Introduction. Welcome to the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust.

Transcription

1 Introduction Welcome to the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust. This booklet has been developed by the Consultant Orthopaedic Surgeons, Nurses, Occupational Therapists and Physiotherapists working in this hospital, as well as people who have had hip replacement surgery. Your name, telephone number and hospital number (if known) on the answer machine and a Nurse Practitioner will call you back as soon as possible. Or contact: The Physiotherapy Practitioner on It will provide you with sufficient information to enable you to make informed decisions about: Your operation and The care that you receive during your stay with us. Please keep this booklet in a safe place and use it as a guide to help answer any questions or concerns that you may have regarding your operation and aftercare. If you do not understand any part of this booklet, or have any further questions or comments about your operation or recovery, please write them down. Bring them with you to your next appointment, when they will be discussed. Alternatively, if you feel you would like to talk to a Nurse Practitioner who works with your Consultant Surgeon please call: Log book: Hospital No: --- / Your hip replacement is an Inserted on / /. Consultant. The Hip and Knee Helpline Telephone: / A Nurse Practitioner will answer your call if available, otherwise please leave: 1

2 Contents Page You and Your Hip Replacement Pages 6-7 Risks of Hip Replacement Pages 7-11 Reducing the Risks Page Benefits of Hip Replacement Page 12 Follow up Page 13 Getting Fit for Your Operation Pages Pre-operative Assessment Pages Bone Donation / Blood Test Information Pages Taking Tissue at Operation Pages On Admission / Pre-operative visit Pages The Operation Pages Post operative period Pages Activities of Daily Living: Physiotherapy Pages Occupational Therapy: Post-Operative Precautions Pages Self Care Page 31 Transfers Pages Domestic tasks Pages Getting in and out of the car Pages Work, Leisure and Sexual intercourse Pages Discharge Home Pages Tips to Remember Page 41 First Follow up / Telephone Contact Numbers Pages Notes section Page 44 You and Your Hip Replacement When is a Total Hip Replacement Recommended? People are considered for hip replacement if: You have significant pain during the day. Your activities of daily living are severely restricted. The pain disturbs your sleep. Your symptoms are not relieved by conservative treatment, (such as painkillers and the use of a walking stick, etc). Hip pain and stiffness often occur as a result of: Osteoarthritis (the breaking down of cartilage in your joints, mostly due to wear and tear), which makes your hip bones grate together, causing pain. Rheumatoid arthritis. Infection. Congenital hip dislocation Following injury to your hip and loss of the blood supply to the bones of your hip. Like your own hip, your hip replacement is made up of a ball and socket that fits together to form a joint. 2

3 After carefully finding the cause for your hip problem: Your Consultant Orthopaedic Surgeon chooses the best joint replacement design for you. In order to get the most benefit and results from your surgery, it is important that you: Take an active part in your rehabilitation. Follow the advice of your health care team. Risks of Hip Replacement Infection: At this hospital there is approximately a 0.5% (1 in 200) chance of infection occurring around your hip replacement. The national rates for such an infection are 2.99% (6 in 200). Please see Risks of infection after surgery at the Robert Jones & Agnes Hunt Hospital booklet. This could happen at the time of surgery, or later in life following spread from another source of infection. It is a wise precaution to inform your doctor, dentist, or hospital that you have had a hip replacement when you visit them for treatment. In some circumstances, you may be required to take a short course of antibiotics to prevent an infection. Your risks of such an infection occurring are increased if you suffer with: Diabetes. Rheumatoid arthritis. Psoriasis. Leg ulcers. You are overweight. You are having revision hip replacement surgery. You have other inflammatory conditions. If the artificial joint becomes infected it will probably need to be removed and replaced again at a later operation, after the infection has cleared. This may mean that you are in hospital for at least two weeks. Very occasionally, it is not possible to put an artificial joint back in the hip. This would mean that your leg is left short and is less mobile. This is known as a Girdlestone procedure. Dislocation: The artificial joint does not have the ligaments of the natural hip joint and is therefore less stable, particularly in the first few months after surgery, until your muscles have regained their strength. If you suffer with Rheumatoid Arthritis your risk of dislocation is increased. You should follow the instructions given to you by your Consultant surgeon and the rest of the team to minimise the risk of dislocation. 3

4 Nerve and Blood Vessel Damage: Damage to nerves and blood vessels on and around the bone and soft tissues surrounding the hip can occur during the operation. This is rare; however should it occur this can include: Blood Clots: All patients having lower limb surgery have a high risk of developing a clot in the veins of the leg, known as a deep vein thrombosis (DVT). Damage to a nerve resulting in a foot drop. This means that your big toe would be pointing forwards (like a ballet dancer) and you would be unable to pull your toe to an upright position. This would not stop you from walking; you may however need to wear a splint to support your foot. A foot drop may take several months to get better. Sometimes the damage to the nerve is permanent. This is a rare complication, but if you have a foot drop of those affected approximately 5 % (5 in 100) will never recover from this. Should this happen the leg, particularly the calf is Very painful / tender Swollen Sore Red If this occurs you will be commenced on Warfarin tablets, usually for a period of three months. It is safe to stop Warfarin completely when directed to do so by your GP / Haematologist. If this occurs after your discharge from hospital, your GP should be notified immediately. Early Loosening: Occasionally the artificial hip becomes loose or wears for various reasons. If this happens, the operation will need to be repeated, this is called a revision procedure. Discomfort from Wires (if used): Sometimes the wires that are put into the bone around the hip cause discomfort. You should discuss this problem with your surgeon at a follow up appointment should it occur. Occasionally this clot can move to the patient s lung. This is called a pulmonary embolus (PE) and can cause the patient to become seriously ill. If you become suddenly breathless your GP should be notified immediately OR Dial 999 if the breathlessness is severe. The risk of death caused by a PE, although small, is possible for several months following hip replacement surgery. 4

5 Death: Can occur not just from a PE, but from other medical complications not related to the hip. It is important to take all these risks into consideration before agreeing to undergo surgery. This is a very rare complication, less than 0.5% (1 in 200). Leg Length Discrepancy: It is sometimes difficult to achieve identical leg lengths after a hip replacement as the degree of arthritis and loss of bone is variable. Any discrepancy in length can be corrected with a heel or shoe raise. If needed, this will be organised either on the ward or at your follow up clinic appointment. Reducing the Risks: We are constantly striving to minimise the risks of hip surgery while you are in hospital by taking the following precautions: Your attendance at pre-operative assessment clinic prior to admission, to establish your fitness for both anaesthetic and surgery; and sorting out any problems before your admission. Careful insertion of the artificial hip. Giving antibiotics to prevent infection at the time of surgery. The use of mechanical foot pumps, getting you up and walking early and occasionally using medication to thin the blood to prevent blood clots. Please remember that over 90% of patients who have had total hip replacements are delighted with their new hip. It must be emphasised that at this hospital less than 5% of patients experience complications. Benefits of Hip Replacement Pain Relief: The pain you experience from the arthritic joint will disappear. Initially you will experience a different type of pain as a result of the surgery; this will get better as your recovery progresses. Improved Movement: You should be able to walk, at least the same distances and probably even further than before your surgery. You should find stairs and everyday activities easier. Quality of Life: Your overall quality of life should improve. Remember it takes time to recover from your operation and build up your muscle strength. All artificial joint replacements will eventually wear out. How long this process takes depends on a number of factors, however, your hip should give you many years of service before further surgery may be necessary. 5

6 Follow up: After your discharge from hospital your progress will be carefully monitored for many years. You will be required to attend follow up clinics approximately: 6-12 weeks after the date of your operation. 1 Year after the date of your operation. 5 years after the date of your operation. Periodically thereafter as required. Occasionally Consultants alter these times. If you have any worries, problems or unanswered questions please contact: The Hip and Knee Helpline Tel: OR contact the Physiotherapy Practitioner Tel: A nurse / physiotherapy practitioner will give you advice and, if necessary, arrange a further appointment with your consultant. Getting fit for your operation: While waiting for your operation, the time can be used to help prepare yourself through the use of: Gentle exercises to strengthen the muscles that you rely on for: Walking Swimming Gardening Housework. A Physiotherapist can show you additional strengthening exercises if you so wish. Pain control: Other methods of pain control can be discussed with our Pain Nurse Specialist. Stop Smoking: Or at least cut down, this will decrease the risk of developing a chest infection or blood clot (DVT) after your operation. For advice on stopping smoking please contact the Help 2 Quit Helpline Tel: Diet: Eating a healthy balanced diet: Helps weight loss, should you need to lose weight. Helps wound healing. Helps you recover after your operation. Advice on healthy eating is available from our Dietician or your GP. 6

7 Other Dietary Concerns: May include: Anaemia (a lack of iron). Good sources of iron are red meat and dark green leafy vegetables. Constipation. Being over or underweight. Osteoporosis thinning of bones. Information about these can be found in the Hip and Knee Diet Booklet available from the dietician.. General Health: Ensure that any problems with any of the following are treated and cleared before you attend the pre operative assessment clinic: Tooth / gum decay. High blood pressure. Leg ulcers. Chest complaints. Urinary incontinence / burning. Other infections. Please contact your GP and Dentist to eliminate any of these problems. Your operation may be cancelled if these problems remain untreated. Oral Contraceptives: Please notify your Consultant Surgeon if you are taking the pill. If your pill contains Oestrogen you will be required to stop taking this four weeks before your operation in order to prevent an increased risk of blood clots. Please use alternative methods of contraception while off the pill. Hormone Replacement Therapy (HRT) may need to be discontinued four weeks prior to surgery as above. Warfarin: If you are taking Warfarin, please mention it to your Consultant Surgeon. The effect this may have on your admission and treatment will be discussed with you. Home Circumstances: If possible plan ahead and arrange for relatives, friends, or a community hospital to help you on your discharge from hospital. It is important to inform the Occupational Therapist at your pre operative assessment visit if you need help with this aspect of your care. This will reduce unnecessary delays in discharging you from hospital. It is important that you are as medically and physically fit for surgery as possible. This will enable you to make a quicker, stronger and healthier recovery. 7

8 Pre Operative Assessment: Usually two to four weeks before the date of your surgery, you will be required to come to a pre operative assessment clinic, to ensure that you are fit for your operation. It is an ideal opportunity for you to meet some of the members of the healthcare team that will be responsible for your care while you are in hospital. It also provides us with an opportunity to answer any questions that either you or your family may have regarding your surgery or aftercare. Please make a note of any questions you wish to ask, and bring them to this appointment together with: Pulse rate. Oxygen saturation rate (the amount of oxygen in your blood). Blood tests. Urine test + analysis. Physical examination. X rays. An electrocardiogram ECG recording (if you are over 60 or have a history of heart / lung / kidney problems). If you have ongoing medical / weight problems it may be necessary to arrange a scan of your heart (Echocardiogram). You may need a separate appointment to see a Consultant Anaesthetist for an Anaesthetic Assessment to make sure you are fit to have your operation. A sample of urine in the bottle containing powder provided. You will be asked to sign the following forms: A complete list of all drugs that you are taking (your GP can provide this list for you) & alternative therapies and other nonprescription treatments that you are using. Consent to operation Bone / tissue donation / retention and National Joint Registry. A recording of your Blood Pressure (the practice nurse at your GP s can take this for you). The Physiotherapist and Occupational Therapist will explain their roles in your rehabilitation. Any forms that you have been sent please fill these in (if possible) before you come to clinic. The following measurements / investigations will be carried out at this assessment: Blood Pressure. Weight / Height. Any problems that we find from the investigations carried out at this assessment can usually be sorted out prior to your admission. If there are any problems, your GP will be notified accordingly. 8

9 If you develop any illness or infection after this assessment but before your admission to this hospital please phone either: The Hip & Knee Helpline - if you require advice whether to go ahead with your operation. OR Admissions - if you wish to alter the date / cancel your operation: The Hip & Knee Helpline Admissions Bone Donation In order to make way for your new hip replacement; some bone will need to be removed. Rather than discard this surplus bone, it may be helpful to use for another patient who has bone loss where it may promote healing. It is important that the bone for grafting is absolutely safe. All bone banks including the Oswestry Bone Bank take special precautions to ensure this safety. If you agree and are able to donate your surplus bone you will, after careful explanation of this process, be asked to give your written consent. It will be necessary for your blood to be tested for signs of infection; this is normal practice for blood donors. The tests consist of two x blood samples, one taken at the time of your operation and the other taken at least six months later. The later sample can be taken either when you attend an outpatient follow up clinic, or we will come to your home. Once these tests are completed, your donated bone will be processed and used to help others enjoy a better quality of life. If you do not wish to donate your excess bone, no reason need be given and no questions will be asked about your decision. This will not affect your medical treatment. Blood Tests - to make sure your bone is safe to use: The grafting of bone from a donor could give another patient infection if special blood tests were not used. A small number of people carry viruses or bacterial infection and are not aware that they do so. Almost all blood tests are negative, however if they were positive it would not be possible to use your donated bone and it would be discarded. We would tell you the results of your test and their meaning to you and arrange all possible medical treatment, counselling and support. The results are held in strict confidence. The second blood test is taken in case you have only recently acquired the infection. The infections we currently test for are: HIV (the AIDS virus) Hepatitis B and C viruses (causes of yellow jaundice and liver damage) Human T cell Lymphotropic Viruses (causes in about 5% cases lymphocytic leukaemia after approximately 30 years) Syphilis (a bacterial infection that can cause changes throughout the body) In some parts of the world, HIV is commoner than others therefore the chance of acquiring HIV without knowing it is greater. 9

10 Although we test blood samples, it is normal practice to avoid using donors who have placed themselves at risk in these countries. There may be other factors in your past medical history that will prevent you from donating your bone. These will be discussed with you at the pre-operative assessment clinic. For further information please contact: The Bone Donation Co-ordinator Theatres Robert Jones & Agnes Hunt Hospital Oswestry Shropshire SY10 7AG Tel: Taking Tissues at Operation Pieces of bone or joint and closely surrounding tissue may be removed as a necessary part of your hip replacement operation. Some of this tissue may be removed because: It needs to be sent to the laboratory for examination to discover the cause of your hip problem. Small pieces of tissue will be preserved and looked at under the microscope. In addition this tissue may be cultured or chemically analysed to try and detect why a joint has failed or whether it is infected. These small pieces of tissues will be kept and will form part of your medical records. Large amounts of tissue will be disposed of by incineration. The retained tissue may be used anonymously for teaching, quality control and ethically approved research into the causes, diagnosis and treatment of disease. If you do not wish this surplus tissue to be treated in this way please ask the ward staff to let the laboratory know and document your wishes in your notes. Your wishes will be respected and any samples disposed of. This will not affect your current medical treatment and legal rights. It will not be possible to review your samples after they are disposed of, this may affect your future medical treatment. We need your permission to take and keep your tissues for use as above. On Admission From the time of your pre-operative assessment we will be planning your rehabilitation and discharge home. With your help we will assess your individual physical and social needs, involving your family and / or carers if you so wish. When you are admitted to hospital you will be introduced to your named nurse who is primarily responsible for planning your nursing care and rehabilitation. You will be encouraged to take an active role in this process. We believe in involving you in all the decisions that will lead to your full rehabilitation. You are encouraged to bring everyday clothes into hospital with you to wear after your operation. 10

11 Pre-operative visit A Sister / Staff Nurse who works in the Theatre / Recovery Unit will, where possible, visit you sometime during the afternoon or evening prior to your operation. The care you will receive on the day of your operation will be explained to you, this will include: The approximate timing of your operation That a Named Nurse will be responsible for your care immediately before and after your operation. Methods of pain relief after your operation. Please feel free to discuss any concerns or worries regarding the day of your operation at this time. The Operation The operation is usually performed under either: A general anaesthetic and a nerve block. A Spinal / Epidural anaesthetic. The anaesthetist will visit you, assess your needs and discuss these with you. Any previous anaesthetic experiences and your past medical history will be taken into account. The procedure involves : This artificial joint may be fixed in place with bone cement, depending on the type and style of implant used. Your Consultant Surgeon will use the most appropriate implant that meets your individual needs. The Post-Operative Period Immediately after your operation you will be taken to either: The Recovery, where you will spend approximately one hour after your operation or until the recovery staff are satisfied with your progress - or The High Dependency Unit, where you will spend approximately 24 hours, depending on the complexity of your operation and your personal needs. Your progress will be carefully monitored by the Recovery / High Dependency Unit staff during your stay with them. It is usual to feel quite sore after this type of surgery; you are therefore advised to accept pain relief to minimise your discomfort. Making a cut over the side / back of your hip usually between approximately 10 30cm (4 12 inches long). NB: this may be longer for complex or revision hip replacement surgery. The worn out parts of your hip are removed and replaced with an artificial joint. Please ask a Nurse at any time if you need help with pain relief. 11

12 For the first 24 hours you: May have a Patient Controlled Analgesia (PCA) device to relieve pain. Your Recovery Nurse will explain how to use this device, helping you to achieve maximum pain relief. Once this device is removed oral pain relieving tablets will be offered to you. Will have an intravenous infusion (drip). The drip will be removed from your arm once you are drinking normally and no longer need an antibiotic infusion. May have drainage tubes at the side of the hip wound. A blood clot may have developed, if so medication will be prescribed to get rid of the clot. If at any time after leaving hospital you experience pains in your chest and / or breathlessness, contact your nearest hospital or GP or Dial 999 and ask for ambulance control as soon as possible. You may have a clot on your lung and these symptoms must not be ignored. Foot pumps attached to your feet and ankles to help circulate your blood adequately while you are in bed. Rehabilitation: It is vital that you actively participate in your rehabilitation. You will be nursed on your back with the operated limb supported. A physiotherapist will visit you on the ward to ensure that you do routine post-operative exercises. These include: Deep breathing exercises and coughing to improve lung function after your anaesthetic. Leg exercises including moving your toes and feet to maintain muscle strength and stimulate your circulation thus reducing the risk of blood clots developing. If you experience any hot, reddened, hard or painful areas in your legs, please notify the Nurses or Doctors immediately. Once the drains are removed you will be encouraged, with assistance, to sit out of bed in a chair for a short time. You will be getting up to: Wash Dress Go to the toilet Walk by yourself, with a walking frame / crutches when you feel confident and safe. It is important to continue using two crutches at all times after your operation as directed by your Consultant Surgeon or a member of his team. 12

13 A stumble or fall may be enough to: Break the wires (if used) around your hip replacement. Cause both soft tissue and bony injury. Activities of Daily Living Physiotherapy: Following your operation, the Physiotherapist will encourage you to strengthen your muscles and improve the mobility of your joints, helping you to be independent and return to normal movement as soon as possible. This can help to make daily activities, such as walking, easier and may also prevent post-operative problems. You will be advised on the safest and easiest ways to: Move in and out of your bed. Move from standing to sitting. Move from sitting to standing. Walk - Using the most appropriate walking aid. Although walking is the recommended form of exercise, periods of rest are essential. Before your discharge from hospital the Physiotherapist will advise you on the safest method of climbing the stairs. The correct technique is as follows: Hold the banister rail with one hand and your crutches in the other. Going up the stairs: Put the unoperated leg on to the stair. Put the operated leg on to the stair. Bring the crutches on to the stair. Going down the stairs: Put the crutches down the stair. Put the operated leg down the stair. Put the unoperated leg down the stair. Remember Good leg up to heaven Bad leg down to hell! The Physiotherapist will be happy at any time to answer any questions you may wish to ask. 13

14 Occupational Therapy The Occupational Therapist (O.T.) will see you after your operation to assess your ability to manage when you go home. This will involve: Teaching you methods of carrying out everyday tasks e.g. getting in and out of the bath. Providing equipment to help you perform tasks on your own. Usually this equipment is on loan for a period of 16 weeks. Providing treatment to help improve your ability to carry out your everyday activities. Post-Operative Precautions: Following your hip operation, the muscles and tissues surrounding your new hip joint need time to heal. This takes at least six to eight weeks, during which time you must take care to protect your hip and minimise the risk of your hip dislocating. There are three main precautions that you will need to follow as directed by your Consultant Surgeon or a member of his team. 1. No excessive bending at the hip There should be no less than a 90/ right angle between your body and your thigh i.e. Bending your body towards A B your feet, or your operated leg towards your body. It is important that the chair that you sit on at home is at the correct height. 2. Do NOT cross your legs - Imagine you have an invisible line running down the middle of your body between your knees, your operated leg C D should not cross this line. This is a lifelong restriction. 3. No twisting around either when standing or sitting always pick up your feet and take little steps to turn around. Do not swivel on your operated leg. They are: The Occupational Therapist will discuss these precautions with you. 14

15 Self Care You will be taught how to wash and dress your lower half to prevent excessive bending; this will include the demonstration and practice of some specialist equipment which the O.T. will discuss with you. Points to remember when dressing: Dress while sitting down, preferably on the side of the bed, or on a chair (of the correct height). Use the dressing gadgets supplied. Always dress the operated leg first and undress it last. Do not twist to pick things up from behind you. Do wear supportive slip on shoes with a low heel. Avoid wearing tight corsets and support tights. Transfers Bed: The correct height for your bed will be discussed with you. When transferring in to bed: Walk right up to the bed, turn yourself around taking small steps and make sure you can feel the bed on the back of your legs. Take both arms out of your crutches, make An H shape with them and hold them in one hand. Keep your operated leg out in front of you. Taking the weight through your unoperated leg reach behind you with your arms and sit on the bed. 15

16 Use your arms to slide backwards on to the bed, so that your lower legs start to come onto the bed. Start to turn yourself on to the bed so that your legs come completely on to it. You can use the unoperated leg to help sit or lie by bending it up and sliding up or down the bed, keeping the operated leg straight. Reverse the procedure to get out of bed. When standing: Push yourself forwards to the front edge of your chair. For the first six weeks you should sleep on your back. Chair: Choose a firm upright chair preferably with arms. Avoid low soft sofas and armchairs. The O.T. will provide you with any equipment that you may need e.g. chair raisers. When sitting down: Keep the operated leg out in front of you. Place your operated leg out in front of you. Push up on the arms of the chair, taking some of the weight through your unoperated leg. Remember do not sit with your legs crossed, do not bend forwards and avoid bending down either side of the chair. Toilet: Follow the same procedure as sitting and standing from a chair (above). Reach back for the arms of the chair and gently lower yourself down, take the weight through your unoperated leg. The O.T. will provide you with any necessary equipment. Bath or Shower: It is recommended that you do not attempt to climb in to the bottom of the bath for 12 weeks following your operation. The O.T. will provide bathing equipment for you e.g. a bath board and seat. 16

17 Bath transfers: Sit on the side of the bath on the edge of the bath board, remember to reach behind you with your arms and put your operated leg out in front of you. If you have a shower over the bath, remain sitting on the bath board to shower. Domestic Tasks Slide yourself backwards. Lean backwards and holding on to the bath board, lift your legs into the bath. Once in the bath, try to keep the operated leg straight out in front of you. Reverse the procedure to get out. Kitchen: You may need to reorganise your kitchen so that the most frequently used items are between head and waist level when standing. Avoid stretching up to high cupboards and bending to low ones. Use your helping hand to reach things. A stool may be useful at the worktop, sink and / or cooker. You may sit at a table to prepare meals, but make sure that the height of the chair is suitable for you. Eat your meals at the worktop or table where possible. If bending is unavoidable: Position yourself by a stable piece of furniture. Put your crutches on one side. Steady yourself by holding on to the support with one hand. Put your operated leg straight out behind you. Bend your knee on the unoperated led as you reach for the object, taking your weight on the unoperated leg and the supporting hand. When fist at home, it is advisable to bath when someone else is in the house, just in case you need assistance. If you use a shower cubicle, a non-slip mat is advised. Do not bend forward from the waist to the 17

18 floor with both feet on the ground. Laundry, Cleaning and Shopping: You should avoid heavy chores for the first three months, e.g. Vacuuming Changing beds You will need help with these chores. Light tasks e.g. Dusting and washing dishes are acceptable. Put your operated leg out in front of you and gently lower yourself down onto the seat. Slide backward towards the drivers side. Pivot your body around leaning backwards and Gently lift your legs into the car. Straighten yourself up, keeping your operated leg straight out in front of you. Bring the backrest up to a comfortable position. If possible sit to iron taking care not to twist. When loading / unloading the washing machine use the bending technique as outlined above. We encourage a balance between activity and rest. Getting in and out of a Car: To get into the front passenger seat: Make sure the seat is as far back as it will go and that it is reclined. If possible stand on the road rather than the pavement. Give your crutches to the driver. Hold on to each side of the doorframe. Reverse the procedure to get out of the car. Do not attempt to drive a car for six to eight weeks after your operation. You must feel confident to perform an emergency stop before you commence driving. AVOID LOW CAR SEATS and make sure you can operate the foot controls easily and without straining. Start with short distances at first and gradually increase as able. Check with your insurance company that you are covered before you start driving again. A plastic bag can be used to aid transfer, Place it under your bottom to help you slide in and out. However, it should be removed while the car is in motion. 18

19 Work Returning to work will depend on the type of work that you do. Discuss this with your doctor, however you should plan to have at least three months off. Leisure We encourage you to go out and do those things that are part of your normal daily life, as long as you feel comfortable and are not in too much pain. You should avoid activities such as gardening and sport for 6 8 weeks, and discuss the activity with your doctor at your first outpatient appointment. Avoid any sports that require any jumping, pulling, twisting or running, as these put excessive strain on your hip. Sexual intercourse It is advisable to wait six to eight weeks after your operation before attempting sexual intercourse; this allows time for the soft tissues around your joint to heal. Resume your sex life with care and in the absence of pain. Care is needed to avoid excessive bending and twisting of your hip. Men You may find sexual activity more comfortable lying on your back with your partner astride you. Men and Women - you can resume a missionary position, with care. Discharge home You will not be discharged home from hospital until your healthcare team are satisfied that you are not at any risk and that you will be safe and able to manage at home. The average length of stay for this type of operation is four to seven days. This of course depends on the complexity of your operation as well as individual circumstances. If your clips / skin stitches have not been removed before your discharge from the ward, the District Nurse at your local GP practice will remove them at home. This will be arranged for you. After your discharge home please contact the Nurse Practitioner via the Helpline or your GP if: You develop a fever. Notice any redness, increased pain or discharge from your wound. It is important to resolve any problems, no matter how trivial, as quickly as possible. It is normal for your leg to swell after your operation. This can take up to one year to return to normal, and often slightly longer for revision surgery. 19

20 If you have any concerns or worries please contact the Hip & Knee Helpline Tel: Tips to Remember Once You are Home: Do take regular short walks on even ground. You may gradually increase the distance as you get stronger. Do wear sensible shoes slip on if possible. Do sit in a high chair with a firm seat and arm rests. Do use crutches until advised otherwise by your Surgeon, Physiotherapist or Nurse Practitioner. Do climb stairs unoperated leg first. Do go down stairs operated leg first. First Follow up If all is going well at your first check-up you can usually expect to Resume driving (if you have not already done so) only drive short distances at first, avoid low car seats and ensure that you can operate the foot controls easily and without straining. Wean off your crutches onto a stick. Sleep on your operated side. Return to your normal activities of daily living, within reason. Avoid prolonged standing in the beginning. Return to light exercise including gardening, walking, swimming and golf. Be careful to avoid breaststroke and diving as well as high impact sports such as jogging, squash and skiing. Do lie on your back until otherwise advised by your Surgeon or Nurse Practitioner. Do avoid crossing your legs whilst sitting, lying or standing. Do avoid swivel twisting or over reaching, either sitting or standing. Easy does it Do things in moderation with no excessive effort. At twelve weeks discontinue the use of equipment unless advised otherwise. 20

21 Telephone contact numbers: Hip and Knee Helpline or Powys Ward Notes Section Please use this section to make a note of any questions or concerns that you may have or consider important. Please feel free to bring this booklet to your outpatient appointments. Date Seen By X-Rays Comments Clwyd Ward Ludlow Ward Ercall Ward Kenyon Ward Physiotherapy Occupational Therapy Outpatient Clinic appointments