Patient & Family Education Total Hip Replacement Surgery orlandohealth.com
INTRODUCTION Thank you for choosing Orlando Health for your healthcare needs. Your team of professionals understands that preparing for surgery can be stressful. We want to make it as easy for you and your loved ones as possible. This booklet will help you prepare for your total hip replacement surgery. Being prepared helps you to be relaxed and helps with your recovery. The intent of this booklet is not to replace any information your surgeon has given you about your procedure. If you have any specific questions about your surgery, please contact your surgeon. Before Surgery There are several things you and your loved ones can do in advance to prepare your home for your return after surgery: Arrange for a ride home once you are discharged from the hospital. Make plans for someone to stay with you for a couple of weeks after surgery until you are able to get around safely. Ask someone to help you with bathing, housework, yard work, pet care and grocery shopping. Patients will use a rolling walker (a walker with wheels) for several weeks. The following are suggestions of things to do to prepare your home and yourself before your surgery. Walker Safety Clear any items from your walking paths. Ask your family or friends to move any furniture that would prevent you from comfortably moving around with your walker. Remove any throw rugs that could make you trip. If you live in a two-story house, you may want to stay primarily on the first floor for the first few weeks. Have someone help you move a bed and any essential items to the first floor. Consider how you will be entering your home. Do you have to climb any steps? Is there a handrail for you to use for support? Making Food You will not be able to bend over from your waist for several weeks to months after your surgery. Have someone help you move your essential cooking items to waist height or above to make them easier for you to access. You may want to make meals in advance that can be frozen and easily reheated for when you return home. Think about how you will be taking plates of heated food to your table or other eating area. A rolling cart can be helpful for this purpose Sleeping/Resting Comfortably It is recommended to sleep on a regular mattress after surgery. Waterbeds are not recommended. Look at the height of your bed. A bed that is too high or too low will be hard to get into after surgery. Choose a chair (preferably with armrests) that is comfortable and easy for you to get in and out of. Recliners are often the most preferred type of chair. Put a small table next to it so you can easily reach the items you may need (e.g., phone, remote control).
Communicating with Your Surgeon Before Surgery Tell your surgeon about all medications that you take. This includes the following: Review any and all pain medication that you are currently taking. It will help the surgeon to better manage your pain. Let your surgeon know if you are seeing a pain management doctor who is prescribing pain medication for you. Tell your surgeon if you take a beta-blocker. You will take this medication with sips of water before your surgery. Tell your surgeon if you use medications for blood clotting (e.g., Coumadin, Plavix, Aggrenox) or if you take aspirin or any anti-inflammatory medications (e.g., Advil, Aleve, ibuprofen, naproxen). You will be told if or when to take these medications before surgery. Tell your surgeon if you take any medications that affect your immune system (e.g., Rheumatrex [methotrexate], Humira [adalimumab], Enbrel [etanercept], Remicade [infliximab] or Kineret [anakinra]). You will be given instructions regarding these medications before and after surgery. Diabetics: If you are currently taking metformin (e.g., Glucophage, Glucophage XR, Metaglip, Glucovance, Avandamet), you must stop taking them 48 hours before your surgery. Talk with your physician who prescribes this medication and ask for instructions on managing your diabetes during this time. You must stop all herbal medications, nutritional supplements and over-the-counter diet medications 2 weeks prior to surgery. Ask your surgeon about what you can expect with your recovery. Ask questions about how long you will be out of work and when you can expect to resume activities. Make a list of questions before your appointment so that you remember them all. PREADMISSION TESTING About a week before surgery, you will need to have blood work and other tests done. These tests help your surgeon look for health problems that need to be addressed before your surgery. Your surgeon s office will schedule this appointment for you. The preadmission testing usually takes between 2 to 3 hours. Please bring the following information to your appointment: Picture identification (such as a driver s license) Your insurance card Complete list of all of your medications Copies of any recent medical tests you have had done Green tickets from your blood donation (if your surgeon has asked you to donate your own blood prior to surgery) Copy of your living will or power of attorney (if you have them)
Day Before Surgery Have a light dinner the night before surgery. Do not have anything to eat or drink after midnight. Only take medications that have been approved by your surgeon with sips of water. If you are currently taking a beta-blocker, your surgeon will recommend that you take this medication in the morning before coming to the hospital. If you want to know if you take a beta-blocker, call your surgeon s office to ask. If you are taking any long-acting pain medications (e.g., Duragesic patch, Oxycontin, MS Contin, methadone), ask your surgeon for how to take this medicine before your surgery. What to Bring to the Hospital Please pack these items for your hospital stay: Glasses, dentures, hearing aids (if needed) CPAP/BiPAP (Bilevel Positive Airway Pressure) machine (if used) Hygiene items (toothbrush, toothpaste, deodorant) Comfortable, non-skid shoes Comfortable, loose-fitting clothes to wear home Please do not bring any money, credit cards, jewelry or other valuables to the hospital. Day of Surgery Check in at the admitting area of the hospital (third floor at ORMC). If you have difficulty walking, request a wheelchair in the lobby on the first floor. Next, you will be taken to the preoperative area where you will be seen by an anesthesiologist. You will have an IV (intravenous line) started at this time. You will be given medication to make you feel relaxed. Then you will be taken into the operating room where your surgeon will perform the surgery. Your loved ones will be taken to the waiting room. When your surgery is done, the surgeon will tell your loved ones in the waiting room how you are doing. RECOVERY ROOM You will wake up in the recovery room. You may feel cold, your mouth may feel dry and your throat might be sore. Your nurse can give you warm blankets and ice chips for your mouth to comfort you. You will be in recovery for a few hours. When you wake up you will notice that you MAY have: A small tube delivering oxygen into your nose A clip or tape attached to your finger with a red light that records your oxygen level and pulse A snug white hose on your legs called TED hose Sleeves wrapped around your legs that fill with air and gently squeeze your legs, starting at your ankles then going to your calves and/or thighs
A wedge-shaped pillow between your legs called an abduction pillow A catheter coming from your bladder that drains urine into a bag A dressing of gauze and tape on your hip A small drainage tube coming from your hip that drains blood and fluid from around your incision into a collection chamber An IV in your vein that is connected to a bag of IV fluids A button that you push to give yourself pain medication Usually a patient stays in the recovery room for an hour or two. In times when the hospital is very full, the stay may be longer. Everything will be done to reduce your delays to a minimum. NURSING UNIT When ready, you will be taken from the recovery room to your hospital room. Your nurse will greet you and make sure that your needs are met. Your nurse will show you how to use your phone, the TV remote and the nurse call button. Your nurse will ask you about your pain and make sure you are as comfortable as possible. It is very important that you tell the nurse if you are having pain or any other problems, such as nausea or itching
Your nurse can help you change positions in bed to help you feel more comfortable. You can be turned on the opposite side of your surgery and have pillows placed behind you for your comfort. When you are on your back, your nurse will check to make sure you do not have too much pressure on your heels. Your surgeon may want you to be assisted out of bed on the night of surgery. You will need help when getting out of bed. Ask before getting out of bed, so your nurse can make sure that you are safe and don t fall. Your nurse will show you how to use the incentive spirometer. This helps your breathing. Try to use this 10 times each hour when you are awake. POSTOPERATIVE SYMPTOMS After surgery, patients often have a lot of discomfort in their hip. Day of Surgery The nursing staff will orient you to your room and plan of care once you arrive to the unit. Depending on your surgery and surgeon preference, Physical Therapy may see you on the same day as your surgery. The physical therapist will start to teach you exercises and get you out of bed. Use your pain button or take pain medications to keep comfortable since this is the first time that you are moving after your surgery. After Surgery: Day 1 If Physical Therapy did not see you on the day of surgery, they will come to your room the first day after your hip replacement. The physical therapist will show you exercises, how to get out of bed, and help you walk with a walker. Use your pain button or take your pain medications to keep comfortable, especially as you are becoming more active. Your urine catheter may be taken out today. The drain in your hip may also be taken out. After Surgery: Day 2 Physical Therapy will continue to see you. If you still have a urine catheter, it will be removed today. This is to reduce your chance of getting an infection. It will also help you to be more active and walk to the bathroom. Increasing your activity is the number one thing you can do to ensure a smooth recovery. You will be given pain medication by mouth, and the pain button and IV pump will be removed. This will make it easier for you to get around when you are out of bed. The drain in your hip will be removed either today or tomorrow if you still have one. Your nurse will change the dressing on your hip. A discharge planner (either a social worker or home health coordinator) will visit you and help you plan everything you will need upon discharge. After Surgery: Day 3 You will be increasing your activity more and more. Usually, any remaining tubes or lines are removed today. Your dressing will be changed. The discharge planner will meet with you and finalize all of your arrangements. Many patients are discharged today. However, every patient is different. Some patients are able to go home on post-op day 2, while some patients will need to stay in the hospital longer.
After Surgery: Other Considerations Diet When you are asleep during surgery, your bowels go to sleep too. Sometimes it takes a day or two for them to begin working properly. Your nurse will listen over your abdomen with a stethoscope to hear the gurgling sounds of your bowels ( bowel sounds ). These sounds will let your nurse know when it is safe to offer you more to drink or eat. It is important to not eat or drink too much too fast. After surgery, you will be given some ice chips to wet your mouth. Later that day you can have some sips of water. If your bowels are continuing to wake up, you can have some liquids (e.g., juice, gelatin, broth). When you are ready, you will be allowed to have light, soft foods, such as pudding and soup. By the next day, most patients are able to resume their normal diet. Bowels Constipation is very common after surgery. This is a side effect of anesthesia, pain medication, inactivity and changes in your eating habits. Restoring bowel function is an important part of your recovery. Your nurse will give you laxatives and other medications to help you with your bowel function. Mobility and walking around more can also help with constipation. Bladder You will have a catheter placed in your bladder while you are asleep in surgery to make it easier for you to urinate. This tube is usually removed the first or second day after your surgery, or as early as possible to reduce the possibility of infection. Lung Health It is important to get out of bed and use your breathing exerciser, called an incentive spirometer, after surgery. These activities will help keep you from having respiratory problems. Your nurse will show you how to use your incentive spirometer correctly. You should use it about 10 times an hour when you are awake. Smoking Research shows that smoking interferes with your body s ability to heal your bone after surgery. Now is the time to stop smoking to give your body the best chance to heal. Your nurse is happy to provide you with resources to help you in your effort to stop smoking. Activity Being active after surgery is the most important thing you can do to prevent complications. You will be helped out of bed either the night of surgery or the following morning. Your physical therapist (PT) and your nurse will review your exercises with you and help you to get out of bed into the chair and walk several times a day. Most patients find themselves able to do more and more each day. Precautions Depending upon the type of hip replacement that you had, you may have specific precautions that your surgeon wants you to follow. Ask your surgeon what type of hip replacement you will be having and what type of precautions you will need to follow after surgery. Physical therapists will also help teach you about your specific hip precautions. The type of hip replacement I am having is:
Special Activity Instructions When getting out of bed: Keep your knees apart and the operative leg out to the side, remembering not to lean forward. When getting up from a sitting position: Do NOT lean forward. Rise to the standing position by standing straight up. Do NOT bend forward. When walking steps: Take one step at a time. Remember the phrase Up with the good, down with the bad. What this means is to go down first on the operative ( bad ) leg and up first on the unoperative ( good ) leg. Preventing Blood Clots Having joint replacement surgery increases your risk of developing blood clots in the veins in your legs. The best way to prevent a blood clot after surgery is to get moving as soon as possible after surgery and stay moving. Your surgeon will prescribe a medication for you to help prevent blood clots. Pain Management Many patients have been experiencing pain for some time prior to surgery and have concerns about how their pain will be managed in the hospital. Talk to your surgeon and nurses about your medications so that your pain can be controlled. Be sure to let your surgeon and nurses know what kind of pain medication you were taking at home before surgery. This information will help us adjust your pain medication to make you as comfortable as possible. Orlando Health uses 0-10 rating scale to measure pain. No pain is 0. A 10 means that you have the worst possible pain. Your nurse will ask you for your pain goal. This number represents the pain level at which you will be able to comfortably get out of bed and do physical therapy. Some patients have side effects from the pain medicine. Side effects include nausea, itching, confusion or just not feeling right. Talk to your surgeon or nurse if you have these side effects. Additional medicines or adjustments to your current dosage can help ease these side effects. (See Medications and Side Effects section later in booklet for more specific information.) Preventing Infection Hand hygiene (e.g., hand washing) is important for preventing infection. It is especially important for you or your loved ones to wash hands or use alcohol-based sanitizer before changing your dressing. Make sure your healthcare provider uses proper hand hygiene. You have the right to ask your healthcare providers whether they washed their hands before coming into your room. Be careful with your surgical site to prevent infection. Do not get your surgical site wet until approved by your surgeon. When in doubt, wash your hands. Another way to prevent infection is to have your catheter removed as soon as possible to prevent a urinary tract infection (UTI). Talk with your surgeon and nurse about having it removed as early as possible. Some surgeons prefer to remove your catheter the day after surgery, and this is an ideal way to minimize the chance of infection. Coping with Stress Many patients undergoing surgery experience some stress and anxiety. Having realistic goals for your recovery and keeping a positive outlook will help. Some patients use deep breathing and relaxation techniques. Orlando Health has a team of patient and family counselors and spiritual care representatives to help you cope with your feelings.
Discharge Planning Most patients are discharged 3 days after surgery. Some even go home earlier. Most patients also require physical therapy at home or at an outpatient center once they are discharged from the hospital. No matter what your situation, it is important to have help when you go home. From equipment to home health services, our discharge planners will help you with all of your discharge needs. They will meet with you and your loved ones after surgery to talk about how they can help meet your needs. Some patients need more time or physical therapy before they can safely go home. If you need extra help, the discharge planners can make arrangements for an appropriate rehabilitation or skilled nursing facility. The discharge planning team will talk to you about your options. DISCHARGE INSTRUCTIONS Incision Care and Hygiene Watch for redness, swelling and drainage from your incision. Make sure your dressing is changed daily and cover it with gauze and flexible netting. If you have steri-strips (small surgical tapes), they will begin to fall off on their own. You do not need to replace them. If you have stitches or staples, your surgeon will tell you when to have them taken out. You will either have them taken out by the surgeon or by the home healthcare nurse. This usually is about 10-14 days after surgery. Do not get your surgery site wet when showering. Cover it with plastic wrap or a plastic bag to keep the area dry. Change your dressing when you get out of the shower. Do not take a bath, swim, or sit in a hot tub until approved by your surgeon. For your safety, use your walker and a handheld showerhead in the shower. A shower chair is also helpful. Many elevated toilet seats may also be used as a shower chair.
Preventing Blood Clots Having joint replacement surgery increases your risk of developing blood clots in the veins in your legs. The best way to prevent a blood clot after surgery is to be active. The signs of a blood clot include: increased pain or redness in your calf or thigh and increased swelling in your calf, ankle or foot. However, most of the time patients with blood clots have no symptoms. Sometimes a blood clot in the leg can travel and become lodged in the lung. This is called a pulmonary embolus (PE). Symptoms of a PE are sudden shortness of breath, chest pain and coughing. CALL 9-1-1 immediately if you have any of these signs. Your surgeon will prescribe a medication to help prevent blood clots. Be sure to take this medication exactly as it is prescribed. Activity Try to get 8 hours of sleep at night and have several rest periods throughout your day. You should not drive until your surgeon says it is OK. You can ride in the car for short trips. Use the rolling walker (a walker with wheels) until you are stronger and steady on your feet. Some patients then use a cane for a period of time after the rolling walker. An elevated toilet seat (also known as 3-in-1 commodes) can help you when you go home. Most toilets at home are too low and do not have handles. Handles help you to sit or stand. Walking will help your recovery. Try to walk every day. Start with short distances and work toward longer distances. Choose a comfortable chair with armrests for sitting. Do not stay in bed most of the day. Try to be more active each day until you are able to have a normal routine. If you are not active, you could develop a blood clot. Blood clots can be dangerous, as talked about previously.
Some patients find it helpful to purchase a reacher for once they are home. It can help you pick up things off the ground or reach items on a high shelf. For patients who like to wear socks, a sock aid is another tool that can be helpful. A physical therapist or occupational therapist can help in teaching you how to use it to put socks on without having to bend too far down. Medications and Side Effects Do not resume any anti-inflammatory medications (e.g., Celebrex, ibuprofen [Advil/Motrin], naproxen [Aleve]) until your surgeon says it is OK. Your surgeon will give you information about your pain medications. Side effects are common. Many patients feel sleepy and may become constipated from the medicine. Some patients also have mild itching with no visible rash as a side effect. To prevent constipation, try to drink lots of fluids and eat a diet high in fiber. Use an over-the-counter laxative (e.g., Senokot-S, Miralax, Milk of Magnesia ) to help with constipation. These are helpful to take while you are taking pain medication to prevent constipation. Read the package for the dosage. For Senokot-S, the usual dose is 2 pills twice a day. Sometimes you can increase the dose gradually if needed. The goal is to have a bowel movement every day or every other day. Call your surgeon if you do not reach this goal. If you have itching due to the pain medicine, you can take over-the-counter Benadryl (diphenhydramine) as directed by the package. If you develop a rash due to any medicine, stop taking the medicine and call your surgeon immediately. If you notice you get nauseated or sick to your stomach while you are taking pain medicines or other medicines that have been prescribed to you by your surgeon, it can be helpful to take them with food. Protecting Your New Hip Notify your orthopedic surgeon if you need to undergo any dental procedures or minor surgery. Your surgeon will want to prescribe antibiotics for you to prevent any infection from developing in your new hip. When to Call the Doctor If you notice any new or increased redness, swelling or drainage from your surgery site If you have a fever (temperature over 101 F) If you cannot have a bowel movement after taking laxatives If you have weakness or swelling in your legs, or your calf muscle is tender If you have a higher level of pain than you can tolerate If you experience any sudden difficulty breathing or chest pain, CALL 9-1-1
ANTI EMBOLIC EXERCISES Repeat all exercises 10-15 times 2-3 times per day. 1. Ankle Pumps: Move foot up. Keep knee straight. Move foot down. 4. Heel Slide: Lie on back. Slide one heel to bottom. Slide back down. Repeat with other leg. 2. Thigh Muscles - Quad Set: Lie on back. Press knee into mat, tightening muscles on front of thigh Do not hold breath. 5. Knee Extension or Lift: Sit with back against chair. Straighten knee. Hold 5 counts. 3. Buttock Muscles - Gluteal Set: Squeeze bottom together. Do not hold breath.
Arm Strengthening Exercises These exercises can be performed on a daily basis to improve your upper body strength prior to your joint replacement surgery. Getting stronger prior to surgery can help your recovery go much smoother. Perform these exercises 10 times, 2-3 times per day. At home, you can use soup cans or other similar handheld items to add weight and resistance while performing the exercises. Triceps Extension Start with your elbow bent and pointed toward the ceiling. Support the arm with your other hand. Extend your elbow while raising your hand to the ceiling. Then, slowly lower your hand again. Repeat on the other side Biceps Curl Place both arms straight down at your sides. While keeping your arms close to your sides, bend your elbows while bringing your hands to your shoulders. Then, slowly straighten your arms again back down to your sides. Shoulder Flexion Start with your arm straight by your side. While keeping your arm straight, raise it up until it is parallel with the floor. Then lower your arm back down to your side and repeat on the other side. Armchair Push-up Place your hands on armrests. Straighten arms and raise your bottom off of the chair and then lower yourself down. Keep feet on floor. Wall Push-up Stand at arms length from wall, with feet shoulder width apart. Place palms on wall. Lean your body toward the wall, then slowly push away from the wall until your arms are straight again
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