How Long to Ice After Hip Replacement

How Many Days to Ice After Hip Replacement —

A common question patient ask after hip replacement is how long do they have to ice their leg. Most know that icing or cryotherapy is the most effective way to not only decrease pain but also swelling. Ice is a powerful tool due to its anti-inflammatory properties.  

The icing question needs to be answered in two parts, one regarding the time for each icing session and the other for the amount of times per day you are allowed to use ice.

Icing your hip replacement between 20-30 minutes but no longer than 60 minutes provides the most beneficial effects. Ice your hip anywhere from 3-7 times per day in the first few weeks after hip replacement.   Continue icing between 30-90 days after hip replacement depending on your symptoms. This protocol allows opportunity to improve your symptoms and ease return to activities of daily living (ADLs).  

The 20-30 minutes of application time to your new hip joint should provide relief lasting anywhere from 1-3 hours depending on the irritation level of the area.   The 60 minute time  limit for icing is to reduce the chance of ice burn or skin irritation. Even though 7 times per day may seem high, the icing benefits are well worth it.  

Icing Advice After Your Hip is Replaced

When applying ice to your hip, be sure to have a thin barrier of material between the skin and ice pack while applying.  Two reliable thin barrier options are standard pillow cases and regular kitchen tea towels.  

Thick spongy towels or fleece materials would not be good choices as they would provide too much of a barrier for the cold.  It is important to note that in order for the ice to be effective you must actually feel the cold in your hip.  

If you are not feeling any cold sensation after a few minutes of applying you should remove a barrier and try again.  Do not directly apply ice to the skin.

Best Way to Ice After Total Hip Replacement  

There are many different ways to perform effective icing at home with all methods being more than adequate to do the job.  As long as the applied ice is around its freezing point of 32 degrees Fahrenheit it will be most effective.  

For reference, ice removed straight from the freezer is usually at 0 degrees Fahrenheit.  You need the the thin barrier layer mentioned above to reduce the temperature on the skin.  Never place ice directly on the skin as this can do damage to the skin and surrounding areas.

A standard gel ice pack is the easiest and most reusable form of ice. It can be placed back in the freezer for quick reuse later on making it very user friendly.  For my hip replacement patients, I recommend keeping at least 2 if not 3 large gel ice packs in the freezer.  

Having cold ice available to use throughout the day for 20-30 minute sessions is crucial.  Gel material maintains the cold for longer periods of time and also can shape to fit the form of your leg.  This will provide the most effective direct benefits from the ice. Be sure to surround the entire hip region with the ice when using gel ice packs.  

Can I Use Regular Ice Cubes for Icing My Hip?

A second option is to use just regular ice cubes placed in either ziploc bags or the old fashioned rubber ice holder bags.  Make sure you double bag to prevent leakage. Surround the bag again by a thin barrier material to lessen skin irritation.  

The old fashioned rubber ice bag holder does not require an additional barrier most times as it is usually a thicker rubber material thus bringing up the temperature closer to the 32 degree Fahrenheit goal.  Place the bag on the hip incision area and surrounding tissues for 20-30 minutes.

A third icing option after hip replacement is sometimes provided by the surgeon or hospital, a hip replacement ice machine.  Hip replacement ice machines are electric powered coolers connected by tubing to a wrap-around sleeve which fills with ice cold water.   This maintains the beneficial cold temperature around the hip.  Your health insurance many times covers the cost of hip replacement ice machines so double check on this. You may have a small copay depending on your plan.

The one negative aspect to the ice machine device is that it requires the user to refill manually with ice cubes after each session.  However it does provide a longer lasting option instead of returning to the freezer every 30 minutes.  Ice machines tend to work better on smaller joints such as shoulders and knees that can be surrounded easier.

A home made ice slush pack ice the final icing option that many physical therapists including myself will suggest to their patients. This is for those who do not yet have a gel pack or ice machine at home. 

The simple recipe is 1 part rubbing alcohol to every 2 parts water into a ziploc bag, double bagged to prevent leaks.  

I would suggest the largest possible ziploc bag to allow good coverage of your hip region.  The amount of each depends on how large your ziploc bags are.  These slush ice packs are just as effective as the other options listed above and can be reusable for weeks on end.

How Many Days To Ice After Hip Replacement

Once you return home it is common to wonder how long to continue icing after hip replacement.  A good rule of thumb in home care physical therapy is to continue icing daily for at least 2 weeks between 3-7 times per day.  

Some patients continue to ice much longer than this 2 week period and there is no downside to this practice.  In fact, some patients continue to ice their new hips for up to a year simply to reduce any soreness or occasional swelling that may continue. 

A common question is “Can you ice too much after hip replacement surgery?” Naturally you do not want to be icing your leg 24/7 however you can perform daily icing within the parameters previously discussed as long as you so choose.

Can I Use Heat or Ice After Hip Replacement Surgery?

Only after a period of 2 weeks do most surgeons do allow their patients to start using moist heat. Heat helps with stretching and pliability of the muscles and tissues.  

A 20-30 minute heat application is common practice at this stage again with a barrier layer between the heating pad and skin to reduce skin irritation and burn.  Just as in icing, heating between 3-7 times per day is allowed depending on your needs.

Heat is not mandatory at this 2 week post-operative stage.  Some patients do prefer the warm vs cold on their skin to relax and sooth the painful areas.  

A common practice is to switch back and forth between ice and heat throughout the day to gain the benefits of both modalities.  The heat vs ice discussion is one that certainly has many angles. However, once both are allowed it truly becomes a patient preference at that point. 

How to Position Your Hip During Icing

One aspect of icing your that PT should discuss early on is the positioning of the leg during the icing activity.  In most cases, your leg will be swollen during the first 1-2 weeks at home after surgery simply from continued exercise and irritation.  

To assist in reduction of the swelling, a good technique is to elevate the leg during icing.  By using 2-3 pillows lengthwise directly under the surgery leg for the 20-30 minutes this assists in swelling reduction. However, jamming pillows only under the knee is not allowed so be sure to support the entire leg with pillows.

Larger wedge pillows designed specifically for this task are available online for purchase that can provide a sturdier support base however this is not necessary for this temporary need.  It is important to keep the hip bent less than 90 degrees however this technique is perfectly safe and will keep the hip flexion angle well below 50 degrees maximum.

Can I Ice My Incision Area If It Is Irritated?

For irritated scar incision regions, something that can be of use is called an ice massage.  This technique involves direct icing to the scar region for a 5-10 minute period of time.  

For setup, place a small styrofoam or paper cup 3/4 filled with water in the freezer and let freeze.  Once frozen, remove the surrounding cup material and begin to massage the scar area for 5-10 minutes in a circular motion.

The ice will begin to melt, providing a very cold but effective ice massage.  It would be suggested to place a towel under your hip as the area will become wet from the melted ice.  This technique is more effective for close to the skin or superficial pain areas such as incision or scar pain.  

Final Thoughts on Icing After Your Hip Replacement

  • Ice between 20-30 minutes per session
  • Ice anywhere from 3-7 times per day
  • Ice between 30-90 days after hip replacement
  • Ice helps with both pain and swelling after hip replacement

One of my favorite phrases to my patients is: “Ice is Your Friend”.  By saying this, I’m simply emphasizing the importance and benefits of using ice after a major surgery.  Icing properly by using the above guidelines can and should be a major tool in your recovery to independence after hip replacement surgery. 

About Jeffrey Roth MPT

Owner and operator of Roth Therapy Services in Pittsburgh, PA focusing on in home rehabilitation physical therapy services.


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