hip replacement Patient Education Guide
Thank you for choosing the PeaceHealth Sacred Heart Joint Replacement Center (JRC) to help restore you to a higher quality of active living with your new prosthetic joint. We’ll help you prepare for your hip replacement surgery and provide the information you’ll need to ensure a fast return to normal activities. This guidebook will help you understand what you’ll need to do during the pre-operative time period to achieve a good outcome for you and your new hip. We encourage your active participation in the process. USING THE GUIDEB OOK Preparation, education, continuity of care, and a pre-planned discharge are essential for optimum results in joint surgery. Communication is essential to this process. The guidebook is designed to educate you so that you know:
What to expect every step of the way
What you need to do
How to care for your new joint
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Remember, this is just a guide. Your physician, physician’s assistant, nurses, or therapist may add to or change any of the recommendations. Always use their recommendations first and ask questions if you are unsure of any information. Keep your guidebook as a handy reference for at least the first year after your surgery. The information in the guidebook covers a lot of details, so it may look overwhelming. As it will assist you with your surgery, we recommend reading the entire guide, at a pace that suits you.
Bring this guidebook with you to appointments, the hip replacement class, and the hospital on the day of your surgery.
Joint Replacement Center
541-222-5186
(ORTHO 001 • 013014) © 2014 PeaceHealth. Not to be reproduced without permission
AB OUT HIP REPL ACEMENT SURGERY
OVERVIEW OF THE CENTER FOR J OINT REPL ACEMENT
Each year, more than 700,000 people undergo joint replacement surgery. Primary candidates are individuals with chronic joint pain from arthritis that interferes with daily activities, walking, exercise, leisure, recreation, and work. The surgery aims to relieve your pain, restore your independence, and return you to work and other daily activities.
The Joint Replacement Center is unique. It is a dedicated center within the hospital, and each step is designed to encourage the best results leading to a discharge from the hospital two to three days after surgery. Features of the program include:
Total hip replacement patients typically recover quickly. Patients will typically be able to walk the day of surgery. In general, patients are able to return to driving in 3 to 6 weeks, dancing in 4 to 6 weeks, and golf in 6 to 12 weeks. The Joint Replacement Center has implemented a comprehensive course of treatment. We believe that you play a key role in promoting a successful recovery. Our goal is to involve you in your treatment through each step of the program. This guide will give you the necessary information to promote a more successful surgical outcome. Your team includes physicians, physicians’ assistants, nurses, nursing aides, and physical and occupational therapists and aides who specialize in total joint care. Every detail, from beforesurgery teaching to post-operative exercising, is considered and reviewed with you. The Joint Replacement Program Coordinator will guide you through your treatment program.
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Nurses and therapists who specialize in the care of joint patients
Casual clothes (no drafty gowns)
Private rooms
Emphasis on group activities as well as individual care
Family and friends participate as “coaches” in the recovery process
A Joint Replacement Center Coordinator
Medical Social Worker and RN Care Coordinator to assist with discharge planning and arrange home therapy and equipment
A comprehensive patient guide for you to follow from four weeks before surgery until three months after surgery and beyond
Quarterly luncheons for former patients and coaches
Daily newsletters to update you with the activities and expectations for each post-op day
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Developed by Brian Jewett, MD, of Slocum Orthopedics and the orthopedic staff of PeaceHealth Sacred Heart Medical Center. Special thanks to: Kirsten Harlan, OT; Rudolf Hoellrich, MD; Brick Lantz, MD; Craig Mohler, MD; Steve Shah, MD; Bethany Ameen, MSN, MBA; Heather Wall, RN; Candice Gregory, PT; Dana Haskins, PT and Katie Vendrasco, PT.
appointments Patient name: _______________________________________ Phone: ___________________ Surgeon name: ______________________________________ Primary Care Physician (PCP): _________________________________ Phone: __________________ Registration (PeaceHealth Sacred Heart Medical Center): ____/____/____ at ____:____ a.m. / p.m. 541-686-7166 or 866-907-6329 Allow 30 minutes and please have your insurance information available. Anesthesia Clinic appointment (PeaceHealth Sacred Heart Medical Center): ____/____/____ at ____:____ a.m. / p.m. 541-686-7166 or 866-907-6329 Visit: ____/____/____ at ____:____ a.m. / p.m. Allow 1–2 hours for this appointment. Pre-operative Hip Replacement Class: Every Tuesday 1:00 p.m. to 2 p.m. and Thursday 10 a.m. to 11 a.m. PeaceHealth Sacred Heart Medical Center at RiverBend Oregon Heart & Vascular Institute, 3311 RiverBend Drive, Springfield, OR, Room 12C See page 2, Preparing for Surgery, for information on pre-registration by phone or online, and for directions to the conference room. Pre-operative visit with your surgeon: ____/____/____ at ____:____ a.m. / p.m. Surgery date: ____/____/____ Time to report to the hospital: ____:____ a.m. / p.m. PeaceHealth Sacred Heart Medical Center, 3333 RiverBend Drive, Springfield See Resources section in back of this book. Post-operative surgeon visit: ____/____/____ at ____:____ a.m. / p.m.
Please see enclosed map of PeaceHealth Sacred Heart Medical Center at RiverBend for building locations. PeaceHealth Sacred Heart Medical Center
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Finding Your Way ANES THESIA CLINIC The Anesthesia Clinic is on the 3rd floor of the Northwest Specialty Clinics (NSC) building. Park on any level of Garage C. Take the garage elevator to the 3rd floor and turn right to the access the hallway that leads to the Sky Bridge. The Sky Bridge leads directly to the Anesthesia Clinic. SURGERY CHECK- IN Park on any level of Garage S and proceed to the 3rd floor of the garage, and then into the hospital. Note: only floors 1 and 3 of the hospital may be accessed from Garage S.
PeaceHealth Sacred Heart Medical Center 3333 RiverBend Drive, Springfield, Oregon 97477 541-222-7300 (Information & Patient Location) PeaceHealth Sacred Heart Anesthesia Clinic 3355 RiverBend Drive, Suite 320 Springfield, Oregon 97477 541-686-7166 866-907-6329 (toll free) www.peacehealth.org/shmc
VISITOR S Park on any level of Garage S. Enter the hospital on the ground level and follow the signs to the Main Lobby. Elevators to all patient rooms are at the back of the Lobby. Note: All parking is free for patients and visitors to PeaceHealth Sacred Heart Medical Center at RiverBend. Refer to the RiverBend visitor map for parking garage and clinic locations. PRE-OPERATIVE HIP & KNEE CLASS Park at Oregon Heart & Vascular Institute surface lot, directly in front of OHVI, 3311 RiverBend Drive, Springfield, OR. Use the main OHVI entrance, continue until you can't go any farther, then turn left. Room 12C will be on your right side.
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Useful Phone Numbers Anesthesia Clinic 541-686-7183 PeaceHealth Sacred Heart Medical Center Financial Services Payments or payment arrangements: 541-335-2149 888-872-1330 (toll free) All other billing questions: 541-686-7191 800-873-8253 (toll free)
PeaceHealth Sacred Heart Medical Center information and patient location Main hospital lines: 541-222-7300 800-288-7444 (toll free) Slocum Orthopedics 541-485-8111 800-866-7906 (toll free) PeaceHealth Medical Group Orthopedics 541-687-6021
Physical and Occupational Therapy 541-222-5430
Primary Care Physician:
Spiritual Care 541-686-7402
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Patient Information 541-222-7300 Patient Registration 541-686-7166 Guest House 541-685-1970 6 North (Hospital Orthopedic Unit) 541-222-5200 RN Care Manager, Orthopedic Unit 541-222-5874 Medical Social Worker 541-222-2440 Joint Replacement Center Program Coordinator 541-222-5186
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table of contents PREPAR ING FOR SURGERY
LE AVING AND DISCHARGE
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Preparing for Surgery
51 Preparing for Discharge
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Plans for After Surgery
54 Going Home
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Other Preparations
55 Around the House
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Medication Information
10 Pre-Operative Procedures 18 Final Preparations for Surgery 19 Pre and Post-Operative Exercises
YOUR HOSPITAL S TAY 25 Arriving at the Hospital 26 Your Surgery
AF TER YOUR S TAY 57 Your Surgical Wound 59 Preventing Blood Clots 60 Hip Dislocation Precautions
MEDIC ATIONS 63 Pain Medications 64 Other Medications
27 Information for Your Family 28 Your Hospitalization
SPECIAL C ARE
31 Daily Routines After Surgery
65 Activities in the First 6 Weeks
33 Pain Control 34 Physical Therapy 43 Occupational Therapy
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After Your Hip Surgery 67 Post-Operative Exercises and Goals 69 Returning to Normal Life Activities
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Preparing for Surgery TIME LINE FOR COMPLETING PRE - OPER ATIVE APPOINTMENT S
Four Weeks Before Surgery Perform your pre-operative exercises daily to strengthen the muscles around your hip. Register for the Pre-Operative Hip Replacement Class. Register for your hospitalization and make your Anesthesia Clinic appointment. Prepare for home equipment. Make arrangements to have a caregiver available to help you for the first 7–10 days after discharge.
One Week Before Surgery See your surgeon to discuss your medical clearance, your discharge plan, your current medications (please bring a complete list), and the plan for surgery. You should now stop taking medications that may cause excessive bleeding as discussed with your surgeon.
Night Before Surgery Do not eat anything after midnight, but you can drink clear liquids up to 4 hours before your surgery. Take a good shower before going to bed and use the special antibacterial soap.
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Three Weeks Before Surgery Attend Pre-Operative Hip Replacement Class. Go to PeaceHealth Sacred Heart Medical Center Anesthesia Clinic. You will meet with your anesthesia doctor. If you have been identified as “high risk” for Obstructive Sleep Apnea, your physician may recommend an evaluation by a sleep physician. See page 12, for more details.
Morning of Surgery Remember, nothing to eat. Take only those medications approved by your doctor and anesthesia doctor with a sip of water. Come to the hospital at the designated time and place, realizing that you will be there a few hours before the actual surgery begins.
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Preparing for Surgery (Continued) REG IS TER ING FOR YOUR HOSPITAL S TAY You will need to set up an account with PeaceHealth Sacred Heart Medical Center for your surgery. This needs to be done before you go to the Anesthesia Clinic appointment and can be done at any point once the surgery date has been determined. You may register by phone. The hours are 8:30 a.m. to 5 p.m., Monday through Friday. The numbers are 541-686-7166 or 866-907-6329. You may register in person. Patient registration is located on the 3rd floor of the Northwest Specialty Clinics Building, 3355 RiverBend Drive, Springfield. If you decide to register the day of your Anesthesia Clinic appointment, please allow an extra 20 minutes for this process. Registration may occur at any time before your appointments.
You may register for your class online by visiting www.peacehealth.org/shmc joint, then click on patient education and then click on “Sign up for your pre-operative hip and knee replacement class” at the bottom of the page. You may also register by phone by calling: 541-222-5830. In the event of inclement weather, please call the number above to see if your class has been cancelled. We strongly encourage you to bring the coach or family member who will be assisting you after your surgery. The class will last approximately 60–90 minutes. These classes are a wonderful opportunity to discuss your concerns with nurses and therapists. If you have had a hip replacement before, check with your surgeon about attending another a pre-operative education class because new information may have been added since your last surgery. Let your surgeon know if you cannot attend the class so we can assist you with getting the information.
REG IS TER FOR PRE - OPER ATIVE HIP REPL ACEMENT CL A SS You must register and attend a pre-operative education class, prior to your surgery. Classes are given twice weekly on Tuesdays from 1 p.m. to 2 p.m. and Thursdays from 10 a.m. to 11 a.m. at PeaceHealth Oregon Heart & Vascular Institute, Conference Room 12C. (Park on the surface lot directly in front of OHVI, 3311 RiverBend Drive, Springfield, OR.)
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Preparing for Surgery (Continued) Class Topics Will Include the Following: 1. How to prepare for surgery and what to bring to the hospital. 2. Daily routine in the hospital. 3. What to expect when you arrive in your hospital room after surgery. 4. How to prepare for discharge from the hospital. 5. Home discharge expectations.
You should leave this class with a firm understanding of how your hospital stay will proceed. We have found that the patients who do the best after surgery are the ones who know the most about their surgery beforehand. Take this time to ask questions and explore any concerns you may have.
A SPECIAL WOR D AB OUT YOUR COACH OR C AREGIVER In the process of a joint replacement, the involvement of a family friend or relative acting as your coach is very important. Your coach will be with you from the pre-op process through your stay in the hospital and to your discharge to home. They will attend pre-op class, give support during exercise classes, and keep you focused on healing. They will ensure that you continue exercising when you return home and see that home remains safe during your recovery.
Plan to attend the class at least 3 to 4 weeks before your surgery. This will give you ample time to practice your exercises and make final preparations before your surgery. For convenience you may want to schedule your class for the same day as your Anesthesia Clinic appointment. Use this time to understand all you can about how best to recover from your surgery. This will help lessen your worry about going home and, we hope, will help put you in charge of the recovery process.
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Plans for After Surgery PREPARE YOUR HOME FOR YOUR RETUR N FROM THE HOSPITAL It is important to have your house ready for your arrival back home. Use this checklist as you complete each task. Put things that you use often (like an iron or coffee pot) on a shelf or surface that is easy to reach.
Check railings to make sure they are not loose.
Put clean linens on the bed.
Prepare meals and freeze them in singleserving containers.
Cut the grass, tend to the garden, and finish any other yard work.
Pick up throw rugs and tack down loose carpeting.
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Remove electrical cords and other obstructions from walkways.
Install night-lights in bathrooms, bedrooms, and hallways.
Install grab bars in the shower/bathtub. Put adhesive non-slip strips or a rubber mat in the bottom of the tub.
Arrange to have someone collect your mail and take care of pets.
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DISCHARGE PL ANNING It is always good to plan ahead. Knowing your discharge plan for when you leave the hospital before you enter the hospital will ensure a smooth transition after surgery.
Most patients, after undergoing hip replacement surgery, should be able to go home. The first 2 to 3 weeks will be challenging. Most patients are able to perform daily activities such as getting out of bed, getting on and off the toilet, and dressing with minimal assistance on leaving the hospital. Most patients will need assistance 24 hours a day for the first 7 to 10 days. Depending on your progress, home health care or outpatient physical therapy will be recommended. If you live alone or have a disabled partner, you will need to make plans for assistance for 7 to 10 days after discharge from the hospital. REHAB FACILITIES If you do not make progress with physical and occupational therapy, you may require a short stay in a sub-acute rehab facility. Please remember that sub-acute stays must be approved by your insurance company prior to payment. A patient’s stay in a sub-acute rehab facility must be done in accordance with the guidelines established by Medicare. Although you may desire to go to sub-acute when you are discharged, your progress will be monitored by your insurance company while you are in the hospital. Upon evaluation of your progress, either you will meet the criteria to benefit from sub-acute rehab or your insurance company may recommend that you return home with other care arrangements. Therefore, it is important for you to make alternative plans preoperatively for care at home. Some local facilities are listed on the following page.
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Plans for After Surgery (Continued) In the event that sub-acute rehab is not approved by your insurance company, you can go to subacute rehab and pay privately. Please keep in mind that the majority of our patients recover quickly and therefore do not meet the guidelines to qualify for sub-acute rehab. Also, keep in mind that insurance companies do not become involved in social issues, such as lack of a caregiver, animals, etc. These are issues you will have to address before admission. LOC AL MEDIC ARE - CER TIFIED SK ILLED FACILITIES Coast Fork Nursing Center 515 Grant Street Cottage Grove, OR 97424 541-942-5528 Creswell Care Center 525 S. 2nd Street Creswell, OR 97426 541-895-3333 Eugene Good Samaritan Center 3500 Hilyard Street Eugene, OR 97405 541-687-9211 Eugene Rehab & Specialty Care 2360 Chambers Eugene, OR 97405 541-687-1310
Green Valley Rehabilitation 1736 Adkins Street Eugene, OR 97401 541-683-5032 Hillside Heights Rehabilitation Center 1201 McLean Blvd. Eugene, OR 97405 541-683-2155 Marquis Care of Springfield 1333 North First Street Springfield, OR 97477 541-746-6581 Regency of Florence 1951 East 21st Street Florence, OR 97439 541-997-8436 River Park Nursing and Rehabilitation Center 425 Alexander Loop Eugene, OR 97401 541-345-6199 South Hills Rehabilitation Center 1166 E. 28th Street Eugene, OR 97403 541-345-0534 Valley West Health Care Center 2300 Warren Street Eugene, OR 97405 541-686-2828
Grandview Rehabilitation 530 Birch Street Junction City, OR 97448 541-998-2395 PeaceHealth Sacred Heart Medical Center
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Plans for After Surgery (Continued) PUT YOUR HE ALTH C ARE DECISIONS IN WR ITING It is our policy to place patients’ wishes and individual considerations at the forefront of their care and to respect and uphold those wishes.
On admission to the hospital, you will be asked if you have an Advance Directive. If you do, please bring copies of the documents to the hospital with you so they can become a part of your Medical Record. Advance Directives are not a requirement for hospital admission.
WHAT ARE ADVANCE MEDIC AL DIREC TIVES? Advance Directives are a means of communicating to all caregivers the patient’s wishes regarding health care. If a patient has a Living Will or has appointed a Health Care Agent and is no longer able to express his or her wishes to the physician, family, or hospital staff, the Medical Center is committed to honoring the wishes of the patient as they are documented at the time the patient was able to make that determination. There are different types of Advance Directives and you may wish to consult your attorney concerning the legal implications of each.
Living wills are written instructions that explain your wishes for health care if you have a terminal condition or irreversible coma and are unable to communicate.
Appointment of a health care agent (sometimes called a medical power of attorney) is a document that lets you name a person (your agent) to make medical decisions for you, if you become unable to do so.
Health care instructions are your specific choices regarding use of life-sustaining equipment, hydration and nutrition, and use of pain medications.
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Other Preparations S TOP SMOK ING
B RE ATHING E XERCISES
It is essential to stop smoking before surgery. Smoking delays your healing process. Smoking reduces the size of your blood vessels and decreases the amount of oxygen circulated in your blood. Smoking can also increase clotting, which can cause problems with your heart. Smoking increases your blood pressure and heart rate. If you quit smoking before you have surgery you will increase your ability to heal. If you need help quitting, ask about hospital resources.
To prevent potential problems such as pneumonia, it is important to understand and practice breathing exercises. Techniques such as deep breathing and coughing may also help you recover more quickly.
Tips to Aid in Quitting
Decide to quit.
Choose the date.
Cut down the amount you smoke by limiting the area where you can smoke.
Give yourself a reward for each day without cigarettes.
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When you are Ready…
Deep Breathing
To deep breathe, you must use the muscles of your abdomen and chest.
Breathe in through your nose as deep as you can.
Hold your breath for 5 to 10 seconds.
Let your breath out slowly through your mouth. As you breathe out, do it slowly and completely. Breathe out as if you were blowing out a candle (this is called “pursed lip breathing”). When you do this correctly, you should notice your stomach going in. Breathe out for 10–20 seconds.
Take a break and then repeat the exercise 10 times.
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Throw away all your cigarettes.
Throw away all ashtrays.
Coughing
Don’t smoke in your home.
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Don’t put yourself in situations where others smoke such as at bars and parties.
Remind yourself that this can be done— be positive.
Take it one day at a time. If you slip, just get right back to your decision to quit.
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If you need to consider aids to quit—overthe-counter products such as chewing gum, patches or prescription aids—check with your doctor.
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To help you cough, take a slow deep breath. Breathe in through your nose and concentrate on filling your lungs completely.
Breathe out through your mouth and concentrate on your chest emptying completely.
Repeat with another breath in the same way.
Take another breath, but hold your breath and then cough hard. When you cough, focus on emptying your lungs.
Repeat all steps twice.
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Medication Information There are certain medications that deserve special attention when preparing for hip replacement surgery. Hip replacement surgery can cause serious bleeding, and medications, herbal products, and vitamins that may cause excessive bleeding should be discussed with both your primary doctor and your orthopedic surgeon. Anti-inflammatory Medicines Most anti-inflammatory medicines such as aspirin, ibuprofen and Naprosyn can weaken your platelet function and cause bleeding. Unless you take these medications for your heart or circulation, we recommend stopping these medicines at least 3 days before your surgery to allow your body time to clear them from your system. If you are taking aspirin, please discuss this with your surgeon. However, some patients will continue on low dose aspirin. We realize that these are pain medicines also, and some patients may require light pain medicine coverage during this time. Talk to your doctor about this. Tylenol has no effect on bleeding and can be used during this time as an over-the-counter alternative. Vitamin E Some vitamins, specifically vitamin E, can cause bleeding and should be stopped 3 days before surgery. Herbal Supplements It is recommended that all herbs are stopped 5 days before surgery. They may interact with conventional medication and cause undesirable results. The ones we are most concerned about are: Ephedra (Ma-Huang), Feverfew, Ginkgo (Ginkgo Biloba), Ginseng, Kava-Kava, 8
Valerian, St. John’s Wort, Saw Palmetto, Licorice, Goldenseal, Ginger, Garlic and Echinacea. Coumadin Coumadin, a strong blood thinner medication, usually requires a specific plan of care surrounding hip replacement surgery. In general, if you take Coumadin for cardiac arrhythmias or blood clots, it is recommended to stop the medication 5 days in advance of your surgery. We will check the blood level the morning of surgery. If you take the medicine for artificial heart valves or other serious conditions, a special plan of care will need to be arranged between your doctor and surgeon. Check with your Doctor regarding Coumadin or Plavix prior to surgery. Hormone Therapy Hormone therapy (for women) has been shown to increase the risk of blood clots. We generally do not restart your hormones after surgery for 2 weeks, unless you have a bad reaction when taken off your hormones. Patients with Arthritis Most patients with arthritis have been on antiinflammatory medication for some time. Some of these medicines can weaken the lining of your stomach and may cause bleeding. We generally will start you on stomach acid reduction medicine (Pepcid or Protonix) to help with this. Please ask questions regarding your medication, and always bring a copy of the list of medicines you are currently taking with you to all your pre-operative visits.
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Medication Information (Continued) CUR RENT MEDIC ATION LIS T Please list all prescriptions, herbs, vitamins and over-the-counter medicine information. Allergies/Intolerances (food and drug):____________________________________________________ __________________________________________________________________________________
Medicine Name
Dosage/Frequency
For What?
How Long?
Aspirin
325mg/Once a day
My heart
5 years
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Pre-Operative Procedures PRE - OPER ATIVE MEDIC AL EVALUATION Hip replacement surgery is a serious surgery and can put added stress on your body. It is important that you be in the best possible shape you can be prior to surgery. It is also important to have chronic medical conditions, like diabetes and hypertension, well controlled before and during surgery to prevent medical complications like heart attack and stroke.
If you have multiple or serious medical conditions you will most likely need to see your primary care physician for a physical before surgery. Your treating orthopedic surgeon will help arrange that visit. If you are from out of town, you may need to see a local physician here in EugeneSpringfield before surgery so that they can help coordinate your medical care after surgery.
Therefore, before surgery, you will visit with an anesthesia doctor in the pre-admission Anesthesia Clinic. There, a team of nurses and anesthesia physicians will review your medications, check an EKG test of your heart, and perform laboratory checks of your blood, kidney, heart, and liver functions to make sure you are in good shape before surgery. This visit will occur typically 3 weeks before your surgery. It is important to bring all the original medication pill bottles (including vitamins and herbs) with you to this visit. You should ask your family doctor to forward any recent information, like a recent physical or laboratory evaluation, to the anesthesia clinic as well to help them evaluate your overall medical health. If there are any questions or concerns that arise from this medical visit, the anesthesia physicians and nurses can help coordinate additional tests and consultations to assure that you are in good shape and ready for your hip surgery.
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Pre-Operative Procedures (Continued) REDUCING THE R ISK OF INFEC TION The possibility of an infection caused by bacteria already in your system must be minimized. The most likely source of these bacteria would be either a dental or kidney infection. Although frequency, urgency and burning are symptoms of a urinary tract infection, you may have an infection without symptoms. As part of your medical work-up, a test of your urine will be performed, and if an infection is found, antibiotic treatment will be required before your operation. You should discuss with your doctor any need for dental, gastrointestinal, foot or urologic procedures that may need to be done. It is better to have any procedures done before your hip replacement to reduce the risk of infection.
We have stopped the routine practice of preoperative blood donations in hip replacement surgery. Large controlled studies have shown that donating your own blood before surgery does not reduce the likelihood you will need blood bank transfusions. We will, however, make available to you the option of donating your own blood if you have strong concerns about the safety of banked blood. If you are unable to receive transfusions for personal or religious reasons, there are alternatives that should be discussed thoroughly with your surgeon before your operation. DENTAL WORK Unhealthy teeth can lead to a serious infection in your new joint. For this reason, dental work should be completed prior to surgery.
B LO OD REPL ACEMENT
OB ESIT Y
There is a certain amount of blood loss associated with hip surgery. The blood normally lost during surgery, and immediately after, is collected, filtered and safely given back to you reducing the need for transfusions. However, there is still a possibility you might need a blood transfusion.
Obesity can lead to serious problems both during and after surgery. If you are overweight or obese, your surgeon may ask you to lose weight prior to surgery.
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Pre-Operative Procedures (Continued) WHAT YOU SHOULD K NOW AB OUT S TAPH INFEC TIONS
swabbing your nose, the inside of your mouth (toward the back of your cheek), and your groin.
What is Staph Aureus?
The test will come back within 2–3 days and at your pre-operative visit, your surgeon will discuss the results with you and give you any instructions you may need.
Staphylococcus aureus, also known as “staph,” is a type of germ that lives on the skin or in the nose of healthy people. Sometimes, staph can cause an infection. Staph is one of the most common causes of skin infections in the United States. Most of these skin infections are minor and can be treated without medication. However, in a small number of cases, staph also can cause more serious infections (such as surgical wound infections and bloodstream infections).
If your test shows no MSSA or MRSA:
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If your test shows MSSA or MRSA:
Your surgeon will prescribe a medication and provide you with medicated soap and showering instructions for 5 days, to get rid of the germs;
You will be asked to keep track of each dose of medication that you take and each time you shower with medicated soap; and
On admission to the hospital, you will be asked to report how many times you took the prescribed medication and showered with the soap.
If your test showed that you had MRSA, and you did not take any medications, you will be placed in Contact Precautions to help us prevent the spread of MRSA in the hospital. Contact Precautions means that staff who care for you will be wearing gloves and a gown.
Please note that the treatment for MSSA and MRSA does not mean that you will never again carry the germs on your body (become re-colonized). For any future admission to the hospital you will be placed in Contact Precautions (staff who come into contact with you will be wearing gloves and a gown) and another culture may be done.
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What is Methicillin? Methicillin is a common antibiotic used to treat infections. What is MSSA?
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Methicillin-sensitive Staphylococcus aureus (MSSA) is a kind of staph germ that can be killed by the common antibiotic methicillin. ■
What is MRSA? Methicillin-resistant Staphylococcus aureus (MRSA) is a kind of staph germ that is able to survive being treated with methicillin. It has developed resistance to methicillin and is probably resistant to other common antibiotics as well. How do you test for MRSA and MSSA? Staph germs like living in warm, moist environments. If staph are living in or on a person’s body, they are very likely to be found in the nose, mouth, and/or groin folds The test involves
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You will not require any treatment before surgery.
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Pre-Operative Procedures (Continued) What does it mean if someone is colonized with MSSA or MRSA? If you are colonized with MSSA or MRSA, the germs are living in your nose or on your skin, but you don’t have symptoms of an illness or an infection. Being a “carrier” means the same as being “colonized.” MSSA is a common germ that lives on about 30% of people. A much smaller number of people are colonized with MRSA. MRSA carriers have a higher risk of developing a MRSA infection and may spread the germs to others who could develop an infection. MRSA infections are serious because they cannot be treated with common antibiotics. What does it mean if someone is infected with MSSA or MRSA? If you have an infection, you have symptoms. The germs are present and causing illness. MSSA causes “staph infections” which are common and easily treated. An infection with MRSA is less common and harder to treat. It usually causes a skin infection that may have redness, swelling, and pain. It can look and feel like a spider bite. MRSA infections are resistant to many antibiotics and should always be treated by a doctor. It is also possible to have an infection with either MSSA or MRSA in other parts of the body, such as the blood, lungs, eyes, and urine.
bandages, and razors that have touched infected skin. Staph infections are most likely to be spread in places where people are in close contact with others—such as day care, nursing homes, and school locker rooms. Staph can live on surfaces and objects for weeks and longer unless the germs are killed by cleaning. How can I keep from getting skin infections, including MSSA and MRSA? Practice good hygiene:
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Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand cleaner.
Keep cuts and scrapes clean and covered with a bandage until healed.
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Avoid contact with other people’s wounds or bandages.
Avoid sharing personal items such as towels, washcloths, and clothing.
Use clothing or towels between you and any surfaces you share with others (like gym equipment)
Shower right away after activities that involve direct skin contact with others.
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How is Staph spread? All staph germs, including MSSA and MRSA, are usually passed from one person to another by direct skin contact. These germs can also spread by contact with personal items like towels,
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Pre-Operative Procedures (Continued) “DECOLONIZ ATION” TR ACK ING FOR M Please follow the directions below to help keep track of the number of showers and nasal swabs for decolonization.
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With dry hands, open sponge packet (package is hard to open with wet hands)
Date of surgery____________
First, wash with your own shampoo and soap, then rinse
(5 showers)
Wet sponge side, wash body from neck down for 2 minutes, then rinse (avoid genital area)
4 days before date of surgery
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Do not use if allergic to Chlorhexidine/ hibiclens
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Bathe with 1 sponge each day (place a ✓ in this column)
3 days before date of surgery 2 days before date of surgery
Use the soft spongy side of sponge, NOT the bristle side.
Night before day of surgery Morning of surgery
If you develop a rash, rinse skin thoroughly with cool water; stop using the sponge and report rash to your nurse on day of surgery. Use this side
Do not use this side
Nasal Swab Instructions Use mupirocin swabs twice a day for a total of 10 swabs. Date of surgery____________ (10 nasal swabs)
Morning (place a ✓ in this column)
Evening (place a ✓ in this column)
6 days before date of surgery 5 days before date of surgery 4 days before date of surgery 3 days before date of surgery 2 days before date of surgery Day Before Morning of surgery
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Pre-Operative Procedures (Continued) PRE-OPERATIVE SCREENING FOR OBSTRUCTIVE SLEEP APNEA (OSA) We are screening joint replacement patients for Obstructive Sleep Apnea (OSA). OSA is a disorder that limits or obstructs breathing during sleep. People with OSA do not get enough deep, restorative sleep and suffer from repeated low oxygen levels during sleep.
Prevalence of OSA Studies show that 1 in 5 people have mild OSA, and 1 in 15 have moderate to severe OSA. Most people are unaware that they have OSA. People with mild OSA can develop severe OSA while on narcotics for pain management after surgery or after receiving anesthesia. Consequences Of Untreated OSA
Loud snoring
Gasping or choking during sleep
Excessive daytime fatigue
Feeling groggy when you wake up
There are long-term consequences of untreated OSA. Chronic insufficient restorative sleep and low oxygen levels are very hard on your body. Untreated OSA is associated with high blood pressure, memory loss, decreased mental acuity, depression, sexual dysfunction, diabetes, cardiovascular problems and stroke.
Morning headaches
STOP-Bang Questionnaire
Frequent nighttime urination
Weight gain
The STOP-Bang Questionnaire is a screening tool we use to determine if further testing is recommended. We ask you to fill it out as accurately as possible. You may need to ask your family for help in answering the questions, as many people are not aware of some symptoms.
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Untreated OSA and Joint Replacement Patients We are concerned about untreated OSA for joint replacement patients as they can experience increased respiratory problems from anesthetics, narcotics and sedatives used during and after surgery. There is also an increased risk for perioperative (during) and postoperative (after) complications, longer hospital stays and increased recovery time.
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If You are at Risk If you are identified as “at risk,” your results will be given to you and sent to your primary care provider with a recommendation for further evaluation or you will be offered a referral to a sleep specialist for further evaluation.
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Pre-Operative Procedures (Continued) ANES THESIA CLINIC AND MEETING W ITH YOUR ANES THESIA DOC TOR The surgery scheduler will call and make an appointment for your Anesthesia Clinic visit. This may occur before or after your pre-operative meeting with your surgeon. There, a nurse will review your medications and general medical history. You may have blood drawn or special studies such as a chest X-ray or EKG, if requested by either your primary doctor, orthopedic surgeon or anesthesiologist.
operation; however, this is generally reserved for patients undergoing bilateral (both) hip replacement
Feel free to discuss all of these options with your anesthesia doctor. Remember to bring your bottles of medicines you are currently taking to assist both the doctors and nurses who will be tending to your care. QUES TIONS YOU MIGHT A SK YOUR ANES THESIA DO C TOR
How is my heart? Can it withstand the stress of major joint replacement surgery?
Are my hypertension medications controlling my high blood pressure adequately?
Are my lungs in good shape for surgery?
Do I need to change or stop any of my medications before my surgery?
Should I be on medication to help prevent bleeding from my stomach because the orthopedic surgeon will be using blood thinner medicine to prevent blood clots?
Will I need dental or prostate surgery in the next few months? If so, should I do that now before my surgery?
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Then you will meet with the anesthesia doctor who will discuss your options for anesthesia during your hip replacement surgery. The doctor will review your medical history and allergies, and develop a plan that is best for you. Doctors from Northwest Anesthesia Physicians will provide your anesthesia. They are MDs with special training in anesthesia.
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T Y PES OF ANES THESIA A spinal anesthetic requires a needle to be placed into your low back to numb the nerves of your legs while medicine goes through your veins to make you sleepy. It has a low rate of blood clots and lung complications after surgery.
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A general anesthetic requires a breathing tube be placed into your throat after the anesthesia puts you completely to sleep.
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Pre-Operative Procedures (Continued) PRE - OPER ATIVE OR THOPEDIC EVALUATION
QUES TIONS YOU MIGHT A SK YOUR SURGEON
Once you have been seen by the anesthesia doctor and he or she has cleared you for surgery, you will return to see your orthopedic surgeon for a pre-operative consultation in a week. You should bring a complete list of medications for your surgeon to review.
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You should have a firm idea of where you will be going after discharge from the hospital. You will need 24-hour help available in the first 7 to 10 days after your hospitalization. Come prepared to discuss your plan with your surgeon. Your surgeon should answer any questions you have regarding the nature of the surgery, your hospital stay and any potential complications that may arise.
What implants will you be using and why?
Are there any special concerns that might make my operation more difficult?
How much weight will I be able to put on my operative leg?
When will I be able to return to specific activities?
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Your surgeon will want to review your medical status report from the Anesthesia Clinic and discuss your medications and any concerns with you. It is a good idea to bring a family member with you to meet your surgeon. This is the time to address any lingering questions or concerns.
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Final Preparations for Surgery THE NIGHT B EFORE YOUR HIP SURGERY
THE MOR NING OF YOUR HIP SURGERY
The final preparations for your hip surgery come during your last night at home before coming to the hospital. We ask you to do the following: Drink plenty of fluids throughout the day until bedtime. Avoid coffee, tea, alcohol and drinks with caffeine.
The morning of surgery you should take your medications with only a sip of water. You should only take those medications cleared by both your medical doctor and the anesthesia doctor. Non-vital medications can usually be restarted after surgery, but medications for your heart, blood pressure, diabetes and lungs generally need to be taken the morning of surgery.
Do not eat or drink anything after midnight the night before your surgery. Food in your stomach during surgery significantly increases your risk of vomiting and aspirating food (food going into your lungs), which can cause a severe pneumonia. If you have food in your stomach when you show up to the hospital, your surgery will most likely be canceled.
Now you are ready to go to the hospital. Bring your inhaler or prescription eye drops with you to the hospital.
Important Leave all medications, vitamins, and herbs at home.
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Pre and Post-Operative Exercises Many patients with arthritis favor the painful leg. As a result, the muscles become weaker making recovery slower and more difficult. For this reason, it is very important to begin an exercise program before surgery as you will learn the exercises at the optimal time and initiate the work toward improving strength and flexibility. This can make recovery faster and easier. E XERCISING B EFORE SURGERY It is important to be as flexible and strong as possible before undergoing a total hip replacement. Always consult your physician before starting a pre-operative exercise plan. Thirteen basic exercises are listed here that your physician may instruct you to start doing now and continue until your surgery. You should be able to do them in 15 to 20 minutes and it is typically recommended that you do all of them twice a day. Consider this a minimum amount of “training” prior to your surgery.
10. Standing Mini Squats 11. Armchair Push-Ups
Do not do any exercise that is too painful. Remember that you need to strengthen your entire body, not just your legs. It is very important that you strengthen your arms by doing chair push-ups (exercise #11) because after surgery you will be relying on your arms to support you when walking with the walker or crutches. You will also rely on your arms to help you get in and out of bed and chairs as well as on and off the toilet. You should also exercise your heart and lungs by performing light endurance activities—for example, walking for 10 to 15 minutes each day.
Pre-Operative Hip Exercises 1. Ankle Pumps 2. Quad Sets 3. Gluteal Sets 4. Heel Slides 5. Short Arc Quads 6. Long Arc Quads 7. Standing Heel/Toe Raises 8. Standing Knee Flexion 9. Standing Rock Over the Operated Leg
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Pre and Post-Operative Exercises (Continued)
R ANGE OF MOTION AND S TRENGTHENING E XERCISES 1. Ankle Pumps
3. Gluteal Sets Squeeze the buttocks together as tightly as possible. Hold for 5 seconds.
Gently point toes up towards your nose, then point down towards the surface. Do both ankles at the same time or alternate your feet. Perform slowly.
Note: Place hands on right and left gluteal (buttocks) area and feel for equal muscle contractions. Do 2 times per day, work up to 20 repetitions.
4. Heel Slides Note: Do 10 to 20 repetitions per hour throughout the day. Continue doing ankle pumps until you are walking as much as you were before surgery. Start doing them again if you are on a long car trip or doing other prolonged sitting.
Bend operated knee and slide heel toward buttocks.
2. Quad Sets Tighten thigh muscles of legs, pushing knees down into the surface. Hold for 5 seconds.
Note: Assist stretch with belt if needed. Make sure the belt is on the INSIDE of your knee (not shown in picture). Do 2 times per day, work up to 20 repetitions. Do NOT go beyond 90 degrees of hip flexion. Note: Look and feel for the muscle above the knee to contract. Done correctly, the heel should come slightly off the surface. Do 10 to 20 repetitions per hour throughout the day. Continue doing quad sets until both thighs look the same when you are doing them (same muscle tone).
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Pre and Post-Operative Exercises (Continued)
5. Short Arc Quads
7. Standing Heel/Toe Raises:
Place a large can or rolled towel (about 8”diameter) under operated knee. Straighten knee, keeping back of knee on roll. Slowly lower.
Holding on to an immovable surface, rise up on toes slowly for 5 seconds. Come back down and lift toes off floor.
Note: Work for full extension (straightening) of the knee. Your coach may assist with a hand under your heel or use belt to assist lift. Do 2 times per day, work up to 20 repetitions.
6. Long Arc Quads Slowly straighten operated leg and try to hold it for 5 seconds, then let knee bend. You may place small towel roll under thigh for better positioning.
Note: When lifting up, do not lean backward. Do 2 times per day, work upto 20 repetitions.
Note: Work for full extension (straightening) of the knee. Your coach may assist with a hand under your heel. Do 2 times per day, work up to 20 repetitions.
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Pre and Post-Operative Exercises (Continued)
8. Standing Knee Flexion
9. Standing Rock over Operated Leg
Holding onto an immovable surface, bend the operated leg up behind you.
Holding on to an immovable surface, step nonoperated leg forward. Rock weight back and forth over the operated leg, keeping the knee straight.
Note: Minimize forward/backward movement of hips as knee is bent. Do 2 times per day, work up to 20 repetitions.
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Note: Keep knee straight on the operated leg, and equal weight bearing through both legs. Do 2 times per day, work up to 20 repetitions.
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Pre and Post-Operative Exercises (Continued)
10. Standing Mini Squat
11. Armchair Push-Ups
Holding on to an immovable surface, slowly bend knees. Keep both feet flat on the floor. Straighten to a full stand with weight on both legs.
Sitting in a sturdy armchair with feet flat on the floor, scoot to the front of the seat and place your hands on the armrests. Straighten your arms raising your bottom up from seat as far as possible. Use your legs as needed to help you lift.
Note: As you get stronger, progress to using only
Note: Keep erect posture with no bending at the waist. Do 2 times per day, work up to 20 repetitions.
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your arms and the “non-operated” leg to perform the push-up. This will be how you will get up from a chair after surgery. Do not hold your breath or strain too hard. Perform 2 sets of 10 reps.
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Personal Notes
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Arriving at the Hospital On the day of surgery, please arrive at the designated time to the Surgery Lobby, 3333 RiverBend Drive, Springfield (on the RiverBend campus). After you check in, you will be escorted to your room where you will be provided with a hospital gown and ID bracelet. A nurse will start your IV and review your medical history with you. When it is time for you to go to surgery, your family or support people may wait in the surgery waiting area, located near the surgery lobby.
Day After Surgery
Crutches adjustable to your height
If you have adaptive equipment such as a reacher or a walker, you may have them brought to you after your surgery.
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THINGS TO LE AVE AT HOME
Excessive clothes or food.
Money or jewelry.
Your own medications and/or supplements. (Medications will be supplied by the hospital pharmacy). Most insurance companies pay for medications while you are in the hospital; this way you can leave the medications you have paid for at home.
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THINGS TO B R ING W ITH YOU TO THE HOSPITAL
Hip Replacement book
List of current medications with dosages and frequency
Prescription eye drop medication and inhalers, if you have them (leave other medications at home)
CPAP, BiPap machine (your own)
Loose fitting clothing, night gown, pajamas, walking shorts and shirt/blouse
Information on special diets, or other needs
Comfortable pair of walking shoes or wellfitted slippers with non-skid soles
Knee-length robe that opens down the front (optional)
Personal care items
Copy of Advance Directives
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Your Surgery THE PRE - OPER ATIVE HOLDING ROOM When you leave the Surgical Procedure Area, you will be taken on a stretcher to the pre-operative holding room near the main operating room. Your family or support people should go to the Family Lounge at this time. This holding room is designed for you to wait comfortably before going directly into surgery. During your time there, a nurse will ask you, “Which side are we operating on today?” The nursing staff will clip the hair at the surgical site and again apply a sterilizing agent on your skin. Your surgeon may visit you here and confirm which leg is to be operated on. You will be given medication to make you drowsy prior to going directly to the operating room. THE OPER ATING ROOM In the operating room, you will see big, overhead spotlights and assorted equipment around the room. There will be nurses and doctors wearing gowns and surgical masks preparing the surgical instruments. You will be asked to slide over to the operating room table from the stretcher. The table will seem narrow and firm, the room will be cool. The anesthesia personnel will place sticky patches on your chest and hands to monitor your heart rate and breathing, as well as a blood pressure cuff on your arm to monitor your blood pressure. When these are in place, you will hear the monitor beeping in conjunction with your heart rate.
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If you have chosen a spinal, the anesthesia doctor will ask you to lie on your side in order to insert the catheter into your spine. If you have chosen a general anesthetic, medication will be administered through your IV. Your surgery will take anywhere from 1 to 2 hours, depending upon the status of your hip. Revision surgeries may take longer. THE POS T- OPER ATIVE RECOVERY RO OM You will wake up in the recovery room in your hospital bed. Nurses will be taking your blood pressure and heart rate frequently. X-rays will be taken of your new hip replacement. You will feel leg compresses and stockings on your legs. The compression will alternately tighten and loosen. This improves the circulation in your legs and helps prevent blood clots from forming. The nurses will be making you comfortable with pain medication. You will remain in the recovery room at least 1 to 3 hours. You will be moved to your room, in your bed, when you are fully awake or when your spinal anesthesia has worn off. The doctor will speak with your family or support person shortly after you arrive in the recovery room to inform them of how the surgery went. Expect at least 1 to 3 hours before they can see you in the Joint Replacement Center.
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Information for Your Family SURG IC AL WAITING ARE A FOR YOUR FAMILY
SMAR TR ACK PATIENT TR ACK ING S YS TEM
When you leave the Surgical Procedure Area to go to the pre-operative holding room, your family and support people will be asked to go to a family lounge. These areas are indicated on your visitor map. The staff will direct them to the proper area. They should check in when they arrive at the waiting area, and check out if they decide to leave for food or to move the car. The volunteer at the desk keeps track of who is available should the doctor need to speak with the family or support person.
We recognize that your family may be stressed while waiting for your surgery to be completed. In order to keep them better informed, patient tracking monitors are located in:
After surgery, your surgeon will phone your family or support person in the surgical waiting area. He will inform them of how the surgery went and how you are doing in the recovery room. They should expect about 1 to 3 hours wait before they will be able to see you in the Joint Replacement Center.
Surgical Procedure Area (SPA) Family Lounge — Third Floor
Intensive Care Unit (ICU) Surgery Family Lounge — Fourth Floor
Riverview Café (cafeteria) — Second Floor
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On the day of your surgery, you will be assigned a tracking number that can be provided to your family members. This number appears on the patient tracking monitors and enables your family to follow you as you move through the surgical process. They will be able to see when you move from pre-op holding to the operating room and from the operating room to the recovery room. SmarTrack can also be accessed online for family members who are not able to visit the hospital. The internet address is www.peacehealth.org. Move your mouse arrow over “Hospitals” click on Peacehealth Sacred Heart Medical Center at RiverBend. Next, click on For Patients and Families in the green navigation bar and select SmarTrack — Surgery Patient Tracking.
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Your Hospitalization The staff on the orthopedic floor is dedicated to your recovery. The staff consists of a Nurse Manager, Charge Nurses, Staff Nurses, Certified Nursing Assistants, Care Managers (Nurse or Social Worker), Physical and Occupational Therapists, Pharmacists, and the Joint Replacement Program Coordinator. All of these people are here to assist you during your hospital stay and provide you with individualized care.
MD. Your Orthopedic Surgeon coordinates your medical care.
THE MEMB ER S OF THE INTER DISCIPLINARY TE AM
Joint Replacement Program Coordinator. Oversees the continuum of your care in the JRC.
PT. Physical Therapists teach you how to regain mobility and use assistive devices (such as walker and crutches) to put you on the path to rehabilitation. OT. Occupational Therapists teach you how to perform self-care activities and household tasks safely. They will instruct you in using adaptive equipment such as reacher and dressing aids. RN or LPN. Nurses provide your direct care (medication administration and wound management), teach you and your family about your care, help plan your care and supervise the CNAs. CNA. Certified Nursing Assistants help you with activities such as bathing, making your bed, and taking vital signs. RT. Respiratory Therapist addresses any specialized respiratory care you may need such as breathing treatments. CM. Care Manager can be either a Nurse or a Medical Social Worker who assists in the coordination of your care and helps you prepare for discharge. 28
CN. Charge Nurse coordinates and supervises your nursing care. The CN can address any specialized problems or concerns you may have. Lab Tech. Draws all blood needed for lab tests. Nurse Manager. Manages the Orthopedic Unit and ensures the unit runs smoothly.
HOSPITAL EQUIPMENT This is a list of the hospital equipment that you may see used during your stay: SCDS. Sequential compression device. A pump system that squeezes your calf and improves your circulation. I/E. Incentive breathing exerciser. Device to measure your breathing and remind you to breathe deeply. This helps keep your lungs healthy and prevent pneumonia. Pulse Oximetry. A machine that measures the amount of oxygen in your system using a small clip on your finger. Oxygen Cannula. Plastic tubing and nose-piece that delivers oxygen. TED Hose. Compression stocking to keep swelling to a minimum and prevent blood clots. OrthoPat. A device that collects the bloody drainage from your hips and washes it so that it can be re-infused PeaceHealth Sacred Heart Medical Center
Your Hospitalization (Continued) PeaceHealth Sacred Heart Medical Center strives to create a healing environment that ensures the care you receive meets your individual needs. Although there are certain tasks that we routinely need to complete (such as taking vital signs and administering medication), our staff will work with you to make your stay as pleasant as possible.
How can I bathe while I am in the hospital?
COMMONLY A SK ED QUES TIONS AB OUT YOUR HOSPITALIZ ATION
Will I have to use a bedpan?
When will I feel like having visitors? Many people are comfortable with having family and friends visit for short periods once they return to their room from the recovery area. It is not uncommon for people to be very tired that first evening as your body adjusts to the effects of anesthesia and medications. You may wish to have your visitors come by later on in your recovery or you may feel ready to have everyone come earlier. Do I have to be woken up at night? The staff will try to be as respectful as possible during the night, but in order for us to assess how your recovery is going, it will be necessary for the staff to check on you through the night. As your recovery progresses, you can expect these visits to be less frequent. Medication to help you sleep may be ordered if you find you are having difficulty.
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The staff will offer you assistance in taking a sponge bath every day. As you are able to do more for yourself, we will encourage you to take a more active part in your daily hygiene needs. Caps containing rinseless shampoo are available also.
Some patients may find that they will need to use one of the plastic bedpans during their first day after surgery. Catheters are not recommended as a way of managing normal urinary needs due to the high risk of infection. After you are able to get up with assistance, we will encourage you to use the restroom each time. What if I have special communication needs such as an interpreter? The hospital has in-house interpreters for Spanish and contracts with Certified Languages International to provide interpreters for other languages. These interpreter services are at no charge to you.
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Your Hospitalization (Continued) A SPECIAL NOTE FOR FAMILY AND SUPPOR T PEOPLE You are an important part of the care-giving team. In the process of a joint replacement, the involvement of a family friend or relative acting as a coach is very important. We want you to be included in patient teaching during your family member’s hospital stay. We want you to feel welcome to participate in your family member’s care. If you have any special needs or questions, please direct them to any of our staff members. We will assist you in any way possible. Hospital visiting hours are flexible based on patient needs. We ask that you be considerate of other patients’ needs as well. Feel free to call for general information at 541-222-5200. The ward clerk will direct your inquiry to the appropriate person. Additional Resources for Help
Department of Medical Social Work at 541-222-2440
The Care Manager at 541-222-5874
The Joint Replacement Program Coordinator at 541-222-5186
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Daily Routines After Surgery This “pathway” outlines the typical progression following hip surgery. It represents a general idea of what to expect each day and is outlined below.
Each day you will receive the JRC Daily Newsletter with useful tips and information about your new joint.
Discharge planning will begin.
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DAY OF SURGERY
Family and support people are involved and feel welcome.
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You may feel drowsy after surgery.
The nurse will be checking on you frequently and encouraging you to take deep breaths, cough, and use your incentive exerciser (breathing exerciser).
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You will be started on oral pain medication to help control your pain.
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You will be on a liquid diet with intravenous fluids immediately after surgery; however, most patients are able to return to a normal diet the evening of surgery.
You will be prompted to tilt off your back every few hours while you are in bed.
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You should perform your ankle pumps every hour while you are awake. This is very important to help prevent blood clots from forming in your legs.
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There may be equipment connected to you such as SCDS (sequential compression device), stockings, an intravenous pump, surgical drains such as OrthoPat (reinfusion device). Bladder catheterization may be needed.
Dislocation precautions will be reviewed.
You will be encouraged to sit up and even walk, using assistance.
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FIR S T DAY AF TER SURGERY
Before breakfast, you will be helped out of bed, dressed, and seated in a recliner in your room. This is where you will spend your day when you are not in therapy.
You will still be encouraged to take deep breaths, cough, and use your incentive exerciser (breathing exerciser).
You will continue with SCDS and stockings, if ordered by your surgeon.
If ordered by your surgeon, you will begin to be taught how to give yourself injections of low molecular weight heparin (LMWH) to prevent blood clots.
Your drain will be discontinued and your dressing will be changed.
Physical therapists will teach you to use a walker or crutches with a goal of walking 50–100 feet. Home equipment needs will be clarified. In the afternoon, you will attend group exercise class.
Dislocation precautions will be reinforced.
Your pain will be managed by oral pain medicine, ice, elevation, and physical therapy exercises.
Discharge plans will be defined and arranged. Your Coach, or support person, is encouraged to be present as much as possible. Other visitors are welcome, preferably late afternoons or evenings.
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Daily Routines After Surgery (Continued) SECOND DAY AF TER SURGERY / DAY OF DISCHARGE
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Before breakfast, you will start to initiate your own self-care. Your Coach is encouraged to help you with your self-care needs. You will then be helped into your recliner for breakfast. You will still be encouraged to take deep breaths, cough, and use your incentive exerciser (breathing exerciser).
The nurse will start discussing bowel interventions with you if you have not yet had a bowel movement.
You will attend a group discharge teaching class with your Coach in the morning, following group physical therapy.
A physical therapist will teach you to use a walker or crutches with a goal of walking 250 feet. They will also instruct you on stair climbing. Home equipment will be ordered and post-op exercises reinforced.
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You should be able to state and demon strate your dislocation precautions, exercise program, and activity restrictions.
If you do not discharge home after morning group therapy, you will attend group exercise class again in the afternoon. Your Coach is strongly encouraged to attend.
Dislocation precautions will be reinforced.
Discharge instructions and surgeon appointments will be reviewed. Some patients may be ready to discharge home after group therapy.
Discharge is by 11:00 a.m. The person giving you a ride home needs to be here one hour before you leave.
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THIR D DAY AF TER SURGERY / DAY OF DISCHARGE
You will continue to use your recliner chair.
You and your Coach should feel confident and prepared for discharge.
You should be tolerating a general diet and moving your bowels.
You will be encouraged to demonstrate how to change your dressing, instructed on signs and symptoms of infection, and conditions for showering.
Physical therapists will continue teaching proper walking techniques with a goal of 350 feet.
You should be able to state and demonstrate your dislocation precautions, exercise program, and activity restrictions.
Your pain should be controlled with your discharge pain medication.
Discharge instructions and surgeon appointments will be reviewed.
Discharge is by 11:00 a.m. The person giving you a ride home needs to be here one hour before you leave.
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Pain Control UNDER S TANDING PAIN CONTROL All patients have a right to have their pain managed. Pain can be chronic (lasting a long time) or intense (breakthrough). Pain can change through the recovery process. If you need more help with your pain management, talk to your nurse, the JRC Coordinator, or your doctor. Controlling your pain after hip replacement surgery is very important to achieve a good outcome. Your surgeon will order pain medication specific to your needs. If you have had epidural anesthesia for a bilateral (both) hip replacement, that same catheter may be used after surgery to provide pain relief. You will start oral pain medication shortly after surgery. Oral pain medication will help control your pain and has fewer side effects than the other forms of pain medication. Oral pain medication is ordered every 3 to 4 hours as needed. There are other activities that you can do to help achieve pain relief. Ice, elevation, and physical therapy exercises are natural pain-relieving methods and are often very effective. Distracting your mind from the pain by watching TV, talking to someone, or reading has been demonstrated to assist in pain relief. Achieving a relaxed state by taking slow, deep breaths and focusing on your breathing is another effective tool. The nurses will be checking how your pain feels to you. Pain is measured on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain imaginable. The goal is that you are comfortable
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enough so you can move, exercise and participate in therapy. If you do not get adequate relief, please let your nurse know so they can adjust your medications.
NO HURT
HURTS LITTLE BIT
HURTS LITTLE MORE
HURTS EVEN MORE
HURTS WHOLE LOT
HURTS WORST
Some commonly experienced side effects of pain medications are itching, nausea, drowsiness, or constipation. Please let your nurse know if you experience any of these. COMMONLY A SK ED QUES TIONS AB OUT PAIN CONTROL How do I know when I need medication? Ask for pain medication when your pain is starting to worsen. Do not wait until the pain is severe, as medication works best if given before you become tense with pain. Ask for pain medication before individual and group physical therapy. Patients recover more quickly if they are comfortable enough to move. What if the medication does not work? Inform your nurse. She or he will have specific guidelines on changing medication dosages, timing, and even changing the medication. Your comfort is our goal, and a nurse will assist you.
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Physical Therapy YOUR RECOVERY Recovering from hip surgery is a team effort. A comprehensive physical and occupational therapy program during your hospitalization is crucial for your full recovery. After surgery, as soon as you are able, you may begin the simple exercises that you were practicing before surgery: Ankle pumps, Quad sets (tightening your thigh muscles), Gluteal sets (tightening your buttocks), and Hamstring sets. All of these exercises can be done without moving your hip, and they are important to keep the blood moving in your legs.
You will be instructed in hip precautions with activities of daily living, such as toileting, getting in and out of bed, the shower, and climbing stairs. It is important to practice these activities to learn the proper way of handling your leg to prevent dislocations of the hip. In cases of revision hip surgery, your specific physical therapy program will be tailored to you. With revision hip surgery, the weight allowed on your new hip may be less than discussed above and your therapist will instruct you according to your surgeon’s orders.
Physical therapy may begin the day of surgery or the next morning, if you had afternoon or evening surgery. Usually you will be allowed to put 50%–100% of your weight on your new hip with the use of assistive devices, such as a walker or crutches, depending on your surgeon’s order. This is to help protect the muscles as they heal from surgery. We will encourage you to use crutches during this time, but you may feel more secure with a walker. Each day, you will be instructed in proper gait and walk longer distances in the halls. Once cleared by your therapist, you will begin to walk independently using crutches or a walker, and mark your progress on the Back On Track walking board. After the first day, you will attend group therapy class twice a day.
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Physical Therapy (Continued) HIP DISLOC ATION PREC AUTIONS Care must be taken to prevent your new hip from coming out of the socket, or dislocating from the pelvis. Dislocation is most likely to happen in the first 3 months after surgery. If this occurs, call an ambulance to transport you to the Emergency Room so that your surgeon can “reduce” the hip joint. Most cases of dislocation require a short hospital stay, followed by 6 to 12 weeks of bracing. In most cases, the surgeon is able to realign the joint without surgery.
2. Do not reach down and twist inward at the same time.
GENER AL HIP PREC AUTIONS (FOR LIFE) In general, there are two hip precautions that apply to everyone. Note: arrows indicate the operative side.
3. Do not put your leg behind you, or extend your hip 15 degrees past neutral while twisting your leg outward, as shown in these pictures.
1. Never bend at the hip and rotate inward at the same time, as shown in these examples.
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Physical Therapy (Continued) POS TER IOR AND REVISION HIP PREC AUTIONS
3. Do not cross your legs or bring your leg toward the midline of your body.
Some patients will have a posterior surgical approach and require additional specific precautions for 6 weeks as shown below. After that initial recovery period when you are released from these precautions by your surgeon, you will follow the General Hip Precautions. Patients undergoing surgery for a revision may also have these precautions. Your surgeon and physical therapy team will instruct you on the duration of these precautions. Note: arrow indicates the operative side. 1. Do not bend your hip past 90 degrees, or at a right angle.
COR REC T SIT TING POS TURE 2. Do not twist or rotate your leg inward, do not internally rotate your hip.
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Physical Therapy (Continued) S TANDING UP FROM A CHAIR 1. Do not pull up on the walker to stand! 2. Sit in a chair with arm rests when possible.
3. Extend your operated leg so the knee is lower than your hips. 4. Scoot your hips to the edge of the chair
5. Push up with both hands on the armrests. If sitting in a chair without armrests, place one hand on the walker while pushing off the side of the chair with the other.
6. Balance yourself before grabbing for the walker.
S TAND TO SIT 1. Back up to the center of the chair until you feel the chair on the back of your legs. 2. Slide out the foot of the operated hip, keeping the strong leg close to the chair for sitting. 3. Reach back for the arm rest one at a time 4. Slowly lower your body to the chair, keeping the operated leg forward as you sit.
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Physical Therapy (Continued) TR ANSFER R ING TO B ED Getting into Bed 1. Back up to the bed until you feel it on the back of your legs (you need to be midway between the foot and the head of the bed).
2. Reaching back with both hands, sit down on the edge of the bed and then scoot back toward the center of the mattress. (Silk pajama bottoms, satin sheets, or sitting on a plastic bag may make it easier.)
3. Move your walker out of the way, but keep it within reach. 4. Scoot your hips around so that you are facing the foot of the bed. 5. Lift your leg into the bed while scooting around (if this is your surgical leg, you may use a cane, a rolled bed sheet, a belt, or your elastic band to assist with lifting that leg into bed).
6. Keep scooting and lift your other leg into the bed using the assistive device. Do not use your other leg to help as this may break your hip precautions. Ask your therapist if it is okay for you to do this. 7. Scoot your hips towards the center of the bed.
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Physical Therapy (Continued) Lying in Bed: How to Maintain Hip Precautions
Getting Out of Bed
1. Keep a pillow between your legs when back lying. Position your leg such that your toes are pointing to the ceiling—not inward or outward.
2. Sit up while lowering your non-surgical leg to the floor.
1. Scoot your hips to the edge of the bed.
3. If necessary, use a leg-lifter to lower your surgical leg to the floor. 4. Scoot to the edge of the bed. 5. Use both hands to push off the bed. If the bed is too low, place one hand in the center of the walker while pushing up off the bed with the other. 6. Balance yourself before grabbing for the walker.
2. To roll from your back to your side, bend your knees slightly, and place a large pillow (or two) between your legs so that your operated leg does not cross the midline. Roll onto your side.
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Physical Therapy (Continued) TR ANSFER R ING TO TUB
2. Scoot to the edge of the bath seat.
Getting Into the Tub Using a Bath Seat
3. Push up with one hand on the back of the bath seat while holding on to the center of the walker with the other hand.
1. Select a bath seat that is tall enough to ensure hip precautions can be followed. 2. Place the bath seat in the tub facing the faucets. 3. Back up to the tub until you can feel it at the back of your knees. Be sure you are in line with the bath seat. 4. Reach back with one hand for the bath seat. Keep the other hand in the center of the walker. 5. Slowly lower yourself onto the bath seat, keeping the surgical leg out straight. 6. Move the walker out of the way, but keep it within reach. 7. Lift your legs over the edge of the tub, using a leg lifter for the surgical leg, if necessary. Hold onto the shower seat or railing.
Getting Out of the Tub Using a Bath Seat 1. Lift your legs over the outside of the tub.
4. Balance yourself before grabbing the walker.
Use a rubber mat or non-skid adhesive on the bottom of the tub or shower. To keep soap within easy reach, make a soap-ona-rope by placing a bar of soap in the toe of an old pair of pantyhose and attach it to the bath seat.
Important Although bath seats, grab bars, long-handled bath brushes, and hand-held showers make bathing easier and safer, they are typically not covered by insurance.
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Physical Therapy (Continued) WALK ING 1. Push the rolling walker forward.
Walking Normally
2. Step forward placing the foot of the surgical leg in the middle of the walker area.
If using a rolling walker, you can
3. Step forward with the non-surgical leg. Do not step past the front wheels of the walker.
advance from this basic tech-
Take small steps. Keep the walker in contact with the floor, pushing it forward like a shopping cart.
Holding onto the walker, step
S TAIR CLIMB ING 1. Ascend with non-surgical leg first (Up with the good).
nique to a normal walking pattern. forward with the surgical leg, pushing the walker as you go; then try to alternate with an equal step forward using the non-operated leg. Continue to push the walker
2. Descend with the surgical leg first (Down with the bad).
forward as you would a shopping
3. Always hold onto the railing!
cart. When you first start, this may not be possible, but as you “loosen up” you will find this gets easier. Do not walk forward past the walker center or way behind the walker’s rear legs.
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Physical Therapy (Continued) GET TING INTO THE C AR 1. Push the car seat all the way back; recline the seat back to allow access and egress, but always have it in the upright position for travel.
5. Lean back as you lift the operated leg into the car. You may use your cane, leg lifter or other device to assist.
2. Place a plastic back on the seat to help you slide. 3. Back up to the car until you feel it touch the back of your leg.
4. Hold on to an immovable object—car seat, dashboard and slide the operated foot out straight. Mind your head as you sit down. Slowly lower yourself to the car seat.
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Occupational Therapy You will first learn about Occupational therapy and adaptive equipment, at your pre-operative education class. During your hospital stay, an occupational therapist will work with you one or two times before you discharge from the hospital. You will be instructed in alternate methods of performing your self-care to avoid injury to your operative leg. During your first six weeks you will need help for certain self-care activities such as bathing and dressing unless you are using adaptive equipment. The occupational therapist will reinforce your hip dislocation precautions and instruct you in the use of adaptive equipment (see next page). You may want to consider purchasing your adaptive equipment prior to your surgery so you will have it immediately available after surgery. Some items may even be helpful to use before surgery. Adaptive equipment can be purchased at medical supply stores, local drug stores, or ordered from adaptive equipment catalogs. In some cases, the equipment may be less expensive if purchased online. Usually, adaptive equipment is not covered by insurance so you may want to take the time to compare prices. TOILET H YGIENE If you have difficulty reaching from the front or back without twisting or bending beyond your dislocation precautions, it is best to try reaching from the opposite side of your operative leg. Hygiene can be done sitting or standing. There is also specific adaptive equipment that can assist with reaching, when it comes to hygiene.
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BATHING It is best to use a stall shower with grab bars, if available. Your occupational therapist will instruct you in stepping in and out of your bathtub for showering if you don’t have a stall shower. Step into the tub or shower only if the edge is lower than the height of your knees. Step in with the non-surgical leg first. Another option is to use an adjustable height shower seat or tub transfer bench. In the shower, use a long-handled sponge to clean both legs below the knees. If you do not have a long-handled sponge, you will need someone to wash your lower legs for you. GET TING DRESSED You may carefully sit forward on the edge of the chair, put your foot on a stool or box, bend forward reaching between your knees with both hands (allowing your operative leg to roll out slightly) while avoiding twisting. It may take 2–3 weeks or more of trying before you can reach your foot without causing undue stress at your hip. When you can reach your foot in the above described position, you may begin to put on your own shoes and socks. With posterior precautions you must wait six weeks after surgery before trying to put on your own shoes and socks with the above technique.
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Occupational Therapy (Continued) ADAP TIVE EQUIPMENT (GET TING DRESSED) Reacher
Sock Aid Device that allows you to slide your foot into your sock without bending at the hip.
Can be used for getting dressed, adjusting bed covers, or picking up items.
Dressing stick Elastic shoe laces
Assists in pulling up slacks or skirts, removing socks, pulling zippers, and shoelace loops.
Allow you to slip your foot into and out of a shoe without retying.
Long-handled shoehorn Allows you to put on shoes without bending at the hip.
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Occupational Therapy (Continued) Footstool
Walker Basket
Low height
Attaches to your walker and allows you to transport light items.
Crutches Adjustable height to help you walk.
Firm chair cushion Such as a boat cushion. Provides added height to chairs at home
ADAP TIVE EQUIPMENT (MOB ILIT Y AND COMFOR T ) Walker Supportive device to assist with mobility. Adjustable height front wheeled walker.
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Occupational Therapy (Continued) ADAPTIVE EQUIPMENT (HYGIENE) Some of this equipment is optional and will be discussed with you in the pre-operative education class, prior to your surgery. Toilet safety frame (Versaframe)
Bedside commode Can be used:
Over toilet
Next to bed
In stall shower
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Provides support arms on each side of toilet.
Raised toilet seat Toilet aid
Aids you in getting on and off the toilet.
Helps you reach to wipe yourself without bending at the hip.
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Occupational Therapy (Continued) ADAPTIVE EQUIPMENT (BATHING) Some of this equipment is optional and will be discussed with you in the pre-operative education class, prior to your surgery.
Non-Slip Bath Mat (in or out of shower) Provides safe footing
Grab Bars Bars installed in the shower for support to get in and out.
Hand-Held Shower Shower head that can be used while sitting on a shower seat.
Long-Handled Sponge
Shower Seat Assists you safely into and out of the tub for showering.
Used to wash your lower legs and feet.
Shower Seat Provides adjustable height seating in the shower stall.
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Occupational Therapy (Continued) USING ADAP TIVE EQUIPMENT Using a “Reacher” or “Dressing Stick” to Put on Pants and Underwear 1. Sit down. 2. Put your surgical leg in first and then your non-surgical leg. Use a reacher or dressing stick to guide the waistband over your foot.
Taking off Pants and Underwear 1. Back up to the chair or bed where you will be undressing. 2. Unfasten your pants and let them drop to the floor. Push your underwear down to your knees. 3. Lower yourself down, keeping your surgical leg out straight.
3. Pull your pants up over your knees, within easy reach.
4. Take your non-surgical leg out first and then the surgical leg.
4. Stand with the walker in front of you to pull your pants up the rest of the way.
5. A reacher or dressing stick can help you remove your pants from your foot and off the floor.
How to Use a Sock Aid 1. Slide the sock onto the sock aid. 2. Hold the cord and drop the sock aid in front of your foot. It is easier to do this if your knee is bent. 3. Slip your foot into the sock aid. 4. Straighten your knee, point your toe and pull the sock on. Keep pulling until the sock aid pulls out.
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Occupational Therapy (Continued) Using a Long-Handled Shoehorn 1. Use your reacher, dressing stick, or longhandled shoehorn to slide your shoe in front of your foot. 2. Place the shoehorn inside the shoe against the back of the heel. Have the curve of the shoehorn match the curve of your shoe. 3. Lean back, if necessary, as you lift your leg and place your toes in your shoe. 4. Step down into your shoe, sliding your heel down the shoehorn.
This can be performed sitting or standing. Wear sturdy slip-on shoes, or shoes with Velcro closures or elastic shoelaces. Do not wear high-heeled shoes or shoes without backs.
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Personal Notes
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Preparing for Discharge Now that your surgery is over, it is time to implement the discharge plan that you created before your surgery. This includes having someone available to stay with you 24 hours a day for 7–10 days when you go home from the hospital. In addition, you must reach certain milestones before you leave the hospital.
As a team we will work together with you and your family or support person to prepare you for a smooth transition from the hospital to a safe and appropriate destination that will further your rehabilitation and recovery.
The milestones that you will need to achieve before you leave the hospital include: I am eating my normal diet. I have had a bowel movement. I am able to urinate. My pain is adequately controlled with pain pills. I am progressing with my mobility. I know my activity restrictions and dislocation precautions. I have my adaptive equipment arranged for home, as needed. If ordered by my surgeon, I can give myself the LMW Heparin shots or have someone who can. I have the dressing change supplies provided to me by my nurse and understand that if I need more, a friend or a loved one will need to purchase more for me, from a drugstore.
It is important that you continue to progress in your daily activity. Participation in individual and group therapy sessions helps you to do this safely while building up your strength and preparing you for discharge from the hospital. In addition, these activities reduce the incidence of compli cations such as blood clots and pneumonia.
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Preparing for Discharge (Continued) DISCHARGE PREPAR ATION CHECK LIS T Before I leave the hospital, the following should be completed: I have been involved in decisions about what will take place after I leave the hospital. I understand where I am going after I leave the hospital and what will happen to me once I arrive. I have the name and phone number of a person I should contact if a problem arises during my transfer. I understand what my medications are, how to obtain them and how to take them. Medication pick up has been arranged during regular pharmacy hours. My Coach or family knows that I am coming home and what I will need once I leave the hospital. I know whom to call with questions about my bill or account: Patient Accounts at 541-686-7191 or (800) 873-8253. I understand what symptoms I need to watch out for and whom to call should I notice them. I understand how to keep my health problems from becoming worse.
I understand the potential side effects of my medications and whom to call if I experience them. I am going directly home. I have scheduled a follow-up appointment with my doctor, and I have transportation to this appointment. I have retrieved my valuables and belongings.
Discharge time from the hospital is 11 a.m., Please make transportation arrangements well in advance of your discharge. The hospital staff will be happy to assist you in making discharge arrangements and to answer any questions you may have about the discharge policy. Questions for My Doctor or Nurse: _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________
My doctor or nurse has answered my most important questions prior to leaving the hospital.
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Preparing for Discharge (Continued) DAY OF DISCHARGE The day of discharge is quite busy. Your surgeon may see you that morning and make sure that you have a prescription for your pain medication and for your blood thinner. Generally it will be the same oral pain medicine that worked best for you in the hospital. You may want to ask for the prescription before the day of discharge so that a family member or support person can fill the prescription for you. Discharge occurs in the morning, by 11:00 a.m.
A therapist will review your exercises with you. These exercises should be done 2 times a day for the first 6 weeks. These exercises will help strengthen the muscles around the hip. Be careful about overworking the muscles. The exercises should not produce lasting pain or exhaustion. If they do, you may be overdoing the exercises. You should have your follow-up appointment with your surgeon already scheduled. If not, please call the office to make or confirm your appointment.
The therapist will show you, before discharge, how best to get into and out of your specific car for the ride home. Please remind your driver to bring extra pillows to help position your leg for the ride home. If it is a long ride, plan to stop and walk every 60 to 90 minutes to help the circulation in your legs, and remember to do your ankle pumps while riding in the car. You will attend a discharge class in the morning, with specific individual instruction by your nurse.
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Going Home C AR
ALTER NATE TR ANSPOR TATION
Usually you will be able to go home from the hospital in a mid-sized or larger car after joint replacement surgery.
A care manager can assist with alternate transportation as needed. Costs of a wheelchair-van or other transport may not be covered by your insurance, and payment is your responsibility at the time of service.
Car Transfers/Driving/Riding Position the seat as far back as possible. You may recline the seat slightly if desired. Get in on the passenger side of the front seat. Back up to the car and sit on the edge of the seat. Scoot in at an angle, and assist one leg in at a time; reverse to exit the car. You may ride in the car 60 to 90 minutes at a time. If your trip by car will be a long one, it is a good idea to do your ankle pump exercises frequently and plan to stop every 60 to 90 minutes to stretch, change position and walk around using your walker or crutches. When your doctor gives you permission, you may drive. This is usually in 3 to 6 weeks, depending on your leg strength, your leg control and reaction time, whether your car has an automatic transmission, power steering, power brakes, which leg was operated on, and be off your narcotic pain medication before you drive.
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AIR PL ANE If you need to travel by air, it is important to request a bulkhead or first class seat so that you have enough room to stretch out your leg during the flight. You should have a travel companion to help with luggage and getting on and off the plane. It is a good idea to do your ankle pump exercises frequently during the flight. TR AVEL It is a good idea to plan to stay in town during your first 4 to 6 weeks after surgery. Travel in the first month after surgery by plane or long car rides can increase your risk of blood clots.
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Around the House SAVING ENERGY AND PROTEC TING YOUR J OINT S Kitchen Do not get down on your knees to scrub floors. Use a mop and long-handled brushes.
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Do not wear open-toe slippers or shoes without backs. They do not provide adequate support and can lead to slips and falls.
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Sit in chairs with arms and no wheels. It makes it easier to get up.
Rise slowly from either a sitting or lying position to avoid getting light-headed.
Do not lift heavy objects for the first three months and then only with your surgeon’s permission.
Plan ahead! Gather all your cooking supplies at one time. Then, sit to prepare your meal.
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Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.
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Bathroom Do not get down on your knees to scrub the bathtub.
Keep extension cords and telephone cords out of pathways. Do not run wires under rugs, this is a fire hazard.
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Use a mop or other long-handled brushes.
Safety and Avoiding Falls
Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.
Be aware of all floor hazards such as pets, small objects, or uneven surfaces.
Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms, and hallways.
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Personal Notes
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Your Surgical Wound C AR ING FOR YOUR WOUND The incision over your hip could remain somewhat red, warm, and painful for 2 to 3 weeks following your hip replacement surgery. Your thigh may swell for 4 to 6 weeks after surgery.In general, your incision should be dry by the time you leave the hospital, but it is not unusual for your hip incision to drain for 5 to 7 days after surgery. We will place an Post-Op Visible dressing on your incision prior to discharge. You will leave this on for 7 days. Some spotting on the bandage is normal for up to 1 week. You may shower with dressing in place. No baths, no soaking, just showering. Soaking the wound can lead to healing problems and possibly infection.The incision will fade with time, and no special creams or lotions are necessary.
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You have constant pain that is increasing and not relieved by pain medication. Your temperature exceeds 101.5 degrees.
DRESSING CHANGE PROCEDURE You may need your Coach to assist you with the dressing change. 1. For posterior or lateral approach, stand or lay flat on your side with a pillow between your knees while you coach changes your dressing. 2. Before you change your dressing, wash your hands thoroughly. 3. Remove dressing from outer packaging. 4. Apply no sting barrier wipe to the skin that will be under the dressing and allow to dry. 5. Remove the old dressing and inspect the incision for any signs or infection, listed above. 6. Peel away the backing papers marked 1.
Usually your wound is closed with absorbable sutures that do not need to be removed. The small pieces of tape on the incision will curl and fall off as the incision heals. Leave these in place when you change your bandage.
7. Holding the non-adhesive tabs at the end of the dressing, carefully position the dressing over designated area.
You Should Call your Doctor If:
9. Smooth the dressing into place, applying light pressure around the edges. Using the small tab, peel off the top carrier marked 2.
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You have persistent or new drainage in the wound, or notice an odor; You experience increasing warmth, swelling, or redness that does not go away with simple elevation, rest, and ice;
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8. DO NOT STRETCH DRESSING.
10. Ensure dressing is comfortable. 11. As an added precaution, place clean sheet or towel over your chair or couch to prevent pet hair and dander from wafting up into your incision.
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Your Surgical Wound (Continued) INFEC TION CONTROL In the United States, more than 270,000 hip and knee replacements are performed each year. The infection rate for these procedures is very low, averaging 0.5%. Orthopedic surgeons performing these operations attempt to lower the surgical infection rate by using antibiotics during and after surgery, special operating rooms and selfcontained exhaust suits.
It is very important to let your dentist and primary care physician know that you have an implanted hip prosthesis so they can prescribe antibiotics before any dental or diagnostic procedures if there is a risk of infection.
Infections that develop around the hip weeks or months after discharge are also rare. Infections that occur 6 months or longer after surgery are usually the result of an infection elsewhere in the body. Urinary tract, pulmonary (lungs), skin, and dental infections are potential causes of such an infection and therefore, should be treated aggressively.
The best way to help prevent infection is handwashing.
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Preventing Blood Clots B LO OD CLOT S
PULMONARY EMB OLUS
The most common complication following joint replacement surgery is blood clots in the veins (deep vein thrombosis—DVT). This is because surgery may cause the blood to slow and coagulate in the veins of your legs, creating a blood clot. To help avoid this complication, which can be life threatening, you may receive a blood thinning medication that will either be injected into the fat of the abdomen, or taken orally. Whether injectable or oral, the medication will only be taken once a day. Your surgeon will decide on the most appropriate blood thinning medication for you.
An unrecognized blood clot could break away from the vein and travel to the lungs. This is an emergency and you should call 911 if suspected.
Check with your insurance company because some companies may not cover the cost of the medication, which can be up to $400. Signs of Blood Clots in Legs
Swelling in thigh, calf, or ankle that does not go down with elevation.
Pain, heat, and tenderness in calf, back of knee or groin area. Note: blood clots can form in either leg.
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If you recognize any of the above signs, call your surgeon’s office immediately.
To Help Prevent Blood Clots
Perform foot and ankle pumps
Walk several times a day
Take your blood thinner as directed
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Signs of a Pulmonary Embolus
Sudden chest pain
Difficult and/or rapid breathing
Shortness of breath
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Prevention of Pulmonary Embolus
Prevent blood clot in legs
Recognize if a blood clot forms in your leg and call your physician immediately
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A Brief Word about Swelling One of the most common complaints after joint replacement surgery, is swelling in the surgical leg. Swelling can lead to an increase in pain. When you are taking a break from your exercises, it is very important to ice the surgical leg for at least 20 minutes, and keep the leg elevated. Compression stockings are also very effective at reducing the swelling in your lower legs. If you have been prescribed compression stockings to wear after surgery, you should continue to wear them during the day for two weeks. You may remove the stockings at night. Remember, any swelling that does not go down with ice, rest, and elevation should signal a call to your surgeon’s office as this may be a sign that a blood clot has developed.
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Hip Dislocation Precautions HIP DISLOC ATION PREC AUTIONS Care must be taken to prevent your new hip from coming out of the socket, or dislocating from the pelvis. Dislocation is most likely to happen in the first 3 months after surgery. If this occurs, call an ambulance to transport you to the Emergency Room so that your surgeon can “reduce” the hip joint. Most cases of dislocation require a short hospital stay, followed by 6 to 12 weeks of bracing. In most cases, the surgeon is able to realign the joint without surgery.
2. Do not reach down and twist inward at the same time.
GENER AL HIP PREC AUTIONS (FOR LIFE) In general, there are two hip precautions that apply to everyone. Note: arrows indicate the operative side.
3. Do not put your leg behind you, or extend your hip 15 degrees past neutral while twisting your leg outward, as shown in these pictures.
1. Never bend at the hip and rotate inward at the same time, as shown in these examples.
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Hip Dislocation Precautions (Continued) POS TER IOR AND REVISION HIP PREC AUTIONS
3. Do not cross your legs or bring your leg toward the midline of your body.
Some patients will have a posterior surgical approach and require additional specific precautions for 6 weeks as shown below. After that initial recovery period when you are released from these precautions by your surgeon, you will follow the General Hip Precautions. Patients undergoing surgery for a revision may also have these precautions. Your surgeon and physical therapy team will instruct you on the duration of these precautions. Note: arrow indicates the operative side. 1. Do not bend your hip past 90 degrees, or at a right angle.
2. Do not twist or rotate your leg inward, do not internally rotate your hip.
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COR REC T SIT TING POS TURE
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Hip Dislocation Precautions (Continued) S TANDING UP FROM A CHAIR 1. Do not pull up on the walker to stand! 2. Sit in a chair with arm rests when possible.
3. Extend your operated leg so the knee is lower than your hips. 4. Scoot your hips to the edge of the chair
5. Push up with both hands on the armrests. If sitting in a chair without armrests, place one hand on the walker while pushing off the side of the chair with the other.
6. Balance yourself before grabbing for the walker.
S TAND TO SIT 1. Back up to the center of the chair until you feel the chair on the back of your legs. 2. Slide out the foot of the operated hip, keeping the strong leg close to the chair for sitting. 3. Reach back for the arm rest one at a time 4. Slowly lower your body to the chair, keeping the operated leg forward as you sit.
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Pain Medications When you leave the hospital, you will be given a prescription for pain medicine. The medicine you are given will generally be the medicine that worked best to control your pain while in the hospital. These medicines can be taken every 4 to 6 hours. All of these medicines contain some amount of Tylenol. Do not take regular Tylenol or acetaminophen in addition to these medicines. Pain medication is needed for the first few weeks after surgery. Take your pain medication at least 30 minutes before physical therapy. Gradually wean yourself from your pain medication to a non-prescription pain reliever (do not take antiinflammatory medication until you have stopped your blood thinning medication). You may take 2 Extra-Strength Tylenol in place of your prescription medication up to four times per day. Most patients are able to wean themselves from the medication during the first month after surgery.
Sleeping medication is not prescribed on a routine basis. The reason is that pain medication and sleeping medication combined can cause confusion. This would increase the risk of falling and/or injuring your hip. Try simple methods to get better sleep while at home, such as going to bed the same time every night, drinking warm milk (it works for adults, too), not exercising or showering at night, and avoiding caffeinated drinks close to bedtime. Constipation is a side effect of narcotics, so please make sure you are taking stool softeners.
If your pain medication begins to run low (2 to 3 days left), please call your pharmacist, who will contact your surgeon’s office. Plan ahead. Try to avoid calling at night or on the weekend. Please anticipate your needs early in the week. Expectations are that you should be off pain medication within 6 weeks. Some exceptions can be made. If your pain situation has more to do with chronic pain than post-surgical pain, you may be referred back to your primary physician at 6 weeks.
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Other Medications Anti-inflammatory Medication
Hormone Replacement
Most anti-inflammatory medications that control the pain of arthritis can be restarted after your surgery once the blood thinner medication has been stopped. Taking both non-steroidal antiinflammatory (NSAID) medication and blood thinning medication can dramatically increase your risk of bleeding from your stomach. Avoid aspirin and any NSAID medications such as Ibuprofen, Advil, Motrin, Aleve or Naprosyn while you are taking LMW Heparin.
Patients on hormone replacement therapy should resume their medication once the blood thinning medication has been stopped. These hormones have been shown to slightly increase the risk of blood clots; therefore, we usually stop them during your hospital stay. Patients with adverse reactions to stopping their hormones may need to resume their hormones sooner.
It should be safe to restart your anti-inflammatory medication one day after the last dose of blood thinning medication. Celebrex is an exception that has been shown to be safe to take while you are on LMW Heparin.
Other Medications Any modifications made to your regular medication list during your hospitalization should be under the supervision of your primary medical doctor. Please call your medical doctor when you are discharged from the hospital to discuss any changes.
Iron Your surgeon may place you on an iron supplement for 1 month after surgery, either a multivitamin with iron once a day or ferrous sulfate 325 mg 3 times a day. This will help your body rebuild the red blood cells lost during your surgery. Remember that iron can cause constipation, and you should, therefore, use an over-the-counter stool softener while taking iron. Stomach Acid Inhibitors You may have been started on either Pepcid or Protonix medication while in the hospital. These medications protect the stomach from ulcers and can prevent bleeding while taking blood thinner medication. It is a good idea to continue this medication while on blood thinners, after your operation. Check with your primary medical doctor if you have concerns or questions. 64
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Activities in the First 6 Weeks after Your Hip Surgery The first 6 weeks following your joint replacement is a time to focus on you and your new hip. You will gradually find the pain easing, and your ability to get up and move around will slowly improve. You will gradually increase your activity level. For the first few days, you may wish to move only around your house and participate in simple activities such as dining with family and watching TV. Feel comfortable to venture outside on even, dry pavement. Riding in a car is acceptable. Always remember the proper method of getting in and out of a car. Listed below are the Dos and Don’ts to follow for the first 6 weeks after your surgery. These are general guidelines. Your surgeon may make exceptions according to your surgical approach specific requests.
Do not bend down without observing your dislocation precautions to put on your shoes and socks or to pick up objects from the floor.
Do not twist across your body when you are reaching for objects.
Do not sit in a bathtub until at least 3 months after your surgery. You may shower in a tub when your wound is completely dry. You may wish to use a tub or shower bench. Ask the therapist to show you the best way to use the bench.
Do not take a lot of naps during the day so that you will sleep better at night.
Do not drive a vehicle for 3 to 6 weeks after surgery. Check with your surgeon if you have questions.
Do not take chances. Be careful walking on uneven ground, ice, snow, and tiled or waxed floors. Remove all scatter rugs from your house. Wear rubber-soled shoes.
Do not return to work until you have discussed this with your surgeon.
Do not add new exercises or increase your weight-bearing status without your surgeon’s permission.
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Do not sleep on your operative side for 4 to 6 weeks. You may tilt 30° to 40° on either side with the support of pillows, or sleep on your non-operative side with pillows between legs unless you had a revision surgery.
Do not cross your legs when you are lying down, sitting or standing. Try to keep a pillow bet ween your legs when you are lying down.
Do not sit on low stools, low chairs and low toilets. Elevate low seat heights with a firm cushion, so that your hip does not bend more than it should. Also avoid high stools or dangling operative leg getting out of a high truck.
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Activities in the First 6 Weeks after Your Hip Surgery (Continued)
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Do use ice for pain control. Applying ice to your affected joint will decrease discomfort. It is recommended for at least 30 minutes each hour. You can use it before and after your exercise program. A bag of frozen peas wrapped in a kitchen towel works well because the bag will easily mold to the shape of your hip. Mark the bag and return the bag of peas to the freezer so they can be used again. Do take your pain medication at least 30 minutes before physical therapy. Gradually wean yourself from your pain medication to a non-prescription pain reliever (do not take anti-inflammatory medication until you have stopped your blood thinning medication). You may take 2 Extra-Strength Tylenol in place of your prescription medication up to four times per day.
Do have someone help you with pillows when turning to your non-operative side.
Do have someone help support your leg when you are getting in and out of bed until you have enough strength to lift your leg without assistance.
Do sit in chairs with arms. Chair arms aid you in rising to a standing position without twisting. Do not sit continuously for more than 1 hour.
Do get up from a chair by first moving to the edge of the chair. Place your operative leg in front of you as you rise, and keep the other leg well under the chair for better balance. Use a rocking chair if available.
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Do use your crutches or walker when taking a step until given permission by your surgeon or therapist to wean you from these devices.
Do get up and move around the house every 1–2 hours. Take a longer walk every day, and gradually increase the distance (up to 1 mile if able).
Do use your raised toilet seat if indicated.
Do use a transfer tub bench as indicated.
Do your exercises several times a day.
Do limit yourself to light housework, with no bending or lifting until directed by your surgeon. You may wash dishes, prepare food, etc., by standing in place.
Do use your reacher.
Do resume sexual activity when you are comfortable. Discuss precautions with your surgeon or therapist.
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Post-Operative Exercises and Goals AC TIVIT Y GUIDELINES
4. Heel Slides
Exercising is important to obtain the best results from total hip surgery. Always consult your physician before starting a home exercise program. You may receive exercises from a physical therapist at an outpatient facility or at home. In either case, you need to participate in an ongoing home exercise program as well. After each therapy session, ask your therapist to recommend changes to your program that will keep you moving towards the goals listed on the next few pages.
5. Short Arc Quads
WEEK S 1– 2 After two to three days, you should be ready for discharge from the hospital. During weeks one and two of your recovery, typical goals are to:
Continue with walker or two crutches unless otherwise instructed.
Walk at least 300 feet with support.
If needed, be able to climb and descend a flight of stairs (12–14 steps) with a rail once a day.
Independently sponge bath or shower and dress.
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Gradually resume homemaking tasks.
Do 20 minutes of home exercises twice a day, with or without the therapist, from the program given to you.
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6. Long Arc Quads 7. Standing Heel/Toe Raises 8. Standing Knee Flexion 9. Standing Rock Over the Operated Leg 10. Standing Mini Squats
The above exercises are listed in the tab “Preparing for Surgery”: Pre and Post-Operative Exercises (see page 19). WEEK S 2 – 4 Weeks 2–4 will see you gain more independence. Even if you are receiving outpatient therapy, you will need to be very faithful to your home exercise program to be able to achieve the best outcome. Your goals for the period are to:
Achieve one- to two-week goals.
Move from full support to a cane or single crutch as instructed. Make sure to use the crutch or cane in the hand that is opposite of the surgery leg until your limp is gone
Walk at least one-quarter mile.
If needed, be able to climb and descend a flight of stairs (12–14 steps) more than once daily.
Independently shower and dress.
Resume homemaking tasks.
Do 20 minutes of home exercises twice a day with or without the therapist.
Begin driving if left hip had surgery. You will need permission from therapist.
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Post-Operative Exercise Plan
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1. Ankle Pumps
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2. Quad Sets 3. Gluteal Sets
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Post-Operative Exercises and Goals (Continued) WEEK S 4 – 6
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Week’s 4–6 will see much more recovery to full independence. Your home exercise program will be even more important as you receive less supervised therapy. Your goals are to:
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Achieve one- to four-week goals.
Walk with a cane or single crutch.
Walk one-quarter to one-half mile.
Begin progressing on stairs from one foot at a time to regular stair climbing (foot over foot).
Drive a car (either right or left hip had surgery).
Continue with home exercise program twice a day.
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You may sit upright and begin to lean forward to pick things up off the floor or shave your legs, always reaching between your legs.
You may gradually begin using toilet seats of regular height.
You may continue to use the tub bench. Avoid sitting in the bathtub.
You may massage your incision with vitamin E oil, cocoa butter or alcohol-free lotion.
You may begin to ride a stationary bike, limiting yourself to 5 minutes, and then gradually increasing your time as you can tolerate it. Set the seat level so that your feet touch the floor and your hip remains slightly bent with each rotation.
You may begin swimming pool exercises. We recommend walking in chest high water. Use steps rather than a ladder to get in and out of the pool. Do not do the butterfly and breaststroke.
You may drive a car. Please practice in an empty lot or road first. Your insurance company may not cover you in case of an accident unless you can demonstrate that your operative leg is as strong as your non-operative leg.
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WEEK S 6 –12 During weeks 6–12 you should be able to begin resuming all of your activities. Your goals for this time period are to:
Achieve one- to six-week goals.
Walk with no cane or crutch and without a limp. It is important to use a cane or a crutch until you are able to walk without a limp.
Climb and descend stairs in normal fashion (foot over foot).
Walk one-half to one mile.
Improve strength to 80%.
You may sleep without a pillow between your legs.
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Returning to Normal Life Activities AC TIVITIES 3 MONTHS AF TER SURGERY
You may sleep on your stomach by simply rolling over.
You may walk without a cane or crutch when your limp is gone.
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You may check with your surgeon about other specific recreational activities.
AC TIVITIES 6 TO 12 MONTHS AF TER SURGERY
You may begin playing golf or doubles tennis.
You may begin using other exercise equipment.
You may begin long hikes and snow skiing.
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AC TIVITIES TO B E AVOIDED W ITH YOUR NEW HIP REPL ACEMENT
At the 6-Week Visit You will have x-rays taken and your surgeon will evaluate your strength and motion. Your weightbearing status will be increased, and you will be shown new exercises to do. At the 3-Month Visit X-rays may be taken, and your surgeon will assess your walking ability, strength, and leg lengths. At Your Annual Follow-Up X-rays will be taken. Your motion and walking abilities will be assessed. At each successive follow-up, x-rays will be taken of your hip replacement. It is important to have x-rays taken routinely, because problems can occur in the hip joint that you might not feel. Occasionally we will need to operate again (average 10 to 15 years). Please remember to keep your follow-up appointments.
You should not run long distances, jump, lift excessively, ski in the moguls, or put yourself in situations where you might twist at the waist or bend excessively at your hip, which might cause a dislocation. Your artificial hip is subject to wear and tear and could wear out, break, or loosen if not treated with care or respect. FOLLOW- UP E X AMINATIONS After your surgery, your surgeon will want to see you in the office at 6 weeks, 3 months, 1 year, and then every 2 years.
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Personal Notes
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