The number of total hip replacements performed in the United States has skyrocketed during the past couple of decades. According to the National Center for Health Statistics (NCHS), replacements among patients age 45 and older more than doubled during a 10-year period, increasing from 138,700 in 2000 to 310,800 in 2010 — a rate increase of 142.2 per 100,000 people to 257 per 100,000.
Researchers aren’t sure why the numbers are growing so substantially, but they have some theories. There are have more seniors in the population today than there has been before, and they want to stay active in their later lives. Osteoarthritis is also becoming more common, particularly among middle-aged and older adults. The surgery itself has undergone improvements, with a faster recovery and technologically advanced implants making it easier for more people to undergo the procedure.
These factors and more translate to about 1 million hip and knee replacement operations performed each year in the United States. If you’re one of those people about to go through a total hip replacement, you may wonder how long it will take for you to recover.
Data from the HCHS report shows that the average hospital stay decreased from nearly five days in 2000 to slightly less than four days in 2010. However, the hospital stay is only the first part of recovery. Physical therapy is common after that and is likely to last for several weeks.
Is there a way to shorten your recovery time?
What Happens During a Total Hip Replacement?
Hips that have been damaged by arthritis or injuries can become so painful that taking a walk or getting up out of a chair can seem like insurmountable challenges. The hip may also feel stiff, making it hard to get dressed and might even keep you up at night.
When symptoms become this problematic, X-rays show extensive damage in the hip joint and medications and lifestyle changes no longer work, doctors typically recommend a total hip replacement. The procedure was first performed in 1960 and has become one of the most common and successful operations available today.
During the surgery, doctors remove the damaged femoral head (top of the thighbone) and replace it with a metal stem set into the hollow center of the femur (thighbone). A metal or ceramic ball is placed on the upper part of the stem.
Doctors then remove any damaged cartilage in the hip socket (acetabulum) and replace it with a metal socket. A plastic, ceramic or metal spacer is inserted between the new ball and socket to create a smooth gliding surface and, finally, the components are merged into the completed implant.
What Does Recovery Look Like?
Recovery from the surgery typically proceeds in three stages:
1. Acute Post-surgery
This is the period immediately after surgery when you’re still in the hospital. It’s important at this stage to make sure you get your painkillers on time to keep the pain under control. The surgery damages soft tissues and muscles and also may bruise the bone, so your body has a lot of healing to do.
For the first couple days, you’ll focus on recovering from the surgery itself. You’ll likely get up that first day and walk at least a few steps. Studies have shown that early movement helps stimulate healing. During this time, you’ll use a walker or crutches and start seeing physical therapists.
You’ll also start getting back to your regular diet and will shift from IV medications to oral painkillers. You’ll also be taking medications to prevent blood clots, which are more likely after surgery.
2. Early Recovery
At this point, you’ve either gone home from the hospital, or you’ve moved into a rehabilitation center. The initial pain from the surgery will have diminished, and you’ll be able to walk for longer distances. You should be back on your regular diet and feeling more like yourself.
Around four to five days after surgery, you should start needing less pain medication, although it’s still important not to let the pain get too serious as that can delay recovery. You’ll want to take care of your incision to prevent infection and continue with your physical therapy exercises. The goal is to keep moving as much as you can as that speeds healing and reduces the risk of blood clots.
3. Extended Recovery
This period starts around 10 to 15 days after surgery. If you had stitches that didn’t dissolve, you may have them removed, and you can start getting the area wet in baths and showers. Your tissues and muscles will be healing up and the bone will be repairing itself. Acute pain should be gone, although you may still feel some pain in the hip area.
This is the period when you get to work. You focus intently on your exercises, eat right, stay on top of the pain and push yourself in your exercises gently so you can walk more, bend more and get up out of your chair eventually.
Within three to six weeks of surgery, you should be able to return to most of your light daily activities, and you’ll probably be able to walk without assistance. You should also be driving by this stage. By the 10- to 12-week mark, you will be mostly back to normal, although it’s important to talk to your doctor about any strenuous activities, such as running, jumping and lifting.
7 Ways to Speed Recovery After a Hip Replacement Surgery
Your doctor and therapists will help guide you through the various steps you’ll take after surgery, but you can do some things on your own that will help speed up your recovery.
1. Manage the Pain
Pain management is important after surgery because if it’s done well, it can help speed your recovery. Researchers reported in 2016 that effective pain management “can improve health-related quality of life and functional status of patients after total hip arthroplasty.”
They added that postoperative pain after surgery can negatively impact the patient’s ability to move, increase the risk of blood clots and impair rehabilitation. An earlier study found similar results, stating that post-operative pain can delay recovery.
Pain management is also critical to successful physical therapy. Early exercise and muscle strengthening can help you recover faster, but only if you can keep the pain under control while you’re doing those exercises.
First, talk to your doctor before the procedure, so you know what to expect as far as pain is concerned. Then, communicate regularly about the pain you feel. Use a number scale of 0 to 10 to rate your pain, and try to be as descriptive as you can about where you feel the pain, what makes it feel better or worse and what methods of pain control have worked for you in the past.
Realize that there are multiple approaches to relieving pain. You’ll be on painkillers for the first few days, but other methods like icing, over-the-counter pain relievers, movement, meditation and alternative medications may all be used as you go through your recovery.
2. Prevent Infection
Infection can slow your recovery in a hurry, so you want to do everything you can to avoid it. First, avoid dental procedures right before and for several weeks after your hip replacement surgery. Bacteria in the mouth can enter the bloodstream during these procedures and can increase your risk of infection.
Next, follow your doctor’s instructions on wound care. Keep the incision area clean and dry, and change the dressings as needed. Cover when showering — your doctor or nurse will show you how. When the sutures are removed or when your doctor says, you can get it wet again — usually 10 to 14 days after surgery.
Keep your hands clean and be sure to wash before doing anything with the incision area. If it starts to appear red or begins to drain, this could be a sign of infection — tell your doctor right away. Don’t wait as an infection can get worse quickly and create more complications.
3. Be Consistent with Ice and Elevation
You can expect mild to moderate swelling in the surgical area and your calf and ankle for three to six months after surgery. You can reduce that swelling by regularly applying ice and elevating your leg. Icing also helps reduce pain, so especially in the early days after surgery, it’s important for your overall recovery.
Rest with your eggs elevated — knees above the heart — for about 15 to 20 minutes four or five times a day. Apply a cold pack to any swollen areas at the same time and for the same duration of time. The more consistent you are with this routine, the less pain you will feel, the more your swelling will go down and the easier it will be to do your exercises.
4. Prevent Blood Clots
Joint replacement patients are at the highest risk of developing a deep vein thrombosis (DVT) — blood clot in the leg — two to 10 days after surgery. The risk remains at a lower level for about three months after surgery. If you develop a blood clot in the leg, there is a risk that it could travel up to your lungs, potentially causing a life-threatening pulmonary embolism (PE), which is a blood clot in the lung. Taking steps to prevent blood clots is important to your recovery.
Any surgery increases the risk of blood clots, but joint replacement surgery does so even more than other types of surgery. One of the reasons is that your surgeon has to manipulate bones to place the new joint, which can force bone marrow into the blood vessels, activating the clotting process. The longer you’re not moving, the higher the risk as when your legs are still that the blood flow slows down, setting the stage for clotting.
After surgery, blood clots may also occur in the veins in the thigh, although this is rare. These clots are typically larger than those that form in the calf and can also lead to PE. Be aware of the potential symptoms:
- Painful or tender calves
- Swelling in the calf
- Redness or warmth in the leg
- Accelerated heartbeat
- Low-grade fever
To prevent blood clots, first, tell your doctor about any risk factors you have before surgery. If you have a family history of DVT, for example, if you’re taking hormone replacement therapy or birth control pills or if you have other conditions like heart disease, make sure he or she is aware of these. Then, after surgery, take your medications as instructed, wear compression stockings and get up and move as often as you can.
5. Be Disciplined About Doing Your Exercises
This may be the most important thing you can do to speed your recovery. In a 2018 review, scientists looked at the results of 30 individual studies and seven other reviews and found that, in general, rehabilitation was beneficial for recovery, although the intensity and duration of the exercises varied.
What we do know is that patients can manage more intense exercises if they’re done right. In a small 2012 study, researchers had one group perform regular exercises after hip replacement surgery while a second group performed more intense exercises using resistance bands. Both groups improved in gait speed, muscle strength, one-legged stance and quality of life. Those doing the more intense exercises reported no more pain than those performing the standard exercises. Both groups were satisfied with the results of the exercise programs.
We also know that performing the exercises at home can be just as effective as performing them at the doctor’s office — as long as the patient is performing them correctly. In a 2013 review, researchers looked at five studies and found that physical therapy improved hip abductor strength, gait speed and cadence and that the exercises were similarly effective whether they were performed at home or in the physical therapist’s office.
6. Watch Your Diet
Good nutrition is essential for recovery as the foods you eat can affect your mood, energy and healing potential. The right foods can get you feeling better faster while the wrong ones can slow you down.
In general, eat more fruits and vegetables, whole grains, lean meats and probiotic-rich options. More specifically, make sure you’re getting enough of these nutrients:
- Protein: It helps build and repair healthy tissue. Choose eggs, Greek yogurt, lean meats, nuts, whole grains, broccoli, lentils and fish.
- Vitamin C: This vitamin is necessary for repairing damaged tissues, and helping bones to recover. Choose citrus fruits, melons, berries, peppers, kale and Brussels sprouts.
- Calcium: This mineral helps build and maintain bone strength and is also necessary for muscle movement and nerve health. It’s best to get it from food over supplements. Choose yogurt, cheese, seeds, beans and nuts.
- Fiber: Fiber will keep your digestion moving smoothly throughout your recovery. Choose beans, bran cereal, almonds, fruit, barley, avocados, flaxseed and cabbage.
In addition, be sure you’re drinking plenty of water. It helps flush toxins out of your system, keeps you hydrated, reduces the risk of infection and can help reduce swelling.
7. Maintain a Positive Attitude
Believe it or not, your attitude can have a lot to do with your recovery. In a 2009 study, researchers reported that active participation in rehabilitation was important to recovery from hip replacement surgery but so was a positive attitude. Researchers wrote, “Participants reported that rehabilitation services greatly facilitated their recovery. Participants also recognized the importance of their own internal drive or motivation and noted that it was essential to maintain a positive attitude and to engage in the recommended rehabilitation activities fully.”
One review examining 16 studies that spanned 30 years found that the better a patient’s expectations about how they would do after surgery, the better they actually did. Studies have also shown that positive thinking can reduce your perception of pain.
You can help improve your attitude by first, setting reasonable expectations before surgery. Talk to your doctor, discuss any fears that you may have, and then choose to believe that your recovery will go well. Patients who expect a recovery to be slow often experience a slow recovery, so expect that yours will be faster than normal. Be realistic yet optimistic.
One thing that can also help is to keep a checklist of tasks you want to do and mark when you’re able to do them. Some examples may include walking for a quarter-mile, getting up from a chair on your own, driving, walking up and down stairs and performing other activities you normally do. As you accomplish each task, cross it off. This will help you see your progress and can motivate you to keep going despite any setbacks you may experience.
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AAOS. (n.d.). Total Hip Replacement – OrthoInfo – AAOS. Retrieved from https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
ABC News. (2006, January 6). Positive Thinking, Faster Recovery. Retrieved from https://abcnews.go.com/Health/story?id=117317&page=1
CDC. (2015, February 12). Products – Data Briefs – Number 186 – February 2015. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db186.htm
Chang, L. (2018, April 15). Timeline: Hip Replacement Surgery. Retrieved from https://www.webmd.com/osteoarthritis/timeline-hip-replacement#1
Coulter, C. L., Scarvell, J. M., Neeman, T. M., & Smith, P. N. (2013). Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. Journal of Physiotherapy, 59(4), 219-226. doi:10.1016/s1836-9553(13)70198-x
Kuchálik, J., Granath, B., Ljunggren, A., Magnuson, A., Lundin, A., & Gupta, A. (2013). Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia. British Journal of Anaesthesia, 111(5), 793-799. doi:10.1093/bja/aet248
Snell, D., Hipango, J., Sinnott, K. A., Dunn, J. A., Rothwell, A., Hsieh, C. J., … Hooper, G. (2017). Rehabilitation after total joint replacement: a scoping study. Disability and Rehabilitation, 40(14), 1718-1731. doi:10.1080/09638288.2017.1300947
Mayo Clinic. (2018, June 19). For Medical Professionals – First nationwide prevalence study of hip and knee arthroplasty shows 7.2 million Americans living with implants. Retrieved from https://www.mayoclinic.org/medical-professionals/clinical-updates/orthopedic-surgery/study-hip-knee-arthroplasty-shows-7-2-million-americans-living-with-implants
Mikkelsen, L. R., Mikkelsen, S. S., & Christensen, F. B. (2012). Early, Intensified Home-based Exercise after Total Hip Replacement – A Pilot Study. Physiotherapy Research International, 17(4), 214-226. doi:10.1002/pri.1523
Min, B., Kim, Y., Cho, H., Park, K., Yoon, P. W., Nho, J., … Moon, K. (2016). Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines. Hip & Pelvis, 28(1), 15. doi:10.5371/hp.2016.28.1.15
Young, Y., & Resnick, B. (2009). Don’t Worry, Be Positive: Improving Functional Recovery 1 Year After Hip Fracture. Rehabilitation Nursing, 34(3), 110-117. doi:10.1002/j.2048-7940.2009.tb00265.x