Typical Total Hip Pre-Operative Exercises

(Please note that these exercises are for example only and any exercises
you want to do should be prescribed by your physician and/or your physical
therapist. Trinitas Regional Medical Center is not liable for any injury or
condition you may experience by choosing to emulate these exercises. They
are presented for informational purposes only.)

A. Gluteal Sets
Starting Position: Lying on your back.
Exercise: Squeeze buttocks firmly together. Hold for approximately five
seconds, then relax.
Duration: Repeat 10 times, two to three times a day.

B. Straight Leg Raises

Starting Position: Lying on your back with one leg straight and the other leg
bent (you can vary the exercise by having your foot pointing either upwards,
inwards or outwards).
Exercise: Exercise your straight leg by pulling the toes up, straightening the
knee and lifting the leg 20 centimeters off the bed. Slowly relax.
Duration: Repeat 10-15 times per day with both legs, two to three times a
day.

C. Hip Extension
Starting Position: Stand with a rubber exercise band around your ankle.
Exercise: Pull the band by bringing your leg straight backwards.
Duration: Repeat 10-15 times, two to three times a day.

D. Hip Abduction
Starting Position: Sidelying. Keep the leg that's on the bed bent and the
upper leg straight.
Exercise: Lift the upper leg straight up with ankle flexed and the heel
leading the movement.
Duration: Repeat 10-15 times, two to three times a day.

E. Standing Hip Adduction

Starting Position: Stand with a rubber exercise band around your ankle.

Exercise: Pull the band by bringing your leg out to the side.
Duration: Repeat 10-15 times, two to three times a day.

F. Hip Abduction
Starting Position: Sit. Place a ball between your knees.
Exercise: Squeeze the ball. Hold for five seconds
Duration: Repeat 10-15 times, two to three times a day.

G. Supported Squat
Starting Position: Stand in front of a table or chair holding on to the support
with both hands.
Exercise: Slowly crouch, keeping your back straight and heels on the floor.
Stay down for approximately five seconds and feel the stretching in your
buttocks and the front of your thighs.
Duration: Repeat 10 times, two to three times a day.

H. Heel Raises
Starting Position: Stand and hold onto something sturdy for balance.
Exercise: Push up on your toes.
Duration: Repeat 10-15 times, two to three times a day.
Typical Total Hip Post-Operative Exercises
(Please note that these exercises are for example only and any exercises
you want to do should be prescribed by your physician and/or your physical
therapist. Trinitas Regional Medical Center is not liable for any injury or
condition you may experience by choosing to emulate these exercises. They
are presented for informational purposes only.)

A. Gluteal Sets
Starting Position: Lying on your back.
Exercise: Squeeze buttocks firmly together. Hold for approximately five
seconds, then relax.
Duration: Repeat 10-15 times, two to three times a day.

B. Knee Extension
Starting Position: Lying on your back, bend one leg and put your foot on
the bed and put a cushion under the other knee.
Exercise: Exercise your straight leg by pulling your foot and toes up,
tightening your thigh muscle and straightening the knee (keep your knee on
the cushion). Hold for approximately five seconds and slowly relax. To make
the exercise harder, put a light weight around your ankle.
Duration: Repeat 10-15 times, two to three times a day.

C. Straight Leg Raises

Starting Position: Lying on your back with one leg straight and the other
leg bent (you can vary the exercise by having your foot pointing either
upwards, inwards or outwards).
Exercise: Exercise your straight leg by pulling the toes up, straightening the
knee and lifting the leg 20 centimeters off the bed. Hold for approximately
five seconds then slowly relax.
Duration: Repeat 10-15 times, two to three times a day.

D. Supported Squat
Starting Position: Stand in front of a table or chair, holding on to the
support with both hands.
Exercise: Slowly crouch, keeping your back straight and heels on the floor.
Stay down for approximately 20 seconds and feel the stretching in your
buttocks and the front of your thighs.
Duration: Repeat 10-15 times, two to three times a day.

E. Heel Raises
Starting Position: Stand.
Exercise: Push up on your toes.
Duration: Repeat 10-15 times, two to three times a day.

F. Hip Abduction
Starting Position: Stand straight, holding on to a support.
Exercise: Lift your leg sideways and bring it back, keeping your trunk
straight throughout the exercise.
Duration: Repeat 10-15 times, two to three times a day.
Dos and Don'ts
The Dos

Do keep the leg facing forward

Do keep the affected leg in front as you sit or stand

Do use a high kitchen or barstool in the kitchen

Do kneel on the knee on the operated leg (the bad side)

Do use ice to reduce pain and swelling, but remember that ice will
diminish sensation. Don't apply ice directly to the skin; use an ice pack or
wrap it in a damp towel

Do apply heat before exercising to assist with range of motion. Use a

heating pad or hot, damp towel for 15 to 20 minutes

Do cut back on your exercises if your muscles begin to ache, but don't
stop doing them

The Don'ts

Don't cross your legs at the knees for at least 8 weeks

Don't bring your knee up higher than your hip

Don't lean forward while sitting or as you sit down

Don't try to pick up something on the floor while you are sitting

Don't turn your feet excessively inward or outward when you bend
down

Don't reach down to pull up blankets when lying in bed

Don't bend at the waist beyond 90

Don't stand pigeon-toed

Don't kneel on the knee on the non-operated leg (the good side)

Don't use pain as a guide for what you may or may not do

References

American Academy of Orthopedic

Surgeons:http://orthoinfo.aaos.org/topic.cfm?topic=a00356

Total Hip Replacement Equipment

If you are being discharged to a sub acute rehab center, they will
supply you with equipment

If you are going home, we would recommend the following:

General Considerations

Your surgeon will tell you about any specific positions/activities to

avoid. Please follow those rules to minimize the risk of falling, dislocation,
etc.

If you used a pillow ("abduction pillow") between your legs in the

hospital, generally continue to use it at home when lying in bed until your
surgeon says you do not need it anymore

Sitting

Avoid sitting surfaces that are so low that your knee is higher than
your hip in the seated position

Use pillows if you have to raise the height of the seat of the chair to
achieve this position

Bending

Avoid bending at the hip to pick up objects

Use a reacher to pick things up off the floor

Turning

Avoid rotating your upper body on your operated leg

Sitting/Crossing Your Legs

Avoid crossing the leg of your operated hip over your other leg

Sleeping/Getting Out of Bed

When sleeping,
-- If your surgeon had you use a pillow in the hospital to keep your legs
separated, continue to use it at home until your surgeon tells you that
you can sleep without it
-- If you did not use a pillow between your legs in the hospital, consider
using a pillow between your legs, especially when sleeping on your side

Getting Into Your Car

Consider using a pillow on the car seat to keep your knee below your
hip when sitting

Sit down on the edge of the car seat

Swing one leg over into the car, then the other

Pivot in seat to face forward, buckle seat belt

Getting Out Of the Car

Reverse the above process

Opening A Door

When door swings away: Walk up as close to the door as possible,

while holding onto your walker/cane with one hand, open the door fully
and then walk through

When door swings toward you: Stand to the side of the door, open the
door then walk through.

DO NOT PLACE THE WALKER LEGS OR THE CANE TIP(S) ON THE

DOOR SADDLE

Home Environment: Safety First!

Pick up throw rugs and tack down loose carpeting. Cover slippery
surfaces with carpets that are firmly anchored to the floor or that have
non-skid backs

Be aware of all floor hazards such as pets, small objects, electrical

cords or uneven surfaces

Provide good lighting throughout. Install nightlights in the bathrooms,

bedrooms and hallways.

Keep extension cords and telephone cords out of pathways. DO NOT

run wires under rugs; this is a fire hazard

DO NOT lift heavy objects for the first three months, and then only
with your surgeon's permission

DO NOT wear open-toe slippers or shoes without backs. They do not

provide adequate support and can lead to slips and falls

Stop and think. Use good judgment

Showering/Bathing

In general, you can shower approximately 3 days after surgery if the

wound is dry. Limit the amount of time water is exposed to the incision
site. Pat the incision dry when finished

Do not immerse the incision in a tub or Jacuzzi for at least 3-4 weeks
after surgery

Use long handled brush to clean lower legs

Daily Activities

Remember, you just had major joint surgery. Your joint needs time to
heal and has to be eased back into daily activities

Slowly increase your daily activities to a level similar to your normal

daily activity level
Use a sock/pant aide to pull up your socks and pants

Other Sensations

Due to your surgery, you may notice that the skin around the incision
site may feel numb. This usually decreases over time

Your muscles might get sore after exercise or performing daily

activities. This is a normal response and muscle soreness should not last
more than an hour or so after exercise/activity. If it does last longer, do
not start another bout of exercise or strenuous activity until the
discomfort has gone away

Travel/Driving

When traveling, stop and change position frequently to prevent your

joint from tightening.

Your physician will tell you when you can travel in planes
-- Your total hip replacement has metal components that may cause the
setting off of alarms at security checkpoints in airports and other public
travel areas
-- Advise the authorities before you are screened that you have a total
hip replacement. On airplanes, request a bulkhead seat so you have
more room
-- Wear your support socks (TEDS) and do ankle pumping frequently

In general, persons with a total hip replacement can begin driving

themselves at approximately 4-6 weeks after surgery providing:
-- You no longer are taking narcotic medication for pain
-- You have regained your strength and reflexes
-- We recommend testing your driving ability by driving in an open
parking lot with a friend

Return to Work

Persons with more desk/administrative type jobs can return to work in

a matter of a few weeks

Persons with more physically demanding jobs usually return to work in

3 to 6 months. Discuss with your surgeon the impact of your job on your
total hip replacement

Sex

Some forms of sexual relations can be resumed 4-6 weeks after

surgery. Discuss with your doctor for more information

Precautions

Call your Doctor if you experience any of the following:

-- Marked increase in pain in your hip above normal discomfort
experienced when exercising or walking
-- Increased swelling, warmth or redness around the hip
-- Red, raised areas along incision line
-- Drainage from the incision site
-- Fever/Productive cough
-- If either of your calf muscles become swollen, painful or tender to
touch

Discuss with your Doctor /Dentist about the need to take antibiotics
before you are having dental work or other invasive procedures for two
years after total joint surgery.

For hip replacement patients, post-operative pain is among the

top concerns prior to surgery. To be honest, theres not an awful
lot a person with an arthritic hip can do before hip replacement
surgery to lessen postoperative pain. When joints are damaged
to the extent they need replacement, the damage is irreversible
and medications will do little but take the edge off the pain.
Below are some of the factors that can influence postoperative
pain after hip replacement surgery.

 Before Surgery
It is said that losing weight (if youre considerably heavy)
or doing exercise (if youre a couch potato) will lessen
postoperative pain, but thats not altogether true. Unless an
overweight person can lose a considerable amount of weight in a
healthy manner before surgery, its really not going to make a lot
of difference to the outcome. Obese and considerably
overweight people can have good outcomes just as much as thin
and average weight people!
As for exercise, it is best to try and keep some tone and strength
in the muscles, as fit muscles will recover better and more easily
than will flabby ones! But dont ever force your arthritic joints to
exercise if you experience pain doing so. The amount of
painkillers you will have to take as a result, can impact the
effectiveness of pain medications after surgery.

During Surgery
The first principle of surgery is for surgeons to handle tissues
gently, carefully and as little as possible. Surgeons who adhere
to this credo will minimize postoperative pain and swelling, and
lessen the risk of adhesions. This also applies to the gentle use
of retractors and other surgical instruments, which might bruise
and stretch the tissues. An equally important factor is that the
wound be kept open for the shortest amount of time possible.
This lessens moisture loss from the tissues, which if allowed to
dry out can also increase pain, swelling and the risk of
adhesions.

 Your surgeon and the entire operating theater team must be very
particular in aseptic technique, including the anesthetists and
orderlies. Breaches of this discipline can lead to infection, which
is a very painful thing.

After Surgery
Once surgery is complete, the primary tools for controlling pain
are simple: Rest, Elevate, Ice and take the pain medications as
prescribed by your doctor.
Rest for the first couple of weeks at least, your only job is to
rest, making trips as necessary to the bathroom or kitchen. Short
walks are all that is required at this point. Do not get anxious
about your mobility, it might decrease at this stage because the
swelling may get worse

Pillows stacked for elevation in joint replacement recovery

The best thing you can do to manage swelling, as well as pain,
is elevation and ice. Elevation requires a straight stack of
pillows with nothing bunched up behind the knee. Pressure
applied behind the knee can encourage clots and may delay the
ability to extend your knee, meaning to put it out straight. As for
the height, toes above nose is a good maxim whilst making

sure you dont violate any bending restrictions you have been
given.
Use ice as long as you want tohours at a time is fine, provided
that when the ice pack is fresh, you protect your skin from the
fierceness of fresh ice with a pillowcase or similar cloth. Skin can
get freezer burn!
Pain medications are essential at this stage. Take what you
have been prescribed and take it religiously, especially before
the pain starts up again. After 2-3 weeks, you can start adjusting
doses or timing, but at the start, stick with what works. There is
no rush to be off the pain medications your doctor prescribed, so
dont be frightened by tales of people becoming addicts because
of a few weeks taking prescribed pain relievers. You need them
at this stage and should continue using them as prescribed for
as long as 6-8 weeks if necessary, although towards the end,
you might find yourself requiring less and less.

Total Hip Replacement Exercise Guide

Regular exercises to restore your normal hip motion and strength and a gradual return to
everyday activities are important for your full recovery. Your orthopaedic surgeon and
physical therapist may recommend that you exercise 20 to 30 minutes 2 or 3 times a day
during your early recovery. They may suggest some of the following exercises.

Early Postoperative Exercises

These exercises are important for increasing circulation to your legs and feet to prevent
blood clots. They also are important to strengthen muscles and to improve your hip
movement. You may begin these exercises in the recovery room shortly after surgery. It
may feel uncomfortable at first, but these exercises will speed your recovery and reduce
your postoperative pain. These exercises should be done as you lie on your back with
your legs spread slightly apart.

Top of page

 Ankle Pumps

Slowly push your foot up and down. Do this exercise several times as often as every 5 or
10 minutes. This exercise can begin immediately after surgery and continue until you are
fully recovered.

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Ankle Rotations

Move your ankle inward toward your other foot and then outward away from your other
foot.

Repeat 5 times in each direction 3 or 4 times a day.

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Bed-Supported Knee Bends

Slide your heel toward your buttocks, bending your knee and keeping your heel on the
bed. Do not let your knee roll inward.

Repeat 10 times 3 or 4 times a day

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Buttock Contractions

Tighten buttock muscles and hold to a count of 5.

Repeat 10 times 3 or 4 times a day

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Abduction Exercise

Slide your leg out to the side as far as you can and then back.

Repeat 10 times 3 or 4 times a day

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Quadriceps Set

Tighten your thigh muscle. Try to straighten your knee. Hold for 5 to 10 seconds.

Repeat this exercise 10 times during a 10-minute period.

Continue until your thigh feels fatigued.

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Straight Leg Raises

Tighten your thigh muscle with your knee fully straightened on the bed. As your thigh
muscle tightens, lift your leg several inches off the bed. Hold for 5 to 10 seconds. Slowly
lower.

Repeat until your thigh feels fatigued.

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Standing Exercises

Soon after your surgery, you will be out of bed and able to stand. You will require help
since you may become dizzy the first several times you stand. As you regain your
strength, you will be able to stand independently. While doing these standing exercises,

make sure you are holding on to a firm surface such as a bar attached to your bed or a
wall.

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Standing Knee Raises

Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2
or 3 counts and put your leg down.
Repeat 10 times 3 or 4 times a day
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Standing Hip Abduction

Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With
your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the
floor.

Repeat 10 times 3 or 4 times a day

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Standing Hip Extensions

Lift your operated leg backward slowly. Try to keep your back straight. Hold for 2 or 3 counts.
Return your foot to the floor.
Repeat 10 times 3 or 4 times a day
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Walking and Early Activity

Soon after surgery, you will begin to walk short distances in your hospital room and
perform light everyday activities. This early activity helps your recovery by helping your
hip muscles regain strength and movement.

Top of page

Stand comfortably and erect with your weight evenly balanced on your walker or
crutches. Move your walker or crutches forward a short distance. Then move forward,
lifting your operated leg so that the heel of your foot will touch the floor first. As you
move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As
you complete the step allow your toe to lift off the floor. Move the walker again and your
knee and hip will again reach forward for your next step. Remember, touch your heel
first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you
can. Don't hurry. As your muscle strength and endurance improve, you may spend more
time walking. Gradually, you will put more and more weight on your leg.

Walking with Walker, Full Weightbearing

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Walking with Cane or Crutch

A walker is often used for the first several weeks to help your balance and to avoid falls.
A cane or a crutch is then used for several more weeks until your full strength and
balance skills have returned. Use the cane or crutch in the hand opposite the operated
hip. You are ready to use a cane or single crutch when you can stand and balance
without your walker, when your weight is placed fully on both feet, and when you are no
longer leaning on your hands while using your walker.

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Stair Climbing and Descending

The ability to go up and down stairs requires both flexibility and strength. At first, you will
need a handrail for support and you will only be able to go one step at a time. Always
lead up the stairs with your good leg and down the stairs with your operated leg.
Remember "up with the good" and "down with the bad." You may want to have someone
help you until you have regained most of your strength and mobility. Stair climbing is an
excellent strengthening and endurance activity. Do not try to climb steps higher than
those of the standard height of seven inches and always use the handrail for balance.
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Advanced Exercises and Activities

A full recovery will take many months. The pain from your problem hip before your
surgery and the pain and swelling after surgery have weakened your hip muscles. The
following exercises and activities will help your hip muscles recover fully.

These exercises should be done in 10 repetitions four times a day with one end of the
tubing around the ankle of your operated leg and the opposite end of the tubing attached
to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar
for balance.

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Elastic Tube Exercises

Resistive Hip Flexion

Stand with your feet slightly apart. Bring your operated leg forward keeping the knee straight.
Allow your leg to return to its previous position.

Resistive Hip Abduction

Stand sideways from the door and extend your operated leg out to the side. Allow your leg to
return to its previous position.

Resistive Hip Extensions

Face the door or heavy object to which the tubing is attached and pull your leg straight back.
Allow your leg to return to its previous position.

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Exercycling

Exercycling is an excellent activity to help you regain muscle strength and hip mobility.
Adjust the seat height so that the bottom of your foot just touches the pedal with your
knee almost straight. Pedal backwards at first. Pedal forward only after comfortable
cycling motion is possible backwards. As you become stronger (at about 4 to 6 weeks)
slowly increase the tension on the exercycle. Exercycle forward 10 to 15 minutes twice a
day, gradually building up to 20 to 30 minutes 3 to 4 times a week.

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Walking

Take a cane with you until you have regained your balance skills. In the beginning, walk
5 or 10 minutes 3 or 4 times a day. As your strength and endurance improves, you can
walk for 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular
walks, 20 or 30 minutes 3 or 4 times a week, will help maintain your strength.

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Preparing for Your Discharge

Most patients wish to and can safely return directly to their homes three days after their joint
replacement surgery. To help make your recovery as smooth as possible, planning should begin
well before your surgery!
Preparing Your Home
When you return home, some activities will be more difficult for a while. The following
information and suggestions will make your recuperation safer and easier.

You will learn how to manage stairs before you are discharged. There should be no
need to relocate your bed if it is on the second floor.
Remove loose rugs, electrical cords, and other small items from areas where you will
walk.
Make sure there are night lights in the bedroom and bathroom.
A stable chair with a firm back, arms, and a high seat will allow you to get up easily.
Make a list of telephone numbers of helpful friends, family members, and your doctor.
Place a copy by each phone. A cordless telephone or mobile phone will be useful during your
recovery.
Make sure any pets are out of the way so that they do not present a safety hazard
while you are recovering.
Check the path from your parking spot into the house. Make any needed repairs to
walkways or porches so that your return home will go smoothly. Make sure banisters and
railings (inside and outside) are safe and secure.
Plan seating in rooms where you will be spending time. You'll want a chair with some
padding but one that isn't too soft or too low. (For example, it might be difficult to get up
from a soft sofa at first, especially if you'll only have one armrest to use for support when
standing.) Do not use a chair on wheels, even if it has brakes. Plan to have needed items
within easy reach.
Organize your bathroom so that you don't have to move a lot while performing daily
routines.
You may want to prepare some meals in advance and freeze them for use after your
surgery. Also, remember that you will not be able to bend over to reach inside low cabinets
right after surgery. Put items you'll need within easy reach before you go to the hospital.
We don't recommend that you buy special equipment, because you won't know exactly
what you'll need until after surgery. However, if friends offer to loan you items such as
crutches, a walker, a cane, a tub seat, or a raised toilet seat, feel free to accept. (If you
borrow crutches, a walker, or a cane, bring these to the hospital so your physical therapist
can make sure they fit you properly.)
Lots of people stock up on books, movies, or project work to keep them busy during
recovery. This is okay, but remember - you will be busy with exercising and building your
endurance and may not have as much 'free' time as you think.
Arrange for Help
You will need help with cooking, cleaning, shopping, other routine household tasks, and
personal care during your first week or two at home. A relative, friend and/or home health
agency person should be available to help you throughout this time period. Please make sure
that you have prepared for this very important assistance well before your surgery date.
Plan Where You Will Get Your Physical Therapy
Plan where you will get your physical therapy once you are at home. If you haven't had
physical therapy recently, you may want to visit outpatient clinics near your home to choose
one that is best for you.
Plan for Transfer to Extended Care
Although most patients go directly home after their surgery, in certain instances it may be
necessary for you to go to an extended care facility (ECF) as an inpatient for a short time

when you leave the hospital. Extended care facilities include skilled nursing facilities (SNF)
and acute rehabilitation facilities (ARF). At these facilities, nurses and rehabilitation staff
take active roles in planning your care in consultation with doctors. You may be advised to go
to an ECF if you:

live alone and do not have anyone to help you at home

have other health conditions that require closer medical management
are unable to perform certain functions after surgery (such as getting into and out of
bed alone or using the toilet without help)
After your surgery, our nurses, doctors, case managers, and physical therapists will help to
identify the best plans for your ongoing care. If you think it is likely that you will need to go
to an ECF, please contact your insurance company before your surgery to find out what
facilities and costs are covered. You and your family may want to visit these facilities before
your surgery to see which ones might best meet your needs. However, please note that
sometimes beds are not available at a particular facility on the day you are ready for
discharge and another ECF may need to be chosen.

Hip Replacement Surgery

During hip surgery, the surgeon replaces the area between the femur
and the pelvis with an implant that fits the patient's body. The implant
consists of two components: a shaft with a ball that is implanted in
the femur, and a cup implanted in the pelvis. The ball of the femur
rotates within the cup, allowing the
hip to function

To perform a successful total hip replacement, the surgeon has to

precisely position the implant components relative to the patient's
pelvis and femur. Accurate joint alignment will reduce post-operative
complications that can possibly lead to additional surgery. A
successful total hip replacement can be like having a healthy hip as it
allows the leg to move freely within its
normal range of motion.

Instructions after Total Hip Replacement

Weight Bearing Status
Put as much weight as you can on your operated leg with the help of the walking aid
provided by the physical therapist. Initially you start with a walker, with time you will
progress on to crutches and then on to a cane. If using a cane, use it on the opposite
side as your knee replacement. Use the most appropriate walking aid until 6 weeks.

This prevents you from tripping and falling over while your muscles around the knee
recover
Anticoagulation
Anticoagulation helps to prevent phlebitis, pulmonary embolism, and blood clots. Please
be sure you understand the type of anticoagulation you must take. You started the
anticoagulation while in the hospital. The medication sheet which is completed by the
MD/PA when you are discharged will list the anticoagulation medicine which you are
taking.
If you are on Coumadin, the dose will be ordered either by your Primary Care Physician
or your Orthopedic MD. Make sure you understand this prior to discharge. Once you are
home, you have arrangements made for blood draw twice a week to know the level of
the blood thinner following which the above doctor would prescribe you further doses of
Coumadin.
If you are on Aspirin, you need to take 325 mg of Aspirin twice a day for a total period
of 6 weeks. You can buy this over the counter as prescription is not required for Aspirin.
If you are on Lovenox, you need to have an injection as directed by your Orthopaedic
MD.

Diet
You need to eat to gain back your strength. You should resume your pre-hospitalization
diet unless otherwise instructed.
Dressing and Incision care
You can shower when you get home. The dressing provided is water proof. If the central
pad of the dressing appears soaked from underneath then inform us and come and see
us in the office immediately. Make sure you do not immerse the incision in a bath tub. If
for any reason the water runs into the incision site, remove the dressing and apply a
fresh one. The dressing applied in the hospital (if not soaked by leakage from the
wound) can be left on until removed by us in the office.
Pain Medicine
You have been given a prescription for pain medication. Please remember the following:

Take only what is prescribed by your doctor.

Take your pain medicine 45 minutes prior to exercise.

Try to take the medicine before it becomes severe.

If the medicine does not reduce your pain, call your surgeon.

If you are taking pain medicine, you MUST avoid alcohol, and illicit or illegal
drugs

Home Recovery Program

Our specially-designed Home Recovery Program, a series of basic instructions and
exercises, will help you regain your mobility and, thus, speed your recovery. Tested and
refined at the Orthopaedic specialist, the program is straightforward and effective. You
do not have to do every exercise at each session. Though you do not have to follow a
particular order, doing the lying exercises in sequence is easier and more convenient.
The Home Recovery Program allows you to choose from the four exercises you were
taught in the hospital. The number of times you do each exercise depends on your
capacity, which will increase as you progress towards recovery. Recovery doesn't
happen overnight, so don't be discouraged, and don't try to do too much too soon. The
exercises should not cause pain. If they do, eliminate them from your program.
Continue to follow precautions outlined by your physical therapist until told otherwise
by your surgeon.
Climbing Stairs
The following are instructions (NOT exercises) for climbing and descending stairs.

If you have one (1) total hip:

UPSTAIRS

The non-operated leg goes first.

The operated leg goes second.

The crutches go last (at the same time as the operated leg).

DOWNSTAIRS

The crutches go first.

The operated leg goes second.

The non-operated leg goes last.

If you have two (2) total hips:

UPSTAIRS

The stronger leg goes first.

The weaker leg goes second.

The crutches go last (at the same time as the weaker leg).

DOWNSTAIRS

The crutches go first.

The weaker leg goes second.

The stronger leg goes last.

Putting on Socks and Stockings

During your recovery, many otherwise ordinary tasks, such as getting dressed, will
require special attention. One of the most difficult is putting on socks and stockings;
this simple activity normally requires you to bend past a 90-degree angle, which can
dislocate your new hip. Men should use knee-high socks, and women, knee-high socks
or stockings. For your comfort, your physical therapist can order a sock aid, a device
that has two cords which you hold in your hands and pull up to put on a sock or
stockings.
To put on a sock or stocking, place sock around rim of sock
aid. Slide sock up halfway so that the toe of sock is secure
against the sock aid. Stick foot in so that toe is making
contact with the toe of the sock. Pull up on the cords of
the sock aid to pull on sock. You may put the sock on your
non-operated foot in your usual manner. To take off a sock
or stocking, use either your reacher or your long handled
shoehorn to push sock off foot.
Homemaking Tips

Use an apron with several pockets.

Carry hot liquids in containers with covers.

Slide objects along the countertop, rather than carry them.

Sit on a high stool when doing countertop tasks.

Use a reacher for objects on the floor. DO NOT bend down to pick up objects.

If you are discharged with a walker, a walker bag is available. The bag fits in your
walker and can be used to carry items including plates, silverware and food in sealed
containers.
Remove scatter rugs from the floor to avoid
tripping over them.
Lying on your back:
1. Tighten thigh muscles by pressing
knees down into the bed.
2. Hold for a count of 6. Do not hold
your breath.
3. Relax.
4. Repeat.
Gluteal Set
Lying on your back:
1. Squeeze buttocks together.
2. Hold for a count of 6. Do not hold your breath.
3. Relax
4. Repeat
Ankle Pumps
Lying on your back:
Keeping legs flat on bed, move both your ankles up and down.
Leg Rotation
Lying on your back:
1. Roll your operated leg inward so that your kneecap and foot are pointed toward
the ceiling. Do not internally rotate your operated leg past this neutral point.

2. Relax
3. Repeat
Heel Slides
Lying on your back:
1. Bend hip and knee of operated side to about 40-45 degrees.
2. Hold for a count of 6. Do not hold your breath.
3. Relax
4. Repeat
Advanced Exercises
These exercises place slightly greater demands on your hip. Progress to them only after
you are seen by your surgeon on your first post-op visit.
Straight Leg Raise
To build muscle strength perform this exercise twice each day. Work up to 20 lifts each
time.
Lying on your back with your non-operated leg bent and your foot flat on the bed:
1. Raise your operated leg 12-18 inches.
2. Hold for 2 counts
3. Lower leg slowly.
4. Repeat
Side Leg Raise
To improve your hip's range of motion, perform this exercise twice each day. Work up to
20 lifts each time.
Lying on your non-operated side
1. Raise your operated leg 12-18 inches
2. Hold for 2 counts.

3. Lower leg slowly.

4. Repeat
Stationary Bicycle
If you have a stationary bicycle, use it at no resistance for 15-20 minutes each day.
Swimming
Swim as much as you like. It is an excellent exercise and will help in your recovery.
You must call your physician if you experience any of the following problems
1. Drainage from the incision
2. Increasing redness of the suture line.
3. Temperature over 101 degrees
4. Sudden shortness of breath or chest pain or difficulty in breathing.
5. Increasing tenderness of thigh or calf or increasing pain.
6. Swelling of the knee, calf, or ankle that does not respond to elevation for one
hour. The leg and ankle must be elevated above the level of the heart.
Frequently Asked Questions:
How long should I use the pain medication?
This is different for each patient. Some are able to use Tylenol or Advil after you leave
the hospital and others require narcotic pain medications for two to three weeks.
Generally, you should try to decrease the use of medications as time passes.
When should I go to outpatient therapy?
If you are going home or to a rehab centre, in either case you should have PT within a
few days following your release from them. If you do not have a prescription for PT,
please call your surgeons office and they will provide a prescription and list of places.
When can I go to the dentist?
Not for three months after surgery. As the hip is gently healing and there is increased
blood flow to this area, there is a higher risk of infection.
You must take prophylactic antibiotics if any of the following things pertain to you for
the next two years.

1. Another operation anywhere on your body

2. Any dental procedure
3. Lung, bladder, or colon scope or procedure
4. If you develop an infection anywhere in your body
Immuno compromised patients with Rheumatoid Arthritis, Lupus, Insulin Dependent
Diabetes, chemical or radiation induced immuno-supression need to take prophylactic
antibiotics for life.
Total hip replacement patients who require dental work on gums or roots must adhere
to the following antibiotic procedure:
For patients not allergic to Penicillin: Cephalexin, Cephradine or Amoxicilin: 2 grams
orally 1 hour prior to the dental procedure
For patients allergic to Penicillin: Clindamycin: 600mg orally 1 hour prior to the dental
procedure.
Patients should adhere to this regimen for the first two years following joint
replacement.Immunocompromised patients, including those with inflammatory
arthropathies, rheumatoid arthritis, drug or radiation-induced immunosuppression,
insulin-dependent diabetes or any other major medical problem should follow this
antibiotic routine indefinitely.
Antibiotics can reduce the risk of infection but cannot completely eliminate that risk.
Preventing infection must be the concern of all the healthcare professionals who treat
you. MAKE SURE YOU INFORM YOUR PHYSICIAN AND DENTIST THAT YOU HAVE HAD A
TOTAL HIP REPLACEMENT.
When can I drive?
You should not drive as long as you are taking narcotic pain medications. If it is your
left hip, you can resume driving when you feel you actually return back to normal in
about three weeks. If it is your right hip I would like to evaluate you at 6 weeks-hence
no driving before 6 weeks in cases of surgery to the right hip.
My hip clicks after surgery. Usually clicking after surgery is normal. The clicking is a
result of soft tissue moving across the front of the hip or the metal parts coming into
contact with one another. This sensation usually diminishes, as your muscles get
stronger.
I am experiencing a lot of swelling, is it normal?
Fluid can accumulate in the legs due to the effects of gravity. Usually it is not a problem
in the hospital, but it gets worse when you go home or rehab because you are doing

more. To reduce this you should elevate your legs at night. Lie on the back and place
pillows underneath the legs so that they are above the heart.
How long do I have to wear the stockings?
You should wear the stockings in both legs. Have someone help you with them in the
morning, wear then throughout the day and then take them off at night. If you did not
get the stockings from the hospital you can purchase knee height, medium,
compression, surgical stockings from any pharmacy shop. Try to wear them for 6 weeks
if possible. This helps to reduce leg swelling and prevent blood clot formation in your
legs.
When can I return to work?
It depends on your occupation. Its never a mistake to take more time off in the
beginning of the recovery. That way you can focus on your hip. I recommend taking at
least three weeks following your surgery. Keep in mind that you need to be using
crutches.
Can I travel?
In general, I would like to see you before you fly. If you are traveling by car you should
be sure to take frequent breaks so that you do not feel too stiff in getting up; or in
airplane, I would like you to wear compression stocking and take couple of walks during
the flight. Having aisle and/or bulk head seat will help you get more space.
Leg Swelling
Following hip replacement, most patients develop swelling in the operated leg. Although
the amount of swelling can vary from patient to patient, the swelling itself in the leg,
knee, ankle or foot is normal, and will usually resolve gradually over several weeks.
For the first month after your operation, the amount of time spent in a sitting position
should be 30 TO 45 MINUTES ONLY, as sitting tends to worsen the swelling. Periods of
walking should be alternated with periods of elevating the swollen leg. When elevating
the leg, the ankle should be above the level of the heart. You should lie with one pillow
under your head and four to five pillows under your foot and leg to elevate your leg
above your chest.
Do's and Donts after Your Total Hip Replacement
Below is a general list of precautions to follow after your total hip replacement. If
additional precautions are necessary, the staff will provide instructions.
Lying Down

Keep the abductor pillow between your knees when you lie on your back.

Keep the bed flat when you exercise or get out of bed.

You may turn on the non-operated side with the help of your nurse.

Avoid crossing your legs.

Sitting
Your surgeon or therapist will tell you when to start sitting in a high chair.
Do:

Keep your knees lower than or equal to your hips.

Use a high toilet or a raised toilet seat on a standard toilet.

Sit on a firm chair (preferably) using two firm pillows.

Don't:

Sit in low, soft chairs such as sofas.

Bend to pick up any objects from the floor.

Bend to clean or dry your feet.

If you leave the hospital by carpenter the car from street level to avoid bending your
hip too far; sit in the front seat, making sure the car seat is all the way back and in an
upright position. Sit on two pillows.
DO NOT ELEVATE YOUR FEET while sitting in a chair
It is often helpful to spend an hour in this elevated position in the early afternoon to
help diminish the swelling which may have developed during your morning walks.
To prevent or reduce leg and ankle swelling:

Elevate the operated leg

Avoid sitting for more than 30 to 45 minutes at a time

Perform ankle exercises

Use elastic compression socks

Sports Activities
After full recovery, some patients enjoy light sports activities. Activities you can enjoy
after total hip replacement include walking, bicycling, bowling, swimming, golf and
doubles tennis. Avoid high impact activities, such as:

Jogging

Running

Jumping

Skiing
Other positions to avoid following Total Hip Replacement

Sexual Relations

The following questions, answers and illustrations respond to the common concerns of
patients and their partners after hip replacement surgery.
Will I be able to resume sexual relations now that my hip has been replaced?
The vast majority of patients are able to resume safe and enjoyable sexual intercourse
after hip replacement. Patients whose sexual function had been impaired by
preoperative hip pain and stiffness welcome their new pain-free mobility. However,
gaining full confidence with your new hip may take several weeks.
When can I resume sexual intercourse?
In general, intercourse can be resumed safely approximately eight weeks after surgery.
Though individual recovery time varies greatly, this timeframe allows the incision and
the muscles around the hip to heal. If you recuperate rapidly, you will be able to
resume sooner, as long as you are free of pain.
What positions are safe during intercourse?
Total hip replacement precautions need to be observed during all activities, including
sexual intercourse. In general, follow the do's and don'ts on pages 26-27 and the
positions illustrated on page 29. As advised in the discharge instructions, you should
avoid excessive hip flexion (knee toward chest), adduction (leg towards center of
body), and internal rotation (toes turned inward).
Most patients, male and female, prefer 'passive' intercourse in the 'bottom' position, an
option some find less fatiguing. As your hip heals, you may resume a more active role.
After a few months, patients can resume sexual activities in any comfortable position.
What should I tell my partner?
As good communication is essential, you may want to share information in this booklet
with your partner. In addition, you can discuss the hip precautions that the hospital
staff reviewed with you.
Sexual Positions Recommended Following Total Hip Replacement
Pillows placed under your knees can provide extra support and comfort

Sexual Positions to avoid Following Total Hip Replacement

Limb-Length Restoration
The first step in establishing correct limb length after THR begins with a careful assessment of
leg-length inequality. Differentiating between true versus apparent leg-length inequality is
performed with patients supine on the examining table. True limb lengths can be determined by
measuring from the anterosuperior iliac spine to the medial malleolus of each leg, while
apparent limb-length inequality will be evident with the patient standing or recumbent and may
reflect problems such as scoliosis, abduction contractures, or adduction contractures.
One of the goals of THR is restoration of normal hip biomechanics; therefore, apparent limb
inequality may persist despite successful hip reconstruction in the setting of problems that
produce pelvic obliquity independent of hip anatomy. Preoperative counseling of such patients
will avoid one source of patient dissatisfaction.
Preoperative templating is an important second step for restoring hip biomechanics and limb
length. Templating allows accurate prediction of implant size. Templating also allows the
surgeon to judge the effect of the selected implant and its position on restoring or maintaining
limb length.1
The level of resection of the femoral neck should be individualized for each patient relative to
the selected implant system. The anatomic center of rotation of the femoral head should be
reconstructed without the use of extra-long, skirted femoral head components, which reduce the
arc of motion of the hip and may increase the risk of dislocation (Figure 1).2

Figure 1: AP radiograph shows the proximal

femur with a femoral template overlay. The
standard head length is placed over the
center of rotation of the femoral head, while
simultaneously assuring optimum canal fill and
neutral implant position. The necessity for a
lateral offset stem also may be predicted from
this process. The height of neck resection
above the lesser trochanter is estimated in
millimeters and marked on the radiograph (20
on this radiograph). The position of the
shoulder of the femoral stem below the tip of
the greater trochanter also is referenced (+5
on this radiograph).

Using some method of limb-length measurement intraoperatively is essential. A variety of

calipers and other measurement techniques are available for this purpose.3-6 In addition to using
an objective form of limb-length assessment, leg length should be compared intraoperatively by
assessing the equivalence of the malleoli and knee joints.

The author uses a simple method to objectively measure limb length. Prior to joint dislocation,
the patients legs are positioned as identically as possible (ie, in the lateral decubitus position,
both hips and knees are flexed equally).
Next, one end of a 36-inch umbilical tape is knotted. The knot is positioned over the
anterosuperior iliac spine. The tape is stretched over the anterior thigh, and a second knot is
made at the superior pole of the patella (Figure 2).

Figure 2: An umbilical tape can be used to

monitor limb length. The patient is placed in
the lateral decubitus position with both legs
flexed equally at the hip and knee. An
umbilical tape with a knot in the proximal end
is positioned at the anterosuperior iliac spine
and stretched over the anterior thigh to the
superior pole of the patella. A second knot is
placed in the umbilical tape at the position of
the hemostat. After trial reduction, the
umbilical tape is used to remeasure limb
length.

During trial reduction of the hip, this umbilical tape is used to measure limb length. This
technique allows a precision of 3-4 mm, which is adequate for hip reconstruction.
Additional intraoperative clues to limb length are the soft-tissue tension of structures around the
hip. For instance, in the absence of a severe flexion contracture, the anterior hip capsule serves

as a useful indicator of limb-length maintenance during trial reduction of a reconstruction

performed through a posterolateral approach.
The toggle test, in which the hip is distracted while in neutral position, also indicates length
restoration. In general, no more than 2 mm of distraction should be possible with the hip in
neutral position. Similarly, extreme difficulty during reduction of a hip with near-normal limb
length preoperatively indicates over-lengthening of the joint.

Prevention of Dislocation
Stability of the prosthetic hip joint is the result of a complex set of variables that includes
component position, proper soft-tissue tension (restoration of length and biomechanics),
component design, and patient factors such as compliance and soft-tissue healing. The
preponderance of these factors is under the surgeons control.
Position of the acetabular component is optimum at approximately 45 to the horizontal and 20
to 30 of forward flexion or anteversion. Assessment of acetabular position can be challenging,
particularly if a smaller, less invasive surgical exposure is used.
Careful exposure of the bony rim of the acetabulum by debridement of the labrum serves as an
accurate guide to implant placement in the majority of cases. However, situations that distort
acetabular anatomy such as dysplasia, trauma, or acetabular retroversion force the surgeon to
rely on assessment of the inserter instrumentation and reference to the pelvic position (supine
for direct lateral or anterolateral approaches, or rigid positioning of the pelvis at 90 to the
operating table for posterolateral approaches).
Femoral component positioning in approximately 15 of anteversion is necessary to avoid
impingement of the prosthetic neck against the acetabular rim throughout range of motion. Any
impingement of the neck may lead to dislocation.
The diameter of the prosthetic femoral head and the thickness of the prosthetic femoral neck (or
ratio of femoral head diameter to neck dimension in the plane of motion) are also important
determinants of implant stability. Larger femoral heads are inherently more stable than smaller
heads, although some compromise will be necessary based on the materials combination of the
wear couple.7-9

Intraoperative assessment of stability represents the surgeons last chance to correct

component malposition and should be performed carefully. With the limb positioned in neutral
abduction and adduction, the hip should flex to 90 without subluxation or dislocation.
There also should be no indication of subluxation with the hip flexed 90 in 30 of adduction.
The hip is further tested at a position of 90 flexion, neutral abduction or adduction, and 30 of
internal rotation.
Finally, the hip should be checked in maximal extension and external rotation to ensure there is
no impingement of the prosthetic femoral neck against the acetabular rim or prosthesis, which
may lead to anterior dislocation. Any tendency toward subluxation at any point during this
assessment should lead to a critical reassessment of implant position and limb length.
The issue of patient education and compliance with postoperative limitations following THR is
important, although use of the anterolateral approach may be advantageous for hip stability and
allow relaxation of postoperative hip precautions.10 Careful and realistic patient selection helps
avoid early postoperative dislocation, although larger diameter femoral heads may obviate this
problem to some extent.
Despite the current popularity of marketing minimally invasive THR as a way of achieving more
rapid recovery following THR, the surgeon must remember biologic healing and restitution of the
hip pseudocapsule is an important adjunct to long-term stability of the prosthetic joint, and the
healing process is a function of biology rather than optimistic marketing.

Summary
Limb-length restoration and maintenance during THR is the result of careful preoperative
assessment and planning. Intraoperative objective measurement of limb length is critical to
avoid over-lengthening. Stability of the reconstructed hip is the result of a combination of proper
implant position, proper soft-tissue tension, component design, and patient education.