Total Hip Arthroplasty Standard Protocol: 1. Assess resident within 1-3 days of entering Victoria Place Retirement Residence 2. Weight bearing status noted from physician referral 3. Education on restrictions and precautions, information sheets provided to resident Do not cross your legs at the knees Do not twist your body at the waist Do not turn operative foot inward Do not flex your hip greater than 90° Do not bend at the waist Minimize lifting to no more than 20 pounds in the first three months and 40 pounds thereafter Keep pillows between legs when sleeping Sit only 30-45 minutes at a time May ride in a car, stopping every 30 minutes to get out and stretch for 5 - 10 minutes May sleep on operative side two weeks after surgery with a pillow between your legs Please note the following equipment may be beneficial to improving and maximizing activities of daily living during recovery: Crutches or walker – possibly both Cane Raised commode Shower/tub chair Extended shoe horn Long handled grabber Hip chair (an elevated chair to help prevent bending greater than 90 degrees at the hip joint) Sock aide (to assist in putting on socks) Elastic shoe laces (to avoid bending down to tie your shoes) Long-handled sponge for bathing TED stockings may be prescribed by the physician (worn during the day and removed at night for 2 weeks post-surgery or until swelling is gone) 4. Initial Physiotherapy Assessment Measure hip range of motion, strength, balance, mobility with transfers and ambulation (noting hip precautions) Assess chest as necessary Check Homan’s sign and observe the leg for signs of DVT 5. Physiotherapy Treatment Provided daily by rehab assistant and assessed and re-assessed by physiotherapist once each week for approximately 6 weeks (will vary with each individual’s recovery process) Foot and ankle pumping when lying in bed Education on positioning, transfers, ambulation with aids, and restrictions Progress ambulation as tolerated, and practice stairs where appropriate Active or active assisted lower extremity strengthening exercises – in standing as tolerated (hip extension, abduction, and flexion (with leg extended outward); sitting with theraband for strengthening (hip abduction), quads exercises; and lying (quads, hip abduction and extension) Home exercises to be prescribed by the physiotherapist for the other days of the week Pain management as required to decrease pain and swelling Restrictions: Posterior Approach No flexion greater than 90 degrees, no internal rotation or adduction beyond neutral Lateral Approach As above, including no external rotation past neutral and no active abduction exercises for 6 weeks post THA (Functional abduction for ambulation and transfers in/out of bed is allowed) Greater Trochanter Detached Passive abduction only, unless otherwise ordered by the surgeon Staff and Physiotherapist to Watch for Adverse Signs and Symptoms: Deep Vein Thrombosis Pulmonary Embolism Excessive Bleeding Increasing leg pain Shortness of breath Excessive bleeding after shaving Swelling that does not decrease Chest pain that may be worse Bleeding from the gums with leg elevation with deep breaths Enlargement of the veins near the Coughing up blood Black or red stool skin surface Reddish skin color Rapid heart beat Skin that is warm to the touch Feeling faint The physician should be notified immediately if any resident experiences these symptoms. Total Hip Replacement Recovery Activities of Daily Living: Do's and Don'ts Your new hip is designed to eliminate pain and increase function. There are certain movements that place undue stress on your new hip. For your safety, these should be avoided. This is especially true during the first few months after your surgery. DO NOT move your operated hip toward your chest (flexion) any more than a right angle. This is 90 degrees. DO NOT sit on chairs without arms. DO grasp chair arms to help you rise safely to standing position. Place extra pillow(s) or cushion(s) in your chair so that you do not bend your hip more than 90 degrees. DO NOT get up like this. Keep your involved leg in front while getting up. DO use a chair with arms. Place your operated leg in front and your uninvolved leg well under. DO NOT sit low on toilet or chair. DO get up from toilet as directed by your therapist. Use the elevated toilet seat if we have given you one. DO NOT pull blankets up like this. DO use a long-handled reacher to pull up sheets or blankets or as directed by therapist. DO NOT bend way over. DO NOT turn your knee cap inward when sitting, standing, or lying down. DO NOT try to put on your own shoes or stockings in the usual way. By doing this improperly you could bend or cross your operated leg too far. DO these activities as directed by your therapist. DO NOT cross your operated leg across the midline of your body (in toward your other leg). DO NOT lie without pillow between legs. DO keep a pillow between your legs when you roll onto your "good" side. This is to keep your operated leg from crossing the midline. Activity Continue to walk with crutches or a walker as directed by the doctor or physiotherapist Your physician will determine how much weight you can place on your operated leg Walking is one of the better forms of physical therapy and for muscle strengthening However, walking does not replace the exercise program which you are taught in the hospital. The success of the operation depends to a great extent on how well you do the exercises and strengthen weakened muscles If excess muscle aching occurs, you should cut back on your exercises as directed by the physiotherapist Sitting Avoid sitting more than 60 minutes at a time. DO NOT cross your legs. In fact, keep your knees 12 to 18 inches apart. Always sit in a chair with arms. The arms provide leverage to push yourself up to the standing position. A high kitchen or bar-type stool works well for kitchen activities. Avoid low chairs and overstuffed furniture because they require too much bending (flexion) in your hip in order to get up. Do not bend forward while sitting in a chair, causing more than a 90 degree bend in your hip. Use the toilet seat riser for the next eight weeks to avoid excessive bending of the hips. Bending For the first eight weeks, you should not bend over to pick up things from the floor. You may want to acquire a pair of slip-on shoes and a long-handled shoe horn to avoid excessive bending. Your incision Keep the incision clean and dry. Also, upon returning home, be alert for certain warning signs. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor. Generally, the staples are removed in three weeks. Prevention of infection If at any time (even years after the surgery) an infection develops such as strep throat or pneumonia, notify your physician. Antibiotics should be administered promptly to prevent the occasional complication of distant infection localizing in the hip area. This also applies if any teeth are pulled or dental work is performed. Inform the general physician or dentist that you have had a joint replacement, then antibiotics that are needed during dental or oral surgery, or if a bacterial infection develops can be provided. When Do I return to the Hospital for follow-up with the surgeon? Your first return appointment is 6 weeks after discharge, unless you return here to have your staples removed. (You may wish to have your staples removed by your local doctor.) At your 6 week return you will be examined and have x-rays. Subsequent appointments are then at 6 months, one year, and two years after surgery.
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