Hip replacement tips

RogerBill

I had my left hip replaced 11 days ago and got out of hospital after two nights. Thus far my recovery seems to be going well so I thought I’d share some tips which might help anyone waiting for a THR.

I’m 69, reasonably healthy and not overweight. Until this year I used to enjoy regular eight mile walks but then osteoarthritis hit hard and I was only able to walk for 10 minutes. Initially the pains were in my thigh and I thought it was a muscular problem. I did lots of exercises proposed by a physiotherapist without any noticeable improvement. As NHS waiting lists were 12+ months and as I don’t have medical insurance I reluctantly decided to pay for a private operation.

During the three months waiting for the operation I did a lot of exercises to strengthen muscles. I also got a wobble board to help with balance. I think the investment of time in doing all this before the operation is helping my recovery.

Before the operation I raised my sofa on bricks and made a platform to raise my favourite chair. I find a reclining chair or lying on the sofa is more comfortable than sitting upright for any length of time. I also bought a sock puller and an easy grabber. These are incredibly useful. I hang the easy grabber on my crutch with a loop of cord so it’s easy to carry around and I’m less likely to drop it. I put some padding on top of the frame by the shower door which is a good hand hold to help getting in and out of the shower.

I found the raised toilet seat the hospital gave me to be an instrument of torture!! The pain caused me to move awkwardly and I heard a loud crack. Fortunately I don’t think I’ve done any lasting damage, but I bought a seat with frame. It cost £50+VAT which I think is good value for the added comfort and security. The seat is much more comfortable and the arms on the seat enable me to take some of the weight off the bruised and tender area around the operation site. It’s also easier to get on and off the toilet without bending more than 90 degrees.

No matter how careful I am I occasionally break the rules for not bending more than 90 degrees or twisting. Causes some pain but I don’t seem to have done any real damage and I can’t imagine anyone would be able to adhere to the rules 100%. Before the operation I did practice limiting my movements and using crutches to get up and downstairs. If nothing else this saved time during my time with the physiotherapist in the hospital.

A ruck sack is really useful for carrying things around when on two crutches. A water canister is useful for carrying drinks.

I’ve got a long handled shoehorn which is OK but requires a lot of fiddling to get the shoe just right. Maybe I need to practice more or maybe a wider shoehorn would be better.

Since the operation I’ve been diligently doing all the exercises and gradually building up walking. It’s not pleasant but it is getting easier and I can now walk 15 to 20 minutes twice a day with only two or three ibuprofen or paracetamol per day. I think the exercises are essential and are helping. The arthritis pains are completely gone but my hip and leg ache and feel sore but are not really very painful, which I think is wonderful given it’s a fairly brutal operation.

I tend to lose concentration while doing the exercises so I got a cheap electronic tally counter to keep track of the number of repetitions. My phone doesn’t seem to reliably count the number of steps walked, probably because I’m treading carefully, so I record the time of my walks rather than the number of steps. I created tick charts to record my exercises, walks and the medication I take which I find to be really useful. The injections to prevent blood clots have to be done alternately on left and right side of the abdomen and I’d never remember without a tick chart.

Constipation is a problem I expected. The hospital gave me some Movicol sachets which seem to work as well and a little more gently than Lactulose which I’ve previously used. I’ll need to buy some more unless things sort themselves out soon.

My first day out of hospital was really good, no doubt helped by all the pain killers. Things then went a little downhill. I expected recovery would be a bit up and down. Four days after the operation my thigh, hip and knee swelled up alarmingly. I didn’t realise this could be a delayed reaction but resting and sleeping with legs on a couple of cushions seems to have helped get the swelling back down to a small amount. I didn’t find ice helped but a heat pad does provide some comfort. Interestingly the operated hip sticks out more than the other and I don’t think that’s all just because of the swelling.

I’ve been instructed to sleep on my back for six weeks. I’m hoping a couple of pillows down my side and a knee cushion between my legs will stop me rolling over in the night. I find sleeping on my back leads to disturbed nights. Typically I wake every two hours and rather than lie in bed trying to get back to sleep I find it better to get up and potter around for five minutes.

This week I’ve got appointments with a nurse to remove the dressings and with a physiotherapist.

I’m indebted to my partner for all her help and support. Life would be virtually impossible without such help and kindness.

Sorry for the long rambling post but while I appreciate everyone is different, I thought anyone waiting for a THR might pick up one or two useful nuggets of information. 

Poppyjane

Hi @RogerBill ,

Good to hear that you had a successful hip replacement operation. Thank you for sharing your experience I am sure new and existing members will find it very valuable.

Take care

Poppyjane

Lilymary

Hi @RogerBill , I'm so pleased to hear things are going pretty well for you. I found sleeping on my back awful too, but I decided to just tough it out, as sleeping on my side was too painful and made my hip feel even more weird. It was week 7 before I felt safe and comfortable sleeping on my side.

All your other tips are good ones. Like you, I found heat pads more helpful than ice packs, but everyone's different. The only problem with heat pads is that they are more likely to induce seepage in unhealed wounds, but if the wound has healed up pretty well, that shouldn't be a problem. (Looking back at some record photos I took post op, there had been some additional bleeding in the two weeks before the dressing was removed, so maybe the heat pads were to blame? I'm still here despite that, so no lasting damage!)

My bowels were so delighted not to be on codeine any more I had precisely the opposite result, which took several months to settle down. Still not quite right now, over 5 months later, but ANYTHING is better than trying to pass concrete!

I broke the rules from time to time too, but was constantly mindful of friends who had multiple dislocations. Now 5 months on I still tend to be careful, but have gradually introduced a greater range of movement, including putting on shoes and socks unaided, and have found techniques for safely getting up off the floor without using furniture etc. I suspect I twist too much, but my hip tells me when I'm pushing my luck.

I was in too much pain to exercise pre op, and I reckon that had a big impact on my slow recovery. One friend, a ski instructor, was still walking her dog every day right up to her THR, and she positively bounced back. So to everyone else, if you can, get those muscles strengthened pre-surgery!

Do keep posting, it's useful for others to hear a different experience to my catalogue of errors. And yes, a big shout out to supportive partners!

RogerBill

Thanks @Lilymary I didn't know heat pads were likely to induce seepage in unhealed wounds. I'll be a bit more careful! Like you I know someone who suffered agonising dislocations. Certainly a risk I want to minimise as far as possible.

Coddfish

Hi Roger, I am 26 days on from my hip replacement, so a little ahead of you, you might find my own write up helpful. I am now at the point where I can walk around 4K using just one elbow crutch, and don’t need the crutches in the house. Whilst progress isn’t completely linear, it does move forward very noticeably most days. As well as religiously doing the physiotherapist’s exercises, I try to walk a little more each day, with the occasional rest day. Unfortunately the 2 hour sleep cycles are still there for me, the need to sleep on my back leads to a dry mouth and lots of water, with inevitable consequences. On the upside, my surgeon didn’t prescribe blood thinning injections, but I am still using compression socks overnight (reckon I am mobile enough in the daytime, possibly also overnight given the 2-hourly cycle!). Thankfully constipation isn’t a problem, probably because I didn’t get on with opioids. It’s been around a week since I needed any painkillers or ice packs. Fortunately I also haven’t had any swelling or bruising to worry about. When the staples came out, I needed steri strips over the bottom of the wound, but they have now dropped off and it’s all ok. I am looking forward to getting back in the swimming pool once the scabbing is all gone.

RogerBill

Hi @Coddfish Thanks for your post here and I found your write up really interesting and encouraging. It's interesting the similarities and differences. For example, after leaving hospital I haven't had to wear compression stockings but I am doing the blood thinning self injections. I hope to follow in your footsteps and be in a similarly advanced stage of recovery when I reach the 26 day mark.

LizB12

Hi @RogerBill thank you very much for posting details of your hip replacement on here. It makes the thought of a THR a bit less scary when you know more about what happens as well as some very useful tips. Thank you too @Coddfish, @Lilymary I am trying to keep up to exercises to relieve my pain but haven’t got back to walking yet. I must be more positive and build up my walking little by little. I am managing my pain better now but need to concentrate on other methods rather than relying solely on medication. I hope you all continue to improve, sending my best wishes

RogerBill

I'm glad if my comments help @LizB12 Before the operation walking and standing were extremely difficult but I was fortunate that I could do most exercises without too much difficulty. In my area you can self refer to Dynamichealth which is a physiotherapy service funded by the NHS. I used exercises recommended by them but then when I started to have some difficulty I switched to a set of exercises by Lou Grant a physiotherapist based in Leeds, UK who had a hip replacement herself a couple of years ago. Her company website contains a lot of free, useful videos and documents which as far as I can tell seem to offer sound advice.

LizB12

Ooh thanks for that @RogerBill I shall have a look

RogerBill

Now starting week three after THR so thought it time for a brief update. I'm still very limited in what I can do. Sitting is uncomfortable even with a cushion but it is getting a little better. The toilet seat with frame I bought is a god send and I no longer need the laxatives. I'm taking just two ibuprofen a day and aim to stop them completely in the next day or so.

I made good progress during the first week out of hospital but for past week I felt I'd slipped back. But was really glad to hear encouraging words from the physio. She said I was doing really well compared to others and not to expect too much too soon. I can now walk with one crutch 15 or 20 minutes, twice a day which I didn't think was very good. As a "reward", she gave me more exercises and another appointment in three weeks!!!

Just noticed bruises on both sides of my foot. I guess this, like the knee, is another area where I was man-handled during surgery. I do tend to bruise easily but it’s odd that it’s a delayed reaction. Also find my heels are sore after sleeping on my back. The hospital bed had a proper gel heel protector pad but these are expensive to buy at around £150 so I thought a little improvisation was in order. I’m trying an old padded body warmer rolled up to see if that will ease the pressure on my heels. 

Forgot to mention in my original post that my operation was assisted by a Mako robot. This is said to help the surgeon ensure accurate leg length as the operation is planned using a 3D computer model generated from a CT scan done a couple of weeks before the op. My leg lengths do seem to be more equal than they were before the operation. Also I had a general anaesthetic and the surgeon used the posterior technique with a curved incision on the side and back of the hip.

On the whole recovery is going well, the arthritis pains are completely gone and it's amazing to be as good as I am so soon after such a brutal operation. In about four weeks I should be able to bend more than 90 degrees, drive and I won't have to sleep on my back.

To finish on two more interesting notes. After taking an opioid pain killer the pattern on the bedroom wallpaper moved off the wall and floated for a second or two. No wonder those pills are addictive! I've now got more of a 36 24 36 figure as the new hip sticks out more, partly because of the swelling!

RogerBill

PS Just discovered bruising is a side effect of the Dalteparin I’m self injecting for 28 days after the op. These are to prevent blood clots. I guess that might help explain the bruising around my foot and it’s delayed appearance.

Other points on exercises: In the morning the hip and knee bend exercise is quite uncomfortable/painful/difficult but eases after the first three or four repetitions. Similarly with walking, it takes a minute or two to get going. It would be easy to give up on the exercises and walking but I’m sure it’s better to push on through this but being careful not to overdo it. Some of the exercises require a squeeze of the buttocks. I’m finding this tricky but I think it’s a question of developing a better technique.

Lilymary

That all sounds par for the course @RogerBill . I found my rump was very tender for a good four weeks or so, and swollen as you describe. Soft pillows on my chair worked for me. I started getting bruising on my shin a few weeks after surgery and was told it’s just old subcutaneous bleeding working it’s way down my leg by gravity. It went eventually.

The walking sounds good. Keep it up. I used 2 crutches for balance for a while longer as the ground is so uneven where I live, but was soon on one only round the house.

I ditched the oramorph for good after week 2 when I found myself rather stoned all day after one dose in the wee small hours. Luckily the worst of the pain (mostly at night) had passed by then anyway.

i got the sores on the back of my heels thing at night too. Coming home made me realise how good hospital mattresses are at preventing pressure points. I tried resting my heels on something soft and squashy but it didn’t work, so I devised a long row of soft pillows and cushions under my spine from shoulder to knee, then put my knee pillow under my ankles so that my feet were suspended slightly in mid air. That worked a treat. I was still stiff as a board in the morning though.

I’m also very stiff if I’ve been sitting for more than an hour, even 5 months on. It’s mostly in my hips and knees, making me stagger about like a robot for a bit till they start to ease off again. Not sure when this will pass, but it does highlight the value of doing general stretching exercises to keep the rest of your body mobilised. It helps if you can remember to stand up and walk about for a bit at least once an hour. Otherwise it sounds like you’ve got the balance right. Keep squeezing those buttocks!

RogerBill

Thanks @Lilymary it's really great to compare experiences with someone who has been through the same operation. Although everyone is different there are considerable similarities, par for the course as you say.

I've suggested Versus Arthritis might like to set up a buddy or one to one support scheme. I'm a volunteer on the UK prostate cancer scheme who match new patients with a volunteer who was in a similar position for telephone conversations. It's a service well liked by patients to compliment other resources such as online forums like this and group sessions.

RogerBill

@LizB12 just thought of something I should have included in my 4th Oct post: as well as providing a physiotherapy service, Dynamichealth were able to refer me to a local NHS hospital for an x-ray of my hips. They then checked on waiting times for hip replacement operations in local NHS hospitals and, because they were 12+ months, I asked them to refer me to my preferred private hospital. Based on my recent experience, access to our GP practice is difficult and so I think Dynamichealth was a quicker and easier route in these difficult Covid times.

Coddfish

Hi @RogerBill, sounds like you are doing well. It’s not linear. Some days bring huge break throughs, others are more difficult. I am now a couple of days short of 5 weeks, and I would say the changes at around the 4 week mark were probably the most significant. It was the point at which I could reliably go out with one crutch, and start walking with none inside the house. It’s now just a case of working up from there. I haven’t had a problem with bruising and am wondering if that’s an advantage of being on a compression sock rather than blood thinners regime. Although I don’t use them during the day now, I have continued to wear them at night. Other things which have helped me are being able to drive again (just started this weekend), and working out how to get on / off the floor without breaching the movement restrictions, this has enabled me to do proper glute bridges and the like.

Setting yourself targets and treats helps. I am a huge rugby fan and we had tickets for last night’s Harlequins v Bristol match, arranged before I knew my surgery date. When I knew how little recovery time I would have, I was wondering if I would be fit enough to go, just 4 and a half weeks from surgery. So I made it one of my targets to achieve. We got to the stadium early so I could get to my seat before it got busy. I took a stadium seat cushion to make it a bit easier. The nature of the match, and the fact that ‘my’ team won, helped me manage any discomfort. If anything, there was less discomfort than I used to have with my old hip - which is quite something given I haven’t been there since March 2020, which was a long time before diagnosis. We’d already had a lengthy walk in a country park earlier in the day, so I was fairly tired when I got home. Thankfully no ill effects today.

I have also noticed the scar is now completely healed so my next target / treat is swimming on Monday. I love swimming and have missed it these last 5 weeks.

Lilymary

Really great to hear that people are doing so well. Just a small reminder, the target isn’t to ditch the crutches as soon as possible. We’re told by our surgeons to keep using them for 6 weeks because that’s how long bones take to heal, on average, and we need to allow them to bond with our new implants. With lateral surgery, which involves removal of a section of bone at the top of the femur and grafting it back on again, the surgeon insists the patient stays on crutches for a full 12 weeks for this reason (which is why I went for posterior surgery). My recovery has been famously slow, but even had I been a miracle case, I still would have stayed on at least one crutch till my six week review and X-ray to check the healing process.

Coddfish

@Lilymary Just to add that everyone is different and will have been given advice specific to them. In my case, my surgeon advised using crutches for 4 weeks. My prosthesis is not cemented and it needs load bearing to encourage bone growth so that it bonds with the prosthesis. I needed to use crutches until the internal healing of tendons, flesh etc had progressed enough to remove pain, but not to protect the bone. I do still need 1 crutch at almost 5 weeks for my own comfort for anything more than 200m or so. The hospital physiotherapist, at 3 weeks, asked me to start building up distances without crutches. So whilst it’s interesting to understand someone else’s experience, they often don’t directly translate to one’s own.

stickywicket

I think it's good that people are sharing their various - and varied - experiences of THR surgery. Lest anyone with inflammatory arthritis or, indeed, widespread OA is reading this, can I just say that, even if you can't manage to hold crutches or sticks, you, too, can go the THR ball, Cinderella.

I've always been started on a gutter frame, sent home on a zimmer and immediately progressed to walking round the furniture. Rigorous exercises and rest have made for perfect recoveries every time.. My hips have never got me up mountains but they have faithfully got me round supermarkets and local beauty spots. .One of my THRs must be heading for 30 years old. I treat them well: they serve me well.

Lilymary

I stand corrected. Good to hear that surgeons are working on faster recovery routes that are tailor made. I was given various slightly contradictory advice from other hippies pre-surgery, mostly on the 6 week rule, but most of whom had theirs some years ago, but it appears that modern methods are improving all the time. 🙂

RogerBill

Thanks for your comments and for sharing your experiences @Lilymary @Coddfish and @stickywicket "Everyone is different" is the answer I received from the physio and medics to many of my questions. Also it seems every surgeon has their own preferred approach and I even found some contradictions in the documents I received from my hospital. Because of all this it really is helpful and reassuring to share experiences with others who have been through the op and recovery process.

As an example: I noticed this morning that the bruising on my foot is now spreading up my calf. It's reassuring to know @Lilymary experienced a similar delayed reaction and as @Coddfish said it could be that I'm injecting blood thinners rather than wearing compression socks. Clearly if I had DVT symptoms I'd be more concerned.

Talking of surgeons having their own preferred approach reminded me of this joke about economists: "What happens when you put 10 economists in a room? You'll get 11 opinions." 😊

Lilymary

@RogerBill , worryingly, I had a surgeon tell me the same, ie 3 medical experts resulting in 5 opinions!

Do keep an eye on the bruising spread, mine came out sooner than that, if you’re worried, it won’t do any harm to mention it to your GP.

Coddfish

@RogerBill @Lilymary @stickywicket, I think a lot of advice comes from risk avoidance and that things have always been done this way.

I read a couple of academic papers recently (I know, I am slightly strange).

The first concerned whether there was any benefit from the standard advice on hip movement restrictions that we would all be familiar with. 50% of participants were given the standard advice. 50% were just told to avoid anything that felt uncomfortable. There was no statistical difference in the level of dislocations experienced in the groups, but the second group were more active and less fearful. You can probably guess I am tending towards avoiding the uncomfortable and am looking forward to tying my own shoelaces once it doesn’t feel uncomfortable to reach down (I am nearly there)!

The second was about return to exercise. I am particularly interested in this one because I want to return to running and have had a lot of negativity thrown at me. My surgeon was possibly the most positive with “I give you mobility, it’s up to you what you do with it”, but both anaesthetist and hospital physio were in the “I wouldn’t do that if I were you” camp. If you are not a runner (or whatever sport is being considered), I suspect the impact of not doing something you love seems less important than the risk of of adding wear to the prosthesis. One of the many reasons I went with a surgeon who is an amateur triathlete is that I felt my need to get back to as much activity as possible. The paper followed up people who had returned to various forms of sport over a 5 year period. There was a slightly higher rate of prosthesis failure amongst those doing the most exercise, but overall this group had much better cardiovascular health and a higher self reported quality of life. I know what I will be doing when I am a little further down the line.

Lilymary

An interesting debate @Coddfish . I asked my surgeon at my 6 week review about alarmist posts I’d seen on the “University of the Internet” (😉) which said things like “10 things you should NEVER do if you’ve had hip replacement”, such as bending down to tie shoes, twisting from the hips, getting down onto hands and knees etc. I asked him if there was any truth in the assertion that some movements were out of bounds forever. His view was that it was not correct, most movements should be achievable eventually, or with care, but he did add “not many of my patients take up running”. My hip tells me when I’m pushing my luck, but I’m already comfortably breaking most of those “rules”.

I agree that getting back as much activity as possible and the associated mental health benefits are really important, but bear in mind the more we punish our new joints, the greater the wear and risk of dislocation. Apols if I sound like a stuck record, but I know one person with a dislocated new knee and two people who’ve had multiple hip dislocations (4 each, one of them in front of me) eventually requiring revisionary surgery. One “hippie” was a keen walker who had a tendency for falling over. The other was simply on her hands and knees in pilates.... so there may be some truth to the rumours.

One of my surgeons was extremely scathing of the punishing Andy Murray is giving his new (resurfaced?) hip and said all the surgeon’s good work would be ruined in no time and was keen to make sure I got the message. We also need to bear in mind that replacing an artificial hip is much more complex than the first new one, and they only get one shot at it. When that wears out, all you can do is manage what’s left.

At the end of the day it’s our body, our life, and we’ll each decide what’s most important to us. But I prefer to strike a balance between living my best life, not compromising the (somewhat brutal) surgery and avoiding the risk of running out of working hips before my time is up.

RogerBill

@Lilymary "most movements should be achievable" I was told something similar and that after 12 weeks I'll be able to cycle, garden and play golf but to avoid contact sports and heavy lifting.

@Coddfish in a week and a bit I'm hoping to experience some significant changes like you did four weeks after your op. For the past few days I've hit a plateau and even though I've done all the exercises without fail, I only feel comfortable extending my twice daily walks in small increments and at this rate of improvement I'll certainly not be able to do 4k walks at my 26 day mark.

Lilymary

@RogerBill , if you want to be encouraged about how well you’re doing, read my account of glacially slow recovery in my “New Hip Day” blog. Trust me, you’re doing fine! At 4 weeks the pain had only just subsided to the level where I could start exercising properly and start extending my walks round the village a bit. I’m now nearly at the 6 month mark, and I’m finally doing 5-6 miles at a reasonable pace, and starting to incorporate moderate gradients. But it’s been a right long haul. Our bodies work to a different agenda to our ambition. Find some middle ground, and work from there. Every now and then we plateau or even go backwards a bit, but it will improve. I was told to avoid ladders and scaffold for 3-6 months, (I have a strange job) but was up there in 4. I’m able to do most gardening tasks other than digging holes and hauling out larger shrubs. I was never much into cycling, but I’m really looking forward to taking up contact sports! 😂

RogerBill

Thanks @Lilymary all good and encouraging points.