Patient’s Guide to Hip Replacement
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What is Total Hip Arthroplasty?

A total hip arthroplasty (THA) is a surgical procedure in which the hip joint is replaced. During the surgery, the ball and socket of the hip joint are removed and replaced with an artificial prosthesis.

This type of surgery is usually done when conditions, such as severe arthritis or complicated hip fractures, cause significant joint stiffness and pain, which greatly interferes with a person's ability to function normally.

Following surgery, most patients experience significant pain relief and regain near normal movement in the joint. Total hip arthroplasty patients are then able to carry out normal activities of daily living.

Getting Ready for Surgery

Health Exam

Before surgery, your doctor mav ask YOU to get a general physical exam or special pre-operative tests. This may include a chest X-rav, blood work, EKG of vour heart, or X-rays of your hip.

Medications

It is very important you tell your orthopaedic surgeon all of the oral and injectable medications you are taking, including vitamins, herbs and over-the-counter medications. There are some medications that must be stopped before surgery. You will receive a phone call from the pre-admission testing office approximately one week before your surgery to review the medications you should stop prior to surgery and to discuss when they should be stopped.

Donating Your Own Blood

You may donate your own blood for use during the surgery. If you are interested in doing so, talk with your orthopaedic surgeon for more information. Your blood donation must occur four to six weeks prior to surgery in order for the blood to be processed and ready.

Diet

The doctor may encourage you to diet if you are overweight. Extra \veight can put stress on your new joint. You should eat well-balanced meals for nutritional purposes and drink at least six to eight glasses of water a day.

Smoking

It is highly recommended that you stop smoking prior to surgery because it inhibits your ability to heal timely and properly.

Items To Bring With You To The Hospital

  • Medications in their original bottles should be brought in the dav of surgerv. Once your medications are verified a decision will be made regarding when medication can be returned home.
  • Comfortable, loose fitting clothes and supportive footwear will be needed for therapy sessions.
  • We also ask that you leave valuables at home as Sinai-Grace Hospital cannot be responsible for personal items.

Pre-Surgery Activity

You should strive to maintain an active lifestyle right up until surgery. If you currently exercise continue your routine. The more fit you are before surgery, the smoother your recovery will be.

Preparing your home before surgery will make recovering much easier. Consider the following safety tips:

Throughout Your Home:

  • Be aware of uneven surfaces. If possible, make walking surfaces level.
  • Remove throw rugs.
  • Secure extension cords.
  • Make sure lighting is good. Install night lights in the bathroom and hallways.
  • Place emergency phone numbers by the phone.
  • Choose footwear that is secure on your feet with non-skid soles.
  • Place clothes and items needed in drawers at least waist high.
  • Get a comfortable chair with armrests and a firm seat that keeps your body and legs at a 90 degree angle.

In the Kitchen

  • Replenish your food supply and prepare some meals prior to your surgery.
  • Store items within easy reach in cabinets and refrigerator.
  • Use a Lazy Susan for easier reaching.
  • Have a chair with armrests available to sit in at meals or when you are tired.

In the Bathroom

  • Place a non-skid surface in the tub and shower.
  • Install safety rails in tub, showers and near the toilet if possible.
  • Obtain a raised toilet seat or commode chair with armrests.
  • Use a tub seat and a hand-held shower spray.

After surgery, the Sinai-Grace rehabilitation staff will advise you of any additional equipment you may need for your specific circumstances. You will be best prepared to return home if YOU start making plans for your discharge now. First, arrange for someone to take YOU home from the hospital. Usually, patients leave two or three days after surgery. Second, realize you mav need help with the following:

  • Activities of daily living (i.e.: bathing, dressing)                                        
  • Shopping
  • Transportation
  • Meals    
  • Laundrv

The hospital stay is generally two to three days, but recovery will take longer. Arrange for family or friends to assist you with these daily necessities while you recuperate.

Most patients having joint replacement surgery require continued physical therapy after discharge from the hospital. You will be provided a prescription for outpatient therapy when you are discharged from the hospital.

In the event you are unable to attend outpatient therapy immediately after discharge, arrangements will be made to provide home nursing and physical therapy services.

The Day Before Surgery

It is important to follow the four instructions below prior to surgery:

  • Do not eat or drink after midnight (unless YOU were told to take your medications before coming to the hospital in the morning).
  • Take a mild laxative the day before surgery if YOU have not had a bowel movement.
  • Take a bath or shower at bedtime or early in the morning with an antibacterial soap.
  • Do not smoke three days prior to surgery.

Your surgery may be postponed if you develop any of the following:

  • Fever
  • Sore throat or upper respiratory infection
  • Oral or dental problems
  • Frequent urination or burning with urination
  • Skin infection or insect bites that won't heal

Please call your orthopaedic surgeon if you develop any of the above signs.

When you arrive at the hospital, a greeter will meet you in the lobby on the first floor near the elevators. After registering, you will be escorted to the Pre-op Holding Area on the ground floor. This is where you will get ready for surgery.

  • You will be asked to put on a hospital gown, take off all jewelry and take out your dentures. Please leave all your valuables at home.
  • An intravenous (IV) line will be started to give you fluids and medicine you need during surgery.

When the surgery team is ready, you will be taken by a stretcher to the operating room.

The Operation

  • The surgery team will hegin bv giving vou medicine that will make you sleepy.
  • An incision (or cut) will be made over the hip.
  • Any damaged bone will be removed.
  • The new joint is put into place.
  • A drainage tube may be placed by your joint and the incision will be closed with staples or sutures.
  • A dressing is placed over the incision and you will be taken to recovery where you will stay for several hours.
  • When the anesthetic begins to wear off and you start to become alert, you will be taken to your room.

The surgery will last approximately two hours. Your orthopaedic surgeon will talk to your family after the surgery to update them on your condition.

After Surgery

Breathing Exercises

It is important to begin taking deep breaths and coughing after surgery. These simple exercises should be done every hour while you are awake. This helps to prevent serious illness, such as pneumonia.

You will also have an Incentive Spirometer to encourage deep breathing. You should perform 10 breaths on the Incentive Spirometer every hour. The nurse will assist you, if needed.

Managing Your Pain

An anesthesiologist will discuss the variety of pain management systems available with you in detail on the morning of surgery. Some of the different types of pain medications/systems include:

  • Patient-Controlled Analgesia (PCA) With this system, you may receive a continuous dose of medication and be able to give yourself booster shots through your IV when you have pain. You do not need to worry about giving yourself too much medicine because there is a lockout feature that prevents you from giving too much medicine.
  • Patient-Controlled Epidural (PCE) An epidural (similar to an IV) is placed in your back to allow for small continuous doses of pain medication through your back. This system can also have a continuous dose and/or booster shots. There is a lockout feature on this system too.
  • IV Medication If you do not have a patient-controlled system, medication can be given through your IV when you ask for it.
  • Femoral Nerve Block. This block involves the application of a local anesthetic to the femoral nerve, which is located in your groin. This will reduce pain and sensation in the operative leg. The anesthetic would be applied in the pre-operative period before your surgery takes place.

It is normal to feel pain after surgery, but rest assured it can be controlled. It is also normal for pain medication to make you feel sick to your stomach. If this happens, tell your nurse or doctor so you can get something to help decrease the nausea. As you start to feel better, you will start to take pain medications by mouth.

Diet

Usually, the first meal you get after surgery will be soft foods like gelatin, ice cream and liquids. As soon as you are feeling better, you can eat solid foods. If you were on a special diet before your surgery, talk to your orthopaedic surgeon about continuing it after surgery.

Preventing Blood Clots

To improve blood circulation and decrease the risk of blood clots, you will be asked to wear foot pumps on both legs. Foot pumps inflate and deflate with air to compress your feet and help circulation. Wiggle your toes and pump your ankles up and down every hour. You may also be given medicine to thin your blood. Your nurse will tell you which medication you will be taking.

Incision Care

After surgery, you will have a large dressing over your incision. This will be taken off in a day or so. The doctors and nurses will be checking your incision regularly for drainage and signs of infection, including redness, tenderness and swelling. You may have a drainage tube placed in your joint during surgery. This will be removed a couple days after surgery. Always keep your incision clean and dry.

Foley Catheter

There will also be a foley catheter in your bladder to monitor how much urine your body is making. This \vill usually be removed during the first day following surgery.

Starting to Move After Your Surgery

• There will be a special pillow between your legs called an abduction pillow. It is a triangular-shaped pillow made of foam. This is to stop you from crossing your legs and to keep your hip in the proper position.

• You may move in the bed to reposition yourself. Rolling to your nonsurgery side with the pillow between your legs is permitted.

• A trapeze bar will be placed over your bed. This will help you to move more easily in bed.

• Elevate your leg above the level of your heart to decrease the swelling and ease the pain when you are lying down.

• The day of or the day after surgery you will begin your rehabilitation. This will include physical therapy and occupational therapy. You will be expected to get out of bed, and begin walking as soon as possible.

Physical Therapy (P.T.)

• A physical therapist will be by to start treatment the day of surgery or the morning after surgery.

• You will have physical therapy twice a day.

• In physical therapy, you will begin learning how to get out of bed, walk with a walker or crutches and begin exercising your new hip.

• The amount of weight that you can put on your hip depends on what your orthopaedic surgeon recommends and the type of surgery you had. Your physical therapist will help to remind you of your weight-bearing status.

Occupational Therapy (O.T.)

• An occupational therapist will see you and instruct you in the use of specialized techniques and tools to perform bathing, dressing, home management and other activities of daily living with your new hip.

• Occupational therapists may also help you to arrange the purchase of any specialized medical equipment you may need after discharge. The specialized items may include raised toilet seat, shower chair or reacher.

Special Precautions

After surgery there is potential for the hip joint to shift or dislocate. To prevent this, there are three position precautions that you must follow until the hip muscles regain their strength. Your orthopaedic surgeon will discontinue the precautions at the appropriate time.

Do not cross mid-line of your body with your operated leg, this means:

• No crossing your legs

• Use your ahduction pillow in bed

• Moving your operated leg out toward the operated side is permitted.

Do not bend past 90 degrees at the hip, this most often occurs when you:

• Sit on a low chair or toilet

• Bend to pick objects off the floor

• Bend to put on socks or shoes

Do not twist/rotate operated leg from the hip, this can occur when you:

• Change direction when walking

• Lie in bed and your leg rotates outward

Additionally, you should not drive until given permission by your doctor. Your therapists will remind you of these precautions as part of your post-operative therapy, feel free to discuss any concerns you have with them.

Call your orthopaedic surgeon if YOU have any of the following:

• Fever - temperature higher than 101 degrees Fahrenheit

• Increased pain in your leg

• Redness, swelling or drainage from your incision

• Numbness or pins and needles in your leg

• Pain in the calf of your legs

• Questions about medications, the amount of activity or your follow-up care.

Follow-Up Visit

You will follow up with your doctor about two weeks after your surgery. The orthopaedic surgeon will check your hip and see how you are doing. If you have any questions about activities you would like to start doing, such as swimming, golfing or driving, please talk to your doctor before beginning them.

Dental Work After a Joint Replacement

Everyone knows good dental health is important. But for people with artificial joints, a visit to the dentist can be especially significant. The bacteria that causes infection in the teeth or gums can easily travel through the bloodstream and settle in the artificial joint which can cause even more problems than a toothache.

Representatives from the American Dental Association and the American Academy of Orthopaedic Surgeons developed the following recommendations for people with joint replacement who are planning to have some dental work done. Because there is little data on this topic, these recommendations are guidelines only. Working together, your dentist and your orthopaedic surgeon will determine an appropriate course of treatment for you.

Preventative Antibiotics

You won't need to get preventative antibiotics for most dental procedures, but because you have an artificial joint, your risk of contracting a blood-borne infection is higher than normal. Therefore, preventative treatment is advised if the dental procedure involves high levels of bacteria.

Preventative antibiotics are recommended before dental procedures if:

• You have an inflammatory type of arthritis such as rheumatoid arthritis or systemic lupus erythematosis

• Your immune system has been weakened by disease, drugs or radiation

• You have insulin-dependent (Type 1) diabetes

• You had a joint replacement less than two years ago

• You had previous infections in your artificial joint

• You are undernourished or malnourished

• You have hemophilia

It is also recommended to get preventative antibiotics for the following dental procedures:

• Dental extractions

• Periodontal (gum disease) procedures

• Dental implant placement and re-implantation of teeth that were knocked out

• Endodontic (root canal) instrumentation or surgery

• Initial placement of orthodontic bands (not brackets)

• Injection of a local anesthetic into the gums near the jaw

• Regular cleaning of teeth or implants where bleeding is anticipated

These guidelines are designed to help doctors and dentists make decisions about preventative antibiotics for dental patients with artificial joints. It is not a standard of care or a substitute for the practitioner's clinical judgment, because it is impossible to make recommendations that would cover every situation. Practitioners must exercise their own clinical judgment in determining whether or not preventative antibiotics are appropriate.

Your New Hip

Taking care of your new hip will allow you to return to a functional lifestyle. If you have any questions or concerns regarding the type of physical activity your new hip can endure, talk with your orthopaedic surgeon. You should be able to enjoy your new hip for many years to come.

In the event that YOU receive a metal component in your joint replacement, you will receive a wallet identification card during your post-op visit with your orthopaedic surgeon. This card identifies the exact metal component you received. You will be able to present it if YOU activate a metal detector in a store or airport.