Q: What activities can I expect to return to after hip replacement?
A: In the first 6 weeks after hip replacement there will be restrictions of hip positioning dependent upon the approach utilized.
The concern with hip positioning is that particularly after a posterior approach, the hip can dislocate resulting in the need for further surgery. The incidence of dislocation after a posterior approach is approximately 1.5%. The incidence of dislocation after the anterior approach is considerably less.
Most people after a hip replacement feel like their hip is as normal as when they were younger. And there are generally no restrictions in terms of activity other than high impact activities such as running on concrete. The concern with high impact activity again is a possibility of wear of the plastic which is even less likely with a hip replacement than a knee replacement. In general, after a hip replacement people can return to tennis hiking, skiing, riding a bike, golf, elliptical, and weight lifting.
Q: What is the typical rehabilitation program associated with a hip replacement?
A: Hip replacement is a far less painful and a less difficult recovery than knee replacement. Most people will use a walker just for safety for a week or 2. Usually can return to ambulating outside the house without ambulatory aids within 2 to 3 weeks. Unlike knee replacement, stiffness is usually not an issue with hip
replacement. But returning to normal strength and balance is a very important part of rehabilitation after hip replacement.
Supervised physical therapy while helpful is not always essential after hip replacement. This depends in large part on how much disability has accrued prior to the hip replacement. The typical exercises immediately after surgery are ankle pumps, knee bends, straight leg raises, buttock contractures, and then in a few weeks standing knee raises and working more on balance training. Balance training focuses on twisting, change of direction, start stop activities, and working on uneven surfaces.
Q: What are the most, potential complications of hip replacement?
A: A blood clot in the legs can occur after hip replacement; therefore, all patients after hip replacement are placed on a blood thinner typically for 6 weeks after surgery. The blood thinner will depend in part on the risk factors of each patient.
Infection is the most disastrous outcome after hip replacement. There are 2 types of infection. One is a superficial wound infection in the immediate postoperative period which often can be treated with antibiotics. A deep infection however, usually necessitates further surgery and long-term antibiotics. This can even result in the need for a series of surgeries to get rid of the infection. The risk of infection is correlated with the patient’s risk profile. Patients that are immunocompromised, for example diabetes, rheumatoid arthritis, and obesity all have a higher risk of infection.
Dislocation is a risk unique to hip replacement and not seen in knee replacement. The incidence over a lifetime with a posterior approach is in the neighborhood of 1 to 2%. With the anterior approach the dislocation risk is considerably lower. Most dislocations occur in the first couple months after surgery. There will be positional limitations particularly after a posterior approach to prevent dislocation.