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Orthopaedics – Total Hip Replacement
Patient information Leaflet
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INTRODUCTION TO TOTAL HIP REPLACEMENT
Total hip replacement is one of the most successful operations performed at the present time. In the UK alone, over 70,000 hip replacements are performed annually. They help to relieve pain and allow many people to regain their mobility and
independence.
The first successful total hip replacement was performed in 1959 by Sir John Charnley at Wrightington Hospital (near Wigan). Since then many other successful designs have been used world-wide.
We hope this booklet will help answer some of your questions. We believe that it is important for you to be as prepared as possible, to give you some idea of what the operation and your hospital stay will involve. Our aim is to help you improve the quality of your life and benefit fully from your new hip replacement.
THE HIP JOINT
WHAT IS A HIP REPLACEMENT?
A hip replacement is the replacement of your worn (or damaged) hip joint with an artificial joint, usually made from plastic and metal (and sometimes ceramic).
The hip joint is a ball and socket joint located in the groin. The ball is the head of the femur (at the top of the thigh bone). The socket, (the acetabulum) is in the pelvis. In a normal joint, both the ball and socket are covered in cartilage allowing smooth
movement. A capsule surrounds the joint holding it together. The inside of the capsule produces a fluid which lubricates the joint and facilitates movement.
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WHY IS IT NECESSARY?
The operation is advised for pain relief and to improve mobility, which is usually the result of arthritis in the joint. For various reasons, the articular cartilage (which covers the bone in the joint) can become soft, cracked or flaky. The cartilage itself does not readily heal and so over the course of time the quality and depth of the cartilage is reduced. The joint space then becomes narrowed and irregular. When damage is severe, the joint becomes stiff and painful. A hip replacement is usually offered after other types of treatment have been tried, such as pain killers, anti inflammatory drugs, physiotherapy and the use of a stick.
REPLACING YOUR HIP JOINT
The operation essentially involves removing the damaged arthritic cartilage and bone of the:
i. femoral head (ball) and replacing it with a metal (and sometimes ceramic) prosthesis
ii. acetabulum (socket) of the hip joint and replacing it with plastic ‘polyethylene’cup
The metal components may be fixed to the bone using a grouting agent/cement.
WHAT ARE THE RISKS OF HIP REPLACEMENT SURGERY?
Although all necessary precautions are taken occasionally complications may occur. There is a risk of respiratory problems from the anaesthetic. Bleeding or deep bruising can occur around the operation site. A blood clot could form in the legs called Deep Vein Thrombosis (DVT). Rarely one of these clots may travel to the lung and cause a Pulmonary Embolism (PE). An infection may develop either
immediately after your surgery or sometime later that may require other procedures which could involve a return to theatre. Skin changes such as blisters, discolouration or numbness may occur around the scar. The artificial joint may dislocate. This means that the ball may come out of the socket. You will be advised what ovements and positions to avoid in order to decrease the risk of this happening. In the long term it is unlikely that your hip joint will wear out. However your artificial joint may become loose. Should this happen a further operation may be required. Rarely, your thigh bone may break below the implant and this would require another procedure to fix the break. As with all major operations, during or following surgery, death is a risk. However it must be emphasised that this is extremely rare.
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WHAT ARE THE ALTERNATIVES TO SURGERY?
The decision to have surgery or not is entirely yours, although your doctor will be happy to advise you. If the hip is not replaced it will continue to wear and the pain may become worse and stiffness and deformity increase. Eventually the pain may become severe enough to require the constant use of walking aids or even a
wheelchair. However, the condition is not life threatening but it can limit your mobility.
BEFORE YOUR SURGERY
It is important that you are as fit as possible before your operation. You should try not to be overweight as this increases the risks associated with surgery and may reduce the life expectancy of your new hip. It may be advisable to see your GP or dietician for advice. Any blood pressure problems should be known to, and being treated by, your Doctor. You should continue with any exercises your physio or occupational therapist has adivsed. You should remain as mobile as possible. This will help to keep your muscles as strong as possible. The stronger your muscles are before surgery the easier you will find your recovery.
SMOKING AND ALCOHOL
Smoking prior to surgery delays wound healing and increases your risk of developing chest complications during and after surgery not to mention increasing your risk of long term chest problems. Prior to hopital admission we advise that you stop smoking at least 2 weeks before and for at least 6 weeks after. If you require assistance with stopping smoking prior to surgery please visit your GP for advice.
Tameside Hospital is a non smoking site.
Alcohol intake should also be reduced prior to admission and for around 6-8 weeks after. If your intake is excessive please inform clinic staff or visit your GP.
Think about how you will cope on return from hospital. You may need to alter the position of your bed so you can get out easy. You also may need to rearrange your kitchen and wardobes so that items can be easily accessed. Your occupational therapist or physiotherapist will be happy to offer advice. You may require a high cushioned chair and raised toilet seat with the the occupational therapist will organise before your hospital admission.
PRE-OPERATIVE EXERCISES
These exercises are designed to mobilise the hip joint, stretch tight tissue structures and strengthen muscle groups around the hip, prior to surgery.
Page 5 of 22 Calf Pumps
briskly move your feet up and down, and round in circles, from the ankles for 1 minute
Static Quadriceps
lie on your back with your leg straight, tighten your thigh muscle and push the back of your knee down into the bed then pull your foot up towards you hold for 5 seconds repeat x 10
Gluts Squeezes (can be done seated or lay down)
tense/squeeze your buttocks hold for 5 seconds, relax repeat x 10
Seated Extension
in sitting, tighten your thigh muscle and slowly lift up and straighten your leg out in front of you hold for a few seconds, then slowly relax it down to the floor repeat x
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DIETARY INFORMATION
Research shows that if you are well nourished and hydrated before and after your surgery you may recover better and more quickly.
You should try to eat as normally as possible up until your surgery.
- Eat regular meals containing protein foods such as meat, fish, eggs, cheese, lentils and milk.
- Include carbohydrate foods at each meal such as cereals, bread, rice, pasta and potatoes.
- If you are underweight or experiencing unintentional weight loss
Avoid using low fat foods / drinks – use full fat milk, margarine / butter, cheese, and yogurts
Include extra snacks e.g. yogurts, cheese and crackers, rice pudding etc. and nourishing fluids e.g. full fat milk
It may be advisable to see your GP to investigate causes for weight loss
After your surgery you should eat and drink as soon as you feel able, and try to continue to eat as normally as possible. This will help you in your recovery. If you are having difficulty eating, the nurses will monitor your intake, and refer you to the dietician.
Developed by Nutrition and Dietetic Dept, Tameside General Hospital. March 2011
PRE-OPERATIVE ASSESSMENT CLINIC
The purpose of your pre-operative assessment visit is to provide information and prepare you for your surgery. You will be given information about your surgery, and what we expect from you to prepare for surgery. We will also ask you questions about your medical history, general health and wellbeing. This is allows us to ensure you are at optimum health before your surgery. It also gives us the opportunity to make sure arrangements have been made for your admission and discharge. Routine bloods tests and an electrocardiogram are ordered.
Whilst in pre-operative assessment clinic you will see a pre-op assessment nurse and the Occupational Therapist. This is your opportunity to ask any questions you may have.
Planning your discharge begins at pre-operative assessment clinic. You will need to make arrangements for family and/or friends to support you on discharge from
hospital if this is not possible please inform the nurse at clinic as it may be necessary to arrange some support for you at home.
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You will need to bring contact details of the person who will take you home after discharge, if there is nobody available to do this please inform the clinic.
MEDICATIONS
Please ensure you bring all your current medications, inhalers, creams, eye drops, ointments and any non-prescribed/herbal medications with you to clinic and on admission to the ward.Where possible please bring your medications in their original packaging.
In pre-op clinic, the nurses will go through your medication and identfy any which need to be stopped prior to admission for your operation, ideally herbal medication should be stopped at least two weeks prior to your operation, as these can
sometimes cause complications during your surgery.
ROLE OF OT IN PRE-OPERATIVE CLINIC
When you attend the clinic the Occupational Therapist will:
Explain the precautions you must follow for 12 weeks after your surgery Measure you Leg Length to establish the correct height for you to sit on after
surgery
Assess your furniture at home according to the measurement form you return to determine the equipment you require after your surgery.
Discuss how you will manage at home after surgery and inform you of the support available on discharge.
ELECTIVE UNIT
On the day of your surgery you will be admitted to the Elective Unit. This ward accommodates patients undergoing orthpaedic procedures. Male and Female patients are nursed in separate areas. Please be assured that it is a very rare occurrence that we have to cancel patients on the day of planned surgery. The visiting times are 3pm to 4.30 pm and 6.30pm to 8 pm every day.
The ward has a quiet period every day after lunch to allow patients to rest. The ward is closed to visitors in this time.
Please nominate one person to ring the ward with any enquiries as answering
multiple phonecalls greatly impacts on time nurses could spend with patients. Please advise your family members that specific details of your condition cannot be
discussed over the telephone.
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DAY OF ADMISSION
Please bring in the following items:
All medications in their original packaging if possible.
Day clothes- practical shoes which must have backs. Comfortable, loose clothing is recommended whilst in hospital- shorts, tracksuits or comfortable skirts are ideal.
Nightclothes, dressing gown and slippers (practical and well fitting, mule type slippers are not safe for walking around the ward after your operation)
Toiletries and towels (please note there are no facilities for washing patient’s belongings in the hospital)
We adivse that expensive jewellery, personal belongings and large amounts of money are NOT brought into hospital. We suggest that patients keep no more than £10 with them at any one time.
Most patients will be admitted the morning of their surgery. Research has shown that this reduces anxiety. If the healthcare team feel you need to be admitted sooner you will be contacted.
You will be able to eat normally up to 6 hours before your operation and be allowed clear fluids up to 2 hours before surgery, unless otherwise directed. Clear fluids means water/black tea or coffee or cordial no milky drinks are allowed.
DAY OF SURGERY
On the day of surgery a shower should be taken (this should be at home prior to arrival to the hospital). This ensures your skin is as clean as possible prior to your surgery and can help to reduce the risk of wound infections.
You will also be required to change into a hospital gown.
The staff on the ward and escort staff willl ask you some questions on what is called a “pre-operative check list”.
You will be asked to confirm your signiture on your consent form and whether you understand what the surgeon is planning to do and that you are aware of potential risks/complications. (Consent for surgery will either be gained in clinic or on the ward/unit prior to surgery)
An Anaesthetist may see you prior to theatre to discuss the options availablefor pain relief.
You will be escorted to theatre for your operation either via a trolley or walking, depending on your preference.
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Sometimes after surgery it is necessary for patients to go to a High Dependency Unit (HDU) for closer monitoring. Often this decision is planned and the Anaesthetist will have discussed this prior to surgery, however, there are occassions when an
unplanned transfer to HDU is required.
On return to the Elective Unit your nurse will closely monitor you vital signs, including: Blood Pressure
Pulse
Respirations and oxygen levels Temperature
Urine output Consious level
Nausea and Pain scores
Your nurse will also need to regularly check your wound. You will be assisted in adjusting your position on a regular basis. Please be aware that these observations are important and staff will have to wake you in the night to continue to monitor you safely.
After your surgery it is essential you perform deep breathing and circulatory exercises as explained to you in pre-op clinic.
PAIN CONTROL
The majority of patients undergoing orthopaedic surgery, will receive both a general anaesthetic, and a spinal to help ensure your pain is controlled following your
surgery.
What Is A Spinal?
A local anaesthetic drug is injected through a needle into the small of your back to numb the nerves that supply the lower half of your body for a few hours.
How Is A Spinal Performed?
1. Your anaesthetist will ideally discuss the procedure with you, before your surgery.
2. You will meet an anaesthetic nurse who will stay with you throughout your time in theatre. They will assist you when getting into the correct position for the spinal.
You will be asked to either sit upright on a trolley with your feet on a stool or lie on your side, curled up with your knees tucked up towards your chest. In both cases the nurse will support you and reassure you during the spinal.
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3. The anaesthetist will explain what is happening throughout the procedure so that you are aware.
4. As the spinal begins to take effect, your anaesthetist will measure your progress and test how well the spinal is working.
What Will I Feel?
Usually a spinal should cause no unpleasant feelings and should take only a few minutes to perform. However as the medicine is given into your back you may feel pins and needles or a sharp tingle in one of your legs – if you do, try to remain still, and tell your anaesthetist about it.
When the injection has been completed you will be lay flat as the spinal works quickly and usually works within 5 – 10 minutes. To begin with the skin usually feels numb to the touch and the leg muscles feel weak. When the spinal is working fully you will be unable to move your legs or feel any pain below your waist. Oxygen is usually given during this procedure to improve the level of oxygen in your blood stream.
What Are The Benefits Of Having A Spinal?
Reduced blood loss during surgery and less need for a blood transfusion. Less risk of blood clots forming in the leg veins
Less risk of chest infections after surgery Less effect on the heart and lungs
Good pain relief immediately after surgery Less need for strong pain relieving drugs Less sickness and vomiting
Earlier return to drinking and eating after surgery Less confusion after the operation in older people
Nursing Observations
Following your spinal the nurses will regularly assess how effective the spinal is in controlling your pain. They will also monitor your other observations such as blood pressure, pulse and pain score. This enables them to monitor the effectiveness of your spinal and identify when it is beginning to wear off.
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After Your Spinal
It takes approximately 1½ – 4 hours or maybe longer for the feeling to return to the area of your body that has been numbed. If you have any worries about this please speak to the staff. As the sensation/feeling returns you may experience tingling in the skin as the spinal wears off. At this point you may start to feel discomfort at the site of your operation, and it is important that you let the nurses know so that they can give you some more pain relief to prevent the pain from becoming too severe.
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As the spinal wears off you will also need to ask the staff for help when first getting out of bed, to ensure that you do not fall.
What Are The Alternatives To Spinals?
Oral Tablets and medicines: These are used for all types of pain and take at least 20-30 minutes to have some effect. However they may not be as effective as spinal anaesthetic/analgesia in treating severe pain and are usually given with a spinal to promote comfort.
Injections: can be given directly into your vein for immediate effect or into your leg or buttock muscle. This method of administration usually takes 20 minutes before the pain relief starts working. Injections administered directly into a vein are very effective as it enables the pain relieving medication to be given according to your individual level of pain.
Suppositories: are inserted into your back passage, where they dissolve and eventually enter your bloodstream, they will not make you open your bowels. Suppositories may be given if you are ‘nil by mouth’ or unable to tolerate fluids.
Patient Controlled Analgesia: This system relies on a special pump, which contains opiates and sometimes anti-sickness medication. The pump is connected to a hand held button, which when pressed by yourself gives a small amount of pain relieving medicine straight into a vein usually in your arm or hand.
Epidural Analgesia: This is a method by which a small tube is placed close to the spinal cord. The tube is then connected to a machine, which gives drugs, to numb the nerves at and around the site of the operation.
Peripheral Nerve Block: Local anaesthetic is injected around tissues and nerves in and around the site of your operation, to numb them. These drugs continue to work for a number of hours post-surgery.
What Are The Side Effects Of Spinals?
Very common and common side effects – Affects 1 in 10 people
Headache
When the spinal wears off and you begin to move around there is a risk of a headache occurring, but it is easily treated with fluids and pain relieving tablets.
Low blood pressure
As the spinal starts to work, it can lower your blood pressure and make you feel faint or sick. This can be controlled with fluids given by a drip and by occasionally giving you medicines to increase your blood pressure.
Page 12 of 22 Itching
This may occur as a side effect of the Morphine like drugs used in the spinal. If you experience itching, please let staff know so that they can give you something to ease it.
Difficulty passing water (urinary retention)
You may find it difficult to empty your bladder normally for as long as the spinal lasts. Once the spinal has worn off, you should be able to pass water normally.
Occasionally a tube (catheter) may be placed into your bladder temporarily, either until the spinal wears off or as part of your operation.
Pain during the injection
As previously mentioned, you should tell your anaesthetist immediately if you feel any pain or pins and needles in your legs or bottom as this may indicate irritation or damage to a nerve and the needle will need to be repositioned.
Rare Complications – affects 1 in 10,000 people
Nerve Damage
This is a rare complication of spinal anaesthetics. Temporary loss of sensation, pins and needles and sometimes muscle weakness may last for a few days or even
weeks but almost all patients who have these symptoms make a full recovery in time. Permanent nerve damage is even rarer. In the unlikely event that you experience persistent tingling, heaviness or weakness in your legs after the spinal has worn off or you have an increasing pain in your back, whilst in hospital inform the ward nurse immediately.
If There Is a Problem
In the unlikely event that you experience persistent tingling, heaviness or weakness in your legs after the spinal has worn off or you have an increasing pain in your back, whilst in hospital inform the ward nurse immediately so they can contact a doctor or the acute pain team. If you experience any of these symptoms and have been discharged it is important that you contact the oncall anaesthetist at the hospital immediately via switchboard on 0161 922 6000. After speaking to the on call Anaesthetist they may arrange to see you in the Accident and Emergency Department in order to examine you.
Local infilitration
Prior to the closing of your wound, your surgeon will administer a local anaesthetic into the surroundong tissue to help with your pain control.
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AFTER SURGERY
It is important that after surgery you follow the daily routine that is outlined for you by your Physio . You may have a wound drain in place which will be removed 24-48 hours after surgery.
For the first 24 hours you will have Flowtron boots (intermittent compression boots) in place which are designed to reduce the incidence of clots in your legs also known as DVT’s. You will also receive a small injection each day to reduce to risk of DVT’S, and this will continue for a short period after discharge from hospital. Alternatively you may be prescribed tablets to thin your blood which you will continue to take for a short period of time after discharge from hospital.
Blood tests and X-rays will be ordered in the days after your surgery this will be done by your team of doctors.
Diet and Fluids
You can eat and drink as normal and to your tolerance, we may monitor your food intake to ensure you are eating and drinking enough to help you in your recovery. See the Dietary advice section within this booklet (page 9).
Sickness
Sometimes people experience feeling or being sick after an operation. If you do develop such symptoms please inform staff and they can give you some medication (sometimes in injection form) to help relieve this.
Pain
You will be provided with regular medication to control the pain, which will be prescibed according to your requirements. It is imprtant that you inform staff if you are experiencing pain and is not relieved by the medication provided. As adjustments can be made. Severe pain on very rare occassions could indicate a problem with the surgery and therefore should be reported to staff. See the pain section of this booklet (page 13).
Mobility
You will be expected to sit out of bed for around 2 hours on the day of surgery. You will be assisted to do this by the physiotherapy team and the staff on the Elective Unit. Staff will remind you regularly of the benefits of the breathing and circulatory exercises that you should be performing. You will be seen by the Physiotherapy team on a daily basis, the staff on the unit will also be encouraging you to increase your mobility a little further each day. Also see the detailed Physiotherapy section of this booklet (page 18).
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Occupational Therapy
Following your surgery you will be seen by the dedicated Orthopaedic Occupational Therapy team, who will assess your needs in preparation for discharge home. See the Occupational Therapy section of this booklet (page 22).
Wounds
It is not unusual for your wound to be slighty red and uncomfortable for the first 1 to 2 weeks. However, please let us know if your wound becomes:
Inflammed (red), swollen or painful Begins to discharge fluid
Or seperates in any place
POST-OPERATIVE PHYSIOTHERAPY
Physiotherapy commences on the day of your surgery – try to start doing some of the circulation exercises ( see page 17) as soon as you come round from your operation .
Your Physiotherapy team may visit you on the day of your surgery and will definitely see you the morning after when they will assist you to get out of bed and sit in a chair. You will also be able to take your first few steps /have a short walk. The Physiotherapist will visit you each day and monitor your progress, but it is important that you continue to practice walking and exercises regularly (as directed by your Physiotherapist): either with the Nursing staff or independently.
The Physiotherapist will provide you with education on walking on your new joint. You will initially walk with a walking frame, then progress onto crutches. You should start the exercises in this booklet as soon as possible once you have woken after your surgery.
You will be assessed for safety in managing steps and stairs before you go home, as appropriate.
MOBILISATION: Getting out of bed:
Your Physiotherapist will assist you to stand from the bed. You must get out on the operated side to avoid crossing your legs:
- using your hands, push yourself to the edge of the bed
- allow your leg to gently bend over the side of the bed as you come forward (your Physiotherapist will assist you initially)
Page 15 of 22 Sit to stand:
- slide your operated leg slightly forward
- using your arms beside you (on the bed or chair arms), push up into standing before reaching for your walking aid
Walking:
To begin with, you will use a walking frame, and then progress to crutches as appropriate.
The correct sequence when walking is:
1. move the walking aid forwards/in front first 2. step the operated leg forward
3. step the un-operated leg forward, so it is level with the other
When turning you must always be careful not to twist your new hip: always step round towards your good/un-operated hip, picking up your feet.
Sitting down:
- always ensure you have turned and backed up to the chair so that it is aligned behind you ie. never twist into the chair
- let go of your walking aid
- feel for the chair arms
- slide the foot of your operated leg forwards as you slowly lower yourself down into the chair
Getting into bed:
- sit on the edge of the bed
- using your hands beside you, push yourself back to sit far enough back on the bed so that the operated leg is supported
- turn to position yourself on the bed
EXERCISES:
Start the following as soon as you feel able after coming round from your surgery: (see previous explanationsin pre op physiotherapy section page 7 )
calf pumps
static quadriceps
gluts/buttock squeezes breathing exercises
o take 4-6 deep breaths in and out then finish with a cough o this will help to clear away any build up of mucus
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These exercises are important. Blood clots can develop in the legs following surgery. These exercises will help to increase the circulation in your legs and help prevent blood clots. These excercises will also improve the muscle strength in your legs which will help to prevent dislocation of your new hip. Some patients can experience some muscle pain following surgery please advise your nurse/physio if this occurs. Start the following as soon as you are able to walk independently:
(perform these 3 x daily in addition previous exercises) Standing Hip Flexion
hold onto something for support lift your operated leg forwards, up
and in front of you, bending at the hip and knee
do not go past 90 degrees slowly lower down
repeat x 10
Standing Hip Extension
hold onto something for support tense your buttock
lift your operated leg up and backwards behind you, keeping the knee as straight as possible slowly lower down
repeat x 10
Standing Hip Abduction
hold onto something for support tense your buttock
lift your operated leg up and sideways away from you, keeping the knee as straight as possible
slowly lower down repeat x 10
ensure the pelvis remains level i.e. do not ‘hitch’ the hip up
TACKLING STAIRS/STEPS:
Page 17 of 22 Going up:
1. pass one crutch in front of your body into your other hand (so crutches are in a cross + shape)
2. hold onto the banister/handrail with your free hand 3. step up with your good/unoperated leg
4. bring up your bad/operated leg 5. bring your crutch up last
Going down:
1. place your crutch down onto the step below 2. slide your hand down the banister
3. lower your bad/operated leg down first
4. bring your good/un-operated leg onto the same step
GENERAL ADVICE
Progression is largely dependent on you. You must exercise regularly to regain movement, strength and independence. Periods of rest in between are equally important. Do not sit still for too long: get up and walk and exercise regularly. Little and often is the key!
Initially, you are advised to sleep on your back. After the clips have been removed from your wound, you may try sleeping on the operated side, if it is comfortable to do so.
Do NOT lie on the un-operated side until advised to do so (by your Physiotherapist).
Points to remember:
do not discard your walking aids until advised to do so (then please return them to the Physiotherapy Department, Hartshead North Building) or arrange to return them to Rosscare on 0161 344 0482
avoid kneeling
avoid long periods of standing
stand with your weight evenly distributed through each foot do not drive until advised to do so by your Doctor
You will be invited to attend a post-op group session between 3 and 6 weeks after your surgery.
Once you are home you must continue with all of your exercises.
By approximately 3 months post-op you will be largely back to your normal activities, although improvement continues for up to a year.
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OCCUPATIONAL THERAPRY POST OPERATIVE INFORMATION
The following precautions must be followed for the 12 weeks after your hip operation: 1. DO NOT FLEX THE HIP BEYOND 90°
2. DO NOT CROSS YOUR LEGS 3. DO NOT TWIST THE HIPS
To assist you to manage independently at home you will be assessed by the
Occupational Therapist who will provide equipment to help you prevent dislocation of your new hip.
ACTIVITIES OF DAILY LIVING
Dressing
DO NOT FLEX THE HIP BEYOND 90°
Do not lean forward from the waist or let the hands reach below the knees.
You will be provided with the following dressing aids:
HELPING HAND – used to dress lower limbs e.g. putting trousers on, underwear and shoes
LONG HANDLED SHOE HORN – used to put shoes on
SOCK OR TIGHT AID – used to put socks, stockings or tights on LONG HANDLED SPONGE - used to wash below the knees and feet
These dressing aids must be used for 12 weeks after surgery.
DO NOT TWIST THE HIPS
To dress sit on the edge of bed or on a chair. Position clothes so they are in reach and you don’t have to twist or reach across your body.
Always lift the foot, do not swivel. Do not twist your operated leg round.
DO NOT CROSS YOUR LEGS
The operated leg must not cross the mid-line of the body. Dress the operated leg first, undress it last.
Please bring clothes into hospital with you so the dressing aids can be demonstrated e.g. socks trousers/skirt
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Heights of Furniture
It is important to measure the heights of your furniture to avoid bending the hip beyond 90°. If your knee is higher than your hip when you are seated, you are breaking this rule. Please complete the measurement form provided.
CHAIR – The chair may need to be raised either with additional cushions or chair Raisers.
TOILET – The toilet can be raised with a Raised Toilet Seat
BED – The bed can be raised with an additional matress or bed raisers
If any equipment is required it will be loaned to you, free of charge for 12 weeks after which it should be returned to the equipment store.
Bathing
Your OT will discuss this with you at pre-op clinic or after your surgery. You should not sit in the bottom of the bath for 12 weeks.
If you have a shower over the bath, a shower board may be assessed for and provided. This depends on the shape of your bath and your ability to use the equipment safely without breaking the precautions.
If you have a shower cubicle avoid standing for too long
Domestic and Kitchen Tasks
Do not stand for too long, take regular rest breaks. A stool or chair of the correct height may be used
Do not twist or over reach e.g. no hoovering.
Do not bend forward from the waist to pick things up off the floor. Use your helping hand
Do not use a step ladder or kneel
Do not reach to low controls on a gas-fire or low plug sockets Remove all loose rugs and mats to avoid risk of trips or falls
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DISCHARGE HOME
It is our aim for you to be in your own home recovering as soon as possible. It is important that adequate support from your family and friends is organised prior to your surgery, as adequate rest is also an important part of your recovery. We aim to discharge you from hospital in line with your expected date of discharge so please take note of the number of days assigned to your procedure.
Preparing to leave the hospital
You must arrange for a family member or friend to collect you from the elective unit on your day of discharge.
You will need to bring into hospital appropriate outdoor clothes to go home in. When you leave hospital
A discharge letter will be sent to your GP detailing the events of your hospital stay. A 7 day supply of your medications/pain relief will be provided from the hospital pharmacy it is important that you contact your GP before your supply runs out.
A referal to the District Nurses will be made, you will be given a copy of the referral form. This referral will be for administration and/or teaching of self administration of fragmin injections, for wound check/dressing change and clip removal, if required. When you first return home you are likely to feel tired for a while. We recommend that you build your strength up before coming into hospital with gentle exercise and a good dietary intake.
Before you leave the unit, you will be given a phone number for the clinic and you will receive an appointment in the post for approximately 6 weeks following surgery. Only contact the clinic if you have not received an appointment through the post after 3 weeks.
At the discretion of your consultant, you may after 10-12 weeks attempt the following:-
- Drive a car.
- Attempt sexual intercourse. - Try general household activities.
- Commence hobbies, e.g. gardening, bowling and swimming.
Driving
You should always speak with your insurance company before coming into hospital as your insurance policy may be affected. We advise that you should not start driving again until your strength and speed of movement are up to coping with an
Page 21 of 22 Travel
Please check with your consultant/GP before flying especially long flights. Long car journeys are also best avoided for at least 12 weeks following your operation. If this is unavoidable, we recommend you take regular stops. Consideration must be given to the height of the seat, prehaps discuss with your Occupational Therapist.
Air travel should be avoided for four months following surgery. Work
If you work we advise that you discuss with your boss the need for time off work after your operation and support on your return to work before coming into hospital. If available, talk with your Occupational Health Department. The length of time off will depend on what job you do. You must consider the heights of furniture if returning to work within the first 12 weeks.
Complications are a very rare occurance however it is important to know what to do if one occurs.
Below are several useful contact numbers where you can seek advice:
Useful Contact Numbers:
Elective Unit: 0161922 6235/6208 (24hrs)
Orthopaedic Physiotherapy 0161 331 6313(mon-fri 8.30am-4.30pm) Occupational Therapy 0161 3315171 (mon-fri 8am-4pm) Rosscare Equipment Service 0161344 0482
Go to Doc (GP service) 0161 785 0805 (out of hours)
NHS Direct 0845 46 47 (24hr helpline)
Emergency Services 999
You can also contact your own GP or District Nurses for advice.
Useful Websites/information
Department of Health (www.dh.gov.uk)
NHS Choices (www.nhs.uk/conditions/enhanced-recovery) NHS institute for innovation
and improvement (www.institute.nhs.uk/enhanced_recovery_programme) NHS Improvement (www.improvement.nhs.uk/enhancedrecovery)
Patient Information Centre Royal College of Anaesthetists
Source of good practice
In compiling this information leaflet a number of recognised professional bodies including the The Department of Health, NHS Choices, Royal College of
Anaesthetists have been used.
If you have any questions you want to ask, you can use this space below to remind you
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If you have a visual impairment this leaflet can be made
available in bigger print or on audiotape. If you require either of
these options please contact the Patient Information Centre on
0161 331 5332
Document control information Authors :
Dawn Fletcher, Jenna Gilbert, Janet Perkins, Emma Brown , Jillian Barlow.
Division/Department: Orthopaedics Date Created: September 2012 Reference Number:
