Recovering from Hip Surgery

Unfortunately, bruising is one of the most common issues after surgery. Some people bruise easily and so significantly that the entire leg may appear black and blue. This is usually worst at 5–7 days after surgery but be reassured it will settle. We use a combination of blood thinners after hip replacement surgery which can make for some dramatic bruises. Your body will completely resorb the bruises by 2–3 weeks. This is normal and will take a few weeks to resolve. Just like the elite athletes, we recommend the use of ice, compression and relative rest to control the bruising.

After any injury or surgery, it’s normal to trigger a pain response and this varies widely. Some people seem to skip through with nothing more than a paracetamol (e.g. Panadol) and a bag of frozen peas, while others who are not so lucky find themselves struggling for many months. We use a layered, or multimodal, approach that is individualised by your anaesthetist, our physician Dr Granger and the Acute Pain Service while in hospital.

Going into surgery, it is important we establish a baseline to better work out what is right for you and your recovery. 

After surgery, in addition to baseline meds such as paracetamol, ice and anti-inflammatories, we usually use a background slow-release pain killer such as tapentadol (Palexia) with immediate release for breakthrough pain or acute discomfort. These are just guidelines, and your anaesthetist will discuss this with you in some detail.

Swelling after surgery is due to a lot of factors. Your lymphatic and venous drainage system can be impaired during the first few weeks, even causing swollen ankles. Elevation, moderating your exercise and gentle massage will help. Rest assured it will settle but, in some patients, it can persist for up to 9 months. This is normal.

Elevate! Elevate! Elevate! It is very normal to have pain and swelling after surgery, and this may be around for up to 3 months. Focus your efforts on elevating your operative leg higher than your heart. Remember “TOES ABOVE YOUR NOSE”. Gentle compression can help to reduce swelling. It should feel snug but not tight like it’s cutting off your circulation.

It is normal to have swelling and fluid separate your new joint surfaces. This causes a “click” when the hard metal and plastic surfaces come back in contact with each other, but this typically settles when the swelling has reduced and your muscles have tightened around the joint. Importantly, it isn’t dangerous and is nothing to worry about.

You may not know it, but you have two scars. One on the skin and a separate one on the inside of your hip. This internal scar may get inflamed, causing heat as well as some discomfort. If the swelling and the heat increase, be sure to let us or your GP know. Don’t forget to ice, compress, and elevate.

Contact us or your GP as soon as possible if you have increasing redness, heat, pain, swelling or any signs of pus around your joint. It’s common to have reactions to the dressing or sometimes patients develop a suture granuloma (a mass of tissue around the wound) which should settle with time. It’s important we know either way.

Deep Vein Thrombosis (DVT) is a blood clot that occurs in a deep vein, that is, a vein that is not on the surface of the skin. DVT can occur anywhere in the body but is most often seen in the leg. The most serious complication of DVT is pulmonary embolism, which is when a piece of the blood clot breaks off and lodges in the lung. This causes a serious illness and is potentially life-threatening. The main signs of DVT are pain and swelling in the affected area, usually your calf or thigh.

You will be discharged with aspirin (if you are not on any other blood-thinning medication) to help thin the blood and reduce the risk of a DVT. Please continue to finish the packet you have been discharged with.

If any symptoms arise, please contact your GP or our rooms immediately to get further testing, such as an ultrasound, to confirm the presence of a DVT and receive appropriate treatment if needed. Please avoid any massage to the area until cleared.

It’s quite common to have neuropathic (nerve-related) discomfort at night. This is normal and will settle. Neuropathic pain is often worst at night because we lack the normal daytime stimuli and signals that distract our brain. With no distractions at night, full attention is turned to your joint which, for some people, results in deep discomfort and many early-morning hours watching the clock.

A good sleep routine (regular bedtime, dark environment, cool temperature, avoiding blue light from computer screens) and heat such as a hot shower and a heat pack over your muscles (but not the joint so soon after surgery), and slow-release medication should help. Spasm and cramping at night gradually improve and typically takes 6–8 weeks to resolve. You can try taking magnesium (200 mg once a day) to help.

The delicate healing of your wound can be upset if you rub it too hard or rub in the wrong compounds. Please seek nursing or medical clearance before you use creams on your wound.

It is very common to have constipation after surgery, especially when taking pain medication. Kiwi fruit (skin and all) is great for constipation. Taking an over-the-counter stool softener, such as Coloxyl, is also a good way to prevent this problem. If this is not enough, you can add senna twice a day. Please make sure you’re staying hydrated and drinking plenty of fluids. You can try prune juice in addition to water. Some patients have found Smooth Move, a senna-based tea, to be helpful in relieving constipation.

Take these medications until you have regular daily bowel movements, then decrease to once a day. You should not use these medications if you experience loose stools or diarrhoea. If you develop severe abdominal pain/bloating and cannot eat or tolerate fluids, please present to the Emergency Department for evaluation.

Get in touch with Dan and his team to see if hip replacement surgery may be right for you.