• A small number of patients develop wound or deep joint infection.
• Signs include redness, warmth, wound discharge, or a temperature over 38°C.
• Rarely, infection may occur months or years later.
• If infection develops, further surgery and antibiotics may be required.

• A deep vein thrombosis (DVT) is a clot in the leg veins. It can cause swelling, heat, and pain.
• A pulmonary embolism (PE) is when a clot travels to the lungs, which can be life-threatening. Symptoms include sudden breathlessness, chest pain, or fainting.
• You will be given blood-thinning medication and advised on exercises to help prevent clots.

• The artificial hip can dislocate in the first 12 weeks.
• Signs include sudden pain, the leg turning outwards, and difficulty moving the leg.
• Following hip precautions will reduce the risk.

• Leg length difference (sometimes unavoidable)
• Nerve damage (rare, usually temporary)
• Numbness or altered sensation around the scar
• Swelling, bruising, and pain that may last weeks to months
• Prosthesis loosening after many years, sometimes requiring revision surgery
• A small risk of serious complications such as heart attack, stroke, or death (approximately 0.1%)

Occasionally slight numbness around the scar or part of the leg can happen but this is not anything to worry about.

Swelling of the foot and ankle is very common after surgery and may last several months. The swelling is usually better first thing in the morning and gradually increases as the day progresses. Doing your ‘circulatory exercises’ will help and having a one hour rest on the bed in the afternoons should help reduce swelling.

You can expect pain for 6-12 weeks after surgery. The pain may be referred into the knee and shin. It is not unusual to have pain in other joints as your gait may be altered in the first period after surgery.

It is common to become constipated after surgery. This can be due to several reasons including the effects of analgesia (painkillers), fasting and change of mobility. Please speak to staff if you become uncomfortable.

Sometimes patients will lose blood through surgery. If this happens you may require a blood transfusion. Like all medical interventions, a transfusion will only be offered if really necessary.

• You will go to the recovery area before returning to the ward.
• You may have monitoring equipment, a drip, or oxygen in place.
• You may be helped out of bed the same day as your operation with staff support.
• Most people are ready to go home after 1–2 days.

• Tell staff if you are in pain; medicines can be adjusted.
• Take painkillers before physiotherapy or walking sessions.
• Tablets are usually used instead of injections once pain is under control.

• You’ll be given blood-thinning tablets during your hospital stay and after you go home (usually for 35 days).
• Do your ankle and leg exercises regularly.
• Watch for any unusual bleeding and report it immediately.

• Your dressing is designed to stay in place for up to 2 weeks.
• Clips are removed by a district nurse at around 12–14 days after surgery, unless dissolvable stitches are used.
• Special dressings with a small battery pack may be used; the battery lasts 5–7 days.

• Constipation is common; drink fluids, eat fruit and vegetables, and let staff know if your bowels don’t move for 2 days.
• Medicines can be given for constipation or sickness if needed.

Knee surgery increases the risk of blood clots. To reduce this, you may be prescribed a short course of blood-thinning tablets (such as rivaroxaban) or injections. These must be taken exactly as prescribed.

Seek medical help if you notice:

• Calf pain or swelling
• Chest pain or sudden breathlessness
• Unusual bleeding (e.g. blood in urine/stool, nosebleeds lasting >5 mins, coughing blood, heavy cuts that won’t stop bleeding)

Rivaroxaban tips:

• Take with food
• Don’t double up if you miss a dose
• Inform your GP if you feel dizzy, faint, or notice side effects
• Tell your doctor about any other medicines, as some increase bleeding risk

You may be prescribed a short course of antibiotic injections around the time of surgery to prevent infection. Occasionally you may require a longer courseof antibiotics if you develop an infection following surgery. Again it is important to complete the course even if you feel well as this will help prevent joint infections. Side effects of antibiotics may include rash or diarrhoea. You should inform healthcare staff if your side effects are troublesome. Please also advise staff if you are allergic to penicillin, for example.

An important part of your care is to ensure that you do not experience excessive pain. A range of painkilling medications are used. Most patients will receive paracetamol, which is a very effective and safe painkiller on its own or in combination with other painkillers. You are advised to take these on a regular basis until the pain is negligible.

You are also likely to be prescribed a stronger opiate painkiller according to your requirements. Opiate painkillers include codeine, dihydrocodeine, tramadol, morphine and oxycodone. These may be given regularly or when you need them in either tablet or liquid form. Other painkillers are sometimes added if you have inflammation or nerve pain.

It is particularly important to take adequate pain relief before movement and physiotherapy. Your painkillers will be rationalised as your pain improves. If you are in pain, please do not suffer in silence and ask your nurse for assistance.

Side effects you may experience with the stronger (opiate) painkillers include drowsiness, nausea and constipation. These side effects can be managed with other medicines or by taking the painkillers at a lower dose or only when needed.

It is common for many surgical patients to become constipated in hospital. The reasons for this include: the effects of surgery, fasting before surgery, change of diet, effects of painkillers and through lack of fluids and reduced physical activity. There is therefore no reason to worry if your bowels do not move as often as normal, but do advise staff if you feel uncomfortable and would like laxatives to help. These can usually be stopped within days when your bowel function returns to normal.

You may feel nausea (sickness) or actually vomit after your operation. In this case you can be offered anti-sickness medicines and your painkillers may be reviewed.

Your pharmacist, doctor or nurse can offer advice and help you with a range of potential medication problems and to respond to any other symptoms that may trouble you.

Because you have had an anaesthetic and are not as active as normal, it is important that you perform some deep breathing exercises to help keep your lungs clear.

• Take a deep breath in through your nose until you feel that your lungs are full of air, hold for a second then sigh the air out through your mouth. Keep your shoulders relaxed.

Perform this exercise 3 times every hour while you are awake.

These exercises will improve your circulation while you are immobilised in bed. This will reduce the risk of developing a blood clot.

Point your toes down towards the end of the bed and then pull them up towards you as far as you can. You should feel your skin and calf muscles tightening as you do these exercises.

Pull your foot up towards you, then push the back of your knee down onto the bed. You should feel your kneecap tightening. Hold for 5 seconds, then relax.

Tighten your buttocks together as firmly as you can. Hold for 5 seconds, then relax.

Perform 20 of each exercise every hour while you are awake.

You will begin walking on the same day as surgery with the Physiotherapist and/or Nurse (if medically well enough) with a walking frame to ease the weight on your new hip.

The sequence is always:

• walking aid → operated leg → unoperated leg.

Turning round can be to either side, but you must prevent twisting or pivoting on your new hip. Therefore, feet must be picked up at each step so that the operated leg is not placed too far in or out.

As your confidence and leg control improves, you will progress to walking with crutches/sticks. You should practice with these until a satisfactory walking pattern is achieved.

Most people will manage with two walking sticks by the time the hospital discharge occurs, unless there are associated problems with other joints. Your physiotherapist will assess these problems with you.

It is important that you are measured correctly by your physiotherapist for the walking aid that you are using.
Returning to a “normal” walking pattern is extremely important. Often because of pain and deformity in the affected hip, you have had to change the way you move. This will vary from patient to patient.

It will take considerable time and effort to regain a “normal” walking pattern, but it will get better if you persevere.

Your physiotherapist will help and instruct you in the best way to correct both walking and posture, thus enabling you to use your “new” hip to its full advantage.

You will be taught to negotiate steps and stairs by your Physiotherapist before discharge – always using aids to support the operated leg.

The sequence is as follows:

• Going up: unoperated leg first → operated leg → sticks/crutches.
• Going down: sticks/crutches first → operated leg → unoperated leg.

The physiotherapist will practice stairs with you before you go home.

1. Sit up in bed and gently pivot your bottom while lifting your legs out one at a time. Keep your trunk and operated leg in line, avoiding bending past 90 degrees.
2. Sit upright with both feet flat on the floor.
3. Place your hands on the bed beside you, push down, and stand up while drawing your operated leg slightly back.
4. Once standing and balanced, take hold of your walking aids.

Getting back into bed is the reverse process. Always support your operated leg and pivot carefully.

• Baths: Do not attempt to get in or out of a bath for 12 weeks after surgery.
• Showering in a bath: Avoid stepping into a bath to shower until you no longer need to follow hip precautions.
• Showering in a cubicle: A high shower stool may be used. Wash your legs and feet using a long-handled sponge or brush. To step out, place weight on your unoperated leg first, then carefully bring out your operated leg.

• Always use a firm, high chair with arms.
• Position yourself so the backs of your legs touch the chair.
• Reach back for the arms of the chair one hand at a time.
• Slide your operated leg out in front and lower yourself gently, leaning back slightly.
• Push yourself backwards until comfortable.

When getting into a car, make sure the passenger seat is as far back as possible and slightly reclined. Back up to the seat until the backs of your legs touch it, then sit down carefully while keeping your operated leg straight out in front. Once seated, pivot your bottom and bring both legs into the car together. To get out, reverse this process – swing both legs out first, then stand up carefully using your arms for support.

DO NOT bend your operated leg excessively. Instead, hold onto something solid, such as a table, window ledge or work surface and slide your operated leg out behind, keeping it straight. You can then go down, bending the knee of the unoperated leg.

You must not bend forward too far or lift your operated leg too high. Dressing aids (such as a long-handled shoehorn, sock aid, and reacher) can help you remain independent.

• Always follow the hip precautions.
• Avoid standing for long periods – a perching stool may help.
• Spread household chores evenly through the week.
• Rest regularly.
• Avoid heavy activities (like vacuuming) for at least 6 weeks. Ask friends or family for help in the short term.

You can usually cook as before, but do not lift hot dishes from the oven as this requires both hands. Instead, use the hob, grill, or microwave for the first 4 weeks.

• Always use your sticks (or one stick and the work surface) when moving around.
• You may stand without sticks when working at the sink, table, or cooker.
• Avoid bending — instead, hold onto something solid and slide your operated leg behind you, keeping it straight while bending your unoperated knee.

Activities such as gardening, dancing, bowling and golfing may be recommenced 12 weeks after your operation. Initially activities should be undertaken gently and without excessive effort. Always pay attention to your hip. If you experience an increase in pain you should ease back on the effort of the activity or stop and try again later in your recovery.

Low impact activities such as walking can start immediately after surgery by gradually increasing this activity to your pace of recovery. Exercise bike is usually safe to start 12 weeks after your surgery when it is comfortable to climb on and off the bike.

Swimming is a good form of low impact exercise. However, you should wait until you have had your 6 week post-surgery review to ensure that your wound is well enough healed to go back into the water. Breast stroke is allowed 12 weeks after surgery but only if it is comfortable to do so. If you experience discomfort or pain with this stroke you should stop and change the type of stroke. Resistance walking in the swimming pool is allowed.

Do:

• Take short, regular walks
• Continue physiotherapy exercises 3–4 times a day
• Use walking sticks as advised
• Lie flat on your back for an hour each day

Do not:

• Bend past 90° or twist your operated leg
• Cross your legs or kneel
• Sit in low chairs or lean forward too far
• Travel long distances
• Drive until at least after your six week appointment

Points to consider when choosing a Reacher:

• Grip and comfort: Choose a Reacher with a comfortable squeeze handle that fits well in your hand. Avoid handles that are too small or don’t spread the pressure evenly across your fingers, as these can be painful to use.
• Length: Reachers come in different lengths, typically from 46cm (18”) to 81cm (32”). Make sure the length suits your height and intended use — if it’s too long or too short, it may be awkward to handle.
• Price: Prices usually range from about £6 to £19. The most expensive option isn’t always the best; focus on comfort, grip, and suitability for your needs.

Points to consider when choosing a Sock Aid:

• Handles: Sock aids with ribbon handles are usually more comfortable than rope handles, which can dig into your hands when pulling.
• Plastic sock aids: If using a plain plastic sock aid, dust it lightly with talc powder. This reduces the risk of your foot sticking to the plastic surface.
• Gutter style sock aids: These are shaped to the contours of your foot, making it easier to slide the sock on compared to flat versions.
• Sensitive feet: If you have fragile skin or reduced sensation in your feet, look for a sock aid with a softer protective layer for added comfort.

Points to Consider for Sock Aids

• Ribbon Handles: Consider a sock aid with ribbon handles rather than rope, as this can be less painful when wrapping around your hands.
• Plastic Sock Aid: If you’re using a plain plastic sock aid, dust it with a little talcum powder to reduce the risk of your foot sticking to the surface.
• Gutter-Style Sock Aid: A gutter-style sock aid, shaped to the contours of your foot, may make it easier to slide on compared to a flat version.
• For Sensitive Feet: If you have altered sensation or fragile skin, choose a sock aid with a softer protective layer for added comfort.

You can also find demonstration videos online by searching for: “Hip precaution dressing techniques” or “Lower body dressing after hip replacement.”