Orthopaedic Surgery - Total Hip replacement surgery – what is involved and what to expect

Dear .....................................................................................................

You have been listed for a total hip replacement (THR). You will be given an appointment to attend a rehabilitation clinic.

This is a mandatory requirement for all patients undergoing a THR. Failure to attend this group may have implications for your surgery.

You may be given a walking aid for you to take home and practice with. We realise that in some cases this may not be practical for you, so alternative arrangements can be made.

In the leaflet you will find a measurement sheet, which we would like you to complete prior to the rehabilitation clinic. If you are not able to do this, we can do this at a later date. The measurements are important as it gives us information on any equipment that you may require to use within your home following your operation. This is not necessary for all THR patients.

Any equipment you may need is supplied and may be fitted prior to your admission to hospital; this will be discussed with you during your clinic visit. All equipment will be removed once you no longer require it.

Many thanks.

Measurement Sheet 

Patient Name:                 
Leg length:         
Hospital no:     
Ward:            
Date form issued:         
Date form collected:             
Date equipment ordered:             
Equipment received on discharge:  

 

General information

You are about to have a hip replacement. The advice and exercises shown in this leaflet will help you to recover from your operation and get the most out of your new hip. It is important that you understand that it takes a lot of commitment from yourself to regain the strength and movement of your hip and prevent dislocation after the operation.

Whilst you are in hospital, your physiotherapist will help you to regain your mobility by teaching you how to walk effectively with crutches. They will also teach you exercises to regain the movement and strength in your hip.

You will also be seen by an occupational therapist (OT). They will assess your ability to manage activities of daily living and help you regain your independence. They will be responsible for providing any necessary equipment you may need following your discharge.

The therapy team will discuss precautions with you that you will have to follow after your operation in order to minimise the risk of dislocation. How long you are following these precautions after your operation will be dependent on your consultant.

What to bring to hospital?

Please bring footwear and clothing that is appropriate for you to mobilise and exercise in, i.e. flat comfortable shoes/slippers (with backs) and loose day clothes.

If we have been unable to organise any necessary equipment prior to your admission, please bring contact details into hospital of someone who has access to your house so that we can arrange delivery of any equipment you may need at home before you are discharged.

Day of Admission

You may be admitted either on the day of, or on the day before your operation.

Where possible, the therapy team will assess you on admission, to establish your potential requirements for discharge. If this is not possible, you will be seen after you have had your surgery.

You will be given a gown to change into before you are taken to theatre. A theatre nurse will accompany you from the ward to the operating theatre where they will make sure you are comfortable and ready for your operation.

After your operation you will go to the recovery room. From there you will be taken back to the ward.

After your operation, there will be a large dressing over your hip and your wound will be closed with a row of staples. You may have a cushioned wedge placed be-tween your lower legs to help maintain a good position whilst in bed.

You will be wearing a pair of elastic stockings (TEDs), which may come up over your knee to your thigh. You will need to wear these for 6 weeks following your operation as they reduce the risk of you developing a blood clot and help control the swelling in your leg.

You will be given pain relief either orally or via a PCA (patient- controlled analgesia). It is essential that you receive adequate pain relief following your surgery to ensure that you can comply with your rehabilitation.

Following your operation

The therapy team on the ward will see you. The team will assist you to transfer out of bed and practice walking with crutches or another walking aid that is suitable for you. This may occur on the same day as your operation.

Over the following days you will:

• Progress your walking so that you are happy to walk independently using your crutches
• Be assessed and showed how to negotiate stairs/step. Going up- place un-operated leg up first and follow with the operated leg and crutch. Going down- place crutch down, then the operated leg, then the un-operated leg
• Be assessed on your ability to manage your activities of daily living, i.e. bed transfers. See later section for more information on activities of daily living
• Be reminded of the precautions that you will have to follow. See later section on precautions

You will have an x-ray of your new hip prior to being discharged.

If the team who are looking after you feel that you may need some extra help at home whilst you are recovering from your hip operation this will be discussed with you. You will also have the opportunity to speak to a social worker on the ward.

How to use crutches

• Place the crutches into the “H” position. Then place one hand onto both handles 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 handout 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

Stairs

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

Coming down

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

Discharge

You will be discharged between days 1 and 4 after your operation, providing:

• You are safe and independent with elbow crutches and activities of daily living
• You are safe and independent on the stairs/step (if applicable)
• You have a home exercise programme to follow
• The hospital staff are happy with your progress
• Any equipment or services you may need have been arranged

Following Discharge

Within Salford, the Supported Discharge Team will arrange to visit you at your home in order to monitor and progress your therapy. They will provide advice regarding your precautions and progression of exercises. This advice is dependent on your consultant.

Should you live outside the City of Salford; referrals to your local community team/therapy department will be made.

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, as they will help to prevent a blood clot.

A follow-up appointment to attend clinic will 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.

Precautions

After your operation there are precautions that you must follow in order to minimise the risk of dislocation to your new hip. You will be given advice regarding the length of time you will need to follow these precautions, as this will depend on the consultant who has operated on you.

These precautions are as follows:

Don’ts

• Do not bend your operated hip more than at a right angle (90 degrees). For example:

• Do not bend to touch below your knees
• Do not bring the thigh of your operated leg towards your chest

• Do not kneel down
• Do not use a ladder or climb onto a chair
• Do not twist the hip when sitting or standing

• Do not sit or lie with your legs or ankles crossed

Dos

Whilst following these precautions it is important that you:

• Sit with your weight taken evenly through both buttocks
• Place weight evenly through both legs when sitting and standing
• Lift feet from the floor when stepping round, rather than pivoting

Your guide to daily activities

The precautions you are required to follow after your hip operation require you to change the way you carryout 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 in and out of bed

• Get into bed with your un-operated leg first. Get out of bed with your 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.

• Push up from the bed with your arms to bring yourself up into a standing position
• 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 that any chair you sit on is the correct height for you. The OT will measure your leg and inform of the safe 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 them 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
• Use the dressing aids you may be provided with (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
• Do not bring your operated leg up, towards your chest
• If you have lace-up shoes, do not bend down to tie them, do not wear them. Wear slip-ons 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

• You may use a cubicle shower. If there is a step, go in with your un-operated leg first and come out with your operated leg first.
• You may use a bath board over the bath. Use a similar technique to get on and off the board, as you would use to get in and out of bed
• Slide your bottom back along the length of the board and lean back slightly. Then, one at a time, lift your legs into the bath. Ensure that you follow your precautions at all times. Reverse this procedure for getting out
• Do not sit on the bottom of the bath until informed by the therapy team, that you can do so. Please discuss the use of any existing bathing equipment with the OT before using it after your operation
• To wash/dry below your knees long handled aids are required. Alternatively, you can get someone to assist you during this period
• If appropriate, a bath board assessment will take place prior to discharge.

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

Getting in and 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

Picking something up

• Ask somebody else to pick items up off the floor
• If nobody else is available, use your ‘helping hand’ if provided

Exercises

Your therapy team will have taught you the exercises showed in this leaflet whilst you are on the ward. However, it is important that you maintain these exercises following discharge in order to increase the movement, strength and stability of your new hip.

Exercises to do when you are lying in bed

• Tense up your buttocks as hard as you can. Hold for 10 seconds. Repeat 10 times.
• Tense up your thigh muscles as hard as you can, pushing your knee into the bed and straightening your leg. Hold for 10 seconds.  Repeat this 10 times
• Tense up your thigh muscles and lift your heel off the bed, keeping your leg straight. Hold for 5 seconds. Repeat 5 times

Exercises to do in standing

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

• Take your operated leg out to the side, keeping it straight at all times

• On your operated side raise your knee in front of you (but not higher than hip level)

• Raise the heel of your operated leg towards your buttock, keeping your hip and back straight

General Advice

• The height of your furniture is important. The OT will check this prior to discharge
• You are advised to remove any loose rugs and mats at home to minimise the risk of falls whilst using elbow crutches
• In the kitchen, keep items frequently used at worktop level and avoid bending into low cupboards
• Avoid twisting to reach things
• Continue to take regular exercise, such as short walks, in addition to those given to you on the ward
• Do not sit or stand for long periods of time as this may cause stiffness in your new hip

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.

Contact details

Physiotherapy Department, Salford Royal Hospital - 0161 206 5328
Occupational Therapy Department, Salford Royal Hospital - 0161 206 4557
Ward B5, Salford Royal Hospital - 0161 206 4600