This depends on what approach was done for the hip replacement
A more traditional posterior approach or antero -lateral Hardinge approach can take time for the tissues to heal as muscles/tendons that a cut or detached have to heal and can take upto 6-8 weeks. Patients undergoing this technique are usually still on crutches and can take upto 4-6 weeks or longer to come off depending on the complexity of the operation.
There could be come pain and patients are usually taking strong pain meds
There will be swelling still persisting down the lower legs and operation site.
Hip precautions have to be followed for 6-8 weeks and wont be able to drive
However for patients who had an anterior hip replacements – most patients are usually mobilising with less pain and swelling and hardly any restrictions. Most patients usually get rid of the crutches between few days to 2 weeks post-surgery depending on individuals and complexity of the surgery.
Patients are usually driving within 1-3 weeks of surgery according to one study that was done on patients after bikini anterior hip replacements – https://www.sicot-j.org/articles/sicotj/pdf/2018/01/sicotj180085.pdf
Disclaimer – Individual results can vary – patients are asked to discuss their specific restrictions with their surgeon after surgery.
This depends on what approach was utilized to do the hip replacement .
If the hip replacement was done through the more traditional posterior or antero- lateral/Hardinge approach – most patients have hip precautions for upto 6-8 weeks.
This is because muscles/tendons are usually cut/detached during the operation and then repaired during closure. It can take upto 6-8 weeks for the tissues to heal and hence the prolonged hip precautions before being able to tie shoe laces, bend down and pick up things, crossing the legs, sleeping on the side or even driving.
With the anterior approach hip replacement techniques, no muscles or tendons are cut or detached and hence patients can start doing things much earlier including tying shoe laces soon after surgery within days or weeks post-surgery. But it has to be understood that some patients may take several weeks before they can do this as they haven’t been able to do this for some time and it can take time for the tissues to stretch around the hip to accommodate the movements/positions of shoe lace tying.
With soaring health care costs patients are paying more and more for their health care
Private health insurance premiums are increasing annually and so are the costs to surgeons / practices with indemnity cover, practice/staff costs.
The government has also reduced the rebate for prosthesis by 7.5% followed by another 10% which is a total of 17.5% reduction on costs of prosthesis for hip or knee replacements. However the funds still increase the premiums annually despite saving 17% on prosthesis costs and not passed onto to members.
More recently some funds have aligned with some surgeons to offer no gap surgery to some patients to reduce costs – but this also means that the surgeon may have less autonomy and all patients could be classed the same for example a less complex hip replacement may be classified as the same as a more complex hip replacement in some cases. As a result the surgeon’s ability to decide on whats best for the patient in terms of implants may be compromised. The extra cost saved by the funds is a profit but not passed onto the fund members but only passed onto share holders/executive board.
Most surgeons usually charge a gap which can vary from procedure to procedure and complexity of the surgery itself. The Australian medical association has a recommended fee structure but this is only a guide in keeping up with inflation.
There is no fast solution to this problem and the patients should do their research well about who they go to see for their procedure, speak to relatives or friends, talk to their GP and do some internet research / reviews on the surgeon/doctor. Patients should Not be encouraged by their fund to go to “the fund doctors” whose surgical experiences may vary. Word of mouth is usually the best advice.
Understandably, patients who have undergone hip replacement surgery have a strong desire to return to normal activities — especially considering it may have been some time since they were able to perform them comfortably.
Driving is one vital activity that, prior to hip replacement surgery, may have been difficult or impossible. Medical and legal guidelines regarding when it is safe to drive following a hip replacement are currently somewhat unclear, and are difficult to legislate as everyone experiences a different healing process.
The most recent medical advice for driving post-surgery is a minimum of 6-8 weeks after the procedure. The issue with this recommendation is the fact that it is based on outdated studies which used a traditional posterior hip replacement. They are also only based on soft tissue recovery.
More recently, anterior hip replacements have shown much faster recovery times. One study stated that brake reaction times resumed around 2 days after micro-invasive surgery. Dr. Nizam has run one of the most extensive studies in regards to safe driving after anterior bikini hip replacement surgery. As this procedure does not involve the cutting of any muscles or tendons, the muscle around the hip joint remains intact. This leads to a faster recovery with less restriction, pain, swelling, and muscle weakness.
Over a 14-month period, Dr. Nizam found the following post-surgery results from the 212 anterior hip replacement procedure:
There was no significant difference in these figures when comparing the operative sides of surgery. One main variation, however, was patients with right-sided anterior hip replacements resumed driving sooner and experienced less pain as they got in and out of the car.
The study also found no significant correlation between recovery time and transmission of vehicle (automatic/manual gear). 49.5% of Dr. Nizam’s patients were able to move around without the use of walking aids before the resumption of driving.
The study also looked at the position of the hip, knee, and ankle of the drivers to determine possible causes of any discomfort. The majority of movements while accelerating or braking involve the ankle joint, with the knee also predominantly engaged while braking (0-5° knee extension).
During emergency braking there can be a rise in downward ankle flexion to 30° when maximum force is applied to brake completely. Hip adduction and internal rotation of up to 5-10° was also noted when the right lower extremity was engaged to move from the accelerator to the brake, a minimal movement in automatic vehicles.
The study also revealed that patients were able to return to work within 1 to 79 days (on average, 24 days).
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