• Posted May 21, 2024

What to Expect During Rehab After Hip Replacement

Hip replacement is a major, arduous elective surgery, and rehabilitation afterwards takes time, according to an expert from Johns Hopkins Medicine in Baltimore.

It'll also take coordinated planning between yourself, your care team and your family and caregivers, said Dr. Savya Thakkar, an orthopedic surgeon and expert in minimally invasive and robotic-assisted total joint replacements at Hopkins.

Hospital discharge

Hospital stays after a hip gets replaced are not long, Thakkar said.

"Most patients can start walking and can go home the day of the surgery,"Thakkar said in a Hopkins news release. "Most people don't need bed rest. In fact, moving your new joint keeps it from becoming stiff."

Post-surgical overnight hospital stays are typically only mandated for folks with underlying medical conditions (for example heart or lung issues that might need monitoring).

Or, if you do not have someone who can take you home and then help you out there, an extra night in the hospital might be warranted.

Inpatient rehab at the hospital could also be advised for patients who've had particularly complex hip replacement surgeries, Thakkar added.

How soon will rehabilitation start?

"Patients will have physical therapy before the hip replacement surgery, and then work with a physical therapist right after the surgery to reinforce exercises before they go home,"Thakkar explained.

Next, rehab continues for a few days post-surgery, and appointments will be set up to see occupational and physical therapists. You'll also get instructions on exercises to do at home.

Rehabilitation typically starts with training in simple tasks -- getting out of a bed or chair, for example. Then it progresses to more complex tasks such as getting in and out of cars or climbing stairs, Thakkar said.

All of that requires muscle strength, so weight training and resistance exercises -- especially those focused on the hips and knees -- are always a part of hip replacement rehabilitation.

Will you need to use a cane or walker?

That's evaluated by your health care team, Thakkar said, but these devices might be needed to lower your odds for a fall. It is generally not necessary to keep the weight off the surgically repaired hip, however.

What about that hip incision - how long till it heals?

"The incisions for a hip replacement surgery nowadays are very small and are closed up with absorbable sutures,"Thakkar said. Modern incisions take about six weeks to heal. They're covered with a dressing, but you can shower per usual, although its best to avoid baths and swimming until the incision heals completely.

How much post-op pain is considered normal?

The area around the hip replacement will swell and there will be some discomfort, Thakkar said. Some pain is to be expected, but if you judge your pain to be consistently at a 6 or higher on a 1-to-10 pain scale, tell your doctor, since that could signal infection or some other complication.

Some ways to ease the pain during rehab:

• Rest up between therapy sessions

• Use ice on the leg/incision site

• After checking first with your doctor, try taking anti-inflammatory meds

• "Keeping the leg elevated above the heart when you lay down can also help the swelling to recede,"Thakkar added.

Ideally, as rehabilitation continues your pain should gradually subside till it reaches a 1 to 2 on the scale within three months after your operation.

You want to return to regular activities -- how soon can that happen?

Thakkar said that all depends on how physically strenuous the activity is.

Driving. This depends largely on which hip you had replaced -- if its the left hip, then driving is probably feasible about one or two weeks post-op, but if it's the right hip, count on closer to a month before getting back behind the wheel.

Work. Again, that depends on your job: Desk jobs take usually two weeks to feel comfortable again, while jobs that demand heavy lifting might take up to six weeks to return to, Thakkar said.

Sports. You might resume easier sports like golf whenever it feels comfortable. But stay away from rougher contact sports for about six weeks, according to Thakkar. Swimming is problematic, too, and you need to wait until the incision fully heals before getting back into the pool, usually up to six weeks.

How long does it take full recover?

"On average, hip replacement recovery can take around two to four weeks, but everyone is different,"Thakkar said. Pre-surgical activity levels, your age, nutrition, preexisting conditions and other health and lifestyle factors can all impact recovery times.

"Achieving a certain level of activity before you have the surgery can help you bounce back more quickly," Thakkar said. "We use a regimen called pre-rehabilitation, or prehab, to help patients get in a physical shape that will set them up for a successful recovery."

Watch out for certain hazards

"As with any surgery, there is some risk of complications during and after a hip replacement, which may include infection at the incision site, bone fractures and hip dislocations,"Thakkar explained.

Warning signs are fever, drainage from the site of incision, trouble moving or severe pain that meds don't relieve are all signs you need to reach out to your doctor.

In general, be careful during rehab to avoid sudden, sharp movements that can trigger dislocations, and of course take care to avoid falls.

How long will my new hip last?

Older hip implants were made of metal, but newer ones are largely composed of ceramic and plastic, so their life expectancy is much longer -- typically 20 to 30 years, Thakkar said.

You've had one hip replaced -- what about the other one?

"If you suffer from severe arthritis in both hips, you could get both joints replaced at the same time [double hip replacement]. This might actually be safer and lead to quicker recovery in some patients,"Thakkar said.

There are pros and cons to a double hip replacement, however. On the pro side, recovery can actually take less time, because anesthesia isn't as big of an issue, Thakkar explained, and recovery times can actually be shorter.

However, getting both hips replaced at once does require a doubling of effort during rehabilitation, because both legs will need strengthening. It might also mean you need more help at home during the rehab period.

On the other hand, Thakkar said, if you want both hips replaced but not at the same time, wait at least six weeks between the procedures to lower your odds for a blood clot.

SOURCE: Johns Hopkins Medicine