Everything I wish I had known before, and after, my hip replacement
So you’re thinking about a hip replacement. Here’s what you can learn from my experience before and after surgery, from pain management to when to get your teeth cleaned … and will you be able to manage the dog?
When I had a total hip replacement earlier this year, like many people I had no idea what I was in for. These are all of the things I wish I’d known before and after the procedure.
Why wait? Your artificial joint might last a lot longer than you think
I was limping around for almost three years before my hip replacement, doing everything I could to delay the procedure. I figured I should wait for as long as possible before going under the knife given what I’d been told about prostheses generally lasting only around 20 years. I was stunned when I went to see my orthopaedic surgeon and he told me the new generation joint he would implant in my body could well last me a lifetime.
Nobody really knows the life of these new joints, but the prospects of them lasting a lot longer than 20 or 30 years seems high, according to orthopaedic surgeons.
One thing that many people don’t necessarily consider when they try to put off hip surgery is the biomechanical impacts on the rest of the body. Lack of mobility in the hips and an impaired gait has knock-on effects on the posture and potentially the knees.
No orthopaedic surgery is without risks, and a total hip replacement is not a decision to be taken lightly. There’s no guarantee of a perfect result, but the surgery is one of the most successful orthopaedic surgeries with a very high rate of good outcomes. Despite being relatively young for this surgery, I’m glad I didn’t wait any longer than I did.
The surgical approach
The traditional surgical method in a total hip replacement is the posterior approach, in which an incision is made at the back of the hip near the buttocks. During the surgery, the surgeon will split the gluteus maximus muscle to access the hip joint.
Some surgeons instead perform hip surgery via an anterior approach, where the incision is made at the front of the hip. This avoids cutting through muscle and can lead to less soft-tissue damage, less pain and a faster recovery, but it is associated with a small risk of nerve damage.
Another modern technique is hip resurfacing, which involves trimming damaged parts of the femoral head and replacing the hip socket with a metal cap. Hip resurfacing may be suitable for younger people who are keen to return to high-impact exercise after surgery (this is the type of hip surgery the British tennis player Andy Murray had before going on to continue playing professional tennis).
Preparing for surgery
In the weeks leading up to your surgery, you’re going to want to get organised with a set of crutches, a “grabber” to allow you pick things up off the floor as you won’t be able to bend down for several weeks after the surgery, and a shower chair for the first couple of weeks. A raised toilet seat is highly recommended as if you have the posterior approach, it’s recommended that your bottom is always higher than your hips when sitting – this is one of the hip precautions to minimise the risk of dislocation.
For the same reason, a wedge cushion for sitting on chairs or the couch is also very useful. Be sure to have a couple of ice packs on hand at home as well.
In the months leading up to your surgery, you should do all that you can to strengthen your lower body. This will stand you in good stead for your recovery. The stronger you go in to the surgery, the stronger you’ll come out.
Call in help
Be sure to stock your freezer with meals for the first week or two, or organise a food delivery service. If you have a dog, organise someone to walk your dog for a few weeks. Even though you’ll be walking soon after surgery, you won’t be able to manage walking a dog while you’re on crutches. If you’re on your own, as long as you have these factors organised, having a carer with you for more than a couple of days probably won’t be necessary, but be prepared to let the cleaning go for a few weeks.
The days before
Your anaesthetist should call you in the week leading up to surgery. If you’ve taken pain medicines before, make sure you tell them what has worked well for you in the past and what hasn’t. Hospitals typically give endone as pain relief immediately after surgery, but some people are non-responders to this medication and if it hasn’t worked for you in the past, you should tell your anaesthetist. It’s useful to specifically discuss with your anaesthetist what the protocols are for pain management. Oxycodone given orally is the first line of pain management in some hospitals, and believe me if it’s not doing anything for you, you’re going to want to know what the protocol is for accessing stronger drugs or an IV unit.
On the day before the operation, it’s recommended you use an antibacterial wash on your skin the night before and the morning of surgery to minimise infection risk. Make sure you stay really well hydrated the day before surgery. Some people take Gatorade for this reason.
Immediately after the surgery
You’ll typically have a spinal anaesthetic as well as general, so pain should be minimal upon waking up from surgery. Your legs may feel numb from the spinal. Nurses may give you oxycodone orally or via IV once you’re on the ward. It’s very important to stay on top of your pain relief after surgery. Doctors speak of “staying ahead of the pain”, and this means you should never wait until you’re in a lot of pain to take medication. It’s best to take pain meds continually so the pain is manageable – this is really important in order to get you up and moving as soon as possible.
You’ll have a urinary catheter in immediately after surgery so you don’t need to worry about navigating your way to the toilet for the first 24 hours or so.
You’ll typically be visited by a physio within 12 or 24 hours after the surgery who will help you take a small walk supported by a walking frame. Hospital stays after hip replacement are generally a few days, and during this time physios will help you learn to manage stairs and let you know when you may be ready to progress from a walker to crutches. People are generally discharged from hospital on crutches (you’ll need your own).
Don’t worry if you have stairs in your house – navigating stairs after hip replacement is really very easy, with the method being to lead up the steps with your non-operated leg, and down steps operated leg first.
You will be able to shower sitting in a chair in the hospital as soon as you’re mobile – surgical dressings used these days are very waterproof.
Be prepared to deal with constipation – oxycodone blocks most people up. The hospital will generally give you an osmotic laxative daily, but be sure to drink a lot of water and don’t be shy to ask nurses to give you a glycerol suppository if you haven’t moved your bowels after a few days. Prunes and pears are great to have on hand.
Pain and swelling
Don’t be surprised if your operated leg is black and blue after surgery. Significant swelling is also normal, and this should subside within a few weeks but sometimes can hang around a lot longer. Apply ice packs regularly in the days and weeks after surgery.
It’s difficult to predict how much pain you may experience. Hip replacement is major surgery. Some people are in a lot of pain in the days after surgery, and others not. For most people, the worst of the pain subsides within about a week.
Sleeping
For the first couple of days after surgery you’ll have to sleep on your back, which can be a challenge for side sleepers. After a few days, ask your doctor whether it’s okay to sleep on your non-operated side with a pillow between your legs. You won’t feel comfortable to sleep on the operated side until a few weeks after surgery.
Take as many naps as you need in the weeks after surgery. Many people feel a lot of fatigue.
Keep moving
Walking is the best thing you can do for rehabilitation. You can build up a little more every day, but try not to increase your step count or distance too quickly – a little more every day is the key. After two to three weeks, you may be able to walk a kilometre or even two on your crutches, but don’t worry if you’re much slower to progress. All recovery is individual.
Physios in the hospital will give you some exercises to do. Usually these include leg slides in your bed, squeezing your glute muscles in bed, and then progressing to standing lateral raises and vertical raises of your operated leg, and perhaps sitting up and down out of a chair if you’re ready.
If you are in a health fund, your policy should provide you with ongoing physio at home for a few weeks, either through a hospital in the home rehab provider or a private physio. You also have the option of choosing to go to a rehabilitation facility, although the outcomes between these two options are little different, according to the evidence.
Once your incision is fully healed, generally after a few weeks, you will be able to move your rehab to a swimming pool if you wish. The water provides excellent resistance during exercises such as walking in the water or performing lateral raises or kickbacks to build up your strength.
Returning to work
I was able to return to work after three weeks, working a couple of days from the office and the rest of the time at home. Some people need a lot longer. Prepare your workplace that you may need six weeks off, or more if you work a manual job.
The long term
After you see your surgeon for the six-week follow-up and get the all-clear to return to exercise, if you wish you can progress your movement to stationary-bike cycling. Avoid treadmills at first as they are too risky given the moving platform. Under the guidance of your physio you should also be able to start to increase the resistance using bands or weights in strength-based exercise to rebuild your legs, focusing on quads, glutes, abductors, adductors and hip flexors. Be sure to be gentle on yourself; after surgery, your body is still working to integrate your metal joint by growing native bone around the prosthesis. If you are a gym-goer, performing upper-body strength work as normal should be fine after six weeks but be guided by your physio.
I would stay away from gym classes for a while as they can be too fast and unpredictable. My surgeon said yoga was OK but just be careful of your hip precautions (such as avoiding too much hip flexion) and let the teacher know you’ve had a hip replacement. My surgeon also recommended never squatting below 90 degrees or deep lunging after a hip replacement, and to avoid any rotational movements for the first few months.
Expect to notice a significant difference in strength between your operated and non-operated leg for a substantial period of time. It’s likely to take a year or even more to feel fully back to normal.
As far as driving goes, you’ll need to get clearance from your surgeon before getting back behind the wheel. You won’t be able to drive until your operated leg has recovered sufficiently to be able to operate the pedals – for most people this generally takes four weeks or so.
Leg length discrepancies
Some people notice that their operated leg seems longer than the other one after surgery. It’s very rare that there is a true leg length discrepancy given that surgeons are so precise in their measurements. Usually the cause is a tilt or twist of the pelvis because of the impaired way you’ve been walking prior to having the surgery. Try not to panic if your legs seem markedly different in length. The body usually naturally balances itself out. If you feel particularly uneven in the longer term you can see a podiatrist who may recommend an orthotic, or you can wear heel lifts in your shoes. Often people may need the other hip replaced in future too – and if this is the case your legs will generally end up the same length once you’ve had your other hip done.
Red flags
There is a small risk for weeks, months or even years after surgery of an infection forming in the prosthesis. A lot of people opt to get a dental scale and clean before the surgery as this procedure can release bacteria into the bloodstream. You should be particularly careful that any cuts or scrapes don’t become infected after you’ve had surgery, and to take antibiotics promptly if you develop a urinary tract infection. If you notice any redness developing around your incision site at any point, contact your surgeon or see your doctor immediately.
Preserving the life of your new hip
Unless you can’t live without it, it’s not recommended to return to jogging or any high-impact exercise after a hip replacement. If you do so, be prepared that your new hip won’t last as long. Otherwise, life can return to normal in every other way after recovering from a hip replacement. Most people are overjoyed to be able to live a pain-free life. Oh, and you’re probably not going to set off any alarms at airport security either. The days when prosthesis triggered alerts seem to be behind us in most airports.
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