Hip replacement:
what is decided in the first four days

A deep joint that surface cold reaches badly

Surface cold works poorly on a hip, and that is a matter of anatomy rather than protocol.

The knee is a superficial joint. The hip sits buried under the gluteus medius, the tensor fasciae latae and a thick muscle mass. An ice pack laid over the trochanteric region diffuses poorly beyond the adipose and muscle planes, and does not reach the capsule.

Thigh drainage is the second problem. It is gravity dependent and requires active tissue mobilisation. A static compression bandage contains without draining. Dynamic compression produces that mobilisation, and it also brings the cold closer to the deep planes.

The peak comes after discharge

Oedema and bleeding peak between the 48th and the 96th hour. That is precisely the window in which standing, walking with an assistive device and the first exercises begin.

Capsular distension and effusion reflexively inhibit recruitment of the quadriceps and the hip flexors. This arthrogenic muscle inhibition is not a nuisance, it is what degrades the quality of the first weight bearing.

And since discharge is now early, between D1 and D3, this decisive week plays out at home, most often without an appropriate device.

What the studies show

A Japanese randomised study followed 60 patients after total hip arthroplasty, half on continuous local cooling at 5 °C for 72 hours, half on standard care¹.

At D4, the operated thigh exceeded the healthy thigh by 4.1% in the cooling group against 6.7% in the control group (p = 0.045). On satisfaction relating to walking ability, the gap is wider still: 62 out of 100 against 38 at D4 (p = 0.030), and 67 against 48 at D7 (p = 0.040)¹.

On the bleeding side, a Dutch study compared 15 cryocompression sessions of 30 minutes against a compression bandage alone after elective hip arthroplasty². The drop in haemoglobin at D1 was 1.87 mmol/L against 2.34 (p = 0.027), around 20% less.

After a hip replacement, post-operative anaemia is not just a line of laboratory data. It translates into fatigue, breathlessness on the slightest effort and dizziness on standing, all of which delay the return to walking accordingly.

Across the whole body of data, a 2025 systematic review devoted to joints other than the knee gathered 7 studies and 542 patients for the hip³. Its conclusion: the hip is the joint showing the most consistent benefits from cryotherapy, across all parameters studied.

What these trials do not show

In the Japanese study, estimated blood loss did not differ between groups (700 against 785 mL, p = 0.268), nor did pain scores at D4¹. The documented effect is on oedema and on perceived comfort, not on pain intensity itself.

In the Dutch study, the advantage on haemoglobin is no longer significant at D3 (p = 0.646)². The lower morphine consumption and shorter stays observed are trends, in a sample of 30 patients.

These reservations do not cancel the signal. They place its scope: a real benefit over the first week, not a substitute analgesic effect.

The protocol in practice

The D0 to D7 window is the one of maximum benefit. Starting from theatre discharge or on return home prevents the rise in oedema rather than treating it once established.

Around physiotherapy sessions, an application before prepares and relaxes the joint, an application after controls the inflammatory response to the effort. Cryocompression conditions how well rehabilitation is tolerated, without standing in for it.

Precautions. Where epidural analgesia is still in effect, skin sensitivity is altered: closer monitoring and shorter sessions in the first hours. The dressing stays watertight and the wrap is applied over it. Under anticoagulation, use remains possible with monitoring of superficial haematomas.

Kolde at the patient's home

Kolde rents the Game Ready® GRPro 2.1 directly to the patient's home, with delivery, set-up and a hands-on walkthrough by a member of the team, and support reachable at any hour. The oedema peak falls between the 48th and the 96th hour¹, which is after discharge. That is the window to cover, not the one of the inpatient stay.