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Total Hip Replacement

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									patient education
for those scheduled for surgery
Total Hip Replacement
patient education
for those scheduled for surgery
Discussion of Arthritis
What Are The Major Causes of Joint Pain?
  Osteoarthritis
  Post Traumatic
   Arthritis
  Rheumatoid
   Arthritis
  Avascular Necrosis
  Paget’s Disease
  Systemic Lupus
Osteoarthritis of the Hip

 Ligaments




Femur




                   Pelvis

              Femoral Head   Diseased Femoral Head


             Healthy Hip     Arthritic Hip
Total Hip Replacement: The Implant

 Ligaments                        Acetabular
                                  Cup
                                  &
                                  Acetabular
                                  Head




Femur                            Stem




                       Pelvis

                  Femoral Head                                Modular Neck

             Healthy Hip                 Post-Surgery, with BFH® Implant
Total Hip Replacement: Animated
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Surgical Pro’s
  Major Improvement:
     Pain - Less or no pain medication
     Return to normal, daily activities
     Fitness & recreation
patient education
for those scheduled for surgery
Discussion of Surgery
Preparation for Surgery
 Advance preparation helps
  reduce complications both during
  and after the operation
 A well informed patient recovers
  quicker, and studies show this
 Medical evaluation & diagnostic
  tests will be performed
 Think Ahead
    Special parking permit?
     Discuss this with your surgeon
    Prepare your body
    Prepare your home
Preparing for Surgery: Your Body
 Medications: Advise your surgeon of all medications
  you're currently taking, prescription or over-the-
  counter.
 Prepare Your Skin: Your skin should be free of any
  infections or irritations before your surgery.
 Donate Blood: Although not critical, you may choose
  to donate blood in case you need a transfusion after
  surgery
 Finish Dental Work: If possible, finalize all dental
  work before your hip replacement surgery.
Preparing for Surgery: Your Body
 Lose Weight: If you are overweight, it's a good idea
  to drop some pounds before surgery if possible.
 Stop Smoking and Drinking: It's advisable to quit
  smoking - or at least cut back - prior to your operation.
  Don't drink alcohol for at least 48 hours prior to your
  surgery.
 Urinary Evaluation: If you have a history of frequent
  urinary infections, schedule a urological evaluation
  before your surgery. This is especially important for
  men with prostate disease.
 Exercise: Exercise prior to surgery to increase your
  strength, so you will have flexibility to exercise after
  your surgery.
Preparing for Surgery: Your Home
 Rearrange Furniture: Create wide traffic paths and
  remove obstacles
 Check your shoes: Wear rubber-soled shoes to
  prevent slipping
 Remove electrical cords: To avoid tripping, remove
  them, hide them or tape them to the floor
 Pack up the throw rugs: Rugs can shift or bunch,
  causing you to slip or trip.
 Watch the floor: Always keep an eye on the floor to
  avoid tripping over pets or small objects.
 Purchase assistive devices: i.e. long handled grabber,
  raised toilet seat, shower bench, hand grips
Preparing for Surgery: Your Home
 Stock up on food: Store all supplies
  between waist and shoulder level to
  avoid bending.
 Prepare a bed downstairs: Prepare
  a bed on the ground floor of your
  home to use temporarily
 Get help with household chores:
  Arrange a short stay at an extended
  care rehab facility or ask family and
  friends to help out.
 Insurance: Check with your carrier
  in advance to see if you need pre-
  certification for surgery, as well as
  whether your insurance plan covers
  a private room
Preparing for Surgery: Your Home
 Don’t forget your pets: Arrange for
  someone to care for them. You don't
  want to trip over them or have them
  possibly knock you down, and you
  may have problems picking them up
  or cleaning up after them.
The Day of Surgery
 Plan to arrive at the hospital 2
 hours prior to surgery to fill out
 pre-admission paperwork.
 Make sure you bring:
   Your health insurance card
   A list of your medications and
    any allergies
   Your living will or power of
    attorney
   Emergency contact info
The Day of Surgery
 Don't wear jewelry or
  makeup
 Remove nail polish, dentures
  and contact lenses or
  glasses
 Do not use lotion, perfume
  or deodorant
 Don't eat or drink anything
  after midnight on the night
  before your surgery
 You may brush your teeth
  and rinse your mouth, but
  don't swallow any water
Before Surgery
 After the paperwork is completed,
  your nurse will review your
  personal health history and your
  home medications with you. It's
  important that you share any recent
  changes in your health.

 You'll also be asked to remove your
  clothing and put on a hospital
  gown. Then you'll be assigned to a
  bed in the preoperative holding
  area.
Preoperative Holding
 A nurse will start an intravenous
  infusion
 An anesthesiologist will
  discusses with you the type of
  anesthesia best for your case
 Anesthesia is designed to make
  the procedure as comfortable
  as possible for you
    general anesthetic (asleep)
    spinal anesthetic (awake, but
     no feeling from waist down)
Preoperative Holding
 Answer questions: Regarding your medication,
  allergies, medical history, and your vital signs will
  be taken.
 Receive medication: You'll be given medication to
  help you relax.
 Say goodbye to your family: They'll be taken to a
  waiting area where they can be kept informed of
  your progress during surgery.
 You'll then be wheeled into your operating room.
  The Procedure – Operating Room
 In the OR, you'll be moved from your gurney onto the
  operating bed
    Temperature is intentionally cool to help prevent infections
    Nursing team will cover you with blankets to keep you warm
 EKG electrodes will be placed on your chest and sides
  to monitor your heart
 Then the anesthesiologist will inject medication
  through your IV line.
 A nurse may insert a urinary catheter - a thin, sterile
  tube inserted into your bladder to drain urine.
 The surgery itself generally takes between 45 minutes
  to 2 hours.
The Procedure – Operating Room
 Surgeon determines what length of incision will be needed.
    Minimally-invasive surgery technique (2-3 inches)
        preserves vital muscles & tendons
        less pain, scarring, blood loss, and increased function
         immediately after surgery.
    Traditional hip surgery (6-8 inches)
The Procedure - Recovery Room

 You'll awaken slowly in the
  recovery room, where you'll
  spend your first hour or two
  after surgery.
 Your nurse will constantly
  monitor your progress to
  ensure that your vital signs
  are stable.
The Procedure - After Surgery
 After the recovery room, you'll
  be taken to your hospital room.
 Bulky dressing over the surgical
  incision and may have a drain in
  place to help decrease swelling
  of your hip.
 Your heels will be elevated to
  decrease pressure on the
  surgically repaired hip.
 You'll also be hooked up to an
  IV line, through which you'll
  receive fluids and medication
  (including an antibiotic).
The Procedure - After Surgery
 You'll remain in bed sitting up with nurse's
  assistance
 Nursing team will regularly turn you and provide skin
  care
    Be sure to tell them if you experience any tender
     or burning areas
 Start your home medications as soon as you can
  tolerate liquids
 Diet will be initially limited, the range of foods
  available to you will increase as your appetite returns
 Medications will help reduce any nausea
Hospital Stay
 Day after your surgery
    Technician will draw blood; IV fluids and
     medications will continue
    Nurse will help you to move into a reclining
     wheelchair
 Second day after surgery
    Nurse will remove your incisional drain and
     catheter
    IV fluids may be stopped, and social services will
     discuss discharge planning with you
 Third day after surgery
    Most patients discharged
    You'll be able to visit the bathroom with walker
    Staff will show you how to maintain proper hip
     alignment using the toilet
Hospital Discharge
 Your nurse will change your
  dressing and teach you on
  how to care for your incision
  site at home
 Your pain medication pump
  will also be discontinued.
 You’ll receive discharge orders
  and instructions. If you are not
  discharged to your home,
  you'll go to a rehab unit,
  extended care or skilled
  nursing unit
 Your Healthcare Team
  During your surgery and rehabilitation, you'll work
  closely with a healthcare team that includes the
  following people:
 Orthopaedic Surgeon: surgery and recovery
 Nurses: Pre and post-op surgery
  and pain management
 Physical Therapist (PT): Muscle
  strengthening and exercise
 Occupational Therapist (OT):
  Daily activity management
 Case Manager: Discharge
Pain Management
 Ask for pain management
  BEFORE the pain becomes
  too intense to handle

 Fatigue decreases your
  tolerance for pain, so avoid
  becoming overtired
 Pace your activities to allow
  for rest periods
 If you're not sleeping well,
  inform your nurse
    Your doctor may prescribe
      medication
Patient-Controlled Analgesia.
 Patient-controlled analgesia
  (PCA) provides optimal
  pain relief without the use
  of injections
 Intravenous, continual,
  small dose of pain
  medication
 Small, computerized pump
  allows you to self-
  administer an additional
  amount of medicine as
  needed
 All you have to do is push a
  button
Increasing Muscle Strength
 Key to rehabilitating your hip
 A physical therapist (PT) will
  visit you to
    Review essential exercises
    Cover what to expect from
     your first therapy session
    Answer any questions.
 You'll begin walking and other
  exercises a day or two after
  surgery
 In most hospitals, therapy is
  performed twice a day.
Body Alignment
 Proper body alignment
  helps lessen pain
 Nursing staff will help
  you change position at
  frequent intervals to
  maximize comfort
 Don't try to turn on your
  own following surgery,
  ask for help whenever
  you want to shift position
 Keep a pillow between
  your legs when sleeping.
Pain Medications
 Several types of anti-pain
  medications: narcotic and
  non-narcotic pain relievers,
  muscle relaxants and anti-
  inflammatories
    Administered through
      injections, in pills or via an
      IV tube
    Your doctor may prescribe
      a combination
    If medication does not
      successfully control your
      pain, alert your nurse
Pain Medication Side Effects
 Most common side effects of pain
  medications:
    upset stomach, nausea,
      constipation and drowsiness
 Always take medication with
  something
    Milk, juice, crackers
 Choose HIGH FIBER foods and
  fruit juices
 Drink 5-6 glasses of water daily
 If no bowel movement in 3 days,
  inform your nurse
Prevention of Infection
 The risk of infection following hip surgery is low,
  however it's important to take the possibility seriously.
 Notify your orthopaedic surgeon if:
    The incision site has drainage, redness, swelling
     and/or foul odor.
    You think that you may have an infection.
        an ingrown toenail, bladder infection, skin sores, a
         tooth abscess, etc.
    You have ncreased hip pain at rest or when active.
    You undergo a procedure through which bacteria
     might spread into your bloodstream.
    You have a persistent fever above 101°F for 2
     days.
Deep Vein Thrombosis (Blood Clots)
 Notify your orthopaedic surgeon if you have blood
  clot symptoms:
    Chest pain
    Shortness of breath
    Drainage or foul odor from the incision
    Redness at the incision site
    Redness, warmth or pain in legs
    Excessive pain or swelling in the hip, calf or feet
    Elevated temperature of more than 101ºF
Rehabilitation
 Rehabilitation can take weeks
  or months
 Dependent on the state of your
  health before the operation
 How well you follow the rehab
  regimen
 Be cautious with your new hip
  and avoid overly strenuous or
  prohibited activities
 Be patient - your recovery will
  take some time and effort
 You should again be able to
  enjoy most of the same
  activities you did before hip
  pain
Rehabilitation
 Using a Walker: Start slowly by
  moving the walker a few inches in
  front of you, taking small, even
  steps
 Using Crutches: Require a
  considerable amount of upper
  body strength, so their use is
  advisable only for certain patients
 Exercises: Your physical therapist
  will show you exercises designed
  to strengthen your muscles and
  increase your range of motion
When to Call Your Doctor

 If you experience swelling around the surgical
  incision, or in a calf or leg
 If you have unusual hip or leg pain
 If the incision leaks fluid
 If you have trouble breathing or experience
  chest pains
 If you have fever over 101ºF for 2 days
patient education
After Hip Replacement
Living With Your New Hip - Diet
 May experience some
  loss of appetite
 Eat a healthy, balanced
  diet
 Advisable to take an iron
  supplement or eat iron-
  rich foods to help restore
  muscle strength and
  promote tissue healing
 Drink plenty of fluids
New Hip – Getting Into Vehicles
 Make sure that the passenger
  seat is pushed all the way
  back in your vehicle
 Lower yourself carefully onto
  the seat, keeping your
  operated leg forward and
  allowing the seat to support
  you
 Slide back onto the seat in a
  semi-reclining position and
  pivot your body so that you're
  facing the front of the vehicle
 Pull your legs into the vehicle
  one at a time
New Hip - Walking Back to Health
 Walking is essential to your
  recovery
 Make walking part of your
  daily routine, gradually
  increasing the amount of
  time you spend doing it
 Focus on walking heel to
  toe with a smooth motion,
  spending equal weight and
  time on each foot
 As your recovery
  progresses, move on to
  more advanced activities,
  like stairs
New Hip - Aids to Assist You
 Bathing: Your therapist or nurse will show you
  how to use a shower bench or chair while bathing.
  Use a long-handled sponge, shower hose or hand-
  held showerhead to make bathing easier. You may
  also want to consider having grab bars installed in
  your shower or bathtub to provide support as you
  get in and out.
 Hand Grips: Install handrails or safety bars next to
  stairs. If you already have these in place, secure
  them firmly before your surgery.
New Hip - Aids to Assist You
 Toilet: Use a raised toilet seat to keep your hip in a
  more stable position and minimize bending.
 Dressing: To avoid bending, try to dress while
  sitting on a chair. A sock aid
  and long-handled shoehorn
  can assist you.
 Housekeeping and Cooking: Use
  a long-handled reacher or grabber
  for objects too high or low for you
  to to reach without stretching or
  bending.
New Hip - Best Standing Positions
 When stepping up on a curb, move as close to your
  walker as possible, then put your weight on both
  legs and lift it onto the sidewalk. Step onto the
  sidewalk first with the un-operated leg. Using the
  walker to support your weight, bring up
  the operated leg.
 Use your good leg first in walking
  up stairs, then bring your operated
  leg up to meet it.
  When going downstairs, always step
  down with your operated leg first.
New Hip – Best Sitting Positions
 To sit, back up until the edge of the chair or bed
  touches your leg. Then, using the armrests to support
  your weight, lower yourself into a sitting position. To
  stand, reverse these steps.
 Use a firm chair with a straight back, armrests and a
  high seat.
 Always sit with your knees level with or lower than
  your hips. (Don’t cross your legs.)
 Always sit with your back upright.
 Keep both feet on the floor and your hips 6 inches
  apart.
 Don't let your hip cross the midline of your body.
New Hip – Getting Out of Bed
 Get out of bed on the side of
  your prosthetic hip, keeping
  your thighs apart.
 Pivot on your hips, using
  your arms to help. With your
  good leg, gradually scoot to
  the edge of the bed. Keep
  your operated leg out to the
  side. Do not twist it inward.
 Sit on the edge of the bed
  with your operated leg
  slightly forward. With your
  hands behind your hips, push
  up - without bending forward
  - to stand up.
New Hip – Using the Toilet
 When using the toilet, step back until you feel the
  toilet touch the back of your legs.

 Place your operated leg in front of you, keeping
  your weight on the other leg.

 Looking behind you, grasp the side rails and lower
  yourself onto the front of the toilet, then edge back.
  To stand up, reverse these steps.
New Hip - Intimacy
 Partial hip replacement
  patients may resume sexual
  activity when comfortable,
  as restrictions are minimal.
 Total hip replacement
  patients may usually
  resume sexual activity 4-6
  weeks after surgery.
 Always ask your doctor
  first, though, as this
  timeframe varies depending
  on your type of prosthesis.
Frequently Asked Questions
 When will my staples be
  removed?
  Staples are removed
  approximately 10-14 days
  after your surgery.
 How long do I wear the
  white support stockings?
  This varies by doctor and
  individual recovery times.
  Generally speaking, the
  stockings should be worn
  during the day, but can be
  removed at night. If there
  is no swelling after 2-3
  weeks, use can be
  discontinued.
Frequently Asked Questions
 When do I start physical
  therapy?
  It varies by case and by
  doctor. Ask your surgeon
  for his preference.
 How much weight will my
  surgical leg bear?
  It depends on the type of
  surgery and your doctor's
  individual preference.
  Usually, partial weight
  bearing is recommended.
Frequently Asked Questions
 When can I drive?
  This also varies by doctor
  and also depends on the
  type of surgery
  performed. Usually, you'll
  be able to drive within 2-6
  weeks - your doctor will
  let you know when it's
  safe.
 When can I swim?
  Most doctors agree that
  you should wait 6 weeks
  before beginning active
  swimming. However,
  walking in water is great
  rehabilitative exercise.
Frequently Asked Questions
 When can I take a shower?
  You may shower after surgery.
  Leave the dressing in place.
  Afterward, remove the
  dressing, dry completely, clean
  thoroughly with peroxide and
  apply a clean dressing. Do not
  take a bath until your staples
  have been removed and your
  incision is healed.
 How long after surgery will I
  need to take antibiotics prior to
  dental work?
  For the rest of your life. It's
  recommended that you have
  any dental work done prior to
  surgery, if possible.
thank you

								
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