Put your best foot forward
This information has been designed to give you a basic understanding of your hip replacement operation and to give you some idea of what to expect during your hospitalisation. Please keep in mind that this is only a guideline and that each individual has different needs. You may progress at a different rate to that which is outlined.
Your Orthopaedics SA specialist will be happy to address any questions which might arise after reading this information.
Total Hip Replacement is the surgery performed to replace a damaged or worn hip joint. The hip is a ball and socket joint formed by the head of the thighbone (femur) and the socket of the pelvis (acetabulum).
A smooth and compressible substance known as articular cartilage coats the surface of these bones. Arthritis occurs when the articular cartilage wears away exposing the underlying bone. This causes roughening and distortion of the joint, resulting in painful and restricted movement. A limp will often develop and the leg may become wasted and shortened.
The new joint relieves pain, improves walking ability, decreases stiffness and in most cases restores leg length and may correct the limp.
Osteoarthritis of the hip is generally a disease of the older person but may occur in younger people following rheumatoid arthritis, fractures of the hip and other rarer conditions.
There are many different types available, but all consist of the same basic components – one component replaces the worn socket and is called the acetabular cup and the other replaces the worn head of the femur and consists of a metal alloy ball mounted on a stem. Some hip replacements are fixed in place using special bone cement. Others have a rough, porous surface into which bone grows to lock the implant in place. Each type has advantages and disadvantages. The standard bearing surface is metal on plastic. Occasionally your surgeon may recommend other materials.
Overall patients generally have a 95% chance of being happy with their hip for at least 10 years.
This operation is designed to improve quality of life and is usually undertaken when other avenues of treatment have failed and the benefits outweigh the risks. It should never be entered into lightly! In general terms the pain should be severe, your walking distance significantly reduced and simple analgesics have failed to control the pain before you consider surgery.
The aim of surgery is to relieve pain so you can walk comfortably. It does not give you a normal hip and will not allow you to run.
This is a good time to make sure your home will be a safe environment for you upon your discharge from hospital.
Position furniture to give you clear walkways and roll up any rugs which might cause you to slip.
Put commonly used items within reach in your bathroom and kitchen to prevent you needing to bend down.
It is also a good time to commence some gentle exercises to tone up your muscles, especially the quadriceps. Not all exercises will be possible because of pain or stiffness. You will find examples of some recommended exercises included in this information. Your physiotherapist will advise which of these exercises will be suitable after your operation.
Most hospitals encourage a pre-admission visit to hospital to show you the hospital, streamline the admission process and explain the hospital stay.
You are also encouraged to see the Anaesthetist prior to surgery.
You will usually be admitted to hospital on the morning of surgery and will be seen by the Nursing Staff and Anaesthetist.
Please bring with you any medication that you take and your X-rays, along with your pyjamas, toiletries, etc.
You may be suitable to give your own blood, have it stored and then given back to you during and after surgery. This minimises the need for having banked blood (i.e. other people’s blood from the Red Cross). Up to 3 pints of blood are collected and the process takes three visits spread over three weeks. Most people will require a blood transfusion.
If you are a smoker it is advisable to stop smoking, or at least reduce the number of cigarettes that you smoke, in order to reduce the risk of chest and circulation problems after surgery. The Hospital is a SMOKE FREE ZONE.
Anti-Inflammatory medication including VOLTAREN, FELDENE, NAPROSYN, CELEBREX and ASPIRIN should NOT be taken for seven days, prior to your surgery, as they affect the way your blood clots.
Anti-platelet medication including ASTRIX, CARTIA, CLOPIDOGREL (eg. PLAVIX, ISCOVER) and TICLOPIDINE (eg. TICLID,TILODENE) can also affect the way in which your blood clots. These medications should NOT be taken for seven days prior to your surgery.
If you are unsure about your current medications and the possible complications, please speak with your Doctor prior to surgery.
The Orthopaedic Liaison Nurse will phone you prior to your admission to hospital to arrange a suitable time for you to visit the Pre-Admission Clinic. During this visit the nurse will discuss details of your hospital stay and the recovery process and answer any questions that you or your family may have. To streamline the admission process a nursing history and health assessment will be carried out. The aim of this visit is to provide information that will better prepare you for surgery and to commence planning for your recovery.
During your hospital stay, the Orthopaedic Liaison Nurse may visit you on the ward to check on your progress.
This service offers ongoing support and assistance as required after discharge from hospital.
The Orthopaedic Liaison Nurse can be contacted at any time if you or your family have any concerns, queries or problems – phone (08) 8267 8267.
You will be required to fast for about six hours before surgery. The operation itself takes approximately two hours. Some time is then spent in the recovery room prior to you returning to the High Dependency Unit or Ward.
The length of hospital stay is usually between 5 and 8 days. We aim to plan your length of stay and have discharge arrangements in place prior to your admission.
If necessary you will be in the “high dependency” area: which is part of the routine to keep an extra careful eye on you in the first 18 hours or so after surgery. (High Dependency Units (HDU) have a higher ratio of nurses to patients).
The following routine is a guideline only. It depends on your speed of recovery and individuals do differ in the time needed for muscle strength to return. Each stage has to be completed before progressing to the next.
During the first few days you will experience some pain. This will be controlled by intravenous or epidural medication for the first 24-48 hours. After removal of the drip, you may require injections and/or tablets. It is important, initially, to take the pain relieving medication on a regular basis. This will allow you to exercise and move more freely. It may also be necessary to continue taking pain relief tablets when you return home. The nursing staff or pharmacist will instruct you on appropriate doses.
A small injection into the skin of your abdomen of anti-coagulant is usually administered once a day during your stay in hospital. This helps to thin the blood and helps prevent the formation of clots in your legs.
Assist you to become mobile again following your operation and teach you specific exercises.
Usually you will stand and begin walking the day after surgery. All the “tubes” are removed by two days after surgery. A physiotherapist will assist you with exercises and walking. The aim is to walk early and often. This minimises complications.
You will be able to sit for short periods in a high chair and use the toilet with a toilet “raiser” seat. It is important that you don’t sit in a chair, which is too low, as too much hip flexion may result in dislocation.
You may be able to have a soft pillow between your legs during the daytime and the triangular shaped pillow only at night.
The joint is stable immediately after the procedure, but the weakened muscles and soft tissue surrounding the joint require a longer-term program of physiotherapy and exercise to be restored to normal functioning.
Your mobility will gradually increase and with it, your independence. Physio continues and once your wound has healed you may go to the hydrotherapy pool with the physio to perform exercises in water.
These exercises are recommended before surgery to help build up muscle tone and during rehabilitation after surgery. You may not be able to complete all exercises due to pain or stiffness. Your physiotherapist will advise which of the exercises are suitable for you after your operation.
Do the following exercises 10 times each and at least 3 times per day.
You will have a suture line on the side of your hip that requires a dressing while you are in hospital. The nursing staff will attend to this.
Sometimes you may have sutures that lie underneath the skin surface. These do not need to be removed and will dissolve in about 2 weeks. Skin staples are normally removed around ten days.
Prior to discharge your nurse will speak to you regarding care of your suture line once you are home. Wash your suture line daily and pat it dry with a clean towel. Avoid using any powders until the healing is complete as they “clog” the suture line and cause bacteria to grow.
Swelling of the leg may take 8 weeks or more to resolve. To minimise this, when resting, have your legs up rather than spend long periods sitting with your legs down.
Observe your suture line for any signs of tenderness, redness, swelling or discharge. If you have any problems, contact your Surgeon, Local Doctor or the Orthopaedic Liaison Nurse.
As you might expect, wound discomfort and restriction of position will mean adopting a sleep position, which is unnatural for you. This may result in a disturbance to your sleep pattern, and/or restlessness.
Oral analgesia and warm drinks before going to bed may assist in relaxation.
Your decreased activity level and appetite, reduced fluid intake and some medication may lead to bowel irregularity. You will be encouraged to drink fluids, increase the fibre content of your diet and, if necessary, take mild laxatives.
Resumption of sexual activity depends on when you feel comfortable. There are no restrictions if you keep to the guidelines given to you by your surgeon and physiotherapist for your daily activities.
Your surgeon will want to see you about 6 weeks after your surgery. The appointment will be make before you leave hospital by the nursing staff. It is important that you keep this appointment, as your surgeon will want to check your progress. You will be able to ask the surgeon questions regarding increasing your level of activity and resumption of driving.
If you attended a pre-admission session then the following will have been discussed.
IF YOU HAVE ANY ADDITIONAL QUESTIONS, FEEL FREE TO CONTACT THE ORTHOPAEDIC LIAISON NURSE. PHONE: (08) 8267 8267
It is in your interest to read this carefully. It concerns what is going to happen to you in hospital. If you do not understand, you should approach your specialist or his secretary, for clarification of any point.
You will be liable for several accounts in relation to your hospitalisation and operation. An account may be received from: