What is the postoperative care for hip surgery swelling (edema)?

From the Guidelines

To effectively manage swelling after hip surgery, it is crucial to elevate the leg above heart level, apply ice packs, and take prescribed pain medications and anti-inflammatories as directed, prioritizing recent guidelines that emphasize the importance of multimodal pain management and thromboprophylaxis. When considering postoperative care for hip surgery swelling, several key strategies can be employed to minimize edema and promote recovery.

• Elevating the leg above heart level when sitting or lying down for the first few days can help reduce swelling by improving venous return.
• Applying ice packs to the surgical area for 15-20 minutes every 2-3 hours during waking hours for the first 48-72 hours, always wrapping the ice in a thin towel to protect the skin, can help reduce pain and inflammation 1.
• Taking prescribed pain medications and anti-inflammatories as directed by the surgeon is essential; medications like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily) are commonly recommended if approved by the doctor.
• Wearing compression stockings if recommended by the healthcare provider can improve circulation and reduce swelling, as suggested by guidelines for preventing thromboembolism 1.
• Performing gentle ankle pumps (flexing and pointing the foot) several times per hour while awake can promote blood flow and help prevent complications.
• Staying hydrated and maintaining a balanced diet low in sodium can help the body manage fluid retention.
• Following prescribed physical therapy exercises, but avoiding overexertion, is crucial for recovery.
• It is also important to note that recent guidelines, such as those from the PROSPECT study 1, recommend a multimodal approach to pain management, including the use of paracetamol, cyclo-oxygenase-2-selective inhibitors, and non-steroidal anti-inflammatory drugs, with opioids used as rescue analgesics. Swelling typically improves gradually over several weeks as the body heals from the trauma of surgery.
• Monitoring for signs of complications such as infection or blood clots, including severe, worsening swelling, increasing pain, redness, warmth, or fever, and contacting the healthcare provider if these symptoms occur, is vital for preventing morbidity and mortality.

From the Research

Postoperative Care for Hip Surgery Swelling (Edema)

• The use of compression dressings after total hip replacement (THR) has been shown to slightly reduce leg swelling, with a study finding that postoperative leg swelling was lower in the compression group (241 ± 234 mL vs. 307 ± 287 mL; p = 0.01) 2.
• Another study found that magnesium sulfate wet compress, iodophor wet compress, and ice compress were all effective in reducing postoperative perineal swelling in children with developmental hip dislocation, with statistical differences observed between the intervention groups and the control group (P < 0.05) 3.
• Calf-thigh intermittent pneumatic compression devices have been found to be more effective than plantar compression devices in reducing thigh swelling during the early postoperative stage, with a significant difference in the increased ratio of the circumference of the thigh (P << 0.01) 4.
• A study on postoperative lymphedema after primary total hip arthroplasty found that the direct anterior approach (DAA) was associated with a higher incidence of postoperative lymphedema, with 98.9% of patients in the DAA group showing swelling symptoms requiring treatment, compared to 39.4% in the standard surgery group 5.
• While not directly addressing edema, a study on patients' experience of pain and pain relief following hip replacement surgery found that easing of postoperative pain was related to professional care features, such as nursing staff, pharmacological pain relief, and technical aids, as well as self-care features like relieving body positions, endurance, and looking ahead 6.