THR - Total Hip Replacement
Early recovery - the first 12 weeks
You will probably need some help at first when you get home. If you live alone, arrange for a friend or neighbour to call in to see you, or have a phone number handy to call someone.
Remember you don't need to be cleaning anything unless the Queen is stopping by for tea. People will understand if things are not in perfect order. [luvinlex]
Car Travel
Secrets to getting in and out of a car:-
Take your time
Get the driver to park away from other cars
Make use of disabled & 'family' spaces
I had a 'sliding sheet' for getting into the seat, but an old carrier bag works just as well
Push the seat right back, and have the backrest reclined if possible
If you have NHS sticks, use them reversed to hook under and lift your foot in
If you have NHS sticks, use them reversed to close the door
'Upright' cars are better, but I managed ok in a Honda Jazz
The painkillers you are given for use at home have timing constraints and will not be as strong as the ones they are able to administer in hospital.
Continue to take pain relieving medication as long as you need it. Keep up your physiotherapy exercises regularly every day. If you have not been given any exercises to do, there are many websites with suggested exercises. These usually comprise of;
'Upright' cars are better, but I
Calf raises
Knee bends (heel backwards)
Leg extensions (knee backwards)
Leg raises (knee forwards)
Squats
Other exercises are;
Stationary exercise bike
Cross trainer
Clam shells (look on you tube for examples). Lay on your
side on your bed, clench your bottom and lift up your upper knee keeping
your feet placed as close to your bottom as you can (do not allow your
feet to lift up). Bear in mind you will barely move when you first start,
but keeping going and you will soon see an improvement.
As much walking as you can without causing pain or
fatigue, building up slowly. Lots of people using walking poles as this
keeps your posture correct without offering the support of a crutch.
Massaging your muscles in the thigh to release and
stimulate them into action and to help with any swelling
Standing on the operated leg like a flamingo, with the
non-operated leg lifted for as long as you can, counting higher and
higher.
Commit to an amount of time every day if you can doing
these things, and your limp should soon go. Remember that you are learning
to walk again and it does take time, lots of time.
For videos of the exercises, I have found no better source than Hampshire Hospitals NHS Foundation Trust website 'Hip and Knee.tv' http://hipandknee.tv/hip-patients-journey/
Downloadable documents on various aspects of hip replacement are also provided at http://hipandknee.tv/resources/
There are ways around the 90 degree rule, try the "golfer's stretch" putting your operated leg out behind you to allow you to bend over and pick up something from the ground.
You will need to be extra careful to avoid falls in the first few weeks after surgery as this could damage your hip, meaning you may then require more surgery. Use any walking aid, such as crutches, a cane or a walker as directed by your physiotherapist. Take extra care on the stairs and in the kitchen and bathroom as these are all common places where people can have accidental falls. [NHS]
Penguin walking 
If you are walking like a penguin, as an alternative to walking sticks, consider purchasing walking poles. The hand position is much better for your arms and shoulder, and you can use them as a balancing aid rather than for weight bearing, this will encourage your muscles to work harder. Antalgic gait is a walking gait that develops as a way to avoid pain. It is a good indication of weight-bearing pain, following THR associated with groin, thigh and other leg pains. [CelsB]
Scar Pain
Some pain is to be expected in the scar area, massaging the area will de-sensitise the area. Massaging of your scar area with Bio Oil is also recommended by the NHS website to break down and soften the scar tissues inside your body, obviously not until some time after any staples or sutures have been removed. You should not use aqueous cream, recent evidence has shown it can cause burning, stinging, itching and redness. Read more about emollients on the NHS website using this link. (NHS Website)
BUPA recommend massaging the wound site after around 2 to 3 weeks http://www.bupa.co.uk/health-information/directory/s/surgical-wounds [CelsB]
Itching
We all know that we are not supposed to scratch a wound during the healing phase. Here is an excellent guide to why itching occurs and ways to sooth it.
https://advancedtissue.com/2014/10/understanding-wound-healing-itching-dilemma/
Wounds - healing and infection
Here is an excellent guide to spotting the differences between a good wound that is healing, and an infected wound.
https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/
Heat Rash or Bed Sores
When sleeping on your back and being almost chair bound for so long, you may suffer heat rash or bed sores on your back and posterior. Aloe Vera Gel, Almond Oil or a course of hydrocortisone cream may help, but Gold Bond Medicated Powder is highly recommended. Try using the Gold Bond powder at night, and Aloe Vera during the daytime. [Skidget]
Improvements and the roller coaster
You may find that you get sudden improvements when you least expect them - you may get all despondent about making no progress, then suddenly wake up, and it's as if your hip has "seen the light", and you can do something that you couldn't do before, such as walking without sticks. Many people call this the Roller Coaster Ride feeling.
There are major milestones in your progress, but think of them in terms of what you can do, rather than it being a certain time after your operation. So "I can walk half a mile", or "I can walk inside without sticks", or "I can walk outside without sticks", rather than thinking "it's 6 weeks, so I should be able to ....." which is a bit negative.
Recovery alone
Just because you don't have a partner does not mean you cannot make a successful recovery, however good planning is essential.
Stock up with food, put as much as you can higher up (not too high!) so you can reach it easily.
Get emergency supplies like long life milk, part baked bread, tinned food. Cereals keep a long time, and with milk are nutritious.
Get all the aids you can, and practise with them BEFORE the operation.
I used a travel mug with a lid for the first weeks, I found I could get it in my jeans pocket to transport it.
Over-the-shoulder bag (such as an old camera bag), to transport stuff.
Get at least one long reach grabber.
Get stick clips (see Home Preparation) for sticks and grabbers.
Get a long handled shoehorn
Make sure you have some slip on shoes
Keep your mobile phone with you at all times, and program it with a list of friends who can help you if you get stuck, and taxi company numbers in case you need them.
Check out your favourite supermarket delivery options.
Get a 'no bend' washing sponge on a stick, and pet bowls on sticks if you have a pet.
Make sure you have a non-slip bath or shower mat
Get some wet wipes
Stock up on things to occupy you (helps forget the pains), jigsaws, colouring books, music, sewing, knitting, whatever you like.
Get a pedicure
Make sure your washing and ironing are all done before the operation
Get some medical ice packs to reduce swelling.
Everyone Recovers at a Different Rate
Remember, this is not a race, you have already won, you are now pain free.
Most of us have selective memory and only choose to remember the superstar recoveries. The reality is that the majority of patients do recover on the slower side which in fact is more the average side. Many that believe their recoveries are slower choose not to post, thinking they will discourage others from having the surgery. This is MAJOR surgery; we all seem to forget that. If you ever watched one of the videos of a live surgery, you would realize that a lot of trauma goes on during the procedure. When all that happens, our bodies need time to heal, plus this surgery gives us all a 'chance' at our full active lives back. Our rehab and recovery is up to us, the surgeon did his/her job, now it is up to you to relearn how to walk again.... correctly. Do your Physio Therapy exercises religiously as well as your walks but without overdoing it.
Remember that your recovery will be like a roller coaster ride, you will have your up days and you will have your down days. Some days you will feel like you are full of energy, then the next day you could hit a wall. It is all normal.
Take your time; listen to your body.
In the beginning, walk 5 or 10 minutes 3 or 4 times a day with your walking sticks or canes. As your strength and endurance improves, you can walk for 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week will help maintain your strength.
There is NO way you can go back to work at two weeks; your mind will not be all there. It will be hard to keep your attention span for very long; you will probably not think very clearly for several weeks after surgery.
As far as extremes go, you will get some patients that return to running a marathon, at three months post op, or return to skiing at four weeks post op, and while others will return to full out surfing at six weeks post op.
The majority of patients will just take their time and slowly return to normal day-to-day activities and lose their crutches in a month or two months or some even three months. Some patients will be put on very restrictive post op rehab protocols due to having very complicated hip conditions. Remember, the super star recoveries are just a few out of the thousands of stories and patients that have posted on hippy support groups. The average and normal are what we tend to consider "slow", when in reality they are not slow, they are more the average.
Recovery times also vary by surgeon. Check to see what your doctors post op rehab protocol is. If you are a runner and your doctor recommends that you never run again, maybe it's time to look for another doctor? There are different approaches to surgery that cut and disturb different muscles that can add or shorten recovery times. Some doctors have a 90-degree restriction, some do not.
Variables That Can Affect Recovery Times
Your attitude going into surgery! - Some may not look at this as important; but it is very important. The power of positive thinking! Going into surgery, fully trusting in your surgeon and believing you will have a positive outcome can help tremendously.
Surgeon and the surgery - The approach he/she uses, muscles that are cut and or disturbed, tendons that are re-attached or not, how the surgical staff handles the dislocation of your hip (rough handling has caused things such as knee injuries), the type of anaesthesia used and how you handle that personally.
Your hip condition - Your age, your athletic condition going into surgery, how long you have limped and compensated for the bad hip, your muscle mass or loss of it due to the bad hip, how your body deals with trauma, how your body handles anaesthesia and pain meds, successful placement of your resurfacing device, PT and sticking to doing the instructed exercises religiously, walking and listening to your body. If it hurts, stop.
Things to remember
Start up pain/stiffness: Remember that it is common to have start up pain. This is where you first stand up and start walking, you will find yourself limping for the first few steps due to a stiff feeling in your hip. It takes several steps to shake it off but you limp first. Even if you walk it off, then sit down just for a second, stand up again and it comes right back. It seems frustrating, like it will never go away. One brilliant idea that came from Kate on the Patient.Info forum is to tap your foot on the ground when getting up from sitting (either the operated one or the un-operated one), it seems to "wake up" the muscles and stops the ache we seem to experience then we get up for the first few faltering steps. [Kate53CornUK]
According to my physiotherapist, Kate's Toe Tapping Technique stimulates the blood flow that is restricted when we sit down. Walking 'heels and toes on the spot' is good when you stand as it gets the whole leg involved in waking up again. Heel to Toe walking explained on YouTube https://www.youtube.com/watch?v=fhZUQ6ZydA4
Manage expectations. Your expectations of recovery will be
WAY too high for the first 6 weeks. At 12 weeks you may be feeling where
you thought you'd be at 6 weeks. Full recovery really doesn't come until
about 1 year post THR. [LDW]
Be proactive. The more responsibility you take for
understanding your own body and it's messages, and time you take
researching the many methods of healing that are going to work for you,
the better. [LDW]
It's right to call on the professionals when you are
worried about something to give you the peace of mind you need to help
your body stay relaxed during this rehabilitation / healing process. [LDW]
Not all physios are created equal. If yours isn't working
for you, then find a new one. [LDW]
Clunking: it is not uncommon to experience clunking, a sensation that the metal is somehow rubbing against the metal, it is actually ligaments or soft tissues moving around, this should disappear or decrease with time.
Leg Length Discrepancy (LLD): It is common to have the feeling that one leg is longer than the other right after surgery. This also usually disappears with time. Do not wear a shoe lift until you are at least six months out and your body has had the time to adjust itself, and not unless your doctor tells you it is OK. What will happen is that your body will adjust to wearing the shoe lift and you will never even out.
Low Grade Fever: Remember a low grade fever is common after any major surgery, it is only a concern if it goes above 101.
Night Sweats: Another pretty common occurrence is night sweats following surgery. The body has been through a huge trauma and it is trying to release all the toxins that are in the meds you have been on or are on. Some patients wake up completely soaked, others have it mild. Several patients that said their beds were soaked and they even had to change shirts several times during one night. It is irritating, feeling cold and yet be sweating and hot, it is the weirdest thing.
Swelling: Swelling also can occur but not in all patients. Some patients swell up and say their leg looks like an elephant's. Others, experience no bruising or swelling post op. The important thing to remember if you do swell up is to keep your feet elevated, toes above the heart at all times that you are at rest. Use ice, ice and more ice. It is best to prevent swelling from getting started, once it does, it will take a lot more to reduce it. If you sit at a desk or computer, make sure you get up at least every 30 to 45 minutes to walk around and stretch. It is NOT good to sit still following major surgery, you risk blood clots by doing so. Make sure you also WALK, walk and walk some more, plus do your designated PT exercises religiously. You have to keep the circulation going.
Numbness around incision: Another pretty common occurrence is the feeling of numbness around your incision, that will vary as far as length of time it will last, but very common following a major hip surgery like this.
Heel Pain: Another common occurrence is heel pain, this is due to the pressure of the foot constantly being on the bed, similar to a bed sore. It is a heel pressure sore. It may help to place a pillow or two under your ankle and calf to raise your foot so your heel does not touch the bed.
Tired and exhausted: It is also common to feel tired or exhausted a lot, for up to three months post op, gradually decreasing with time. Your body has just been through a tremendous amount of trauma, it needs time to heal; you will be tired for a reason.
Emotions: Besides your physical recovery being like a roller coaster, many also find their emotions become a roller coaster ride. A lot of patients will find themselves all of a sudden crying for what appears to be no reason whatsoever, and not understanding why. It is post surgery depression. It could be the release of all those years of pain we have gone through, for some it is the effects of the anesthesia wearing off, others have been so involved in researching and obsessed with thinking hips 24/7, that once it is all over, we feel left with sort of a "what now" feeling and not knowing what to do with our emotions. Just know that this too is common and will pass.
Recovery Summary: The best advice you can follow is to listen to your doctor; you may have special restrictions due to your own individual case, do not try to keep up with the super recoveries, realize that we are all unique. And ultimately, Listen to your body! It will tell you when you are tired, if it does, rest. It will tell you if it hurts, if it does, stop. Then walk, walk and walk some more.
Shoes: It is a good idea to get a new pair of shoes to wear after surgery. Closed toe, closed heel, slip on. Why? We wear walking patterns into our shoes and bad hips create their own patterns of wear. So we need to avoid slipping back into the former walking patterns by beginning with a new pair of shoes after surgery. We do not need to replace all of our shoes, just that one pair that we use the most. So while you are gathering your post op gadgets and readying your little nest where you will spend the most of your time healing, remember that a new pair of shoes is important also. [DawnDedee]
If you change shoes and the height of your shoes is different, remember to adjust your crutches or sticks to the correct height. [lynn66084]
Big Toe Pain:
As you have to lie on your back after the operation, your toes are in the air with the duvet resting on them. Your big toes being longer than the rest will take the weight of the duvet and the pressure on the nails can be painful for some people. A bed cradle, a sort of metal u shape that you slide under the mattress, will help by keeping the duvet off your feet. You can get them online on Amazon and eBay. [annedi] Although I successfully used a cushion placed upright between my feet.
Bruising
Bruising of the operated leg is common, it is caused when the surgical team dislocate your hip joint during the early stages of the operation. One forum member even had a hand shaped bruise on the thigh and finger print bruises on the arms for a week or so following the operation [Hailea]
Hearing changes
Along with some others, I found that for a couple of weeks after the operation I could apparently hear my own heartbeat in one ear. Hearing loss or changes are reported as one of the most likely complications of a spinal anaesthetic.
Bladder weakness and urgency
Many of us suffer from an urgency to urinate following THR surgery, this may result in a need to urinate once every hour for the first 12 hours or so, this urgency may last for several weeks. It is also reasonably common, especially for women it seems, to suffer from bladder weakness following THR surgery resulting in a wet bed. Sitting around too long and not walking correctly all adds to pelvic and core muscle weakness. One exercise that works well and also strengthens up pelvic floor muscles is to imagine you are trying to get into a pair of jeans that are too tight to do up, around the waist, you tighten up, or suck in, your lower stomach below your belly button. BELOW THE BELLY BUTTON is the trick, after a while it comes, and you at the same time can feel your pelvic floor tighten up. Another reason for this may be that you have a very low grade urinary infection (UTI), this can sometimes be introduced by having a catheter fitted.
Wise words
Give in to not sleeping well. Sleep when you can (day or night), when you are awake watch TV, read or listen to music until you sleep again. Pain will slow your healing process, so keep taking the painkillers. [jamie0456]
I used to use my iPod with a soothing classical music selection.
On any given day, in any given workout, do a little less than you think you can. That will give you a greater reserve of strength for the next session. The night sweats, swelling, mild fevers, sleepless nights, start up pain WILL all eventually go away and you will feel whole again. You are now officially a Hippy. [www.hipresurfacingsite.com]
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Page last updated: 10 August 2018