The preoperative level of fitness and functional capacity is, as might be expected, the major determinant of the need for support after surgery. Having said that, the “average” patient should be independently mobile with crutches or sticks by the time they leave hospital after hip replacement surgery and capable of negotiating stairs. Most should be able to get in and out of bed independently with the use of assistive devices such as a leg lifter. All patients are advised to continue with the physiotherapy regimen that they had in the hospital and mobilise “little and often”. The idea is to improve the functional recovery constantly by gradually increasing the mobilisations and the prescribed exercises in a steady manner.
It is understandable that confidence will be low at first upon return to home. This is particularly likely for stairs when it would be helpful for another individual to be present with the patient for the first week. Generally patients are advised to use their TED stockings for about 6 weeks and most will be unable to put these on by themselves even with the use of a stocking or sock aid. Where possible, families may wish to help with the stockings first thing in the morning and these can be then left on until the patient retires to bed at night – always providing there are no circulation or skin issues in the feett or legs. Patients can generally manage toileting independently but may require a raised toilet set for which they should have been assessed prior to discharge from hospital. Appropriate grab handles help, but generally the requirement for these is broadly as prior to the surgery. Patients who have level access to a shower, will be able to manage but will appreciate somebody at hand for assist and confidence for about a week or so until they are able to devise a routine that they can implement independently. Wounds are kept covered at this time with a waterproof dressing until the stitches/clips are removed at about 10-12 days after the surgery. Patients will generally find it difficult to get in and out of a low chair or sofa and so a high chair is helpful. Some chairs can be “lifted’ by blocks for the purpose available in shops selling disability aids.
Fetching and carrying will be difficult while using two crutches/sticks. Some items can be placed in a satchel type bag, but that may not be possible for all food items, such as meals in a plate. Some families or carers may find it helpful to have the patient “setup” for the day, by having most needed items and food and drink, including hot drinks in a flask, nearby.
Patients generally experience a steady improvement in confidence and ability but it is not usually before about 4 weeks that the average patient is feeling confident enough to go out for a walk. They will need to be accompanied for about a week and then should be able to manage unaccompanied depending upon their general state of recovery and their state of fitness prior to the operation.