On behalf of the orthopaedic surgeons and staff at Newton-Wellesley Hospital, thank you for entrusting us with your care. We are proud of the orthopaedic care we provide. We are pleased to offer this Guide as a way for you and your family to fully understand what you can expect when you come to Newton Wellesley Hospital for your total joint replacement surgery.
Preparing for any type of surgery is an undertaking for patients, as well as their families. Each patient is an individual and assumes a very important role in planning his or her care. The material contained in this Guide describes the typical routines and practices associated with having and recovering from a total joint replacement.
The information and advice contained here comes from the collective experience of health care providers, patients and families at Newton-Wellesley Hospital. In no way is it intended to substitute for the dialogue you will have with your surgeon and other health care providers involved in your care. We hope that the material will help in your conversations with those involved in your care so that the course of treatment is as smooth as possible. We encourage you to carry this Guide and refer to it throughout your experience. You will also find that it is a convenient place to file other information, pertaining to your care.
Thank you again for choosing Newton-Wellesley Hospital and for entrusting your care to one of our physicians.
Joint Center Physicians/Education Committee
Newton Wellesley Hospital
TABLE OF CONTENTS
Understanding Hip Replacement Surgery
- Overview of the Procedure
- Why You Need a Joint Replacement
- About the Procedures
- What You Can Expect
Staff you’ll meet
Preparing for Surgery
- Preoperative Education Classes
- Preadmission Visit
- Medication guidelines
- Informed Consent
- Case Management
- Preparing yourself physically
- Preparing yourself mentally
- Planning for your return home
- Day before surgery
- What to take to the hospital
- Arriving at the Hospital
- Going to Surgery
- After Surgery -PACU
Your Hospital Stay
- Day of surgery
- Post-Operative Day 1
- Post-Operative Day 2
- Post-Operative Day 3
Leaving the Hospital
- Daily guidelines
- Protecting your joint from infection
- Getting Back to Your Usual Activities
- Signs & Symptoms to report
Frequently Asked Questions About Joint Replacement
o Business card holder o Pocket to hold additional instructions
Understanding Joint Replacement Surgery
Overview of the Procedure
As a patient considering total hip replacement surgery (THR), you probably have many questions. This information will help prepare you for what to expect during your hospitalization and rehabilitation.
Total hip replacement surgery is done to replace an arthritic or badly damaged hip joint with man-made parts. The man-made part is called a prosthesis (prohs-thee-sis) and can be made of many different materials, including metal, polyethylene (or plastic), ceramics or a mixture of materials. Your surgeon will choose the prosthesis best for you. The goal of THR surgery is to increase mobility and lessen pain.
Total hip replacements are also called total joint arthroplasty (TJA).
Why You Need a Joint Replacement
Usually people who need a joint replacement have a long history of osteoarthritis (ohstee-o-arth-ri-tis) or rheumatoid (rew-muh-toid) arthritis of the hip or knee.
When you have rheumatoid arthritis, the tissue lining the joint (synovium) becomes inflamed and causes pain. Over the years, this inflammation causes swelling in the joint and damages the cartilage and bone of the affected joints.
Cartilage is the pearly white covering at the ends of bones that provides a smooth surface.
When you have osteoarthritis, the cartilage becomes frayed and pitted from wear and tear of repeated stress and trauma. When the cartilage is damaged, the normally smooth movement at the joint is replaced by painful friction. Osteoarthritis occurs primarily in weight-bearing joints such as the hip, knee or foot.
About the Procedure
The normal hip is shown in Figure 1.
The hip is a ball and socket joint. The head of the femur (thighbone) fits into the acetabulum (socket of the pelvic bone) to form the hip joint. In a healthy joint the ends of the bones are covered with articular cartilage which allows smooth pain free motion. The most common reason for a hip replacement is related to wearing away of the cartilage leading to pain, limited mobility and instability.
During hip replacement surgery, the surgeon makes an incision to expose the hip joint. The surgeon prepares the acetabulum by removing the damaged cartilage and replacing it with a prosthetic part or cup that serves as the new socket. Then, the surgeon prepares the femur to accommodate the stem of the prosthesis. The stem and its bearing surface (ball) are then inserted into the canal of the femur. The stem may or may not be cemented in place.
Finally, the ball and socket are lined up precisely (see Figure 2). A drain tube may be placed into the wound, and the wound is closed. A bandage is applied.
Figure 2. Hip with prosthesis in place
What You Can Expect
Joint replacement takes about 2 to 3 hours and requires about a 3-day stay in the hospital. Patients usually are admitted on the morning of surgery.
Routine care after joint replacement involves wound care, pain management, physical therapy and occupational therapy. These are described in greater detail later in this guide.
Recovering from joint replacement surgery depends on your general health before the procedure and the type of joint that is being replaced. The goal of this period is to comfortably return you to the activities of daily living which are important to you. While most hip replacements are successful in relieving pain and/or improving movement, recovery does take time. Most patients need at least 3 to 5 months to get back their strength and energy.
Staff You’ll Meet
It takes many people to make a hospital run smoothly. Your health care team will work together to make your hospital stay a positive experience. Each staff member is committed to making your stay comfortable and successful. Please feel free to ask questions and share concerns with any of your health care team. The following is a list of some of the people who will provide your hospital care:
Attending physician is your surgeon. Your surgeon will be primarily responsible for your care while you are in the hospital. He will work in conjunction with fellows, residents, physician’s assistants (PA) and nurse practitioners (NP) to provide comprehensive care.
- Fellows-doctors who have completed residency training in orthopaedic surgery and are specializing in joint replacement surgery.
- Residents-doctors in their second through fifth year of specialized training in orthopaedic surgery.
- Physician's assistant- A clinician with specialized training who may assist your surgeon in the operating room and during your hospital stay.
- Nurse Practitioner- A nurse with advanced training who may assist your surgeon in the operating room, during your hospital stay & follow-up appointment.
Hospitalist. A medical doctor who may see you at the request of your surgeon.
Nursing staff. A registered nurse (RN) will care for you throughout your hospital stay. Your nurse will make sure that you receive the appropriate medications, any medical treatments and tests ordered by your doctors. Your nurse will also provide information and education to prepare you for discharge. A nurse is always available to answer questions or to discuss concerns you or your family may have. The name of the nurse caring for you on each shift will be available at the nurses' station or listed on a board in your room.
- Patient care assistant (PCA). The patient care assistant will assist your nurse in providing your daily care. He or she may help with bathing, taking vital signs, or transporting you to and from tests.
Case Management Team
- Case manager- This is a nurse who may assist in your care while you are in the hospital, in particular when it is time to plan for discharge. These staff members are familiar with resources in your community and can help arrange home care, or if necessary, help you select an appropriate extended care facility. He/she can also help with any questions or problems about your medical insurance or financial issues during your hospital stay.
- Social worker- A social worker is always available to discuss any concerns that you or your family may have about coping with your hospitalization. He/she may also assist with arranging home care or placement in an extended care facility.
Rehabilitation staff. These staff members have a very important role in helping you recover from your joint replacement surgery.
- Physical therapist (PT) will work with you each day of your hospital stay to get you moving around safely with your new joint. The PT will teach you how to progress your activity, regain your range of motion and strengthen your muscles. You will also learn how to protect your joint by using certain positions and avoiding others.
- Occupational therapist (OT) will help you resume activities of daily living, including grooming, bathing, hygiene and dressing. This therapist may offer you special devices to help you be as independent as possible during your recovery in the hospital and at home.
- Physical therapy assistant (PTA) may assist your physical therapist in exercises and mobility training.
Other hospital staff. Housekeepers, dietary workers, radiology technicians, chaplains, pharmacists, transporters and other staff members are all part of your health care team.
Preparing For Surgery
Once you have scheduled your surgery, preparing yourself physically and mentally are important for a healthy recovery. Here are a few steps to help you get ready for your surgery.
Preoperative Education Classes
Newton Wellesley Hospital provides classes to assist patients and families in preparing for surgery. These classes are designed to provide information on the surgery, the postoperative course and rehabilitation after hip surgery. During class the surgical procedure will be discussed, you will have the opportunity to see an example of a prosthesis and ask questions about your surgery and hospital stay. You are strongly urged to attend class.
The classes can be booked by calling;
Newton-Wellesley Hospital Center for Joint Reconstruction @ 617-243-5155.
Check with your surgeon's office for more information. You will find a list of books, films and Web sites at the end of this book that also may be helpful.
Once your surgery has been scheduled, the schedulers in your surgeon's office will arrange a pre-admission screening appointment. It can be scheduled as much as 4 weeks before your surgery. This is a separate appointment from your visit with your surgeon or primary care doctor. During your appointment you will meet staff from different departments including Anesthesia, Nursing and Physical Therapy. The purpose of this visit is to make sure you are fully prepared for your surgery.
The average pre-admission visit is about 2 to 3 hours long.
Please call to pre-register @ 617-243-6122.
Please eat before this visit and take your regular medications.
On the day of your pre-admission visit, be sure to bring the information listed on this page.
Make a list of any questions you have.
List of Allergies
List any medications and dosages you take on a regular basis, including vitamins, herbs and other over-the-counter medications:
Results of any recent tests at another hospital.
Names, addresses and phone numbers of all doctors you see, including specialists
Please share any previous problems or reactions to anesthesia.
The nurse will;
- Confirm the surgical procedure you are having
- Conduct a nursing assessment which includes past medical conditions, previous hospitalizations and a complete list of medications-prescription meds, over the counter and any dietary supplements.
- Confirm any allergies you have to drugs, food or latex.
- Let you know if any meds need to be stopped before surgery (see medication list)
- Review arrival time for the day of surgery
You will also have any testing your physician has ordered this may include lab tests, an EKG and a chest x-ray.
In some situations, patients are advised by their physician to have their own blood available prior to surgery. If so, this may require separate appointments at the Blood Bank.
The Physical therapist will;
- Do a brief physical exam which includes range of motion, strength measurements, and mobility assessment.
- Ask you about the physical set up of your home (levels, stairs, railings, tub, shower, etc.)
- Ask you who will be with you when you return home and to what extent they may be able to offer minimal assistance if needed
- Demonstrate and review an illustrated group of exercises which you should do from the day of your pre admission visit until your surgery
- Go over a home safety checklist written by your occupational therapy team which will provide tips for making your home ready.
- Give you an overview of what kind of rehab schedule to expect after surgery and until your discharge
- Answer any questions you may have about your rehabilitation
A member of the anesthesia department is available to speak with you before surgery.
Before surgery you will be asked to sign consent forms. You have the right to understand your health problem and treatment options in words you can understand. Your doctor should also tell you about the risks and benefits of each treatment. Please feel free to ask questions.
Preparing yourself Physically
Here are some health tips that will help you focus on a smooth recovery and better health after surgery.
- Stay as active as possible
- Continue your normal activity and exercise programs.
- Stop smoking. If you smoke, try to stop or cut back on the number of cigarettes you smoke every day. Smoking can cause complications with the anesthesia you receive for your surgery. Stopping even for a short time can be helpful. For help, you may contact the Quit Smoking Programs at:
For further information, contact 1-800-TRY-TO-STOP or check the Web site www.trytostop.org.
- Watch your weight. If you are overweight, your doctor may ask you to lose some weight before surgery. This will lessen the stress on your new joint. You may want to contact a dietitian for help losing weight and maintaining a lower weight after surgery. Weight management resources are available by contacting the Nutrition Department at Newton Wellesley Hospital.
- Dental visit. Discuss with your surgeon the need for a routine dental exam prior to surgery. Any tooth or gum problems may need to be treated.
- If you have a fever or flu symptoms or other medical issues please contact your surgeon's office.
Preparing Yourself Mentally
Having surgery can be stressful. Learn as much as you can about the surgery. Share this information with family members and friends who will be involved in helping you with recovery. Don’t be hesitant to ask for help from others during your recovery.
You will receive a phone call from a case manger about 2 weeks prior to your scheduled surgery. At this time she will discuss options for discharge after your hospital stay. It is important to begin planning for your return home before your surgical procedure. Find out from family and friends how they will be able to assist you. Arrange for transportation home from the hospital.
Many patients are able to return directly home after hospitalization and receive services from a home care agency. However some patients will need additional time in an extended care facility to achieve their goals. Your eligibility for care in an extended care facility and/or home care services is determined by a number of factors including physical need and insurance coverage. Your insurance company must authorize any services. Your health care team will work with you to make the decision that is right for you.
Planning for Your Return Home
After your surgery, a team composed of a nurse case manager and social worker will continue to work with you, your surgeon and other members of the health care team to assist in planning for your discharge.
The goals for safe return to home;
- Get in and out of bed safely by yourself
- Walk 100 to 150 feet with your crutches or a walker
- Walk up and down stairs with crutches if you have stairs
- Complete self care tasks (dressing, bathing, toileting, simple meal preparation) independently or assist of another
All patients need help with shopping, cooking, laundry and other everyday activities when they first return home.
The rehabilitation staff will help you plan for any other equipment you may need at home such as:
- bedside commode
- raised toilet seat
- shower bench
- long handled sponge & shower hose
- safety bars/hand rails
This equipment is not always covered by your insurance.
HOME SAFETY CHECKLIST
The occupational therapy department has compiled the checklist below to help you prepare your home for your recovery. We encourage you to review this list with family members and friends and make any needed changes BEFORE your surgery. These recommendations can help you safely manage at home during your recovery period.
- Remove all loose rugs and electrical cords from areas where you walk in your home, as they can easily become caught under walkers/crutches.
- Make sure that carpet edges are tacked down to reduce potential for falls.
- Be sure all walking areas are free of clutter.
- You will need a stable chair with a firm back and seat cushion that allows your knees to be lower than your hips when sitting during the day. Seat height can be built up with a firm pillow or folded linens. A chair with arms is recommended.
- Also make sure that your bed height is 18 inches or more, in order to keep your hips above your knees when you sit on the edge. Inexpensive bed risers can be placed under bed legs.
- Place a lamp or light switch within reach from your bed.
- Place needed items in bathroom, bedroom, kitchen and living areas within easy reach (not too high, and not too low!).
- A cordless phone or cell phone that you can keep with you during the day will be very handy.
- Place rubber mats or non-slip decals in the tub/shower.
- If you have equipment, such as a commode or tub seat, take it out before your surgery to make sure it is in good working order.
- Consider having grab bars installed in the tub/shower wall and near the toilet to optimize safety when toileting or bathing.
- A hand-held shower head can be very helpful when sitting on a tub seat to shower.
- Put night-lights in your bathroom and in the hallway leading from your bedroom to bathroom.
- Ensure that handrails at stairs are securely fastened and extend the full length of the stairs.
- Be sure that outdoor walkways, steps and porches are free of rocks, loose boards, and other tripping hazards.
Feel free to contact the Occupational Therapy Department at (617) 243-6172 if you have questions about these recommendations.
Anesthesiologists and nurse anesthetists are responsible for your safety and comfort during surgery. Your surgeon will be working with you and the anesthesiologist to plan the best type of anesthesia for you.
Described below are the most common types of anesthesia used in joint replacement surgery. Depending on the type of joint replacement surgery, some type of general or regional anesthesia will be selected to keep you comfortable. Someone from the Anesthesia Department will be with you at all times in the operating room.
General anesthesia involves medications that keep you completely asleep during surgery. These medications are given through your intravenous (IV) and by inhalation.
Some of the most common side effects of general anesthesia include nausea & vomiting and sore throat. You will be given medication to prevent nausea. The anesthesiologist will describe these risks to you when you sign a consent form for anesthesia. This consent is separate from your consent for surgery.
Regional anesthesia involves medicine that is injected through a needle into an area of the body to keep that part of the body numb. There are different types of regional anesthesia including spinals, epidurals, and nerve blocks.
Spinal and epidural anesthesia involves medication put into your back through a needle. It makes your body numb from the waist and down. While lying on your side or sitting up, a needle is placed into your back and the medicine is given. You will not be able to move your legs when the medicine starts to work. You can move your legs 3 to 4 hours after surgery as the medicine wears off. The key difference between a spinal and epidural is that with an epidural a catheter or very small tube is left in place to treat your pain after surgery.
Nerve blocks can be done for surgery on any part of the body. This involves injecting medicine to numb a specific nerve in a certain part of the body.
With any regional anesthesia, you will also receive sedative medication through your IV to make you feel sleepy and more relaxed. You may still feel pressure and/or pushing where the surgeons are working. If you have any pain or discomfort, your anesthesiologist will give you additional medication.
Sometimes a combination of regional and general anesthesia is used depending on the type and duration of your surgery.
Sometimes it takes a while for the medicine to wear off. No matter what type of anesthesia you have, there will be many people watching you closely for any side effects.
The Day Before Your Surgery
On the day before your surgery, make sure to follow these specific instructions:
Shower and wash your body thoroughly. Some surgeons may give you a special soap to use the day before surgery.
Follow the instructions you received at your pre-admission visit about all your medications.
Do not eat solids after midnight; this includes food of any kind, milk or coffee lightener, orange juice, alcohol, gum, candy & mints)
Clear liquids are allowed up to 4 hrs. before surgery; water, black coffee, clear tea, apple juice (no cider) & cranberry juice
Absolutely nothing by mouth within 4 hours of surgery.
What To Take To The Hospital
Personal toiletries, short robe
Short robe, loose pajamas
Do Not Bring
Pocketbook, wallet and all valuables, including watches, earrings and other jewelry at home.
Seven to 10 days before surgery, you should stop taking aspirin and other anti-inflammatory agents (ibuprofen, Motrin, Advil, Aleve). Other drugs that should also be stopped 7 to 10 days before surgery include Plavix, Narcil, or other similar drugs. A complete list of medications and substances that should be stopped before surgery is provided in the next section. Anesthesia will review this with you.
- Do not take vitamin E or any herbal supplements for one week before surgery.
- If aspirin is prescribed for your heart or problems with your blood vessels, please check with your primary care doctor or cardiologist before stopping this.
- You may take acetaminophen (Tylenol).
- You may not be aware of the many medicines that contain aspirin. Most medicines that help to relieve the symptoms of cold or sinus congestion contain aspirin. Look at the ingredients on the label.
- You should notify your surgeon if you are on warfarin (Coumadin) or another anticoagulation medication
The following is a partial list of other over-the-counter products that contain aspirin or aspirin-like medicine. These may affect bleeding during and after surgery. If you are taking any of these medicines, check with anesthesia about if and when you should stop taking them.
Advil Alka-seltzer Aluprin
Anacin AP.C. (P.AC.) Arthritis Strength Bufferin A.S.A
Codeine Compound (Capsules No.2 and No.4) Ascriptin Aspergum Aspirin Bayer Aspirin Bufferin Cephalgesic Children's Aspirin Congesprin Cope Coricidin Coumadin Darvon Dristan Duragesic Tablets Ecotrin Empirin
Excedrin Fiorinal 4-Way Cold Tabs Ibuprofen Indocin Midol
Motrin Nardil Naprosyn Percodan Robaxisol Talwin
Trigesic Norgesic Tablets Plavix
Sine-Aid Tolectin Vanquish
Pepto Bismol Phenergan Sine-Off Triaminicin Zactrin Zoma
Discontinue the following herbal supplements because they may enhance bleeding and interact with anticoagulation medicines that you may receive following your surgery:
Dong Quai (Angelica) Garlic Ginger
Ginkgo Ginseng St. John's Wort
Ephedra (contained in Ephedrine) may interact with general anesthesia.
Arriving at the Hospital
Hospital admission usually occurs on the day of your surgery. You will be asked to arrive at the hospital 11/2 hours before surgery.
After checking in at the Surgical Center Registration, you will be taken to the pre-operative holding area. Your belongings will be stored and delivered to your room later in the day.
A nurse in the pre-operative area will coordinate your preparation for surgery which includes;
- meeting your perioperative team who will assist your surgeon which includes nurses, anesthesiologist and/or nurse anesthetist and the resident.
- checking your vital signs (temperature, blood pressure, pulse & respirations)
- placing an intravenous (IV) tube in your arm so that you can receive fluids, medications and blood transfusion if necessary.
- Meeting a member of the Anesthesia team who will confirm the type of anesthesia you will receive.
Your family is welcome to stay with you until it is time for you to go to the operating room (OR). When you are taken to the OR, your family will be directed to the family waiting area where they can wait during your surgery.
In the OR, the surgical team will work to ensure your procedure goes as smoothly. They will be continuously watching your heart rate, blood pressure and breathing. A catheter (small tube) will be placed in your bladder to keep track of fluids during surgery.
Your surgeon will speak with your family when surgery is completed.
After Surgery - in the PACU (Post anesthesia care unit)
After surgery, you will wake up in your bed in the recovery room or Post Anesthesia Care Unit (PACU). You may not remember much of this part of your stay.
Here are some of the routine activities that will be happening as you wake up from your surgery.
- Vital signs will be taken frequently
- You will be wearing compression boots to promote circulation. Compression boots are wraps that are placed on your legs. The wraps are attached to a machine that automatically inflates and deflates.
- Your nurse will check to make sure you are as comfortable as possible. The nurse will frequently ask you to rate your pain using a pain scale from 0 to 10, with 0 being no pain and 10 being severe pain.
Your pain will be managed in one of several ways:
- Patient controlled analgesia (PCA)-a pump that releases pain medication in small doses through your IV. Your physician will order the amount and type of medication for you.
- Epidural catheter-continuous pain medication that is given through a small tube or catheter in your back.
- Narcotic pain medications taken by injection or by mouth.
- Your will have a small drain from your incision which drains extra fluid from under the skin.
- Your nurse will check the catheter (tube) from your bladder.
- The nurse will also check on IV fluids and antibiotics you receive.
- You will be asked to cough and breathe deeply every hour while you are awake.
When your are awake, comfortable and your vital signs are stable you will be moved to your hospital room.
Your Hospital Stay
During your recovery, the focus of your care will be on managing your pain, caring for your incision, and keeping your new joint safe. It is difficult to describe a typical day in the hospital because each person’s care depends on his/her specific needs. One thing is fairly certain, you will be busy.
You may expect the following beginning the Day of Surgery
Vital signs will be taken by a nurse or patient care assistant several times a day.
This may include your temperature, blood pressure, heart rate, oxygen level and pain levels.
Medications will be given to you by your nurse. If you have any questions about your medicines, please be sure to ask your nurse. You will be on a blood thinning medication.
Managing your pain. For at least the first 24 hours, you will likely continue with the same method of pain control that was started in the recovery room. Some discomfort is expected after joint replacement surgery. The hospital staff will make every effort to keep you comfortable. If you ever feel that your pain is not well controlled, you should tell your nurse as soon as possible.
- If your pain is being controlled by the PCA pump, you can give yourself a dose of pain medication by pushing the button that controls the pump. In all cases, the pump is set with individual limits ordered by your physician.
- Pain medication can also be taken by mouth. Both narcotic and non-narcotic medications can be taken this way.
Keep in mind that it is important to take pain medicine when you are having pain. This will help you get up and move around more quickly.
Ice may be applied to your hip to decrease pain and swelling.
Care of your incision. Your incision will be covered with a bandage (dressing) for the first few days after surgery. Your surgeon will remove the wound drain on the day after surgery.
Foley catheter Your nurse will check the drainage from the catheter (tube) from your bladder.
IV (Intravenous catheter) The nurse will also check on IV fluids and antibiotics you receive.
Incentive Spirometer (IS) You will be asked to cough and breathe deeply every hour while you are awake, and use an incentive spirometer (clear plastic tube assist with deep breathing).
Diet Your diet will go from liquids to solids as your stomach settles down in the days after surgery. Meal service is provided three times daily. You will be given menus to choose foods that you like. A dietary worker or patient care assistant can help you to complete the menus. Also, snacks and beverages are almost always available at the nursing station.
Tests may include lab work or x-rays.
Rounds Your surgeon is the leader of your health care team. During your hospital stay various members of your health care team may visit you.
Physical Therapy/Occupational Therapy The Rehab staff will see you 1-2 times daily after an initial evaluation session. PT will teach you how to get in & out of bed, move about the room and walk with an assistive device.
OT will teach you strategies to assist with activities of daily living such as dressing, bathing and meal preparation.
Keeping your new joint safe. Your operative leg may be supported using sling suspension. Proper positioning is important for the safety and recovery of your new joint. Your nurse and therapists will teach you how to protect your joint when in bed and moving around. These positions will be reviewed with you each day and will be posted in picture form by your bed
Discharge Planning Early in your stay the staff will be talking to you about leaving the hospital. The health care team will work with you and your family to plan for your needs after leaving the hospital
Daily plan of Care
“Everyone progresses at his/her own pace. The activities listed below are a guideline for what to expect during your hospital stay.”
Post-Operative Day 1
- You will continue with a pain pump which you control or oral medications. It is important to communicate with staff how well your pain is being relieved.
- A blood thinning (anticoagulant) medication will continue.
- Ice may be applied to your hip to help with swelling and pain control
- The nursing staff will assist you with bathing and changing positions in bed.
- Your doctor (resident/PA/NP) will remove the drain tube from your incision, and the bandage may be changed.
- Orthopaedic resident and PA/NP round daily on patients
- You will continue to have an IV catheter, usually for 2 days after surgery.
- You bladder catheter, usually for 2 days after surgery.
- Compression boots will be worn to promote circulation and prevent blood clots. You may also have elastic stockings.
- Blood tests will be done.
- Begin taking liquids and your usual diet as tolerated.
- Occupational therapy and Physical therapy evaluations
- Follow positions to protect your joint.
- Sit at the edge of the bed with assistance
- Perform the exercises with your therapists, as you are able.
- Begin transfers from bed to chair with assistance from therapists and nursing
- Begin walking with a walker and help from your therapists.
- Maintain your hip precautions.
- Your case manager or social worker will be in to be in to discuss discharge plans, make referrals to extended care facility or home care as needed.
- Your expected length of stay and discharge plans will be reviewed with you.
Post-Operative Day 2
- Continue with incentive spirometer to exercise your lungs.
- Pain medicines will continue as you need them. The PCA device is usually stopped on this day, and oral medicines for pain are used.
- A blood thinning (anticoagulant) medication will continue.
- IV fluids and antibiotics will be stopped
- Smaller bandages will be put over your incision.
- A laxative will be given at bedtime if needed.
- Orthopaedic resident and PA/NP round daily on patients
- Ice may be applied to your hip to help with swelling and pain
- Compression boots will be worn to promote circulation and prevent blood clots. You may also have elastic stockings.
- The bladder catheter may be removed.
- Lab tests may be done.
- Diet is advanced as tolerated, increase fluids to prevent constipation
- If you have not already done so, encourage a family member or friend to come to the hospital to review tomorrow's discharge planning with a member of your health care team. Staff will provide a tentative discharge time.
- Physical Therapy:
- Progression of strengthening and range of motion exercises
- Progression of bed mobility, transfers bed to chair and back, and walking
- Occupational Therapy:
- Self-care activities, such as bathing, dressing, grooming while sitting.
- Training in use of adaptive equipment
- Bathroom transfers on/off commode or toilet
- Continue to follow positions to protect your joint
- You will spend more time out of bed during the day.
- Perform the exercises given by your therapists – try to do a little more each day.
- More walking and transfers from bed to chair with help from your therapists and nurses.
- Case manager or social worker may be in to further discuss discharge plan.
- Arrange for home services if needed.
Post-Operative Day 3
- Continue with incentive spirometer to exercise your lungs.
- Oral medications for pain, assess effectiveness. It is important to communicate with staff how well your pain is being relieved
- A blood thinning (anticoagulant) medication will continue.
- Smaller bandages will be placed on your incision, or it will be left open to air.
- Lab tests may be done.
- Orthopaedic resident and PA/NP round daily on patients
- Your nurse will review discharge instruction which will include any medications you will be taking at home.
- Pain medication
- Anticoagulation medication
- Resume your usual diet increasing fluids to prevent constipation.
- You will be independent getting in and out of bed
- You will progress to being able to walk alone 150 feet
- You will do stairs with your therapist if you have stairs at home to do
- You will be able to repeat all of the hip precautions for your surgery
If you are going to a rehab facility:
Therapy will see you in the morning before you leave and they will go over all of your discharge instructions. You will also continue to work on strengthening exercises and improved functional mobility, like going bed to chair and walking.
- Occupational Therapy:
- You will progress in self-care tasks by practicing the use of adaptive equipment or performing some tasks while standing in the bathroom.
- If going home, your OT will work with you on home care activities, such as light meal preparation, while following your hip precautions.
- Your therapists will provide a list of exercises and activity instructions for you to follow once you are home.
- If you are going home:
- Your OT or PT will practice a car transfer with you and your family.
- OT and PT will assess the need for any equipment to help you at home and coordinate with you, your family, and your case manager to procure recommended equipment.
- Case manager or social worker may be in to further discuss discharge plan.
LEAVING THE HOSPITAL
Leaving the hospital can sometimes be scary because your recovery is not complete.
Some days you will feel that you have made great progress. Some days will be harder.
In general, the guidelines below will apply whether you are going directly home or to an extended care facility. Your health care team will also provide you with some additional instructions depending on the type of surgery.
In the first week after leaving the hospital, please follow these daily guidelines:
· Take all your medicines.
· Maintain your hip precautions.
· Continue your exercise routine on your own or with a physical therapist.
· Take pain medicine as needed, especially before exercising.
· Follow instructions for wound care.
· Drink plenty of liquids and eat healthy foods.
· If you are on anticoagulation medicine, your blood tests will be done as ordered by your physician. You will need to take the medication and have blood tests for 3 to 6 weeks after your surgery.
· Because it is common to be somewhat anemic after joint replacement surgery, daily doses of iron are commonly used to build up the blood.
Protecting Your Joint from Infection
After joint replacement surgery, it is important to protect your new joint from infection. An infection in one part of your body can travel in your blood and possibly spread to your new joint. The following section lists some infections which can cause problems. If you have any of these symptoms, you should report them immediately to your primary care doctor.
· Urinary tract infections. Symptoms of a urinary tract infection include a frequent and urgent need to pass urine, pain in your lower back or lower pelvic region, cloudy, foul-smelling urine, chills or fever, lack of energy or appetite, or sand-like material in your urine.
· Skin infections. Injuries to your skin should receive prompt care. After an injury, wash the area with soap and water, and apply a bandage. Serious cuts may require stitches. If an injury develops drainage, enlargement, blistering, swelling or redness, or if you develop a temperature, you should call your primary care physician immediately.
· Dental infections. Good dental hygiene is important. You should see your dentist regularly for dental care even if you are not having any dental problems. When you see your dentist, be sure to inform him or her that you have had joint replacement surgery
If you have a dental or surgical procedure, colonoscopy for which the surgeon or dentist feels it is possible that you may get an infection, you should take antibiotics before the procedure. The dentist or surgeon performing the procedure can prescribe an appropriate antibiotic.
Getting Back to Your Usual Activities
During the first few weeks at home, you can adapt what you learned at the hospital to your own setting. You should continue doing the exercises provided by your therapist. Staff from a home care agency, such as a nurse or physical therapist, may visit you as you make the transition to home. Home therapists may update your exercises and work further on home management activities.
Most people feel very tired when they leave the hospital. For this reason, it is best to pace yourself as you return to your usual daily routine. If you feel tired, take a short morning or afternoon nap. As you recover, your energy will increase.
You cannot do everything yourself. Don't be afraid to ask for help with daily tasks such as grocery shopping, laundry and housecleaning.
Take care of yourself. Try to find ways to be good to yourself during this time.
Signs & Symptoms to Report
Any of the signals listed below can be of concern. Call your surgeon if you have any of them when you go home.
. Temperature greater than 100.5°
· Signs of infection (redness, swelling, draining wound, increasing pain)
· Arm or leg calf tenderness or pain
· Chest pain, shortness of breath, rapid heart beat
· Persistent nausea and vomiting
· Bruising easily
· Swelling in either leg that does not decrease when your leg is elevated for a few hours or overnight. It is common to have swelling of the lower leg that decreases each morning after you have been in bed all night
-If you have sudden pain, are unable to walk or have weakness in your leg, or if you hear a popping sound, you may have dislocated your new joint. Your leg may turn inward. You will need to report to the nearest emergency department to have it relocated.
Recovering from Total Hip Replacement at Home
Household Tips from the Occupational Therapy Department
Keep these helpful tips in mind when doing things around the house. It is important to share this information with family or friends who might be assisting you. These tips are in addition to those listed on the Home Safety Checklist that was provided to you before your surgery.
- If you are using crutches, wear an apron with pockets or a belt pack. Remember you will not be able to carry things in your hands while using crutches.
- If you are using a walker, consider buying a walker bag or basket for use in transporting items.
- Store frequently used items between waist and shoulder level. Do not stand on your tiptoes or bend excessively to reach for things. Use your reacher to do this whenever possible.
- Arrange for help with child or pet care.
- Always use your crutches or walker when taking a step. It is not safe to hold onto furniture, even for a few steps.
- Ground floor bedrooms and bathrooms are ideal, but if your bedroom or bathroom is upstairs, you will be taught to negotiate stairs with care using crutches.
- Save a new book or seated project to tackle once you are home.
- If possible, move your kitchen table close enough to the counter so you can easily pass food items back and forth without twisting.
- To move an item from one part of the counter to the other, simply slide it along the countertop. If the item is hot, place a potholder under it.
- If you must set your crutches aside temporarily while preparing food at the counter, make sure they are in a safe place where they will not fall to the floor. You may rest your hips or stomach against the counter for support.
- Frequently used refrigerated items should be within easy reach (i.e. between waist and shoulder level).
- Keep your freezer stocked with ready to eat foods.
- Lighter weight and single serving items are easier to handle than large containers.
- Arrange kitchen cabinets so that frequently used items are within easy reach to avoid excessive bending or reaching.
- Use only stovetop or counter level appliances to prepare food. Do not use low ovens or attempt to load/unload the bottom rack of the dishwasher.
- Keep your trashcan accessible.
- If you are more than five feet tall, you may need a raised toilet seat or commode.
- Do not use towel bars, soap dish handles, shower curtain rods or toilet paper dispensers for support when getting in and out of the shower or on/off the toilet.
- Use a tub or shower chair as recommended by your occupational therapist.
- It is important that you are able to reach your soap, shampoo, washcloth, and long-handled sponge in the shower without excessive bending.
- For a homemade “soap on a rope”, put a bar of soap in the leg of a pair of panty hose. Tie the other end to a tub seat or soap dish.
- Always make sure there is no water on the floor when stepping in/out of the tub/shower. If necessary seek help to dry the area before attempting to enter or exit the shower.
- Sitting down to dry off after showering is recommended.
If you have any questions about these suggestions once you are home, don’t hesitate to contact the Occupational Therapy Department at (617) 243-6172. An occupational therapist will be happy to talk with you.
9. FREQUENTLY ASKED QUESTIONS AFTER HIP REPLACEMENT
What is the recovery time?
Everyone heals from surgery at a different pace. In most cases, you will need to use a walker or crutches for at least 4 to 6 weeks after surgery. You will then be advised to use a cane outdoors and try getting around the house with no support for several weeks. It usually takes about 3 months to gradually return to normal function without using any devices. It could, however, take longer.
How long do I need a bandage for?
You should use a bandage for about 1 week until your incision is closed and there is no fluid oozing from your wound. It should be changed daily to a new, dry, sterile gauze. You may continue to wear a bandage to protect the incision from the irritation of clothing.
How long should I use elastic stockings (TEDS)?
These should be used for the first few weeks in order to help reduce swelling and improve circulation. You may wear them longer, especially if you find that your ankles swell without them.
Should I use ice or heat?
Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Once the initial swelling has gone down, you may use ice and/or heat.
While you are in the hospital, the staff will help you with this.
When can I shower (get incision wet)?
It is usually advised that you wait 1 week after surgery before showering, or until the wound is closed. If no drainage is present at the incision, your surgeon may agree that you can shower earlier. Initially, try to keep the incision dry with a plastic wrap. If it gets wet, pat it dry.
How long will I be on pain medicine?
You will need some form of pain medicine for about 2 to 3 months. At first, you will take a strong medicine, such as a narcotic. Most people are able to stop narcotics within 1 month after surgery. You can then change to an over-the-counter pain medicine such as Tylenol. If you are taking Coumadin (warfarin), you should talk with your primary care doctor before making any changes in your pain medicine. Tylenol is ok if you are taking Coumadin.
Where will I go after my hospital stay?
Many people are able to go home after surgery. Others may go to a rehabilitation hospital or extended care facility to achieve their goals. Many factors will be considered in this decision including how you are feeling, who can help you with daily activities at home, and how well you can get around safely at home. Your insurance coverage will also be an important deciding factor. The case manager will assist you in discharge planning.
Do I need therapy?
Yes! The therapist plays a very important role in your recovery. You will see a physical therapist (PT) and occupational therapist (OT) soon after your operation and throughout your stay at the hospital. If you go home after your hospitalization, you will likely have an OT and PT come to visit you 2 to 3 times a week. You could also be referred to see an outpatient PT or OT. If you go to an extended care facility, you will receive therapy there.
Your physical therapist will help you walk, negotiate stairs, regain motion, and improve your strength. The occupational therapist will help you to resume important activities of daily living, including self-care, meal preparation and home management tasks. Your therapists will keep your surgeon informed of your progress.
Can I go up and down stairs?
Yes. Initially, you will lead with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. You can use the phrase, "up with the good, down with bad" to help you remember. You will need to use crutches or a cane in one hand and the handrail with the other.
What activities can I do after surgery?
You may return to most activities when you feel up to it. You should avoid high impact activities such as running, downhill skiing on expert slopes, and vigorous racquet sports such as singles tennis or squash.
How long do I have to use my crutches or walker?
Your doctor will determine when it is safe for you to bear full weight on your new joint so that you may stop using your crutches or a walker. You may be advised to use a cane after you have stopped using crutches. Using crutches or a walker for a shorter period of time than suggested may cause complications.
When can I put more weight on my leg?
Your weight bearing status will be explained to you before you leave the hospital. If you are able to bear weight as tolerated, you can put more weight on your leg as it feels comfortable to do so. If you are considered non- or partial-weight bearing, your surgeon will evaluate you at your next appointment to determine whether it has become safe for you to bear weight. Be sure you are clear with your surgeon about this.
Should I tell my dentist or doctor that I have had a joint replacement?
Yes, for some procedures they will want to give you antibiotics to prevent infection of your new joint. Usually this is done for the first 2 years after surgery. Check with your surgeon before stopping this practice.
What exercises should I do?
You will be instructed by your physical therapist on appropriate exercises and given a list to follow. Be sure to talk with your surgeon and your therapists about when you can begin new activities.
Can I use weights?
Generally, we do not advise using weights for at least the first 2 months. However, everyone's strength is different. Talk with your physical therapist about when would be the right time to start using weights. Use lightweights to begin with and gradually progress from 1 pound to a maximum of 5 pounds.
Can I have sex?
For the most part, you can gradually resume sexual activity when you are comfortable.
Patients who have a new hip joint should wait several weeks to reduce the risk of dislocating the hip. Be sure to follow the joint precautions your surgeon has given you.
Can I kneel?
After 6 weeks, you can try. Touch down with your operative knee or leg first. To get up, use your non-operative leg to take the weight off your operative knee or leg.
Although this may be uncomfortable at first, the knee will not be injured. Most people find the more you kneel, the easier it gets. Again, be sure to talk with your therapist or surgeon if you are worried about this.
When can I drive?
You should not drive until you can manage your pain without narcotics. You should also be able to move your legs freely without crutches before driving. If you had surgery on your right side, you should not drive for at least 4-6 weeks. After 1 month, you may return to driving, as you feel comfortable. If you had surgery on your left side, you may return to driving, as you feel comfortable, as long as you have an automatic transmission.
When can I return to work?
This depends on the type of work. You may return to work after about 1 month if your work involves mostly sitting. If your work is more rigorous, you may require up to 3 months before you can return to full work. In some cases, more time may be needed.
When can I travel?
You may travel as soon as you feel comfortable, but avoid long distance travel for 4 to 6 weeks or until after seeing your surgeon. We advise you to get up to stretch or walk at least once an hour when taking long trips. This is important to help prevent blood clots.
Will it set off the machines at airport security? Do I need a doctor's note about my surgery?
The increasing sensitivity of security detectors at airports and public buildings may cause your prosthesis to trigger an alert. We recommend you alert airport security that you have a prosthesis. In some situations security guards may also move a wand up and down your hip and leg that locates your joint replacement. They may also pad you down on the area that triggers the wand.
How long will I be on a "blood thinner"?
Usually, you will be on a blood thinner to help prevent blood clots. You may be on Coumadin, Lovenox or Aspirin. The duration of your therapy will be determined by your physician. Your nurse will review your instructions for blood thinners at the time of discharge.
How long should I take iron supplements?
Four weeks is usually enough time to build up blood after surgery.
What should I do about constipation after surgery?
It is very common to have constipation after surgery, especially when taking narcotic pain medicine. A simple over-the-counter stool softener (such as Colace) is the best way to prevent this problem. Increasing fruits and vegetables in your diet will also help.
In rare instances, you may require a suppository or enema.
Can I drink alcohol?
Alcohol use is not advised until you have stopped your narcotic pain medicine and are walking steadily.
I feel depressed - is this normal?
It is common to have feelings of depression or trouble sleeping after your surgery. This may be due to a variety of factors such as difficulty getting around, discomfort, or increased dependency on others. These feelings will typically fade as you begin to return to your regular activities. If they continue, consult your primary care doctor.
When do I need to follow-up with my surgeon?
Follow-up appointments are usually made after surgery at 4 to 6 weeks, 6 months, 1 year, 2 years, 5 years, 7 years and 10 years. Check with your surgeon
I think my leg lengths are different, what should I do?
After surgery, it is common to feel as though your leg lengths are different. At surgery, leg lengths are checked very carefully and every attempt is made to make them as equal as possible. The body and its muscles take time to adjust to a new joint In some cases, a shoe lift may be prescribed for a true difference in leg lengths. In most cases, however, no treatment is necessary.
How long will my joint replacement last?
This varies from patient to patient. For each year after your surgery, you have a 1 % chance of requiring additional surgery. For example, at 10 years after surgery, there is a 90% success rate.
What is a dislocation of the hip and how can I prevent it?
A dislocation of the hip occurs when the femoral head (ball) comes out of the acetabulum (socket). While this risk is very small, there are things you can do to prevent dislocation depending on the approach used for surgery.
In general, you will want to avoid bending too much at the hip· for the first 6 months.
· Avoid low chairs and furniture.
· Use a chair that has arms that will help you get up to a standing position.
· An elevated toilet seat may also be helpful.
· When sitting, do not cross your legs.
· If you must reach to the floor when seated, always reach between your legs, not to the outside.
Your surgeon may also give you more specific instructions:
· If the approach to surgery was from the front of your hip, you need to avoid outward rotation of your hip, that is, pointing your toe outward. You will also be advised to avoid excessive extension such as lying on your abdomen.
· If the approach was from the back, you need to avoid inward rotation of your hip, that is, pointing your toe inward. You will also be advised to avoid flexing (bending) at the hip more than 90'
Follow these instructions very carefully for the first 6 months. You should be cautious about extreme positions of your hip forever. Be sure to ask your surgeon about the approach used for your surgery and the precautions that are specific to you.
Can I sleep on my side?
You may sleep on your operative side whenever you feel comfortable. You may sleep on your non-operative side at 4 weeks with a pillow between your knees.
When do my stitches come out?
If your stitches are absorbable, they do not need to be removed. The steri-strips can be kept in place until they fall off on their own. They will help keep the skin edges together. If they have not fallen off by 3 weeks, it is OK to peel them off. If your stitches are not absorbable, they’re removed after 10 ~o 14 days.
When can I place my hip in water (e.g. bath, swimming pool, ocean, hot" tub)?
You can place your hip in water to bathe or swim after stitches have been removed or about 2 weeks after surgery if there is no drainage from your incision.
What should I expect for my range of motion (ROM) at 6 weeks? At 1 year?
Everyone's range of motion (ROM) varies and depends on individual factors. Your potential will be determined at the time of your surgery. In most cases, you will have enough motion to put on socks and tie your shoes. Clipping toenails may be difficult.
The "Your Orthopaedic Connection" web page on the American Academy of Orthopaedic Surgeons web site. Go to www.aaos.orq.Click on Patient/Public Information tab along the top and "Your Orthopaedic Connection" is the first link in drop down menu. If you prefer to go there directly, the address is:
This would be a separate section
Use this section as you collect information during your stay. It contains:
· Business card holder · Pocket to hold additional instructions
WISHING YOU A HEALTHY RECOVERY
In the months after your joint replacement surgery, gradually you will move toward greater independence in all your activities. Continuing to exercise will help you build stamina and endurance. You may find it challenging at times. Sometimes you may need to find a new way to do things.
As you recover from your surgery, try to be active and stay healthy. Keep your weight at a level that is appropriate for your height and body type. Adding pounds can put stress on your new joint. As your muscles get stronger, it is important to stick with a regular exercise program to maintain total body fitness. No one is too old to exercise. If you have questions on how to keep active and stay healthy, talk to your primary care physician, surgeon, physical therapist or orthopaedic care coordinator/case manager.
We hope this guide has answered many of your questions about having total joint replacement surgery and what to expect after surgery. We believe that the most satisfied patients are those who are well informed. If you have any other questions, please do not hesitate to contact your surgeon.
Thank you for entrusting your care to the orthopaedic surgeons at Newton Welleslet Hospitals.
Best wishes for success with your new joint and continued health.