Orthopaedic Surgery - Therapy Information Following Hip Surgery

Introduction

You have had a hip operation because you have fractured your hip or the middle (shaft) of your thigh bone (femur).

There are different types of hip fixation procedures.

The procedure you have had is …………………………….........................................

Some patients have to follow hip precautions after their operation. You do/do not have to follow hip precautions.

Please ensure you read pages 6 and 7 if you DO have to follow hip precautions.

If you have not had a total hip replacement or hip hemiarthroplasty and would like more information about your specific procedure, please speak to your therapist.

Measurement sheet

It would assist the Occupational Therapy Department if you could please measure the following (in inches or centimetres).

Any problems please phone the Occupational Therapy Department on 0161 206 4557
 
Please only complete the information in the boxes

Having a total hip replacement

What a total hip replacement involves

The hip comprises of the head of the femur (thigh bone) and the socket (acetabulum) of the pelvis. Together these form a ball and socket joint. This is a mobile joint, which is capable of many different movements.

When you have a total hip replacement, the surgery involves:

What is a Hemiarthroplasty?

It is an operation that is commonly used to treat a fractured or broken hip.

The hip joint is a ball and socket joint:

When you fracture or break your hip it is usually the neck of the thigh bone (femur) which is affected and an operation is the safest treatment option.

In your operation only half the joint, the ball portion of the hip joint is replaced, not the socket.

Hip Precautions

After your operation there are precautions that you may need to follow to minimise the risk of your hip dislocating. Your ward therapist will advise whether or not you need to follow these precautions. It depends which consultant has completed your surgery.

It is important to remember the above rules help reduce the risk of your hip dislocating.

Advice to help you comply with hip precautions

1. It is important your furniture is the right height - please complete the heights form given to you by the Occupational Therapist.
2. Get out of bed on the side you have had your operation on.
3. Get into bed the same side you got out.
4. Sleep on your back.
5. Do not bend down to put on shoes/socks/underwear/trousers.
6. When walking take small steps to turn around - do not twist.
7. When in the kitchen avoid bending and twisting. Keep frequently used items at worktop level.
8. Avoid twisting to reach things e.g. move toilet paper to within easy reach.
9. Picking something up - ask somebody else to pick items up off the floor. If nobody else is available, use your ‘helping hand’ if provided.

How to use a wheeled Zimmer frame

Standing

• Push up from your chair/bed/toilet. Do NOT pull on the wheeled Zimmer frame. Once you are stood, reach forward and hold onto the handles of the wheeled Zimmer frame

Walking

• Push the wheeled Zimmer frame forward. Step your operated leg forward then your non-operated leg. Do NOT lift the wheeled Zimmer frame off the floor. Keep a gap between yourself and the horizontal bar at the front of the frame.

Sitting

• When you feel balanced and can feel the chair/bed/ toilet on the back of your legs, reach back for the arms of the chair/the bed/the toilet rails (if you have any). In a slow and controlled manner, lower yourself into a sitting position

How to use elbow crutches

Standing

• Place the crutches into the “H” position. Then place one hand on both handles and your other hand on whatever furniture you are sat on and stand up. Once you are balanced in standing, place each hand through the arms of the crutches and hold the handles (the handles should be facing forwards)

The safest standing position can be seen in the photograph. Each crutch should be slightly in front and out to the side of your feet, this increases stability when standing.

Sitting

• Take each hand out of the crutches and place them into a “H” position. Once you feel balanced reach back with your free hand for the arm of the chair. In a slow and controlled manner lower yourself into a sitting position

Stairs

• If using a banister/stair rail take your hand out of the crutch and pass it over to the other side gripping it (as in the photograph) with your other hand

Going up

1. Non-operated leg
2. Operated leg
3. Crutch

Coming down

1. Crutch
2. Operated leg
3. Non-operated leg

How to complete a step

Going up a step

Place your wheel Zimmer frame onto the step. Step up on the step with your non-operated leg followed by your operated leg.

You can hold onto the frame while you do this as long as it is being secured by someone.

Going down a step

Place your walking aid down onto the step below or the floor below followed by the operated leg then the non-operated leg.

Following discharge

If the therapy team feel you require further therapy in your recovery you may be referred to the community therapy team in your area. They will visit you at home in order to monitor and progress your therapy. If appropriate, you will be referred to your local outpatients therapy department instead.

Your staples will be removed approximately 7-10 days following your operation. The nursing staff will arrange this.

It is essential that you continue to wear your TED stockings for 6 weeks (unless you are advised otherwise), as they will help to prevent a blood clot.

A follow-up appointment to attend clinic may be arranged for you, the details of this will be sent to you after you have been discharged. At post-op clinic visits, an appropriate member of your consultant’s team will see you; this may include extended- scope physiotherapists. An x-ray of your hip may be taken on arrival at this clinic. Alternatively, your consultant may be happy for community health staff to monitor your recovery. If necessary, they can liaise with your consultant.

Your guide to daily activities

Should you need to follow precautions after your hip operation you will need to change the way you carry out everyday tasks to reduce the risk of dislocating your new hip.

Sleeping

• It will be necessary for you to sleep on your back immediately after your operation. The therapy team can advise you on changing your sleeping position as required
• Do not cross your legs in bed. Try to keep your legs slightly apart when sleeping (putting a pillow between your legs may help with this)

Getting into bed

• Get into bed with your un-operated leg first. When getting into bed, slide your bottom back towards the pillow to ensure that your operated leg is supported before lifting it into bed

Getting out of bed

• Get out of bed with your operated leg first
• Do not sleep on a low bed. The OT will ensure that your bed is correct height prior to discharge
• Bed transfers will be assessed on the ward prior to discharge

Getting in and out of a chair

• Ensure any chair you sit on is the correct height. The OT will measure your leg and inform you of the correct height for you
• Your knees should not be higher than your hips when seated
• Sit in a chair with arms where possible
• Always stand up before putting your arms into your crutches and remove crutches before sitting down
• Do not sit with your legs or ankles crossed
• Chair transfers will be assessed prior to discharge

Dressing and undressing

• Sit on a highchair or bed
• Dress your operated leg first and undress it last
• You may need to purchase dressing aids (i.e. helping hand, sock aid and long handled shoehorn), as you must avoid bending down to reach below your knees or bending to the floor. You will be taught how to use these before going home
• Do not bring your operated leg up, towards your chest
• If you have lace up shoes, do not bend down to tie them. If possible, wear shoes without laces instead

Getting on and off the toilet

• Only sit on a toilet that is the correct height for you. The OT will advise you about this
• Use the same technique as getting on and off a chair
• Do not twist when reaching for toilet paper or when going to flush the toilet
• Toilet transfers will be assessed prior to discharge

Bathing

• All patients should strip wash until the community therapist advises it is safe to use the shower or bath. If necessary, the ward occupational therapist will assess and provide you with a perching stool so you can sit and wash at your sink

• Following assessment by the community or outpatient therapist, you may be able to use a cubicle shower. If there is a step to step over, go in with your non-operated leg first and come out with your operated leg first

• Following assessment, you may be able to use a bath board over the bath. The community therapist will teach you how to use this.

Car transfers

• You may travel home in a car, following discharge from hospital
• You are advised not to drive any vehicle until informed that you can do so by your therapy team/consultant

To get in/out of the car:

• Ask someone to push the passenger seat as far back as possible and recline the backrest
• Avoid getting into the car from a kerb where possible and try to park away from the pavement
• Sit on the seat as you would a chair, slide yourself backwards towards the handbrake, then bring one leg in at a time avoiding excessive bending or twisting of your hip. Try to lean backwards at all times. You can bring the backrest forwards once you are in the car, but avoid excessive bending
• To get out of a car, reverse this procedure

Things to avoid:

• Long journeys; break the journey every hour and walk a short distance to avoid hip stiffness
• Avoid using vehicles that require you to bend or stoop in order to access them, e.g. black cabs and the rear of minibuses

Always ask the advice of the therapy team if you are unsure about a car transfer.

General advice

• You are advised to remove any loose rugs and mats at home to minimise the risk of falls
• Continue to take regular exercise, such as short walks, in addition to those given to you on the ward. Your community physiotherapist will practice outdoor mobility with you if you are lacking confidence walking outdoors. You should not mobilise outdoors with a Zimmer frame. Your community therapist will advise you when it is safe to mobilise outdoors
• Do not sit or stand for long periods of time as this may cause stiffness in your lower limb

Problems to watch out for

You may notice some numbness around your incision. This is normal. The numb area will shrink in size but you may experience a small area of numbness permanently.

Signs of possible problems include:

• Increased temperature. It is normal to have a slight fever following surgery but anything more or that lasts may indicate a problem
• Increased hip soreness not reduced with medication
• Dramatic increase in hip swelling
• Stomach upset after taking medication
• Excessive weeping from the wound
• Sustained loss of hip movement
• Marked calf pain or swelling

If you experience any of these problems, please contact your GP or the orthopaedic ward you were discharged from.

Therapy treatment

You will be seen by the therapy team on the ward the first day after your operation. The therapist on the ward will assist you to get out of bed. When appropriate, they will practice you walking with a Zimmer frame (or another appropriate walking aid).

They will teach you exercises to do:

1.    Deep breathing exercises

Sit upright in the bed or chair (not in a slumped position). Ask the Nursing staff to help you reposition if you are unable to do this by yourself.

Every hour, take 5 deep breaths. Breathe in deeply through your nose (your stomach should expand as you do this) and then breathe out slowly through your mouth (your stomach should deflate as you do this).

2.    Toes and ankle exercises

Wiggle your toes. Repeat this 10 times.
Move your ankles up, down and in a circle. Repeat this 10 times. 
You can do this when in bed as well as when sat in a chair.

3.    Static glutes contraction

Squeeze/clench your bottom muscles. Hold for 10 seconds. Repeat 5-10 times as able.
You can do this when in bed as well as when sat in a chair.

4.    Static quads contraction

Pull your toes up, tighten the muscle on the front of your thigh pushing your knee down into the bed.
Hold for 10 seconds. Repeat 5-10 times as able.

5.    Straight leg raise

Pull your toes up, tighten the muscle on the front of your thigh and lift your leg 20cm off the bed keeping your knee straight.
Hold for 5-10 seconds. Repeat 5-10 times as able.

6.    Straighten your leg and slide it out to the edge of the bed and back to the middle (see below).

Repeat this 5-10 times, as able.

7.    Lying flat on the bed, slide your heel along the bed towards you bending your knee up (see below).

Do not bend past 90 degrees at your hips if following hip precautions. Use a rolled towel or belt to help you gently achieve these movements, as demonstrated by your therapist.
Repeat this 5-10 times, as able.

8.    Chair Exercise

Sit on a chair, pull your toes up, tighten your thigh muscle and straighten your knee.
Remember to do Exercises 1 & 2 when sat in your chair.
Hold for 10 seconds, repeat this 10 times.

Exercises to do in standing

Always support yourself by holding on to something high and firmly fixed e.g. kitchen worktop.

•    Take your operated leg out to the side, keeping it straight at all times.
Repeat 5-10 times as able.

On your operated side raise your knee in front of you (but not higher than hip level if you are following hip precautions).
Repeat 5-10 times as able.

Raise the heel of your operated leg towards your buttock, keeping your hip and back straight.
Repeat 5-10 times as able.

Exercise frequency

Aim to complete your exercises 4 times per day e.g. morning (bed exercises), midday (chair or standing exercises), teatime (chair or bed exercises), bedtime (bed exercises).

Pain relief

If you are finding it difficult to complete your exercises or mobilise due to pain, you should request strong pain relief (not just paracetamol) regularly from the nurse on the ward and take it regularly once home.
 

Contact details

For queries regarding follow up therapy after discharge home.

Ward B6, Salford Royal Hospital
0161 206 4574

Inpatient therapy office, Salford Royal Hospital
0161 206 4557

Salford Supported Discharge Team
0161 906 1550