Hip Clinical Pearls: #16 Initial Hip Surgical Recovery |
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Clinical Pearl #16: Initial Hip Surgical Recovery
In previous sections, we discussed some recovery commonalities related to the hip scope and PAO. Surgical recovery differs depending on the procedure(s) you undergo. Since the PAO is a much more involved, there will be greater limitations with function for a longer time than after a hip scope alone. Your surgery will have motion restrictions, and likely weight bearing precautions for a period of time, as previously discussed. Please be certain to consult with your surgical team regarding any questions regarding post operative care and expectations.
Hospitalization After Hip Surgery:
Hip arthroscopy is primarily an outpatient procedure, returning home the same day of surgery. With all that is involved with the PAO, hospitalization is expected. It is common for patients to be hospitalized for 3-5 days after a PAO. With each of these procedures, numbness in the outer thigh is a common side effect. This is a sensory related issue. This means that the thigh muscles will still function, but how the body perceives tactile input may be altered or diminished.
Pain After Hip Surgery
Pain control is important immediately following surgery. It is imperative to discuss the medication regimen with the surgeon, and the preferred process to reduce and discontinue the use of medications. If you have any adverse reactions to medications, consult your surgeon immediately. It is equally important to ensure safety with walking using crutches or a walker for discharge to your home. Basic activities such as getting in and out of bed, toileting, short household distances will all be more challenging than you anticipate upon returning home. Many patients return home after a hip scope using crutches. After a PAO, a walker may be preferred then transition to crutches when strength and endurance improves. Use of a reacher/grabber, long shoe horn, shower chair and a raised toilet seat are examples of accessories to help improve daily activity ability. Please see #10 Surgical Preparation or Carey Martin's suggestions at https://careymartin.com/ultimate-pao-supplies-list/ . It will be difficult to move objects from one place to another while using a walker or crutches, so considering an accessory pocket of either of these to place items, or using a small backpack around your home are ideas to increase independence.
Sleeping After Hip Surgery
Sleeping will be different following surgery. Sleep is a very vital part of recovery to help tissues heal while resting. If the body feels the need to nap during the days of initial recovery, please listen to the body! Be kind to it! While many people are side sleepers, it takes time to resume this position after surgery. Sleeping while lying on your back is expected post operative, and some physicians may use a bolster between the knees while sleeping to keep the legs separated. While it may be more comfortable to sleep with a pillow under the knees while lying on your back, this is NOT a long term solution, and should be discontinued as soon as the body tolerates. Typically, this should be within the first few days to a week after a hip scope, and within the first couple of weeks after a PAO. Sleeping with a pillow under your knees can contribute to shortening of the muscles and tissues on the front of your hip over time, and you want to minimize this potential.
Returning to Work After Hip Surgery
This is a common question I am asked, hands down! I encourage anyone to consult with the HR department at work regarding time off, FMLA, and such. This gets way beyond my scope, thus why I refer folks to appropriate entities.
When it comes to the hip arthroscopic procedure, many people think "it's just a scope, I'll be back in no time!" While this may be relatively true when it comes to a knee arthroscopic procedure, it's not always the case with a hip scope. I recommend at least 2 weeks away from work to initiate. In this ever changing world, many people are able to work remotely, thus question why time off is really needed. For one, ridding your system of anesthesia. The effects of this on your system will upset the homeostasis many are accustomed to. This can be at least a few day to a week or more. Have you ever heard of "anesthesia brain"? People commonly call the fog after surgery because short term memory isn't the same and they report not feeling a clear headed as usual. Combine this with the potential of pain medication, I recommend patients give themselves a bit more time to get on top of pain, increase tolerance to sitting (if the job in question is more computer related), and get to feeling "more normal" again. There's nothing worse than getting emails back when you can't remember sending them! If you have a procedure within surgery which puts you non weight bearing after the procedure, this could factor into your capability to return to an office, even if you have a "desk job". The metabolic strain on your system to get to/from the office, around your office and such just for existence is that much greater than usual, and your stamina will be lower. This effects you physically, but your mental capacity will be diminished with this as well initially.
After a PAO or DFO, my recommendation is at least a month post operative for anyone who could return to work at home, even if it is to start with emails or meeting where your job is to listen primarily. I cannot tell you the number of folks I made this recommendation, and they started around 2 weeks post op with emails alone. The level of fatigue went up significantly, even with only 1-2 hours starting. Although the nature of checking emails is low for physical energy output, it is high for mental or emotional energy output. Many folks are still on various medications at 2 weeks post op. The level of fatigue is always shocking to folks! Then I hear "now I understand why you recommended to wait".
I look at it another way. Remember the section of being nice to yourself through the process? There is only one time you will have to focus on your recovery, and the time is especially crucial in the initial stages post operatively. Resuming work early takes that focus away from your recovery, and places your recovery on the back burner. It also contributes to a greater stress earlier of "how am I supposed to balance work and rehab". I am not implying that work is not important, and for many, you may not have a choice in the amount of time you can take off from work. I try to encourage folks to create the ability to take care of themselves first, work back into more normalized life at home as time progresses, and once this balance is better, returning to work is the next step. The time to work and put your energy in a completely different place is when your body is capable.
When it comes to the hip arthroscopic procedure, many people think "it's just a scope, I'll be back in no time!" While this may be relatively true when it comes to a knee arthroscopic procedure, it's not always the case with a hip scope. I recommend at least 2 weeks away from work to initiate. In this ever changing world, many people are able to work remotely, thus question why time off is really needed. For one, ridding your system of anesthesia. The effects of this on your system will upset the homeostasis many are accustomed to. This can be at least a few day to a week or more. Have you ever heard of "anesthesia brain"? People commonly call the fog after surgery because short term memory isn't the same and they report not feeling a clear headed as usual. Combine this with the potential of pain medication, I recommend patients give themselves a bit more time to get on top of pain, increase tolerance to sitting (if the job in question is more computer related), and get to feeling "more normal" again. There's nothing worse than getting emails back when you can't remember sending them! If you have a procedure within surgery which puts you non weight bearing after the procedure, this could factor into your capability to return to an office, even if you have a "desk job". The metabolic strain on your system to get to/from the office, around your office and such just for existence is that much greater than usual, and your stamina will be lower. This effects you physically, but your mental capacity will be diminished with this as well initially.
After a PAO or DFO, my recommendation is at least a month post operative for anyone who could return to work at home, even if it is to start with emails or meeting where your job is to listen primarily. I cannot tell you the number of folks I made this recommendation, and they started around 2 weeks post op with emails alone. The level of fatigue went up significantly, even with only 1-2 hours starting. Although the nature of checking emails is low for physical energy output, it is high for mental or emotional energy output. Many folks are still on various medications at 2 weeks post op. The level of fatigue is always shocking to folks! Then I hear "now I understand why you recommended to wait".
I look at it another way. Remember the section of being nice to yourself through the process? There is only one time you will have to focus on your recovery, and the time is especially crucial in the initial stages post operatively. Resuming work early takes that focus away from your recovery, and places your recovery on the back burner. It also contributes to a greater stress earlier of "how am I supposed to balance work and rehab". I am not implying that work is not important, and for many, you may not have a choice in the amount of time you can take off from work. I try to encourage folks to create the ability to take care of themselves first, work back into more normalized life at home as time progresses, and once this balance is better, returning to work is the next step. The time to work and put your energy in a completely different place is when your body is capable.
Wound Healing After Hip Surgery
Wound healing, regardless of the procedure(s) you have can take up to 3-4 weeks. Some may take less time. Monitoring the skin around the are, or around the dressings, is important to make sure the local area maintains a healthy look. Hot, red, painful skin you can see around the bandages is not a good sign, and contact your physician immediately. Any flu like signs or symptoms should result in contacting your physician. Unless you have solid waterproof bandages for your incisions, getting into public waters, pool or hot tub, are NOT recommended until your incisions are healed to minimize any potential for infection.
Using Crutches or a Walker After Hip Surgery
These are used post operatively to lessen the load on the hip after surgery. I recommend folks get crutches prior to surgery, fit them, and try walking with them especially if non weight bearing after surgery could be an option. A reference for crutch fitting includes a video. For anyone who may have concerns about home safety after surgery, it might be worth a visit to see a physical therapist to work through any of these concerns. This could include sitting surfaces, stair climbing, bed mobility, to name a few. Many physicians will recommend that crutches are used until you have virtually no limp with your walking. Due to the nature of the leaning involved with using one crutch, I recommend minimizing the use of one crutch walking.
Initiating Physical Therapy After Hip Surgery
As physical therapy is initiated, don’t be surprised with more fatigue, soreness or pain after. Your physician will inform you of when rehab can be initiated. You may want to ask this ahead of surgery to prepare post operatively. Depending on the facility in which you plan to be seen for rehab, they could be booked out for weeks. Scheduling appointments prior to surgery not only helps alleviate any stress about this after surgery, but it also helps get those times/days more suitable for your schedule.
Recovery from physical therapy should be within 24-48 hours. Initiating a home exercise program should be tolerated a couple of times daily. Initially, it is recommended to perform less volume with greater frequency to start the rehabilitation program, increase tolerance and stamina. Each morning following the home program, recovery to a baseline level is expected. Should recovery be greater than baseline, consider how much was done the day before with overall the amount of physical activity performed in addition to rehab. More often than not, increased soreness or stiffness results from greater physical activity more than one's home exercise program.
Remember that the rehab process will not be linear. This is a helpful thing to remember from the start. Working with a physical therapist who understands and supports this process will help with your guidance.
Recovery from physical therapy should be within 24-48 hours. Initiating a home exercise program should be tolerated a couple of times daily. Initially, it is recommended to perform less volume with greater frequency to start the rehabilitation program, increase tolerance and stamina. Each morning following the home program, recovery to a baseline level is expected. Should recovery be greater than baseline, consider how much was done the day before with overall the amount of physical activity performed in addition to rehab. More often than not, increased soreness or stiffness results from greater physical activity more than one's home exercise program.
Remember that the rehab process will not be linear. This is a helpful thing to remember from the start. Working with a physical therapist who understands and supports this process will help with your guidance.