Direct Anterior Approach Total Hip Replacement Surgery

You will wake up in the Recovery Unit, although you may not remember this. An X-ray will be taken to confirm that everything looks as expected. Nurses will carefully monitor you to ensure you have recovered well from the anaesthetic. The IV tubes attached to you can usually be removed at this time.

Once these steps are complete, you will be taken back to the surgical ward:

• Upon arrival, it will be time to eat and drink something to regain your energy. Try to drink 2 or 3 cups of water at a minimum.
• Your legs will have stockings on them to prevent blood clots. Your feet may have foot pumps as well. A foot pump is a Velcro shoe device that squeezes your feet to encourage blood flow and prevent blood clots.
• Your leg will be bandaged, and there will be a small anaesthetic infusion device attached near your hip that looks like a ball.
• Your leg will be a bright pink colour from the surgical preparation.

After eating and drinking, get dressed in your own clothes, which should be loose and comfortable. If necessary, ask the nurses for help with this.

PAIN MANAGEMENT

Immediately after surgery, managing your pain is a priority. You’ll be given medication to help control pain levels, allowing you to start moving and walking as soon as possible. Please let the hospital team or Dr Martin know if your pain isn’t well controlled. Pain relief medications, along with swelling management, play a significant role in your recovery. Rest, ice, elevation, and compression all contribute to reducing swelling.

Pain Medication Schedule:

• Paracetamol/Panadol Osteo: Take regularly as per instructions on the packet. This should be the last pain reliever you stop using.
• Non-Steroidal Anti-Inflammatory Drugs (e.g., Celebrex): If you know you can take them safely, use them regularly as per instructions on the packet. Aim to stop them after one week.
• Pantoprazole: Take this medication when you are taking non-steroidal anti-inflammatories regularly to prevent stomach upset. You can stop taking it when you stop the anti-inflammatories.
• Palexia: A strong painkiller, take it regularly as prescribed. It can be stopped early if not needed, but it is reasonable to take it for a few weeks if necessary.
• Endone: Another strong painkiller, take it as a breakthrough medication if regular Palexia is not sufficient.

You can use ice or an ice pack for pain relief. Be sure to wrap the ice pack in a clean towel and never apply frozen material directly to your skin to avoid frostbite or skin damage.

MONITORING AND WOUND CARE

Your healthcare team will closely monitor your recovery, paying particular attention to your wound, ensuring it’s healing properly and showing no signs of infection.

REHABILITATION AND PHYSIOTHERAPY

From day one, you’ll start a rehabilitation program tailored to strengthen your hip muscles and improve mobility, crucial for a speedy return to full function.

• You will be out of bed and walking within 4 hours after surgery. Make sure a nurse or a physiotherapist is present the first time you get up to supervise.
• Initially, you will use a frame, crutches, or a stick for balance, whichever aid works best for you.
• You will be allowed to put your full weight on your leg.

HOSPITAL STAY

Typically, patients stay in the hospital for 48-72 hours, depending on the complexity of the surgery, overall health, and individual recovery progress. In some cases, you may even be able to go home the day of surgery if:

• You have recovered well
• You have good, general health
• You have someone at home to look after you.

It’s common for your hip to feel sorer and heavier 2-3 days after surgery. This is often the most challenging period, as your leg may feel heavier, more swollen, and the pain may become more noticeable.

• The elastic bandage and anaesthetic infusion are usually removed around 48-72 hours post-surgery.
• To keep your wound dry while showering, wrap your hip in plastic or use a plastic bag secured with surgical tape.
• Continue following your rehabilitation exercises as advised by your physiotherapist.
• Ensure you take enough pain relief medication and manage swelling by resting, icing, elevating, and applying compression to your hip.

If you were discharged within the first 24 hours after surgery, you may have a follow-up appointment with Dr Martin’s team 2-3 days post-op to check your progress and remove the pain buster.

• By days 4 to 7, you should start noticing improvement, with things gradually becoming easier.
• Stay on top of managing pain and swelling, and if your hip is moving well and you can walk comfortably, you’re on the right track.
• Your rehabilitation plan will include prescribed home exercises to focus on improving hip mobility, gentle strengthening, and maintaining joint flexibility.
• Continue using a walker or crutches as recommended by Dr Martin until you regain enough strength and balance to walk unaided.

During days 7 to 14, regular physiotherapy sessions will help you progress to more challenging exercises, aimed at improving your strength and range of motion. This is also a good time to schedule an appointment with your GP to address any medication or other concerns. Be sure to book this in advance. Depending on your progress, Dr Martin may recommend gradually increasing weight-bearing activities to aid in your recovery.

In the first week after your total hip replacement surgery, you may experience several common post-operative symptoms. Dr Martin emphasises the importance of understanding these symptoms and managing them effectively to ensure a smooth recovery.

• Swelling – It is common to experience swelling from your thigh down into your foot. This swelling may increase during the first few days after surgery and can be quite pronounced. Swelling can be reduced by walking, as muscle activity helps push fluid away. When not walking, elevate your limb above the level of your hip to help diminish the swelling. Swelling may persist for up to 12 months but will gradually diminish over time
• Bruising – Marked bruising can occur from your thigh down to your foot, sometimes appearing quite dramatic. This bruising is due to residual bleeding making its way to the surface and is more pronounced due to the blood-thinning medications you will be taking. The bruising will resolve as your body reabsorbs the blood. The use of blood thinners is essential to prevent blood clots, despite the increased bruising.
• Blistering – Occasionally, blisters may develop near the operation site, possibly extending above it. These blisters are caused by surface fluid and can appear dramatic but are usually of no consequence. Blisters typically resolve on their own. If they are large, they may be drained to make dressings more comfortable. Bandages will be changed after about a week, once the wound is sealed enough to reduce the risk of infection. Tissue swelling associated with bruising can also cause blistering.
• Muscle soreness – You may experience stiffness and soreness in the muscles around the operated site due to the stretching and pulling of muscles during surgery. This can result in pain similar to a corked thigh, and you may also feel cramps and spasms. This discomfort will resolve over time. Activities such as walking, stretching, and physiotherapy will help speed up the improvement.
• Heat – the operated site may feel hot, a sensation that can last for up to 12 months. This heat is due to increased blood supply required for the healing process. This is a normal part of the healing process and should not be a cause for concern.

For the first 2 weeks after surgery your activity level is usually limited however, you will be able to walk independently, use the bathroom and perform normal activities of daily living. Remember, this operation is done from the front and as a result, hip bending will not be limited.

• It is quite normal for your hip to be warm for weeks or months after a hip replacement. Swelling for weeks or months is normal too, as is a numb patch on the outside of the incision.
• Bruising up or down your leg is reasonably common. This occurs when some blood tracks under the skin, causing a bruise, which can be painful when it happens.
• It is also common for patients to have a tough week or experience a period where they feel like they are going backwards for a little while. As long as things improve again, this is okay. Night pain can also be an issue for a period after the surgery.
• People who have had both hip replaced often find differences between the recovery in each hip.

• Excess pain or trouble with movement can be a sign that something is wrong.
• Severe pain can indicate an emergency and is a reason to go to the hospital.
• Signs of infection, such as fever, pain, redness, or fluid/pus leaking from the incision, should not be ignored. If you suspect an infection in your hip replacement, it is best to see Dr Martin or go to the emergency department rather than your GP. Antibiotic tablets alone will not be sufficient to treat an infected hip replacement.
• Significant leg or foot swelling can be a sign of a dangerous blood clot.
• Difficulty breathing or chest pain can be a sign of a clot in the lungs, which is an emergency.

These issues, or any other concerns, are reasons to contact Dr Martin, attend a local emergency department, seek other urgent medical assessment, or call an ambulance if you are unwell.

Within approximately six weeks, you can expect to have resumed most of your normal activities. Complete surgical healing typically takes about 6 to 8 weeks. During this period, some swelling and discomfort are normal and should be manageable with the prescribed medication. Maintaining a positive attitude is crucial, as hip replacement surgery aims to relieve pain and stiffness, allowing you to return to the activities you enjoy.

The anterior approach offers the benefit of potentially quicker recovery times. This approach allows for a faster return to daily activities, helping you get back to enjoying life as it was before your pain.

Key Points to Remember:

• Resumption of Activities: Most normal activities can be resumed within six weeks, but complete healing may take up to eight weeks.
• Swelling and Discomfort: These are common during the recovery phase and should be manageable with medication.
• Positive Attitude: Staying positive and motivated is important for a successful recovery.
• Anterior Approach Benefits: This surgical technique can potentially facilitate a faster return to daily life and activities.