6 Weeks After Surgery

Please phone my office to book a six week follow up appointment.  Before coming to this appointment I would like you to review the following frequently asked questions.

Common Questions and Answers

What do I do if my scar is thick or puckering?

Scar mobilization can help decrease tethering of the skin to the underlying tissues. Once the wound has healed nicely (usually 4 weeks after surgery) you can start manipulating the scar. Place your thumb or palm on the incision and with increasing force rub in circles moving your way down the scar to break up the scar tissue.

When can I resume driving?

The evidence on when to drive after a joint replacement is conflicting and the most common theme is that you need to be relatively pain free and able to move you leg quickly from the gas to the brake to be safe. A good guideline for most people is that you can gradually return to driving when you are off narcotic medications AND using minimal assistance of walking devices. For most of my patients after a total hip replacement this will be somewhere between 2 to 6 weeks post op.
Please use common sense and be safe. If you are unsure or feel unsafe please wait to check with myself, another health care provider or SGI!

If my skin has pain or numbness, will this go away?

Numbness around the incision is quite common after a hip replacement (from cutting the skin nerves passing through the incision). It can take up to a year for you to get to your new normal and some people have some residual numbness. Tenderness around the hip is usually from tendonitis and inflammation. This will sometimes worsen a few months after the hip replacement and will usually resolve when your pelvic stabilizer strength improves. Anti-inflammatories (including medications and creams) can be helpful in the short term. Also, if the pain is lateral, making sure you use a cane to decrease limping is important. If significant pain or discomfort please let my office know.

What excercises are most important to help me function normally?

In the first 6 weeks it is VERY important to follow the instructions that the physiotherapist gave you post-operatively (most specifically the range of motion restrictions). At 6 weeks I will allow you to relax most of the post op hip precautions including crossing your legs and bending past ninety degrees however you need to make sure that you avoid internal rotation of you leg especially in flexion. This means that when you bring your knee up (or bend forward) your knees have to move to the outwards. This means you can see the inside part of your ankle but not the outside part. I have attached a video to explain this in more detail below. When increasing your range of motion, do it gradually and if you have pain or stiffness respond to this (listen to your body). It takes 4 to 6 months for the posterior soft tissue repair to be fully healed so these range of motion restrictions will last until this time. Strengthening after a hip replacement means not only getting the leg muscles stronger but also getting your core muscles stronger. When people have pain after a hip replacement most often it is from having weak pelvic stabilizer muscles. Please refer to your physiotherapist or my section on muscle strengthening for more guidance.

When should I use a cane?

Initially most people will start with a walker. You may transition to a cane when you are stable enough that you will not fall and hurt yourself. As your stability and strength increases over time you can stop using the cane. If you notice that during an activity you are starting to limp you should either stop the activity or use the cane for the remainder of the activity. Limping means your muscles are not strong enough yet! If you limp too much it can cause pinching in your hip (anterior hip pain) or trochanteric bursitis (lateral hip pain). This will not wreck your hip replacement but if can be quite uncomfortable.

What else can I do for my pain, swelling and stiffness?

Heat can be good for rehab especially if you are feeling stiff (ie. in the morning). Ice, cooling pads or even cooling machines (such as ColdTherapy or Game Ready) can be helpful to decrease inflammation. This may be useful after activities or excercise. Compression can be used to decrease swelling in the foot and leg. Tensor bandages, compression stockings or compression machines (such as Game Ready) can decrease swelling and improve circulation. Swelling in the leg can last for months after a joint replacement.

Where can I get Cold Therapy or Game Ready Machines

Cold therapy (ie cryocuff) or similar machines will circulate iced water over the area of concern. These machines are available many places in the city however if you are having difficulty locating a place to rent or purchase you can call Mike at SOSMC (https://www.sportsmedcenter.ca/contact). Game Ready is a unique device that provides compression and cooling in one device. To rent this please contact Stephanie Thoms at s.thoms@sasktel.net or (306) 229-6093. Benifit companies will often cover a portion of these costs.

When can I travel after a hip replacement?

I usully don't put any restrictions on travel post op. All I ask is that you attend your regular follow up. Travelling may increase your risks slightly as discussed below. If you have prolonged immobility (ie sitting in a plane or vehicle for hours) this can increase your risk of blood clot. We give 4 weeks of blood thinners post op but if you are travelling and still have symtomps/swelling after coming off blood thinners then you can take ASA daily a few days before and after travelling if this is safe for you to do (and if you are worried discuss this with your family doctor). Please note ... if you leave the province or country you may not have the appropriate coverage or they may not cover you because it is a pre-existing condition.

When do I need to take antibiotics?

If you have an infection not associated with your joint replacement, you should have this treated early with antibiotics (especially if it is associated with fevers and chills). If you are worried about an infection in or around your joint replacement PLEASE do not start antibiotics without contacting my office. If you are having an invasive procedure or routine teeth cleaning within 4 to 6 months of your joint replacement it would be ideal to delay if possible. If you cannot delay then you should have prophylactic antibiotics (and these can be prescribed by your doctor/dentist or myself). If you are having routine dental work AFTER 6 months it is currently the recommendation of the Canadian Dental College and the Canadian Medical Association that prophylactic antibiotics are not routinely needed.

When can I lie on my side?

You are allowed to lie on your side when your wound has healed nicely. It may be too tender to lie on initially (especially if you have trochanteric bursitis) however it will not wreck your hip. If you are lying on your side you should have a pillow between your legs for the first 4 to 6 months to avoid internal rotation of the operative leg (see excercise question for more information).

When should I return to work?

Return to work is quite variable after a joint replacement. It depends on your ability to function and the type of job you are returning to. For you to be successful you must be able to have time to perform physio/rehab. If you are returning to a sedentary job, you can often return to work when you are mobilizing safely and have your pain under control (sometime in the first six weeks). For semi-labor jobs it can be up to 4 to 6 months until you can return safely. The best plan for return to work is to have your physiotherapist develop a return to work plan. If you need to have this reviewed by me please send a copy to my office.

When can I resume activities such as sex, vaccuming or other activities (and yes, these are the 2 most commonly asked about;)?

After a hip replacement you have to be careful of the ranges of motion that you move into. As long as you are able to stay within the range of motion restrictions that are appropriate for your stage of recovery, I am happy with you doing either of these activities. If you do too much of either of these or any other activity you may end up being more sore but it will not do any long term damage. You must be careful when you put yourself in dangerous positions (such as climbing ladders and going on the roof) because if you have pain or weakness that limits you, it can put you at a higher risk of injuring yourself.