Hip replacement recovery: truths & myths

What is a rapid recovery programme?

Hugh: Rapid recovery is a way of managing patients that I developed back in 2003. This essentially meant, getting all of the people who work with me together, to help patients get better: the anaesthetist, physios, the pharmacists, the Occupational Therapists, the ward staff - everyone involved in your care. And we looked at how we could optimise every element of the care, to bring it all together in a joined up way, so that patients could recover more quickly.

What was the impact of rapid recovery programmes?

Hugh: To put it in perspective, before rapid recovery, patients would have to be in hospital, sometimes up to a week, and after rapid recovery was introduced - and these simple techniques were introduced - we were able to reduce the length of stay (in hospital) to two days.

And the wonderful thing about rapid recovery is that it also led to a reduction in complications from surgery and improvements in people's health and general well-being. With rapid recovery, it enables everyone to do their jobs properly, and when everyone does their jobs properly, the risks to the patient reduce enormously.

How does rapid recovery work?

Hugh: So, patients come into surgery, on the day of their surgery, in the morning. We do the operation and we have people starting their recovery as soon as they get back to the ward. We start them with simple exercises, we get them out of bed, we show them their hip will work, and if you can get walking on the day of your surgery, it kickstarts the whole journey.

63% of Hugh Apthorp's patients describe results as 'Excellent' just 6 months after surgery, vs 42.5%, the average for all other surgeons. Call 020 8064 0875 for more information.

Usually people will be in hospital for two days. By the time they leave hospital they'll be able to climb the stairs, get themselves dressed. They're comfortable, and usually at that point people can go home in a car. Some of my patients even go home on the train if it's simpler, if they've got somebody with them because they're confident they can walk.

They usually go home with a pair of crutches. Most of my patients can actually walk without crutches but I give them crutches because it helps them rehabilitate with good posture, so that they learn to walk properly. So the crutches aren't there to hold them up, they are there to help them rehabilitate their muscles.

When they first get home, patients will usually within a few days be able to walk around their homes, without too much support, perhaps using one crutch to walk longer distances.

How do patients feel after 2 weeks?

Hugh: By the time I see people at two weeks, their wounds have healed, they don't have to worry about their dressings, usually we just take off their dressing. I've usually sealed the wound with glue, so there are no stitches to come out. They'll have a bit of bruising and swelling on the side of their leg, which is normal. The hip will feel a little bit stiff, but as they walk, it gets less stiff and gradually, the hip gets better and better.

What can patients do 2 weeks after a hip replacement?

Hugh: By the time I see people at two weeks, they can usually get back to driving - so you can see how quickly people are recovering - and to be able to drive obviously you've got to be comfortable, and you've got to be safe.

Between two weeks and six weeks, gradually they'll find that their hip will get more supple, they'll start to walk more normally, they gain independence, they can go shopping and do the things they enjoy - go out to restaurants. And by the time people get to about six weeks, they're starting to look much more to the future, so at this point you can start thinking about going on holiday.

When can people fly after hip relacement surgery?

Because of the restrictions of airline travel after surgery, really you can only go short haul within the first six weeks and for longer haul flights you need to give it a little more time, sometimes up to about three months. And that's because of the risk of thrombosis. But my patients generally get going so quickly, the risk of thrombosis is very small.

By the time people get to six weeks (post surgery), they've usually progressed to the point that they're about 95% of where they want to be. They're starting to look to the future, they want to think about sport. So, usually people can go swimming at this stage, they can start to think about getting back to the golf course.

How do patients return to sports after hip replacement?

Hugh: The best way of starting sport is to do a little bit slowly, see how you feel the next day. So, if you're starting, for instance to get back to playing golf - go down the driving range, hit a few balls, just reassure yourself you can do it, and then see how you feel the next day. If you feel okay, go and do some more.

So, you build things up slowly, because after an operation like this, there's not only a recovery from the surgery, there's a recovery from all the things that led up to you needing the surgery.

So, you have to have a slightly patient view about these things, and you have to have confidence in the fact that you know things are going to get better and better, and that's the wonderful thing about hip replacement surgery, it gets better and better and better, until you get to a point where its behind you and life goes on again, and you get your life back.