Hip Replacement : On The Mend

Medication

Take all medications as directed.  It is very likely that you will be given a blood thinner to prevent life-threatening clots from forming in the veins of your calf and thigh, either in the form of tablets or subcutaneous injections, which the nursing staff will teach you how to self administer.

NB: post operative medications listed on this protocol must not be administered unless they are written on appropriate medication chart and signed by the doctor.

  • Analgesia: Endone (as per doctors orders), then digesic / panadeine forte (as per Doctors orders).
  • Prophylactic therapy: IV antibiotics as ordered, Fragmin daily until discharge as ordered by the doctor, Patient to wear anti-embolic stockings for 6 weeks, SCD to continue for 48 hours, Calf Exercises.
  • Investigate procedures: FBC, MBA 1st Post-operative day and Check X-ray 1st post –operative day.

Going Home

The average hospital stay after hip surgery is between 3 to 5 days. When you can perform certain skills such as getting out of the bed alone, using the toilet, showering yourself and climbing stairs you can be discharged.

Depending on your condition and after discussion with you, your family, the hospital discharge planner and Dr. Al Muderis will reach a decision regarding your discharge destination, as to whether you go home or to a rehabilitation centre. If you go straight home, you will need help at home for several weeks. If going straight home is too difficult, you may need to spend some time at a rehabilitation centre.


Wound Care

Keep the skin clean and dry. You can have a daily shower as usual and wet the surgical site with warm water and soap, just make sure you dry the area well with a clean towel using padding technique; do not wipe the region.

The dressing applied in the hospital is usually waterproof so it should last a few days, however, it may need to be changed if it gets dirty or becomes loose. A community nurse can help you with the change of dressing if you are not able to do it yourself.

Swelling is normal for the first 3 to 6 months after surgery. Elevate your leg above the level of your hip when lying down and always put a stool under your heel when sitting on a chair.

Apply an ice pack for 15 to 20 minutes at a time, a few times a day for the fist few weeks after surgery.

Sutures

Generally speaking we use a cosmetic technique and suturing material that does not need to be removed, however in certain conditions where this technique is not advisable (such as contaminated trauma or surgery in certain parts of the body) then the suturing material may need to be removed. We usually organise this on your first postoperative visit to the clinic in which we perform a wound check and examination of the region at the same time. Depending on your condition an X-ray may be taken also.


Diet

By the time you leave the hospital, you should be eating your normal diet. Continue to drink plenty of fluids. Consult your doctor regarding taking any vitamins and avoid excessive intake of vitamin K while you are taking the blood-thinner medication. Try to limit your intake of coffee and alcohol. You should watch your weight closely since your body metabolism is different in the recovery stage.


The first post operative visit

We will arrange your first post operative visit between one to two weeks after your surgery. If you are still in the rehabilitation hospital then we will communicate with your rehabilitation physician regarding your well being and visit you there if needed.


Activity

Follow clinical pathway unless otherwise staged by Dr Al Muderis. Elevate foot of bed.

Day 1 Exercises in bed, up with physiotherapist (drains in) late am or pm at physiotherapist discretion using FASF, WBAT, Sit out of bed as tolerated.
Day 2 Progress mobility with physiotherapist.
Day 3 Commence hydrotherapy at physiotherapist discretion & commence crutches as able.
Day 4 - 6 Education handouts given ‘Care of hip’ + ‘Home Exercise program’. Stair practice and discharge information should be given.

***Patient should have raised bed, chair and toilet***
Day 4 *Special* - Patient to be dressed in ‘day clothes’

Drains: Doctor will order removal at 24hrs and IDC 36hrs at 12 MN ABT drains not be on ‘free drainage’.

Wound Management: Change dressings when drain removed and then review twice daily and re-new PRN. Waterproof dressing for showering, and hydrotherapy, Re-apply steri-strips as necessary. Re-dress with Island Tegaderm, Sutures end clipped Day 7.
Day 5 - 7 Discharge: Directly home if patient is independent with ADL’s, Dopplers before discharge, Patient may be discharged earlier if being transferred to a rehabilitation facility. Follow up appointment to be made with Dr Al Muderis (6 weeks following discharge) and outpatient physiotherapy/hydrotherapy.

 
Try to stay active when you get home, but avoid overdoing your exercises. You will face well days and bad days; this is normal. You will gradually get better over time.

Walking

We recommend mobilisation with a small level of weight bearing allowed using a walking aid. This is based on current medical evidence. The amount of weight bearing you will be allowed varies depending on the type of your surgery.

Stair Climbing

This should be limited if possible until healing is far enough along.  When ready, the following information may be useful:

To climb the stairs:  use the unaffected leg to step up first, then bring the affected leg up to the same step, and then bring your crutches or canes up with you.

To go down stairs: put your crutches or canes on the lower step, bring the affected leg down to that step and finally step down with the unaffected leg.


Sitting:

  • Try to organise a comfortable chair with arms and a stool to put under your heels while sitting. The chair should be high enough, especially in case of hip replacement surgery.  Do not sit on low chairs.
  • In cases of hip or knee replacement surgery,  while sitting, do not cross your legs at the knees.
  • When trying to stand up from the chair always use the unaffected leg to push up and keep your affected leg out in front of you.
  • Get up and move around on a regular basis, at least once every hour or two.
  • While seated try to keep moving your toes and ankles up and down, this will help pump fluids up your leg and reduce the chance of deep venous thrombosis.


Sleeping

Sleep on your back with your legs slightly apart or on your side with an abduction pillow in case of hip arthroplasty.  With regards to all other surgeries you should avoid sleeping on the side of the wound for the first six weeks after surgery. It is common to get sudden sharp onsets of pain while you are asleep  and this should disappear after a few minutes.

 

Getting in and Out of Car

If possible, it is advisable to use a high car like a four-wheel drive in the first three months. However, if you have a normal sedan car then you may need to put a pillow on the seat and use the front seat of the car. We do not recommend getting into a sports car, especially if you just had hip replacement surgery.

 

Driving

You can begin driving an automatic car around the 6 weeks mark, provided you are no longer taking narcotic pain medication. If you have a manual gear car then you may need to wait another few more weeks until your leg is strong enough to press the clutch down.


Work

The time to go back to work varies depending on the type of surgery you had and the nature of your work. If you had minor surgery or you work in an office then you could go back to work after two to three weeks of surgery. On the other hand, if you had major surgery or your work requires heavy activity, such as climbing ladders, then you may need a few months before returning to work.

Sex

You can resume your normal sexual relation four to six weeks after surgery. Precautions need to be taken in the case of hip replacement arthroplasty where certain positions are not advisable. For further details you will need to speak to your doctor.

Swimming

You can begin swimming as soon as the wound is healed; approximately six weeks after surgery.


Sports

Certain sports are not allowed in the case of joint replacement surgery. Before resuming sports, you need to discuss the sports you enjoy with your doctor.