Hospital Stay

Depending on the timing of surgery patients will be given a time to arrive at the hospital. Most patients are anxious arriving at the hospital in the anticipation of having a surgical procedure done. The level of anxiety varies from person to person. Every hospital staff are aware of this and will do their best to alleviate the anxiety with the care they provide. Fasting time details will be given depending on the timing of surgery. Clear water can be continued at least until two hours before the surgery. Admission process will be completed by the admitting nursing staff. They will confirm patient’s details, procedure to be done, list of medications, known allergy, adverse reaction to medications and other relevant details. Female patients in childbearing age group will need pregnancy test carried out on the day of operation. Admitting staff will discuss this. Checks at multiple stages will be carried out in the best interest of patients. It is called WHO  checklist (World Health Organisation) to make sure patients are safe to proceed with surgery, avoid wrong procedures or  wrong side procedures etc.

After admission patients will be seen by the surgeon before the surgery. By this time, you would have been given most or all information about the procedure, recovery etc. You can ask questions to clear all your doubts if not answered before or new questions came to your mind. Consent form will be signed by both the surgeon and you. The correct leg will be marked.

Type of anaesthesia will be discussed by the anaesthetist before surgery. Aim is to provide the safest and effective anaesthesia that will provide good pain control and early mobilisation with least possible side effects. Spinal anaesthesia is the most preferred technique. It has significant advantages. It reduces the chance of side effects from general anaesthesia such as drowsiness, provides better pain control immediately after the procedure and reduces average blood loss during surgery. There is some evidence that it reduces the risk of deep vein thrombosis. Some patients might need general anaesthesia.

Operating Theatre :

Once all admission process is completed and patient is satisfied with details given, they will be taken to the anaesthetic room in the theatre. Though everyone in the hospital will do their best to start your operation at the time mentioned to you it is not uncommon it gets delayed slightly due to various reasons. Once in the anaesthetic room theatre staff and the anaesthetist will confirm patient’s identity and the procedure. Anaesthesia will be given as discussed before the surgery. Patients will be positioned in the anaesthetic room and pre surgery preparations of the limb to be operated will be done in the anaesthetic room.

Once the surgical staff are ready patient will be taken into the operating room. Patient’s identity and planned procedure check will be carried out just before the preparation of limb to be operated, the actual procedure started and at the completion of procedure.

Once surgery is completed patients will be taken to the recovery room. Recovery staff will make sure patients are comfortable and pain is well under control. Patient’s vital signs such as pulse rate, blood pressure, urine output if possible etc will be closely monitored. Anti-sickness medications will be given if necessary. If safe patients might be given clear fluid to drink. Once recovery staff are satisfied with patient’s general condition they will be taken back to the ward.


In the hospital

The ward staff will confirm the patients remain stable by checking vital signs after the procedure. Pain level is determined by multiple factors and varies from person to person. Regular pain medications will be given. Additional pain killers will be given at request if regular pain medications are not sufficient. Medications to prevent sickness or nausea, antibiotics, anticoagulants to prevent deep vein thrombosis and patient’s routine medications will be given as prescribed. Drinking and eating food will be started as soon as is safe. It is important to maintain good fluid intake.

Exercises should be started as soon as possible and safe. In bed regular exercises help to maintain good circulation in the legs, get muscles working early and reduce swelling. This also helps to keep the pain under control and reduce the chances of blood pressure dropping when the patients get up the first few times in the bed. Early mobilisation once safe to do so, and little and often exercises are the key for enhanced recovery and minimise complications. Post operative blood tests and x-rays will be done as and when necessary.

The physiotherapists and ward staff will assist with mobilisation. Once they are confident with mobilisation they will be allowed to mobilise independently. Patients will be given list of exercises to do at regular interval. The multidisciplinary team will go through their check lists to confirm patients are safe to be discharged.

At home

Adequate rest is important. Patients do feel tired in the first few weeks and some might feel needing a nap during the day. These symptoms will get better and patients will get back their energy in the first six weeks as they recover.

It is important to maintain good hydration and have adequate diet. Altered bowel habits can be due to reduced activity level, diet, and side effects to medications such as pain killers. Appropriate preventive measures or treatment should be taken for eg – laxatives to prevent constipation.

Pain will get gradually better. There might be fluctuation in the level of pain but overall trend should be pain getting better. As the pain settles down the patients can start weaning off the pain killers.

Some swelling and bruise around the hip is common. Typically seen 3-5 days later. This will track down the leg due to gravity. Some patients might not see any swelling. Some might see more than average. Anticoagulants increase the risk of bruises and swelling. But it is important to finish the course of anticoagulants to reduce the risk of DVT. Swelling and bruise will gradually settle down usually within 6 weeks. Rarely they can be quite gross and might last longer especially in patients with history heart problems, previous leg operations and history of DVT.

It is important to continue with regular exercises. Little and often exercises are the key. Ability to do exercises will get better each day.

Apart from the soft tissue healing there is lot of biological activity goes on in the hip after replacement. One of them is bonding between prostheses and the bone which takes good six weeks. It is better to minimise the micromovement between the prostheses and the bone during this period. Too much stress too early can affect this bonding which can delay full recovery or very rarely problems which might need reoperation. Though many patients can walk without aid immediately after the operation or withing few days it is advisable to use support to mobilise until patients get back strength, balance, and flexibility to protect the bonding between the prostheses and the bone. It is advisable to use two crutches for the first two weeks. One crutch between 2-4 weeks. After 4 weeks can try and walk without support.  Some patients will be able to wean off early and others might be advised to use it bit longer. Using support during this period, avoiding pivoting on the operated leg, and preventing excessive force on that leg help better bonding.

If patients develop symptoms or signs of complications, they should report to the surgeon or the hospital for prompt assessment and management.