Guide to Total Hip Replacement Surgery

Going Home

You should be able to go directly home with an exercise program. However, your surgeon or health care team may decide you need further rehabilitation. If so, you will be referred to one of the following, depending on your needs:

• An out-patient physical therapy clinic or rehabilitation program at your local or rural hospital
• Home care
• An exercise program in your community
• Admission to a sub-acute care or rehabilitation facility

Transportation will be arranged by the hospital if you are being transferred as an in-patient to another facility. You will need to arrange your own transportation if you are going home from hospital.
No two people will progress at the same rate. The speed and success of rehabilitation following total hip replacement surgery depends heavily on you.
It is normal for your hip to be swollen for several weeks following surgery as the healing process continues. You may use ice packs on your hip to help reduce pain and swelling. Ask your physical therapist for specific instructions. It is also normal to feel some numbness in the skin around the incision.
Avoid any sudden jarring, twisting or uncontrolled bending of the hip. Sleep with a pillow between your legs and lie on your good side.
Continue your home exercise program. This will help your leg muscles become strong and supportive and will help you resume your normal activities.
Most importantly, walk as much as you can tolerate every day. Begin with short, frequent walks and slowly increase the distance.

Managing at Home
The following instructions will help you manage daily activities while recovering.  Gradually add activities to your daily routine, remembering to avoid bending your new hip excessively, twisting the hip, and bringing your legs together.

Sitting in a Chair
Choose a chair with a firm seat and armrests.  The chair seat should be no more than 1 inch to 2 inches above your knee when standing.  The seat height may be raised by adding a firm cushion. Avoid low or soft chairs and couches and do not use chairs that have wheels, rockers or swivel.
To Sit:

	Back up until you can feel the chair at the back of your legs. Slide your operated leg slightly forward. Bend both knees and lower yourself gently onto the chair. Reverse the procedure to stand up.

Using the Toilet
A raised toilet seat and toilet armrests may be recommended to assist you in using the toilet.  Make sure the toilet paper is within easy reach.

To Sit:

	Back up until you feel the toilet seat against the back of your legs. Slide your operated leg slightly forward. Bend both knees and lower yourself slowly onto the toilet seat, using toilet armrests, the countertop or sink for support. Reverse the procedure to get up from the toilet.

Getting in and out of Bed
Avoid low beds and soft mattresses and waterbeds.  Your bed should be   1 inch to 2 inches above your knee when standing.  Do not reach forward to pull up the covers from the foot of the bed.  Instead, use a reacher.  You may lie on your back or on your non-operated side when in bed.  Support your operated leg with pillows when lying on the non-operated side. 

To Get into Bed:

Sit down on the bed in the same manner as you would sit on a chair
Slide your buttocks back until your knees are on the bed.
Pivot on your buttocks as you lift your legs onto the bed.  Remember to keep your legs apart.
You may use a pillow to keep your legs apart when lying in bed.
Reverse the procedure to get out of bed.

NOTE: If your leg is swollen, elevate your entire leg on pillows so that your foot is above the level of your heart while lying in bed.  You should rest in this position for 45 minutes, 2 to 3 times a day.

Dressing
Special adaptive equipment should be used to help you dress yourself (e.g. reacher, long-handled shoehorn, dressing sticks, elastic shoelaces, sock aid).

Choose loose-fitting clothing, including socks. Wear low-heeled shoes with elastic laces. Be sure to dress the operated leg first and to undress it last.

Bathing

You must bathe from a sitting position at the sink or seated in a chair placed in the tub or walk-in shower.  You will not be able to sit on the bottom of the tub to bathe for approximately 3 months.  Have someone help you with tub transfers and showering until you can do them on your own.  Do not reach forward for the faucet.  Instead, have someone turn the faucet on and off.

Transfer Techniques: To Get into the Tub

Back up until you can feel the tub against the back of your legs, hold onto the tub grab bar for support and, with your other hand, reach back for the bath seat and lower your buttocks onto it. Pivot on your buttocks and lift your legs one at a time, up and over the side of the tub. Use a hand-held showerhead, long-handled sponge and soap-on-a-rope to avoid leaning forward and bending excessively. Reverse the procedure to get out of the tub.

Getting in and out of a Vehicle

Avoid small cars with low seats.  Sit in the front seat of the vehicle.  A firm foam cushion may be used to raise the height of the seat so that it is above your knee level.  The front passenger seatback should be reclined slightly and the seat should be positioned as far back as possible.  The driver should park the vehicle several feet from the curb.  You may find that a large plastic bag on the seat makes sliding into and out of the vehicle much easier.

To Sit in the Vehicle:

Back up with your walking aid until you can feel the edge of the vehicle against the back of your legs. Hold onto the back of the seat and the vehicle frame for support, slide your operated leg forward slightly, bend both your knees and sit.  Be careful to avoid hitting your head. Slide your buttocks back towards the middle of the vehicle, and then pivot on your buttocks as you lift your legs one at a time into the vehicle. Reverse the procedure to get out of the vehicle.

Sexual Activity

Most people are able to return to sexual activity when it is comfortable to do so. This activity is safe for your operated leg as long as all the precautions for your hip are followed. Remember:

• Do not bring the knee of your operated leg to your chest.
• Do not turn the knee of your operated leg inward.
• Avoid positions that cause pain.
• Keep the operated leg on a pillow and straight or slightly bent if lying on your side.

Home Management

You will benefit from being organized before surgery.  For example, you can purchase food and prepare meals ahead of time, rearrange cupboards to minimize bending, and move everyday items to ground level to avoid climbing stairs.
If additional assistance is needed when you return home, community services such as Meals-on-Wheels, Home Care, and homemaking services, will be arranged by your Case Manager.  You may have to pay for some of these services.

Meals

• Carry hot liquids in containers with lids (Thermos or thermal mug with lid) to avoid burns.
• Use the oven only if you can do so without bending your hip beyond 90 degrees or twisting. A microwave or stovetop is preferred.
• Use prepared meals, frozen meals, Meals-on-Wheels or order in food.

Kitchen

Keep frequently used items within easy reach and use a long-handled reacher if items are out of reach. Avoid storing food in lower fridge compartments and on low shelves. Slide objects along the countertops – don’t lift them. Use a wheeled trolley or cart to transport items when your hands are occupied with a walking aid. Wear an apron with large pockets or a fanny pack or attach a bag to your walker to carry things. Sit on a high stool when doing countertop tasks. Do not load the lower dishwasher rack, unless you can do so without bending your hip beyond 90 degrees or twisting.

 Shopping

• Shop at stores that are easy to get to and have good parking facilities and elevators.
• Bring your walking aid with you.
• Bring your reacher to pick up items off the lower shelves.
• Use a backpack to carry purchases.
• If possible, get help from family or friends.
• Your local grocery store may deliver for a small fee.
• Dairy companies will deliver milk and other dairy products to your door.
• Use canned or frozen goods to decrease the frequency of shopping trips.

Laundry

• Have someone do laundry for you. If this is not possible, reduce the laundry loads to a few items at a time, carrying them in a plastic bag, backpack or wheeled cart.
• A reacher may make it easier to get laundry in and out of front-loading washers and dryers.
• Sit on a high stool to iron clothes.

Housework and Yard Work

• You should be able to do light housekeeping, such as dusting and washing dishes.
• Arrange to have help with heavy work, such as vacuuming, washing floors, changing bed sheets, cutting the grass and shoveling snow.
• Take out small amounts of garbage at a time if there is no one to do this task.
• Hire assistance if possible.

Driving

• Discuss this with your surgeon. He or she will tell you when it is safe to resume driving. This generally depends on which leg had surgery and whether you drive a car with a standard or an automatic transmission.
• Information regarding alternative transportation in your community is available at the Hip and Knee Clinic.

Activities and Sports

You may feel some stiffness in your new hip, especially during activities that require the hip to be bent to an extreme range. One of the aims of surgery is to improve your hip’s range of motion to regain function. How much movement you obtain is often related to how much stiffness you had before surgery.

Your new hip joint may activate metal detectors at airports. Tell the security guard about your surgery if the alarm is activated. Your surgeon can give you a letter or prosthesis card, which you can carry when you travel to confirm you have a prosthesis.
Take special precautions to avoid falling and injuring your hip. You may require complicated surgery if you sustain a fracture around the prosthesis.

Tell your dentist or other doctors involved in your care that you have had hip replacement surgery.  You may need antibiotics before having other procedures as there is a risk of infection spreading to your new hip.
It is important to keep the muscles surrounding your new hip strong. Participating in regular, light exercise programs will maintain strength and mobility in your new hip joint.

 

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