Hip Replacement Recovery Guide Table of Contents Congratulations!... 2 Recuperating At home... 2 Safe Activities & Movements... 2 Wound Care... 3 Important Signs & Symptoms... 3 Bathing and Showering... 4 Bruising... 4 TEDS/ Support Hose:... 4 Weight-bearing and Assistive Devices... 4 Preventing Falls... 5 Getting comfortable / Pain Management... 5 Constipation Care... 5 Driving... 5 Notify All Providers... 6 Follow Up Appointments... 6 Safe Activities and Movements... 7 Important Reminders (Do s and Don ts)... 7 Stair Climbing... 9 Chair and Toilet Transfers... 10 Tub and Shower Transfers... 11 Car Transfers... 12 Home Exercises... 13 Metal Detectors... 14 Cold Therapy (Ice)... 14 Questions or Problems... 14 1
Congratulations! Congratulations on your new hip! We encourage you to work hard during your recovery period. We hope that you will have excellent results so that you will be able to participate in the activities that you enjoy! Most joint replacement patients do very well following surgery experiencing no complications. The success of your surgery can depend on recognizing and preventing potential complications. Recuperating At home Change does not happen overnight, and your active participation in the healing progress is necessary to assure a successful outcome. While you can expect some good days and bad days, you should notice gradual improvement overtime. It s important to stay active. The key is to not overdo it. Ask for help when you need it. Whether you are discharged home with VNA services or to a rehabilitation facility, it is important to review the following information. When you go home with VNA, a nurse will call you the following day to set up a time to visit you at home. Safe Activities & Movements After having a total hip replacement, there are important restrictions regarding the range of motion in your hip. It is very unlikely that your new hip replacement will dislocate if you pay attention to the precautions. These precautions should be reviewed with your physical therapists. There are some activities listed below that you should be aware of regarding your new hip. 1. When you are sitting in a chair, do not lean forward to pick anything off the floor, put your socks on or tie your shoes. There are assistive devices that your therapists can suggest as such as reachers that you can use to help. 2. You should keep your knees apart approximately shoulder-width when you are sitting or transitioning from sits to stand. 3. You should not cross your legs. 2
These precautions are most important during the first six months after surgery. Your surgeon will discuss long-term restrictions at your follow-up visit. Others suggestions include sleeping with a pillow between your legs for comfort and safety. Do not be alarmed if you wake up and the pillow is no longer between your legs. Wound Care It is important that you take proper care of your incision to avoid infection. There will be staples along the incision that will be removed at the first follow-up visit with your surgeon, between 10 and 15 days after your surgery. Here s what you need to know: Proper care of your incision will help prevent infection. You may feel some numbness in the skin around your incision that may or may not go away. If you had your hip replaced, you will leave the hospital with the dressing over your incision. This may remain in place for one week following surgery, unless drainage is noted or you are advised to change it. Then you may leave your incision uncovered. You may experience some swelling in your surgical leg. Elevate your surgical leg and apply ice to help reduce swelling. Do not use any soaps or lotions on the incision. Important Signs & Symptoms Warning signs of a possible joint replacement infection include: Persistent fever of more than 100.5 F. Chills Increase in redness, tenderness, swelling or warmth around the incision. Bloody or yellow/greenish drainage from your incision. Increase in pain with both activity and rest. Notify your surgeon if you develop any of the signs. 3
Bathing and Showering Hip Replacement Recovery Guide As long as your incision is not draining, you may shower with assistance after 7 days. Allow the water to run over (do not scrub) the incision, don t let your incision becomes saturated. After showering, pat (do not rub) your incision dry. You should not bathe, swim, or submerge the leg in water until your surgeon has cleared you for that activity. Bruising Bruising may develop on the operative leg. The bruising and swelling may even extend to the knee and ankle which is normal. Men may experience bruising and swelling of the scrotum as well. This will improve with time. TEDS/ Support Hose: You should wear support hose that will be put on at the hospital. You should continue to wear them at rehab and possibly at home, if you have someone to help you put them on. Trying to apply them by yourself may increase your risk of dislocating your hip. If you have assistants to put them on and you find the hose to be helpful for controlling your swelling you may continue to use them. They should be removed at night. Weight-bearing and Assistive Devices Knowing your weight bearing status is very important. Most patients are prescribed weight bearing as tolerated, with an assistive device, such as a walker or purchase, which means they are allowed to put as much weight on the surgical leg when walking as they want. Weight beating and movement precautions depend on how your surgery was performed. Your physical therapist will help to advise you regarding progression from the walker to a cane. You may progress to a cane when you feel comfortable and safe. You should hold the cane in the opposite hand from the hip that was replaced. Some people need to use a cane for up to six weeks after surgery. You should continue to use a cane until your 4
walking pattern returns to normal. Safety is a very important factor in your healing process, as avoiding falls is necessary. Preventing Falls A fall after surgery can damage your new joint replacement. Follow the precautions provided to you by your therapist. Remove scatter rugs and electrical cords that could cause you trip. Wear shoes with rubber soles for good traction. Get up slowly from a chair or bed in case you are dizzy. Remove anything that could block your way while walking. Use your walker, crutches or cane as instructed by your physical therapist Getting comfortable / Pain Management Joint replacement patients have different needs for pain medication following the return home. As time goes by, you will need less and less pain medicine. It doesn t take long before most patients are able to switch from a narcotic to an over-the-counter pain medication, and stop using pain medication altogether. Your doctor will guide you through this transition. Constipation Care The pain medication we prescribed can cause constipation. Drinking plenty of fluids will help. You also may need to take a stool softener or a laxative. Driving YOU SHOULD NOT DRIVE UNLESS YOU HAVE BEEN GIVEN INSTRUCTIONS TO DO SO FROM YOUR SURGEON. Driving is a variable situation after surgery. Your surgeon will take into consideration the following things before releasing you to drive. 5
You may not operate a motor vehicle while taking a prescription (narcotic) pain medication. You should also feel comfortable walking with a cane or without an assistive device before considering returning to driving. You need to use common sense and feel sure that you have adequate control and strength of your leg to be a safe driver. You should wait to drive until you feel absolutely safe behind the wheel. Generally we suggest that patients who have had a right total hip arthroplasty wait 6 weeks before driving. Patients who have had a left total hip arthroplasty should wait approximately 4 weeks. Notify All Providers PLEASE NOTIFY ALL OF YOUR PROVIDERS ABOUT YOUR JOINT REPLACEMENT FOR INFECTION PREVENTION It is uncommon for new joints to become infected during or immediately following surgery, but it can happen at any time in the future. An infection in some other part of your body can spread to your new joint, causing it to become infected. Please tell all of your health providers that you have a joint replacement so antibiotics can be prescribed for any medical treatment, if needed. This is especially important before dental procedures or invasive urinary procedures. Hand washing is the most important step in preventing infection. Follow Up Appointments Your first follow-up appointment will be between 10 and 15 days after surgery. You will either see your surgeon or his/her physician assistant at that visit. Your staples will be removed at this visit. Outpatient physical therapy will usually start as soon as possible after this postoperative visit. The second follow-up visit is approximately 6 weeks after surgery. At the six-week post operative visit, x-rays of your hip replacement will be obtained for your surgeon to review with you. Your next follow-up visit is usually 3 to 4 months after surgery depending on your progress. You should return one year after surgery and every 2 to 3 years after that for surveillance x-rays. 6
Safe Activities and Movements Important Reminders (Do s and Don ts) Continue to use your walking device (crutches, cane or walker) until otherwise instructed by your physical therapist or surgeon. Do not sit for longer than one to two hours without getting up and changing position. When lying in bed, lie flat for at least a few hours each night. Precautions are an important part of your recovery. Make sure you understand whether your surgeon operated through an anterior (front of the hip) or a posterior (back of the hip) incision. Posterior Precautions (If your incision is toward the back of your hip, closer to your buttock) 1. Do not raise your hip higher than hip level or bend forward when seated. NO! 2. Do not cross your legs. NO! 7
3. Do not twist on your operative hip with your foot planted. NO! 4. Do not go into a lunge position (hyperextend leg or swing leg behind you). NO! 8
Stair Climbing Up with the good To properly ascend stairs, it is "up with the good." If there is a rail, hold the rail with one hand and a crutch or cane in the other. If there is no rail, hold two crutches. Advance the stronger (non-operative) leg first, placing it on the step above where you are standing. Advance the weaker (operative) leg up to the same step where the stronger leg is located. Advance the crutch or cane with the operative leg. Down with the bad To properly descend stairs, it is "down with the bad." If there is a rail, hold the rail with one hand and a crutch or cane in the other. If there is no rail, hold two crutches. Advance the weaker (operative) leg first, placing it on the step below where you are standing. Advance the stronger (non-operative ) leg down to the same step where the stronger leg is located. Advance the crutch or cane with the operative leg 9
Chair and Toilet Transfers Hip Replacement Recovery Guide Choose a seat that is high enough to meet your needs. A thick, firm cushion can be used on a chair to temporarily raise the height. Some prefer to build a platform under the chair to raise it up. A raised toilet seat or commode can modify the toilet seat height temporarily. For hip replacement patients, the seat surface should be at least knee height. Choose a seat with arms In the bathroom, a grab bar or firm counter can be used for support. How to come to a sitting position from standing: Back up to the seat until you feel the chair with the back of your legs. Reach back for the arm rest or the seat surface. Lower gently to sitting. If you can not bend your hip or knee well, you may need to keep your leg straight out in front of you. How to come to a standing position from sitting: Scoot to the front of the seat. Use your arms and legs to push up to stand. 10
Tub and Shower Transfers Hip Replacement Recovery Guide Walk-in Shower (Shower Stall) Step over the edge of the shower with your non-operative leg first. Use your walking device (crutches, walker, or cane) or grab bars for support. Use a shower bench or plastic chair if unable to stand to shower. Tub/Shower Combination Step over the edge of the tub with your non-operative leg first. Use your walking device or grab bars for support. A transfer tub bench can be useful to help you get your legs over the tub edge. Glass shower doors may need to be temporarily replaced with a shower curtain. 11
Car Transfers If you ride in the front seat: Move the seat back as far as possible to allow extra leg room. Tilt the seat back to give you more room for leaning back as you enter the car. Back up to the seat, reach back for the seat or the dashboard and lower yourself gently. Scoot backward toward the driver's seat, then swing legs in. If you ride in the back seat: Back up to the seat and reach back for the seat, lower yourself down gently. Lean slightly back to keep from bending too much at the hip. Slide across the seat, leaving legs straight. Have a pillow to support your back against the door. Either seat: If the car seat is too low to sit safely, a cushion or firm pillow can help raise the surface. A plastic bag on the seat will help you slide more easily. 12
Home Exercises Terminal Knee Extension Lie on your back. Place a towel or blanket roll under your knee. Keep the back of your knee in contact with the roll and lift your foot off the bed and straighten your knee. Straight Leg Raising Lie on your back with the non-operative leg bent. Start by doing a quad set (see page 45) on the operative leg. Hold the quad set and lift your leg off the bed, keeping the knee straight. Lying Heel Slides Lying on your back, bend your knee up, sliding your heel on the bed. Belly Lying Hamstring Curls Lying on your belly, legs out straight, bend your knee, lifting your foot off the bed toward your buttock. 13
Metal Detectors Because your new joint contains metal, it is likely that you may set off metal detectors. The most common places are the airport, public buildings, such as pharmacies, court buildings, and schools.(if you set off the metal detector at the airport, you may have to undergo further inspection, so give yourself a little more time to get through security. Cold Therapy (Ice) To help keep comfortable and ease swelling, apply ice (cold therapy) on the procedural area for 20 minutes at a time, 3-4 times per day. In order to prevent a cold "burn," remember to wrap the ice in a towel so that it is not placed directly on your skin. Reusable ice packs can be purchased at your local pharmacy, and we suggest having a few on hand so that you can rotate throughout the day. Bags of frozen vegetables, such as peas, also work just as well. Questions or Problems A great way to ask a question s about problems, or concerns about your recovery after the hip replacement is by using the comment section in HealthLoop, calling our office at 781 337-5555. It is important that you notify other healthcare providers that you have a hip replacement, since you may require antibiotics prior to procedures. 14