Recovery, rehabilitation and going home

Your recovery timeline

Everyone recovers at their own pace, and other health conditions naturally slow things down. Use this as a rough map, not a target to measure yourself against.

Getting moving early

Modern practice is to get you up and walking within hours, and there is good reason for it. Early movement reduces blood clots, chest infections, pressure sores, constipation and confusion, and prevents the rapid muscle loss that older adults experience during bed rest. It will feel daunting, and the first stand is the hardest. The physiotherapist will not let you fall.

Most patients are allowed to put their full weight through the leg straight away. If your surgeon has restricted this, you will be told clearly — always follow your own instructions over anything you read here.

Looking after your wound

• Leave the dressing alone. It is designed to be absorbent and waterproof and to stay on for several days. Do not peel it back to look.
• Showering is usually fine with a waterproof dressing after 48 hours. Do not soak in a bath or swim until the wound is fully healed, typically around three to four weeks.
• Clips or stitches are removed around 10 to 14 days by a practice or district nurse, if they are not dissolvable.
• Bruising and swelling down the thigh and even to the ankle are normal, and can take several weeks to fade. Elevating the leg when resting helps.
• Numbness in a patch of skin near the scar is common and usually improves.

Contact your team promptly if the wound becomes red, hot, increasingly painful, starts leaking fluid, gapes open, or smells unpleasant, or if you develop a temperature.

Movement precautions for the first six weeks

While the tissues heal, certain positions can pop the new joint out. The exact rules depend on which surgical approach was used, so your team's instructions come first. Commonly you will be asked to avoid:

• Bending the hip more than 90 degrees — so no low chairs, low toilets or deep sofas.
• Crossing the operated leg over the other, at the knees or ankles.
• Twisting on the leg — turn by taking small steps rather than pivoting.
• Bending down to pick things up. Use your grabber.
• Sleeping on your side without a pillow between your knees, at first.

Practical translations: sit on a firm, high chair with arms; use your raised toilet seat; keep dressing aids by the bed; and put your operated leg into the car first, sitting down backwards onto the seat then swinging both legs round together.

Your exercises

Your physiotherapist will give you a personal programme. Do it three times a day, taking painkillers beforehand. Typical exercises include:

• Ankle pumps — point and flex your feet, 10 times every hour while awake. This is your clot prevention.
• Static quadriceps — press the back of your knee down into the bed, hold for five seconds, repeat 10 times.
• Buttock squeezes — squeeze, hold five seconds, repeat 10 times.
• Heel slides — slide your heel towards you, bending the hip and knee only as far as allowed.
• Leg slides out to the side, keeping your toes pointing to the ceiling.
• Standing hip and knee lifts, holding a worktop for support, once you are steady.

Aching afterwards is expected. Sharp pain, or pain that lasts more than a couple of hours, means ease off and mention it at your next contact. Add short, frequent walks — five minutes, several times a day, is better than one exhausting expedition.

Preventing falls

A fall in the first weeks can undo the operation, and older patients are most at risk. Wear firm shoes indoors, keep your walking aid within reach of your bed, turn lights on at night, and take your time when you first stand up — the blood-pressure dip when rising is a common cause. If you feel dizzy on standing, tell your GP: it may be one of your medicines.

Eating, drinking and bowels

Aim for regular meals with protein at each one, and 6 to 8 glasses of fluid a day unless you have been told to restrict fluids. Constipation from opioid painkillers and reduced activity is extremely common — take the laxative you are given, eat fruit and fibre, and keep drinking. Appetite often dips for a week or two; small frequent snacks work better than large meals.

Back to normal life

• Sleep. Often disturbed for the first fortnight. On your back or on the unoperated side with a pillow between the knees is usually most comfortable.
• Driving. Usually around six weeks, and only when you can perform an emergency stop comfortably, are off strong painkillers and can get in and out safely. Check with your insurer.
• Travel. Avoid long flights for around three months because of clot risk. Your implant may set off airport scanners; ask for a letter if you would like one.
• Intimacy. A perfectly reasonable question to ask your team. Usually possible after about six weeks, avoiding positions that bend or twist the hip.
• Activity long term. Walking, swimming, cycling, golf, bowls and gardening are all encouraged. Running, contact sport and deep squatting are generally discouraged.

Looking after your hip for life

Once you have recovered, three habits protect your new joint: keep active and keep the muscles strong, keep your weight steady, and look after your teeth and treat infections promptly, since bacteria can settle on an artificial joint. Tell any dentist or doctor that you have a joint replacement.

You will be reviewed in clinic — often at six weeks, then at intervals over the years, with X-rays to check the implant. Keep the implant details you are given somewhere safe. If, years later, the hip becomes newly painful or you notice a new limp, get it checked rather than assuming it is old age.