Physiotherapy Following Hip Replacement Surgery

This booklet is for patients who have had hip replacement surgery at Gateshead Health NHS Foundation Trust.

Inpatient length of stay

We aim to get you home as soon as possible following surgery once all discharge goals have been achieved and you are medically well. This is usually 1-2 nights after surgery.

Some patients may be suitable to have day case surgery which will be discussed prior to admission. This means you may be discharged on the same day as surgery.

Hip Precautions

Hip precautions are used to keep your hip joint in safe positions that will help prevent dislocation while the soft tissue around the hip is healing.

The following precautions are to be followed for 6 weeks after surgery:

Do NOT bend your hip past 90°
Do NOT move your leg across midline (e.g. no crossing legs, lie on your back in bed)
Do NOT twist when standing

Goals of initial rehabilitation:

Restore hip range of movement (within hip precaution ranges)
Regain strength
Reduce swelling
Adequate pain control

Discomfort

Post-operative pain, swelling, and bruising are a normal part of the recovery process following joint replacement surgery. The muscles and tissues surrounding your hip will take time to heal. You will require pain relief medication on a reducing basis, usually over at least 6 weeks following the surgery. Crutch use, ice, activity pacing and rest may help.

Increased discomfort at night and difficulty sleeping is very common following a hip replacement, this should improve with time.

Following your discharge from hospital; you need to apply the ice pack three to four times daily for 15-20 minutes. You will be able to reduce the frequency after this time but will find that you will benefit from ice therapy for up to three months to help manage the pain.

If you have any concerns regarding managing your pain, please discuss this with your GP.

Swelling

Swelling and inflammation is a normal part of the healing process. This can last up to a few months or longer but will improve with time. Swelling of the leg is different for everyone and may cause the leg to ache and feel very heavy.

Swelling, either around the knee/hip, or throughout the whole leg, is normal. It can worsen once you return home, as you start to do more.

Bruising may appear near the operation site and may then travel throughout the leg (from hip to knee). This is quite normal and may remain for a couple of weeks.

Elevating your leg on a stool or on the bed will also help manage the swelling.

When should I seek help?

You should see your doctor urgently if you:

Have a sudden increase in severe pain, swelling or tenderness in the calf which is getting worse and not just related to pain expected while performing the exercises.
Have concerning pain, swelling or tenderness in the joint which is getting worse.
Develop a high temperature and feel unwell.
See fluid, pus or blood coming from the wound.
Develop new numbness or tingling near to the joint.

Mobility and Walking Aids

After your operation, it may be necessary for you to use crutches to help you walk. Your physiotherapist will provide you with a pair of crutches and show you how to use them.

Everyone is different as to when they stop using crutches; this often depends on your previous level of mobility. When you feel confident with your elbow crutches and you are able to walk without a limp, it is recommended you progress to using only one crutch in the hand on the opposite side of your surgery.

For example: if you have a left hip replacement, use your elbow crutch/stick in your right hand.

Once you are no longer using your crutches; please return them to the hospital. You will be provided with further guidance from the outpatient physiotherapy staff as to when it is appropriate to gradually stop using elbow crutches.

Stairs / Steps

Going up stairs with a rail

Keep your crutch/es on the step you are standing on.

Step up with your un-operated leg, then your operated leg and then bring your crutch/es up onto the same step.

Going down stairs with a rail

Put your crutch/es down first into the middle of the step below. Step down with your operated leg and then follow by your un-operated leg.

Going up stairs without a rail

Keep your crutches on the step you are standing on.

Step up with your un-operated leg, then your operated leg and then bring your crutches up onto the same step.

Going down stairs without a rail

Put your crutches down first into the middle of the step below. Step down with your operated leg and then follow by your un-operated leg.

Exercises

It is important that you continue doing the exercises that have been given to you by the physiotherapist on the ward. These exercises should be completed three to four times a day.

It is normal to experience additional discomfort whilst doing these exercises and for up to an hour afterwards.

Prior to commencing exercise, it is advisable to take adequate pain relief to optimise the benefit of these exercises. Especially if you are finding them difficult. Then use ice following completing your exercises.

Ankle Rotation

Lyingor sitting: rotate your ankle in circular movement

Repeat 10-15 times, 3-4 times a day

Hip abduction (lying)

Lying on your back; slide your leg out to the side. Keep your body straight throughout the exercise

Repeat 10 times, 3-4 times a day

Hip Flexion

Lying on your back; bend knee slowly towards you then straighten maintaining good control

Repeat 10 times, 3-4 times a day