Hip Replacement PROGRAM. Nightingale. Home Healthcare

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1 Hip Replacement PROGRAM TM Nightingale Home Healthcare

2

3 Why Do I Need A Hip Replacement? Hip replacements are performed for one reason; something has happened to the hip joint that has made it 1) too painful for activity and 2) structurally inadequate for weightbearing activities. Though these are the only reasons a Hip Replacement is performed, there are many reasons why the hip becomes painful and structurally unsound. The most common among these are as follows: Osteoarthritis (OA) commonly known as degenerative joint disease, hypertrophic arthritis, and degenerative arthritis. The main principle of OA is degeneration of cartilage that leads to changes in the bone structure and eventually to painful and stiff joints. OA mainly attacks large joints: knees and hips. Rheumatoid Arthritis (RA) - this is an autoimmune disease that leads to degeneration in the bone structure of the hip joint and synovial membrane. RA is usually associated with decreased range of motion, morning joint stiffness that lasts about an hour, and moderate to severe pain. Trauma- some fractures that occur in a motor vehicle accident or during a fall may lead to Hip Replacement. * pg.content/content_id.424/mn.local/joint_id.5/joint_nm.hip/ local_id.4/qx/default.htm

4 What To Expect After Your Surgery After your surgery, you will most likely be in the hospital for two or more days along with a potential stay in a rehabilitation facility. Our goal is to prepare you for what is to come after your surgery by answering questions about your joint and addressing your post-operative exercise program that you will use with the guidence of our professional home healthcare team once you return home. Weight Bearing Precautions: After surgery your physician will give you a weight bearing precaution that is unique to each surgeon. For this reason we define each of these for you. It is important that you follow this precaution until notified further by your physician. Please adhere to your weight bearing precaution determined by your physician as marked below. ƛƛ ƛƛ ƛƛ ƛƛ Non-Weight Bearing (NWB) - no weight on the surgical leg. You must use a walker or crutches to avoid bearing any weight on the surgical leg. Toe Touch Weight Bearing (TTWB) - only minimum weight is allowed on the surgical leg. You may rest your toes of the surgical leg on the ground to gain balance but not to bear weight. Partial Weight Bearing this is usually defined as 25-50% of the body s weight allowed on the surgical leg. An assistive device such as a walker or crutches must be used to decrease weight bearing on the involved leg. Weight Bearing As Tolerated - you can put as much weight on the surgical leg as you want, as long as it does not cause sharp or an increased level of pain lasting longer than 20 minutes. Even though you are allowed to bear as much weight as you like, you may be instructed by your orthopedic surgeon to continue using an assistive device for safety reasons.

5 How To Get Home From The Hospital What kind of vehicle should I use? It is best to use a vehicle that is not too high off the ground, doesn t have running boards, and has large accessible doors. You will also want to plan your route from the car to the house and make sure it is a clear path for safe entry into your house. How do I get in and out of the car? First, remember your hip precautions, which are listed next. The therapists at the hospital will work with you on this. But it should be noted that you always want to keep less than a 90 degree angle at the hip joint. This means it will be important to place your surgical leg more forward when getting in and out of the car. It will also help to lean the seat back to decrease the angle on the hip.

6 Hip Precautions In order to perform a Hip replacement the surgeon will have to enter the hip joint through the layers of muscles that surround the hip. This could potentially weaken the stability of the hip joint for a time. For this reason, after the surgery you will have to follow hip precautions to avoid hip dislocation. A physical therapist will contact your surgeon to confirm the hip precautions. Unless instructed otherwise please maintain the following: Do not bend at the waist more than 90 degrees Do not sit in a low chair or couch. Your physical therapist will instruct you which chair will be suitable for you after the surgery. Do not reach down to your toes. Use the equipment that will assist you with socks or shoes. Do not raise your knee higher than your hip. Use an elevated toilet seat. When you sit down, back up until you feel the bed or chair against your legs. Reach back for the bed or armrests of the chair and slide your operated leg straight out in front of you. Do not lean forward as you sit! When you go to stand up, it is very important that you do not bend your hip more than 90 degrees. Do not cross your surgical leg over the other leg. Keep a pillow between your thighs when sleeping. Do not pivot on the operated leg. Take small steps when changing direction. Do not turn or rotate your surgical leg inward toward the other leg. Please note your hip precautions depend on the surgery approach used. Although most hip replacements have these hip precautions, not every hip replacement follows this protocol.

7 Physical Therapy Prior/After Your Joint Replacement. Your therapist will teach you how to do your exercises correctly. You are expected to follow a home exercise program as instructed. The proper exercise program will speed up your recovery and return to your regular activities. All exercises demonstrated are done so by a Physical Therapist.

8 Home Exercise #1: Straight Leg Raise (SLR) Keep the knee of your surgical leg straight by tensing the thigh muscle and lift foot inches off the bed. Lower down slowly and relax. * You may be adviced to bend opposite leg, especially if you have back problems. Then repeat on other leg.

9 Home Exercise #2: Quad Set (QS) With a small towel roll under your knee, push your knee down into the roll by tensing the thigh muscle. Hold 5 seconds and then relax.

10 Home Exercise #3: Ankle Pumps With your feet elevated, move both ankles up and down, like pushing on a car accelerator

11 Home Exercise #4: Sitting Knee Extension (SKE) Sitting in a straight back chair, slowly raise your foot off the floor by straightening your knee (keep your thigh supported on the seat). Hold seconds and then relax down. Repeat for both legs.

12 Home Exercise #5: Resisted Hip Abduction Sitting in a straight back chair with a resistive band around your knees, slowly take your knees away from each other inches, then relax back slowly.

13 Home Exercise #6: Resisted Plantarflexion With the resistive band placed around the ball of your foot, slowly push your foot down against the resistance. DO NOT bend forward at the waist in this position, remember your hip precautions!

14 Home Exercise #7: Isometric Hip Adduction - Pillow Squeezes Sitting in a straight back chair with a folded pillow between your knees, slowly squeeze knees together as strongly as comfortable and hold seconds. Relax. * Remember you should not cross midline with legs due to your hip precautions, so adjust pillow accordingly.

15 !!PLEASE NOTE!! The following exercises are ONLY for Full Weight Bearing (FWB) patients!

16 Home Exercise #8: Standing Heel Raises Standing behind a sturdy chair/ at a counter/ or holding onto stable walker, slowly raise your heels off the floor and then relax back down.

17 Home Exercise #9: Standing Leg Curl Standing behind a sturdy chair/ at a counter/ or holding onto stable walker, slowly bend one knee lifting your foot up behind you to a horizontal position. Hold seconds and then relax back down. Repeat for both legs.

18 Home Exercise #10: Standing Hip Extension Standing behind a sturdy chair/ at a counter/ or holding onto stable walker and keeping knee straight, slowly extend one leg behind you inches and then relax back to normal. Repeat both legs.

19 Home Exercise #11: Partial Squats Standing behind a sturdy chair/ at a counter/ or holding onto stable walker, slowly bend your knees lowering down towards the floor. This is a partial squat, only squat down inches, and then return to a straight position.

20 Home Exercise #12: Standing Hip Abduction Standing behind a sturdy chair/ at a counter/ or holding onto stable walker, keep one knee straight and lift directly out to the side inches and hold seconds. Repeat for both legs.

21 Home Exercise #13: Standing Single Leg Balance Standing behind a sturdy chair/ at a counter/ or holding onto stable walker, lift one foot off the ground while maintaining your balance as best you can. Use your hands to maintain balance only as you need. Hold seconds and relax. Repeat for both legs.

22 Home Exercise #14: Lateral Step Ups If advised by your physical therapist complete standing behind a sturdy chair/ at a counter/ or holding onto stable walker, place your foot on a inch step and slowly lower the heel of your other foot down to the floor and then raise back up.

23 Home Exercise #15: Standing Step Ups Standing facing a inch step. If advised by your Physical Therapist, hold onto a sturdy surface such as a heavy chair or table for balance. Place the foot of your surgical leg up onto the step. Slowly step up. Slowly return to your starting position.

24 Home Exercise #16: Step Downs Stand on a inch low step. If advised by your Physical Therapist, hold onto a sturdy surface such as a heavy chair or table for balance. Step down slowly with your non-surgical leg. Slowly return to your starting position.

25 Home Exercise #17: Standing Kick Backs Stand while holding on to a steady surface, such as a heavy chair or table. Bend your knee as far as it will go comfortably. Hold for a few seconds. Slowly lower the leg.

26 Home Exercise #18: Standing Hip Flexion Stand holding on to a chair or counter.bring hip up < 90 degree in marching position.

27 Other Services: Everyone s needs following a hip replacement differ. You may find physical therapy is not the only assistance you need. Please do not hesitate to inform your therapist if you feel further care is needed. Other services available include: Occupational Therapy: Assessment of your upper body needs and help locating appropriate adaptive equipment such as equipment to assist with picking up items up from the floor or putting on your socks. Skilled Nursing: Assistance with incision care and dressing changes. Home Health Aide / Homemaker/ Companion: Assistance with personal care, cleaning, laundry or meal preparation.

28 Choose Nightingale. Nightingale Home Healthcare is dedicated to Rated providing the highest quality of care while respecting Top 500 the individuality of every patient we serve. For this in the Nation reason we are dedicated to working with you over the next few months to develop an individualized program that will get you back on your feet after your Hip Replacement surgery. Upon discharge from the hospital, please inform your discharge staff that you have already contacted Nightingale Home Healthcare to provide your home based rehabilitation. To ensure you will have everything you need when you get home, a Nightingale representative will help coordinate your care and any special equipment needed. Again, thank you for choosing Nightingale Home Healthcare. We will work with you to help regain your independence as soon as possible and help you meet all your rehabilitation needs. Please let us know if you have any questions or concerns. Dr. Dev Brar, President, Nightingale N I G H T I N G A L E H O M E H E A L T H C A R E IN: (866) IL: (866) MN: (866) NV: (888) TX: (877) CA: (866) (Aspire) TM Nightingale Home Healthcare

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