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KNEE REPLACEMENT (Page 2)

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					Posterior
Total Hip
Replacement
The Procedure and Going Home




                               Joints In Motion
                               HEALTHCARE EDUCATION
                                     Posterior
                                     Total Hip Replacement


                                     This booklet has been developed to help you
                                     understand your total hip replacement surgery.
                                     It will help you find the answers to questions
                                     you may have about your surgery. It is divided
                                     into the following sections:

                                     Section 1
                                     Preparing for Your Hospital Stay       2

                                     Section 2
                                     The Hip Joint and the Hospital Stay    6

                                     Section 3
                                     Rehabilitation                        12
All of us feel more comfortable
dealing with changes in our bodies   Section 4
when we understand what is           Discharge options                     24
occurring, why it is happening and
how it can be treated.
That’s why the staff of Moses Cone
Health System has developed this
booklet. This booklet was revised
in May 2007.
                                                   Posterior Total Hip Replacement




                           Preparing for Your
                                Hospital Stay
What Preparations Should I Make
for My Return Home?

The most important preparation you should          ■Making sure that you have a high, firm chair
make is to arrange for someone to stay with        with armrests to help you sit and stand.
you for one to three weeks when you go home.
Most patients leave the hospital two to three      ■ Removing any furniture which might cause
days after surgery and will need assistance when   you to trip and fall, particularly items in stairs
they return home. It is important that this        and hallways.
person is able to assist with bathing, dressing,
meals and transportation to doctor visits.         ■ Arranging the most frequently used kitchen
                                                   utensils and food on shelves and counters that
Other preparations include:                        can be reached easily.
■ Removing all throw rugs which might cause

you to slip and fall.                              ■ Arranging for someone to care for or feed
                                                   your pets.
2   PREPARING FOR YOUR HOSPITAL STAY                                                  HEALTHCARE EDUCATION
Are There Any                                  ■ A short housecoat or robe that opens down
Medications that I                             the front.
Should Stop Taking
Before Surgery?                                ■ Comfortable supportive shoes for walking.
Ask your orthopedic doctor if you should       Low-heeled, non-skid shoes with laces are
stop taking any medications or herbal          suggested. Slip-on, backless bedroom slippers
supplements before being admitted to the       are NOT safe to use after hip surgery.
hospital. It is usually recommended that
people stop taking aspirin, products           ■ Bring short gowns, pajamas, underwear and
containing aspirin, anticoagulants (such as    socks/stockings and one set of street clothes to
Coumadin) and anti-inflammatory                wear home.
medications (such as Advil, Ibuprofen or
Aleve).                                        ■  Any walking aid that you are presently using
                                               at home, such as a walker or crutches and a
It is important to ask the doctor              list of other adaptive equipment you may
when to stop taking these                      have at home, such as a reacher.
kinds of medications. If you
need medication for pain relief,               ■Any favorite items that you may want for
you need to ask your doctor                    personal hygiene.
about ordering an aspirin-free
product.                                       ■ Any education materials you received at
                                               preadmission classes.

What Do I Do if I Smoke?                       ■ A copy of your Living Will and Healthcare
The hospital is a smoke-free environment,      Power of Attorney if you have either one.
and you will not be allowed to smoke on the    Hospital personnel are required by law to ask
hospital campus. You should try to quit        for these when you are admitted. Hospital
smoking before your surgery or you will need   personnel will make a copy for your medical
to discuss alternatives to smoking with your   record and return your original to you.
doctor.
                                               ■ A copy of your insurance card. Your case
                                               manager may need this information when
                                               determining insurance coverage for
What Do I Bring With Me
                                               equipment, follow up therapy options, etc.
to the Hospital?
■ A list of all the medications that you are

presently taking, including the dosages and
the times they are taken. (Do not bring any
medications to the hospital.)




HEALTHCARE EDUCATION                                                 PREPARING FOR YOUR HOSPITAL STAY   3
Exercises to Help You
Prepare for Surgery
The following exercises will help you          Exercises should not cause soreness that lasts
prepare for the activities you will be doing   into the next day or pain or fatigue for more
after surgery. These exercises focus on the    than 30 minutes after you have stopped
muscles you will need to get out of bed and    exercising. If soreness does occur, decrease your
begin walking.                                 number of repetitions.



                                                    Ankle pumps
                                                    Bend your ankle up, pulling your toes
                                                    toward the ceiling. Then bend your ankle
                                                    down, pointing your toes away. Repeat 10
                                                    times for each leg.



                                                    Knee presses
                                                    Lie on your back and press your knee
                                                    into the bed. Tighten the muscle on the
                                                    front of your thigh. Hold for 5 counts.
                                                    Repeat 10 times for each leg.



                                                    Bridging – one leg
                                                    Lying on your back, bend the knee of the
                                                    leg you are not having surgery on and
                                                    place your foot flat on the bed. Push
                                                    down with this leg to lift your hip up off
                                                    the bed, keeping the leg you will be
                                                    having surgery on straight. Lower hip and
                                                    repeat 10 times.



                                                    Chair push ups
                                                    Sit in chair with armrests. Place your
                                                    hands on armrests. Straighten arms,
                                                    raising buttocks up. Slowly return to
                                                    starting position. Repeat 10 times.


4   PREPARING FOR YOUR HOSPITAL STAY                                             HEALTHCARE EDUCATION
Common Lab Tests Your
Doctor May Order.
Your doctor may order certain test(s) to be                           We hope the explanation of your test(s) will be
done before you have surgery or while you are                         helpful to you and your family. You may ask
in the hospital. Below is a general explanation                       your doctor for the results of these tests.
of some routine tests your doctor may order.


■ Arterial Blood Gas (ABG) – A test used to                           likely to have abnormal bleeding during
determine the amount of oxygen, carbon                                surgery or procedures.
dioxide and other chemicals in the blood. If
required, this bloodtest will be done at the                          ■ Type and Screen, Type and Crossmatch –
same time as other pre-operative tests but                            Tests which identify your blood type before
drawn from a different location on the arm.                           surgery.

■ Chemistry (CMET, BMET, Electrolytes) – A                            ■ Urinalysis (UA) – A test which checks your
test that checks the chemicals in the blood to                        urine for signs of kidney or bladder infection
determine the normal body function of the                             or disease.
heart, lungs, bones and kidneys. The
cholesterol level and the general nutrition of                        ■ Chest X-ray (CXR) – An X-ray to detect lung
the body also may be determined.                                      disease or determine the size and position of
                                                                      the heart, ribs or other structures of the chest.
■ Complete Blood Count (CBC) – A test that
provides a great deal of information about the                        ■ Electrocardiogram (EKG/ECG) – A record of
overall general health of the body by                                 the heart’s electrical activity which is
examining blood cells. This test can also                             important in determining how the heart is
identify complications caused by anemia (low                          functioning.
iron in the blood), infection or bleeding
problems.

■ Differential (Diff) – A test done to examine
the white blood cells to check for infection and
to detect patients who may be at risk for
infection after surgery.

■ Prothrombin Time (PT), Partial
Thromboplastin Time (PTT) – Tests done to
check for signs of abnormal bleeding. It is
done to identify patients who may be more


     NOTE: Many people wonder if they will be routinely tested for HIV while in the hospital. In North Carolina, you must give
    consent for HIV testing of your blood. An exception to this is if a healthcare worker receives a needle stick or other exposure to
               your blood. If this happens, state law requires HIV testing. You will be notified if this testing is necessary.

HEALTHCARE EDUCATION                                                                                  PREPARING FOR YOUR HOSPITAL STAY   5
Posterior Total Hip Replacement




The Hip Joint and
the Hospital Stay
                                                   How the Hip Works

                                                   What does a normal hip look
                                                   like?
                                                   The hip is a ball and socket joint. The ball (head) of
                                                   the thighbone fits into the socket of the hip joint.
                                                   Smooth material called cartilage covers the surfaces of
                                                   the hip bones and acts as a cushion between the ball
                                                   and socket of the hip joint.
                                     HEALTHY HIP


                                                   What is a problem hip?
                                                   When conditions such as arthritis occur, the smooth
                                                   cushion which covers your hip bones is worn away
                                                   and the joint space narrows. This causes the ball
                                                   (head) of the thighbone to rub directly against the
                                                   socket. This is why you will have pain and joint
                                                   stiffness when you walk.
                                    PROBLEM HIP



                                                   The artificial hip joint has two
                                                   parts:
                                                   ■ A ball-and-stem portion which replaces the head of

                                                   the thighbone and fits directly into the thighbone.
                                                   ■ A cup portion which replaces the socket.



                                                   An example of the artificial hip joint is shown in the
                       ARTIFICIAL HIP JOINT        picture to the left.


6   THE HIP JOINT AND THE HOSPITAL STAY                                                        HEALTHCARE EDUCATION
When Will I Be Admitted                            What Bandages and
to the Hospital?                                   Tubes Will Be Used?
You will be admitted the day of surgery.           Staples usually are used to close hip incisions.
General information will be explained to you       There will be a bulky dressing on the
by your nurse. Specific information about          incision, which will be changed two to three
your surgery is explained below.                   days after surgery.


How Is Total Hip                                   Drainage Tube
Replacement Done?                                  You may or may not have a drainage tube
An incision about 6 to 12 inches long is made      coming from under your bandage. This tube
over the hip joint. The top (ball portion) of      allows blood to drain from your hip incision
the thigh bone is removed, and a tunnel is         into a container. Your nurse will empty this
drilled down the shaft of the bone. A metal        container every eight hours or more often if
rod with a metal or ceramic ball attached to       needed. This tube will be removed by your
the end is fitted into the thigh. In the pelvis,   physician one or two days after surgery. An
the damaged socket is replaced with an             example of the drainage tube is shown in the
artificial socket, usually made of hard plastic.   picture below.
Sometimes, special cement is used to hold
the prosthesis in place, especially in people
with poor bone quality or who are older and
inactive. Other times, a cementless
prosthesis, which is made of material that
bone can heal to, is used. A cementless
prosthesis often is used in patients who have
good bone quality and those who are young
and physically active. The operation usually
takes two to four hours. Your doctor will
talk to your family in the surgical waiting
room after surgery.                                Hip drainage tube




HEALTHCARE EDUCATION                                                    THE HIP JOINT AND THE HOSPITAL STAY   7
IV Line                                           Foley Catheter
This is a tube which is connected to a small      You may or may not have this tube, depending
plastic needle placed in your vein. You will be   on your physician’s orders. This is a small tube
given fluids through this tube for a day or two   device which is placed in your bladder and
after surgery. An IV pump is pictured above.      connected to a drainage bag. The purpose of
                                                  the Foley catheter is to measure your urine
                                                  output after surgery.

8   THE HIP JOINT AND THE HOSPITAL STAY                                             HEALTHCARE EDUCATION
How Will My Pain Be
Controlled?
Your physician will order medicine to                    ■ Continuous Epidural Analgesia is pain
ease your pain. This pain medicine may be                medicine that is delivered through a small tube
administered to you by pill, injection, IV, pain         placed in your back. For more on Continuous
pump or epidural.                                        Epidural Analgesia, see appendix A.

■ If your physician orders a pill or an                  ■Ice packs also may be applied to your hip to
injection for pain, you will receive your                help control your pain.
medication every three to six hours,
depending on the medication.                             How Will I Change My
                                                         Position in Bed?
■ Patient Controlled Analgesia (PCA) is pain             A staff member will help you to turn and
medicine that goes through your IV. You                  change your position in bed. Do not try to
control the release of the medicine by                   turn yourself. Make sure you avoid twisting
pushing a button. The PCA pump will only                 your leg when turning in bed. When turning,
release a certain amount of pain medicine                you should have a bed pillow or the
over a certain amount of time, as determined             abduction pillow between your legs. An
by your physician. Later, pills will be ordered          abduction pillow is a large, foam, triangle
for your pain when your IV is stopped.                   shaped pillow. The pillow will remind you to
                                                         keep your legs apart. An abduction pillow is
■ The pain pump is a device filled with a                shown below.
local anesthetic. It is pre-set by your doctor to
automatically deliver a controlled dose of the
medication into your incision area to help
manage your pain.




                       Various
                                                    ■   Listen to music.
                       activities
                       to control                   ■   Watch television.
                       your pain:                   ■   Read books.
                                                    ■   Enjoy visits with your family
                                                        and friends.


HEALTHCARE EDUCATION                                                           THE HIP JOINT AND THE HOSPITAL STAY   9
How Soon Can I Get Out                              How Can I Help Myself
of Bed After Surgery?                               after Surgery?
This varies from patient to patient,                ■ Do breathing exercises to help your lungs.

depending on what your doctor believes is           Take deep breaths and cough every one to
best for you. Most likely your nurse will help      two hours. If needed, your doctor may order
you sit on the side of the bed the evening of       a device called an Incentive Spirometer to
your surgery, depending on your doctor’s            help you take deep breaths. See appendix B
orders. The following day, your nurse or            and C for more information on coughing
physical therapist will help you get out of         and deep breathing (appendix B) and
bed and walk in your room.                          Incentive Spirometry (appendix C).
                                                    ■ Constipation is a problem after surgery. As
Your physician may order a leg splint, called       your diet allows, drink juices and eat foods
an immobilizer, which is shown below. This          with fiber to help prevent constipation.
splint will keep you from bending or twisting       ■ Limit your amount of bedrest. Get out of
your knee and therefore your hip. If your
                                                    bed with assistance as often as your doctor
doctor orders this splint, he or she will specify
                                                    recommends.
when you are to wear it.

                                                    How Can I Improve My
                                                    Circulation?
                                                    Things you can do to improve your
                                                    circulation after surgery are:

                                                    ■ Two easy bed exercises: (see pictures on page 4)
                                                    1. Ankle pumps - bend your
                                                    ankle up, pulling your toes
                                                    toward the ceiling. Then bend
                                                    your ankle down, pointing
                                                    your toes away. Repeat 10
                                                    times for each leg.

                                                    2. Knee presses - lie on your
                                                    back and press your knee into
                                                    the bed. Tighten the muscle on
                                                    the front of your thigh. Hold
                                                    for 5 counts. Repeat 10 times
                                                    for each leg.

                                                    ■ Keep pressure off the back of your knees by
                                                    leaving the bottom of your bed flat. Do not
                                                    put pillows under your knees.


10   THE HIP JOINT AND THE HOSPITAL STAY                                               HEALTHCARE EDUCATION
Your doctor may order one or more of the          When Will I Be Able
following to help prevent blood clots and         to Go Home?
improve circulation:
                                                  In order to go home, you must be:
■ Inflatable wraps that alternately inflate and
deflate when applied to your legs                 ■ Taking pain medication by mouth and no
or your feet before and/or after surgery.         longer have an IV.

                                                  ■ Walking in the hallway with the assistance
                                                  of your caregiver.

                                                  ■ Able to do exercises with the assistance of
                                                  your caregiver as instructed by your physical
                                                  therapist.

                                                  ■ Able to get in and out of bed and back and
                                                  forth to the bathroom with the assistance of
■Elastic support stockings applied                your caregiver.
before and/or after surgery. If the inflatable
wraps or support stockings feel                   ■Go up and down steps, if you have any,
uncomfortable, please inform your nurse.          with the assistance of your caregiver.

■   Aspirin or anticoagulants.

■ Mobility to promote and improve
circulation.




HEALTHCARE EDUCATION                                                 THE HIP JOINT AND THE HOSPITAL STAY   11
                                                  Posterior Total Hip Replacement




Rehabilitation
This section was prepared for you by your         physical and occupational therapists, you
physical and occupational therapists to assist    should feel safe and confident in these
with your transition from hospital to home. It    activities as you return home.
includes precautions you need to protect your
new hip, including how to move in bed, sit,       Please be aware that the suggestions in this
stand, walk, bathe, dress and get in a car        booklet are general principles and guidelines.
properly. Please read this carefully and ask      Your therapist may change or alter directions
about anything that is not clear to you. When     included here to personalize your program to
you leave the hospital, you should be able to     meet your special needs. Finally, instruction
get in and out of bed, walk to the bathroom,      sheets tailored to your needs for stair-climbing
dress and bathe, get in your house and            will be added to your packet.
perform all exercises with the help of a friend
or family member. By working with your



What Precautions Are
Needed After Surgery?
Certain positions can cause excessive stress to   ■ DO NOT bend your operated hip past
your new hip joint and even cause it to           90 degrees (a right angle).
dislocate or “pop” out of joint. It is very
important that you avoid the following three      ■ DO NOT cross your legs or ankles while
positions to ensure the safety of your new        lying, sitting or standing.
total joint:
                                                  ■ DO NOT let your legs roll inward. In
                                                  other words, DO NOT let your toes point
                                                  toward each other.
12   REHABILITATION                                                                 HEALTHCARE EDUCATION
                                   Your Hospital Stay
                                     Before Surgery                             Day of Surgery


   Your Diet                 Do not eat or drink after                  Do not eat or drink before surgery.
                             midnight.                                  You may eat after surgery.

                             Read your Joint Replacement                Use incentive spirometer every hour
                             booklet. Practice coughing, deep           while awake. Continue to cough, deep
                             breathing and bed exercises                breathe and perform bed exercises.
Your Activities
                             (ankle pumps and knee presses -            Keep pillow between your legs when
                             see page 4).                               turning, if ordered by your doctor.


                             Your nurse will give you                   Pain medication.
                             information on controlling your            Use ice pack to hip.
  Controlling                pain and how to rate your pain
  Your Pain                  on a 0-10 scale.




                                                                                                                        Center Spread - Book binds here.
                             Review the Rehabilitation                  Possible Activity:
                             portion of the Joint Replacement           • Sit on side of bed assisted by
                             booklet for the activities you will          nursing staff.
Your Therapy
                             learn after your surgery.                  • Out of bed to chair with Nursing
                                                                          or Physical Therapy, if your doctor
                                                                          approves.

                             Attend the Pre-operative Total              Your nurse will instruct you on
                             Joint Replacement class. Visit the          hospital and department routines.
                             Pre-Admission/Short Stay
Learning About
                             Center. Bring your booklet with
Your Recovery
                             you to the hospital.




                             Think about what you will need             Begin to discuss your discharge needs
                             for recovery at home (i.e.,                with your nurse.
                             caregiver support, equipment,
 Going Home                  home medications, etc.).




  Your individual treatment plan may be different. Most patients who have a Primary Total Hip Replacement are
  may need a few more days. Your healthcare team will adjust this plan to fit your individual needs. Talk with your

14   TOTAL HIP REPLACEMENT                                                                       HEALTHCARE EDUCATION
                                    Hip Replacement Surgery
                                      Day 1 after Surgery                     Day 2 after Surgery                    Day 3 Discharge Day

                                     You may eat solid foods.               Solid foods                             Solid foods


                                     Use incentive spirometer every         Use incentive spirometer every          Use incentive spirometer every
                                     hour while awake. Continue to          hour while awake. Continue to           hour while awake. Continue to
                                     cough, deep breathe and perform        cough, deep breathe and perform         cough, deep breath and perform
                                     bed exercises. Keep pillow             bed exercises. Keep pillow              bed exercises. Keep pillow
                                     between your legs when turning,        between your legs when turning,         between your legs when turning,
                                     if ordered by your doctor.             if ordered by your doctor.              if ordered by your doctor.

                                     Pain medications/begin pain            Pain pills. Use ice pack to hip, as     Pain pills. Use ice pack to hip, as
                                     pills. Use ice pack to hip.            needed.                                 needed.
Center Spread - Book binds here.




                                     Physical therapist will see you        Walk at least twice daily with a        Continue to practice exercises and
                                     to teach you how to move from          walker. Practice mobility and           activities.
                                     the bed to the chair, walking          exercises with physical therapy. An
                                     and exercise.                          occupational therapist may train
                                                                            you on bathing, dressing and going
                                                                            to the bathroom (if appropriate).

                                     Learn about your medications,          Learn about tub/shower                  Review all discharge instructions.
                                     joint precautions and equipment        equipment, etc. Review joint
                                     (walker, commode chair, etc.).         precautions. Learn to care for
                                                                            your incision. Begin reviewing
                                                                            discharge instructions with your
                                                                            nurse. Prepare to go home or to
                                                                            another venue of care.

                                     A case manager will meet with          You and your healthcare team            Discharge home or to another
                                     you to begin planning for your         will discuss your discharge needs       venue of care. Target discharge
                                     discharge needs.                       and confirm your discharge              time is 11 a.m.
                                                                            plans. Home equipment (walker,
                                                                            commode seat, etc.) and home
                                                                            services will be set up, if needed.
                                                                            Plan for transportation home.

                                   in the hospital about three days. Depending on your condition, you may not be in the hospital this long or you
                                   nurses about your recovery goals.

                                     HEALTHCARE EDUCATION                                                                       TOTAL HIP REPLACEMENT   15
Additional Tips to Help                           ■ Carefully follow the instructions given by
You Follow Your                                   your doctor about how much weight you can
Precautions:                                      put on your operated leg:
■ Keep a pillow between your legs when lying          No weight bearing (NWB) – keep leg
                                                      ■



or sitting in a recliner.                             off the ground.
                                                      Touch-down weight bearing (TDWB) –
                                                      ■



■ DO NOT bend to pick up objects off the              touch foot to the ground for balance only.
floor, to touch your feet or to tie your shoes.       Partial weight bearing (PWB) – usually
                                                      ■



                                                      one-fourth to one-half your body weight.
■ DO NOT sit on low chairs, stools or                 Weight bearing as tolerated (WBAT) – as
                                                      ■



toilet seats. When sitting, keep your knees           much as is comfortable.
below your hips.
                                                  These precautions need to be followed during
■   DO NOT sit in rocking chairs.                 all activities throughout the day. Continue to
                                                  follow these precautions until your doctor
■ Continue to use your walker or crutches         allows you to stop. You may have a knee
after surgery as advised by your doctor or        immobilizer or abduction pillow when you
physical therapist.                               come out of surgery. This is to prevent you
                                                  from bending your hip or crossing your legs.
                                                  Your doctor will let you know how often and
                                                  when you should wear your knee
                                                  immobilizer or use your pillow.




                                                          Remember
                                                          ■ DO NOT bend your hip more than
                                                          90 degrees.
                                                          ■ DO NOT cross your legs.
                                                          ■ DO NOT let your legs roll inward.
What Is the Best
Position for Sleeping?
■ You can lie on your back with a pillow

between your legs to prevent your legs from
crossing and rolling inward.

■ You can lie on either side, but you must
keep a pillow between your legs to prevent
your leg from crossing the center of your
body.


HEALTHCARE EDUCATION                                                              REHABILITATION   13
                                                  Where Should I Sit?
                                                  Always sit on a high, firm chair with armrests
                                                  to help you sit and stand. If necessary, add
                                                  extra cushions to raise the seat height or add
                                                  firmness. Your hip cannot bend more than 90
                                                  degrees (a right angle). This means you
                                                  cannot sit on your sofa or any low chairs, and
                                                  you must use caution in your car (see car
                                                  transfer section on page 17). A general rule is
How Should I Get In and                           that seat height should be 19 to 21 inches
Out of Bed?                                       high. This rule also applies to your bed. You
If it is possible, get out of bed toward your     may need to place something sturdy
non-operated side as this is usually easier.      underneath the legs of the bed to elevate it.
Avoid sleeping on a soft mattress. Change         You also will need a bedside commode or a
positions frequently while in bed to              raised toilet seat over your toilet at home.
prevent stiffness. Use a reacher device to pull
covers up from the end of the bed so you will
not have to bend over too far.

To get out of bed:                                Remember
1. Using your non-operated leg, move your
buttocks toward the edge of the bed by             ■   DO NOT cross your legs when sitting.
bridging (see page 4).
                                                   ■   DO NOT lean forward when sitting.
2. Come up onto your elbows while bringing
your non-operated leg off the bed.                 ■   DO NOT raise your knee higher than
                                                       your hip.
3. Push up to your hands until you are
sitting.

4. Rest your operated leg on the floor,
bending your knee as is comfortable.

Reverse this order for returning to bed.


16   REHABILITATION                                                               HEALTHCARE EDUCATION
How Do I Get In and Out
of a Chair (sit-to-stand)?
1. To sit, back up to the chair so that the back   How Do I Get In and
of your non-operated leg touches the chair.        Out of a Car?
                                                   You may drive ONLY with your doctor’s
2. Slide your operated leg forward, reach back     consent.
for the armrests of the chair one hand at a
time and ease into the seat, keeping your          1. The driver should open the door, move
shoulders back to avoid bending too much.          the passenger seat back as far as it will go and
                                                   recline the back of the seat.
3. Sit for only 30-60 minutes at a time, then
get up and walk or practice your exercises.        2. With your walker, back up to the passenger
                                                   seat until you feel the edge of the car behind
4. To stand up, scoot toward the edge of the       your legs. Place your operated leg out in front
chair, place your operated leg forward, then       of you and bend your other leg slightly. With
push up with your hands and non-operated           your left hand, hold onto the dashboard.
leg. Remember to keep your shoulders back          With your right arm, hold onto the door
while standing to avoid leaning too far            frame or backrest of the seat.
forward.
                                                   3. Lower yourself down to the seat, making
                                                   sure to follow your hip precautions.
What Is the Correct Way                            Remember to keep your shoulders back. You
to Walk?                                           may need extra pillows in the seat if it is too
A walker will help you keep your weight off        low.
your new hip joint to allow it to heal. Your       (Continued on page 18.)
doctor will decide how much weight your
operated hip can tolerate. When you go
home, you can walk as much as you can
tolerate without pain or
fatigue. You should                                Remember
continue to use your
walker or crutches after
                                                   ■ DO NOT step unless all four legs of
surgery as advised by your                         the walker are on the floor.
doctor. To walk properly:
1. Set the walker out in
                                                   ■DO NOT use your walker to pull up
front of you so that the                           on – it may tip over.
back of the legs are even
with your toes.
                                                   ■ DO NOT slide or pivot on your foot.
2. Step with your operated leg first.              Take small steps when turning.
3. Taking the weight onto your hands, step
with your non-operated leg.



HEALTHCARE EDUCATION                                                                 REHABILITATION   17
4. Scoot back and recline before you slide
your legs into the car one at a time. Make
sure you do not lift your operated leg too
high. Now you may bring the seat back up
slightly.

5. Have someone close the door for you.
Buckle your seat belt.

6. To get out of the car, reverse the steps.
Make sure you have the back of the seat
reclined as much as possible before sliding
your legs out of the car.

How Do I Get In and Out
of the Bathtub or
Shower
You may shower only with permission from
your doctor.
1. Place a tub bench or shower chair in the
tub as far back as possible. Also, place safety
strips or a rubber mat on the bottom of the
tub. Place a bath towel covering the seat of
the bench or chair to help you slide in and
out.
2. Back up to the tub with your walker until
the backs of your legs touch the edge of the
tub or tub bench.
3. Place your operated leg forward. Reach
behind you with one arm for the back of the
seat, bending slightly at the waist, until you
have one hand on the shower chair or tub
bench. As you start to sit down, reach back
with your other hand as well.
4. Lower yourself to the edge of the seat and
scoot back to position yourself more securely.
5. Lift and slide one leg and then the other
over the tub edge, leaning back to ensure that
you do not bend more than 90 degrees at
your operated hip.

18   REHABILITATION                               HEALTHCARE EDUCATION
                       6. Sit on the seat during the shower. Use a
                       hand-held showerhead and a long-handled
                       sponge or brush to scrub your feet and back.
                       Again, remember you cannot cross your legs,
                       reach your feet or bend forward to turn the
                       water on or off.

                       7. To get out of the tub, reverse the above
                       steps. While still sitting, dry yourself using a
                       reacher or dressing stick to reach your feet.
                       Make sure your feet and the bathroom floor
                       are dry before attempting to stand.

                       8. If you are allowed full weight bearing, you
                       may step into the tub using a grab bar for
                       support. Remember - you cannot bend your
                       hip more than 90 degrees.

                       If you have a walk-in shower:

                       1. Back up to the lip of the shower.

                       2. Step into the shower with your non-
                       operated leg, then your operated leg.

                       3. Reach back with one hand for the shower
                       chair or 3-in-1 commode seat, then reach
                       back with the other hand and slowly sit
                       down.

                       4. Reposition legs in the shower as needed.

                       5. Step out of the shower with your operated
                       leg first.




HEALTHCARE EDUCATION                                      REHABILITATION   19
                            How Do I
                            Sit Down
                            and Get
                            Up From
                            the Toilet?           3. Using the reacher or dressing stick, lower
                            1. You will most      the undergarment to the floor near your
                            likely need a 3-in-   operated leg and slide the undergarment over
                            1 commode seat.       your foot. You will need to lift your leg
                            Your case             slightly.
                            manager will help
                            you obtain one.       4. Slide the reacher or dressing stick over to
                                                  the other side of the waistband and place
2. Place the commode seat over your               your non-operated leg in the hole or bend
toilet (if applicable, remove the bucket.)        your non-operated leg up to place your leg in
                                                  the undergarment.
3. Sit down/stand up following the standard
sit-to-stand instructions on page 17. Make        5. Pull the undergarment up far enough with
sure you do not bend your operated hip            the reacher or dressing stick so that you can
more than 90 degrees and that you use the         reach it with one of your hands without
arms of the commode or grab bars (if              having to bend more than 90 degrees. Pull
applicable). Do not pull up on your walker.       the garment over your knees. Repeat the
                                                  process to put on your pants.

How Do I Dress Myself?                            6. Follow the sit-to-stand instructions on
Your occupational therapist will work             page 17.
with you to find the equipment that best
helps you to get dressed without doing            7. Shift one of your
anything to cause stress to your operated hip.    hands to the middle
Following are instructions for specific           of the walker and
garments:                                         keep your operated
                                                  leg out in front of
Pants and Undergarments                           you. Use the other
1. Sit on the edge of the bed or chair with       hand to pull your
your operated leg in front of you (knee           undergarment and
straight) and operated hip bent no more than      pants over your hip.
90 degrees (you might need to lean back           Switch hands and
slightly).                                        pull undergarment
                                                  over the other hip.
2. Place the waistband of your under-
garment (the side corresponding to your           8. Reverse above procedure to remove
operated hip) on the large hook of the            undergarments and pants.
dressing stick or within the clasped ends on
the reacher.

20   REHABILITATION                                                               HEALTHCARE EDUCATION
Socks/Stockings                                Shoes
1. Sit on the edge of the bed or chair with    Sturdy slip-on shoes with a back are most
your operated leg in front of you (knee        convenient, but you may use elastic shoelaces
straight) and operated hip bent no more than   to make tie-ups serve as slip-ons.
90 degrees (you might need to lean back
slightly).                                     1. Sit on the edge of the bed or chair with
                                               your operated leg in front of you (knee
2. Hold the sock-aid against your leg or       straight) and operated hip bent no more than
stomach with the                                                   90 degrees (you might
open side up.                                                      need to lean back
Place your sock                                                    slightly).
over the other end
of the sock-aid                                                   2. Place the shoe in front
with the heel of                                                  of you and to the outer
the sock facing                                                   side of your operated leg.
down. Slide the                                                   Place the large hook of the
sock down until                                                   dressing stick, the reacher
the sock cannot go                                                or a long-handled
any further (the                                                  shoehorn in the back of
toe of the sock                                                   the shoe.
will be touching
the sock-aid), but do not pull the sock over   3. Direct toes into the shoe and then, using
the end with the cord.                         the adaptive device, work your heel into the
                                               shoe.
3. Holding on to each end of the cord with
each hand, toss the sock-aid (open side up)    4. Remove the shoe by placing the adaptive
in front or your affected foot.                device in back of the heel, lifting the foot
                                               slightly and pushing the shoe off.
4. Slide the sock-aid over your foot, point
toes down, and pull the cord evenly and
steadily on both sides of your leg until the
sock is all the way on and the sock-aid
slides out. Release one side of the cord and
pull the sock-aid up.

5. To remove the sock, place the reacher or
large hook of the dressing stick in the back
of the sock and push the sock down and
over the heel. Use your reacher or dressing
stick to pick up the sock.


HEALTHCARE EDUCATION                                                            REHABILITATION   21
Some Helpful Hints for
Homemaking

Cooking:                                            Bed making:
■ Sit in a chair or stool in the kitchen while      ■ Hold on to the middle of the walker with
preparing and cooking food to save your             one hand and use the reacher to pull sheets
energy.                                             into place. Do not bend your hips more than
                                                    90 degrees while arranging sheets.
■ Arrange your most
frequently used                                     ■ You may sit down in a chair next to the bed
kitchen utensils and                                to tuck the corners under the mattress if you
food on shelves and                                 cannot get them with the reacher.
counters that can be
reached easily.                                     Laundry
                                                    ■ Place your dirty clothes over the front of
■ Leave your most                                   the walker and take them to the laundry
frequently used dishes                              room (if accessible) on a daily basis to avoid
in the dish rack.                                   having to carry a large load.

■  Use a reacher to get items from high and         ■ Use a reacher to get clothes in and out of
low shelves or to pick up objects from the          the washer and dryer if you have a front-
floor. Most reachers have a 1-pound weight          loading machine.
limit.
                                                    Other:
■Place hot pans/dishes on a trivet and slide        ■ Approach drawers, doors, oven door, etc.
on the counter.                                     from the side.

■ Use a rolling cart to take food from the          ■ Use a reacher to pick up items from the
refrigerator to the counter and from the            floor and from high or low places to avoid
kitchen to the dining room, etc. You may push       bending or twisting.
the cart in front of your walker or roll it along
by your side.                                       ■ Sit in a chair at least 19 inches from the
                                                    floor (for a person of average height). It
■ Always face the counter or appliance being        should have two armrests. (Rule of thumb:
used, and turn your walker with you when            do not sit in a chair where your knees are
reaching for objects.                               higher than your hips.)

■  Use a walker bag or apron with pockets to        ■ Remove throw rugs from the floor to avoid
carry small items such as glasses, books,           tripping over them.
silverware, etc.
                                                    ■ Do not try to walk with walker and carry
■ Attach a cup holder to your walker to carry       something at the same time.
drinks in covered cups.

22   REHABILITATION                                                                  HEALTHCARE EDUCATION
The “Don’ts” of                                  process. Many people want to know about
Homemaking                                       when they can resume sexual activity and
                                                 how to protect their new joint after surgery.
■ Do not twist your body to reach for objects;     First, talk to your partner or spouse about
do take small steps to turn the walker with      your surgery process and changes in sexual
you.                                             activity after surgery.
                                                   Next, talk to your surgeon about the
■ Do not bend over to pick up objects from       recovery (healing) process and when it would
the floor or low cabinets. This may make you     be appropriate to resume sexual activity.
bend more than 90 degrees at your hip              Lastly, take the time to educate yourself
and/or lose your balance. If you do not have     about the various restrictions and methods
a reacher, then wait until someone can pick      used to safeguard your new hip. Proper
up the object for you.                           positioning of the hip during sexual activity
                                                 is very important to reduce pain and stay
■ Do not climb on a foot stool or ladder         within a safe range of motion.
to get objects from high places.                   We understand that intimacy is a very
                                                 sensitive and personal topic for many people.
■ Do not sit on a sofa because sofas tend to     If you would like to learn more about
be too low, too soft, and do not have two        intimacy, information is readily available by
armrests that you can use to push up. You        contacting your doctor’s office or the Medical
may cause too much stress on your hip or         Library at Moses Cone Health System.
bend it too much.
                                                 Questions for My
■Do not sit in a chair that is lower than the    Physician
height recommended by your therapist.
                                                 ■When may I shower, take a tub bath or get
                                                 my incision wet?
Remember                                         ■ How long should I wear my support
                                                 stockings (elastic hose)?
■   DO NOT pivot on your operated leg.
                                                 ■When may I put all my weight on my
■DO NOT twist your upper body while
                                                 operated leg?
on your operated leg.
                                                 ■   When may I drive my car?

                                                 ■When do I go to the physician’s office for
Intimacy:                                        my first follow-up visit?
The “Hidden” Question
                                                 ■   When can I go back to work?
Your concerns about sexual activity after
having a total joint replacement are a valid
and important aspect of your recovery

HEALTHCARE EDUCATION                                                               REHABILITATION   23
Posterior Total Hip Replacement




Discharge
Planning
Who Will Help Me With
My Discharge Needs?

A representative from the case management      insurance allows. The case manager also will
department will help coordinate your care      have lists of home health agencies and
while you are in the hospital and assist you   information regarding chore providers and
with your discharge needs. Discharge options   home making services. It is important to note
will be discussed with you and your family.    that most insurance companies and Medicare
Your case manager will notify your insurance   only cover skilled services such as nursing
company of your discharge needs and will       and physical therapy.
inform you of the amount of coverage your




24   DISCHARGE PLANNING                                                       HEALTHCARE EDUCATION
What Are My Discharge                            What Other Things Are
Options?                                         Good to Remember
                                                 When I Go Home?
Most patients go directly home in two to
three days after total hip replacement. It is    ■ Continue to wear your support stockings
important to arrange for someone to stay         after you go home. Remove these stockings
with you one to three weeks after your           for about 30 minutes two to three times a
surgery. This person should be able to assist    day for bathing and skin care. You will need
with bathing, dressing, meals and                help removing and reapplying these
transportation to doctor appointments.           stockings.

Most patients need some type of follow-up        ■ Tell your physician or dentist that you have
therapy once they leave the hospital.            had a hip replacement before having any type
Depending on your individual needs               of surgery or dental work.
(medical status, homebound status, etc.), you
would typically receive either outpatient        ■ Remove scatter rugs and beware of wet
therapy or home health therapy. Your case        spots or objects on the floor which could
manager would assist in determining your         cause you to slip and fall.
options.
                                                 ■ Call your physician if you have a fever,
If you have a slow recovery, there are options   experience shortness of breath, have chest
for continued inpatient care after your          pain or have pain/tenderness in your calf.
hospital stay. These options would include
skilled nursing facilities or an inpatient       ■ Call your physician if you have sudden or
rehabilitation center. Your healthcare team      gradual change of feeling in your
will help you determine if you are a             operated leg (sensations not relieved
candidate for any of these options.              by positional changes).

                                                 ■ Call your physician if you experience
                                                 increased pain and/or loss of use in the leg
                                                 that was operated on.

                                                 ■ Continue to do your exercises at home.
                                                 Your home health or outpatient therapist
                                                 may change some of these exercises as you
                                                 get stronger.

                                                 ■ Use ice packs on your hip after exercising,
                                                 strenuous walking or if you notice any
                                                 swelling.

                                                 Be sure to check with your doctor before adding
                                                 any activities.

HEALTHCARE EDUCATION                                                          DISCHARGE PLANNING   25
Appendix A




Continuous Epidural                              What are some possible side
Analgesia Following                              effects?
Surgery                                          ■ Itching.

                                                 ■ Nausea.

This fact sheet explains how continuous          ■ Difficulty urinating.

epidural analgesia, a pain relief method, is
administered and some possible side effects.     Inform your nurse if you experience any of
The decision to use epidural analgesia is made   these symptoms.
by you, your surgeon and your
anesthesiologist.
                                                 An anesthesiologist usually removes the
                                                 catheter two to three days following surgery.
How is continuous epidural
                                                 Removal of the catheter is simple and usually
analgesia administered?
                                                 pain-free since the tube is taped to your back.
An anesthesiologist will insert a small, soft,
flexible tube between the bones of your spine.
This is usually done at the end of surgery
while you are unconscious. The tube is placed
into a space away from your spinal nerves
called the epidural space. The catheter is
taped to your back and connected to a small
pump, which delivers the pain medication.

Where does the pain
medication go?
The pump moves the medicine into the
epidural space slowly. The medicine then
moves from the epidural space into your
spinal nerves, where it blocks your pain.




26   TOTAL HIP REPLACEMENT                                                        HEALTHCARE EDUCATION
Appendix B




Coughing and Deep Breathing

Following your surgical procedure, deliberate deep breathing and coughing exercises will be
especially helpful for you as you begin to return to your normal health. Deep breathing is vital to
your well-being. It expands the small air sacs of your lungs, called an alveoli, and helps keep your
air passages free from fluid buildup. As you take deep breaths and cough, you will move air
through your lungs. This will help prevent lung problems such as pneumonia. Practice the
exercises below before surgery so you can do them easily following your procedure. Your nurse
will encourage and assist you with these exercises during your hospital stay.



1. Place one hand on your chest and one hand
   on your upper abdomen.

2. Exhale, letting all of the air out of your
   lungs as you normally do.

3. Inhale. As you breathe in, feel the hand on
   your abdomen rise. If this does not occur,
   you are not breathing correctly. Exhale.

4. Now take a slow deep breath. Breathe in
   through your nose and remember to fully
   expand your chest. Breathe out through
   your mouth. Concentrate on pushing all of
   the air out of your chest.

5. Take a third deep breath. This time hold it
   and cough two or three times (once is not
   enough). This will help clear your breathing
   passages. Then take three to five normal
   breaths. Let the air out of your lungs slowly
   and relax.




HEALTHCARE EDUCATION                                                             TOTAL HIP REPLACEMENT   27
Appendix C



Incentive Spirometry

Your physician may order a                         Normally you take many deep breaths every
deep breathing exercise device                     hour when you sigh or yawn. It is important
for you, called incentive                          for you to try to resume your normal
spirometer, to help restore                        breathing pattern after surgery. The incentive
and maintain respiratory                           spirometer will help you do this and may
fitness.                                           prevent postoperative respiratory
                                                   complications.
Deep breathing is vital to
your well-being. It expands                                         The incentive spirometer
the small air sacs of your                                          provides you with visual or
lungs, called an alveoli, and helps keep your      positive feedback when you inhale into the
air passages free from fluid buildup.              device. Your nurse will teach you how to use
                                                   this device, if ordered by your doctor.




How to use your incentive
spirometer

1. Hold the device in an upright position.         5. After inhalation is complete and the white
                                                   disk drops to the bottom, continue to hold
2. Set the flow rate indicator at the prescribed   your breath for three seconds.
   level.
                                                   6. Remove the mouthpiece, exhale normally
3. Exhale (breathe out) normally and seal          and cough. Allow the white disk to return to
   your lips tightly around the mouthpiece.        the bottom of the chamber.

4. Inhale (breathe in) slowly and deeply           7. Take a moment to rest and relax and
   through your mouth until the white disk         breathe normally.
   reaches the volume goal. When inhaling,
   maintain the top of the yellow flow cap in      8. Repeat this exercise for five to 10 breaths
   the “best” flow range.                          every one to two hours while you are awake.




28   TOTAL HIP REPLACEMENT                                                          HEALTHCARE EDUCATION
                Posterior Total Hip Replacement

                   Thanks to all who have contributed to making this
                          patient education manual possible.




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