Recovery after anterior total hip replacement.

Dr Limbers’ current anterior hip protocol does not routinely impose restrictions on sleeping position or hip movement during the first six weeks.

This is worth stating clearly, because it differs from the precautions commonly applied after posterior-approach hip replacement — the “don’t cross your legs, don’t bend past 90 degrees” instructions many patients and physiotherapists expect. Those precautions relate to a different surgical approach.

If you have been given specific restrictions by Dr Limbers or the hospital, follow those.

• Continue moving and exercising as much as pain allows
• Strengthen the muscles around the hip and the opposite leg where you can
• Organise your home before you go in — a firm chair with arms, loose rugs and cords removed, and anything you use often moved to waist height
• Arrange help at home for the first period after surgery
• Arrange your physiotherapy before surgery rather than after

Hospital stay is commonly around three nights, although it may be shorter or longer depending on medical health, mobility and home support. Most patients return home directly, while others require inpatient rehabilitation.

Local anaesthetic is infiltrated around the hip during surgery and pain relief uses a multimodal approach. Patients are encouraged to stand and walk on the day of their surgery with the hospital physiotherapy team, initially with a walking frame, then with crutches followed by a walking stick.

Medication to reduce the risk of blood clots is routinely prescribed after surgery. Low-dose aspirin is commonly continued for up to six weeks. Patients who were taking stronger anticoagulant medication before surgery will usually restart it within the first few days, according to their individual medical and surgical plan.

Weeks 0–2

• Heel slides towards the bottom, followed by return to a straight-leg position — 10 repetitions
• Side heel slides, moving the heel away from and back towards the midline — 10 repetitions
• Isometric gluteal contractions with the knees bent — hold 10 seconds, repeat five times
• Isometric quadriceps contractions with the leg straight — hold 10 seconds, repeat five times
• Active ankle movement, drawing the toes back and then pointing them away — 20 repetitions

Slowly increase walking distance on firm, flat surfaces. Mobility aids should be used as directed and reduced only when walking is safe and controlled.

Weeks 2–4

• Bridging — two sets of 10
• Clams while lying on the non-operated side — two sets of 10
• Supported hip flexion stretch, gently drawing the operated knee towards the chest — hold 10 seconds, repeat five times
• Small squats at a benchtop — two sets of 10
• Standing side leg raises — two sets of 10

Continue increasing walking distance. Hydrotherapy may commence for approximately 15–20 minutes once the wound is suitable and the treating team has approved pool entry.

Weeks 4–6

Continue the previous exercises and gradually progress squats, marching, resistance-band hip abduction, adduction and extension, walking and hydrotherapy. Exercise volume should be increased according to comfort, control and physiotherapy advice.

Stop an exercise and seek advice if it causes sharp pain, a marked increase in symptoms, wound concerns or another unexpected problem.

Driving is often possible after approximately two to three weeks, but only when you can safely control the vehicle and are no longer taking impairing medication.

Most early recovery occurs during the first six weeks, with strength and endurance continuing to improve over three to six months.

Return to desk work can be often be undertaken from home after 2-3 weeks, with a return to the office at 6 weeks. Manual work, swimming, cycling and golf can commence at 6 weeks. Flying can be undertaken from 6 weeks. Running and impact sport can be undertaken cautiously, although they do carry some risk of earlier joint replacement failure due to fracture and wearing of the joint replacement.

Dental work should be deferred for 6 weeks following joint replacement if possible. Your dentist or GP should provide you with a single dose of oral antibiotics (normally Amoxycillin 1 gram orally) approximately 30 minutes before the dental procedure.

A waterproof dressing is applied at the time of surgery. This will remain on for 12-14 days and then will be removed. There are no clips or sutures to be removed (dissolving subcuticular sutures are used) and a new dressing is not required.

Swelling in the thigh and leg is normal after hip replacement and can persist for several months. Bruising that tracks down the thigh is also common and settles on its own.

Elevating the leg when resting and using ice as directed can help. Take pain relief as prescribed, particularly before physiotherapy.

Any wound discharge after joint replacement should be reported the same day, at any point after surgery.

If you have concerns during business hours, contact Dr Limbers’ rooms by phone or email. Outside business hours, contact the ward at the hospital where your procedure was performed. For urgent or severe symptoms, seek emergency care as outlined above.

You will be discharged with post-operative instructions and pain relief. You should see your GP approximately 1 week after discharge, for more pain relief and for help with the wound. You will see Dr Limbers in his rooms with a repeat X-ray 6 weeks after surgery. Any further follow up will be organised at that stage.