When you and your doctor decide the time is right for hip replacement surgery, it can be difficult to think beyond the overwhelm of the surgery itself. But with a bit of time spent on preparation, there a few things you can do to give your hospital stay and recovery process a greater chance of success.

What is hip replacement surgery?

A total hip joint replacement is an operation to replace a damaged or diseased hip joint. Your hip joint comprises two parts; the hip socket and the ball at the top of your thigh bone. During hip replacement surgery, the ball and the socket are replaced with smooth, artificial parts. 

The outcomes of hip replacement surgery are pain relief, reduced stiffness, and improved ability to walk.

Recovery from hip replacement surgery is not the same for everyone. Factors such as age, motivation, health, and response to rehabilitation all have a role to play in the rate of recovery.

Your clinical team is the first place to go for information about your hip replacement surgery. You should receive information from the hospital where your surgery will take place. Make sure you read all the information given to you and ask your clinicians any questions you may have.

The Ministry of Health has some important information about postoperative problems you may encounter and what to do: Postoperative problems | Ministry of Health NZ

Our Osteoarthritis Online Support Group on Facebook offers invaluable first-hand experience and tips from people who have already been through the process. We gathered some helpful advice from two group members – Sandra and Polly.

Sandra gives us her perspective ten days post-op. Her goal after surgery was to return to walking the Great Walks of New Zealand. Polly speaks about a private vs public health pathway. Polly reflects on what she was glad she did before the surgery and provides thoughts on her experience going privately for her operation.

Sandra

Sandra

Sandra gives us her perspective ten days post-op. Her goal after surgery was to return to walking the Great Walks of New Zealand.

Polly

Polly

Polly speaks about a private vs public health pathway. Polly reflects on what she was glad she did before the surgery and provides thoughts on her experience going privately for her operation.

Tips To Get Yourself Ready For Hip Replacement Surgery

  • Smoking. You are strongly advised to stop smoking before and after surgery if you smoke. Continuing to smoke doubles your risk of complications and slows healing after your operation. If you need help quitting smoking, please get in touch with your GP or Quitline (0800 778 778) or visit www.quit.org.nz. You can ask your hospital if they provide free nicotine patches while you are staying there.
  • Alcohol. Alcohol consumption significantly increases the risk of complications, slows healing, and affects sleep quality after your operation. You are advised to avoid or limit alcohol before and after surgery.
  • Keep Active. Building muscle strength in the weeks leading up to your surgery will speed up your recovery. This includes arm and core exercises that will make getting in and out of bed easier. Walking, cycling and swimming are good exercises to build strength and fitness. Sandra said, “In the weeks leading up to your surgery, stay as active as possible.”
  • Upper Body Strength. Try strengthening your upper body as it will help you when you are trying to get in and out of bed, into a chair etc. Polly was glad she had a strength training background just for moving herself about the bed and mobilising in the first couple of days.
  • Single Leg Strength. Polly: “I’m glad I did lots of single leg exercises as it’s making me feel much more confident at getting up from seated.”
  • Weight Loss. If you are overweight, a total hip joint replacement can be more challenging to perform due to more tissue around the hip. Any additional strain on your muscles and joints can make recovery more difficult. Weight loss may not be possible due to your pain and limited mobility, but movement for cardiovascular health, strengthening parts of your body that you can and changes in diet, even without weight loss, can reduce your chance of complications after surgery. Polly said, “I’m a big lass. I lost 6 kg in the nine weeks I had to prepare for surgery. I was grateful for just a little less to move around.”
  • Kai. Good nutrition is necessary to recover well. If your diet needs a bit of a shake-up, start making some healthy habit changes as soon as possible, so you already have good habits for your recovery. Visit How to Get Started – Nutrition and Arthritis for tips on getting started. Polly’s number one piece of advice: “My GP told me to eat two kiwifruits a day pre-op. This was wise💩”
  • Medications. You will be given information about your medicines at your pre-admission / anaesthetic clinic; make sure you adhere to these.

Preparing Your Environment For Your Return Home

The information you will have received from your hospital in the public health system will outline when and how an Occupational Therapist (OT) will contact you to discuss your home environment and what equipment you might need for recovery. Your OT will discuss with you what they can provide or how you can acquire the things you need.

Private hospitals will have different processes. Polly gives us her experience in the private system: “The physio in the hospital talked me through equipment I might need post-op, but you will likely want to organise this earlier. It seems you have more access to support and advice pre-surgery (before your surgery date) in the public system. From the referral, I saw the surgeon twice for 10 minutes each. I was given a very informative leaflet, but this was it in terms of pre-op advice initially. A month before, I was given some information about equipment hire, home care and a few other things.”

Some things you might need are: 

  • High chairs. It would help if you had a firm and preferably higher chair than usual for recovery. Have one in the bedroom too if you have room. This ensures you don’t breach your hip precautions and can sit with your hips higher than your knees.
  • High stool to sit on while preparing food, washing up and using the stove top if you don’t have someone who can do the cooking for you.
  • Raised toilet seat. Hire or borrow. 
  • Shower chair. Hire or borrow (Polly purchased this as she found it was cheaper than hiring)
  • Grabber/reacher. Sandra improvised with some kitchen tongs but concluded they weren’t ideal and recommended getting the real thing.
  • Slip-on shoes. Sandra says to buy shoes before surgery that you can put on without bending over. Preferably not loose-fitting jandals. These may not be your style preference, but they will be your best friend for a short time.” Polly says she bought Sketchers Desert Rose shoes, which she found very comfortable, and the physiotherapist approved.
  • Long shoe horn. For shoes that are not easy to slip on.
  • Sock aid. To help get socks on your feet.
  • Pillow. You will need to sleep with a pillow or two between your legs. Both when you are on your back and when you are on your side. DO NOT sleep on your side without two pillows between your legs for 6-8 weeks. Sandra had one she previously bought from Wish. “I find it stays in place. A regular pillow will do, but in my experience, they don’t stay in place well.
  • Battery-operated nightlights. Helpful for getting up and being extra careful in the dark. You could also keep a torch beside your bed or use the torch on your cellphone. “I had them on the floor in the bedroom and the hallway so the cat didn’t trip me up on the way to the toilet at night,” said Polly.
  • Cross-shoulder bag or an apron with pockets are suitable for carrying small items with you, so you don’t have to use your hands which the crutches or walker might occupy.
  • Clotheshorse for washing.
  • Trolley to move heavier items across the room if you live alone. Remove rugs and mats, loose cords and anything that can be a trip hazard. Place commonly used items at waist height to prevent the need to bend.

Slip-on shoes

Leg pillow.

Leg pillow.

  • Kai. Good nutrition is necessary to recover well. Sandra adds that you may lose your appetite, but nutrition is important, so have a good selection of pre-made meals in the freezer and fruit to snack on. “I couldn’t stomach food for a week as I was nauseous from the pain medication.”
  • Exercycle. Polly hired an exercycle and found it very helpful once she was comfortable using it after her return home from the hospital.
  • Kai. It’s a good idea to make meals and freeze them for your return home to reduce the cooking you need to do immediately post-surgery.

Hospital

Your hospital will give you clear advice and instructions about your hospital stay and what to expect at each stage. Make sure you read all the information provided to you. Our two members picked out a couple of things they thought were important to mention on top of the advice you will be given.

COVID Testing

Public hospitals: Arthritis NZ talked to Auckland central hospitals and they said you would receive a COVID-19 test on the day of your surgery at the hospital free of charge. You should check with your operating hospital for guidance around COVID-19 testing.
Private hospitals: You may need to pay for a saliva PCR test, depending on where you are. The PCR test cost $125 for Polly. 

Clothes

Make sure you take something warm to wear while you are waiting for surgery.

Sandra says that underwear that is loose-fitting after surgery is best. E.g. boxers for men, Boyleg style for women. You don’t want the elastic digging into your stitches. Wear elasticated loose pants or shorts with pockets. You will have swelling, and you can’t bend your leg more than 90°. The pockets will hold your phone etc., so your hands are free for the crutches.

Polly said she didn’t need to take much to the hospital. “Most of the time, I couldn’t get to my bag. I lived in a hospital gown for two days. Not having visitors due to red-light was great. I could rest or doze as I needed. It was only an issue on the day of discharge when there was no one to help me pack my stuff.”

Recovery Expectations

You will probably need to ask your whanau and friends if they can help you in the first couple of weeks or while using crutches or a walking frame. These may help with post-op mental gymnastics: Why Use Mindfulness For Arthritis? – YouTube. Everyday tasks such as showering, getting dressed and undressed, cooking and cleaning, food shopping, getting in and out of the car, etc., will be challenging on your own.

“Expect an emotional roller coaster ride,” says Sandra. “My surgeon said this, and I didn’t get it. But I do now. I get very emotional over nothing. Take your time. Don’t rush anything because that’s when you could accidentally twist your hip or trip.”

Polly hadn’t prepared for quite how dependent she would be on others. “I don’t think my family were prepared for that either.”

Driving: You may be unable to drive for six weeks after surgery. Be prepared for this, and discuss it with your surgeon.

Wound care. In the public system, your nurse will check your wound before discharge and discuss the immediate ongoing care. You will have information about this in your discharge information pack too.

In private care, Polly says wound care will be managed by yourself or your GP practice. “I get super nervous about infection, so I saw the nurse at my GP for re-dressing and wound check. This reassurance was well worth it for me.”

Assistance from others. You will need help for a couple of weeks especially getting the compression socks on and off for showers. If you live alone, you may need someone to come and help you with this, or you might need a sock-aid at least.

Sitting vs moving. If you sit for long periods, you will notice swelling in your foot and ankle of the leg operated on. This will get more noticeable throughout the day. Walking will help to reduce the swelling and keep your feet up when you are sitting. You will notice much less swelling after a night’s sleep. Sandra says getting up every hour, even if you do a circuit of your lounge, will help.

Crutches/Walking frame. Keep using your mobility aids until your surgeon advises you to stop. Take them to your follow-up appointment and discuss them with your surgeon then. “Try to get onto one crutch as soon as you feel comfortable. This leaves one hand free, and take your crutch into the shower. It doesn’t matter if it gets wet and keeps you stable in a slippery environment,” Sandra explains.

Painkillers and sleeping. If you don’t tolerate pain killers well, talk to your GP or specialist at the hospital about some sleep aids if you have trouble sleeping. Sandra stopped all pain relief five days after her operation because it made her nauseous and spaced. “I took a sleeping pill at night to get a good night’s sleep to help me tolerate the pain during the day.”

Set goals every day. Along with the advice from your surgeon or GP, set a goal each day; for example, Sandra made goals like “today I am going to shower myself” or “today I am walking to the letterbox”. It is easy to feel sorry for yourself because you have been through a lot but keep moving and striving for improvements.

Boredom busters. Have some light reading, jigsaw puzzles, knitting, and TV shows sorted. You will get bored, but you will also struggle to concentrate at first so having a variety of boredom-busters is good, recommends Sandra.

Exercise/Physio. You will not require a physiotherapist once you return home. You will be given exercises to do, and it is up to you to do them. You will have a follow-up appointment with your surgeon and discuss if you need to see a physiotherapist at this point. Discuss with your surgeon what type of activity you would like to return to. Your surgeon will help you with the best plan to return you to doing what you usually enjoy. Strenuous activities such as jogging, jumping etc., are unsuitable after a hip replacement. Make sure you discuss this with your surgeon. Injuries involving a hip replacement may be difficult to treat and recover from.

Polly and the private hospital experience: “You will need to organise your physiotherapy should you wish to have some sessions. I have been seeing my physio for three years, so we prepared for surgery together. It’s great seeing him post-op as he knows me and my body and understands why it is moving and not moving in particular ways. If you can afford to see a private physio, do. Otherwise, and in addition, I highly recommend Dr Alyssa Kuhn on youtube as she has heaps of exercises for osteoarthritis to keep us moving.”

Sexual activity. Think about the hip movements and positions that you need to avoid. This information will be given to you by your hospital pre-surgery. Consider using pillows to help with positioning. You can ask your occupational therapist for more information about this.

Temperature-control. Sandra found she was hotter and perspired more post-op. “I guess the body is stressed, have good airflow or a fan/air con, so you don’t overheat and pass out. Even when I felt hot, I kept my legs warm with a light knee blanket as I noticed a lot of muscle spasms when my leg wasn’t kept warm.

Flights. Avoid flying in the first six weeks after your surgery unless necessary, as you are at greater risk of a blood clot.

Returning to work/hobbies. If your job involves bending, stooping, or lifting, you may need more than six weeks before returning to work. Talk to your surgeon about this at your follow-up appointment.

Final words from Polly about the private pathway: private is great for getting in quick, staff with lower patient loads in hospital, good food, lovely premises. However, knowing that everything outside of that might come down to you to organise is helpful.

 

Other resources:

    This article does not take the place of any information given to you by your clinical team and operating hospital. It also does not cover everything you need to know about your operation. 

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