Hip Replacement Wound Care and Scar: Healing, Showering, and Warning Signs

A hip replacement wound usually seals within the first couple of weeks, you can generally shower from about 48 hours with the dressing on, and the scar goes on fading for a year or more; your main jobs are keeping it dry, leaving it alone, and knowing the handful of signs that mean infection. I was strangely squeamish about my wound. I could talk about the new ball and socket all day, but the long line of clips down the outside of my right hip was something I did not want to look at for the first week. That turned out to be the wrong instinct, because looking at it every day was exactly how I would have spotted a problem early. Here is what I learned about how the wound is closed, how to wash with it, what normal healing looks like, the warning signs, and what the scar becomes, with the medical side checked by Ms Raman.

How the wound is closed

Your wound will be closed with dissolvable stitches, clips (also called staples), or skin glue, usually under a waterproof dressing, and the method mostly decides whether anything needs taking out later. Surgeons choose the closure to suit the approach and their own practice, and none of the common methods is clearly better for the final result. Dissolvable stitches sit under the skin and vanish on their own. Clips and non-dissolvable stitches are removed by a nurse, usually after about 10 days, at your clinic or at home ¹. The length of the incision depends on the approach and on you: mine, from a posterior approach, ran along the outer side of the hip and curved slightly towards the buttock, while an anterior incision sits at the front of the hip and is often shorter ². Scar length tells you very little about how big the operation was inside, which is worth knowing if you find yourself comparing scars with someone on the ward. My clips came out on day 12. I had dreaded it for days and it took four minutes, with a sensation more like tugging than pain.

Showering and keeping the dressing dry

Guidance on surgical wounds says you can usually shower safely from about 48 hours after the operation, and most people shower with the waterproof dressing left on. That figure comes from national guidance on preventing surgical site infections, which also advises against routinely putting antiseptic or antibiotic creams on a wound that is healing normally ³. In practice, with a hospital stay of 1 to 3 days, many people take their first shower at home. Mine was on day four, sitting on the shower chair I had put in beforehand, with my daughter on the other side of the door and the hand shower pointed firmly at everything except my hip. Short, warm rather than hot, and patting the dressing dry afterwards was the whole routine. If the dressing lifts at the edges, gets soaked, or fills with fluid, it needs changing; your team will tell you whether to do that yourself or have a nurse do it, and it is worth asking before you leave hospital. Baths, hot tubs, and swimming are a different matter: they wait until the wound is fully closed with no scabs or gaps, which for many people is somewhere around 4 to 6 weeks, and only once your team says so. After a posterior approach a bath is off the menu for longer anyway, because lowering yourself into one bends the hip well past 90 degrees, and the usual precautions rule that out for the first 6 to 12 weeks ⁴. My notes on hip dislocation precautions cover the movements a bath would have broken.

What normal healing looks like, day by day

Normal healing looks like a wound that is a little red, swollen, bruised, and sore for the first few days, then gets steadily quieter rather than angrier. The useful test is direction of travel. Some clear or faintly pink fluid on the dressing in the first 2 to 3 days is common. Bruising can be dramatic and can track down the thigh towards the knee over the first week or two, because blood under the skin follows gravity just as swelling does; my thigh went through a full sunset of purple, green, and yellow before it faded. The skin edges usually seal within the first couple of weeks, though the deeper tissues keep strengthening for weeks after that. Itching as it heals is normal and annoying in equal measure. A firm ridge under the scar, a slight puckering where clips sat, and a band of numbness alongside it are all part of the ordinary picture. The swelling that spreads down the whole leg is its own topic, and I wrote about it separately in swelling after a hip replacement. What I would tell my earlier self: take a photo of the wound each day in the first two weeks. Comparing day eight with day five is far more reliable than trusting your memory, and it gives the nurse something concrete if you ring.

The warning signs that mean call today

Deep infection affects about 1 in 100 hip replacements, and the signs that need a same-day call are spreading redness, a wound getting hotter or more painful instead of less, leaking that persists or turns cloudy, the edges opening, or a fever. That rate is low because of the defences built around the operation: antibiotics given just before the skin is opened, sterile theatre technique, and safety checks of the kind the World Health Organization promotes in its surgical safety checklist ⁵. Deep infection is still taken very seriously, because once bacteria settle on the implant it can need further surgery and a long course of antibiotics ². The distinction that helped me was between a wound that is settling and one that is building. A thin pink line with a little warmth is settling. Redness that spreads outward, skin that feels hot to the back of your hand, throbbing pain that is worse on day six than on day three, fluid that keeps coming beyond about 5 days, or feeling shivery and unwell all point the other way. There are two quieter rules too: do not pick at scabs or pull at the dressing, and keep pets and garden soil well away from an open wound. The full list of what can go wrong, with the real rates, is in my notes on hip replacement risks and complications. I rang the ward once, on day nine, over a spot of fresh fluid on the dressing. It was nothing, and the nurse said she would rather take ten such calls than miss one infection.

What helps the wound heal well

The parts of wound healing that sit with you are not smoking, eating enough protein, keeping blood sugar under control if you have diabetes, and moving within your limits rather than lying still. Smoking is the big one: it slows healing and raises the risk of infection, which is why surgical teams ask people to stop well before the operation and stay stopped afterwards. Diabetes that is poorly controlled around the time of surgery is another recognised risk factor for wound problems, and it is worth a conversation at your pre-operative check if your readings have been creeping up. Food matters more than I expected; I had very little appetite in the first week, and a protein drink in the afternoon was an easy way to stop running on toast alone. Gentle walking and the early exercises help circulation to the healing tissues, and structured rehabilitation after a hip replacement improves function rather than simply passing the time ⁶. Clothing makes a surprising difference too. Loose, soft trousers and underwear with the waistband well away from the scar saved me from a lot of rubbing, especially sitting in the car.

Your scar after the first few months

A hip replacement scar starts pink, raised, and firm, and usually flattens and pales over 12 months or more, often ending as a fine silvery line. Scars keep remodelling long after the skin has closed, and the full recovery from a hip replacement, meaning strength, confidence, and settled tissues, typically takes 6 to 12 months ⁶, so it is no surprise the scar works on a similar clock. Once the wound is fully healed and the clips are out, a plain unperfumed moisturiser and gentle massage along the line can make it feel softer and less tight, and keeping it out of strong sun for the first year helps it fade evenly rather than darkening. The numbness is the part people ask me about most. Small skin nerves are cut when the incision is made, so a patch of numb or tingling skin beside the scar is very common; it often shrinks over the first year, but some of it may stay. Mine was a hand-sized band at three months, as I noted in my week by week recovery timeline, and today it is about the size of a credit card and I only notice it when drying off after a shower. A thick, raised scar that keeps growing beyond the wound edges (a keloid) is uncommon and is worth showing to your surgeon rather than treating yourself. Mostly, the scar becomes the least interesting thing about the hip: a thin line marking the place where two years of limping stopped.

This is general information from a patient’s perspective, checked for accuracy, and not medical advice. How your wound was closed and how it should be cared for depend on your operation and your surgical team. Follow their instructions, and if your wound becomes redder, hotter, more painful, starts leaking, or you develop a fever, contact a qualified clinician the same day.