Anterior Total Hip Replacement The Procedure and Going Home

Anterior Total Hip Replacement Thanks to all who have contributed to making this patient education manual possible.

Joints In Motion 1200 North Elm Street

mktg/jb/3-13

Greensboro, North Carolina 27401 www.conehealth.com

(336) 832-7000

HEALTHCARE EDUCATION

Anterior Total Hip Replacement

This booklet has been developed to help you understand your total hip replacement surgery. It will help you find the answers to questions you may have about your surgery. It is divided into the following sections:

Section 1 Preparing for Your Hospital Stay

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Section 2 The Hip Joint and the Hospital Stay

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Section 3 Rehabilitation All of us feel more comfortable dealing with changes in our bodies when we understand what is occurring, why it is happening and how it can be treated. That’s why the staff of Moses Cone Health System has developed this booklet. This booklet was revised in September 2007.

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Section 4 Discharge Planning

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Anterior Total Hip Replacement

Preparing for Your Hospital Stay What Preparations Should I Make for My Return Home?

Are There Any Medications that I Should Stop Taking Before Surgery? Ask your orthopedic doctor if you should stop taking any medications or herbal supplements before being admitted to the hospital. It is usually recommended that people stop taking aspirin, products containing aspirin, anticoagulants (such as Coumadin) and anti-inflammatory medications (such as Advil, Ibuprofen or Aleve). It is important to ask the doctor when to stop taking these kinds of medications. If you need medication for pain relief, you need to ask your doctor about ordering an aspirin-free product.

What Do I Do if I Smoke? The hospital is a smoke-free environment, and you will not be allowed to smoke on the hospital campus. You should try to quit smoking before your surgery or you will need to discuss alternatives to smoking with your doctor.

A short housecoat or robe that opens down the front. ■

Comfortable supportive shoes for walking. Low-heeled, non-skid shoes with laces are suggested. Slip-on, backless bedroom slippers are NOT safe to use after hip surgery. ■

Bring short gowns, pajamas, underwear and socks/stockings and one set of street clothes to wear home. ■

Any walking aid that you are presently using at home, such as a walker or crutches and a list of other adaptive equipment you may have at home, such as a reacher. ■

Any favorite items that you may want for personal hygiene.

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Any education materials you received at preadmission classes. ■

A copy of your Living Will and Healthcare Power of Attorney if you have either one. Hospital personnel are required by law to ask for these when you are admitted. Hospital personnel will make a copy for your medical record and return your original to you. ■

A copy of your insurance card. Your case manager may need this information when determining insurance coverage for equipment, follow up therapy options, etc. ■

The most important preparation you should make is to arrange for someone to stay with you for one to three weeks when you go home. Most patients leave the hospital two to three days after surgery and will need assistance when they return home. It is important that this person is able to assist with bathing, dressing, meals and transportation to doctor visits. Other preparations include: ■ Removing all throw rugs which might cause you to slip and fall. 2

PREPARING FOR YOUR HOSPITAL STAY

Making sure that you have a high, firm chair with armrests to help you sit and stand. ■

Removing any furniture which might cause you to trip and fall, particularly items in stairways and hallways. ■

Arranging the most frequently used kitchen utensils and food on shelves and counters that can be reached easily. ■

What Do I Bring With Me to the Hospital? ■ A list of all the medications that you are presently taking, including the dosages and the times they are taken. (Do not bring any medications to the hospital.)

Arranging for someone to care for or feed your pets. ■

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Exercises to Help You Prepare for Surgery The following exercises will help you prepare for the activities you will be doing after surgery. These exercises focus on the muscles you will need to get out of bed and begin walking.

Common Lab Tests Your Doctor May Order Exercises should not cause soreness that lasts into the next day or pain or fatigue for more than 30 minutes after you have stopped exercising. If soreness does occur, decrease your number of repetitions.

Your doctor may order certain test(s) to be done before you have surgery or while you are in the hospital. Below is a general explanation of some routine tests your doctor may order.

We hope the explanation of your test(s) will be helpful to you and your family. You may ask your doctor for the results of these tests.

Arterial Blood Gas (ABG) – A test used to determine the amount of oxygen, carbon dioxide and other chemicals in the blood. If required, this bloodtest will be done at the same time as other pre-operative tests but drawn from a different location on the arm.

likely to have abnormal bleeding during surgery or procedures.

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Ankle pumps Bend your ankle up, pulling your toes toward the ceiling. Then bend your ankle down, pointing your toes away. Repeat 10 times for each leg.

Chemistry (CMET, BMET, Electrolytes) – A test that checks the chemicals in the blood to determine the normal body function of the heart, lungs, bones and kidneys. The cholesterol level and the general nutrition of the body also may be determined. ■

Knee presses Lie on your back and press your knee into the bed. Tighten the muscle on the front of your thigh. Hold for 5 counts. Repeat 10 times for each leg.

Bridging – one leg Lying on your back, bend the knee of the leg you are not having surgery on and place your foot flat on the bed. Push down with this leg to lift your hip up off the bed, keeping the leg you will be having surgery on straight. Lower hip and repeat 10 times.

Complete Blood Count (CBC) – A test that provides a great deal of information about the overall general health of the body by examining blood cells. This test can also identify complications caused by anemia (low iron in the blood), infection or bleeding problems.

Type and Screen, Type and Crossmatch – Tests which identify your blood type before surgery. ■

Urinalysis (UA) – A test which checks your urine for signs of kidney or bladder infection or disease. ■

Chest X-ray (CXR) – An X-ray to detect lung disease or determine the size and position of the heart, ribs or other structures of the chest. ■

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Electrocardiogram (EKG/ECG) – A record of the heart’s electrical activity which is important in determining how the heart is functioning. ■

Differential (Diff) – A test done to examine the white blood cells to check for infection and to detect patients who may be at risk for infection after surgery. ■

Prothrombin Time (PT), Partial Thromboplastin Time (PTT) – Tests done to check for signs of abnormal bleeding. It is done to identify patients who may be more ■

Chair push ups Sit in chair with armrests. Place your hands on armrests. Straighten arms, raising buttocks up. Slowly return to starting position. Repeat 10 times. 4

PREPARING FOR YOUR HOSPITAL STAY

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NOTE: Many people wonder if they will be routinely tested for HIV while in the hospital. In North Carolina, you must give consent for HIV testing of your blood. An exception to this is if a healthcare worker receives a needle stick or other exposure to your blood. If this happens, state law requires HIV testing. You will be notified if this testing is necessary. HEALTHCARE EDUCATION

PREPARING FOR YOUR HOSPITAL STAY

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Anterior Total Hip Replacement

The Hip Joint and the Hospital Stay How the Hip Works Socket Ball

Thighbone

What does a normal hip look like? The hip is a ball and socket joint. The ball (head) of the thighbone fits into the socket of the hip joint. Smooth material called cartilage covers the surfaces of the hip bones and acts as a cushion between the ball and socket of the hip joint.

HEALTHY HIP

What is a problem hip? When conditions such as arthritis occur, the smooth cushion which covers your hip bones is worn away and the joint space narrows. This causes the ball (head) of the thighbone to rub directly against the socket. This is why you will have pain and joint stiffness when you walk.

Narrowed Joint Space

Pelvis Thighbone PROBLEM HIP

The artificial hip joint has two parts: ■ A ball-and-stem portion which replaces the head of the thighbone and fits directly into the thighbone. ■ A cup portion which replaces the socket.

ARTIFICIAL HIP JOINT

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THE HIP JOINT AND THE HOSPITAL STAY

An example of the artificial hip joint is shown in the picture to the left.

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When Will I Be Admitted to the Hospital? You will be admitted the day of surgery. Specific information will be explained to you by your nurse. General information about your surgery is explained below.

What Bandages and Tubes Will Be Used? Staples usually are used to close hip incisions. There will be a bulky dressing on the incision, which will be changed two to three days after surgery.

How Is a Total Hip Replacement Done? An incision about 6 to 12 inches long is made over the hip joint. The top (ball portion) of the thigh bone is removed, and a tunnel is drilled down the shaft of the bone. A metal rod with a metal or ceramic ball attached to the end is fitted into the thigh. In the pelvis, the damaged socket is replaced with an artificial socket, usually made of hard plastic.

Drainage Tube

Sometimes, special cement is used to hold the prosthesis in place, especially in people with poor bone quality or who are older and inactive. Other times, a cementless prosthesis, which is made of material that bone can heal to, is used. A cementless prosthesis often is used in patients who have good bone quality and those who are young and physically active. The operation usually takes two to four hours. Your doctor will talk to your family in the surgical waiting room after surgery. HEALTHCARE EDUCATION

You may or may not have a drainage tube coming from under your bandage. This tube allows blood to drain from your hip incision into a container to reduce swelling. Your nurse will empty this container every eight hours or more often if needed. This tube will be removed by your physician one or two days after surgery. An example of the drainage tube is shown in the picture below.

Hip drainage tube

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How Will My Pain Be Controlled? Your physician will order medicine to ease your pain. This pain medicine may be administered to you by pill, injection, IV, pain pump or epidural.

Continuous Epidural Analgesia is pain medicine that is delivered through a small tube placed in your back. For more on Continuous Epidural Analgesia, see appendix A. ■

If your physician orders a pill or an injection for pain, you will receive your medication every three to six hours, depending on the medication.

Ice packs also may be applied to your hip to help control your pain.

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How Will I Change My Position in Bed? A staff member will help you to turn and change your position in bed. Do not try to turn yourself. Make sure you avoid twisting your leg when turning in bed. When turning, you may want to have a bed pillow or an abduction pillow between your legs to help reduce pain. An abduction pillow is a large, foam, triangle shaped pillow. An abduction pillow is shown below.

Patient Controlled Analgesia (PCA) is pain medicine that goes through your IV. You control the release of the medicine by pushing a button. The PCA pump will only release a certain amount of pain medicine over a certain amount of time, as determined by your physician. Later, pills will be ordered for your pain when your IV is stopped. ■

The pain pump is a device filled with a local anesthetic. It is pre-set by your doctor to automatically deliver a controlled dose of the medication into your incision area to help manage your pain. ■

IV Line This is a tube which is connected to a small plastic needle placed in your vein. You will be given fluids through this tube for a day or two after surgery. An IV pump is pictured above.

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THE HIP JOINT AND THE HOSPITAL STAY

Various activities to control your pain:

Foley Catheter You may or may not have this tube, depending on your physician’s orders. This is a small tube which is placed in your bladder and connected to a drainage bag. The purpose of the Foley catheter is to measure your urine output after surgery. HEALTHCARE EDUCATION

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Listen to music.

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Watch television.

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Read books.

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Enjoy visits with your family and friends.

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How Soon Can I Get Out of Bed After Surgery? This varies from patient to patient, depending on what your doctor believes is best for you. Most likely your nurse will help you sit on the side of the bed the evening of your surgery, depending on your doctor’s orders. The following day, your nurse or physical therapist will help you get out of bed and walk in your room.

How Can I Help Myself after Surgery? ■ Do breathing exercises to help your lungs. Take deep breaths and cough every one to two hours. Your doctor will order a device called an Incentive Spirometer to help you take deep breaths. See appendix B and C for more information on coughing and deep breathing (appendix B) and Incentive Spirometry (appendix C).

Your doctor may order one or more of the following to help prevent blood clots and improve circulation:

In order to go home, you must be: Inflatable wraps that alternately inflate and deflate when applied to your legs or your feet before and/or after surgery. ■

Walking in the hallway with the assistance of your caregiver.

Constipation may be a problem after surgery. As your diet allows, drink juices and eat foods with fiber to help prevent constipation.

Able to do exercises with the assistance of your caregiver as instructed by your physical therapist. ■

Able to get in and out of bed and back and forth to the bathroom with the assistance of your caregiver. ■

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How Can I Improve My Circulation? Things you can do to improve your circulation after surgery are:

Taking pain medication by mouth and no longer have an IV. ■

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Limit your amount of bedrest. Get out of bed with assistance as often as your doctor recommends.

When Will I Be Able to Go Home?

Elastic support stockings applied before and/or after surgery. If the inflatable wraps or support stockings feel uncomfortable, please inform your nurse. ■

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Go up and down steps, if you have any, with the assistance of your caregiver. ■

Aspirin or anticoagulants.

Mobility to promote and improve circulation. ■

Two easy bed exercises: (see pictures on page 4) 1. Ankle pumps - bend your ankle up, pulling your toes toward the ceiling. Then bend your ankle down, pointing your toes away. Repeat 10 times for each leg. ■

2. Knee presses - lie on your back and press your knee into the bed. Tighten the muscle on the front of your thigh. Hold for 5 counts. Repeat 10 times for each leg. Keep pressure off the back of your knees by leaving the bottom of your bed flat. Do not put pillows under your knees. ■

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THE HIP JOINT AND THE HOSPITAL STAY

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THE HIP JOINT AND THE HOSPITAL STAY

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Anterior Total Hip Replacement

Additional Tips to Help You Avoid Straining Your Hip: ■ Keep a pillow between your legs when lying in bed or on your side. It may be difficult to bend to pick up objects off the floor, to touch your feet or to tie your shoes. ■

Avoid sitting on low chairs, low stools or low toilet seats as it may be difficult to stand from them. ■

Rehabilitation This section was prepared for you by your physical and occupational therapists to assist with your transition from hospital to home. It includes precautions you need to protect your new hip, including how to move in bed, sit, stand, walk, bathe, dress and get in a car properly. Please read this carefully and ask about anything that is not clear to you. When you leave the hospital, you should be able to get in and out of bed, walk to the bathroom, dress and bathe, get in your house and perform all exercises with the help of a friend or family member. By working with your

What Precautions Are Needed After Surgery? Certain positions can cause excessive stress to your new hip joint and even cause it to dislocate or “pop” out of joint. It is very important that you avoid the following three positions to ensure the safety of your new total joint:

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What Is the Best Position for Sleeping? ■ You can lie on your back. You can lie on either side, but you may want to keep a pillow between your legs to prevent straining your hip. ■

Continue to use your walker or crutches after surgery as advised by your doctor or physical therapist. ■

physical and occupational therapists, you should feel safe and confident in these activities as you return home. Please be aware that the suggestions in this booklet are general principles and guidelines. Your therapist may change or alter directions included here to personalize your program to meet your special needs. Finally, instruction sheets tailored to your needs for stair-climbing will be added to your packet.

Carefully follow the instructions given by your doctor about how much weight you can put on your operated leg: No weight bearing (NWB) – keep leg off the ground. Touch-down weight bearing (TDWB) – touch foot to the ground for balance only. Partial weight bearing (PWB) – usually one-fourth to one-half your body weight. Weight bearing as tolerated (WBAT) – as much as is comfortable.

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These precautions need to be followed during all activities throughout the day. Continue to follow these precautions until your doctor allows you to stop. DO NOT move your leg out to the side while lying or standing. ■

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DO NOT let your leg roll out.

DO NOT extend your leg behind you beyond what is comfortable. ■

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Your Hospital Stay Before Surgery Your Diet

Your Activities

Controlling Your Pain

Your Therapy

Learning About Your Recovery

Going Home

Day of Surgery

Hip Replacement Surgery Day 1 after Surgery

Day 2 after Surgery

Day 3 Discharge Day

Do not eat or drink after midnight.

Do not eat or drink before surgery. You may eat after surgery.

You may eat solid foods.

Solid foods

Solid foods

Read your Joint Replacement booklet. Practice coughing, deep breathing and bed exercises (see page 4).

Use incentive spirometer every hour while awake. Continue to cough, deep breathe and perform bed exercises. Keep pillow between your legs when turning, if ordered by your doctor.

Use incentive spirometer every hour while awake. Continue to cough, deep breathe and perform bed exercises. Consider using a pillow between your legs when turning.

Use incentive spirometer every hour while awake. Continue to cough, deep breathe and perform bed exercises. Consider using a pillow between your legs when turning.

Use incentive spirometer every hour while awake. Continue to cough, deep breath and perform bed exercises. Consider using a pillow between your legs when turning.

Your nurse will give you information on controlling your pain and how to rate your pain on a 0-10 scale.

Pain medication. Use ice pack to hip.

Pain medications/begin pain pills. Use ice pack to hip.

Pain pills. Use ice pack to hip, as needed.

Pain pills. Use ice pack to hip, as needed.

Review the Rehabilitation portion of the Joint Replacement booklet for the activities you will learn after your surgery.

Possible Activity: • Sit on side of bed assisted by nursing staff. • Out of bed to chair with Nursing or Physical Therapy, if your doctor approves.

Physical therapist will work with you to teach you how to move from the bed to the chair, walking and exercise.

Walk at least twice daily with a walker. Practice mobility and exercises with physical therapy. An occupational therapist may train you on bathing, dressing and going to the bathroom (if appropriate).

Continue to practice exercises and activities.

Attend the Pre-operative Total Joint Replacement class. Visit the Pre-Admission/Short Stay Center. Bring your booklet with you to the hospital.

Your nurse will instruct you on hospital and department routines.

Learn about your medications, joint precautions and equipment (walker, commode chair, etc.).

Learn about tub/shower equipment, etc. Review joint precautions. Learn to care for your incision. Begin reviewing discharge instructions with your nurse. Prepare to go home or to another venue of care.

Review all discharge instructions.

Think about what you will need for recovery at home (i.e., caregiver support, equipment, home medications, etc.).

Begin to discuss your discharge needs with your nurse.

A case manager will meet with you to begin planning for your discharge needs.

You and your healthcare team will discuss your discharge needs and confirm your discharge plans. Home equipment (walker, commode seat, etc.) and home services will be set up, if needed. Plan for transportation home.

Discharge home or to another venue of care. Target discharge time is 11 a.m.

Your individual treatment plan may be different. Most patients who have a Primary Total Hip Replacement are in the hospital about three days. Depending on your condition, you may not be in the hospital this long or you

may need a few more days. Your healthcare team will adjust this plan to fit your individual needs. Talk with your nurses about your recovery goals.

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TOTAL HIP REPLACEMENT

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How Do I Get In and Out of a Chair (sit-to-stand)? 1. To sit, back up to the chair so that the back of your non-operated leg touches the chair. 2. Slide your operated leg forward, reach back for the armrests of the chair one hand at a time and ease into the seat. Where Should I Sit? Always sit on a high, firm chair with armrests to help you sit and stand. If necessary, add extra cushions to raise the seat height or add firmness. You may also need a bedside commode or a raised toilet seat over your toilet at home. How Should I Get In and Out of Bed? If it is possible, get out of bed toward your non-operated side as this is usually easier. Avoid sleeping on a soft mattress. Change positions frequently while in bed to prevent stiffness. Use a reacher device to pull covers up from the end of the bed to avoid straining your hip. To get out of bed: 1. Using your non-operated leg, move your buttocks toward the edge of the bed without allowing your operated leg to move out to the side.

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2. Come up onto your elbows while bringing your non-operated leg off the bed.

DO NOT move your leg out to the side. DO NOT let your leg roll out.

DO NOT extend your leg behind you beyond what is comfortable. ■

3. Push up to your hands until you are sitting. 4. Bring your operated leg off the bed and rest it on the floor, bending your knee as is comfortable.

3. Sit for only 30-60 minutes at a time, then get up and walk or practice your exercises. 4. To stand up, scoot toward the edge of the chair, place your operated leg forward, then push up with your hands and non-operated leg. What Is the Correct Way to Walk? A walker will help you keep your weight off your new hip joint to allow it to heal. Your doctor will decide how much weight your operated hip can tolerate. When you go home, you can walk as much as you can tolerate without pain or fatigue. You should continue to use your walker or crutches after surgery as advised by your doctor. To walk properly: 1. Set the walker out in front of you so that the back of the legs are even with your toes. 2. Step with your operated leg first. 3. Taking the weight onto your hands, step with your non-operated leg. 4. Reverse process when backing up.

How Do I Get In and Out of a Car? You may drive ONLY with your doctor’s consent. 1. The driver should open the door, move the passenger seat back as far as it will go and recline the back of the seat. 2. With your walker, back up to the passenger seat until you feel the edge of the car behind your legs. Place your operated leg out in front of you and bend your other leg slightly. With your left hand, hold onto the dashboard. With your right arm, hold onto the door frame or backrest of the seat. 3. Lower yourself down to the seat, You may need extra pillows in the seat if it is too low. (Continued on page 18.)

Remember DO NOT step unless all four legs of the walker are on the floor. ■

DO NOT use your walker to pull up on – it may tip over. ■

DO NOT slide or pivot on your foot. Take small steps when turning. ■

When returning to bed, it is best to enter the bed toward your non-operative side (if possible). 16

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4. Scoot back and recline before you slide your legs into the car one at a time. Now you may bring the seat back up slightly.

6. Sit on the seat during the shower. Use a hand-held showerhead and a long-handled sponge or brush to scrub your feet and back.

5. Have someone close the door for you. Buckle your seat belt.

7. To get out of the tub, reverse the above steps. Dry yourself, while still sitting. Make sure your feet and the bathroom floor are dry before attempting to stand.

6. To get out of the car, reverse the steps. Make sure you have the back of the seat reclined as much as possible before sliding your legs out of the car.

8. If you are allowed full weight bearing, you may step into the tub using a grab bar for support.

How Do I Get In and Out of the Bathtub or Shower You may shower only with permission from your doctor.

If you have a walk-in shower: 1. Back up to the lip of the shower. 2. Step into the shower with your nonoperated leg, then your operated leg.

1. Place a tub bench or shower chair in the tub as far back as possible. Also, place safety strips or a rubber mat on the bottom of the tub. Place a bath towel covering the seat of the bench or chair to help you slide in and out.

3. Place your operated leg forward. Reach back with one hand for the shower chair or 3-in-1 commode seat, then reach back with the other hand and slowly sit down.

2. Back up to the tub with your walker until the backs of your legs touch the edge of the tub or tub bench.

4. Reposition legs in the shower as needed. 5. Step out of the shower with your operated leg first.

3. Place your operated leg forward. Reach behind you with one arm for the back of the seat, bending slightly at the waist, until you have one hand on the shower chair or tub bench. As you start to sit down, reach back with your other hand as well. 4. Lower yourself to the edge of the seat and scoot back to position yourself more securely. 5. Lift and slide one leg and then the other over the tub edge.

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How Do I Sit Down and Get Up From the Toilet? 1. You may or may not need a raised commode seat. Your case manager will help you obtain one if you need one.

3. Using the reacher or dressing stick, lower the undergarment to the floor near your operated leg and slide the undergarment over your foot. You will need to lift your leg slightly.

2. Place the commode seat over your toilet (if applicable, remove the bucket.)

4. Slide the reacher or dressing stick over to the other side of the waistband and place your non-operated leg in the hole or bend your non-operated leg up to place your leg in the undergarment.

3. Sit down/stand up following the standard sit-to-stand instructions on page 17. Make sure that you use the arms of the commode or grab bars (if applicable). Do not pull up on your walker.

5. Pull the undergarment up far enough with the reacher or dressing stick so that you can reach it with one of your hands. Pull the garment over your knees. Repeat the process to put on your pants.

How Do I Dress Myself? Some people may be able to put on their pants and socks without any help, much like they did before surgery. However, if you find putting on pants, socks and/or shoes difficult, an occupational therapist will teach you to use a reacher, dressing stick or sock aid to increase your independence with dressing and instruct you on where to purchase equipment. Pants and Undergarments 1. Sit on the edge of the bed or chair with your operated leg in front of you.

6. Follow the sit-to-stand instructions on page 17. 7. Shift one of your hands to the middle of the walker and keep your operated leg out in front of you. Use the other hand to pull your undergarment and pants over your hip. Switch hands and pull undergarment over the other hip. 8. Reverse above procedure to remove undergarments and pants.

Socks/Stockings 1. Sit on the edge of the bed or chair with your operated leg in front of you. 2. Hold the sock-aid against your leg or stomach with the open side up. Place your sock over the other end of the sock-aid with the heel of the sock facing down. Slide the sock down until the sock cannot go any further (the toe of the sock will be touching the sock-aid), but do not pull the sock over the end with the cord. 3. Holding on to each end of the cord with each hand, toss the sock-aid (open side up) in front or your operated leg. 4. Slide the sock-aid over your foot, point toes down, and pull the cord evenly and steadily on both sides of your leg until the sock is all the way on and the sock-aid slides out. Release one side of the cord and pull the sock-aid up.

Shoes Sturdy slip-on shoes with a back are most convenient, but you may use elastic shoelaces to make tie-ups serve as slip-ons. It is not safe to wear shoes without a back. 1. Sit on the edge of the bed or chair with your operated leg in front of you. 2. Place the shoe in front of you and to the outer side of your operated leg. Place the large hook of the dressing stick, the reacher or a long-handled shoehorn in the back of the shoe. 3. Direct toes into the shoe and then, using the adaptive device, work your heel into the shoe. 4. Remove the shoe by placing the adaptive device in back of the heel, lifting the foot slightly and pushing the shoe off.

5. To remove the sock, place the reacher or large hook of the dressing stick in the back of the sock and push the sock down and over the heel. Use your reacher or dressing stick to pick up the sock.

2. Place the waistband of your undergarment (the side corresponding to your operated hip) on the large hook of the dressing stick or within the clasped ends on the reacher. 20

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Some Helpful Hints for Homemaking Cooking: ■ Sit in a chair or stool in the kitchen while preparing and cooking food to save your energy. Arrange your most frequently used kitchen utensils and food on shelves and counters that can be reached easily.

Bed making: ■ Hold on to the middle of the walker with one hand and use the reacher to pull sheets into place.

Leave your most frequently used dishes in the dish rack. Use a reacher to get items from high and low shelves or to pick up objects from the floor. Most reachers have a 1-pound weight limit.

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You may sit down in a chair next to the bed to tuck the corners under the mattress if you cannot get them with the reacher.

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Laundry ■ Place your dirty clothes over the front of the walker and take them to the laundry room (if accessible) on a daily basis to avoid having to carry a large load. Other: Approach drawers, doors, oven door, etc. from the side.

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Remove throw rugs from the floor to avoid tripping over them.

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Place hot pans/dishes on a trivet and slide on the counter.

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Do not try to walk with walker and carry something at the same time.

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Use a rolling cart to take food from the refrigerator to the counter and from the kitchen to the dining room, etc. You may push the cart in front of your walker or roll it along by your side. Do not try to walk and push the cart at the same time. Instead, push the cart, then walk a few steps and push the cart again.

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Questions for My Physician

Do not twist your body to reach for objects; do take small steps to turn the walker with you.

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Always face the counter or appliance being used, and turn your walker with you when reaching for objects.

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Use a walker bag or apron with pockets to carry small items such as glasses, books, silverware, etc.

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When may I shower, take a tub bath or get my incision wet? How long should I wear my support stockings (elastic hose)? ■

Do not climb on a foot stool or ladder to get objects from high places. ■

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The “Don’ts” of Homemaking

When may I put all my weight on my operated leg? ■

Do not sit on a sofa because sofas tend to be too low, too soft, and do not have two armrests that you can use to push up. ■

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Intimacy: The “Hidden” Question

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Your concerns about sexual activity after having a total joint replacement are a valid and important aspect of your recovery process. Many people want to know about when they can resume sexual activity and how to protect their new joint after surgery. First, talk to your partner or spouse about your surgery process and changes in sexual activity after surgery. Next, talk to your surgeon about the recovery (healing) process and when it would be appropriate to resume sexual activity. Lastly, take the time to educate yourself about the various restrictions and methods used to safeguard your new hip. Proper positioning of the hip during sexual activity is very important to reduce pain and stay within a safe range of motion. We understand that intimacy is a very sensitive and personal topic for many people. If you would like to learn more about intimacy, information is readily available by contacting your doctor’s office or the Medical Library at Moses Cone Health System.

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When may I drive my car?

When do I go to the physician’s office for my first follow-up visit? When can I go back to work?

Attach a cup holder to your walker to carry drinks in covered cups.

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REHABILITATION

HEALTHCARE EDUCATION

HEALTHCARE EDUCATION

REHABILITATION

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Anterior Total Hip Replacement

What Are My Discharge Options? Most patients go directly home in two to three days after total hip replacement. It is important to arrange for someone to stay with you for one to three weeks after your surgery. This person should be able to assist with bathing, dressing, meals and transportation to doctor appointments.

Discharge Planning

What Other Things Are Good to Remember When I Go Home? Continue to wear your support stockings after you go home. Remove these stockings for about 30 minutes two to three times a day for bathing and skin care. You will need help removing and reapplying these stockings. ■

Tell your physician or dentist that you have had a hip replacement before having any type of surgery or dental work.

Most patients need some type of follow-up therapy once they leave the hospital. Depending on your individual needs (medical status, homebound status, etc.), you will typically receive either outpatient therapy or home health therapy. Your case manager will assist in determining your options.

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If you have a slow recovery, there are options for continued inpatient care after your hospital stay. These options include skilled nursing facilities or an inpatient rehabilitation center. Your healthcare team will help you determine if you are a candidate for any of these options.

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Remove scatter rugs and beware of wet spots or objects on the floor which could cause you to slip and fall. ■

Call your physician if you have a fever, experience shortness of breath, have chest pain or have pain/tenderness in your calf. Call your physician if you have sudden or gradual change of feeling in your operated leg (sensations not relieved by positional changes). ■

Call your physician if you experience increased pain and/or loss of use in the leg that was operated on. ■

Who Will Help Me With My Discharge Needs? A representative from the case management department will help coordinate your care while you are in the hospital and assist you with your discharge needs. Discharge options will be discussed with you and your family. Your case manager will notify your insurance company of your discharge needs and will inform you of the amount of coverage your

insurance allows. The case manager also will have lists of home health agencies and information regarding chore providers and home making services. It is important to note that most insurance companies and Medicare only cover skilled services such as nursing and physical therapy.

Continue to do your exercises at home. Your home health or outpatient therapist may change some of these exercises as you get stronger. ■

Use ice packs on your hip after exercising, strenuous walking or if you notice any swelling. ■

Be sure to check with your doctor before adding any activities. 24

DISCHARGE PLANNING

HEALTHCARE EDUCATION

HEALTHCARE EDUCATION

DISCHARGE PLANNING

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Appendix A

Continuous Epidural Analgesia Following Surgery This fact sheet explains how continuous epidural analgesia, a pain relief method, is administered and some possible side effects. The decision to use epidural analgesia is made by you, your surgeon and your anesthesiologist. How is continuous epidural analgesia administered? An anesthesiologist will insert a small, soft, flexible tube between the bones of your spine. This is usually done at the end of surgery while you are unconscious. The tube is placed into a space away from your spinal nerves called the epidural space. The catheter is taped to your back and connected to a small pump, which delivers the pain medication.

Appendix B

What are some possible side effects? ■ Itching. ■ Nausea. ■ Difficulty urinating. Inform your nurse if you experience any of these symptoms. An anesthesiologist usually removes the catheter two to three days following surgery. Removal of the catheter is simple and usually pain-free since the tube is taped to your back.

Coughing and Deep Breathing Following your surgical procedure, deliberate deep breathing and coughing exercises will be especially helpful for you as you begin to return to your normal health. Deep breathing is vital to your well-being. It expands the small air sacs of your lungs, called alveoli, and helps keep your air passages free from fluid buildup. As you take deep breaths and cough, you will move air through your lungs. This will help prevent lung problems such as pneumonia. Practice the exercises below before surgery so you can do them easily following your procedure. Your nurse will encourage and assist you with these exercises during your hospital stay.

1. Place one hand on your chest and one hand on your upper abdomen. 2. Exhale, letting all of the air out of your lungs as you normally do. 3. Inhale. As you breathe in, feel the hand on your abdomen rise. If this does not occur, you are not breathing correctly. Exhale.

Where does the pain medication go? The pump moves the medicine into the epidural space slowly. The medicine then moves from the epidural space into your spinal nerves, where it blocks your pain.

4. Now take a slow deep breath. Breathe in through your nose and remember to fully expand your chest. Breathe out through your mouth. Concentrate on pushing all of the air out of your chest. 5. Take a third deep breath. This time hold it and cough two or three times (once is not enough). This will help clear your breathing passages. Then take three to five normal breaths. Let the air out of your lungs slowly and relax.

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TOTAL HIP REPLACEMENT

HEALTHCARE EDUCATION

HEALTHCARE EDUCATION

TOTAL HIP REPLACEMENT

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Appendix C

Incentive Spirometry Your physician may order a deep breathing exercise device for you, called incentive spirometer, to help restore and maintain respiratory fitness. Deep breathing is vital to your well-being. It expands the small air sacs of your lungs, called alveoli, and helps keep your air passages free from fluid buildup.

Normally you take many deep breaths every hour when you sigh or yawn. It is important for you to try to resume your normal breathing pattern after surgery. The incentive spirometer will help you do this and may prevent postoperative respiratory complications. The incentive spirometer provides you with visual or positive feedback when you inhale into the device. Your nurse will teach you how to use this device, if ordered by your doctor.

How to use your incentive spirometer 1. Hold the device in an upright position. 2. Set the flow rate indicator at the prescribed level. 3. Exhale (breathe out) normally and seal your lips tightly around the mouthpiece. 4. Inhale (breathe in) slowly and deeply through your mouth until the white disk reaches the volume goal. When inhaling, maintain the top of the yellow flow cap in the “best” flow range.

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5. After inhalation is complete and the white disk drops to the bottom, continue to hold your breath for three seconds. 6. Remove the mouthpiece, exhale normally and cough. Allow the white disk to return to the bottom of the chamber. 7. Take a moment to rest and relax and breathe normally. 8. Repeat this exercise for five to 10 breaths every one to two hours while you are awake.

HEALTHCARE EDUCATION