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TOTAL HIP REPLACEMENT GUIDELINES FOR PATIENTS THIS IS MODERN MEDICINE

Guidelines for Patients Having Total Hip Replacement INDIVIDUAL PATIENT NOTES Consultant Name Date of Surgery Weight Bearing Status Walking Device Date for Removal of Sutures Stitches or Staples Clips Contents Other Recommendations Individual Patient Notes 2 Toilets Introduction 4 Using Stairs What is a Total Hip Replacement 5 Rehabilitation Goals What can I Expect from an Artificial Hip 6 Hip Replacement Goals of Care 26 27 Preparing for Admission Checklist 7 General Recommendations 28 29 Discharge Instructions 30 33 Activities Once Discharged 34 37 Preparing for Admission 8 10 Preparing for Discharge 10 14 Occupational Therapy Dressing Washing Showering Kitchen Activity General Safety Advice for Home Cardinal Rules 15 Physiotherapy 16 Exercise Programme 17 Daily Excercises 18 21 23 23 24 25 Call Bells Sleeping Nausea Pain Management Wound Care Signs of Infection Antibiotics Pain Medication Swelling Bruising Stockings Use of Ice Bowel Care Car Transfers When Getting in and Out of the Car Driving Travel Sexual Activity Conclusion 38 Bed Exercises 22 Potential Complications 39 44 Walking 22 Exercise Diary 44 45 3

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement What is a Total Hip Replacement Introduction A total hip replacement THR is designed to replace a hip joint that has been damaged by arthritis The hip is a ball and socket joint formed by the head of the femur or thigh bone sitting into the acetabulum or socket in the side of the pelvis Normally the surfaces are covered by a smooth substance known as articular cartilage or gristle Due to arthritis part or all of this cartilage may wear away exposing the underlying bone thus causing roughening of the joint surfaces stiffness and painful movement A limp will usually develop and the leg may become shorter and also thinner due to muscle wasting This information booklet has been written to give you and your family a better understanding of what is involved when you require total hip replacement surgery A THR replaces the worn head of the femur with a metal ball on a stem which is inserted into the centre of the femur A THR also re lines the socket acetabulum with a cup made of special plastic or metal A painful hip can severely affect your ability to lead a full active life The aim of a total hip replacement is to improve your quality of life giving you independence and healthy pain free activity In this booklet we provide you with information on total hip replacements including things you should know before and after your operation as well as information regarding your discharge from the hospital It is important for you to understand the benefits as well as the possible problems that may occur after this form of surgery Throughout your stay in Beacon Hospital you will receive continuous advice and support from all members of the team 4 A THR is principally designed to relieve pain and restore joint movement It will also aim to correct the shortening effect of arthritis It is important to note that it is not always possible to make both legs equal in length Socket acetabulum Ball femoral head Smooth cartilage Thigh bone femur 5

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement What Can I Expect from an Artificial Hip Pre admission Checklist The main goal of treatment is to alleviate pain There will be some pain from the surgery to start with but you can expect to notice a benefit very soon after the operation After recovery you should have greater mobility and a better quality of life It is important to remember that an artificial hip is not as good as a natural hip It does have some limitations which are summarised later in this booklet Made arrangements for discharge to home or convalescence Bought appropriate clothing footwear for after surgery Dental Clearance cert or letter Watch on line Pre op Education Videos on Beacon Hospital website https www beaconhospital ie department service pre operative clinic Pre operative Assessment attended Know what time to start fasting from food and stop drinking water before surgery What to Bring to Hospital 6 All the medications you are currently taking including those you may have stopped leading up to your surgery Prescribed drugs Over the counter drugs Supplements vitamins minerals and herbals A list of your allergies if any Loose pyjamas or short nightgown dressing gown Correct footwear Loose shorts trousers or tracksuit bottoms Underwear Socks Personal toiletries Anything else you use on a daily basis for example glasses or contact lenses hearing aid etc 7

Guidelines for Patients Having Total Hip Replacement Preparing for Admission Pre operative Joint Education Classes This pre operative meeting is a time for you to speak with the physiotherapist and the orthopaedic nurses and ask any questions you may have regarding your surgery and rehabilitation We recommend and encourage all patients for hip replacement surgery to book in and attend one of these classes preferably at least 2 weeks prior to their surgery Contact the Centre for Orthopaedics to book a place Also please watch the Pre op Education Videos on our website Find a link to this at the end of the booklet Dentist It is important that your teeth and gums are healthy before your operation as bad teeth can be a source of infection Please make sure that you have had a dental check up in the last six months You will need to get a dental clearance letter or cert from your dentist to allow you have your surgery Nutrition Aim to follow a well balanced diet which includes protein fats and carbohydrates It is important to be well nourished to promote wound healing so eat well during your post op recovery Protein is partially important for wound healing It is found in meat fish eggs milk cheese yoghurt beans and pulses We usually advise against trying to lose weight during the first few weeks of your post op recovery On admission if you have any specific dietary requirements please discuss these with the nursing or catering staff If you are on a special diet or have any queries please discuss with your doctor nurse or dietitian Guidelines for Patients Having Total Hip Replacement Smoking It is advisable to stop smoking or at least to reduce the number of cigarettes you smoke a day as smoking interferes with wound healing It also impairs bone growth and repair and will delay or even prevent healing of the joint after surgery If you smoke please inform your Pre op assessment nurse and your admitting nurse Clothing Day time attire of loose comfortable clothing is advised eg long shorts tracksuit bottoms or loose three quarter length trousers Footwear Slip on shoes with a low Back on shoe heel and back are recommended Elastic shoe laces can turn your laced shoes into slip on shoes You will not be able to bend down to tie your shoelaces after your surgery Loose fitting socks are also recommended We do not recommend slippers or backless shoes Do not wear tight fitting shoes as you may experience some temporary swelling in your foot on the operated leg after surgery Valuables Please leave all valuables and jewellery at home There is a small safe in the patient room that can be used to hold small items of value to you during your stay Skin preparation Your skin will have to be prepared for surgery This involves showering with a disinfectant agent and using special anti microbial wipes on the area the night before and the morning of surgery More information on this is provided to you when you attend the pre operative clinic You should avoid all but facial shaving for the 2 days prior to your surgery Any shaving to the area will be carried out in the operating theatre 8 9

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Fasting pre operatively The scheduling department will phone you prior to admission If you are coming in on the day of surgery they will advise on how long to fast Morning of Surgery Admission If you have been asked to come to the hospital in the morning for admission then you must not eat solid food or drink fluids after 12 midnight Afternoon of Surgery Admission If you have been asked to come to the hospital in the afternoon for admission then you may eat a light breakfast as long as you are fasting from food and drink for six hours and water for 2 hours before your surgery If you are being admitted on the same day as your surgery we would ask that you drink some Lucozade Original to help with your recovery Please can you drink 200mls of Original Lucozade the red one 2 hours before your admission time We advise that you remove the lid of the Lucozade bottle 10 minutes before you are going to drink it This will allow the drink to become flat before you drink it Diabetic patients should not drink any Lucozade If you are being admitted the day before your operation there is no requirement for you to drink Lucozade Planning your Discharge Your length of stay in Beacon Hospital after your operation is normally 3 to 5 days If there is any possibility that you may require convalescence or additional help at home now is the time to start planning and arranging it It can be extremely difficult to get a bed in a convalescence centre at short notice If you require further information regarding this we have an information pack to help you plan your convalescence Our Discharge Coordinator can provide further information and assistance regarding this 10 Occupational Therapy The Occupational Therapist s role is to assess a patient s home circumstances looking at the physical environment and assisting patients in maintaining independence with everyday activities If necessary advice can be given on adaptive equipment as well as alternative methods of performing everyday tasks while adhering to your hip precautions ensuring safety with your new hip joint 11

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Dressing Showering Comfortable loose clothing is best Do not bend from the hips to pick up objects from the floor A helping hand long handled reacher will be provided to you from the ward to assist with this Showering can usually be recommenced day 2 or 3 after your surgery A shower usually has a small step in and care should be taken getting in and out A raised chair non slip mat and grab rail will maximise your safety if you choose to use the shower Gather whatever items you need and keep them within close reach Sit on the edge of the bed or a high chair Dress your operated leg first using the helping hand and long handled shoe horn provided to assist with getting shoes slippers on and off Be careful not to bend forward or lift your knees above your hip The Sock aid provided can assist to put on a dress or skirt slip this over your head We would advise that a bath is not recommended as the hip position can be compromised with too much flexion occurring If you require more specific advice in relation to bathing the Occupational Therapist can assist you Kitchen Activity You are likely to require help from your family and friends with shopping meal preparation and cleaning tasks You may need to reorganise your kitchen so that all items objects are placed at waist level and within easy reach A raised stool chair can be used in the kitchen for basic snack and drink prep at the work top A sock aid can assist with getting your socks on and off while avoiding bending at the hip When undressing remove your trousers or underwear from your non operated side first Washing The safest method of washing after your hip replacement is sitting at the wash basin on a suitable high chair or perching stool Or you can sit on the edge of your bed and have someone bring you a basin of water to be placed directly in front of you Use the long handled aids to wash and dry your feet or ask for assistance 12 13

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Cardinal Rules In order to avoid dislocating your new hip you must not stress the joint for the next three months post surgery or until your surgeon says otherwise in the extremes of its motions This can be done if you keep in mind the following precautions Avoid bending past 90 degrees RIGHT WRONG General Safety Advice for Home Avoid twisting your leg in or out Please be aware of the hazards in your home as this will make your recovery easier and safer Move electrical cords phone lines and ensure clear pathways Store items within easy reach specifically in the kitchen and bathroom areas You will not be able to bend down to lower cupboards Remove rugs including bath mats and entrance mats Be careful with pets and children Be aware of water spills slippery floors and always think before you move Pace yourself and take your time Caution should be taken when wet leaves are on footpaths 14 RIGHT WRONG Avoid crossing your legs RIGHT WRONG 15

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Physiotherapy Exercise Programme If you feel well enough your physiotherapy will start a couple of hours after your surgery The Physiotherapist will help you get out of bed and take your first steps If you are late back to the ward you will be seen early the following day Exercise is very important following hip replacement surgery When muscles are not used they become weak and do not perform well in supporting and moving the body Your leg muscles are probably weak because you may not have used them very much due to your hip pain You will be seen in the morning and afternoon for the first two days after your surgery to ensure you are walking with your crutches or sticks and carrying out your exercise programme correctly It is important that you practice your walking and exercise in between your physiotherapy treatments By the end of the second day we will aim to have you climbing the stairs and be walking on your own with crutches The surgery can correct the hip problem but the muscles will remain weak and will only be strengthened through regular exercises Exercise will also help reduce the risk of a blood clot You will be assisted and advised how to do your exercises but the responsibility for exercising is yours 16 Please be sure to read the exercises carefully and ask your Physiotherapist any questions that you may have before you leave the hospital Remember you may feel uncomfortable at first but these exercises will speed up your recovery You should ensure that you have had adequate pain medication prior to seeing your Physiotherapist please discuss your pain with the nursing staff 17

Guidelines for Patients Having Total Hip Replacement Perform the following exercises 15 times each 3 times daily 18 Guidelines for Patients Having Total Hip Replacement 4 Inner Range Quadriceps Place a towel in at the back of the knee of the operated leg 1 Ankle Pumps With your legs straight bend your ankles up and down towards and away from your face Push the back of the knee into the towel and lift the heel up off the bed Hold the contraction for 5 seconds Slowly return to your starting position Repeat 15 times Repeat 15 times Continue this exercise until you are fully recovered and all ankle and lower leg swelling has subsided 5 Active Hip and Knee Flexion Start by lying flat on your back with one pillow under your head legs straight and toes pointed towards the ceiling Keep the heel of your operated leg in contact with the bed and bend your hip and knee Ensure it is not beyond 90 degrees hip flexion Return to starting position Repeat 15 times 6 Active Abduction Place a smooth surface under your legs Lying on your back begin with your legs together Slide your operated leg out to the side then back to the mid position Do not cross the legs Return to starting position Repeat 15 times 2 Quadriceps Contraction With your leg straight out in front of you tighten the muscles at the front of your thigh pushing the back of your knee down into the bed The result should be straightening of the knee Hold the contraction for 5 seconds Repeat 15 times 3 Gluteal Contraction Lie on your back with your legs straight and in contact with the bed Tighten buttocks Hold the contraction for 5 seconds Repeat 15 times 19

Guidelines for Patients Having Total Hip Replacement Standing Exercises Guidelines for Patients Having Total Hip Replacement Standing Exercises 7 Active Abduction in Standing 8 Active Extension in Standing Point toes forward Bring the operated leg away from the body in standing Step your operated leg backwards slowly 9 Active Flexion in Standing Try to keep your back and knee straight hold for 2 seconds Lift your operated leg in front of you slowly Return your foot to start position Remember not to bring your knee higher than the level of your hip Repeat 15 times Try to keep your back straight Return your foot to the floor Repeat 15 times 20 Return to start position slowly Repeat 15 times 21

Guidelines for Patients Having Total Hip Replacement Bed Exercises It is important to follow your Physiotherapist s instructions carefully and to only perform the movements taught to you Walking In most cases after an uncomplicated first hip replacement primary total hip replacement you will be encouraged when using crutches for support to put your full weight through the operated leg Your consultant will advise you when you can reduce your support to one crutch or progress to a stick in the opposite hand If you have had a complicated primary total hip replacement or a revision total hip replacement you will be instructed to reduce the amount of weight bearing on your leg In such a case you will be given specific instructions on how to proceed Guidelines for Patients Having Total Hip Replacement Toilets As most toilets may be too low you will require a raised toilet seat There will be a raised toilet seat in your hospital room Please do not use a commode during your hospital stay as the seat is too low for your new hip Avoid twisting or bending on the toilet Keep toilet paper within easy reach or take some before you sit down Turn your whole body around to flush the toilet Stairs Technique Going Upstairs Walking Pattern with Crutches 1 Stand in the middle of your crutches 2 Place crutches in front of you They should be a comfortable arm s length away 3 Push down on the hand grips Step forward to the crutches with your operated weaker leg Going Upstairs 4 Step past the crutches with your unoperated stronger leg Maintain crutches walking stick on the step below Lead with the unoperated good leg up onto the step above 5 Repeat the same sequence Take your weight onto the unoperated leg by pushing on crutches walking stick and banister Strong foot Weak foot 22 Follow with the crutch walking stick onto the same step Crutch Position 23

Guidelines for Patients Having Total Hip Replacement Going Downstairs Guidelines for Patients Having Total Hip Replacement Rehabilitation Goals Hip Replacement Goals of Care The goals on the following pages have been developed to assist you in understanding your patient journey and also to outline your rehabilitation goals as a patient in Beacon Hospital Your goals are divided into two areas Nursing and Physiotherapy and these start right after your surgery so you have some goals that remain the same from day one with new goals added each day Going Downstairs Put crutch walking stick down onto the step below Follow with the operated leg Take weight onto the operated leg using the crutches and banister for support Follow with the unoperated leg onto the same step Hint The good leg goes up the stairs first and bad leg goes down the stairs first 24 25

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Hip Replacement Goals of Care Nursing Goals You will Day of Procedure Receive adequate pain relief Be started on intravenous IV antibiotics Depending on the time of day you return from theatre you will be given something light to eat and drink May have an x ray of your new joint completed on this day or day one Commence medications to prevent clots from occurring on this day or on day one Have the wound dressing checked to ensure it is intact Have an abduction pillow placed between your legs at all times when you are resting in bed Day One You will Receive adequate pain relief Be given medications to prevent clots and be given IV antibiotics Have bloods taken to check your blood count after surgery Have a wash and get dressed with assistance Have ice packs applied to your hip a minimum of three times per day for 20 mininutes Be encouraged to drink plenty of fluids Have the wound dressing checked to ensure it is intact Have an abduction pillow placed between your legs at all times when you are resting on the bed 26 Your Physiotherapy Goals Depending on the time of day you return to the ward you may receive physiotherapy Nursing Goals Day Two Your Physiotherapist will help you Complete your hip exercises under supervision Get out of bed Walk a short distance with crutches or a frame Understand the cardinal rule after a hip replacement Your Physiotherapist will help you Complete your hip exercises under supervision and encourage you to complete the exercises independently throughout the day Walk with crutches or a frame outside of your room Sit out for short periods of time maximum of 1 5 hours Participate in a second physiotherapy session in the ward or gym where you practice walking hip exercises and the stairs if able Day Three Onwards You will Receive adequate pain relief Be given medications to prevent clots Have your wound dressing checked to ensure it is intact Have a wash and get dressed with assistance a shower Have ice packs applied to your hip at least three times per day for 20 minutes Ensure the abduction pillow is present and dressing is intact at all times when you are resting on the bed Mobilise with an appropriate aid Zimmer frame or crutches under the supervision of the nurse or healthcare assistant You will Receive adequate pain relief Be given medications to prevent clots Be checked by your nurse to ensure your bowels have returned to normal function Have your wound checked to ensure it is clean and dressing intact Have resumed a normal diet Have your Discharge Plan reviewed by your nurse Ensure the abduction pillow is present at all times when resting on the bed if your consultant has requested this Be encouraged to mobilise with appropriate aid Your Physiotherapy Goals Walk longer distances with the help of crutches safely and independently Sit out for a longer period of time Complete exercise independently 3 times throughout the day Participate in a second physiotherapy session where you practice walking exercises and climbing the stairs Walk safely and independently Independent and safe on the stairs Independent in completion of exercise programme Understand the importance of rehabilitation and follow up out patient physiotherapy Ensure you have the adequate equipment for your rehabilitation 27

Guidelines for Patients Having Total Hip Replacement General Recommendations Call Bells Use the call bell to ask for assistance with any transfers in out of bed on off toilet Do not attempt to transfer until you have been taught how to transfer safely and have been cleared by the Physiotherapist to do so Use the call bell when the side rails of your bed are raised Sleeping While in hospital some patients find it harder to sleep for various reasons e g different bed and environment It might be helpful to bring earplugs and headphones for music Before coming to hospital you could explore apps to help you sleep or learn relaxation techniques You can use these when you are recovering from surgery After hip replacement surgery you will have to sleep on your back for 6 weeks unless told otherwise by your consultant This is to reduce the risk of dislocating your hip after surgery Guidelines for Patients Having Total Hip Replacement Nausea Some of the medications you may be prescribed can cause nausea Please inform the nursing staff if you feel sick or are getting sick Your medications may need to be adjusted or you may need additional medications to prevent or treat nausea Pain Management Pain is a common occurrence following any surgical procedure The pain will naturally reduce as your wound heals Medications and ice will also be given to you regularly to manage pain You can ask your nurse for extra painkillers if you need them before your exercises It is important to report pain to the nursing staff who will help you to keep your pain controlled so you can mobilise comfortably perform your physiotherapy exercises and resume normal activities after your surgery You will be required to rate or score your pain regularly after your surgery You will be asked to give a number between 0 and 10 where 0 represents no pain and 10 represents the worst pain you can imagine Your score will depend on how intense your pain is 28 29

Guidelines for Patients Having Total Hip Replacement Discharge Instructions Assuming no complications arise after your operation and once your Physiotherapist considers you independently mobile you will be discharged from hospital This is usually day four of your stay Some people go straight home while others will require some time in convalescence When you leave the hospital you may be given an appointment to see your consultant usually around 6 weeks after the operation This is for a routine check up which will make sure you are progressing satisfactorily and x rays may be taken It is important to still bring your old x rays with you at this time Subsequent appointments may be at 6 months 1 year or 2 years after surgery You will be advised to attend outpatient Physiotherapy within two weeks of discharge You can either attend a Physiotherapist in Beacon Hospital or a Physiotherapist more local to your home If you would prefer to exercise in a group setting Beacon Hospital provides weekly group exercise classes for total hip replacement patients Your Physiotherapist will provide you with the details of these classes You will need to continue your physiotherapy for 2 3 months after your surgery Your Physiotherapists will advise you after your surgery regarding your requirements Wound Care You will leave the hospital with a simple surgical wound Before leaving hospital your dressing will be changed and the wound site checked Keep the wound dressing clean and leave the dressing in place for 5 to 10 days unless indicated otherwise by the nursing staff or your consultant Guidelines for Patients Having Total Hip Replacement Most people will have sutures stitches or staples that will need to be removed approximately 10 14 days after surgery This can be done by your GP Centre for Orthopaedics Consultant or in the convalescence centre Following removal of your sutures or staples your health care professional will advise you regarding the need for further dressings This is normally for no more than a further 3 5 days Signs of Infection Infection can sometimes occur despite your very best efforts If any of the symptoms below occur then you will need to see your GP or liaise with the Centre for Orthopaedics for advice and possibly antibiotics If you develop any of the following signs of infection it is important to report them to your doctor The signs of infection include Redness around the wound site Increased pain in the wound Swelling around the wound Heat at the wound site Discharge of fluid may be green or yellow Odour or smell from the wound Feeling of being generally unwell Fever or temperature Make sure you receive a copy of the Patient Wound Care Discharge Instructions prior to your discharge When changing the dressing it can be removed after showering use a clean towel to dry the skin around the wound gently and apply a fresh dressing 30 31

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Antibiotics Leg Swelling Bruising Following hip replacement surgery there can be a greater risk of developing an infection in the hip with some procedures Antibiotics to prevent the development of an infection in the hip should be taken when having a bladder catheter inserted urinary surgery e g prostatectomy or when having infected teeth removed Always tell your dentist dental hygienist GP or any other consultant that you visit that you have had a total hip replacement Expect to experience bruising and swelling in the leg after surgery This is a normal part of the recovery phase after a total hip replacement and may last a number of weeks The swelling can cause pain in your hip and may restrict the amount of movement you have in the joint To reduce this take the medications that are prescribed for you and ice your leg The swelling can persist for up to 6 12 weeks and sometimes longer and may also affect the ankle and foot Stockings Your consultant may wish for you to go home with elasticated stockings These can be an important part of preventing the development of deep vein thrombosis blood clots in the legs It is recommended to wear these for 6 weeks after surgery on both legs Information regarding care of the stockings is available on the bag in which they are provided Use of Ice Pain Medication On discharge from hospital you will be prescribed some medications Part of the prescription will include medications for pain Plan to do your exercises 30 minutes after taking pain medication as preventing pain is easier than chasing pain If these medications are not relieving your pain or you cannot take the medications due to side effects we advise that you contact your GP We also advise that you contact your GP should you require a repeat prescription 32 Ice is recommended to each area of the operated leg for 15 20 minutes working from the hip down the leg as the swelling progresses You shall continue to ice regularly both as an in patient and on discharge home in order to help control swelling and any pain and also to encourage healing This should be done at least 5 or 6 times a day for the first 6 weeks after surgery and as required after that Bowel Care Try to include sources of fibre in your diet brown bread high fibre cereals fruit vegetables Drink plenty of fluids You may also be prescribed laxatives i e Lactalose Senokot during your hospital stay 33

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Activities Once Discharged During the first 6 weeks after your surgery we recommend limiting your activities to walking with support and completing your exercise programme as advised by your Physiotherapist We recommend that you refrain from more strenuous activities such as golf and social tennis for a period of three months The following are some of our recommendations Not Recommended after Surgery Jogging or running Contact sports and high impact aerobics Vigorous walking or hiking Skiing Tennis Repetitive lifting exceeding 50lbs Expected Activity after Surgery Your consultant will advise you when you can return to the following Recreational walking Golf Driving Light hiking Recreational biking Ballroom dancing Normal stair climbing 34 35

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Car Transfers Driving When travelling in a car you should sit in the front passenger seat A plastic bag on the seat can assist with manoeuvring in and out of the car If you intend to go on a long car journey please include regular safe stops Your family or carer should bring a cushion or pillow to place on the passenger seat raising the height and ensuring your hips are kept above your knees keeping the seat reclined back as far as possible Your consultant will tell you when you are allowed to drive again after your operation In order to be safe driving a motor vehicle you must be in control of the pedals effectively It is recommended that you do not drive a motor vehicle until you have complete control over your legs and your consultant will advise you regarding the same but this does not normally occur until at least 6 weeks after your surgery When you are advised by your consultant to drive it is recommended to complete a trial period in an empty car park to accustom yourself to your new hip pillow When getting into the car lead with your bottom Stand with your back to the car lower yourself keeping your operated leg straight in front of you Slide back on to seat and let your driver assist with your legs keeping both legs together and your knees lower then your hips Please ensure you are not twisting The driver should hand you the seat belt and have the driver close open the door accordingly When getting out of the car lift your legs out of the car first with assistance from your driver Slide towards the edge of the seat and stand up keeping your operated leg stretched out in front of you Travel Prolonged periods of sitting on airlines may predispose to leg swelling and deep venous thrombosis and it is recommended to avoid this until 6 weeks after your surgery If you must travel wear your stockings and keep your leg elevated as much as possible Sexual Activity Sexual activity may be resumed at 4 6 weeks when you are physically and mentally ready and when you have a clear understanding of the precautions to be followed when protecting the new joint 36 37

Guidelines for Patients Having Total Hip Replacement Potential Complications of Hip Replacement Surgery Incidence The majority of patients who undergo hip replacement surgery have a pleasant experience without any complications Of all patients who undergo total hip replacements more than 96 have no complications The following is a comprehensive list of all problems that could potentially occur For informed consent it is important that you know of these problems but please be reassured that the vast majority of patients suffer no complications Pain Conclusion We hope that you have found this The hip area will be sore after the operation If you are in pain it is important to tell staff so that medications can be given Pain will improve with time Rarely pain will be a long term problem but may be due to altered leg length or any other complications listed or sometimes for no obvious reason booklet useful and that it has helped Bleeding to relieve some of your fears and anxieties This is usually small and can be stopped during the operation However patients with large amounts of blood loss may need a blood transfusion or iron tablets Sometimes a blood clot may form or a large bruise may be noticed at the wound site which may become painful and require surgery to remove it regarding your surgery During your hospital stay your medical team will be available to discuss anything mentioned in this booklet or to answer any other queries you may have Before you leave the hospital you will be given contact details of the relevant team members After discharge from hospital you can expect to receive a phone call from an orthopaedic nurse enquiring after your wellbeing Deep Vein Thrombosis DVT A DVT is a blood clot in the vein This may present as red painful and swollen legs usually The risks of a DVT are greater after any surgery and especially bone surgery Although not a problem themselves a DVT can pass in the blood stream and be deposited in the lungs a pulmonary embolism PE This is a very serious condition which affects your breathing We look forward to meeting you soon 38 39

Guidelines for Patients Having Total Hip Replacement Your consultant will prescribe medication to limit the risk of a DVT forming Starting to walk and mobilising after surgery is one of the best ways to prevent clots from forming Discrepancy in Leg Length With arthritis your leg may have shortened If you have bilateral arthritis both legs may be shorter than they once were The aim of joint replacement surgery is to correct the deformity and restore the normal length After a total hip replacement the leg will feel longer due to the swelling in the joint functional lengthening and it may take up to 3 months for this to resolve Occasionally it is necessary to lengthen a leg by a few millimetres to achieve stability and prevent dislocation This rarely requires a further operation or shoe implants to correct the difference Dislocation of Hip If this occurs the joint can usually be put back into place without the need for surgery however you may need an anaesthetic or sedation to relax your muscles Sometimes this is not possible and an operation is required followed by the application of a hip brace or if the hip keeps dislocating a revision operation may be necessary The patient can help prevent dislocation by strictly adhering to the guidelines governing sitting bending and sleeping These are outlined in this booklet Intra operative Post operative Fracture During and after the surgery there is a possibility that bone may fracture If this occurs the fracture will be treated but may temporarily alter the amount of weight that can be put on the affected leg after surgery This complication can occur after a hip replacement if the bone is weak especially in the first two months after surgery Sometimes it is caused by a fall or stumble Periprosthetic femoral fracture causes thigh pain with weight bearing and may cause shortening and rotation of the limb 40 Guidelines for Patients Having Total Hip Replacement Loosening Wear of the Prosthesis Modern operating techniques and new implants mean that most hip replacements last over 15 years In some cases this can be significantly less Although wearing down of the bearing surface may occur it is usually minimal Wear may contribute to loosening and may require corrective surgery if it is excessive The reason is often unknown Implants can wear with overuse There is still a debate as to which material is the strongest The reason for loosening is also unknown Sometimes it is secondary to infection Loosening of the prosthesis causes pain and if the loosening is significant a second joint replacement may be needed or performed This operation is significantly more complicated than the original joint replacement Infection Antibiotics are given just before and after the operation and the procedure will be performed in an operating theatre with sterile equipment Despite this infection may still occur The wound site may become red hot and painful There may also be a discharge of fluid or pus This is usually treated with antibiotics and an operation to wash out the joint may be necessary In rare cases the implants may be removed and replaced at a later date The infection can sometimes lead to sepsis blood infection and strong antibiotics may be required Late Infection Spread of infection from another part of the body to a joint replacement can occur sometimes years after the operation To prevent such infections persons with a joint replacement are generally given antibiotics with extensive dental procedures urinary tract infections or surgery as well as before other types of surgery If an infection occurs anywhere in the body it must be treated promptly with antibiotics 41

Guidelines for Patients Having Total Hip Replacement Guidelines for Patients Having Total Hip Replacement Nerve Injury Damage There are several nerves located near the hip joint In rare cases these may be injured during surgery due to direct damage from surgical instruments or indirect damage due to stretching as the hip joint is manipulated a neuropraxia Most injuries are temporary and may resolve with no permanent damage In rare cases the nerve injury may be permanent The nerve most at risk is the sciatic nerve that runs in the buttock just behind the hip joint If this nerve is damaged during surgery upon returning to the ward the patient may complain of altered sensation in the foot or in more severe cases inability to move their foot foot drop Fortunately the majority of these neuropraxias resolve over a period of time sometimes months In a very small minority the damage may be permanent resulting in loss or heightened sensation and decreased motor muscle function to the leg Heterotropic Ossification Blood Pulmonary Embolism PE There is a small risk of developing ossification or calcification in the muscle tissue around the hip after surgery In the majority of cases this involves small islands of bone that do not cause any functional restriction and are only noticeable on x rays Rarely in less than 1 of cases there may be more extensive ossification that may cause stiffness and pain This can be corrected by surgical removal but only after 12 months or more have passed since the surgery A PE is a consequence of a DVT Deep Vein Thrombosis It is a blood clot that breaks away and can travel to the lungs and can make breathing difficult A PE can be treated but can also be fatal Stroke CVA Sudden Death Although these complications can occur during any surgery they are extremely rare following joint replacements Vascular Injury Damage There are several blood vessels that are located near the hip joint In rare cases injury to the vessels may occur during surgery and are dealt with during the operation by repairing the vessel In extremely rare cases this could result in loss of limb or life 42 43

Exercise Diary Following Total Hip Replacement Surgery DAY POST OPERATION Time of Day DAY 1 Morning Afternoon DAY 3 DAY 2 Evening Morning Afternoon Evening Morning Afternoon DAY 4 Evening Morning Afternoon DAY 5 Evening Morning Afternoon Evening Target Volume Repetitions x Sets 1 Ankle Pumps 2 Quadriceps Contraction 3 Gluteal Contraction 4 Inner Range Quadriceps 5 Active Hip Knee Flexion 6 Active Abduction 7 Active Abduction in Standing 8 Active Extension in Standing 9 Active Flexion in Standing Instructions The exercise programme will begin the first day after your surgery and the physiotherapist will teach you the exercises the first time you perform them Following this you should record the number of repetitions of each exercise that you complete in the boxes in the table above The aim is to perform three exercise sets per day morning afternoon and evening

Guidelines for Patients Having Total Hip Replacement NOTES Please scan this with your phone camera to go to our Pre op Education Videos https www beaconhospital ie department service pre operative clinic

Beacon Centre for Orthopaedics Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 7575 Mon Fri 9am 5pm Email orthoclinic beaconhospital ie www orthopaedics ie Beacon Physiotherapy Department Tel 01 293 6692 Email physiotherapy beaconhospital ie www beaconhospital ie Version 5 February 2021