For many of my hip replacement patients, returning to the lifestyle they had prior to developing hip arthritis and debilitating pain is an exciting part of the healing process. Returning to an active lifestyle can be an invigorating part of recovery, however, the goals of the recovery are to rehabilitate safely and efficiently. I commonly discuss the post-operative recovery with all of my patients multiple times to help set expectations. For example, before surgery, I have patients come in a week prior to their surgery to discuss my post-operative protocol. One of the most important things we discuss is how I expect they will progress in the hospital, at home, and for the next several months after surgery.
Patients can typically stand and begin walking within four hours of surgery (we call this ‘day zero’). Within 24 hours, and occasionally the same day, the majority of patients will be discharged from the hospital. I am sometimes asked how it’s possible to go from surgery to home within 24 hours. Our goals are threefold:
Preoperative planning/setting expectations for recovery
Pain and nausea control
Accelerated postoperative rehabilitation (walking within hours of the surgery)
I stress the importance of a post-operative plan with each patient. We routinely assess how they will be able to go home and what resources (family members, friends, house set-up, etc.) they have to safely accomplish this goal. Sometimes this will require substantial advanced planning to achieve our mutual goals. Once the day of the surgery arrives, we simply enact our plan, confirm that the patient can safely walk, tolerate a diet, and has great pain control prior to returning home.
For my hip replacement patients, there is no structured physical therapy, but they do need to walk and do it on a regular basis. Walking is rehabilitation and by walking they will continue to build up muscle. I do not require a structured therapy protocol but rather clinically evaluate the progress of each of my patients and only utilize a structured program if a patient is not excelling on their own. Each surgery has specific dislocation risks regardless of the approach. Patients should be cognizant of the surgical approach utilized in their total hip replacement in order to avoid a dislocation. Your doctor will review these precautions and motions to avoid with you.
J. Ryan Martin, MD, is a hip and knee surgeon with OrthoCarolina Matthews.