Total Hip Replacement
Information for patients
Understanding
arthritis and hip
replacement
Patient Name_________________________Hospital Number________________
Consultant______________________
Please keep this booklet and bring it with you to all your
appointments, your inpatient stay and your follow up
appointment. The blank pages are provided for you to
write your own notes
Important Dates
Pre Assessment Clinic ______________________________
Notes
Operation Date_____________________________________
Admission Time____________________________________
Notes
Expected discharge Date______________________________
6-10 week Follow up Appointment______________________
Notes
1 Year Assessment___________________________________
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The Hip Joint
The Hip Joint
The hip joint is a ball and socket joint. The ball is on the top of the thigh bone (femur)
and the socket is at the lower part of the pelvic bone and faces sideways. The ends of
the bones are covered by a smooth lining known as articular cartilage and the surfaces
glide on each over with the help of a natural lubricating fluid, called synovial fluid. The
synovial fluid is produced by one of the soft tissues around the hip called the synovium.
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Osteoarthritis
Osteoarthritis
Osteoarthritis, often referred to as OA, is the most common form of arthritis, and is the
most common reason for joint replacement surgery. Osteoarthritis is a degenerative
disease that destroys the joint articular cartilage, often leading to painful bone on bone
contact. It can cause pain, stiffness, swelling and loss of motion in the joint, which may
vary in duration and severity from person to person.
Treatments such as the painkillers, physiotherapy exercise, support braces, and weight
reduction can help control the symptoms of osteoarthritis for a time. When these
treatments fail to provide adequate relief from pain, total hip replacement may be
recommended. Your surgeon will assess your individual condition and prescribe a
treatment that will give you the best results.
Rheumatoid
Rheumatoid
arthritis
Arthritis
Rheumatoid arthritis is an autoimmune deficiency syndrome, meaning the body’s
immune system attacks and destroys healthy joint articular cartilage. Rheumatoid
arthritis can occur at any age, even in children, and it is considered a systemic disease
that affects multiple organs.
In the joints, rheumatoid arthritis causes inflammation of the lining tissue, the
synovium. Inflammation can cause pain, stiffness, swelling, warmth and redness, and
can eventually lead to cartilage loss.
Rheumatoid arthritis often affects many joints such as the hips, knees, and hands. This
disease can have periods of flare-ups followed by a quick remission of symptoms.
Rheumatoid arthritis is a chronic condition that may last a lifetime. However, treatment
is available to help reduce pain and swelling, and slow joint destruction.
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Total Hip Replacement
Total Hip Replacement
When performing a total hip replacement, the surgeon removes the damaged ball
part of the hip and the damaged lining of the socket. The socket is prepared to
receive a plastic material to provide a new lining. The ball part of the hip is replaced
with a new metal ball which is applied to the top of a metal stem, which is implanted
down the shaft of the thigh bone.
Usually, the new socket lining and the stem in the thigh bone are cemented into
place. Sometimes the surgeon may choose not to use cement and if so obtains
fixation of the new hip components directly to the bone. In this situation the
components have a titanium lining that the bone will grow onto and lock the
components to the bone over the first 4 to six weeks.
In some patients the ball and lining to the socket are made from ceramic material if
the surgeon feels that this is the best option for the patient.
The components that are implanted into the pelvis and thigh bone are designed to
closely imitate the mobility of the natural hip joint. The operation takes about one and
a half hours to do and you should be able to leave hospital from 2 days after surgery
depending on your progress and individual circumstances.
Xray of a pelvis showing one hip replaced.
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Preparing
for Surgery
surgery
Preparing
for
We aim to see and treat all patients within 18 weeks from referral from the GP,
however there will be exceptions depending on any other investigations and treatments
which may be required. During this time you will attend several appointments. You will
meet one of the orthopaedic surgeons and have xrays to decide that you really do
need a hip replacement.
You will also need to attend a pre-assessment clinic to make sure that you are fit
enough to have the surgery. During this visit you will attend a pre-operative education
class during which you will be told a lot more about the operation. You will also have to
undergo further tests, depending on your specific problems to ascertain your suitability
for surgery. Some patients may need review by an anaesthetist at this stage,
depending on your medical history.
At this appointment, you may be asked to sign a consent form and the complications
associated with surgery will be explained to you before you give your consent. This
form is very important and you need to listen carefully to the information given to you.
Sometimes this form is completed on the day you come into hospital.
Physical Conditioning –
It is important to be as fit as possible before undergoing joint
replacement. Participating in a doctor-prescribed exercise
program before surgery can help patients make a more rapid
recovery. Moderate exercise is an integral part of treating
arthritis. Activities such as walking, swimming, riding a bike or
gardening can assist in keeping your bones strong and your
joints supple, which may help relieve stiffness.
Low-impact exercise will not wear out your joints. Although exercise may sometimes
cause discomfort, proper exercise will help nourish the cartilage, strengthen the
muscles, and prolong the life of your joints. Your hip may be so painful and stiff that
exercise is not possible, in which case try to keep as active as you can. Having your
muscles in good condition prior to surgery will help you in the recovery phase after the
operation.
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Nutrition
Proper nutrition is a concern for joint replacement patients. Orthopaedic surgeons
recognise that many joint replacement candidates may not be in peak nutritional
health. Try to eat a well balanced diet; more information is available from Preoperative assessment clinic. Proper nutrition can assist in a Rapid Recovery by
assisting in wound healing and energy levels A high intake of Vitamin C the day
before your operation is recommended, fruit and vegetables are a good source
of this.
Stopping Smoking
Before surgery it is absolutely essential to stop smoking. It is necessary to stop
smoking at least two to four weeks before the planned procedure. Smoking impairs the
transfer of oxygen to the healing tissues, which may increase healing time and the
possibility of other complications. The hospital is a non-smoking site so you will not be
able to smoke during your hospital stay. There are lots of national initiatives available
to help you stop smoking. Patches may help you during your hospital stay.
High Blood Pressure
High blood pressure can result in your operation being postponed. If, at pre- operative
assessment clinic or on admission to the ward, your blood pressure is high, you will be
asked to go home and seek advice from your GP. This would obviously be a great
disappointment to you and your family as it could delay your surgery until your blood
pressure is better controlled.
Feet
Your feet are very important and need to be well looked after prior to joint surgery.
You may have found difficulty in bending due to pain and have been unable to treat
your feet, resulting in corns, in growing toe nails etc.
If you have any of these problems then a chiropodist can help you. Getting problems
sorted out before your admission will help you to regain your mobility quicker. It is
probably best to talk to your GP or practice nurse about getting referred to a
chiropodist.
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Bone Donation
The Bone Bank co-ordinator may see you in the Theatre Admissions Lounge on the
day of surgery to ask if you would be willing to donate the piece of bone, femoral head
(ball), removed during surgery. This can be stored and used for others. It requires your
consent and a blood test to look for infections passed on by blood donation. This blood
test is then repeated 6 months to a year later. You will not be able to donate your bone
if you have:

A Blood transfusion

Hepatitis (Jaundice)

Tuberculosis (TB)

Cancer

Syphilis

Rheumatoid Arthritis

Leukaemia

Haemophilia

Multiple Sclerosis

Parkinsons Disease

HIV/AIDS

Long term steroid treatment

Crohns disease/ulcerative colitis

Pagets disease

Perthes Disease
If you require further information please ask for the ‘did you know you could become a
bone donor leaflet’ or telephone 605312.
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Healthy Skin
For your operation to go ahead your skin needs to be healthy and free from sores or
open areas. People who suffer from eczema, psoriasis, leg ulcers or any other skin
conditions need to be extra careful. In the weeks leading up to your operation you must
ensure that any open areas on your skin are healed and there is no infection present.
For advice and treatment of any skin complaint you must consult your GP or practice
nurse.
There is a possibility that your operation could be cancelled if your skin is not healthy.
A swab from your nose and possibly groin will be taken at pre-operative assessment
clinic to ensure you are not carrying the bug Methicillin Resistant Staphylococcus
Aureus (MRSA). If this swab is positive you will receive treatment through your GP and
re-screening. You will not be able to have your operation until the swabs are negative.
Urinary Problems
This is a problem that nobody likes to talk about. Up to three million people in the UK
suffer from stress incontinence (leaking when laughing or coughing). Incontinence can
cause urinary infection and complications following surgery including wound infection.
Getting help with this problem will reduce the risk of infection. A urine sample will be
taken at pre- assessment. If positive, you will need antibiotic treatment before your
operation. It may possibly delay your surgery date. If you are experiencing any
symptoms of a urine infection it is a good idea to visit your GP before your preassessment date.
Support on discharge
You will need further assistance on discharge as you may not be able to manage some
housework and fitting special compression stockings used to prevent thrombosis (see
later). Please ensure that you have somebody to help you with these tasks on
discharge for a temporary period of time. Please discuss your needs at Pre operative
assessment clinic.
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Home Environment
You will be sent a furniture heights form with your appointment to attend pre
assessment clinic.
It is very important that you complete the form and bring it with you to your
appointment. At this appointment a member of the Occupational Therapy team will
discuss your heights form with you and agree on the necessary equipment needed to
aid you in your post operative recovery and ensure you adhere to your hip precautions.
You may need some of your furniture raised depending on your measurements. This
will all be ordered and installed before your admission.
A Checklist to help you prepare for admission:

Ensure you have received all the equipment you are expecting before
admission. If not please contact the occupational therapy department.

Ensure care arrangements are in place for any dependents or pets you
may have.

Ensure you will be able to get out of bed on the side of your operation.

Organise someone to be able to help you with your thrombo-embolic
stockings.

Reorganise your kitchen so that you can reach all essential items without
bending.

Perhaps plan for some ready prepared meals for when you first return
home. Make sure your cupboards are well stocked before admission so
that you don’t need to worry about shopping on discharge.

Try talking to family, friends and neighbours about help with shopping and
heavy household tasks.

If you normally collect your medication, you may need to ask someone to
do this for you initially or organise a delivery service.
If you have any concerns about any of the things to do before your admission, please
notify the occupational therapist (01793 646114) or a member of the team at your preadmission appointment.
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In InHospital
Hospital
Before Surgery
You will be admitted to the theatre admissions lounge (TAL). This is a dedicated area
within the operating theatres where patients can be assessed and prepared for
Orthopaedic surgery. Please bring all your medications into hospital with you.
When you arrive the nurse will assess you, take a blood sample and prepare you for
theatre. You will also be seen by the anaesthetist who will discuss the type of
anaesthetic you are going to have for your operation. A nurse may visit you to discuss
bone donation.
The surgeon will see you and mark the leg that is to be operated upon. The surgeon
will also check your consent formed is correct and signed. This will be completed if not
already done at the pre-assessment clinic.
Your belongings and medications will be taken up to the ward while you are in theatre.
Please do not bring any valuables. The only items needed are sensible footwear, not
new as your feet may be swollen, washing items, a set of day clothes which are easy
to put on, and nightwear/dressing gown. You must also bring your current medications
with you. A small amount of change may be needed for newspaper magazines during
your stay.
The Anaesthetic
While you are in the Theatre Admissions Lounge The Anaesthetist will come to see
you to talk about your anaesthetic.
Generally the type of anaesthetic used for hip surgery is:
Regional anaesthesia with light sedation. This is a spinal anaesthetic which is injected
into your spine and makes you numb from the waist down. The advantage to this is
that you are awake but sedated. There is a lesser risk of blood clots and chest infection
and less sickness associated with this type of anaesthetic. But you may need a urinary
catheter and will not be able to feel your legs for 4-6 hours after surgery.
If you are unable to have a spinal anaesthetic then a general anaesthetic will be used.
This may be supplemented with nerve blocks to numb your leg. The advantage of this
is that you are unconscious during the surgery. This anaesthetic can make you quite
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sleepy and nauseas after surgery. The nausea can be controlled with medication.
The Anaesthetist will discuss with you which procedure is best for you.
After Surgery
You will be collected from the recovery unit by a nurse from the ward. You will be
wheeled back up to the ward in your bed.
You will have an Intravenous Infusion (IVI) in a needle in the back of your hand or arm
when you return to the ward; this will continue for a short while until you are drinking.
You may need a urinary catheter, but if it is required it will be removed as soon as
possible after your surgery.
There may also be drain coming out from your thigh to drain away any blood which
might otherwise accumulate in the operation site.
The anaesthetist will advise you before the operation as to the best method of pain
relief for your operation.
The nurses will be giving you regular painkillers. If these are ineffective then please ask
the nursing staff to review the painkillers that you are receiving. Keeping your pain
controlled enables you to start physiotherapy as soon as possible after your operation.
The physiotherapists will come and help you to stand and maybe take a few steps as
early as 2 hours after you return to the ward. If you are going to stand up on the day of
your surgery the nurse looking after you may put some extra fluid into the intravenous
drip in your arm just before you stand and you should eat something. It is important to
start moving as soon as possible after surgery to encourage blood flow, to regain
motion and to facilitate the recovery process. Early mobility also helps to prevent
complications, see page 17. You will be out of bed and walking with walking aids very
soon after your surgery, often on the day of the operation. A positive frame of mind is
vital to your recovery and you will be encouraged to spend the day out of bed and in
comfortable day clothes, returning to your night wear and bed only for sleeping.
Although they will look after you and care for you, the hospital staff will encourage you
to take responsibility for your recovery and you will be expected to become
independent as you progress following your surgery.
While you are in hospital your progress will be reviewed by medical staff. You may not
see your consultant or the surgeon who carried out your operation but members of his
or her team, which includes doctors and physicians assistants, will assess your
recovery and make any changes to your drugs or treatment that is deemed necessary.
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Any concerns about your recovery will be discussed with your consultant via the
medical team.
Discharge
You can expect to stay in hospital for 2-4 days after your surgery, please be organised
with transport home and put other domestic arrangements in place. The Occupational
therapist will visit you on the ward before your discharge to discuss your individual
home set up. The role of the Occupational Therapist is to assist you in your return to
independence in activities of daily living, at the same time ensuring that you comply
with your post op instructions. You will be given advice on what you can and can not do
on your return home and ways of modifying activities to carry them out safely.
You will be issued with some aids to assist you to get dressed. The Occupational
Therapist will ensure you are able to use these independently prior to your discharge.
You will be shown, by a physiotherapist how to safely climb and descend stairs, how to
get into and out of a seated position and how to care for your hip once you return
home. It is a good idea to enlist the help of friends or family once you do return home.
Before you go home you will be shown some exercises, see page 24. You should be
able to perform these exercises once you are at home. You may experience increased
pain with exercise, but this will settle with rest.
Most people are ready to go home very soon after surgery and this is an important step
in your recovery. When at home, it is important to continue with your exercises as
instructed by your surgeon and physiotherapist.
Wound
Your wound will be redressed prior to you going home. Some slight oozing of blood
through this dressing is perfectly normal and should settle down after a couple of days.
The dressing only needs to be changed if it becomes saturated and if so, the wound
should be checked by a nurse or doctor. It is normal for your wound to be warm and
reddish for up to a week as this is part of the healing process. The wound must be kept
dry until the sutures are removed 12-14 days after the surgery. You will be asked to
make an appointment with your practice nurse for removal of sutures or clips on a
specified date. You must do this as soon as you are at home.
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Swelling and bruising
Bruising can be extensive and reach down to your knee but it should settle in a couple
of weeks.
Your whole leg can swell after hip surgery. You can help reduce this by raising your leg
on a small stool (approx 18 inches in height) whilst sitting. You will be advised to use
an ice pack on your hip; a bag of frozen peas wrapped in a towel will work very well.
Normal post operative swelling should improve (but not always completely disappear)
overnight while your leg is elevated and rested. You will find that your leg swelling gets
worse during the day while you are using it. If the swelling does not improve overnight
or the calf or thigh gets very hard and warm please contact your GP. Swelling can
remain for 3-6 months after surgery.
Pain
It is normal for the hip to be painful after surgery, especially once you go home and
start to walk more and exercise it. If there is a sudden increase in pain associated with
extra activity, try using an ice pack, taking painkillers and reducing the activity for a
day. It may pass but if it doesn’t and is stopping you from walking and/or bending your
hip, contact your GP or the ward for advice on 01793 646333. It is important that you
keep your hip moving and therefore you may need to take pain killers regularly for the
first couple of weeks or even longer. We will give you a supply of painkillers when you
are discharged. If you need any more, you will need to visit your GP.
Rehabilitation
Exercise is necessary to help promote the healing process and ideally you should start
with gentle exercise prior to your surgery to build and strengthen your muscles.
Patients having hip replacement surgery do not tend to need physiotherapy.
This will be discussed with you prior to discharge. It is very important that you continue
to increase your mobility and carry out your exercises after you have been discharged
home, as this will aid your recovery and help you achieve good results.
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An example Timetable explaining what will happen to you during your
hospital stay
Day of operation
DAY 1
DAY 2
You will be assisted out of bed
to sit in the chair. You may
walk with a Zimmer frame if
you feel able.
You will start to mobilise with a
zimmer frame and assistance.
You will have a blood test.
You will need to start hip
exercises and practice walking
with the frame around the
ward.
Your drip will be taken
down once you are drinking
well.
Take regular painkillers and also
laxatives to prevent
constipation.
You may progress onto sticks
and practice stairs with the
Physiotherapist.
The wound will be checked.
The Occupational therapist (OT)
will discuss your home situation.
Take regular painkillers and
also laxatives to prevent
constipation.
The drain (if you have one) will
be removed if it has stopped
draining.
Try to drink plenty of fluids and
eat a normal diet.
Your catheter should be
removed tonight if you have
one.
You may progress onto sticks
and practice stairs with the
Physiotherapist.
Take regular pain killing
tablets.
If you are ready the
Physiotherapist or Rehab
Assistants may practice your
Try to drink plenty of fluids and transfers and teach you hip
eat a light diet.
exercises.
You may have an x-ray.
You may have an x-ray (if not
done day 2).
Try to drink plenty of fluids and
eat a normal diet
You may want to get dressed
with help and advice from the
OT or nurses. The OT will
check you have the right
equipment at home.
Talk to the nurse about your
discharge home/transport etc
You will be discharged as soon
as you are considered
medically fit.
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Blank for your notes
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Risks and
Complications
Risks and Complications
Whilst rare, there are some risks and complications associated with hip replacement surgery.
Some complications include infection, blood clots, implant breakage, mal-alignment, and
premature wear. Although implant surgery is extremely successful in most cases, some
patients still experience pain and stiffness. No implant will last forever and factors such as the
patient’s post-surgical activities and weight can affect longevity of the implant. Be sure to
discuss these and other risks with your surgeon.
There are many things that your surgeon may do to minimise the potential for complications.
You may need to have your dental work up to date and may be shown how to prepare your
home to avoid falls.
The Anaesthetic
As with any surgery there are risks associated with anaesthetic. There is an increased risk of
heart attack, stroke, deep vein thrombosis, a clot in the lung or even death either during the
operation or shortly after it. This risk is minimised by the assessment process at pre admission
clinic where blood tests, heart recordings and x-rays will be carried out. Following this you may
be referred to see an anaesthetist in the Cherwell Pre Assessment Clinic. Unfortunately
unexpected complications do still occur.
Breathing Exercise.
It is important to regularly take several deep breaths every hour; this will help to reduce the
complications that can be experienced following joint replacement surgery.
Deep Vein Thrombosis
This is a blood clot in the veins of the leg, most commonly in the calf, but can also occur in the
thigh/groin. Precautions are taken to avoid this happening but orthopaedic surgery means that
you are at risk. When you are seen in pre-assessment clinic you will be assessed for your risk
of deep vein thrombosis and the treatment you are given will depend on your risk factors.
The main way to avoid a blood clot is to keep the muscles in your legs working and the best
way to do this is to walk around. Whilst you are in bed you should do the following exercises.
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1. Circulatory exercise. When lying or sitting,
rotate both ankles in a clockwise and anticlockwise direction.
Repeat 10 times every hour.
2. Extension exercise. Lying on your back with your legs straight. Pull your toes up
towards you, and then tighten your knees by pushing them down firmly towards the
bed. Hold for 5 seconds then extend your toes away from you and hold for 5
seconds and relax.
Repeat 10 times every hour.
You will receive a small injection of a blood thinning drug every day during your hospital stay.
You will be given medication to take at home and some anti- embolic stockings to wear for the
first 6 weeks at home.
Anti embolic stockings help to prevent DVT by increasing blood flow to prevent pooling of blood
in the veins. They help to keep the veins tight and stop dilation of the veins.
You will be measured for and given a pair on admission by the nurse admitting you; you need
to wear your stockings to go to theatre.
The signs and symptoms of a blood clot are extensive swelling in the calf which may also be
warm and tender to touch. Walking on the leg can also cause pain in the calf. As already
mentioned, swelling occurs after hip surgery but normal swelling usually improves when the leg
is elevated for a period of time. If the swelling does not improve overnight when the leg is
elevated, shows any signs listed above, or you are worried please seek advice from your GP.
Occasionally a blood clot can move to the lungs and this is called a pulmonary embolus (PE).
This is a serious condition if you experience any chest pain which is worse when taking a deep
breath or any unexplained shortness of breath please come to the emergency department for
urgent assessment.
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Stiffness
Although the new hip is very good at removing pain and making walking easier it does not
move as far as a normal, natural hip joint. Sometimes the hip joint becomes quite stiff because
of excessive bone or scar formation in the muscles around the hip. Most people find, however,
that the relief of their arthritic pain is so good that a certain amount of stiffness does not worry
them.
Swelling
Your leg may swell after your operation for some time (3-6months). Elevate your leg on a foot
stool on and off during the day. The foot stool should be no higher than the chair you are sitting
on.
Dislocation
It takes three months for the muscles and tissues to heal around the hip. During this time there
is a danger that your new hip could dislocate, that is, the ball part of the joint coming out of the
socket.
The following precautions will help to prevent this from happening.
1. Do not cross your legs
The operated leg must always be held out to the side, away from the midline of the body.
2. Do not bend the hip more than 90°
Do not sit on low chairs or beds, do not lean forward. When sitting do not bend down to
reach the floor – use your ‘easy reach’
3. Do not twist your body while keeping your legs still.
For example: reaching too far across your body and turning corners.
4. Do not lie on your unoperated side.
For the first 4-6 weeks you should sleep on your back. After 4-6 weeks you can sleep on
your operated side with a pillow between your knees.
Remember – if it hurts, stop it!!
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Wearing out and loosening
All hip replacements wear with the passage of time and this leads to loosening of the hip within
the bone. The younger you are at operation the more likely you are to wear the hip out.
Approximately 1% of hip replacements fail per year so that by 10 years 10% will have failed.
When the hip wears out and fails it becomes painful again and unfortunately the bone tends to
get damaged by the loose hip. It is the quality of the remaining bone and your health at the time
that determines whether a new hip can be done. This is known as a revision hip replacement.
Leg Lengths
The arthritic process in your hip often causes the leg to become a little shorter. It is usually
possible to correct most of this at the hip operation. However, not all hips get full correction
and some legs can even end up a fraction longer. This is usually because the surgeon has
to make sure that the hip is as stable as possible to prevent dislocation. Sometimes an
insole or small raise on the shoe is required to balance the leg length.
Continuing pain
Occasionally, patients do have some remaining discomfort after the operation, often
because of some arthritis in the spine producing pain felt in the hip region. Infection and
loosening can produce pain again. The area of the scar can be tender to lie on in bed at
night.
Constipation
Unfortunately the medications required to control your pain can cause constipation. This
causes you to be unable to open your bowels properly and in rare circumstances your
bowel becoming completely blocked, which is very serious. Please be aware of this and
increase the fibre in your diet, drink plenty of fluids and take the laxatives which are
prescribed for you. If you become very uncomfortable, are not passing wind and/or your
bowels are not working normally, please seek advice from your GP
Rarer Complications
Damage to the main nerves that run around the hip resulting in numbness and weakness
in the leg or ankle, called a drop foot, which may be permanent. This may mean having to
wear a splint to hold the ankle steady while walking.
Occasionally the bone gets cracked in the placement of the new hip, If this happens the
consultant will speak with you and discuss the changes that will be made to your recovery.
It may mean having to use crutches for the first few months while the bone heals.
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AtAtHome
Home
What activity range can be expected after this surgical procedure?
Diligent physiotherapy, proper diet and a willingness to follow all of the recommendations
your medical team makes will contribute to a successful recovery after surgery. Most
patients are able to walk with the aid of sticks or crutches almost immediately. You should
start to move without support as soon as you feel comfortable to do so. This will vary from
individual to individual but many people find that they only need one stick when outdoors
after approximately 6 weeks. It is recommended that you do not drive for a minimum of 6
weeks as your speed of reaction is affected. The responsibility for when you return to work
is yours, however, you will find that your leg gets swollen and that swelling increases with
the more activity you perform. Activities such as golf, doubles tennis and swimming can
usually be resumed but not until three months after the operation. Always follow your
doctor’s recommendations, as recovery time will vary for each patient.
You will typically not be allowed to participate in high-impact activities or contact
sports. These types of activities place extreme amounts of pressure on the joints, which
could lead to complications. Ask your surgeon which activities you should avoid after
surgery.
Hydrotherapy (exercise in water) is beneficial for your recovery and can be commenced
slowly once your wound has healed fully. If you would like to be referred for hydrotherapy
please mention it at your 1st follow up appointment.
Follow Up
You will be seen 6 weeks after your operation by a nurse or physiotherapist who specialise
in seeing people after joint replacement surgery. This is to evaluate your progress. You will
not have an x-ray at this appointment.
You will then be seen 1 year after surgery for an x-ray and consultation with a nurse or
physiotherapist. If everything is ok at this appointment you will be discharged.
The First Three Months
Gardening involving kneeling and bending should be avoided for three months.
Exercise in water or hydrotherapy is often helpful to improve your strength and mobility.
Ask your physiotherapist about this. Swimming breaststroke should be avoided for three
months.
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Common Questions
How long will my joint replacement last?
We usually say that the majority will last at least 10 years but many last 15 – 20 years or
maybe longer.
Can my joint replacement wear out?
The more you use your new joint the quicker you will wear it out but returning to normal
activities and some sports is fine. You should avoid high impact exercise such as jumping,
jogging and skiing. You should also avoid twisting your hip too much.
How long will it take for me to recover from the operation?
A hip replacement is a major operation and it can take many months for the joint to settle
down properly and for you to feel completely well again. Most people feel a lot better in 3-6
months but you may still get some small improvements up to 1 year after the operation.
When can I drive?
Do not drive for six weeks, even if you have an automatic gearbox. Tests show that you will
not regain your speed of reaction until 6 weeks have passed. Your car insurance will not
cover you during the six weeks. You should inform your insurance company that you have
had an operation.
When can I go back to work?
Most people need to take about 3 months off work depending on their job. When you do go
back to work you need to avoid standing or sitting for long periods as your hip will become
stiff. Many people go back to work on a gradual basis.
How long do I need to take the hip precautions for?
You should avoid bending, twisting and sitting on low furniture for 3 months. After this you
can gradually start to return to normal activities but your hip may not be as flexible as a
normal hip.
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Can I have sexual intercourse?
Sexual intercourse may be resumed 6-8 weeks after the operation. A side to side position
with the operated leg uppermost and supported by a pillow or your partners’ thigh is usually
comfortable. Please ensure your operated leg does not cross the midline. Men may find it
more comfortable to lie on their back, with their partner kneeling astride them.
After 3-4 months, intercourse with the man on top may be resumed, but women should avoid
twisting their legs outwards too far.
How and when can I increase my exercise?
Many patients find that after about 3 months they want to start increasing their exercise. You
may also be interested in going to a gym. Under a special scheme you may be able to be
referred by your GP to receive special instruction in the gym at a reduced price. This scheme
is called ‘Steps to Health’.
What should I do if I think that there is a problem?
If you start to experience any problems with your joint replacement either before or after your
1 year follow up appointment you should contact us on the number below or see your GP
who can arrange for you to be seen at the hospital if necessary.
Claire Woodruffe – Orthopaedic Specialist Nurse
01793 605312
Go for short walks regularly, remembering to take equal length strides, and gradually
increasing the distance you walk at a rate that is comfortable to you.
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Home Exercises
1. Stand on your good (un-operated) leg. Raise
your operated leg up towards your nose by
bending it at the knee. Take care not to bed
the hip beyond 90° (a right angle). Hold for 34 seconds, if you can, then lower gently and
repeat. Make sure you stand up straight
when you do this exercise.
2. Again standing on your good leg and
continuing to stand up straight, take your
operated leg behind you. \Do not bend your
knee. You will feel your bottom muscles
tighten up, and again try to hold for 3-4
seconds, before lowering gently and
repeating. Your leg will not move far, so don’t
be discouraged.
3. Standing as you did for exercises 1 and 2,
take your operated leg out to the side. Make
sure that you lead out with your heel, not
your toes, and keep your pelvis still. You will
want to cheat, so again, do not be
disheartened if the movement is small to
begin with! Hold for 3-4 seconds, then lower
gently and repeat.
4. For this exercise you sit in your chair with
your feet on the floor. Now raise your foot off
the floor as high as it will go out in front of
you, keeping your thigh supported on the
chair seat. You should see your foot lift
straight up in front of you. Again hold for 3-4
seconds before lowering and gently
repeating.
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After 12 weeks
Do not carry these exercises out before
12 weeks after your operation.
Lying on your back with your knees
bent
Squeeze your buttocks together and lift
your bottom off the floor. Return to the
starting position
Repeat 20 times.
Aim to do this exercise 3 times a day.
Lying face down.
Lift your leg towards the ceiling keeping
your knee straight.
Repeat 20 times
Aim to do this exercise 3 times a day.
Sidelying. Keep the leg on the bed bent
and the upper leg straight.
Lift the upper leg straight up with the
ankle flexed and the heel leading the
movement.
Repeat 20 times
Aim to do this exercise 3 times a day
Stand with a rubber exercise band
around your ankle
Pull the band by bringing your leg
straight backwards.
Repeat 20 times.
Aim to do this exercise 3 times a day.
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Stand with a rubber exercise band
around your ankle.
Pull the band by bringing your leg out
to the side.
Repeat 20 times.
Aim to do this exercise 3 times a day.
Standing against a wall with feet 3040cms from the wall and knees slightly
bent.
Place a ball between your kness
Squeeze the ball between your knees
and release.
Repeat 20 times.
Aim to do this exercise 3 times a day.
Sitting with your arms crossed.
Stand up and then sit down slowly on a
chair. (This can be made easier and
more difficult by changing the height of
the chair)
Repeat 20 times.
Aim to do this exercise 3 times a day.
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Summary
We know the decision to have surgery is sometimes difficult. We hope this
brochure has helped you understand some of the basics of total hip
replacement surgery so that you can make the best decision for yourself.
Millions of others have made this choice, allowing them to return back to a
more active life.
Some quotes from patients who have received joint replacement surgery
here.
“Don’t give up, sometimes it hurts and is depressing but, the results can be
amazing”
“sleep pattern is doing my head in, but have to put up with it”
“REALLY amazed that all the arthritis pain has gone, in fact NO pain at all, just
the aching”
“That’s 2 weeks post op, still not a whole nights sleep, no pain, just aching”
“I can really see how easy it would be to just sit around and end up with a stiff
leg and a limp! I want to get back to normal, so I MUST PERSEVERE”
“Listen to the professionals as to what you can or can’t do”
“try to know the difference between ‘ouch that REALLY hurts, I have to stop’
and ‘oh that hurts a bit, but I need to do this’”
“Remember a couple of months hard work can give you back a quality of life
that you probably haven’t had for years”
This brochure is not intended to replace the experience and advice of your
orthopaedic surgeon. If you have any further questions, please speak with
your orthopaedic surgeon.
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The British Orthopaedic
Association
Orthocard
Did you know that you can register your new hip joint?
Registering your new hip will protect your new joint. It will show that you have
an artificial joint, which helps prevent infection by letting your dentist, nurse
and doctor know that you have one. It also will help at the airport when going
through metal detectors and other security measures.
If you are interested, please see the nurses on the ward when you are
discharged. You will be given a pack with all the information needed, and once
registered you will be able to use your card.
http://www.boa.ac.uk/Pages/Welcome.aspx
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Author/location
Claire Woodruffe, JPI
Information gathered from internet and Norfolk and Norwich Hospitals
Review Date
Updated
August 2014
August 2012
Contact telephone Number
01793 60 53 12
Leaflet Number
PALs Pil - 0435
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