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Activities After Hip Replacement

Building up your activity slowly but steadily is the best way to boost your energy level and take proper care of your new joint. Joint replacement surgery is a procedure that can restore joint mobility and function in patients with significant joint disease. Although a total joint replacement won't make you an athlete or allow you to do more than you could before the surgery, the goal is a return to comfortable and enjoyable activities of daily life.

Most hip replacement surgeries are very successful in relieving pain and improving motion, but the recuperation can be uncomfortable and requires considerable time and effort by the patient. Typically, patients typically may need three to six months to achieve a full return of strength, energy, motion, and comfort.

Learn how to enjoy your new hip while your safely resume your daily routines:
»  Preparing for Your Discharge
»  Activities in the Hospital
»  Exercises and Joint Positioning After Surgery
»  Recovering at Home
»  Permanent Activity Guidelines

Preparing for Your Discharge

Most patients wish to and can safely return directly to their homes three days after their joint replacement surgery. To help make your recovery as smooth as possible, planning should begin well before your surgery!

Preparing Your Home

When you return home, some activities will be more difficult for a while. The following information and suggestions will make your recuperation safer and easier.

  • You will learn how to manage stairs before you are discharged. There should be no need to relocate your bed if it is on the second floor.
  • Remove loose rugs, electrical cords, and other small items from areas where you will walk.
  • Make sure there are night lights in the bedroom and bathroom.
  • A stable chair with a firm back, arms, and a high seat will allow you to get up easily.
  • Make a list of telephone numbers of helpful friends, family members, and your doctor. Place a copy by each phone. A cordless telephone or mobile phone will be useful during your recovery.
  • Make sure any pets are out of the way so that they do not present a safety hazard while you are recovering.
  • Check the path from your parking spot into the house. Make any needed repairs to walkways or porches so that your return home will go smoothly. Make sure banisters and railings (inside and outside) are safe and secure.
  • Plan seating in rooms where you will be spending time. You'll want a chair with some padding but one that isn't too soft or too low. (For example, it might be difficult to get up from a soft sofa at first, especially if you'll only have one armrest to use for support when standing.) Do not use a chair on wheels, even if it has brakes. Plan to have needed items within easy reach.
  • Organize your bathroom so that you don't have to move a lot while performing daily routines.
  • You may want to prepare some meals in advance and freeze them for use after your surgery. Also, remember that you will not be able to bend over to reach inside low cabinets right after surgery. Put items you'll need within easy reach before you go to the hospital.
  • We don't recommend that you buy special equipment, because you won't know exactly what you'll need until after surgery. However, if friends offer to loan you items such as crutches, a walker, a cane, a tub seat, or a raised toilet seat, feel free to accept. (If you borrow crutches, a walker, or a cane, bring these to the hospital so your physical therapist can make sure they fit you properly.)
  • Lots of people stock up on books, movies, or project work to keep them busy during recovery. This is okay, but remember - you will be busy with exercising and building your endurance and may not have as much 'free' time as you think.

Arrange for Help

You will need help with cooking, cleaning, shopping, other routine household tasks, and personal care during your first week or two at home. A relative, friend and/or home health agency person should be available to help you throughout this time period. Please make sure that you have prepared for this very important assistance well before your surgery date.

Plan Where You Will Get Your Physical Therapy

Plan where you will get your physical therapy once you are at home. If you haven't had physical therapy recently, you may want to visit outpatient clinics near your home to choose one that is best for you.

Plan for Transfer to Extended Care

Although most patients go directly home after their surgery, in certain instances it may be necessary for you to go to an extended care facility (ECF) as an inpatient for a short time when you leave the hospital. Extended care facilities include skilled nursing facilities (SNF) and acute rehabilitation facilities (ARF). At these facilities, nurses and rehabilitation staff take active roles in planning your care in consultation with doctors. You may be advised to go to an ECF if you:

  • live alone and do not have anyone to help you at home
  • have other health conditions that require closer medical management
  • are unable to perform certain functions after surgery (such as getting into and out of bed alone or using the toilet without help)

After your surgery, our nurses, doctors, case managers, and physical therapists will help to identify the best plans for your ongoing care. If you think it is likely that you will need to go to an ECF, please contact your insurance company before your surgery to find out what facilities and costs are covered. You and your family may want to visit these facilities before your surgery to see which ones might best meet your needs. However, please note that sometimes beds are not available at a particular facility on the day you are ready for discharge and another ECF may need to be chosen.

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Activities in the Hospital

Rehabilitation sessions are very important after joint replacement surgery. Your physical therapists help you get safely into and out of your bed or chair, help you walk again, teach you about your post-operative exercise routine, and show you how to use your new joint properly.

The first day after surgery (post-op day one), you will be evaluated by a physical therapist who will help you begin to move your new joint and teach you how to get out of bed and walk. Most patients get out of bed on post-op day one. You may feel dizzy or a bit nauseated the first time you sit up. Take it slowly and these feelings should pass. Don't try to get up alone! But remember - activity helps prevent surgical complications AND is an important part of recovery following joint replacement surgery.

The main focus on post-op day two is getting you up and moving about. Your physical therapist will teach how to properly position your new joint while in bed or moving around. The therapist and nurses will help you get in and out of bed and help you move from chair to bed. You will walk in the hallway using a walker or crutches with assistance on level surfaces and stairs. It will be okay to put weight on your operated leg. You will use a bedside toilet or walk to the bathroom with assistance. If you are like most patients and will be going directly home, the occupational therapist will begin to teach you how to get dressed, bathe yourself, and how to transfer on and off a toilet.

Most patients go home on the third day after surgery. To go home, you should have practiced and be able to:

  • walk independently with a walker or crutches
  • walk up and down stairs with crutches
  • get into and out of a chair and bed by yourself
  • use the bathroom by yourself
  • manage your pain
  • dress yourself
  • do your home exercise program
  • have help at home, if possible

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Exercises and Joint Positioning After Surgery

During the first three months after your hip replacement surgery, you must perform your exercises as instructed, continue with your walking program, and follow instructions regarding positioning your new joint. To protect your new joint while sitting, do not roll the knee on the operated side toward the middle of the body. (That is, no internal rotation.) Follow this precaution for at least three months.

When You Are Sitting

  • DO sit with equal weight on both your hips. Imagine you are sitting on home plate on a baseball field. Position your knees at first base and third base (about six inches apart) with your feet together. DON'T roll the knee on the operated side toward the middle of the body.
  • When getting up and down from a seated position, go straight up and down . Do not  twist. Keep your knees apart with your feet slightly apart.
  • Avoid very low seating positions and use a chair that has arms that you can use to get into a standing position.
  • If you need to pick something up off the floor, reach between your legs.
  • DON'T reach to the outside of your operated leg.
  • DON'T cross your legs at the thighs.

When You Are Resting in Bed

  • While in the hospital, lie with the head of your bed flat at least three times a day for 30 minutes.
  • Do not place a pillow under your operated leg while lying on your back.
  • Once you are home, lie on your stomach three times a day for 30 minutes.
  • When getting into or out of bed, keep your knees apart with your feet slightly apart.

When You Are Sleeping

  • If is safe to sleep on your operated hip if it is comfortable.
  • It is safe to sleep on your stomach. Use a pillow between your legs as you foll onto your stomach.
  • If you choose to sleep on the side of your unoperated hip, it is best to place a pillow between your legs. Make sure your knee from your operated side does not roll over onto the bed.

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Recovering at Home

Once you are at home, it is critically important that you continue with your physical therapy routines on your own every day. The first three to four weeks after surgery are the most crucial in terms of regaining excellent motion of your new joint

Staying as active as you can (while following any restrictions you've been given on how to use your new joint) is a very important part of your recovery. Although you may feel tired, this is not the time to recover by staying in bed! Feeling tired is a normal part of recovering from any surgery. If you need more rest than usual, that's okay. But try to balance periods of rest with periods of activity, gradually increasing your activity each day. Building up your activity slowly but steadily is the best way to boost your energy level and take proper care of your new joint.

Driving

In general, do not drive an automatic transmission vehicle for at least four weeks if you've had left leg surgery or six weeks if your surgery was on the right. (It will be longer before you can drive a car or truck with standard transmission.) You should be walking confidently with a cane or with no support before you begin driving. You must have good leg strength and be able to respond immediately in an emergency - not hesitating because of pain or weakness in the let. You may not drive while you are still taking narcotic pain medication. For specific guidelines about when you may resume driving, please speak to your surgeon at your follow-up appointment.

Walking

Your surgeon and therapist will tell you when you should switch from a walker or crutches to a cane, and when it's okay to walk without support. Remember, patients progress at very different rates. Some patients walk with just a cane after a few weeks, others need more time. Doing what is safe for you is what is most important. Please ask your surgeon or therapist for guidance if you are unsure how to proceed.

Sitting

For the first month after a hip replacement, do not sit for more than two hours in a row. If you do, you may develop swelling in your legs. Frequent walks are very important.

Lifting

Do not lift anything that weighs more than 15 pounds in the first month following surgery.

Kneeling

You may kneel following a hip replacement after six to eight weeks.

Showering and Bathing

In general, you may shower when you incision is completely dry and there are no open areas - usually withing the first week after surgery. Please do not take a tub bath for at least a month. Talk to your surgeon about when you may bathe in the tub.

Sexual Activity

You may resume sexual activity when you feel comfortable, unless your surgeon has instructed otherwise. Please follow the "hip precaution" positions listed below for a full three months.

Swimming and Hot Tubs

Please do not swim or use a hot tub for at least four weeks after your operation. Ask your surgeon when you may resume these activities. When you do, avoid extremely hot water as it can increase swelling.

Exercise in Addition to Physical Therapy

If you are planning to return to the gym or to another form of regular exercise (in addition to your physical therapy), please discuss this with your surgeon and therapist and follow their advice resuming these activities.

Housework

Don't do heavy housework (vacuuming, lifting) for at least one month. Light housework such as doing dishes or preparing meals is okay once you feel up to it. Talk to your surgeon and therapist about when to resume other household activities.

Returning to Work

Returning to work is different for everyone and depends in part on the kind of job you have. If your job requires a lot of walking, standing or physical labor, you could be out of work for two months. Someone who has a desk job can park close to the office and may be able to return in about one month, or possibly sooner on a part-time basis. Please speak to your surgeon and therapist about what is best for you.

Travel

Avoid long-distance travel for about six weeks after surgery. There is an increased risk for developing a blood clot if you are immobile for long periods during this time frame. When you do travel, stretch your legs or walk every hour while awake. If you must travel a long distance in the first six weeks after surgery, it is very important that you contact your surgeon for specific advice regarding blood clot prevention.

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Permanent Activity Guidelines

Joint replacement can help you return to a fuller, more active life. But it is important that you not put unnecessary strain on your artificial joint or it could fail. High-impact activities, excessive body weight and having a joint replaced at an early age are factors that will accelerate the normal wear of the artificial joint and surrounding bone and may cause it to loosen prematurely, becoming painful and unstable.

The  Division of Joint Replacement and Reconstruction at Beth Israel Deaconess Medical Center has provided the permanent activity guidelines following hip replacement surgery.

Approved

Walking
Climbing stairs
Moderate housework
Light or moderate hiking
Swimming
Moderate weight training
Riding a bicycle or a horse
Repetitive aerobic stair climbing
Bowling or golfing
Dancing
Doubles tennis
Cross-country skiing
Moderate alpine skiing

Not Recommended

Singles tennis
Repetitive lifting of 50+ pounds

Should Be Strictly Avoided

Jogging or running
All sports that involve jumping
Basketball
Contact sports
Very heavy lifting
High-impact aerobics

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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Joint Replacement and Reconstruction
Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-3940

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