Post-op care

As with any major surgical procedure, post-operative complications can occur following total hip replacement surgery. Below is a list of some of the more common complications that can occur after hip replacement surgery. This list is not meant to be all-inclusive.


This condition, also commonly referred to as deep vein thrombosis, occurs when blood clots are formed in the large veins of the legs. In some cases, these clots can become dislodged from the veins, travel through the circulatory system, and become stuck in the critical arteries of the lungs. This scenario, called a pulmonary embolism, is a serious medical condition. The following steps may be taken by you and your physician to avoid or prevent thrombophlebitis:

  • Blood-thinning medication (anticoagulants, aspirin)
  • Elastic stockings (TED hose)
  • Foot elevation to prevent swelling
  • Foot and ankle exercises to optimize blood flow
  • Pneumatic devices placed on the feet to improve circulation

IMPORTANT: If you develop swelling, redness, pain and/or tenderness in the calf muscle, report these symptoms immediately to your physician.


Infections occur in a small percentage of patients undergoing hip replacement surgery. Unfortunately, infections can occur even when every effort is made to prevent them. The following steps may help to minimize the risk of post-operative infections.

  • Closely monitor the incision and immediately report and signs of redness, swelling, tenderness, drainage, foul odor, increasing pain, or persistent fever
  • Always wash your hands before and after handling your incision site, especially when the sutures are still in place


A possible side effect of surgery is the development of pneumonia. The following steps may help minimize this risk.

    • Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to: “smell the rose and blow out the candles.” In other words, inhale slowly and deeply through your nose, and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises 8-10 times every waking hour
    • Coughing: This activity helps to loosen the secretions in your lungs and excrete them from your pulmonary system
    • Incentive spirometer: This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique

Hip Dislocation

One of the most common problems following total hip replacement is hip dislocation or subluxation. Because the prosthetic ball and socket are smaller than the natural anatomy, the ball can become dislodged from the socket if the hip is placed in certain positions. The following precautions must be taken to prevent hip dislocation.

      • Do not bend forward to reach your feet. You must no bend your hips at greater than a 90-degree angle
      • Do not lift your knee higher than your hip on the operated side
      • Do not cross your legs
      • Do not allow your legs to internally rotate (feet turned in)
      • Do not twist while lying or standing
      • Sleep on your back with a pillow between your knees to prevent crossing


Hip replacement surgery is a very complex procedure. However, the outcomes following hip replacement are usually very successful. One of the important critical success factors for a successful outcome is following the physical rehabilitation process. In order to help achieve the goals for a successful total hip replacement, you must actively participate in the rehab process and work diligently on your own, as well as the physical therapists, to achieve optimal results.

Once you have completed the post-operative rehabilitation process, you should have near normal range of movement and adequate strength in your hip to perform most activities of daily living.

Early rehabilitation

Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery.

You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.

The physical therapist will begin as early as 1-2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:

      • Gluteal sets: Tighten and relax the buttock muscles
      • Quadricep sets: Tighten and relax the thigh muscles
      • Ankle pumps: Flex and extend the ankles

Your physical therapist will also teach you proper techniques to perform such simple tasks as:

        • Moving up and down in bed
        • Going from lying to sitting
        • Going from sitting to standing
        • Going from standing to sitting
        • Going from sitting to lying

Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer other injury.

Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury.

The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They will provide you with a list of hip precautions which are designed to protect your new hip during the first 8-12 weeks following surgery.


        • Do not bend forward to reach your feet. You must maintain a 90 degree angle between your torso and legs
        • Do not lift your knee higher than your hip on the operated side
        • Do not cross your legs
        • Do not allow your legs to internally rotate (feet turned in)
        • Do not twist while lying or standing
        • Sleep on your back with a pillow between your knees to prevent crossing
        • Strictly observe your weight bearing precautions during standing or walking

Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living.

These devices may include the following:

        • A reacher to dress and pick things up from the floor
        • A sock-aid that will assist in putting on socks
        • A long-handled sponge to wash your legs and feet
        • A leg-lifting device to move the operated leg in and out of the car or bed
        • An elevated toilet seat so that you don’t violate your hip precautions when using the bathroom
        • An elevated bathtub chair to fit in the shower or tub

The precautions following a total hip replacement must be strictly adhered to in order to prevent dislocation of the hip implant and the possibility of re-operation.

At Home

Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regularly basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to mange.

Here is a list of potential exercises that you may be asked to perform. If an exercise is causing pain that is lasting, reduce the number of repetitions. If the pain continues, contact your physical therapist or physician.

        • Ankle pumps
        • Quadricep sets
        • Gluteal sets
        • Heel slides
        • Leg lifts
        • Knee extension
        • Hip abduction

While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use. You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.

Long-term rehabilitation goals

Once you have completed your rehabilitation program, you can expect to be able to perform most activities of daily living with little to no pain or assistance. Patients following total hip replacement routinely are able to walk, dress, bathe, drive, garden, cook, and return to work. Although final outcomes may vary from patient to patient, total hip replacement surgery is one of the most successful procedures in modern medicine and most patients return to a full and active life.

Because total hip arthroplasty is one of the most successful procedures in modern medicine, you can expect to return to a high level of function. However, special precautions should be taken by people with hip replacements.

You should avoid high impact activities as running, vigorous walking, downhill skiing, or other high impact activities. Be careful when lifting heavy objects and continue to follow the basic total hip precautions as stated in the rehabilitation page.

Patients having total hip replacement surgery have successfully returned to such activities as walking, driving, swimming, golf, doubles tennis, stationary cycling, and gardening.

Remember to listen to what your body tells you. If you begin to have pain or swelling for over 24-48 hours, contact your healthcare professional for advice.

How long will your implant last?

It is difficult to predict the length of time a total hip implant will last as its lifespan depends on many factors. Unfortunately, surgical complications can occur and in some cases implants last only a short time. However, the vast majority of implants last for years, providing patients with pain relief and improved function. By following hip precautions and moderating your activity level, you may enhance the function and longevity of your artificial hip.

Surgeons, researchers and implant manufacturers continue to work diligently to improve both the short term and long term outcomes of total hip replacement. For example, Oxinium technology from Smith & Nephew is a new high performance material shown to reduce acetabular component wear by as much as 60-percent. Less implant wear may extend the life of the implant and reduce the need for future corrective surgeries.

For more information about Oxinium technology, visit

Hip Resurfacing

How long will the BIRMINGHAM HIP Resurfacing implant last?

It is impossible to say how long your implant will last because so many factors play into the lifespan of an implant. In the case of resurfacing, for instance, the metal-on-metal bearing surfaces of your new joint may extend its life longer than that of a traditional total hip replacement, but failure to comply with your physical rehabilitation regime may cause your implant to fail within months. A clinical study showed the BIRMINGHAM HIP Resurfacing implant had a survivorship of 98.4-percent at the five-year mark, which is comparable with the survivorship of a traditional total hip replacement in the under-60 age group.

How long will my scar be?

Your surgeon will use an incision of between six and eight inches in length. While some surgeons may use a slightly smaller incision, most will fall in that range.

What are my physical limitations after surgery?

Most surgeons will tell you that after the first year, you can return to whatever physical activity you enjoyed before hip pain limited your mobility. For instance, unlike total hip replacement, you will be able to return to jogging or singles tennis after your first year after surgery. During your first year, more conservative, low-impact activities like walking, swimming and bicycling are recommended for strengthening your femoral neck and the muscles around your resurfaced joint.

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