Total Hip Arthroplasty (Replacement) What To Expect

Transcription

1 Total Hip Arthroplasty (Replacement) What To Expect Compiled by Lynbrook New Hyde Park

2 Total Hip Arthroplasty (Replacement): The information below is to be used as an educational resource following your total hip replacement surgery. Expectations, exercises, precautions, concerns, and hints for daily living are included in this packet. Please note, however, that each individual surgery and patient response to surgery is different and only your surgeon or therapist can appropriately progress you. TOTAL HIP REPLACEMENT PRECAUTIONS In order to prevent the complication of a hip dislocation following your total hip replacement surgery, the following preventative measures should be taken. (If your surgeon has additional precautions or has performed a modified version of a hip replacement, they will inform you of any additional concerns.) DO NOT bend forward from the waist with your legs extended, or flex the hip beyond 90 when sitting or lying (this includes bringing your knees toward your chest). DO NOT DO NOT

3 DO NOT cross your surgical leg over the non-surgical leg. DO NOT twist, turn, or rotate your surgical leg inward (toward the big toe). It is very important to sleep on your back with a pillow between your knees the first 6 weeks after your surgery. If you must sleep on your side, be sure to place a pillow between your knees so that the surgical leg does not cross over the non-surgical leg. WHAT TO EXPECT: Following surgery, you can expect pain and swelling that will gradually decrease over the subsequent days. Although bandaged and likely out of view initially, your hip may have many staples along your incision to assist the stitches in keeping the incision closed. Your staples will be removed by your surgeon days after the surgery. Physical therapy will begin immediately during your 2-3 day hospital stay. Most hospitals utilize therapy 2x/day to review your precautions and assist with your walking, range of motion, strength, and swelling. After leaving the hospital some patients will begin home therapy, while others may spend 1-2 weeks in a rehabilitation facility. Outpatient physical therapy will begin approximately 2-3 weeks after your surgery.

4 The inflammatory response is an important part of your body s response to tissue injury and healing, however, icing for minutes every waking hour will assist in both pain relief and swelling control. If your bandage has been removed and your hip is exposed to the outside environment, be sure to wrap the ice in a towel as application of ice directly to the skin may cause damage. WOUND CARE: A soft compression dressing will be applied to your hip, which is often covered with an elastic wrap. This dressing should be comfortable and absorb any leakage of fluid and/or blood. It should be left on for 48 hours unless 1) The dressing becomes loose and is sliding 2) The dressing is too tight and causes discomfort 3) The dressing becomes dirty or blood soaked If you need to re-wrap your hip, change the wound dressing with sterile gauze and begin by wrapping below the hip and working your way above the hip. Attempt to wrap in a figure 8 pattern, as circular wrapping may act as a tourniquet. The wrap should be slightly tighter at the bottom and looser at the top. Wrapping tightly above the hip may prevent venous return and may cause increased swelling below the hip in the lower leg. If the incision remains open and continues to drain, change the sterile dressing and keep it covered. Leave the white adhesive tape strips in place until they fall off on their own. Re-assess the incision in 1-2 days. Bathing & Showering When you can stand comfortably for 10 to 15 minutes, you may shower with a plastic bag over your dressing. Using a sturdy garbage bag and duct tape will prevent leakage of water onto your incision. If you are unable or are uncomfortable performing this method, a sponge bath is recommended until dressings are removed. DO NOT submerge your hip in a bath or pool. It is appropriate to wash the hip lightly with soap and water, but do not soak the leg or scrub the incision as it may open. You may take a shower with the hip exposed only after the staples have been removed. Adaptive equipment is available for showering, toileting, and dressing yourself following your total hip replacement surgery and is often supplied by the hospital as they deem appropriate. If you are experiencing difficulty with daily activities, please discuss this with your physical therapist or surgeon.

5 Medicine: You may be prescribed medication for pain or swelling following you hip surgery. Take only what your Doctor prescribes, as even over-the-counter pain medication may have an adverse effect on your health. It is imperative that you contact your Doctor if you plan on taking any non-prescribed medication. AS PRESCRIBED BY YOUR DOCTOR Pain medication is often prescribed for the first few days after your surgery. Most often, pain medication will contain codeine or a codeine-type drug. Be sure to read the warning labels as analgesic medication may affect your mental status. As tolerated, gradually increase the time between doses and at no time should you take more than the prescribed dosage. Some pain medications, in conjunction with your inactivity from having surgery, may cause constipation. You can minimize this by drinking several glasses of water per day and eating fresh fruits and vegetables. If necessary, contact your surgeon regarding laxatives or stool softeners. Anti-inflammatory medication will assist in the reduction of swelling. Often reduction of swelling will result in less pain and allow greater movement; however, swelling is a part of the healing process and is necessary for full recovery. If prescribed, take only the dosage your Doctor has indicated. Your surgeon might not prescribe medication for pain or swelling following your surgery. Depending on your individual case, they will prescribe medication as they deem appropriate. Reasons to contact your Doctor following surgery (prior to scheduled follow up) 1) Fever above Fahrenheit It is common to run a low-grade fever for 2-3 days following surgery. This is not a significant concern unless your temperature exceeds Fahrenheit. Should this occur, notify your Doctor. 2) Continued bleeding/drainage that has not stopped after 3-5 days It is normal for a small amount of blood/fluid to exit your incision; however, it should be dry and stop draining within 3-5 days. If your wound continues to drain, or begins to drain after scabs have formed, contact your surgeon.

6 3) If you experience severe redness which extends to the entire hip It is common for a small reddened area or a small amount of pus to accompany the incisions. However, if the redness extends beyond the incision and migrates to the remainder of the hip, contact the surgeon, to determine the necessity for further inspection. 4) If pain continues to increase over 3-5 days post operatively The amount of pain after surgery varies from person to person; however, the pain should gradually decrease after the first 3-5 days. If you experience a progressive increase in your pain level, contact your Doctor. 5) Extremity Numbness/Calf Pain If you experience sharp pain in the calf (that is tender to palpation) or numbness in your feet, contact your surgeon. 6) Follow up Appointment Most surgeons require a follow up visit approximately 10 days after your surgery. If you do not have a follow up appointment, it is recommended that you contact your surgeon s office to schedule an office visit to determine the appropriate time to begin Physical Therapy/Rehabilitation. Goals for patients until follow up with Doctor or Physical Therapy Begins: 1) AWARENESS OF HIP PRECAUTIONS!! 1) Keep wound clean & dry to ensure healing 2) Minimize swelling 3) Regain quadriceps and gluteal muscle control & prevent atrophy 4) Improve weight bearing tolerance 5) Be aware of the symptoms of a deep vein thrombosis: *Extreme pain, redness, swelling, and point tenderness in the calf may be signs of a serious blood clot. If you experience any of these symptoms, contact your Doctor immediately. Activity Modification: Unless otherwise instructed by your surgeon, gradually transition from a walker to a single cane (used in opposite hand of your surgical side), to no assistive device as you feel comfortable. Your physical therapist will be able to assist you in determining when you are ready to progress. You may experience pain and swelling after activity the first few weeks. This is normal and you should attempt to put as much weight through the operative leg as is comfortable.

7 Returning to driving requires your Doctor s clearance, however, most patients are permitted to drive (automatic transmission) after 6 weeks. If the surgery is on your left, the wait may be shorter; if the car has standard transmission, it may be longer. Sexual activity is not recommended for the first 6 weeks following your surgery. After 6 weeks, there are modified positions that allow adherence to your precautions. Direct any questions to your physical therapist or Doctor. EXERCISING: The list of exercises, hints, and progression/expectations below are generally accepted in the medical community, however, each individual surgery is different and you may be slightly ahead or behind of schedule. Your surgeon or physical therapist will progress you accordingly to your functional status, and these guidelines are included only to help you understand what is to come. Early Exercises to perform at home: Once you return home, it is very important to exercise several times per day to ensure the return of good muscle control and your hip flexibility. Below are pictures of recommended exercises and stretches that you should perform until you begin physical therapy at which time, your therapist will progress you appropriately. Ankle Pumps: Elevate your leg on a pillow and pump your ankle up and down. 50x, 5-6x/day. This will improve circulation and reduce the risk of blood clots. Be sure to avoid excessive pressure through the calf muscle.

8 Straight Leg Raises: Keeping you surgical leg straight, lift your leg up to the level of your other knee. 30x, 2x/day. Bridges: With your knees bent, lift your torso up as the picture shows. 30x, 2x/day. External Rotation: Begin lying on your back with your surgical leg straight (left picture). Roll your leg outward as shown in the right picture and then back to the starting position. Be sure not to roll your hip inward. 30x, 2x/day.

9 Glut Set: While on your back, squeeze your gluteal (buttock) muscles together and hold for 3-5 seconds. 30x, 2x/day. Adductor Squeeze: With a foam roll or small pillow (at least 6 ) between your knees, squeeze for 3-5 seconds, 30x, 2x/day. Heel Raises: Rise up on your toes. 30x, 2x/day. Weight Shifting: Lean onto your right leg and then rock back to your left leg. Repeat 30x on both legs, 2x/day. (Be sure to hold onto a counter or table).

10 Hip Flexion: Raise your surgical leg to approximately 50 of hip flexion (as shown). Keep your foot under your knee. 30x, 2x/day. Standing Leg Raise: Keeping your knee straight, raise your entire leg as shown above. 30x, 2x/day. Standing Abduction: Move your surgical leg laterally from your body as shown above. 30x, 2x/day. Standing Extension: Move your surgical leg directly behind you keeping the knee straight. 30x, 2x/day ( If you have back pain, lean slightly forward).

11 Helpful Hints If you have difficulty sleeping due to pain, it is recommended that you take any pain medication you have been prescribed approximately one hour before you go to sleep. Keep your medication and a glass of water nearby, in case you need additional medication during the night. It is not uncommon to experience pain while lying still at night and stiffness in the morning. This is a normal occurrence and will usually decrease over the next few weeks. For your safety Remove all throw rugs and keep all walkways clear. To assist in bed mobility and transfers on/off of furniture. Hook your uninvolved foot under the ankle of your surgical leg. Use your healthy leg to assist and swing your involved knee into/out of bed. Ambulation on level surfaces When using crutches the sequence is: both crutches, surgical leg, non-surgical leg. When using a cane, hold the cane on the side of the non-surgical leg. The sequence is: cane, surgical leg, non-surgical leg. Stair negotiation Going upstairs: Non-surgical leg first, then surgical leg, then crutch or cane. Going downstairs: Crutches (both held in opposite hand of banister) or cane, surgical leg, then non-surgical leg. If a railing exists on your staircase, always hold the railing and put your crutches or cane in your free hand. What to expect from (OUTPATIENT) Physical Therapy: The first few days of physical therapy will focus on reducing pain and swelling. Therapeutic exercises will be given to strengthen your hip muscles and improve your flexibility and ability to walk. The exercises and stretches will gradually increase in intensity with the goal of restoring full mobility, strength, and function. Physical therapy may include aquatic rehabilitation. The buoyancy of a body in water results in decreased hip pressures, which allows for an accelerated progression of exercise with less pain. When using a pool, stairs are preferred to ladders to avoid excessive hip flexion.

12 Aquatic Therapy You can expect a full recovery and return to a normal lifestyle with the aforementioned modifications. Sports and recreations such as swimming, biking, and hiking are excellent means of exercise following your total hip replacement. General Expectations / Guidelines for Rehabilitation: Post Operative Week # Inflam. & pain. Improve motion and standing tolerance. Minimize pain & inflammation. Hip strengthening and stairs. Strength & Function.

13 Expected Function Outcomes: WEEKS 0-2: Walk independently with walker Perform independent transfers from bed, chair, & standing Attempt to control swelling and pain with ice and elevation Improve quad and gluteal control Deep Vein Thrombosis Prophylaxis (per physician) Compliance with hip precautions WEEKS 2-4: Weight bear as tolerated with decreased dependence on assistive device Approximately 3 weeks post operative (1 week after incision is fully closed) Begin aquatic therapy program if available - Pool program to consist of walking, stretching, stair training, balance work, squatting, & hip strengthening Continue use of ice and elevation to decrease pain and swelling WEEKS 3-6: Begin stair training (ascending steps with surgical leg) Discontinue use of assistive device as appropriate Continue pool program Improve voluntary gluteal and quad control Minimize pain and inflammation Continue to build strength and endurance Begin cardiovascular exercises Progression of functional activity Be Aware of Precautions: Often patients begin to feel too good and are less mindful of precautions and place themselves at risk for dislocation. WEEKS 5-10: Initiate walking program Begin endurance program in pool (discontinue aquatic therapy at 6-8 weeks) Return to functional activities Descend stairs with adequate control on surgical leg Continue to develop muscle strength and endurance WEEKS 10 on: Full, non-painful motion Strength 85% of non-involved leg Return to previous level of function

14 RECOMMENDED LONG TERM ACTIVITIES AFTER HIP REPLACEMENT: Good: Walking, Stationary bike, Ballroom dancing, Nordic Track, Swimming, Rowing, Cross country skiing, Light weight lifting. If prior Expertise/Experience, you may return to: Street bike, Golf, Elliptical Machine, Canoeing, Ice skating, Downhill skiing. Avoid: Basketball, Baseball, Football, Handball, Jogging, Lacrosse, Soccer, Tennis, Volleyball. Peak Performance Physical Therapy/Aquatic Rehabilitation would like to remind you that the above information serves only as general guidelines for a standard total hip replacement and that multiple factors may influence your actual progress. Please direct unanswered questions to your surgeon or feel free to contact one of our Physical Therapists in any one of our offices peakptfit.com COPYRIGHT :12/2006