With total hip replacement surgery becoming less invasive, many people are making the decision to have their pain alleviated by having this operation. I doubt that there are few people out there that are as much of an expert as I am on this subject, having just undergone my second total hip this past December. This article will focus on what you will face at home, after you have left the hospital or the convalescent home.
First I want to give you some background in regard to my unique situation with these operations. In 2001, after years of playing sports and a job that had me on my feet most of the day, I was in unbearable pain in my right hip from osteoarthritis. I had no cushion at all between where my leg bone met the hip socket. After going to a specialist, I was told that I needed a total hip replacement. At age 44, I thought my active life would come to a grinding halt, but the severe discomfort made my decision for me.
I had my hip replaced on November 6th, 2001. I returned to work on December 27th, 2001. I played basketball again on January 18th, 2002! I am here to tell you that this operation will allow you to live a normal, pain-free life. As time passed, I was as good, if not better, a ballplayer as I had ever been. I could not run as I could before or leap as high, but I learned to jump off my left leg and played on. Only when my left hip began to bother me did I stop playing, in June of 2005.
What I had going for me that many of you do not is that I was 44 and 48 at the time of my surgeries, very young for total hips. Being in good shape, I was able to bounce back quickly. However, no matter your age, there are still many obstacles to deal with when you come home from this operation. Here they are, in no particular order.
Take into account the layout of your home or apartment.
Picture yourself trying to navigate your surroundings on a pair of crutches, a pair of canes or just one cane. In 2001, I went into a convalescent home for five days after leaving the hospital and then came home. I had 29 staples in my right side to close the incision from the surgery. I was unable to support myself, even at age 44, without the use of crutches. In 2005, advancements in medical technology were such for this procedure it took only 15 to close the opening and I went right home after 4 days. There was lesser trauma to tissue and muscle, and I was able to use 2 canes to move about. In both cases however, it was important for me to identify the problem areas in my home. These included 12 stairs to my upstairs level, 2 as I entered the house through the mudroom, and 2 as I went down into my living room. Each had to be taken with extreme care, so as to avoid falls that would cause possible dislocation of the replacement hip. The first 6 to 8 weeks after the operation, especially in older folks, is when you have to take the utmost care in your environment. Make sure that you have room to maneuver in tight places such as bedrooms, hallways and your bathroom. Be aware that pets can get underfoot and cause you to stumble. Loose rugs can be a hazard for someone on crutches or a cane. For me, it was hard to go up the 2 stairs from my living room, because of the absence of something to hold onto. Prior to the operation, go through the house and look for the places that will be trouble and have a plan on how to conquer them. You can discuss with your physical therapist how to solve these problems while you are in the hospital following surgery.
You will need a commode.
To be able to go the bathroom without hurting yourself, you will need a commode, most likely placed over your existing toilet. A normal toilet is too low for you to sit on for the first couple months following surgery. One of the precautions that you cannot break is the 90 degree rule. Sitting normally, with your back straight, your legs and back meet at a 90 degree angle. People with new hip replacements can suffer a dislocation if they make that angle less than 90 degrees. Sitting on a low toilet seat risks this. For your convenience, the commode can be in the room where you will spend the most time. Mine was in the bathroom, but my young age again allowed me the ability to get to it more easily than an older person might. I was able to sit on the commode and use the toilet normally; I was just higher over it.
There are various devices to help you get dressed.
Putting on socks and shoes, pulling up pants and underwear, and taking these things off are all problematic for people with new hip replacements. You will be shown by therapists how to get your socks on with a device that resembles a hardened glove on 2 straps. The sock goes over it, and then you pull the sock over your foot with it without having to bend. You will have a long shoehorn that helps you get shoes or sneakers on. The laces in your shoes will be replaced with special stretching laces so that they will remain tied all the time. You will have a stick with hooks on the end to help you pull up your pants and underwear. Therapists will show you how these helpful tools are used prior to surgery.
You will receive injections in your stomach for a time after you return home.
The greatest danger following a surgery of this type is from blood clots forming in your legs. To lessen this, you will be administered blood thinners in your lower abdomen twice a day for about 2 weeks after you get home. You can even give yourself the shots. They are not very painful, but can cause some bruising in the area they are given to. Again, if you are to give the shots to yourself, you will be shown how. The fact that this is a blood thinning drug means you do not want to cut yourself. I purchased an electric razor to avoid this problem while shaving.
You will receive physical therapy at home.
I had a physical therapist come to my house for 2 weeks after my surgeries, a total of 10 visits each time. They will give you specific exercises to perform that are designed to increase your strength, stamina and balance. You will do these exercises 2 or 3 times during the day after the therapist leaves. Do not underestimate the importance of these exercises. By doing them properly, they will help you to recover faster. A physical therapist will work with you during your stay in the hospital, showing you what you can and cannot do, such as crossing your legs. They will show you the proper way to sit and stand from a chair. If you have any questions, feel free to ask them. If you have pets, have a plan in place for when the physical therapist shows up.
You will go to outpatient therapy
Your physical therapist will graduate you to outpatient therapy after their visits have run out. I was able to drive to my most recent outpatient sessions, but you may not be sufficiently recovered to drive by this time. You need to know who will be able to take you if you cannot drive yourself to these sessions, preferably before you even have the surgery. Once there, you will be put through the paces on various machines such as treadmills and stair climbers. I had 12 visits scheduled for myself this last time, but had made enough progress that I only needed 9 of them. They are hard work, do not take them lightly.
You will be coming off of some serious narcotic painkillers.
Immediately after surgery, you will be on some form of intravenous morphine for the pain you will be in. Your doctor will send you home with some pretty good stuff for pain, and you will be glad they did. Most of the pain will be from the incision, where muscles are cut and reattached and tissue is sliced open. The staples will come out after a couple of weeks. You will have pain in other areas; remember, to perform this operation, your doctor has to dislocate your hip! Follow your doctor’s direction when it comes to these painkillers. Here is a word of warning. In 2001, I became extremely depressed when I came off of these drugs. I did not realize what caused this then, but found out later that this is a side effect for some people. I was very emotional and did not know why. In 2005, I was prepared for it, and it happened again. At least I understood it and knew why it was happening. Discuss this aspect with your doctor.
You cannot lift even moderately heavy objects for quite some time.
Do not attempt to lift things such as chairs, boxes, vacuum cleaners, or any object with even moderate weight. Your hip is not stable enough and you will feel the pain right away. Give yourself time.
Bathing is going to be a chore.
Getting in and out of the bathtub for a shower may not be possible at first. I was able to get in the tub and stand, but only with the help of my wife for two weeks after surgery. You may have to bathe with a facecloth until you can get in the shower. Ask your therapist to evaluate your ability to do this when you feel ready. Be very, very careful once in the tub, especially when getting out. Make sure you have someone there to help you in and out. Don’t be modest and don’t try to be a hero and do it yourself. It is too risky.
You have to sleep on your back
Because you cannot afford to cross your legs while asleep and risk dislocation, you will sleep with a large, wedge shaped, foam pillow velcroed to your legs when you come home. It will be there when you wake up from surgery, and you will take it home with you. If you do not sleep on your back, like me, this will be difficult. As a matter of fact, this was the single hardest thing for me to deal with after my second surgery. I am a sporadic sleeper to begin with and this made it much worse. Eventually, you will heal enough so that you may lie on your side or stomach, but only with a pillow between your legs as to avoid crossing them. You may need a sleep aid such as Ambien or Lunesta to help you sleep.
I hope this article has been informative for those considering a total hip replacement. It might be hard when you first come home, but if you are prepared for the challenges then you have a head start. I heartily recommend the operation for anyone in pain; it certainly improved the quality of my life. With the advancements in this field, recovery from surgery will be easier and less painful in years to come. Good luck and God bless you.