Total Hip Replacement Surgery (Lateral Approach)

Total Hip Replacement Surgery

(Lateral Approach)

Please bring this book with you to all your appointments before

your surgery and to the hospital the day of your surgery.

Updated October 2020

Appointment Information

Please remember to bring all medications in the original containers and health card to all

appointments.

Surgery

Date:

Time:

Arrival Time at Patient Registration:

(Main Entrance, patient registration on the right)

Pre-Operative Assessment Clinic

Date:

Time

Arrival time at Patient registration:

Anesthetic Consult (if required)

Date:

Time:

Arrival time at Patient registration:

Total Hip Replacement Intake Class

(scheduled by your surgeon)

Date:

Time:

Directions: Main Entrance to through the long hallway, turn left through the double

doors, follow signs to pre-operative class.

Please complete this form and bring it with you when you attend the physiotherapy/occupational

therapy intake class.

Rehabilitation Services

Name:

 Total Knee Replacement

 Total Hip Replacement

Surgery Date

 Right

 Left

Who is your Surgeon?

Have you had any previous knee or hip surgeries?

Do you live alone? ☐ Yes ☐ No With a spouse? ☐Yes ☐ No With family ☐ Yes ☐ No

Check on of the following: ☐ Split Level ☐ Raised Ranch ☐ Bungalow ☐1 Level ☐ 2

storey

☐ Apartment ☐ Condo ☐Other? Please specify:

Are there stairs? ☐ Yes ☐ No

If yes, how many stairs to get into the home? ______________ Is there a railing?

☐ Yes ☐ No

How many stairs inside the home? ______________ Is there a railing?

☐ Yes ☐ No

What floor is the bathroom you will use on? ☐ Lower ☐ Main ☐ 2

☐ Basement

Is your toilet height? ☐ Regular ☐ High

Do you have ☐ Step in shower ☐ Tub/shower combo – is there: ☐ Curtains ☐ Doors

Do you have help in the home? (Example: outside agencies for cleaning, bathing, meals,

etc?

Do you use anything to help you get around? ☐ Cane ☐ Walker ☐ Other?

_____________________________

Do you have any special equipment in the home? Select all that apply:

☐ Raised toilet seat ☐ Sock aid ☐ Long handled shoe horn ☐ Reacher ☐ Tub transfer

bench ☐ Shower chair ☐ Other _____________________________________

My discharge plan from hospital is:

☐ Returning to own home ☐ Returning to family’s home ☐ Respite stay (ex. Retirement

home)

☐ Other (please specify): ____________________

Walker Handle Height: _____________

I have physiotherapy booked for after my hospital stay? ☐ Yes ☐ No

I will be going to: ☐ Brockville General Hospital ☐ Alternate Hospital

☐ OHIP Clinic ☐ Private Practice Physiotherapy Clinic

Clinic Name: ________________________________________________

How many days after surgery is my physiotherapy appointment booked?

________________________

 
5 
 
Contents 
APPOINTMENT INFORMATION ..................................................................................................................................... 2 
GETTING STARTED ............................................................................................................................................................ 6 
TOTAL HIP REPLACEMENT ............................................................................................................................................. 7 
CHOOSING A MENTOR ...................................................................................................................................................... 9 
PHYSICAL PREPARATION FOR SURGERY ............................................................................................................... 10 
LET’S TALK ABOUT LIFESTYLE .................................................................................................................................. 11 
PROTECTING YOURSELF AT HOME........................................................................................................................... 12 
POST ADMISSION PLANNING ...................................................................................................................................... 14 
PRE-SURGICAL APPOINTMENTS ................................................................................................................................ 16 
PRE-SURGERY DAY ......................................................................................................................................................... 18 
YOUR SURGERY DAY ...................................................................................................................................................... 19 
HOSPITAL EXPECTATIONS .......................................................................................................................................... 20 
INPATIENT UNIT EXPECTATIONS ............................................................................................................................. 24 
THE THREE HIP PRECAUTIONS.................................................................................................................................. 25 
YOUR INPATIENT STAY ................................................................................................................................................ 26 
DISCHARGE DAY .............................................................................................................................................................. 27 
RETURNING HOME ......................................................................................................................................................... 28 
POTENTIAL PROBLEMS ................................................................................................................................................ 30 
MAINTAINING YOUR INCISION ................................................................................................................................... 32 
QUESTIONS YOU MAY HAVE FOLLOWING YOUR SURGERY .............................................................................. 33 
HANDLING ACTIVITIES OF DAILY LIVING .............................................................................................................. 34 
RESUMING PHYSICAL ACTIVITY ................................................................................................................................ 39 
PHYSIOTHERAPY .......................................................................................................................................................... 400 
FOLLOW UP APPOINTMENT WITH YOUR SURGEON .......................................................................................... 41 
THANK YOU ....................................................................................................................................................................... 42 

Getting Started

Throughout your total hip replacement journey, this booklet will cover all the information you require

to be successful. It is designed as a guide for your pre-surgery, during your hospital stay, and

throughout your recovery and rehabilitation.

It is our goal as dedicated community team to prepare you, your home, and your family for your

impending surgery and recovery. We look forward to working with you along this journey.

Being an active participant throughout this journey is one of the ways to achieve a successful

outcome. There is much information to remember, however, much of this will be continually

reviewed throughout your journey.

Three things you must plan immediately.

1. See your primary care provider (family doctor) as soon as you make your decision to have

surgery

The healthier you are going into your surgery, the easier and more manageable your surgery

and recovery will be. This includes both physical and mental health. Untreated or unstable

medical conditions may prevent or postpone your surgery. Routine check-ups with your

primary care provider (family doctor) is strongly recommended.

2. See your specialist

Your surgeon may require you to see additional specialists prior to your surgery.

3. Book an appointment with your dentist

Make an appointment with your dentist if you have not been seen in the last six months.

Untreated dental infections could lead to cancellation or postponement of your surgery.

Total Hip Replacement

The hip joint

The hip joint is a large weight-bearing

joint at the top of your thigh where

your lower body connects to your

upper body. It is a ball and socket

joint, which allows a high degree of

movement in a variety or ways. The

joint itself is comprised of two parts:

1. The hip socket, or

acetabulum, is a cup shaped

bone in the pelvis. It is

designed this way to increase

stability of the joint.

2. The head of the femur, or

thigh bone, is shaped like a ball and fits inside the acetabulum. The ball shape allows for a

wide variety of movement.

The replacement

Total Hip Replacements are usually performed for severe arthritic conditions when pain and

immobility affect your quality of life. Osteoarthritis is the most common form of arthritis and usually

occurs with age. As the cartilage wears, the joint is less able to respond to the forces placed on it, and

may become stiff and painful. Many people are able to

manage their symptoms conservatively, through medication,

activity modification, weight loss, and exercise. A hip

replacement is offered after conservative management has

failed and is no longer helpful.

Expectations

90-95% of patients who have undergone a total hip

replacement report pain relief. Many patients who reported

a stiff and painful joint prior to the surgery show improved

range of motion, less stiffness, and better quality of life.

New hip, new look, new me

Your new joint will consist of a ball, a socket, and a stem.

The damaged bone is removed and a metal ball and stem is

inserted into the femur. The acetabulum is widened to

accommodate the new metallic ball and lined with a plastic

cup to mimic the original joint. The metallic ball is then

inserted into the widened acetabulum. The stem is quite porous which allows bone to grow into and

around it creating a very stable connection.

You will require specialized equipment for following your surgery to help with your mobility and

dressing. These are required because of the THREE HIP PRECAUTIONS (page 29).

Our Occupational Therapy team will also review these items and their use during our inpatient stay.

You must obtain these items prior to your surgery.

Instructions on how to use these are found on page 40.

2 Wheeled Walker

Cane

Long Handled Reacher

Long Handled Shoe Horn

Sock-Aid

Bath/Shower Chair

Raised Toilet Seat with/without Arms Rests (dependent on bathroom set up)

If your bathroom can not accommodate this, a standard commode would be needed.

A list of places to obtain these items will also be provided to you.

Choosing a mentor

Choosing a mentor is a very important decision. It must be someone that you can count on from the

start of you journey until the end. This person will accompany you throughout this process and can be

a family member, a friend, or someone who has gone through a total hip replacement. There is great

evidence that supports the link between social support and recovery.

Your mentor will learn with you and be at your side before, during, and after your hospital stay. They

will also be an important part of your rehabilitation as well.

You mentor will:

 Attend all preoperative appointments with you.

 Be a second set of ears to help remember instructions.

 Aid with planning for hospital admission.

 Come with you on surgery day.

 Help you prepare for discharge and arrange transportation home.

 Be available throughout the admission and for discharge home to help settle and remind you

of your instructions.

Physical Preparation for Surgery

The stronger you are going into your surgery, the better your outcome. This is a well-known fact and

supported by research. Our goal, just like yours, should be the best version of you in preparation for

surgery day. It is expected that you train three to five times per week. Start slowly, add more

exercises as you are able to or as you see fit. Continue to be as active as possible leading up to your

surgery and limit your painful activities. If your pain is very severe, you may only be able to exercise in

water or in a reduced capacity. We are here to help you coordinate your program to your individual

needs.

Expect to be sore and experience some pain. This is normal. This is to be expected. This is not to be

feared. You will not be the only one experiencing this. However, we advise you to follow the two-hour

pain rule – if you are sore or are in pain longer than two hours post exercise then you have done too

much. Decrease your exercise duration to limit pain to two hours.

Endurance exercise

Endurance exercises are important for your cardiovascular health, or your heart, lungs, and

circulation. Some examples of endurance activities are:

 Walking.

 Stationary cycling or outdoor cycling.

 Swimming, water aerobics, aqua-fit.

Water activities such as swimming, aerobics, aqua-fit, or simply walking (forwards, backwards,

sideways) in a pool are incredibly beneficial. Your weight in water is reduced thereby decreasing the

force on your joints and the added resistance helps build muscle strength.

Strengthening exercises

Strength training is important for building and maintaining muscle in your legs and arms. The stronger

you are, the better you feel. The exercises have been chosen in a way to focus on the muscles most

important for your total hip replacement. The arm and shoulder exercises are just as important as the

leg exercises. Strong arms and shoulders will make using your walker and crutches after surgery

easier.

 Each exercise should be done twice each day you complete them.

 They can either be done in succession or at different times of the day.

 You are expected to work each side of the body, not just the affected or unaffected

side.

Let’s Talk About Lifestyle

Proper nutrition prior to and following surgery are paramount in your potential outcome. Adequate

nutrient intake is important for good bone health as well as muscular and skin integrity following

surgery. The best nutrition is to eat a variety of foods from each group, and regular meals. One way to

think of nutrition is, “if you don’t grow it or kill it, don’t eat it”. The following websites are good

resources to help with this transition.

 www.healthcanada.gc.ca/foodguide

 www.eattracker.ca

 www.unlockfood.ca

Body weight

Obesity can have a profound effect on both your surgery and your rehabilitation. Research has shown

that a decrease in bodyweight by 10% can decrease the amount of force on your weight bearing joints

by 100N per side. A moderate weight loss prior to surgery can reduce pre-operative joint pain and

allows you to be more active. Gradual weight loss focused on longevity is best. Quick weight loss

programs may work but are nearly impossible to maintain and tend to be unhealthy by creating

massive caloric deficits. This can cause potential harm to your body in a variety of different ways. If

you have questions regarding weight loss or proper nutrition, consult your Primary Care Provider, or

the following is a list of resources:

 Public Health Unit:www.healthunit.org

 Telehealth: 1-866-797-0000

 Private Practice Dietician: https://www.collegeofdietitians.org

Smoking cessation

People who smoke have a greater risk of serious complications with their heart and lungs during and

after surgery. There is also a high correlation between smoking and incisional infection resulting in an

increased length of stay at the hospital.

We understand that smoking is an addiction and can be a very difficult habit to break. As an inpatient

you will not be permitted to smoke in the hospital or on the grounds of the Brockville General

Hospital. We would like to help you take this opportunity to manage your addiction. Advise your

doctor or your nurse if you do smoke and would like nicotine replacement therapy during your stay. If

you have questions regarding smoking cessation, the following is a list of resources:

 Public Health Unit: www.healthunit.org

 Lanark Leeds and Grenville Addictions and Mental Health: https://llgamh.ca

Protecting Yourself at Home

You never feel more safe and secure as when you are in your own home. We have developed a list of

safety checks to help you, your mentor, and your home ready for your return from your Total Hip

Replacement. Please review this list and if you have any questions you can ask them at your Pre-

Operative Assessment Clinic.

☐ I have a secure handrail on all steps/stairs inside my home or I will not have to use the

steps/stairs to access my bedroom, bathroom, or other living area I plan to use during my

recovery.

☐ My bed is at an adequate height to allow getting into and out of it easily. My mattress is

supportive to allow mobility easily and fluently.

☐ I have a comfortable chair that I can easily get into and out of. The chair is set in a way to allow

me to follow the post-operative restrictions as prescribed by my physiotherapist and surgeon.

☐ My bathroom is safe and easy to use. (ex. Raised toilet seat, grab bars, bath/shower

equipment).

☐ I have a night light in my living area to help when I am awake during the night.

☐ I have removed any and all potential tripping hazards from my living area. (ex. area rugs,

cords, rugs, furniture) which leaves an open path with enough room to use a walker.

☐ I have set up my pets in a separate room for the duration of my recovery

☐ I have organized my cupboards and refrigerator so that items are easily accessible and safe to

reach.

☐ I have adequate groceries on hand to help me through the first day of my return home, or I

have set up a meal delivery service.

☐ Emergency contacts and numbers are listed and identifiable in cell phone or placed by each

landline.

☐ I have asked my family to help me with daily chores and heavy lifting during my recovery.

☐ Transportation to the hospital as well as all follow up appointments has been arranged. I am

aware that I will not be driving until approved by my surgeon. (usually a minimum of 6 weeks)

☐ If I am the prime caregiver to my spouse, child, parent, I have made other arrangements for

their care during my recovery.

☐ If I have a pet, I have made arrangements for someone to help care for it throughout my

recovery.

☐ My pet is not allowed to sleep on me or in my bed until my incision has fully closed and

healed. This decreases my risk of an incisional infection.

Post Admission Planning

Following your Total Hip Replacement surgery, expect to remain in the hospital for one to two days.

On post-operative day two you will be discharged from the hospital. This usually happens around

11am. Your team will have given you instructions prior to this on your next steps for care and

recovery. Planning now for your return home allows adequate time to set up and implement the help

and equipment you will require. Things to consider when making plans:

 To sleep, eat, and use a bathroom on the same level.

 To pick up the equipment you will need for your home.

 Have transportation arrangements made prior to your admission.

It is highly recommended that you have a support person in place for when you return home. This

person will help you with meal preparation and offer other physical assistance, as you require. Plan to

have this person stay with you for at least one week after your discharge from the hospital.

Many people underestimate the duration of time associated with their recovery. Although you will

resume activities, it will take months before you are recovered. Discuss this with your family, friends,

and your mentor about the expectations surrounding recovery and its duration.

If, after speaking with family, friends, and your mentor, you find that you don’t have the necessary

assistance to go home, you will need to consider other options for your immediate post-operative

care. These options could include a short-term respite stay, or moving in with a family member or

friend for a short period of time. This decision is not easy. You must do what is best for you. Lean on

your family, friends, and your mentor. They are there to help you through this.

A list of local Retirement Homes that provide short-term respite care is included at the end of this

booklet as a separate leaflet.

Physiotherapy

The day after your surgery you will be seen by a physiotherapist who will help you get out of bed and

begin to walk. They will decide if you meet the requirements for in-home physiotherapy. The majority

of people who undergo a Total Hip Replacement will be moving well enough to for-go this and

proceed directly to an outpatient physiotherapy clinic. Your acute care Physiotherapist will review

with you how to use a walker, the safe management of stairs, review your home exercise program

and answer any questions related to your rehabilitation. Your post-operative exercises are to be

completed as prescribed until your first outpatient appointment, usually between 7 and 14 days post-

operative. The Brockville General Hospital has outpatient physiotherapy available and an

appointment will be discussed at your pre-admission appointment. If you have private coverage and

decide to use it for your rehabilitation, please contact your clinic of choice to set up an appointment

for an initial assessment. A list of local physiotherapy clinics is included at the end of this booklet.

Blood clot prevention

A post-surgical blood clot is a serious situation and can cause many complications. Your surgeon may

prescribe you a medication to help prevent this. Following your surgery, you will be less active, this

can interfere with the normal movement of blood throughout your body. One of the body’s many

defense mechanisms is to create blood clots. This occurs due to a traumatic event such as when

tissues are damaged. A Total Hip Replacement is a traumatic event with tissue damage.

The medication your surgeon will recommend is made in conjunction with you. It can be

administered orally or through injection. If you are to be prescribed an injectable anticoagulant, the

team will ensure you are confident in it’s administration prior to your discharge home from hospital.

You must arrange a time for you and your Mentor to speak with a staff member about this.

Community nurses will not be able to inject you at home. Anti-embolic stockings may also be

prescribed by your surgeon for a period of time following your surgery. The stockings help with

circulation in your legs and decrease your risk of blood clots.

Pre-Surgical Appointments

1. Pre-Operative Assessment Clinic (POAC)

Your surgeon will provide the hospital with the details regarding your surgery. A clerk from the

Operating Room Scheduling Department will contact you to schedule your POAC visit approximately

1-6 week before your surgery. This is a mandatory appointment prior to your surgery.

The clerk will give you instructions about what you need to bring with you on the day of your POAC

visit. You are encouraged to bring your mentor with you to this appointment.

You POAC visit with include:

 Assessment by a registered nurse.

 Assessment by an anesthesiologist.

The Anesthesiologist may need to refer you to other medical specialists or require you to complete

additional blood work or other tests.

Things to complete for this appointment:

1. Contact your mentor and ask if they can accompany you to this appointment. If they can’t

come, then bring a family member or friend.

2. Bring:

a. Your health card.

b. Insurance information (to confirm room coverage).

c. All your medications, in their original containers, including:

i. Prescriptions.

ii. Pills, drops, creams, patches, inhalers, injections.

iii. All vitamins.

iv. All herbal therapies.

v. All other over the counter medications you may be taking.

3. Wear loose, comfortable clothing and comfortable shoes.

4. Do not wear scented personal products.

5. Plan to be at the hospital for about three hours this day. Bring water and a snack.

6. The driving entrance to the hospital and visitor parking is off of Charles Street. Keep your

parking ticket with you. You can pay for parking at the kiosks at the front door as you leave

the hospital. If you are being dropped off at the front door, there is a patient drop off area.

7. Just inside the main entrance is the Information Desk. The volunteers can direct you to

Patient Registration.

8. We ask you to register for your appointment 15-20 minutes before your scheduled time.

Once registered, a staff member will give you directions to the POAC.

2. Physiotherapy and occupational therapy class

The class will last 90 minutes with 30 minutes for questions and answers. You and your mentor will

learn:

1. The items requested by your surgeon. Your surgeon will inform you of which items are

required to be purchased before your surgery and to be brought with you the day of.

2. The Three Hip Precautions. The limitations are in place for 6-12 weeks post-operatively.

3. The exercises you are expected to do pre and post operatively.

4. Your rehabilitation plan following your discharge from the hospital.

5. How to manage your daily activities.

Pre-Surgery Day

This is your checklist for preparing for your surgery:

 You are expected to call the Operating Room Scheduling Clerk (613-345-5649 ext. 1832)

between 1 p.m. and 3 p.m. to receive your surgical time

 Pack a small suitcase or bag with:

o Two sets of loose comfortable clothing, such as elastic wait shorts and tops suitable for

wearing during exercise and in bed.

o Two pairs of loose fitting underwear.

o One pair of comfortable shoes, not slippers.

o This total hip replacement surgery book.

o Personal care items (toothbrush, toothpaste, soap, lotion, razor, comb, brush, tissue,

deodorant). Please refrain from bringing in any scented products. The BGH policy on

scented products can be found at www.brockvillegeneralhospital.ca/policies.

o The items requested by your surgeon.

 Remove all polish and artificial nails from fingers and toes.

 Shower and use the cleansing product you were directed to purchase.

 Follow all instructions given to you by your health care team to prepare for surgery.

 Follow instructions given to you at your POAC appointment about when to stop eating and

drinking.

 DO NOT smoke (cigarettes, e-cigarettes, vaporizers, etc.) chew gum, or hard candy after

midnight the night before your surgery.

 DO NOT use marijuana in any form (inhaled, eatable, oils, etc.) prior to surgery. Recreational

marijuana should be stopped 24 hours prior and medical marijuana should be stopped 8 hours

prior to surgery.

Your Surgery Day

This is your checklist for the day of your surgery

 Shower as directed and use a clean towel or allow your skin to air dry.

 Brush your teeth and try not to swallow the water.

 DO NOT wear any scented personal products.

 Remove all polish and artificial nails from your fingers and toes.

 Remove all jewelry including rings, earrings, necklaces, watches, body piercings etc. Rings that

cannot be removed may be cut off.

 Wear clean comfortable clothing.

 DO NOT eat or drink anything after the time limit.

 DO NOT chew gum, have candy, or smoke.

 Ensure to take all medications that you were instructed to take by your surgeon or Pre-

Admission nurse with just enough water to swallow the pills.

 Ensure you follow any special instructions given to you by your surgeon or nurse.

 DO NOT bring valuables to the hospital such as money or jewelry. Patient and families assume

full responsibility for money, valuables and personal items kept in your room or on your

person.

 Check and bring proof of insurance and any other corresponding documents. Patients are

assigned to the first available bed that meets their needs. We will not know which room you

will go to until the day of admission.

 Bring Photo ID, you will need it when you pick up your pain prescription at your pharmacy the

day of your discharge.

 Ensure all your medications are brought with you to the hospital and in their original

containers.

 Bring this total hip replacement surgery booklet and your needed equipment, such as your

anti-embolic stockings.

 Bring your CPAP breathing machine, along with the appropriate settings.

 Plan to arrive at the time you were instructed to by your pre-admission nurse

o If a time was not specified, arrive 2 hours before your scheduled surgery time.

o Come in as you did for your POAC appointment and report to Patient Registration for

the directions to Day Surgery.

Hospital Expectations

Day of surgery

The day surgery nurse will review with you the following:

 Medications to verify and or make necessary changes.

 Preoperative medical history, physical, and consent.

 Instruct you to leave belongings with family member or mentor who will take them to your

room after surgery.

 Will ask you to identify which is the affected leg and then mark the affected leg.

 Start an intravenous (IV).

 Answer any subsequent questions.

Operating Room

 The operating room is quite cool, you can request a warm blanket.

 You will receive IV antibiotics.

 You will speak with the anesthesiologist who will answer any questions you have regarding the

anesthesia or pain control.

 The Surgical Safety checklist will be completed with you prior to surgery.

 Your surgery is approximately 2 hours.

Post Anesthesia Care Unit (Recovery Room)

 Assessment of you pain, the nurse will provide ongoing pain medication at your request.

 Assessment of degree of nausea and/or vomiting and provide you with medication for these

symptoms.

 Review deep breathing and foot exercises.

 Complete an x-ray of your hip.

 You will have a dressing applied to your hip and your stay in the recovery room with be 1-2

hours before you are transferred to your inpatient room.

Inpatient stay

 Your vital signs will be routinely taken throughout the day and night.

 Circulation, sensation, and pulse of your leg and foot with be checked as well.

 You will be reminded about your deep breathing and foot and ankle exercises as well as how

often to complete them.

Deep breathing exercises

Deep breathing exercises help to:

 Exercise the lungs and move mucous along the airway to maintain a clear path.

 Increase blood and oxygen and enhance circulation.

 Lower respiratory complications such as pneumonia or infection.

How to complete deep breathing exercises

1. Place hands on lower sides of your ribcage.

2. Take a deep breath through your nose, hold for one second and then slowly exhale through

your mouth.

3. You goal should be 10 deep breaths every hour.

4. Cough as often as you need, this helps clear any excess mucous.

5. You Physiotherapist may also review incentive spirometry with you.

Foot and ankle exercises

1. Practice drawing the upper case alphabet with your foot.

2. This helps with circulation and range of motion of the ankle and foot.

3. Don’t forget to wiggle your toes as often as possible.

4. Aim for one alphabet every half hour.

Pain Assessment

Your nurse will be routinely monitoring your pain levels using a Visual Analogue Scale of 0-10. 0 being

no pain and 10 being worst pain ever.

It is very important to have you pain under control and you must notify your nurse if it is not. It is

normal to have pain following surgery and very normal to not be able to rid you of all pain. Pain

control is a necessary part of your recovery because without adequate pain control you will not be

able to participate in your rehab in hospital or be able to get up and move around very well. The goal

of pain management is to make you comfortable so that you can participate.

Nausea and vomiting is an unfortunate side effect of the anesthetic and is common in people post-

surgery. There is additional medication that you can be given so it is important for you to notify your

nurse about any of these symptoms.

Confusion and delirium are another common side effect following surgery and can last from days to

weeks. You may experience confusion, hallucinations, and changes in behavior. This can be related to

the anesthetic, pain medication, lack of sleep, or alcohol withdrawal. It is important to notify your

nurse if you begin to experience any of these symptoms.

Diet

You will begin with fluids and then progress to a regular high fiber diet barring any surgical

complications.

Getting up after surgery

Approximately four hours after you have arrived on the inpatient floor your nurse with complete a

physical exam of you. If all is well and your pain is under control they will assist you sitting at bedside

and getting you into a chair. The change in position is good for lung health. You will be moving around

with a walker and starting to take few steps. Tiredness and dizziness after first getting out of bed is a

very normal.

Urinary tract health

Urinary problems can arise following surgery and it is important to rectify this quickly to prevent an

infection. If you are having trouble urinating, notify your nurse. They may use a device to check your

bladder and if needed insert a catheter to help drain excess urine.

Fall prevention

Our goal is always patient safety and certain measures have been put in place while you are here to

keep you safe from falling.

Any important items will be easily within your reach:

 Call bell if you need assistance.

 Pull cord for your light.

 Bedside table and telephone.

 Personal items, meal, drinks.

 Eyeglasses and hearing aides.

 Walker.

We will ensure:

 To check on you often.

 Clean up spills immediately.

 Follow up medications to manage side-effects and help decrease risk of falls.

 You are aware of your room number and where your bathroom is located.

 Your area is well lit.

 Your pain is well managed.

 Your bed is in the lowest position with brakes locked.

 All pathways are clear.

You can help us by:

 Only getting up on your own once approved by a nurse or physiotherapist.

 Wearing non-skid footwear.

 Call for help when needed.

 Not leaning on equipment for help other than your walker.

Let’s help each other by making sure you’re safe at all times.

Inpatient Unit Expectations

You may have blood drawn for testing.

Your nurse will

 Monitor you closely and often.

 Assess your pain closely and often.

 Include your mentor and family in your plan of care.

 Assist you with mobility and repositioning to ensure your comfort.

Your physiotherapist will

 Review your deep breathing and foot/ankle exercises.

 Review that proper footwear is important for safe mobilization and walking, closed toe with

good tread and laces or Velcro.

 Teach you safe use of your walker and get you moving.

 Review your weight bearing restrictions.

 Review your post-operative exercises with you and how to do them safely.

 Reinforce the need for continued post-operative exercise to aid in your recovery and increase

your outcome potential.

Your occupational therapist will

 Review how to use your equipment and maintain The Three Hip Precautions during daily

activities.

 Review any concerns about home set up and equipment.

The Three Hip Precautions

Follow the Three Hip Precautions for 6-12 weeks after your surgery

DO NOT BEND PAST 90° AT THE WAIST WHILE STANDING, SITTING, OR LYING

DO NOT CROSS YOUR LEGS OR ANKLES

DO NOT TWIST YOUR HIP OR LEG IN OUR OUT

Your inpatient stay

You will continue to have your vital signs checked; you may have follow up blood work. You must

continue your deep breathing as well as your foot/ankle exercises.

Your nurse will:

 Instruct you on wound healing promotion through

o Proper nutrition.

o Diabetic control.

o Smoking cessation, reminder that smoking is prohibited on all Brockville General

Hospital property.

 Teach you infection prevention as well as the signs and symptoms of infection.

 Incision hygiene.

 Instruct you on how to change the dressing and when.

 If prescribed an injectable anti-coagulant (blood thinner), will teach you how to inject yourself

because you may need to continue this medication at home.

 Provide a laxative or a fleet enema if you are experiencing constipation as well as instruct you

on how to avoid constipation at home.

Your physiotherapist will:

 Increase your walking, exercises and practice stair management if/when you are ready

 Review the Three Hip Precautions again (see page XX)

o Do not bend past 90 degrees at the waist while standing, sitting, or lying.

o Do not cross your legs or ankles.

o Do not twist your hip or legs in or out.

These precautions are imperative for your recovery and must be followed at all times.

Your occupational therapist will:

 Teach you how to dress your lower body using assistive devices as well as the Three Hip

Precautions.

 Review the equipment and assistive devices you have at home.

If you care plan is for a short term respite stay while you recover

you must have this set up in advance and call the day before

your discharge to inform them that you will be arriving the next day.

Please see list of Retirement Homes which offer short stay respite care

at the end of the booklet.

Discharge Day

You must confirm your ride home the day before your discharge. Plan to be ready to leave at 11:00am

following your physiotherapy session.

Your physiotherapist will review:

 How to get into/out of bed with the Three Hip Precautions.

 How to safely walk with your walker with the Three Hip Precautions.

 How to safely manage stairs with the Three Hip Precautions.

 Review your exercises and your exercise plan for home.

 Your outpatient physiotherapy plans.

Your nurse will review:

 You home medications as well as review when to start them.

 Your staple removal in approximately 10-14 days post-operative and will take place in the

Orthopedic Clinic, you will need an appointment for this.

You and your mentor will:

 Have made arrangements for discharge including transportation home (patient pick up area at

the main entrance).

 Arrange and pack all your belongings.

If you have concerns:

 See ‘Potential Problems’ section.

When your family or mentor are here to pick you up and you are ready to be discharged, a staff

member will accompany you to your car.

All members of the healthcare team will be happy to answer any and all

of your questions that you, your family, or your mentor may have.

Returning Home

CONGRATULATIONS! You have made it through your surgical journey and are now at home. You have

met the expectations of your surgeon, hospital, physiotherapist, occupational therapist and have met

the required discharge criteria. However, there is still much work left to be done in your recovery and

rehabilitation. You may think you are alone but we want to assure you that we stand firmly by your

side.

Here is more information for your review and to help you succeed at home.

Protecting yourself from falls

In your house:

 Ensure there is enough lighting to see.

 Install night lights in hallways and bathrooms to guide you at night.

 Avoid the use of area rugs, they are a tripping hazard.

 Ensure that all carpeting is firmly tacked down.

 Keep you floors free and clear of debris.

 Arrange furniture to avoid accidently catching yourself or clothing on it.

 Keep pets out of your walking path.

Bathroom

 Floors clear and dry.

 Shower curtains or doors should be fully closed to keep all water in.

 A non-skid mat is outside the tub to absorb water and give you a secure place to step out.

 A rubber bath mat inside the tub for traction while standing.

 Especially for seniors

o Consider handles/grab bars for toilets, tubs, and showers.

o Bath seats.

o Raised toilet seat.

Stairways

 A handrail is present and in good repair.

 Clear of clutter and debris and in good repair.

 Any carpeting is firmly tacked down.

 Bare stairs have a non-skid surface.

 All pathways are clear.

Kitchen

 All floors are clear and dry.

 Appliance and cupboard doors are kept closed.

 Regularly used kitchen materials are kept in an easily accessible place.

 Heavier items are stored on lower shelves or on the counter.

Outdoors

 All entrances are well lit.

 Stairs and decks have secured handrails and are clear of snow, ice, and other debris.

 Bare stairs have a nonskid surface.

 All tools are put away when not in use.

It is important that you know and understand your own limitations. If you have a history of falls,

consider the potential causes and implement ways to prevent future falls.

Potential Problems

Just because you have been discharged from the hospital does not mean that post-operative

complications will not arise. Make sure that you continue self-monitoring for symptoms. We have

compiled a list of potential problems that can arise following surgery outside of the hospital setting.

Blood clots

There is still a possibility of a blood clot forming in your veins after surgery. We stress the importance

of continuing on your blood thinner as prescribed for the recommended duration. To help reduce the

risk of a blood clot forming you should be walking a short distance at least once every hour that you

are awake. You must maintain your foot/ankle exercises that you were doing in hospital as well to

help reduce this risk.

Pain

Your pain should lessen as time passes. It is important to maintain the pain management protocol

that you were put on in the hospital. This will allow you to move more and complete your rehab

exercises.

 If you have increased pain that is not relieved by your medication, then call your surgeon. If

you are unable to reach your surgeon, then proceed to your Emergency Department but

contact your surgeon the next day to notify them of the problem you experienced.

 Once you no longer need the prescribed narcotic, take all extra pills back to your pharmacy for

proper disposal. Do not leave them in your home.

Call 911 immediately if you experience

 Unexplained shortness of breath.

 Sudden onset of chest pain.

Notify your surgeon, primary care provider, or go to the Emergency Department if you experience

 Increased pain or tenderness in your legs or unexplained shortness of breath.

 Heat or redness in the calf area of either leg.

 Increasing severe swelling noted in your legs.

 Persistent vomiting that does not go away.

 You notice bright red or dark black stools (if not on an iron supplement).

 Excessive or continuous wound seepage .

Anti-embolic stockings (directed by your surgeon)

You are expected to continue wearing your stockings until your surgeon tells you to stop, normally

around post-operative week six.

 Ask your surgeon about when to wear them, they should be removed daily for skin inspection

of your legs and feet before reapplying.

 Ensure they fit smoothly without any wrinkles.

 Do not turn down stocking tops as it can then act like a tourniquet and cut off circulation.

 They should be washed/changed every third day. Wash with warm water and lay flat to dry.

You may want to consider having to pairs.

Diet

You may return to your normal diet as tolerated. Ensure you drink plenty of water to keep yourself

well hydrated. Refrain from alcohol for the next two weeks or longer if you are still taking your pain

medication.

Dental and surgery precautions

It is important to inform your dentist and other specialists that you have undergone a Total Hip

Replacement. Although the risk of post-operative infection is low, dental work has a risk of allowing

bacteria directly into the bloodstream which could travel to your prosthesis and create an infection.

Avoid dental procedures for at least three months after your surgery.

Maintaining Your Incision

Taking care of the dressing

If the dressing is dry, intact, and staying in place, leave it alone.

Change the dressing if:

 It has fallen off.

 It has become wet.

 Excessive drainage is present.

To change the dressing:

 Purchase dressing supplies from any pharmacy.

 WASH YOUR HANDS FIRST.

 If anyone helps you, they must WASH THEIR HANDS FIRST.

 Carefully removed the soiled dressing.

 Do not touch the incision with your hands. Use a clean gauze square and a saline solution to

clean the incision and pat the area dry.

 Open the dressing package, peel off the backing and carefully lay it on your incision to cover it

completely.

Preventing infection

 Please do not shower or bathe until the staples have been removed and your incision is well

healed.

 Good hygiene can help prevent infection.

 If incisions are not treated with care they can become infected and can cause serious

complications.

 Washing your hands is very important.

Signs and symptoms of possible infection

 Chills or fever of 38.5° C (101° F) for 24 consecutive hours.

 Increased drainage from the incision that may be cloudy or foul smelling.

 Increased redness, swelling, heat, or severe bruising around the site.

 Flu like symptoms.

What to do if symptoms present?

 Call your surgeon or primary care provider the first day you experience or see any of the above

changes.

 If you can’t reach your surgeon or primary care provider, go to the Emergency Department.

 If you go to the Emergency Department, call your surgeon’s office the next day.

Questions You May Have Following Your Surgery

How much weight can I put on the leg I had surgery on?

Your surgeon and physiotherapist will routinely instruct you throughout your stay on how

much weight you can be putting on your operated leg. If you can’t remember, it is also listed

on your discharge sheets that were given to you before you left the hospital. Most often it is

partial weight bearing, full weight bearing, or weight bearing as tolerated.

How long do I need to use the walker, cane, crutches, or other walking aid for?

You must continue to use the appropriate gait aid until either your surgeon or physiotherapist

progresses you to where you no longer require it. You will also be given further instructions on

any changes in weight bearing status, equipment or aid use.

Is a bowel routine needed at home?

The short answer is yes. You are at a higher risk of constipation because the anesthetic and

pain medication slow down your digestive system. You may need to consider using a stool

softener or laxative, both are available at your local pharmacy. We advise that you speak with

your pharmacist for the proper instructions on how to use the softener or laxative. Don’t

forget to increase your water intake and eat high fiber foods with plenty of fruits and

vegetables. If you notice dark black stools (and not taking an iron supplement) or bright red

stools, you need to contact your surgeon immediately or go to the Emergency Department.

Do I need to make clinic physiotherapy appointments?

You should have booked your initial assessment appointment for your Brockville General

Hospital outpatient physiotherapy at the pre-admission clinic. If you do not plan on using the

Brockville General Hospital outpatient services, then prior to surgery you must arrange them

elsewhere.

Handling Activities of Daily Living

When needing to dress on your own, ensure that you have all of your clothing and equipment

(reacher, sock-air, etc) close by so that you are not moving beyond what is safe. Think about all the

rooms where you may be reaching for something, set this up appropriately prior to your surgery.

Safely attempt this prior to surgery.

Steps to dressing – underwear and pants

1. Sit down on a bed or chair.

2. Use the long handled reacher to catch the

waistband of the underwear/pants.

3. Lower reacher to floor and gently guide the

clothes onto the affected leg first then

complete with the non-affected leg.

4. Pull clothing to your thigh.

5. Stand with the walker in front of you and

pull the underwear and pants up together.

Steps to undressing – underwear/pants

1. Stand to push down your pants and

underwear to your things.

2. Sit and use the long handled reacher to finish removing the clothes from your non-affected leg

first.

Steps to dressing – socks

Because you are unable to bend forward to reach

your feet you will need to use a sock-aid to get your

socks on.

1. Slip the sock on the sock aid with the heel on

the curved part of the sock aid.

2. Make sure to pull the sock up the sock-aid so

the toe of the sock is tight but not over the

knots in the rope.

3. Use the ropes to throw the sock-aid towards

the floor.

4. Slide your foot in the sock-aid all the way to

the toe of your sock and then scoop it over your heel.

5. Pull up on the ropes until your sock comes off onto your foot. You may have to wiggle your

ankle up and down.

6. Tips:

o Longer socks work best (not ankle socks).

o Sprinkle baby powder on sock-aid if feet are sticking to plastic.

o Push socks off using a long handled shoe horn

Steps to dressing – shoes

Use both the long handled reacher and long handled

shoehorn to put on and take off your shoes.

Consider the use of elastic shoelaces, slip on shoes,

or velcro to avoid bending and breaking one of the

Three Hip Precautions.

Toilet Safety at Home

You may require toileting equipment to help prevent breaking The Three Hip Precautions. You must

ensure that the equipment is safe and secure. Additional framing can be installed to make it easier to

sit and stand when using.

Depending on the type of toilet and your own personal needs you may want to consider a height

adjustable stationary commode. The commode is better used for people who do not have a usable

bathroom on the main floor.

Raised Toilet Seat with Arm Rests Height Adjustable Stationary Commode

Bathing Safety at Home

It is important for you not to get your incision wet until after your staples have been removed and

your incision is closed. This means you will need to sponge bathe for the first 14 days after surgery.

You are not to lay down or sit down in the bottom of the tub, use as shower only for the first 6 weeks.

You may benefit from the use of a bath and shower transfer chair. You are to never use soap dishes or

towel racks to support yourself. This is very dangerous and unsafe and could lead to a fall. These are

not designed to support you and are at risk of breaking or failing resulting in a fall. Consider installing

grab bars.

Bath Bench Bath Chair Bath Transfer Bench

Standing With A Walker

Sitting Down with a Walker

Walking Safety With Your Walker

Turning With Your Walker

Navigating Stairs

• If you have a railing, you will hold the rail and use a cane or 1 crutch in the free hand.

A cane is usually preferred.

• If you do not have Railings, your hospital Physiotherapist will recommend the best

way for you to go up and down stairs before you go home. Some people may be

comfortable using 2 crutches on the stairs.

Going Up Stairs:

• Step UP with your NON-OPERATED leg. Follow with your operated leg and the cane

or crutch.

Going Down Stairs:

• Step DOWN with your OPERATED leg and the cane or crutch. Follow with your non-

operated leg.

Managing your kitchen

 Remove rugs and over obstacles to avoid tripping.

 Use clothing or an apron with several pockets.

 A walker bag can be purchased to carry items including plates, silverware, and food in sealed

containers.

 Carry hot liquids in containers with secure covers in a bag or basket attached to your walker.

 Slide objects along the counter instead of carrying them.

 Sit on a high stool when doing tasks at the counter.

 A reacher may be useful for objects that are too high or too low.

 A utility cart would be useful to carry many objects at once and cut down on trips. Simply push

it ahead of your walker which allows your hands to be on the walker.

Getting in and out of a car

 Ensure you are on level ground and not up on a curb. This will make it easier to complete the

transfer.

 Don’t forget to have someone hold the door.

 Maximize the leg room in the passenger seat by moving the seat back as far as possible.

 Place a plastic bag on the seat to decrease friction and allow you to slide more easily or a

pillow.

 Stand with your back toward the seat and hang onto the seat and the dashboard while you

slowly lower yourself down onto the seat.

 Supporting your affected leg, slowly lift and move it into the car.

 Reverse the procedure for getting out of the car.

 Don’t forget about the Three Hip Precautions, recline the backrest to avoid breaking the 90

Rule.

Resuming Physical Activity

Your surgeon and physiotherapist will continue to instruct you on your weight bearing restrictions.

You may be walking with partial weight bearing or full weight bearing. Use your walker at all times

when moving. Your surgeon or physiotherapist will tell you when you can switch to a cane or

crutches.

Continue to progress your activity as you tolerate. This includes increasing your range of motion,

inside of the Three Hip Precautions (see page 29), strengthening exercises and your walking tolerance.

These need to be done before you can achieve functional independence.

Activity restrictions after a total hip replacement

 You must adhere to the Three Hip Precautions for at least 6-12 weeks following your surgery

to allow appropriate time for healing. Failure to follow these could result in a hip dislocation.

Your surgeon will notify you when you can discontinue with the Three Hip Precautions

 Use a soft pillow in between your legs for the next six weeks when in bed or rolling from side

to side.

 Use your walker at all times, your physiotherapist will tell you when you can transition to a

cane or crutches.

 Driving will be restricted for a minimum of 6 weeks and its reintroduction will be dependent

upon your individual progress. You will need to speak with your surgeon about return to

driving. You will not be allowed to drive while you are on narcotic pain management.

 You are advised to take at least 6 weeks off from work. Your surgeon will decide when you are

able to return to work. You will need to discuss with your employer any special needs you will

require upon your return.

 Low impact leisure and sport activities usually start again around three months after surgery.

These include walking, dancing, swimming, golf, and bowling.

 Your surgeon will advise you when you can resume sexual activity. The best position for you

will be laying on your back.

General Activity Guidelines

 Maintain a healthy weight.

 Stay healthy and active.

 Avoid repetitive heavy lifting.

 Do not lift or push heavy objects.

 Avoid excess stair climbing.

 Consult your surgeon prior to starting any new sport or activity.

 Avoid any physical activities involving quick stop-start motions, twisting, or high impact.

 Avoid excessive bending when weight bearing.

Physiotherapy

Physiotherapy Visits

Your pain management and control must extend into your physiotherapy visits. You should time your

pain medication to be taken just before starting your physiotherapy intervention. This will allow you

to participate while your pain is better controlled. This enables more comfort throughout.

Your surgery has solved the damaged joint, but the muscles surrounding the joint will have become

smaller and weaker. The only way for these to get bigger and stronger is through regular exercise and

strength training. These exercises will be designed by your physiotherapist in a way that they can be

completed at home. The only way to achieve the best overall outcome of your Total Hip Replacement

is to follow a strict exercise regime.

The physiotherapist will

 Review the Three Hip Precautions,

o Do not bend your waist past 90° while standing, sitting, or lying.

o Do not cross your legs or ankles.

o Do not twist your hip/leg in or out.

 Stress that you need to follow these precautions with exercises and activities.

 Build upon the exercises that you have already done in the hospital when you are ready and

able.

 Assess your progress.

Outpatient Physiotherapy

Your outpatient physiotherapy at Brockville General Hospital should begin about 7-14 days after the

date of your surgery. The physiotherapist will advise you how long and how often you will attend.

Each person’s needs are different.

Follow up Appointment with Your Surgeon

Location: Orthopedic Clinic

Ground Floor, Charles Street Site

Brockville General Hospital

75 Charles Street, Brockville ON

You will need a follow up appointment with your surgeon. If you do not have one scheduled, then

please call their office to schedule an appointment.

Wear loose, comfortable clothing to your appointment.

After you register at Patient Registration, you may be taken to Diagnostic Imaging to have X-rays of

your hip completed prior to seeing your surgeon.

Your surgeon will assess your progress, evaluate your incision, and your recovery.

Questions to ask your surgeon at this appointment

 How much weight should I be putting on my operated leg now?

 How much longer am I to wear my anti-embolism stockings?

 What future follow up appointments with you do I need?

 How long do I follow the activity restrictions?

Thank You

As we near the end of your Total Hip Replacement journey, we continue to work toward our goal of

optimal care for you. We care about your recovery and we tried to make this transition for you as

smoothly as possible.

Thank you for your commitment to this process. It hasn’t been an easy one for you but it is well worth

the time and effort that you put forth.

For information regarding Brockville General Hospital and our various amenities,

please ask for a copy of our Patient and Family Guide.

Surgical Department

Bundled Care – Elective Unilateral Hip and Knee Replacement

Achieving Excellence Together

brockvillegeneralhospital.ca | 613-345-5649