Warning signs after hip surgery: when to call the doctor

If you are the adult child managing a parent's recovery after hip surgery, you are the one who will notice the warning signs first. You are the person seeing the wound at each dressing change, watching how your parent moves from bed to chair, and picking up on whether they seem more confused, more short of breath, or more in pain than they were yesterday. Most guidance about hip surgery complications is written for the patient — but an 80-year-old three days out from surgery, on pain medication and short on sleep, is often not the person best positioned to judge whether something is wrong. That job frequently falls to family. This guide is written for you: the person doing the watching.

It covers both hip replacement (an elective, planned surgery) and hip fracture repair (an emergency surgery after a fall). The warning signs overlap heavily, but fracture patients tend to be frailer, are more likely to develop delirium, and are at higher risk for blood clots and infection — so the same symptom can be more urgent in a fracture recovery than in a routine replacement.

This article is educational and is not medical advice. Always follow the instructions you receive from your parent's surgeon, physical therapists, and nurses. Your parent's discharge papers will list specific thresholds and a number to call — those instructions override anything general written here. If anything below conflicts with their guidance, follow their guidance. When breathing, chest, or stroke-like symptoms are involved, do not spend time deciding: call 911.

How to use this as a reference card

The point of this page is to be read once, early in recovery, and then kept handy. Every warning sign below is sorted into one of two buckets:

• Call the surgeon or doctor — worrying, needs professional judgment today, but not an immediate threat to life. This usually means calling the surgeon's office (they often have a nurse line) or your parent's primary care doctor.
• Call 911 now — a possible emergency where minutes matter. Do not call the surgeon's office first and wait for a callback.

Before you need it, do two things. First, write the surgeon's after-hours number, the physical therapy contact, and your parent's medication list somewhere everyone in the family can find them. Second, read the discharge instructions and find the surgeon's own thresholds — the exact fever number, the exact drainage description, the specific pain expectations — and use those over the general numbers here.

Blood clots: the complication families underestimate

After hip surgery, your parent is at elevated risk for a blood clot, because reduced movement plus the surgery itself makes clots more likely. A clot in the leg is called a deep vein thrombosis (DVT). If a piece breaks off and travels to the lungs, it becomes a pulmonary embolism (PE) — which is life-threatening. This is why the care team prescribes blood thinners, compression devices, or both, and why they push early walking. The CDC notes that surgery, especially hip or knee surgery, is one of the biggest risk factors for developing a blood clot, so this risk is not a rare edge case — it is expected enough that prevention is built into the standard recovery plan.

Signs of a leg clot (DVT) — call the surgeon today:

• Swelling in one leg, especially the calf, that is noticeably more than the other leg
• Calf or leg pain, tenderness, or cramping — often described as different from the surgical pain
• Warmth or redness over one area of the calf or leg
• Skin that looks reddish or discolored

MedlinePlus describes the classic picture of a leg clot as swelling, pain, tenderness, and warmth or redness, usually in one leg. Because some post-surgical leg swelling is normal, the key is asymmetry and change: one leg clearly worse than the other, or a new area of pain and warmth that was not there before.

Signs a clot has traveled to the lungs (PE) — call 911 now:

• Sudden shortness of breath or trouble breathing
• Sharp chest pain that may worsen with a deep breath
• Coughing, sometimes coughing up blood
• Rapid heartbeat, lightheadedness, or fainting

MedlinePlus lists sudden shortness of breath, chest pain, and coughing up blood among the main signs of a pulmonary embolism — and this is an emergency, not a same-day phone call. If your parent suddenly cannot catch their breath or clutches their chest, call 911 and mention the recent hip surgery, because it changes how emergency responders will think about the problem.

Wound and surgical site infection

The incision is a window into how recovery is going. Some redness right at the edges, mild swelling, and a small amount of clear or lightly blood-tinged fluid in the first days is often normal. What you are watching for is a wound that is getting worse over time instead of better. MedlinePlus describes the signs of a surgical wound infection as increasing redness, pain, swelling, warmth, or drainage of cloudy or foul-smelling fluid, often with a fever — the same picture to bring to the surgeon's office.

Signs of a wound infection — call the surgeon:

• Redness around the incision that is spreading or expanding day over day
• The wound feeling increasingly hot to the touch
• Increasing swelling around the incision after the first few days
• Drainage that becomes thick, cloudy, yellow, green, or foul-smelling, or any pus
• The incision opening up or edges separating
• Increasing pain at the site when pain should be easing
• Fever or chills accompanying any of the above

A simple habit helps here: take a photo of the incision at each dressing change with your phone. Comparing today's photo to two days ago makes "is this getting worse?" a factual question instead of a guess — and it gives the surgeon's office something concrete if they ask you to describe it or send an image. Because most hip fracture patients spend their first weeks in a skilled nursing facility, the wound checks may be happening in a facility; ask the nursing staff to loop you in on any change, and see what a skilled nursing facility is and how it works for how to stay in the communication loop.

Dislocation: specific to hip replacement

This warning sign applies mainly to hip replacement, where the new joint can pop out of position — a dislocation — usually because the leg moved into a forbidden position (bending the hip past 90 degrees, crossing the legs, or turning the foot inward, depending on the surgical approach). Fracture repairs with plates and screws don't dislocate the same way, though your parent's surgeon will explain their specific movement restrictions. The American Academy of Orthopaedic Surgeons explains that dislocation is a known risk after total hip replacement, especially in the first months while the tissues around the joint heal.

Signs of a possible dislocation — call the surgeon urgently; a dislocation is usually treated in the ER:

• Sudden, severe hip or groin pain, often after a specific movement
• The leg suddenly looking shorter, or the foot rotating in or out at an odd angle
• Inability to bear weight or move the leg
• A pop or clunk followed by pain and being unable to stand

A dislocation usually needs to be put back in place by a professional and is not something to manage at home. Call the surgeon's office right away; if your parent is in severe pain and cannot move the leg, a dislocation is typically handled in the emergency room, so go there unless your surgeon's discharge instructions tell you otherwise. If the foot or leg below the joint becomes numb, cold, pale, or loses its pulse, call 911 — that can mean the joint is pressing on blood vessels or nerves, which is a true emergency. Knowing and enforcing your parent's specific movement restrictions is one of the most important daily jobs for a family caregiver — the family caregiver guide to home recovery after hip replacement covers those restrictions in detail.

Fever thresholds

A slightly elevated temperature in the first day or two after surgery is common and, by itself, is usually not a crisis. What matters is how high, how persistent, and what else is happening. MedlinePlus notes that most fevers are caused by infection — which is why, after surgery, the care team wants to hear about one that crosses their threshold or comes alongside a worsening incision.

Call the surgeon if:

• The temperature reaches 101°F (38.3°C) or higher, or hits whatever threshold the discharge papers specify
• Any fever comes with worsening wound redness, drainage, or pain
• Fever comes with chills, shaking, or new confusion
• A low-grade fever persists for several days instead of settling

Fever is rarely a standalone signal — read it together with the wound and how your parent is acting overall. Fever plus a worsening incision points toward infection; fever plus new confusion in a frail parent is a reason to call the same day. Log the actual numbers and times so you can tell the office "it's been 100.5 to 101 for two days" instead of "he feels warm."

New confusion (post-operative delirium)

New confusion after surgery in an older adult is one of the most common — and most alarming to families — warning signs. It is called post-operative delirium, and it is especially common after hip fracture surgery. It is usually not a psychiatric problem or a sign of dementia developing; MedlinePlus explains that delirium is sudden, often reversible confusion that is frequently triggered by anesthesia, medications, infection, dehydration, or another physical illness, and that it is common in older adults.

Call the care team the same day if your parent:

• Is suddenly confused, disoriented, or not recognizing people or place
• Is unusually drowsy or "not themselves" (but if your parent cannot be woken, is very hard to rouse, or is breathing abnormally, call 911 — do not wait for a call back)
• Is agitated, seeing or hearing things that aren't there, or has a sudden personality change
• Has confusion that comes and goes through the day

The reason confusion warrants a call rather than a wait-and-see is that it can be the first visible sign of an infection or a blood clot, especially in a parent who can't clearly report their own symptoms. If new confusion appears alongside shortness of breath, chest pain, one-sided weakness, or facial drooping, treat it as a 911 emergency — those combinations can signal a clot or a stroke. If your parent already lives with dementia, delirium on top of it can be harder to spot and more dangerous; the guide to when a parent with dementia has a fall or hip fracture covers that overlap.

Pain: normal recovery versus a red flag

Pain is expected after hip surgery. The useful distinction is the direction and location of the pain, not its mere presence.

Normal: Surgical-area pain that is gradually improving day over day and responds to prescribed medication, ice, rest, and elevation. Soreness with therapy exercises.

Call the surgeon if pain:

• Suddenly spikes or is dramatically worse than the day before
• Is centered in the calf rather than the hip (possible clot)
• Comes with new swelling, redness, or warmth in the leg
• Is not controlled by the prescribed medication at all
• Comes with an inability to bear weight or move the leg as therapy expects

A steady ache that is slowly easing is the recovery working. A sudden, severe, or new-location pain is the one to flag.

The two-bucket quick reference

Keep this near the phone or in a shared family note.

| Situation | What to do | |---|---| | Sudden shortness of breath, chest pain, or coughing up blood | Call 911 | | Confusion with one-sided weakness, facial droop, or slurred speech | Call 911 | | Fainting, unresponsiveness, or a new fall with a possible new injury | Call 911 | | Severe hip pain with the leg looking shorter/rotated and unable to move it | Call surgeon urgently; ER if instructed | | One-sided calf/leg swelling, pain, warmth, or redness | Call surgeon today (possible DVT) | | Wound spreading redness, heat, pus, foul drainage, or opening up | Call surgeon (possible infection) | | Temperature 101°F+ or any fever with worsening wound/pain/chills | Call surgeon | | New confusion, drowsiness, or agitation (no breathing/stroke signs) | Call care team same day | | Sudden pain spike, calf-centered pain, or new inability to bear weight | Call surgeon | | Steadily improving surgical pain, mild incision redness, expected soreness | Continue recovery plan; note in your log |

Common mistakes families make

Waiting to "not bother" the surgeon. Surgeons' offices expect these calls; the nurse line exists precisely for "is this normal?" questions. Calling about something that turns out fine is far better than missing an infection or clot early.

Calling the office first during a real emergency. If it is shortness of breath, chest pain, or stroke-like symptoms, call 911 — do not leave a message and wait for a callback. Time matters more than reaching a familiar voice.

Judging symptoms from memory instead of a record. "He seems warmer" and "her leg looks a little swollen" are hard for a nurse to act on. Keep a simple daily log of temperature, pain level, wound photos, and anything unusual. A short written record turns a vague worry into a specific report — the post-hospital symptom and red-flag tracker template is built for exactly this, and works for hip recovery too.

Assuming rehab staff will catch everything. If your parent is in a skilled nursing facility, the staff are watching — but you know your parent's baseline better than anyone on a rotating shift. Ask to be told about any change, and speak up if something seems off.

Related planning steps

• Recovery after hip fracture surgery: what family caregivers need to know — why fracture recovery is harder and what outcomes to expect realistically
• Caring for a parent at home after hip replacement: a family caregiver guide — day-to-day home recovery, movement restrictions, and wound care
• Hospital discharge checklist for an elderly parent coming home — equipment, medications, follow-ups, and red flags to monitor
• What is a skilled nursing facility: a family caregiver guide — where most hip fracture patients recover first