Post Surgical Care
Home Preparation Items
Check with your doctor and hospital about what you will need. Generally you will be provided with the following equipment or need to obtain them from a home health equipment store. In most cases these devices will be needed for the first six weeks to help avoid the risk of dislocation before the hip capsule heals. Some of these devices may be helpful before surgery to make life less painful. I bought a reacher about a year before surgery and it helped a lot.
- Long-handled reacher.
This is to allow you to pick things up from the floor and pull up pants without bending at the waist more than 90 degrees.
- Sock tool.
This device allows you to put on your socks without reaching down to your feet. The sock slides over the tool which is then pulled up using the ropes.
- Long-handled shoehorn.
As the name implies, this device allows you to slip on shoes without reaching low.
- Long-handled sponge.
Allows you to wash below your knees without bending more than 90 degrees.
- Elevated toilet seat.
Allows sitting on the toilet without having your knees above your hips.
In addition you will need a walker or crutches to use before you are allowed 100% weight bearing. Usually these are provided at the hospital where the physical therapy department will instruct you on their proper use.
In addition to the required items the following equipment or modifications may be helpful:
- Chair cushions
In order to sit in chairs that might otherwise be too low, causing you to sit with your hips bent past 90 degrees, you will need some cushions to raise the height of the seat. Cushions made for wooden chairs may be enough or you might get some boat cushions from a marine supply store. The advantage of the boat cushions is they often have handles so they can be carried from place-to-place. Two or more may be stacked, where necessary.
- Shower chair
Adjust so that you can sit on it without bending your hips past 90 degrees. Useful if you are not allowed 50% weight-bearing. Also it can be handy for support if you lean into the shower/tub to wash before being allowed to immerse your incision.
- Handheld shower
For about $30 you can get at handheld shower extender you may find useful for washing your hair before you are allowed to take a full shower due to the incision. These are available at hardware stores or homecenters and can be installed with one wrench.
- Grab bars
Depending on your home shower/tub it may be helpful to have some grab bars to help steady yourself while getting into the shower/tub.
- Backback or fanny pack.
I was surprised by how mobile I was on crutches, but one problem was that with both hands on the crutches I didn’t have any way to carry things around the house or at the office. A backpack or fanny pack helps. If you’re using a walker you can buy a pack that attaches to the walker.
- Water bottle
As described in the item above carrying things around is difficult. If you like to have a beverage with you, I recommend a jogger’s water bottle with a belt holster. I used one a lot.
- Cordless phone with belt clip
Handy to keep phone nearby at all times (you won’t want to be running across the house to catch the phone). A “hands-free” headset may also be helpful.
- Kitchen cart
If you need to prepare food and carry dishes from counter to table you can find inexpensive carts at Target or Wal-Mart or similar you can use for that purpose.
- Hospital bed
Sleeping while observing the hip restrictions in the first six weeks can be difficult. A hospital bed can be rented from home health suppliers and may be covered by your insurance.
- Move things higher.
During the time you have the 90 degree bending rule you may have difficulty reaching things on lower shelves or in lower cabinets. Move often-used items to shelves that can be reached without bending over.
Physical and Occupational Therapy
- First 4-6 Weeks
In the hospital the patient will likely be given a set of isometric exercises to do which will help the circulation in the lower legs, and begin the process of restoring the muscles that were separated for surgery. Typically this includes doing “ankle pumps”, “knee presses” (presses ones knees down while in a prone position), and glute’ squeezes (squeezing the gluteous maximus muscles). One the patient is able to get out of bed, they will be shown how to walk with a walker and/or crutches, including how to negotiate stairs. Walking with a walker or crutches will be the primary exercise until the hip capsule has healed and full weight bearing is allowed. Your surgeon will advise on the length of time for this. While in the hospital or rehab, an occupational therapist will show the patient how to use the dressing aides to wash and get dressed without violating the hip restrictions that might risk dislocation.
- Restoring Strength and Gait
Once the hip capsule has healed and increased weight bearing is allowed, a prescription can be written for full physical therapy. At this time, usually 4-6 weeks after surgery (longer if bone grafting was required), the patient will meet with a physical therapist who will design an exercise and stretching program for the patient. The program will be tailored for the patient, depending on their current state of recovery and what they have gone through in the months, or years, before the surgery. The physical therapy may include exercises such as water walking, leg lifts in four directions (to the front, back, toward the inside and out to the side), stretching of various kinds, including forced stretching by the therapist.
- Restoring Range of Motion – Stretching
If the patient has a dislocation-resistant implant (generally hip resurfacing or large-diameter total-hip replacement) and well-healed hip capsule they may be interested in contining a stretching and exercise program. Consult your surgeon and physical therapist about what is appropriate and safe for your case. Here are some resources on learning about proper stretching. More information on Stretching Scientifically from Amazon.com
Making it last
I’m often asked what activities I’m allowed to do. Only sky diving and bunging jumping were completely ruled-out, but I was told to avoid recreational, competitive sports such as basketball and to not “overdo” activities such as cycling. Regardless of what the patient is allowed by their doctor, there is no avoiding that hard use accelerates wear. It is often said that the lifetime of an implant should be measured in “miles” rather than years. So as you would with a new set of tires, you might consider some common sense ways to avoid excessive wear on the implant(s). The following are presented as suggestions without being scientifically proven:
- Avoid stairs
Stair climbing can exert a force of three times your body weight on your hips. The total force measured on descending stairs is actually slightly higher than ascending.
- Avoid running and jogging
Jogging can exert a force of five to six times your body weight on your hips, and stumbling during during jogging was measured at a force of seven times body weight.
- Try heel cushions in shoes
These can be purchased at sporting good stores or shoe stores. The inserts will reduce the impact of each heel strike and may cushion the blow to your knee and hip joints. Air soled shoes such as Nike “Air” or New Balance “Shock Abzorb” could also be used.
- Wear soft-soled shoes
Dress shoe brands such as Clarks, Rockport and Ecco have soft soles and help absorb shock. I have a pair of Clarks that are really comfortable.
- Maintain upper body strength
Using your upper body strength to lift yourself from a chair, help pull yourself up from the floor or similar motions may save some wear on your hips.
After the incision closes completely it will likely leave a hard ridge that will gradually resorb with time. You may hasten this by rubbing the scar 1-3 times per day. Some have claimed improvement using ointment containing vitamin-E, but there is no evidence that the contents of the salve have any beneficial effect beyond the massaging effect of applying them. There is an ointment on the market, brand named Mederma, that claims to aid healing and reduce incision contrast. It costs about $25-30 per tube. Treatment strips by Cica-care can be used to reduce the visible scar and any raised scars known as hypertopic or keloid scars. The self-adhesive strips are cut to fit the scar and are placed over the scar for at least 12 hours per day. The strips can be reapplied and used for up to four months. It will take 2-4 months to see results. Cica-care can be obtained over-the-counter in the US. The cost is about $40 at drugstores such as Walgreens.
It is recommended that you avoid exposure to the sun to avoid scarring along the incision.
If, after it is completely healed, you want to have your scar “erased” by plastic surgery, there are new laser techniques shown to be effective for this after a 1-3 treatments. One commonly-used brand of laser is Candela.