The advances of minimally invasive surgical techniques along with those in pain management techniques have provided a recovery time line after total hip replacement surgery that is dramatically improved over past experience.
With minimally invasive surgery there is less dissection and cutting of the muscles and ligaments of the hip. The patient observes that the skin incision is shorter, muscle function returns more quickly, that the hospital stay is shorter, and that ambulatory aids (cane, walker or crutches) can be discarded sooner. The operation itself usually takes 90 minutes to complete.
In Hospital Physical Therapy:
Early efforts at mobilizing the patient are made on the day of surgery. Typically the patient is helped up in a chair and walking that day. On the day after surgery, therapy starts in earnest. Full weight bearing is encouraged. Strengthening exercises are started. Stair climbing is taught.
The hospital stay is generally two to three days (i.e. Monday surgery would equate to a Wednesday or Thursday discharge). Younger and physically fit patients may be discharged home on the second postop day. Older patients, those less fit, or those planning a discharge to a rehabilitation facility will typically stay three nights.
It is safe to get the wound wet on the 5th day postop if all drainage had ceased. If any drainage persists, the wound should be kept clean and dry with a sterile gauze dressing applied and changed as necessary till it completely stops.
Physical Therapy after Hospital Discharge:
Three options are available for post hospital therapy.
- Rehab facility transfer – Direct transfer from the hospital to a rehab facility is sometimes necessary. This option is most appropriate for older patients and for those who live alone. Insurance coverage for rehab stay varies and needs be investigated in advance. Duration of rehab stay can be as short a few days or as long as several weeks and depends on the speed of recovery and the amount of support each patient will have when returning home.
- Home therapy – This is now the most commonly employed option. Most patients have insurance coverage for home therapy. The quality of home therapy is quite excellent. Duration varies, but is generally employed for 2 to 3 weeks.
- Outpatient therapy – Outpatient therapy in a physical therapy department has the advantage of better equipment vs. what is available in home. More mobile patients often opt for outpatient care. Patients often transition from home to outpatient therapy as they become more mobile.
Time on Walker or Crutches:
Full weight bearing is generally allowed immediately after surgery. Most patients can wean off the walker or crutches as their muscle function, swelling and soreness allows. Many patients have moved to the use of a cane by 1 to 2 weeks postop.
Time on a Cane:
Once off the walker or crutches, the use of a cane in the opposite hand is sometimes helpful for a short time. Most physically fit patients are off all ambulatory aids including a cane by 2 to 3 weeks postop.
Time Until Return to Driving:
Patients should not return to driving until cleared to do so postop. In part this is due to liability issues if an accident should occur. It is generally safe to return to driving 2 to 4 weeks after left hip surgery and 4 to 6 weeks after right hip surgery.
Returning to Work:
Predicting a return to work date is difficult. Motivational issues play and important role. Great variability exists. In general, patients returning to a sedentary job tend to return to work 4 to 6 weeks postop and those with more physically demanding jobs tend to return at 3 months postop.
Returning to Recreational Athletics:
Patients can begin to return to light recreational sports such as golf by 4 to 6 weeks postop. More strenuous sports such as tennis may require 12 to 16 weeks before a return is possible.