If the joint replaced was the only area of arthritis no further anti-inflammatory tablets will be required. If other joints are affected or you suffer from rheumatoid arthritis, the tablets may be restarted if possible after an interval of 6 weeks. Pain killers may be taken during this time.
After 1 days the physiotherapist will get you out of bed to commence walking with the help of crutches or a walking frame. The physiotherapists will also begin to encourage you to bend the hip and knee. Sitting is allowed only after 2 days and then only on a high chair. The early exercises and mobilising of the hip will cause some discomfort and swelling. However, this is normal and is just the healing process occurring. Any swelling or discomfort in the calf muscle of either leg should be brought to the attention of the nursing staff.
After 5 - 10 days you are usually able to walk with minimal or no pain, although the assistance of sticks, crutches or a frame may be necessary. You should be able to manage stairs with the assistance of a banister, and to care for yourself around the home. When this is possible you will be discharged from hospital. This is usually within 5-7 days.
Whilst at home the exercise programme of hip exercises should be vigorously continued. Approximately 10 minutes each hour will be ample. Out patient physiotherapy sessions should be arranged during this period. The progress is variable, so do not worry if your progress is a little slow at this stage. If the hip becomes more swollen or more painful than during the first day, or the wound becomes infected, please return to your General Practitioner for early review. I will review your progress in the clinic after 4 or 6 weeks.
Results and Complications
Modern techniques and technology ensure that the complication rate is minimal. Beside the anaesthetic risks, which are very low, infection that involves the joint is less than 1:200. This would present as the hip becoming hot, swollen, throbbing and painful after 2-4 days, or alternatively at any period thereafter. Venous thrombosis is in the order of 1:5. To avoid thrombosis anti-coagulant therapy will be given for a short period after the operation. Thrombosis presents with a swollen, tender calf muscle, or intermittent pain in the chest on deep breathing. There is a risk to the major vessels and nerves of the hip, but this is very rare.
Dislocation of the hip replacement may occasionally occur. This usually happens when the hip is bent excessively or the legs crossed. In order to avoid this problem a pillow between the legs should be used at night for 3 months. The legs should not be crossed. Sitting in low arm chairs and couches should be avoided and a raised lavatory seat is available from the Occupational Therapist who is contacted through your General Practitioner.
Generally, hip replacement should, if cared for, last 15 years in over 90% of patients. After joint replacement, in order to avoid infection of the new joint, all infections or dirty cuts must be adequately treated with antibiotics. This includes any urinary infections or bad chest infections. Any further surgery must be covered by a short period of antibiotic therapy. This includes any dental treatment or urinary catheterisation. A yearly review should be undertaken with an up-to-date X-ray. This is to ensure that the prosthesis is not becoming loose. If you move home you should inform the secretary so that follow-up can be arranged.
Return to Work / Sport
If your job is sedentary and mostly sitting you may wish to return after only 3 - 6 weeks. If your job is physically demanding and requires standing or walking for most of the day, your return to work may take several months. Driving can usually be performed after 4 to 6 weeks, providing that the hip is pain free and you are able to control the car with foot pedals and make an emergency stop. Swimming is often possible after 3 - 6 weeks. Return to golf, gentle tennis or badminton may take 3 months. Jogging and squash is not advised.
The first follow up appointment is usually arranged for 4 weeks after surgery and subsequently after some weeks or if progress is good a year later.