What to do and what to expect before, during and after your surgery

Transcription

1 A New Hip for You YOUR GUIDE TO HIP REPLACEMENT What to do and what to expect before, during and after your surgery January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved.

2 Date Time Subject Appointments Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

3 Contents Introduction 2 Why Do I Need My Hip Replaced? 3 Risks of surgery 4 While You Are Waiting for Your Surgery 5 Instructions before surgery 7 Equipment you need for a safe and successful recovery 8 Phase 1 exercises to build your strength before surgery 9 What to bring to hospital 12 The day before surgery 12 Checklist 13 On the Day of Your Surgery 14 Using the special skin cleaning sponge at home 14 When you get to the hospital 14 In the operating room 15 In your hospital room 16 After Surgery 17 Pain after surgery 17 Managing your bathroom needs after surgery 19 Rehabilitation 20 Leg swelling 21 Movements to avoid after surgery 22 Managing at Home 23 Sitting in a chair 23 Using the toilet 23 Getting into and out of bed 24 Getting dressed 24 Bathing 25 Getting into and out of a car or truck 26 Preparing meals 26 Driving 28 Going Home 29 Activities and Sports 32 Signs of Problems 34 Frequently Asked Questions 35 Phase 2 Exercises to Improve Your Recovery after Surgery 37 January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 1

4 Introduction Now that you are going to have hip replacement surgery, it is important to know all you can about it, including: Why you need your hip replaced. What you will have in place of your hip. The risks of surgery. What you can expect before, during and after surgery. What you can do to help make your surgery a success. This guide will help answer these questions. Take the time to read it with your family and friends, especially those who will be giving you some help. You and they will have the benefit of knowing what you should do to get ready for your surgery, what will happen during your stay in the hospital, and what you can do to get back on your feet after surgery. All your appointments before and after surgery will be at the Hip and Knee Replacement Clinic. Your Case Manager will arrange all of your care with input from the rest of your health care team. The team will include your surgeon, other doctors, medical office assistants, an occupational therapist and a physical therapist. Others may be added to your health care team as needed. Your Case Manager and other health care team members will support you while you wait for surgery and as you go through rehabilitation and recovery. You will also play an important role by following the easy steps in this guide. It is important that you find someone who will be your buddy. This person will help you with the things you must do to prepare for surgery and to have a successful recovery from surgery. This will include going with you to and from the Hip and Knee Replacement Clinic and the hospital. Talk to your Case Manager if you have any concerns or questions. Please bring this guide with you when you visit the Hip and Knee Replacement Clinic, attend therapy sessions and go to the hospital. 2 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

5 Why Do I Need My Hip Replaced? Most people have a hip replacement because the cartilage, or cushioning, between the bones in their hip has worn away and the bones are rubbing against each other. This causes pain and stiffness in the hip. If you have this problem, the pain might be keeping you awake at night. It may be causing you to cut back or stop doing your normal everyday activities, such as working, going for a walk, going up and down stairs, gardening and shopping. After trying treatments such as drugs and exercise, the pain and stiffness haven t gone away or are worse. A hip replacement means that the damaged hip joint is removed and replaced with parts made of metal, plastic and metal, or ceramic and metal. The pain should stop or you should feel only a low level of pain or discomfort, and your hip should be more flexible with the new parts. There are three types of hip replacement surgery. Your surgeon will tell you which type you need. The three types are: Total hip replacement: The entire hip joint is removed and replaced with new parts. Hip resurfacing: Only the damaged surfaces in the hip joint are removed and replaced with new parts. Hip revision: The parts used to replace the hip have become damaged or loose and have to be removed and replaced with new ones. There are many types of hip replacement parts. The type you need depends on the condition of your hip, your age and weight, and the activities you like to do. Your surgeon will tell you about the type that is best for you. Healthy Hip Joint Damaged Hip Hip Replacement Hip socket Ball of thigh bone Stem of thigh bone Damaged ball and socket Hip socket New ball and stem Thigh bone January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 3

6 Risks of Surgery Hip replacements are safe in general, but there are risks. Your surgeon and health care team will talk to you about the risks of surgery. Some of the risks and the steps taken to reduce them are as follows: Germs enter the body and cause an infection: Infections can come from anywhere on your body, such as your teeth, skin, throat and urine. Drugs are given before and after surgery to prevent infection. It is important to let your Case Manager know if you think you have an infection anywhere. Blood hardens into a clump called a blood clot: Clots can develop in the deep veins in the legs. Blood thinners are taken to prevent clots. Getting up and moving around as soon as possible after surgery also helps to prevent clots. In a very small number of cases, blood clots can move to the lungs becoming a serious problem. Tell your surgeon and Case Manager if you have ever had a blood clot. The ball of the new hip joint pops out of the socket: This is called a dislocation. You can help prevent this by following the steps in this guide and using your equipment and aids until your health care team tells you they are no longer needed. Change in leg length: Your operated leg may be longer after surgery. When this happens, the increase is usually small and does not need to be treated. A shoe lift can be used if necessary. A break in the bone around your new joint: You may need to put less weight on your leg or have another surgery if this happens. Nerve damage, bleeding, or blood vessel injury: Changes in feeling and movement may occur after surgery. Be sure to tell your health care team about any changes. Heart attack, breathing or lung problems, stroke, allergic reaction to drugs, or death: These are risks with any surgery. You and your health care team will work together to reduce them. The new hip parts become loose: Your new hip joint may loosen over time. It is important to tell your health care team about any new pain in your hip. It is also important to go to all of your follow-up visits after surgery. You may need surgery again if your new joint becomes too loose. 4 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

7 While You Are Waiting for Your Surgery Be as healthy as possible: Eat healthy foods, drink lots of fluids, and get plenty of rest and exercise. Use Canada s Food Guide to choose the type and amount of food you need for good health. Healthy eating before surgery will help you: Reduce the risk of illness that may delay your surgery or make it more difficult. Build up iron in your blood to increase your energy level and help your body fight infections. Reach and stay at a healthy weight. Look after health problems before surgery: This especially includes problems with your teeth and eyesight, with the prostate (a male gland), and with the urinary tract, which enables you to urinate. Have prescriptions for medications refilled. Get dental work done: You must have any problems with your teeth taken care of before surgery. This will reduce the risk of infection after surgery. Get your teeth cleaned. Make sure all the work that must be done on your teeth is completed. Your surgery will be delayed if this is not done. Find a buddy: Your buddy will be your main support helping with the many things that must done before and after surgery and while you are in the hospital. Your Case Manager at the Hip and Knee Replacement Clinic will ask for the name of your buddy. Arrange for support after surgery: You will most likely be in the hospital 2 to 3 days. Talk to your buddy and other friends or family members about your surgery and explain how they can help once you return home. Some of the ways they can help you are: Doing housework and yard work, driving, shopping and making meals. Taking you to and from appointments. Staying with you, if you live alone and need help. Giving you medication by needle. Helping with your bandages. If someone depends on you for care, arrange for someone else to give the care while you are recovering. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 5

8 Quit (or cut down) smoking: It will take longer to heal if you smoke. If you need help to quit smoking, call QUIT or go to Note: You will not be allowed to smoke anywhere on hospital property. Get your home ready for your recovery: Make it as easy and safe as possible to get around your home after surgery by doing some simple things ahead of time: Arrange items in the kitchen and other areas of your home so you can reach them without bending more than 90 degrees (see Movements to Avoid after Surgery on page 22). Adjust the height of your bed so that the top of the mattress is 5 cm to 10 cm (2 inches to 4 inches) above your knee. Position your furniture so that you have space to move around safely using a walker or crutches. Remove loose mats or clutter that could cause you to trip or slip. Install handrails on stairways. If you cannot install handrails, arrange to have someone help you go up and down stairs when you first arrive home. Make sure you have the right type of chair (see Managing at Home on page 23). If you have a tub with a shower door, take off the door and replace it with a shower curtain. Have all of the equipment you will need for your recovery in place 1 to 2 weeks before your surgery (see Equipment You Need for a Safe and Successful Recovery on page 8). Having the equipment in place ahead of time will give you the chance to practice with it before surgery so that you can manage more easily and safely once you return home. Get heavy housework done ahead of time: Do laundry, vacuuming and other heavy work around the house before your surgery. Plan for your food needs: Stock up on groceries and make frozen meals. 6 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

9 Arrange your transportation: You could be released from the hospital at any time of the day. Make plans to have your buddy available to pick you up at any time. Improve the health of your blood: You may be asked to join a program to make your blood healthier. Studies show that patients with healthy blood before surgery are less likely to need donated blood during surgery, spend less time in the hospital, and recover more quickly. Stay active and do your exercises: Continue to do all your regular activities. Begin right away to build strength in your legs, arms and stomach by doing the simple exercises on pages 9 to 11 in this guide. Doing these exercises before your surgery will help you get moving again after surgery. Ask questions: Be sure you understand what will be done and what you are agreeing to when you sign the form for surgery. Read this guide before going to your Hip and Knee Replacement teaching class and write down your questions or concerns. Review the risks of surgery on page 4. Instructions before Surgery Your surgeon and Case Manager will tell you which of your prescription and non-prescription medications to stop taking before surgery. Tell your Case Manager before your surgery if: You have allergies to medications or metals. Your medications have changed. There have been any changes in your health. It is very important that you: Do not use any lotions or creams of any kind on your legs beginning 5 days before your surgery. Do not drink alcohol beginning 48 hours before your surgery. Do not eat after midnight on the night before your surgery. You may drink clear fluids until 4 hours before your surgery. Clear fluids include water, black tea or coffee, carbonated beverages, pulp-free juices or gelatin desserts such as JELL-O. DO NOT DRINK milk, cream or juices containing pulp. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 7

10 Equipment You Need for a Safe and Successful Recovery Your health care team will tell you about the equipment you will need to protect your hip and reduce the risk of falling after surgery. You should have all of the equipment you need in place 1 to 2 weeks before surgery and begin practicing with it right away. Keep it for about 3 months after surgery. Crutches, cane and walker Reacher Sock aid, elastic shoelaces and long-handled shoehorn Long-handled sponge/brush Raised toilet seat Toilet armrests Bathtub seat, shower seat and bathtub transfer bench Removable bathtub grab bar Non-slip bathtub mat Chair with armrests Other equipment as suggested by your health care team These items may be: 1. Rented or bought from medical and surgical supply stores, which are listed in the Yellow Pages phone book or online at under Home Health Care Supplies. Note: To save shopping around, you can buy crutches at the hospital on the day you arrive for surgery, unless you need special crutches for your height or weight. You can also rent crutches and a walker from a pharmacy. 2. Borrowed from a medical equipment loan program if available in your area. 3. Borrowed from friends or family as long as the items are in good working order and safe, and are the right type for your height and weight. 4. Borrowed from the Community Health Unit or Home Care. 8 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

11 Phase 1 Exercises to Build Your Strength before Surgery Begin Now and Continue after Surgery You must exercise before and after surgery to build your strength and flexibility. Exercising is necessary for a successful recovery and return to normal living. Start doing these exercises at home right away and continue to do them at home after your surgery. Be sure to do them on both legs so that they become equally strong. Do all exercises slowly and with control. Repeat each one at least 5 times, increasing the number of times as long as it does not cause too much pain. Exercise 1: Increase hip flexibility and strengthen back thigh muscles Bend one knee and hip by sliding your heel along the bed toward your buttocks (backside). Keep your knee facing the ceiling. Hold for a count of 3 to 5. Slowly straighten your knee sliding your heel back to the starting position. Repeat. Exercise 2: Increase hip flexibility and leg strength Slide one leg out to the side and back again so that it is in line with your bellybutton. Make sure to not go any further than shown in the picture. Keep your knee straight and toes pointed to the ceiling while sliding your leg. Hold for a count of 3 to 5. Repeat. Exercise 3: Strengthen front thigh muscles Place a firm roll under one knee. Straighten the leg, lifting your foot off the bed. Hold for a count of 3 to 5. Slowly lower your foot. Repeat. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 9

12 Exercise 4: Strengthen stomach muscles Lying on your back, bend both knees while keeping your feet flat. Tighten your lower stomach muscles by pulling your bellybutton down toward your spine. Breathe normally while holding muscles tight for a count of 3 to 5. Relax and repeat. Exercise 5: Strengthen front thigh muscles Sitting on a steady chair with your thigh supported, lift one foot and straighten your knee. Hold for a count of 3 to 5. Slowly lower your foot to the floor. Repeat. Exercise 6: Strengthen back thigh muscles and increase leg flexibility Sitting on a steady chair with your feet on a smooth surface, slowly slide one foot back as far as possible. Hold for a count of 3 to 5. Slowly slide your foot back to the starting position. Repeat. Exercise 7: Strengthen upper arms and shoulders Sitting on a steady chair with your feet flat on the floor, push up with both arms to lift yourself from the chair only partially. Hold for a count of 3 to 5. Slowly lower yourself onto the chair. Repeat. Exercise 8: Strengthen stomach muscles Sit on a steady chair and put both feet flat on the floor. Tighten your lower stomach muscles by pulling your bellybutton toward the back of the chair. Breathe normally while holding muscles tight for a count of 3 to 5. Relax and repeat. 10 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

13 When doing the exercises below, remember to stand straight, tuck in your stomach and tighten your buttocks. Exercise 9: Increase hip flexibility and leg strength Holding onto a table or countertop for stable support, stand with your back and legs straight. Slowly move one leg out to the side, then back toward your bellybutton keeping the leg straight at all times. Repeat. Exercise 10: Increase hip flexibility and leg strength Holding onto a table or countertop for stable support, keep your back and legs straight and slowly move one leg behind you. Do not lean forward. Keep the leg straight. Slowly return your leg to the starting position. Repeat. Exercise 11: Increase hip flexibility and leg strength Holding onto a table or countertop for stable support, lift one knee as if to go up a step. Hold for a count of 3 to 5. Slowly lower your foot to the floor. Repeat. Exercise 12: Strengthen back thigh muscles Holding onto a table or countertop for stable support, bend one knee by lifting the heel of your foot toward your buttocks. Do not move your thigh forward. Hold for a count of 3 to 5. Slowly lower your foot to the floor. Repeat. Exercise 13: Strengthen front thigh and buttock muscles Holding onto a table or countertop for stable support, stand with your legs shoulder width apart and your toes pointed forward. Slowly bend your knees, keeping your heels on the floor and your knees apart. Do not bend forward. Keep your weight on your heels as you bend your knees. Do not move the tips of your knees past your toes at the bottom of the bend. Hold for a count of 3 to 5. Slowly return to a standing position. Repeat. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 11

14 What to Bring to Hospital Your Guide to Hip Replacement. Personal care items, such as toothbrush, toothpaste, hair brush, soap, shampoo, deodorant and shaving items. Loose-fitting clothes that are easy to put on, including: robe, pyjamas, pants, shorts, underwear and socks. Adjustable non-slip shoes that give you good support and can be loosened if your feet swell. All the medications you take, including prescription and over-thecounter drugs, herbal products and inhalers. Bring these in their original container or package so that your care team can see which medications and how much of them you are taking. DO NOT use your own medications while you are in the hospital. The ones you need will be given to you. Walker, crutches and dressing aids. A label with your name. Your CPAP (continuous positive airway pressure) machine if you have one. There is not much storage space in hospital rooms so please pack only what you need in a small overnight bag. Do not bring electronic items, such as laptop computers and cell phones, or anything of value, such as jewellery and credit cards. The Day before Surgery Be sure you have everything you need for your stay in the hospital. Review the agreement you signed with your Case Manager at the Hip and Knee Replacement Clinic. If you have questions, phone the clinic and speak with your Case Manager. Don t forget: Do not eat or drink anything other than clear fluids after midnight before your surgery. Do not drink anything at all beginning four hours before your surgery. 12 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

15 Checklist My dental work is up to date. I am exercising every day to prepare for surgery. I have my buddy (name) who will help me when I get home. I have arranged for someone to take me home from the hospital after surgery. All heavy housekeeping activities (vacuuming, laundry, etc.) have been done ahead of time. I have arranged for help after surgery with: housework making meals yard work banking other I have stocked up on groceries. I have the equipment and walking aids I will need after surgery. I have rearranged the things I need at home so I can reach them easily and safely. I have arranged furniture so that I have the space to move around safely with my walker or crutches. I have the right type of chair. I know which of my prescription and non-prescription drugs to stop taking. I have packed a bag for my hospital stay and put my name on all my things. I have packed Your Guide to Hip Replacement. I have packed all my prescription and non-prescription medications and herbal products in their original container or pharmacy package. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 13

16 On the Day of Your Surgery Using the Special Skin Cleaning Sponge at Home Now that your surgery day has arrived, it s time to use the special sponge you were given at the Hip and Knee Replacement Clinic to clean your skin. Use it in the shower at home. Rub the sponge over the skin around the area of surgery for 2 to 3 minutes, until it becomes foamy (see picture). Rinse away the soap and towel dry. Phone your Case Manager if you have any questions. When You Get to the Hospital You will be checked into the hospital by the admitting nurse on the day of your surgery. The nurse will check that you have followed all instructions leading up to surgery and will prepare you for surgery. Tell the nurse or surgeon of any changes in your health since your last visit to the Hip and Knee Replacement Clinic. Before you go into the operating room, an intravenous (in-tra-vee-nus), also called an IV, will be put into a vein (usually in your hand or arm). Medication and fluids will be given to you through the IV during and after surgery. You will meet the doctor who will give you medication to control pain during surgery. This doctor is called an anesthesiologist (an-es-theez-ee-ol-o-gist). Your buddy, a family member or friend may stay with you until you go into the operating room. 14 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

17 In the Operating Room Once you are in the operating room, you will see different types of equipment used to closely watch your condition during surgery. This includes a machine to monitor your heart, a cuff to monitor your blood pressure, and a sensor that is attached to your finger to monitor your oxygen level. You will be given medication called an anesthetic (an-ess-the-tik) to control pain. There are two types of anesthetic. Both keep you comfortable and free of pain during surgery. They are: 1) Spinal anesthesia, which causes you to lose feeling in the lower part of your body. Spinal is used most commonly because patients do not feel as sick and are able to get up and begin moving around sooner after surgery. If you have a spinal, you will be given medication to make you feel drowsy during surgery. It is normal for the feeling in the lower part of your body to return slowly after surgery. 2) General anesthesia, which puts you to sleep during surgery. If you have general anesthesia, a tube will be inserted through your mouth into your windpipe to help you breathe. The tube will be taken out once you are awake fully. Surgery involves opening up your skin and muscles to get to the hip joint, removing the damaged parts and replacing them. The muscles are then reattached and the incision, or cut, in the skin is closed. A bandage is put on the area to protect it. A plastic tube, called a catheter, may be placed in your bladder to drain urine without having to go to a toilet. In the Recovery Room After surgery, you will be taken into the recovery room for about an hour. During this time, a nurse will ask you to take deep breaths to clear your lungs and do foot and ankle exercises to prevent blood clots. The nurse will also check the circulation and feeling in your legs and keep an eye on your breathing, heart rate, temperature, blood pressure and pain level. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 15

18 In Your Hospital Room Your breathing, heart rate, temperature, and blood pressure will continue to be watched once you are moved to your hospital room from the recovery room. You will still have an IV. A nurse will show you where the call bell is located and how to use it to call for help. The side rails on your bed will be raised for your safety until the effects of the anesthetic have worn off. A pillow will be placed between your legs to keep your hip in the right position and keep your legs apart to reduce the risk of dislocating your new hip. You will have to breathe deeply and cough often to prevent lung problems after surgery. At first, do not try to change your position or get out of bed without the help of hospital staff. You will be shown how to use your arms and healthy leg to change position in bed without damaging your new hip. Your physical therapist or nurse will tell you when to change your position in bed, sit at the edge of the bed, sit up in a chair, get out of bed, and begin walking. You will stand and take some steps on the day you have surgery. You will be able to have visitors once your nurse has checked your condition. 16 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

19 After Surgery Pain after Surgery All patients have pain after hip replacement surgery, even when they take pain medication. Your health care team will help you to control your pain after surgery so that you can stand, walk and get the most out of your physical therapy. How You Can Help Control Your Pain Tell hospital staff about any pain medications you were taking before your surgery. Tell hospital staff when you begin to have pain. The pain medication will be most effective when it is taken regularly, and it should be taken 30 to 45 minutes before your physical therapy sessions. Ask questions and tell hospital staff how well your pain medication is working and if you are having any side-effects. Ask for ice to place on your hip and for pillows to keep your leg raised. This will reduce pain and swelling. Use the Pain Scale All hip replacement patients need medication to control their pain after surgery. You will be asked to indicate your level of pain by selecting a number on the scale below. The level of pain you indicate on the scale will help hospital staff to know how much pain medication you need and how well the medication is working (No (Worst pain pain) possible) January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 17

20 Ways You Can Be Given Medication to Manage Your Pain IV: You will be given medication through an IV to help manage your pain or if you feel sick to your stomach. Pills: You will be given pills for your pain once you start eating and drinking after surgery. A combination of medications will be used if you have a lot of pain during the first day or two. It is important that your pain is managed with pills as soon as possible because you cannot go home from the hospital while you are taking pain medication through an IV. Make sure you have a prescription for the pain medication you will need to take at home. Deep Breathing, Coughing and Moving after Surgery You will have to breathe deeply and cough often after surgery to clear your lungs. You will also stand and take some steps on the day you have surgery. Preventing Blood Clots You must take a blood thinner after surgery to prevent blood clots, which can partially or completely block the flow of blood. Your surgeon will decide how long you should be on a blood thinner based on your medical history. You will be given a prescription for the blood thinner you must take at home. It will be taken by pill or needle. Your health care team will give you more information about the blood thinner and how to take it before you leave the hospital. Hospital staff will also ask you to do foot and ankle exercises to help prevent blood clots. You must do these exercises every hour. Replacing Blood Lost during Surgery Everyone loses blood during hip replacement surgery. Losing too much blood may leave you feeling dizzy, tired, short of breath and sick to your stomach, and you may develop a headache. This can slow your healing and make your recovery from surgery more difficult. Your surgeon may decide to give you blood through an IV or may give you iron pills to build up your blood levels if you lose too much blood during surgery. 18 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

21 Diet It is important to eat healthy foods and drink lots of fluids after your surgery. You will be given fluids through an IV after surgery. Follow the healthy eating advice in Canada s Food Guide once you feel well enough to eat and drink. Ask your health care team about taking a supplement if you are not getting enough healthy food. Healthy eating after surgery: Helps repair muscles and tissues. Builds up iron, helping restore blood that was lost during surgery. Boosts strength and energy to do exercises. Reduces the chance of feeling sick, losing too much body fluid, and losing too much weight. Managing Your Bathroom Needs after Surgery If you had a tube inserted to drain your urine during and after surgery, it will be taken out the morning after surgery. The nurses will make sure you can urinate without the tube. You should drink at least 8 glasses of water, eat foods with fibre, walk and do your exercises every day after surgery. This will help prevent constipation. If you are constipated, a nurse will offer you something to help your stools pass. It is important to tell the nurse when you have passed stools. Washing, Brushing and Other Personal Needs You should look after washing, brushing your teeth and other personal cleanliness needs on your own as much as you can. Hospital staff will help you when necessary and will make sure all the items you need, such as soap, toothpaste and toothbrush, are within reach. You will be allowed to shower after the bandages around the area of surgery are changed for the first time or when your surgeon tells you it is alright to shower. Do not put any lotions or creams on your operated leg during the first six weeks after surgery. Rest and Activity Both rest and exercise are needed for a successful recovery. You will become tired easily the first few weeks after surgery and your normal sleep patterns may change. Rest when you feel tired. You will benefit more from shorter activities done more often, such as walking, than from a single long activity. Remember to do the foot and ankle exercises every hour. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 19

22 Rehabilitation You will be helped to move from your bed to a chair and may be standing and taking some steps within 4 to 8 hours after surgery. Your activity level will increase every day. You will also begin a program to help improve the flexibility or range of movement in your new hip and make the hip stronger. Most patients are allowed to put as much weight on their operated leg as they can tolerate. Your health care team will let you know if your surgeon wants to limit the amount of weight you can put on your leg. Your physical therapist will teach you to walk with a walker and crutches and will review the exercises you must do. Your health care team will check your ability to do exercises on your own and to move around, and whether you have the skills needed to manage at home. Your health care team will use the results to recommend when you should leave the hospital and which, if any, community services you will need at home. It is important to continue using your walking aids until your surgeon or physical therapist tells you they are no longer needed. 20 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

23 Leg Swelling Your leg will swell as you become more active after surgery. The amount of swelling can change. It is normal for your hip to be warm and swollen for many weeks after surgery. To control the swelling, do not sit for more than 20 to 30 minutes at a time. Lie down on your back with your operated leg resting on pillows so that your foot is above the level of your heart. Keep your leg as straight as you can. Make sure a pillow is not positioned under the back of your knee. The weight of your knee on the pillow can put pressure on the blood vessels in your leg. Raise your operated leg this way 2 to 3 times a day for 45 minutes each time. A cold pack should be put on the warm or swollen area after you have done your exercises. Use crushed ice in a bag, an instant cold pack or a bag of frozen peas or corn. A thin towel should be placed between your skin and the cold pack to protect your skin. Do not leave the cold pack in one place for more than 20 minutes at a time. Contact your Case Manager right away if you have: A fever. Increased redness or pain around your incision. Fluid draining from your incision. A bad odour coming from your incision. Pain in the back of your calf. Go to the Emergency Department of the nearest hospital or call an ambulance if you have: Chest pain, or Shortness of breath. Chest pain or shortness of breath could be a sign that you have a blood clot or that you are having heart problems. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 21

24 Movements to Avoid after Surgery You should increase your activities after surgery a little at a time. But there are some movements you should not do at all because of the risk of dislocating your new hip. Bending your hip more than 90 degrees Do not bring your knee higher than your hip when sitting. Do not reach beyond your knees. Do not reach down for objects on the floor. 90 degrees looks like this: Crossing your legs Twisting and Pivoting Do not jar or twist your operated leg when standing, sitting or lying down. Keep your toes facing the same direction. Take small steps when turning instead of twisting your leg. Do not bring your leg across the mid-line of your body. Do not cross your legs at the knee or ankle when sitting, standing or lying down. You can sleep on either side but you must have pillows between your legs when sleeping on your back or side to prevent your legs crossing. Make sure the pillows are supporting the entire leg including your ankle when sleeping on your side. Do not put a pillow under the knee of your operated leg when sleeping on your back. Sleeping this way could cause a permanent bend in the knee and the weight of your knee on the pillow could put pressure on blood vessels in the leg. 22 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

25 Managing at Home The following information will help you to learn new ways to go about your daily activities safely and reduce the risk of dislocating your new hip while you are recovering. Add to your daily activities a little at a time, being careful to avoid the movements and positions that are not safe for your operated leg (see Movements to Avoid after Surgery on page 22). Sitting in a Chair Choose a steady chair with a firm seat and armrests. You can raise the seat height by adding a firm cushion. Do not sit on low or soft chairs and couches or on chairs that have wheels or that rock or swivel. To Sit: Using the Toilet 1. Back up until you feel the chair at the back of your legs. 2. Slide your operated leg forward slightly. 3. Bend both knees and lower yourself gently onto the chair using the armrests for support. 4. Do the reverse to stand. Do not use your walker to raise yourself from the chair. Always push up with your hands from where you are seated. You may need a raised toilet seat and toilet armrests. Make sure the toilet paper is within easy reach. To Sit: 1. Back up until you feel the toilet seat against the back of your legs. 2. Slide your operated leg forward slightly. 3. Bend both knees and lower yourself slowly onto the toilet seat using toilet armrests, the countertop or the sink for support. 4. Do the reverse to get up from the toilet. Do not use your walker to raise yourself from the toilet. Always push up with your hands from where you are seated. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 23

26 Getting into and out of Bed Avoid low beds, soft mattresses and waterbeds. Adjust the bed height so that the top of the mattress is 5 cm to 10 cm (2 inches to 4 inches) above your knee. Do not reach forward to pull up the covers. Use a reacher instead. Support your operated leg with pillows when lying on your good side. Do not rest with a pillow under your knee when you are lying on your back. To Get into Bed: 1. Sit on the bed the same way you would sit on a chair. 2. Slide your buttocks back until your knees are on the bed. 3. Pivot on your buttocks as you lift your legs onto the bed but remember to keep your legs apart and your toes in line with your nose to avoid twisting your operated hip. 4. Use a pillow to keep your legs apart when lying in bed. 5. Do the reverse to get out of bed. Getting Dressed Use special equipment to avoid bending more than 90 degrees when dressing yourself. This includes a reacher, a long-handled shoehorn, dressing sticks, elastic shoelaces, and sock aid. Other steps to make getting dressed easier and safer are as follow: Choose loose-fitting clothing, including socks. Wear low-heeled shoes with elastic laces. Be sure to dress your operated leg first and undress it last. 24 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

27 Bathing You will not be able to sit on the bottom of the tub to bathe for at least 3 months. You should bathe from a sitting position using a chair at the sink or in the tub or walk-in shower. Have someone help you get into and out of the tub and with showering until you can do this safely on your own. Once you are in the tub, do not reach forward for the faucet. Instead, have someone turn the faucet on and off. If you are steady enough, stand up to turn it on and off yourself. To Get into the Tub: 1. Back up slowly and carefully until you can feel the tub against the back of your legs. Hold onto the tub grab bar for support and, with your other hand, reach back for the bath seat and lower your buttocks onto it. 2. Pivot on your buttocks and lift your legs one at a time over the side of the tub. 3. Use a hand-held showerhead, long-handled sponge and soapon-a-rope to avoid leaning forward and bending too much. 4. Do the reverse to get out of the tub. Showering Have your buddy or someone else help you get into the shower and keep your walker steady if needed. If there is a grab bar on the wall, use it instead of the walker. A grab bar is more stable. To Get into the Shower: 1. Walk to the lip of the shower and turn so that you are facing away from the shower stall. 2. Reach back with one hand for the back of a seat placed in the shower. 3. Move your operated leg forward. 4. Sit down on the shower seat. 5. Lift your legs over the lip of the shower stall and turn to sit facing the faucet. 6. Do the reverse to get out of the shower. Note: You may stand in the shower if it is too small for a seat and you are steady on your feet. Install grab bars and a rubber bath mat to prevent slipping. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 25

28 Getting into and out of a Car or Truck Avoid small cars with low seats. Sit in the front passenger seat. The seatback should be tilted back a little. The seat should be pushed back as far as possible and raised higher than the knee. Place a pillow on the seat to increase its height if necessary. If you are getting into a car, make sure it is parked about 1 metre (3 feet) from the curb. If you are getting into a higher vehicle, such as an SUV or truck, make sure it is parked close to the curb. Put a large plastic bag on the seat and wear synthetic fabrics such as nylon, acrylic and polyester to make sliding in and out easier. To Get into the Car or Truck: 1. Back up slowly and carefully with your walking aid until you can feel the edge of the car or truck against the back of your legs. 2. Hold onto the back of the seat and the frame for support. Slide your operated leg forward slightly, bend both your knees and sit. Be careful not to hit your head. 3. Slide your buttocks back toward the middle of the seat. Pivot on your buttocks as you lift your legs one at a time into the car or truck. 4. Do the reverse to get out. Preparing Meals Use prepared meals, frozen meals, Meals-on-Wheels or order in food. Use the oven only if you can do so without bending your hip more than 90 degrees or twisting. A microwave or stovetop is best. Move your kettle to a place that is close to where you sit. 26 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

29 Working in the Kitchen Shopping Keep the items you use often within easy reach and use a long-handled reacher if items are out of reach. Try not to store items on low shelves so that you don t have to bend your hip more than 90 degrees to reach them. Slide objects along the countertops don t lift them. Use a wheeled trolley or cart to move items when your hands are busy with a walking aid. Carry things in an apron with large pockets or in a waist pouch, a backpack or a bag attached to your walker. Sit on a high stool when doing countertop tasks (see picture at right). Use containers with tight-fitting lids to move foods and fluids. Get your buddy, family or friends to help you with shopping. Shop at stores that are easy to get to and have elevators and easy-to-use parking areas. Bring your walking aid with you. Bring your reacher to pick up items from the lower shelves. Use a backpack to carry the things you buy. Buy canned or frozen goods to cut back on the number of shopping trips you must make. Note: Some grocery stores will deliver. Check with your local store manager. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 27

30 Doing Laundry Have someone do laundry for you. If this is not possible, reduce the laundry loads to a few items at a time, carrying them in a plastic bag, backpack or wheeled cart. A reacher may make it easier to get laundry in and out of dryers and frontloading washers. Sit on a high stool when ironing clothes. Doing House and Yard Work You should be able to do light housekeeping, such as dusting and washing dishes. Arrange for your buddy or someone else to help with heavy work, such as vacuuming, washing floors, changing bed sheets, cutting the grass and shovelling snow. Take out small amounts of garbage at a time if there is no one to do this for you. Hire help if possible. Driving Your surgeon will tell you when it is safe to start driving again. Hip replacement patients are usually not able to drive safely for 6 weeks after surgery. Your health care team will give you information about transportation services in your community. Having Dental Work Once you have had a hip replacement, you may need to take antibiotics before any dental work including a simple cleaning. Taking an antibiotic will help prevent bacteria, or germs, travelling through the bloodstream from your mouth to the area around your new hip where it could cause an infection and lead to serious problems. It is important that you discuss with your surgeon or Case Manager the use of antibiotics prior to any dental work. 28 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

31 Going Home You will most likely go home on the second or third day after your surgery. Before letting you go home, your health care team will check whether: You have met the goals for your new hip: You can get into and out of a bed and chair without help. You can stand safely with your crutches or walker. You can go up and down stairs safely. You can walk the distance you will need to walk in your home. You are able to do your home exercises and daily living activities safely. You know and can avoid the movements and positions that are not safe for your operated leg (see Movements to Avoid after Surgery on page 22). You are eating and going to the bathroom normally. You may need over-thecounter stool softeners if you are constipated. Ask a pharmacist about this. You can wash, brush your teeth, shave, and look after all your other personal cleanliness needs without help. The incision from your surgery is healthy and free from infection. You may be sent home with bandages for the incision if it is draining fluid. You and your buddy will be taught how to change the bandages or home care may be arranged for you. (Note: It is normal to lose some feeling in the skin around the incision where you had surgery. This usually lessens or goes away after a few months.) Your pain is under control. (Note: You will be given a prescription for pain medication.) Your health care team may decide you need more help before you can go home. No two people improve at the same rate. How you do after your surgery depends mainly on you. When you are at home: Do your home exercises regularly increasing little by little the number of times you do them each day. This will help your leg muscles become strong enough to give you the support you need and will help you get back to your normal everyday activities. Take pain control medication before exercising if you find the exercises bring on pain. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 29

32 Continue to use your walking aids until your surgeon or physical therapist tells you they are no longer needed. Take frequent walks but don t go further than you can manage safely and comfortably. Short walks taken often are better than a single long walk. Have your buddy, a friend or family member go with you on the first few walks to help if there is a problem. Carry a cell phone when walking in case you need to call for help. You may still have some discomfort for a long period. If so, talk to your Case Manager or surgeon about the best way to manage it. 30 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

33 Notes January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 31

34 Activities and Sports Some activities and sports are harder on the hips than others. Talk to your surgeon about when you can start doing the ones you enjoy. As a guideline, you should walk every day, beginning with short walks taken often. Increase your distance a little at a time and be careful not to overdo it. You may feel some stiffness in your new hip, especially when doing activities or sports that cause the hip to bend. One of the aims of surgery is to improve your hip s flexibility, or range of movement, and reduce the stiffness. How much hip movement you get is often related to how much stiffness you had before surgery. Be careful not to fall and injure your hip. Travel tip: Your new hip joint may set off metal detectors at airports. Before you line up to go through a security check, tell a security agent that there are metal parts in your new hip. Activity Guidelines Ask your surgeon about any sports or other activities you wish to do. The following are only guidelines for what you may do: During the First 3 Months after Surgery Walking. Continue doing your home exercises (see Phase 1 Exercises on page 9). After 3 Months Swimming and other pool exercises but do not make any twisting motions such as a whip kick. Low-impact fitness exercises that do not involve jumping, twisting, quick stops and starts or other movements that put sudden force on your hip. Walking on a treadmill. Golfing. Cycling. The seat and handlebars must be set high enough so that you do not have to bend your hip more than 90 degrees. Slow, gentle dancing. Light hiking. Gardening but use raised beds or long-handled tools to avoid bending your hip more than 90 degrees. 32 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014

35 Activities You Should Not Do Lifting and pushing heavy objects. Any activities involving fast or sudden stopping and starting, twisting, jarring or jumping. Contact sports. Sexual Activity Most people who have a hip replacement are able to begin having sex again when it does not cause them pain or discomfort. Sexual activity is safe for your new hip as long as you are careful. Speak to your surgeon if you have any concerns or questions. January 2014 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. 33

36 Signs of Problems Call 911 or your local Emergency Medical Service (EMS), or have someone take you to the nearest Emergency Department if you have either of the following: Pain in your chest. Trouble breathing or shortness of breath. Contact your Case Manager if any of the following happen: There is more pain, swelling and tenderness in your leg. You tried lying down with your leg raised and resting in a straight position on stacked pillows but it didn t help. The incision where you had surgery becomes red, hard, hot and swollen, or fluid begins to drain from it. You have redness or pain in your lower legs, even when resting. You have chills and a fever (above 38.5 C or F). You have a painful click or the range of movement or flexibility in your hip suddenly becomes reduced. You notice blood in your stools or urine, or in the fluid you cough up. You have a lot of bruising or the bruising won t go away. If you cannot get in touch with your Case Manager or another member of your health care team, contact your family doctor or go to the nearest Emergency Department. Call your family doctor if: You have diarrhea that does not go away after a few days. Your medication has changed after surgery. You have any other medical concerns not related to your surgery. Note: It is important to tell your Case Manager about any contact with your family doctor or visits to the Emergency Department that are related to your surgery. 34 Copyright 2010, Alberta Bone and Joint Health Institute. All Rights Reserved. January 2014