not your pelvis). Relax and repeat. Ensure your back is straight. Repeat 5-10 times
- Take your operated leg straight back behind you, tightening buttocks and abdominals. Hold for 2 seconds. Relax and repeat. Keep your back straight; do not lean forward or bend your knee. Repeat 5-10 times
4. Hamstring Curls
Bend the knee of the operated leg whilst keeping the hip straight. Relax and repeat. Repeat 5-10 times
The following exercises should only be carried out if you are full weight bearing. Your physiotherapist will demonstrate them to you.
5. Mini Squats
With your feet shoulder width apart, slowly bend your knees to about 30-40 degrees. Hold for 3-5 seconds and then slowly return to the upright position. Repeat 5-10 times
6. Heel Raises
With your feet shoulder width apart, and equal weight through both legs, lift your heels and stand on your toes. Relax and repeat. Repeat 5-10 times
What Should I Not Do After the Operation?
Having a hip replacement changes some of the original anatomy of the hip. The ligaments and capsule that normally enclose the hip joint are temporarily weakened. You will be relying upon your muscles to maintain and create that stability again after the operation. It will take approximately 4-6 weeks for your ligaments and capsule to heal and your muscles to be strong enough to safely hold the hip in its socket under normal stresses.
During the 4-6 week period, it is imperative that you eliminate any risks that may dislocate your hip. Certain movements must be avoided. These are:
- Do NOT cross your legs over your midline. Keep your knees slightly apart at all times
- Do NOT bend your hip more than 90 degrees. Which means: DON’T raise your knees above the level of your hips. DON’T bend down over your legs. Don’t bend down to pick up objects from the floor or lean forward. Keep your knee lower than your hip at all times.
1. Getting In and Out of Bed
We advise you to get in and out of bed on the side of the operated leg. Your operated leg is likely to feel heavy for the first few days after surgery.
Getting out of bed: Sit yourself forward in bed, propping yourself up on your arms. Using your upper body strength, turn your body around so that your legs come off the edge of the bed. Ensure that you keep your legs apart. Make sure you do not bend forwards further than 90 degrees. Once you are sitting on the edge of the bed put your operated leg out in front of you. Push up from the bed into standing. Your physiotherapist will teach you this movement the first time you are out of bed.
Getting into Bed: Sit down on the edge of the middle of the bed, reaching back with one hand at a time to control your descent. Slide your operated leg forward as you lower yourself putting all your weight on your unoperated leg. Bring your bottom as far back into the bed as possible by supporting your upper body with your arms. Then turn your body around making sure you keep your legs apart. You may need help at first.
2. Sit and Stand (From chair/bed and toilet seat)
It is advisable to sit in a high, firm-backed chair with arms. Avoid sofas, low or backward sloping chairs.
When sitting, back up to the seat until you can feel it against the back of your legs. Slide your operated leg forward as you reach back for the arms of the chair with your hands and slowly lower yourself down taking the weight on your unoperated leg and your arms. When getting up, slide your operated leg forward and use your unoperated leg and arms to push up. Reach for your walking aid only AFTER you have gained your balance standing. NEVER try to pull yourself up from the seat using your walking aid.
The surgical team, or physiotherapist will advise you on the amount of weight you are allowed to put through your new hip. You may be Full Weight Bearing (FWB) or Partial Weight Bearing (PWB) depending on the type of operation. This will dictate which mobility aids you will be using and the way you walk. If you are PWB you will use crutches until your consultant advises otherwise. Your physiotherapist will supervise your walking, correct any abnormal patterns in your gait and progress your mobility as able. When turning, ensure that you do NOT twist but instead step around with the foot of your operated leg facing outwards at all times.
Going up and down stairs: It is important that you successfully complete a flight of stairs before discharge. This is so that when you go home you will know the correct technique for negotiating your stairs at home.
Going up Stairs
Hold the stair rail on one side and your crutches on the other side. Place the unoperated leg up first followed by the crutches and the operated leg to the same step.
REMEMBER THE ‘GOLDEN RULE’: GOOD (unoperated) leg UP to heaven BAD (operated) leg DOWN to hell.
Going upstairs with two elbow crutches
Place unoperated leg up first, then crutch and operated leg together.
Going Down Stairs
Hold the rail on one side and your crutches on the other side. Place the crutches and the operated leg down first, followed by the unoperated leg onto the same step. Remember the crutch and the operated leg move together.
Going down stairs with two elbow crutches
Place crutches with operated leg down first, then unoperated leg.
5. Getting In and Out of a Shower or Bath
The method varies depending on what you have at home. A walk-in shower is the easiest way to wash yourself. It is recommended that you do not bath for at least 6 weeks. If you have a shower in a bath you will need a bathboard or stool to help you get into the bath. Otherwise it is best that you strip wash during the 6 week period. Your physiotherapist will discuss this with you during your stay in hospital.
6. Getting In and Out of a Car
After your operation, you should only sit on the passenger seat and not use a black cab for at least 4-6 weeks. The car should be parked at least half a metre from the kerb with the passenger side adjacent to the footpath. Move the passenger seat back and recline the backrest half way. Enter the car with your bottom first making sure your operated leg is out in front of you and holding onto the dashboard and the side of the car for support. Move as far back into the seat as possible before swinging your legs around. Reverse the order to get out of the car.
Discuss with your consultant when you are able to drive again. It is usually 4-6 weeks after your operation.
Get dressed while sitting on a high chair with arms, or on the bed, and put everything you need within easy reach before you start. The important thing to remember is DON’T bend or twist when dressing the lower half of your body. Use dressing aids to help you. An extend-a-hand (can be purchased from the hospital) is useful for underpants, tights and trousers and for picking up anything out of reach and a sock-aid and long-handled shoe-horn will help with putting on your socks and shoes. With pants, tights and trousers: put them on the operated leg first and take them off the unoperated leg first. The nursing staff will practice this with you before you are discharged from the hospital.
Raised Toilet Seat
You may need to use a raised toilet seat following your surgery. If so, please bring your own toilet seat into hospital with you as we do not provide them.
- A long-handled sponge is useful to wash your legs and feet
- A rail installed by the bath wall may provide you with some stability when getting in and out of a bath.
- Non-slip mats in and outside of the bath or shower will decrease the risk of falling
- If you are worried about turning over in bed, have pillows on either side of you to prevent this
- If you are fit enough, your physiotherapist will show you how to pick up objects off the floor safely using an extend a hand
- An apron with pockets, shoulder bag or knapsack is useful to carry items around the house
- It is recommended that you have a pair of rubber soled slip-on shoes for easy wear and reducing the risk of slipping
- A high stool (without wheels) in the kitchen is helpful especially for doing the dishes
- You may resume sexual intercourse when you feel ready. You should be the passive partner initially. Remember your hip precautions. Stop if it becomes painful
- Once at home, try to gently increase your level of activity, walking a little further each day. You should continue to use your walking aids as advised
- You must continue to adhere to all the precautions listed for at least six weeks after your operation. The tissues around the hip will take this long to heal completely
- Experience has shown that patients do not normally need any special exercises or physiotherapy when they go home, but must continue the exercises that have been shown in hospital
- Tell your GP that you have had a hip joint replacement and inform him/her if you are unwell or develop an infection, skin rash etc. If you need dental treatment, tell your dentist that you have had a joint replacement. The same applies if you have any other form of surgery or treatment.