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Orthopedics & Joint Replacement:
Anterior Approach Total Hip Replacement: Post-operative Instructions

Mercy orthopedic surgeons, Thomas V. Whitten, M.D., Joseph John Ciotola, M.D., Marc W. Hungerford, M.D., and Kamala Littleton, M.D., specialize in anterior hip replacement, which typically allows for a faster recovery and less post-operative restrictions than traditional hip surgery. Below are the general post-operative instructions for anterior hip replacement patients. Mercy’s orthopedic surgeons will review specific instructions with each patient.

Follow up: Call your surgeon’s office when you get home to schedule a follow up appointment if you don’t already have one.

Physical therapy: There is minimal physical therapy required after a total hip through the anterior approach. There are no muscles cut with the anterior approach so extensive rehab is not necessary. The therapy after surgery is simply to get up and start walking, first with a walker, then a cane, then nothing. Outpatient physical therapy is usually not necessary, but may be ordered to help you with this progression. You may put full weight on your leg unless otherwise specified by the doctor. Take frequent rests as needed.  “Hip precautions” are not necessary after anterior approach hip replacement. You may sit, bend, move, sleep and cross your legs however you want. This is because there is a much lower rate of dislocation (<0.8%) when compared to traditional hip replacement (up to 5%). However, because any hip replacement can theoretically dislocate it is recommended that the following guidelines be kept in mind for the first few weeks following surgery.

• Sleep with a pillow between your knees while on your side.
• Try not to bend at the hip past 90 degrees.
• Try to avoid crossing your legs.
• Try to avoid sitting in a low soft chair.

The bottom line is use common sense and be gentle with yourself. Hip replacement is still major surgery and you will need time to recover.

Equipment: No special equipment is required after anterior approach hip replacement. You will be given a walker and a cane. You may not need a special pillow, elevated toilet seat or bed. However, these items can be arranged for you if you would feel more comfortable with them based on your living arrangements.

Incision: Your incision has been closed with sutures that dissolve under the skin or staples. Keep the incision clean and dry. Cover it with a dry gauze and change the dressing daily until your first follow up. Do not put any lotions, peroxide or ointments on the incision. You may shower when there is no further drainage from the incision and staples have been removed. No baths or swimming allowed until cleared by the doctor. Wounds are checked and sutures are removed at two weeks by either the doctor, or the home health care nurse.

Blood clots: To prevent a life threatening blood clot from forming in your deep veins you will be placed on an anticoagulant after surgery. This is usually Asprin or Coumadin. If you were sent home on Coumadin, a home nurse will be out to the house to check your blood level. Please call the nurse case manager at Mercy (410-332-9575) if you have not heard from the home care agency within 2 days. If you were given compressive stockings, please wear them at all times, except while in bed sleeping. They help with post-operative swelling and decrease the likelihood of a clot developing.

Diet:  You may resume your regular diet. Avoid green leafy vegetables and foods with Vitamin K, if you are taking Coumadin.

Driving: You may drive as soon as you feel able and comfortable. You must be able to stop the car and get out without assistance. This usually takes about two weeks for left hips and three for right hips.

Work: You may return to work as soon as you feel able and comfortable

Exercise: You may resume light exercise such as riding an exercise bike and walking 6 weeks after surgery. Ice the hip for 20 minutes after exercise.

Reasons to call the doctor:
1.) Persistent fever greater than 101.5
2.) Calf swelling, pain, tenderness or numbness
3.) Increased pain, redness, drainage, or other signs of Infection.                   
4.) Chest pain or shortness of breath.

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