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August 30, 2016 | Orthopedics
Patients often elect to put off hip replacement until they are elderly or until the pain becomes unmanageable, but many people need the procedure at a much younger age. Prevention says that in 2010, nearly 40 percent of hip replacements went to patients younger than 65. Surgeons performed 42 percent of knee replacements on individuals between 45 and 64.
Many adults I treat are much more active than their parents were. They still play sports, often competitively, which wears down your joints at a younger age. Overall, they work out more than the preceding generation did. On the other hand, however, some adults are carrying excess weight which also strains joints at an earlier age.
Procedures to replace hips and knees are among the most common operations in the U.S. The Mayo Clinic reports that surgeons perform approximately 1 million of them every year. In fact, around 4.7 million Americans have experienced a total knee arthroplasty and about 2.5 million have had a total hip arthroplasty. If you’re a woman, you’re more likely than your male counterparts to undergo one of these surgeries.
After performing a hip or a knee replacement, I want my patients to enjoy a lifestyle similar to the one they had before surgery, but without the pain. The American Academy of Orthopaedic Surgeons (AAOS) suggests that patients should plan to resume their normal activities but might have to change the manner in which they perform them. If, for example, you need to bend, you’ll need to learn a new way to do that to make sure your new hip stays safe.
Here’s a summary of what to expect after surgery:
Advance planning: You’ll need caregiving help for several weeks. Before surgery, rearrange furniture or rooms in your home to move around more easily and avoid stairs. Make sure items like your phone or glasses are easy to reach to avoid bending at the hip. Remove loose rugs and fasten electrical cords to the outside of a room. Make sure you have a good chair with a seat that’s higher than average. If possible, put in a bathtub gripping bar, shower chair and raised commode seat, and get helpful devices like a grabbing tool so you won’t have to bend.
Before hospital discharge: Expect to be in the hospital one to four days. Before leaving, you’ll need to master activities like getting in and out of bed, using the bathroom, walking with a device like a cane, eating, drinking and navigating a couple of stairs. You must also be able to do the home exercises prescribed and understand necessary precautions to prevent injury. If it appears unsafe for you to go directly home, you might move to a skilled nursing or rehabilitation facility temporarily.
At discharge: The hospital staff will discuss possible complications and warning signs of a blood clot or an infection. Discharge instructions cover wound care, specific steps to prevent infection and how and when to change your dressing. Your doctor will specify how long to wait before taking a shower or a bath.
At home: Be alert for signs of an infection and make sure to call your physician promptly if you see them. Expect some swelling for as long as six months. Follow your surgeon’s instructions regarding wearing compression stockings, elevating your leg or applying ice, but call the surgeon if you experience severe or new swelling. Since it’s crucial to avoid bacterial infections in your artificial hip, you’ll probably be taking antibiotics. Although you’ll be on a normal diet, discuss the need for vitamin supplements with your physician. Drink lots of fluids, but steer clear of alcohol and limit coffee. It’s also important to avoid putting on weight, which stresses an artificial hip.
Getting active again: You’ll notice gradual improvement following your surgery. Icing the area can reduce swelling and pain and using heat before exercising can improve range of motion. Your doctor will tell you when you can resume full weight bearing, which depends on the type of hip replacement you had. Once you’ve discontinued narcotic medication for pain, you can ask your doctor whether it’s safe to start driving. You might need to avoid certain sleeping positions or use a pillow between your legs. Many patients are able to resume sexual activity within a few weeks after their surgery, and your doctor will let you know when you can go back to work. If traveling by air, know that pressure changes might cause your new hip to swell. Be sure to tell the airport screener about your device and carry a medical alert card. Most patients also undergo some type of physical therapy for at least two months after a hip replacement. If your muscles start to ache during physical exertion, cut back on your exercise regimen, but don’t discontinue your exercises. Return to sports when your physician says you’re ready.
Specific precautions: Each do and don’t depends on the surgical technique your doctor used. Your orthopedic practice and your physical therapist, if you use one, will provide a list. In general, precautions cover things like crossing your legs, seating position, reaching, knee height and bending.
Everyday Health cites a study regarding the role of physical therapy following hip replacement. After evaluating the progress of two groups of patients at one month and again six months after surgery, researchers concluded that the group using home exercise programs fared as well as the individuals undergoing formal outpatient physical therapy. Typical home programs include gait training, walking, strengthening thigh muscles, standing on one leg, side-lying for muscles near the hip and climbing stairs.
If you’re like most patients, you’ll find it a huge relief to resume physical activities you could no longer do before surgery due to pain.
Michael Carlson, MD
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.