North Kansas City Hospital Total Hip Replacement …4 TOTAL HIP REPLACEMENT SURGERY The 9th Floor...

Total HipReplacement

Nor th Kansas C i ty Hosp i ta l

S U R G E R Y

Total HipReplacement

Level 1Parking

★

PavilionEntrance

NORTH KANSAS CITY HOSPITAL • CAMPUS MAP

T a b l e o f C o n t e n t s

Welcome Letter . . . . . . . . . . . . . . . . . . . . 2

Total Joint Replacement Surgery . . . .3

Things to Know Before Surgery . . . . . 5

Exercises for Hip Surgery Recovery . . 8

Surgery and Recovery . . . . . . . . . . . . 10

Discharge Options . . . . . . . . . . . . . . . 16

Returning Home After Surgery . . . . 17

Preventing Falls at Home . . . . . . . . . 22

When to Call Your Doctor . . . . . . . . 23

General Hip Precautions . . . . . . . 24

How To Manage Your Pain . . . . . 25

Nutrition Guidelines . . . . . . . . . . 27

High Fiber Foods . . . . . . . . . . . . 28

www.nkch.org 3

Total Joint Replacement

Program

N O R T H K A N S A S C I T Y H O S P I T A L

North Kansas City Hospital offers a class to help you learn more about your surgery

and plan for your care after discharge.

The class is offered every other Thursdayfrom 9 a.m. to noon.

Please call (816) 691-1688 to enroll in this class.

A staff member will provide the dates

of upcoming classes.

This packet of information hasbeen developed to provide you and your family with informationconcerning:

• Pre-hospitalization

• Your hospital stay at North Kansas City Hospital

• Discharge planning

For your convenience, parking is available

on Level 1 (Grape Level) of the parking garage.

As you enter the Pavilion, take the elevator

to the 9th Floor. Classes are held

in the Orthopedic Unit Classroom.

4 TOTAL HIP REPLACEMENT SURGERY

The 9th Floor Pavilion is a 50-bed unit that specializes in the care of individuals with orthopedic (bone) problems. It is our role to serve asteachers and assist your return to an optimal level of function during your brief stay with us.

Our nursing staff consists of RNs, LPNs and technicians who provide carefor you as well as other patients. The quickest and most efficient way toreach your nurse is by using your call button. A nurse or aide/tech willanswer your call and page someone to assist you. Shift changes occur at6:50 a.m. and 6:50 p.m. Your day and night nurses will be exchanginginformation at these times, but other staff will be available to assist you.

In addition to nursing staff, you will have contact with a number of peopleduring your stay. A member of Environmental Services will clean yourroom daily. If you have tests through Laboratory, Radiology, RespiratoryTherapy or EKG, those staff members also will be involved in your care.At mealtimes, the Food Service staff will deliver your tray. Your nurse will provide any assistance you need with your meal or alterations toyour diet and will make an effort to check with you at each mealtime. If a procedure has altered the routine mealtimes, your meal will beordered upon your return to the room.

Your daily routine will be based around the activities scheduled that day,such as surgery, physical therapy or testing procedures. Usually yournurse cannot alter the times these events take place. For this reason, your bathing time and other care needs may be done in the morning, mid-afternoon or evening.

We encourage patient and family involvement in your care. To allow thenurse more time at the bedside to meet each individual need, it would behelpful if only one or two family members could be designated as yourspokesperson to receive updates from the nurse on your progress. Thisindividual could then update other family members.

In order to serve patients as efficiently as possible, North Kansas CityHospital evaluates many of its daily practices; therefore, things may notbe done the same way or by the same person as on a previous admission.If you have questions about hospital practices or your care, please feelfree to ask any staff member or me. It is important to us that you areknowledgeable about your illness, procedures, medications and dischargeplans. We will be happy to provide the resources you need to assist youduring your stay. Our goal is to make your hospitalization as comfortableas possible and yet help you maintain your independence. In order to succeed, we welcome any suggestions for improvement.

If I can be of further assistance, please ask your nurse to contact me, or you may call me at extension 1997.

Sincerely,

Marilyn May, Nurse Manager, 9th Floor Pavilion

Dear Patient and Family:

The staff and I

would like to thank you

for choosing

North Kansas City Hospital.

I would like to take

this opportunity to give

you some information

about our unit.

■

Our goal is to make

your hospitalization as

comfortable as possible

and yet help you maintain

your independence.

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Total Joint Replacement SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Total Joint Replacement Surgery

How Joint Replacement WorksA joint is, quite simply, a moveableconnection between the ends of two or more bones. These ends arecovered by a smooth material calledcartilage and connected to each other by flexible ligaments. The joint is lined with a tissue called the synovium, which produces alubricating substance called “synovialfluid.” Muscles and tendons surroundand cross the joint and power itsmovement. For the human body tohave free and easy movement, all of these components must be working well.

Arthritis breaks the fine-tuningbetween bone, cartilage, synovium,ligament and muscle. Just how thearthritic process works is still notclear, but researchers do know itseffects on the joints. In osteoarthritis,the smooth cartilage covering the jointbecomes rough and worn thin, so thatthe bones rub directly against each

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other, causing pain and inflammation.In rheumatoid arthritis, the synoviumbecomes inflamed and attacks cartilage.In both cases, the joint can becomestiff and painful. Eventually, thearthritis sufferer avoids moving thejoint to avoid the pain, which onlyintensifies the condition by makingthe structure adjoining the joint weaker. This makes movementincreasingly difficult.

In joint replacement surgery, theworn-out joint ends are replaced witha prosthesis, or artificial hip, that isusually made of metal and strongplastic. The diseased bones’ ends are cut away and the prosthesis isimplanted in their place. This artificialhip is either attached to the boneswith a cement-like material, or it mayhave an absorbent coating into which,over time, the bone can grow directly.

In joint replacement surgery, the worn-out joint ends are replaced with

a prosthesis, or artificial hip, that is made of metal and strong plastic.


Prosthetic Hip Joint

Socket portionof hip prosthesis

Stem portion of hip prosthesis

Bone cement

Bone cement

Thigh bone(Femur)

"Ball & socket"joint

Diseased boneremoved

Cartilage on head of Femur thin and worn off

Cartilage within socket(acetabulum) of Iliumthin and worn off

Diseased Hip Joint

Bone spursCartilage on head of Femur

Cartilage within socket(acetabulum) of Ilium

Ligaments

Normal Hip Joint(part of hip bone removed to show entire joint)

Thigh bone(femur)

Hip joint

Placing a Joint ProsthesisIn the arthritic hip joint, the protective cartilage covering the bones has beenworn away so that the bones rub directly against each other. This causes pain,inflammation and progressive destruction of the bones.

On the far right, the diseased joint ends have been removed, and a “ball-and-socket”hip prosthesis has been implanted in place of the joint to eliminate pain andallow easier movement.

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Prosthetic Hip JointDiseased Hip JointNormal Hip Joint(part of hip bone removed to show entire joint)

“Ball-and-socket”joint

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The hip is a ball-and-socket joint which is composed of two parts. The socket, or acetabulum,is part of the pelvis, and the ball, or femoral head, is the upper end of the thigh bone. When a totalhip replacement is performed, a polyethylene or“plastic” cup is inserted into the socket. The upperportion of the thigh is replaced with a metal stem.This metal stem has a ball at its upper end to fitinto the socket.

Total hip replacement surgery is usually an elective procedure. There is adequate time to makeall the necessary preparations to ensure that youroperation will go smoothly. You should be in thebest possible state of health, and if there are anyconditions that can be improved or correctedbefore your admission to the hospital, this shouldbe done. It is important that you understand clearly what will be accomplished by the surgery,as well as the risks and benefits. These mattersshould be discussed in detail with your surgeonbefore you are admitted.

Things to Know Before SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Things to Know Before Surgery

Total hip replacement (or arthoplasty) is a common procedure. It is performed for

a variety of reasons, including pain, decreased motion of the hip and decreased

ability to do everyday activities. These symptoms may be due to conditions such

as arthritis or degenerative joint disease, vascular necrosis or injury.

Cartilage on head of Femur

Cartilage within socket(acetabulum) of Ilium

Ligaments

Normal Hip Joint(part of hip bone removed to show entire joint)

Thigh bone(femur)

Hip joint

Socket portionof hip prosthesis

Stem portion of hip prosthesis

Bone cement

Bone cement

Thigh bone(Femur)

"Ball & socket"joint

Diseased boneremoved

Cartilage on head of Femur thin and worn off

ge within socketbulum) of Iliumd worn off

Prosthetic Hip Joint

Normal Hip Joint

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Before SurgeryYou may have blood studies, urineanalysis, electrocardiogram (EKG) and X-rays before surgery. If you havehad a recent infection or cold, have an allergy to antibiotics or other medications, have taken steroids inthe past year or are taking blood thinners such as aspirin, be sure andtell your nurse and doctor. Severalmembers of the health care team willinterview you. You will be asked aboutpast hospitalizations, medical problems(past and current), medications youtake (both prescription and over the counter), and other informationnecessary for your care. It is a goodidea to write these things down soyou can give this list to your nurse ordoctor. The health care team willexamine you and may order other tests.

Prior to surgery, you also will meetwith an anesthesiologist (a doctorwho specializes in anesthesia), whowill discuss the type of anesthesia youwill have during surgery. Be sure tolet the doctor know if you desire aparticular type of anesthesia, have hadany negative reactions to anesthesia orif you have any questions.

In class, we will discuss the use of a walker, and you will be shown exercises to do in your bed before andafter surgery. These exercises helpmaintain good circulation and muscletone. They include pumping the feetand tightening the thighs and buttocks.Your nurse will review these with youafter surgery. The nurse also will teachyou to cough and do deep breathingexercises to speed your recovery andprevent complications.

You will be asked

about past

hospitalizations and

other information

necessary for your

care. It is a good

idea to write these

things down so you

can give this list to

your nurse or doctor.

If ordered by your doctor, your bedwill be fitted with an overhead frameand trapeze bar to help you movearound in bed. Your nurse will showyou how to use this equipment tohelp you lift up and how to use a bedpan. You will be shown how youwill be tilted slightly to your side aftersurgery. You also will be shown howto operate the bed controls and nursecall signal.

You will wash your hip with a specialantibacterial soap at home before surgery and in the pre-op holdingarea. If necessary, excess hair will beremoved from your hip area using a hair removal agent in the pre-op holding area.

Unless otherwise instructed by yoursurgeon or anesthesiologist, you mayNOT eat or drink anything aftermidnight before your surgery.

Check with your surgeon to find out if you should take your usual dailymedications with a sip of water on the day of surgery. You may beinstructed not to take some of yourhome medications before surgery, particularly nonsteroidal anti-inflammatory drugs or blood thinners.

When you come to the hospital, youshould bring a knee-length bathrobeand a pair of supportive slippers or shoes with enclosed backs and nonskid soles. Be sure to review thefollowing page, “What You ShouldBring to the Hospital” and “Please Leavethe Following at Home” for a more complete list.

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WHAT YOU SHOULD BRING TO THE HOSPITAL

Insurance cards/information

Important phone numbers of family members

List of current medications with dosages (include name of medicine, how much you take, how often; vitamins; over-the-counter medicine; and dietary supplements, such as herbal products)

Robe

Eyeglasses (if necessary) with hard case

Hearing aid (if necessary) with extra batteries

Contacts and supplies (if necessary)

Dentures, denture cup (if necessary)

Personal care items: toothbrush, comb, brush

Makeup, if desired

Shaving equipment (an electric razor is necessary if you are on blood thinners)

Full set of loose fitting clothing (i.e., socks, elastic waist pants, underwear)

Non-skid, comfortable shoes with enclosed backs that are not tight; elastic shoelaces are helpful

Walker, if you have one

Medications

We encourage you to wear hospital gowns during your stay. While they arenot particularly fashionable, they are very practical and will allow you tomove about more freely.

PLEASE LEAVE THE FOLLOWING AT HOME

Money

Credit cards

Purse

Jewelry…all patient rooms have a clock, so a watch will not be needed

All other valuables


Exercises for Hip Surgery RecoveryN O R T H K A N S A S C I T Y H O S P I T A L

Exercises for Hip Surgery Recovery

Breathing Exercises Breathing exercises will help protect you from pneumonia, and the muscle exercises willassist in the prevention of blood clots and speed your healing process.

Breathe in as deeply as you can

Hold for one to two seconds

Breathe out completely

Repeat steps 1, 2 and 3 several times.

Breathe as deeply as you can

Cough deeply from your abdomen (not a shallow throat cough)

Repeat this exercise every hour.

Calf Pumping (Ankle Exercise) This exercise helps promote circulation. It also helps to tone and strengthen the musclesof the lower leg.

Lie flat in bed or with the head of the bed slightly elevated

Point your toes toward the foot of the bed

Point your toes toward your head

Repeat the exercise 10 times an hour, one leg at a time or both legs together.

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In order to help speed your recovery following hip surgery,

you should begin practicing these exercises BEFORE your surgery.

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Quadriceps Setting Exercise (Quad Sets) This exercise is important to maintain and strengthen the quadriceps muscles. These arethe muscles on the top of the thigh that are used to straighten the leg. This exercise isstarted the day after surgery. Put your hand on your thigh and you will feel the musclemove as you do this exercise.


Press the back of your knee downward against the bed

Hold this position for five seconds, then release

Repeat this exercise 10 times per hour, one leg at a time or both legs together.

Gluteal Setting Exercise (Gluteal Sets) This exercise is important to maintain strength in the gluteal muscles. The gluteal musclesare the major muscles of the buttocks. This exercise is started the day after surgery.


Tighten buttock muscles

Hold this position for five seconds, then relax

Repeat this exercise 10 times per hour.

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12 TOTAL HIP REPLACEMENT SURGERY12 TOTAL HIP REPLACEMENT SURGERY

Surgery and RecoveryN O R T H K A N S A S C I T Y H O S P I T A L

Surgery and Recovery

On the day of your surgery when you arrive in Pre-Op, you will be met by amember of the Operating Room staff. The nurse will start an intravenous line(IV) to provide you with fluids during surgery, and you will be given the medica-tions that you and the anesthesiologist discussed. Then you will be taken to theOperating Room.

During your surgery, your family and friends can wait in the surgical waitingarea. The receptionist will update them on your progress and inform them whenyou are being brought back to your room.

After surgery, you will be taken to the Recovery Room in your bed. You mayhave a special wedge pillow or pillow between your legs. Your nurse will tell youwhich one you will have in place and for how long. This is to keep your hip inthe proper position. You will have a bulky bandage on your leg and you mayhave a drainage tube (hemovac) coming out from under your bandage. Thisallows excess fluid to drain from the area to minimize swelling.

The nurses will check your vital signs (blood pressure, temperature, breathing,pain level and heart rate) frequently. The circulation in your legs and feet alsowill be checked.

After you have recovered from the anesthesia, you will be taken back to your hospital room where your nurse will continue to check your vital signs, circulation and comfort.

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After SurgeryIt is important for you to do severalthings while you remain in bed:

• Continue deep breathing andcoughing to prevent congestion inyour lungs. Take a slow, deep breath,hold it for 1-2 seconds, and then let it out. This should be done 10 timesevery hour while you are awakeand at night if you awaken.

• Do the bedside exercises youlearned before surgery to enhancethe return of blood to your heartand keep muscles strong. Moveyour feet up and down 10 timesevery hour (pump) while awake tokeep the circulation active anddecrease the chance of blood clots or phlebitis. You also may have elastic stockings, sequential compression devices and/or footpumps to prevent blood clots during hospitalization.

Calf Pumping (Ankle Exercise)

Quadriceps Setting Exercise (Quad Sets)

Gluteal Setting Exercise (Gluteal Sets)

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• Immediately following surgery, youwill have intravenous fluids (fluidsthrough a needle in your vein). Assoon as you are able to take liquidsby mouth, it is essential that youstart drinking a reasonable amounteach day to maintain good kidneyfunction. It is also important not topostpone urination, as this couldlead to overfilling your bladder anddifficulty in passing your urine. Callyour nurse if you need assistance.

• Change your position in bed frequently to prevent skin irritation.The trapeze is useful to help you lift your buttocks off the bed. Whenlifting, do not push down on thebed with your newly operated leg.Your nurse will help you tilt ontoyour side. Tell your nurse if yourbuttocks or heels feel sore or hotbecause several procedures can bedone to relieve this discomfort.

• You should have a knee-lengthbathrobe and a pair of sturdy slippersor shoes with nonskid soles to usefor walking the day after surgery. Be sure your slippers or shoes havean enclosed back.

• Positioning of your hip is veryimportant to prevent dislocation. Do not flex or bend beyond a 90-degree angle. Do not sit upstraight in bed or bring your newlyoperated leg up toward your chest.Keep your legs apart. Use of awedge or pillows between your legswill help you maintain the properposition. Do not lie on your sidewithout the assistance of your nursethe first two days.


MedicationDuring the postoperative period, youmay have pain in your hip area. Thisusually subsides within a few days.There are many ways to relieve yourdiscomfort, including medication, icebags, position changes and relaxationexercises. IV pain medicine is usuallyavailable during the first 48 hours.

Once you are able to eat and drink,oral medicine may be given to relieveyour discomfort. You should ask forpain medication when you need it.Your nurse will help you identifywhich medications will make youmost comfortable. Other medicationsthat may be prescribed include the following:

• Aspirin, warfarin (Coumadin®), or enoxaparin (Lovenox®) may begiven to help prevent the formationof blood clots.

• A laxative, such as docusate,bisacodyl or milk of magnesia,may be given to soften the stool andpromote regular bowel function.Constipation can occur for manydifferent reasons, including medica-tion, inactivity and diet. Your nursewill help you with the necessarysteps to avoid constipation.

• Iron tablets may be ordered by yourdoctor to assist your body to rebuildits own blood supply and recoverfrom the normal blood loss thatoccurs during surgery.

OK

NO!

90˚NO!

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Blood WorkYou may have frequent blood samplestaken. This will allow your doctor toadjust your medications as neededand to be sure your blood countremains at a safe level.

There is a possibility that you may needa blood transfusion. The blood can befrom the blood bank or self-donated.

Your Incision and BandagesThe bandages covering your incisionwill be changed as needed by the doctors or nurses. It is not unusual tosee red or brownish drainage on thebandage. This will gradually decreaseand usually stops within a week. Yourincision is an arch from mid-buttockto mid-thigh. The area around it may appear bruised. Swelling also iscommon and will subside as healingprogresses. Your incision will containstaples or stitches that are visible.These will be removed when healingpermits, usually within 7-14 days.

Therapy After Hip Replacement SurgeryThe day after surgery you will beready to get out of bed and sit in achair. The nurse and your therapistwill review your postoperativeinstructions and physical and occupational therapy will begin.

Use of WalkerThe day after surgery, you will beginwalking using a walker. Be sure thatyou do not attempt to do anythingyou are not completely comfortablewith and that you get help from yournurse or therapist for the first fewdays. It is a good idea to stand at thebedside for a few moments beforebeginning to walk to decrease thechance of dizziness. The amount ofweight that can be put on the leg willbe different for each person. In manycases, patients are able to put someweight on the operated leg, providedthat they use a walker.

During your hospital stay, the therapistwill teach you how to use a walker andwill fit it properly for your use whilein the hospital. If you bring you own,be sure to mark it clearly with yourname and show it to your therapist. If you need a walker for your returnhome, your Case Manager/SocialWorker will assist you.

SittingWhen you are able to walk around your room, and your doctor permits, you may sit in a high-seated chair with arms. When sitting erect, do not lean forward, anddo not raise your knee. This will preventexcessive bending past a 90-degreeangle at the hip joint. You are notallowed to sit in recliner chairs while you have hip precautions.

You will begin to use an elevated toiletseat with arms and other assistiveequipment in the bathroom at this time.

NO!


Getting Out of BedThe nurse will come to your bedside and teach you the correct way to get out ofbed: keeping the operated hip straight and the leg out to the side. Tell the nurse ifyou become dizzy. This is common and will pass as you get used to being up.

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Keeping your knees apart, move legs toward edge of bed. Prop up with elbows.

Keeping knees apart, continue tomove lower extremities to edge ofbed, using elbows and hands to push upper body upright. Remember,do not bend past 90 degrees.

Continue with same motionuntil lower extremities areover edge of bed and feet are flat on floor.

Do not bend forward when sitting at edge of bed.

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In/Out of CarThe use of a four-door sedan is preferred. Slide the front passengerseat all the way back and recline theseat back if possible. Back up to thecar and sit down, then gradually putlegs in the car.

If you must sit in the back seat, backup to the car and sit in order to slideacross the seat before pulling yourlegs into the car. Lean against somepillows placed at the side of the car door.

Techniques will be individuallyreviewed and practiced during therapy.

Occupational Therapy After Hip ReplacementIn Occupational Therapy you willlearn how to perform self-care activitiesafter hip surgery. You will be instructedon how to bathe and dress while following the hip precautions on page 24. To maintain hip precautions,you will need to learn how to use areacher, sock aide, long-handled shoehorn and long-handled sponge.These assistive devices can be purchased at some pharmacies ormedical supply stores.

The Occupational Therapist will teachyou how to maintain proper hip precautions during daily activities. The OT can give recommendations forthe equipment that is most appropriatefor you.

Stair ClimbingA variety of techniques are used toascend and descend stairs. Themethod you use is dependent on the type of steps you have and theparticular assistive device (i.e., cane or walker) you use and your weight-bearing status.

• Going Up Steps: Step up first withthe non-surgical leg, then followwith the operated leg.

• Going Down Steps: Step down firstwith the operated leg, then followwith then non-surgical leg.

“UP WITH THE GOOD, DOWN WITH THE BAD”

ActivityYou will continue to make progress inwalking independently. The physical therapist will instruct you in exercisesto continue at home. You will learnthe proper way to go up and downsteps and to get in and out of cars.

ExerciseExercises may be performed either sitting or lying down. In addition to the exercises you began prior to surgery, you also will work towardbending and straightening your knee and moving the hip out to theside and back. As you progress to outpatient therapy, you also may perform these in a standing position.

Exercises are repeated as instructed by your therapist, and repetitions are increased as tolerated. There may be certain circumstances when exercises are not indicated or need tobe modified, so wait for instructionsbefore beginning.

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Our goal is for patients to go home with home health care after their stay on the

Orthopedic Unit of the hospital. Listed below are possible options for continued

care upon leaving the hospital setting.

Home HealthHome Health Services are provided to most individuals who have a total jointreplacement. Home Health may consist of physical therapist visits, nursing visits,and/or occupational therapist visits, with physical therapy providing the majorityof the services. The number of visits varies depending on your surgeon’s orders,but is typically either three or five days per week. Home Health is designed toassist you in your recovery while it is difficult for you to get out of your home andis covered by most insurance companies.

Acute RehabilitationNorth Kansas City Hospital offers an on-site Acute Rehab Unit. This level of careis often not authorized by insurance companies following total joint replacement.Acceptance in acute rehab is determined on an individual basis by the Rehab UnitAdmission Coordinator and is driven by very strict Medicare guidelines. Theaverage length of stay is 7-10 days. Patients typically receive therapy four timesper day for a total of three hours per day.

Skilled Nursing UnitSkilled nursing is a lower level of care from acute rehab where patients typicallyreceive therapy once daily. If skilled nursing is required after surgery, NorthKansas City Hospital social workers will facilitate this transition to a local skillednursing facility of the patient’s choice. A list of area skilled nursing facilities willbe available at the total joint replacement class and upon admission. Skilled nursing units are located within local nursing homes. The average length of stayvaries. It is determined by progress in physical therapy and insurance approval.

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The following itemsare not covered byinsurance and are usually needed to care for oneself afterhip replacement:

• Reacher

• Sock aid

• Long-handledsponge

• Long-handled shoehorn

• Elastic shoelaces orslip-on shoes

• Elevated toilet seatwith arms

• Shower chair/tub bench

• Safety frames andgrab bars/safetybars

Discharge OptionsN O R T H K A N S A S C I T Y H O S P I T A L

Discharge Options

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Returning Home After SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Returning Home After Surgery

Preparing to Return Home If you live alone, some additional help may be needed while you have hip precautions (your doctor will give you the length of time you need to followyour hip precautions). Long before your discharge, it is very important that thenecessary arrangements be made toward your release from the hospital (includinghelp at home and a ride home). Case Management/Social Services can provideyou with information on how to get help at home. You may need to use a chair thatwill not allow your knee to be higher than your hip, in addition to your walker.

When the staples or stitches are removed from your incision, they may bereplaced by small pieces of special paper adhesive tape called “steri-strips.” After a few days they will begin to fall off by themselves. This is normal. Thenurse will instruct you if any additional care is needed. You will need to keepyour incision clean and dry and watch for any signs and symptoms of infection (i.e., redness, drainage, warmth/fever).

You will be discharged from the hospital on the medications you were takingbefore you were admitted. Your doctor may prescribe additional medication suchas Lovenox® or another type of blood thinner. Continue to eat a well-balanceddiet, high in carbohydrates and protein to aid in tissue healing. If you were on a special diet in the hospital, a nurse or dietitian can answer any questions youmay have.

Included in your packet

of information is a

questionnaire that will

help determine what

type of additional help

you may need.

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Hints for HomeThe following are some things that areimportant for you to remember duringyour daily activities (bathing, dressing,household duties, etc.) and during the necessary adjustments after yougo home. The therapist can provide some suggestions for your particularneeds. Your nurse also will reviewthese points with you.

• You will need to use a firm, highchair with sturdy arms and nowheels, assistive toilet equipmentand walker after leaving the hospital.The Case Manager/Social Workercan assist you in arranging for homeequipment, if needed. Coverage forsuch items is dependent on yourinsurance policy benefits although it usually covers walkers only.

• Avoid bending past 90 degrees atyour hip during household activities.

• Use a “reacher” (a device that reaches and can pick up an item) to avoid bending.

• Reorganize your cabinets, refrigerator, closets and workspacesso that frequently used items arewithin easy reach (not high, notlow) at waist level.

• Sit on a stationary high stool or firmarmchair while working in one spot,especially if you tire easily.

• Eliminate throw rugs, as they can getcaught in your walker and causeyou to lose your balance.

• Your bed height may need to beincreased by adding an extra mattress or by placing blocks underthe legs of the bed. Discuss this withyour doctor or therapist.

• Avoid sitting in low chairs that placeyour knees higher than your hips.

• Clear the pathways between the living area, bedroom and bathroomof furniture and clutter so they arewide enough for a walker to passthrough. This will help make yourreturn to home safe.

Bathing• Do not sit in the bottom of the tub.

Tub benches and shower chairs maybe appropriate for your situation.An Occupational Therapist can helpyou determine what equipment isnecessary for bathing.

• Traction strips, non-slip mats andgrab bars for the shower stall or tubhelp prevent slipping.

• You can use a long-handled spongeto wash your feet to avoid bendingthe hip.

Dressing• You should not try to reach your

feet until you are told you can dothis by your surgeon.

• A long-handled shoehorn can beused to slip shoes on. (Remember to wear flat, enclosed back and well-fitted shoes.)

• Elastic shoelaces can be used to slipshoes on and off without tying oruntying. You also can use shoeswith Velcro straps.

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• A “reacher” can be your best helper!With it, you can pick up objectsyou’ve dropped (following your hipprecautions), put on your pants(remember that the operated leggoes in first), and push off socks.

• A sock aide can allow you to put on your socks while following hip precautions.

Safety• Wear good sturdy shoes with

enclosed back when walking.

• Throw rugs and slippery floors are asafety hazard. Remove all throwrugs from your floors.

• Watch for hazards such as wet spotsor electrical cords on the floor.

• Remember to use your walker forany walking.

• Grab bars are suggested for use inyour bathroom.

• Be especially cautious outside yourhome or in unfamiliar places. In thewinter, rubber-soled boots should beworn for walking in the snow.

• Use handrails (if present) whenwalking up/down stairs or steps.

Driving and TravelYou may be a passenger in a car for 1-2 hours at a time. Check with yourdoctor to determine when you mayresume driving a car. You also mayneed to check with your car insurancecompany before driving so that theyare aware of your surgery.

The metal hardware in your hip may activate the detection devices at airports. Your doctor will give youa metal identification card.

Care of Your IncisionLook at your incision every day for 7-10 days. After your staples havebeen removed, you should wash theskin gently with soap and water daily.Ask your doctor whether or not tocover your incision while showering.

Follow-Up CareYour doctor will want to see you afteryou go home to follow your recoveryprogress. It may be convenient to makethis appointment before you leave thehospital. Do not hesitate to call yourdoctor if you have any questions during your recovery at home.

Use of WalkerBe sure that you know how long youare to use your walker and exactlyhow you are to use it. If you have any questions about this, please askyour therapist. Your home health oroutpatient therapist will progress youto the next appropriate device.

N O T E S


Prevention of InfectionIt is important to do everything possible to prevent infection. If youhave a fever (temperature above 100);swelling, redness or tendernessaround your incision; or drainage,please call your doctor immediately. If you suspect you have an infectionanywhere else in your body, it is very important to notify your doctorimmediately. Prior to dental appoint-ments or any invasive procedures,please remind your doctor or dentistof your hip replacement. In all thesecircumstances, your doctor shoulddetermine whether antibiotics are necessary to treat and/or preventinfection for at least two years.

PainYou may feel some discomfort in yourhip area for some time after your surgery. As long as it does not increaseor become severe, it is usually nothingto worry about. If your pain doesincrease after you go home or persistsfor a long time, call your doctor.

Position of the HipFollowing surgery, it is important to be extremely careful about the position of your hip to minimize therisk of dislocation. After this time, thesoft tissue around the hip usually hashealed sufficiently so that dislocationbecomes less likely. However, thisdoes not mean you should becomecareless about the position of yourhip. Even late dislocations can occur.

It is important that you never forcethe hip into an awkward position andthat you do not try to pull the knee uptoo far. During your recovery phaseyou should never bend past 90 degreesat the hip or pull the knee up towardyou. You may have to modify the wayyou pick things up or tie your shoes.

Do not cross your legs or ankles orturn your surgery foot inward. Refer to the hip precautions on page 24.

Activity LevelAn artificial hip is composed ofmechanical parts that are subject towear and tear. In order to get the maximum useful life from your hip, it is important that these parts not beexposed to excessive stresses andstrains. You should not run or jumpand should not take part in activitiesthat place excessive stress or wear onthe joint.

Sexual RelationsSexual activity is possible with proper precautions. Remember thatthe positioning of your replaced hip is very important during the firstthree months after surgery. Ask yourdoctor or nurse if you have any questions or concerns.


N O T E S

www.nkch.org 23

CHECKLIST

The following is a checklist of items you may want to ask your doctor, nurse, or therapist.

Amount of weight bearing allowed, and for how long

Need for any special devices – sock donner, reacher, etc.

What type of equipment is needed for the toilet/tub/shower

How to get home (family car, wheelchair van, or ambulance – check your insurance coverage)

Length of time to follow hip mobility/precautions

Sexual activity

Need to raise the height of the bed

Follow-up appointment

Need for help at home, especially if you live alone

When you are able to drive

When you need to see or call your doctor


Preventing Falls At HomeN O R T H K A N S A S C I T Y H O S P I T A L

Preventing Falls At Home

By increasing your awareness of the safety issues around the home, you can prevent falls.

How Do You Prevent a Fall? • Proper use of a walker or an assistive device.

Do not carry any objects in your hands. Use awalker basket, walker bag or utility cart to transport objects.

Make sure that all the legs of the walker or otherassistive device are on the floor.

Keep your walker or other assistive device withyou at all times. Do not hold on to furniture. Itmay not be firm enough to support you.

• Proper hand placement while standing up and sitting down. While getting up from a chair, push up from thearms of the chair, get your balance and then reachfor the walker. Do not pull on the walker. It willfall on you.

While sitting down, reach back with both handsto the arms of the chair before sitting.

Other General Considerations 1. Wear shoes that fit well and that have soles that

do not slip.

2. Wear your glasses (if you use them).

3. Call for help if you feel dizzy or weak when youtry to get up.

4. Remove throw rugs and other objects from thewalkways. They could catch in walker legs.

5. To clean up spills, use a reacher, or sit in a chairand use your feet.

6. Use a night-light to see your way to the bathroom at night.

7. Follow your doctor’s recommendations for exer-cises to keep your arms, legs and bones strong.

8. If someone has to help you walk, wear a gait belt.

9. Use a non-slip bath mat, traction strips and/orgrab bars in the tub or shower stall.

How Do You Get Up After You Have Fallen? • First, check for injuries.

1. Do not panic. Think!

2. Make sure you can move all four limbs without pain.

3. If you cannot move one or more limbs, call for help. Cordless phones in the walker bag or in arobe pocket are handy, even in the bathroom.

• To get up 1. In a seated and slightly reclined position

(avoiding bending more than 90 degrees at hips), scoot over and back up to a sturdy piece of furniture.

2. Place your hands on the furniture behind you.

3. Bring the knee of your non-surgical leg forward so that your foot is placed flat on the floor.

4. Using the non-surgical leg, push yourself up so that you come to a seated position on the furniture behind you.

5. Assistance of a second person may be required.

6. If you feel intense pain at any time or if you are unable to get to the furniture, stop and call for help. Do not try to get up.

www.nkch.org 25

Your doctor should be contacted if any of the following signs appear:

• Fever above 100 degrees by mouth. Check your temperature every evening for7-10 days after you leave the hospital.

• Changes in the incision. Report any increase in redness, swelling, drainage orwarmth around the area of your incision. These may be signs of infection.

• Sudden increase in pain. A mild amount of pain is normal. Report any suddenincrease in your pain, inability to walk or difficulty straightening your leg.

In case of a fall, contact your doctor for further instruction.

When to Call Your DoctorN O R T H K A N S A S C I T Y H O S P I T A L

When to Call Your Doctor

N O T E S

OK

NO!

90˚

NO!

Avoid bending more than 90°.

Don’t bend at your hip past 90°. When sitting, always keep your kneeslower than your hips.

Don’t let your knee move

inward past your navel.

Use pillows between your legs at night to keep your hips properly aligned.

Don’t turn your feet in or out.

NO!NO! NO!

NO!

NO!


After Hip Replacement

Surgery, remember

these important rules

to help aid in proper

healing and maintain

use of your hip.

General Hip PrecautionsN O R T H K A N S A S C I T Y H O S P I T A L

General Hip Precautions

N O T E S

www.nkch.org 27

How To Manage Your PainN O R T H K A N S A S C I T Y H O S P I T A L

How To Manage Your Pain

People used to think that pain was something they

“just had to put up with.” But with current treatments,

that’s no longer true. Today, you can work with your

nurses and doctors to prevent or relieve pain.

Pain is a sensation that hurts enough to make you uncomfortable, whether youfeel distress or severe discomfort, and it can be defined only by the person who isfeeling it.

Pain control can help you:• enjoy greater comfort while you heal.

• get well faster. With less pain, you can start walking, breathing better and getyour strength back more quickly. You may even leave the hospital sooner.

• improve your results. People whose pain is well controlled seem to do better.

Help the doctors and nurses “measure” your pain.• They may ask you to rate your pain on a scale of 0 to 10 or to choose a word

that best describes the pain.

• You also may set a pain control goal (such as having no pain that’s worse than3 on the scale).

• Reporting your pain as a number helps the doctors and nurses know how wellyour treatment is working and whether to make any changes.

• They may ask you to use a “pain scale” like the one on the following page.


Are there any general guidelines for relieving pain?It is important to try to prevent the pain before it starts or gets worse by usingsome pain-relief method on a regular schedule. If pain begins, don’t wait for it toget worse before doing something about it. Often it is necessary to take painmedication around the clock.

Will I become addicted if I use narcotics for pain relief?No. Narcotic addiction is defined as dependence on the regular use of narcoticsto satisfy physical, emotional and psychological needs rather than for medicalreasons. Pain relief is a medical reason for taking narcotics. If you have pain, thenarcotics work on the pain.

Tell the doctor or nurse about any pain that won’t go away.• Don’t worry about being a “bother.”

• Pain can be a sign of problems.

• The nurses and doctors want and need to know about it.

• Report if you are constipated, which is a common side effect of narcotics.

0-10 NUMERIC PAIN INTENSITY SCALE

0 1 2 3 4 5 6 7 8 9 10No Moderate WorstPain Pain Pain

N O T E S

www.nkch.org 29

Food helps

promote healing,

so it is very important

to eat after surgery.

A healthy diet is an

important part of your

overall health as well.

During your hospital

stay, a dietitian

may visit you

to answer your

nutrition questions.

The following

information will help

you continue your

healthy diet once

you go home.

For more information

on individual

calorie needs, go to

MyPyramid.gov

Nutrition GuidelinesN O R T H K A N S A S C I T Y H O S P I T A L

Nutrition Guidelines

GRAINS Make half your grains wholeEat at least 3 oz. of whole grain cereals, breads, crackers, rice or pasta every day.

1 oz. is about 1 slice of bread, about 1 cup of breakfast cereal or 1/2 cup of cooked rice, cereal or pasta.

VEGETABLES Vary your veggiesEat more dark green veggies like broccoli, spinach and other dark leafy greens.

Eat more orange vegetables like carrots and sweet potatoes.

Eat more dry beans and peas like pinto beans, kidney beans and lentils.

FRUITS Focus on fruitsEat a variety of fruit.

Choose fresh, frozen, canned or dried fruit.

Go easy on fruit juices.

MILK Get your calcium-rich foodsGo low-fat or fat-free when you choose milk, yogurt and other milk products.

If you don’t or can’t consume milk, choose lactose-free products or other calcium sources such as fortified foods and beverages.

MEAT and BEANS Go lean with proteinChoose low-fat or lean meats and poultry.

Bake it, broil it or grill it.

Vary your protein routine – choose more fish, beans, peas, nuts and seeds.

FATS, SUGARS and SALT (SODIUM)Make most of your fat sources from fish, nuts and vegetable oils.

Limit solid fats like butter, stick margarine, shortening and lard, as well as foods that contain these.

Check the Nutrition Facts label to keep saturated fats, trans fats and sodium low.

Choose food and beverages low in added sugars. Added sugars contribute calories with few, if any, nutrients.


High Fiber FoodsN O R T H K A N S A S C I T Y H O S P I T A L

High Fiber Foods

High Fiber Food Sources• Beans • Oatmeal

• Bran cereal • Potato with skin

• Fresh or frozen peas and lima beans • Nuts

• Fruit (especially apples, peaches, • Whole wheat bread, crackers, pears, raisins, strawberries) pasta, etc.

• Vegetables (especially broccoli, carrots, cabbage, brussel sprouts, spinach, corn)

Tips to Add Fiber to Your Diet• Eat whole grain cereals and breads instead of the refined versions. Any cereal

with at least 3 grams of fiber per 1 oz. serving is a good choice.

• Use whole grains (oatmeal, bran flakes, etc.) as fillers or topping for meatloafor meatballs, casseroles and coating for oven-fried chicken or fish.

• Eat 5 servings of fruit and vegetables every day.

• Double the vegetables in stew, soups, casseroles and spaghetti sauce. Cut the meat in half.

• Eat fruit instead of drinking juice.

• Eat dry beans or peas (legumes such as red beans, navy beans, etc.) at least 3 times per week.

• Add beans to soups, chili, salads and casseroles.

• Add more fiber to your diet gradually. If you add fiber too quickly it may causegas, cramping, bloating or diarrhea.

• Drink plenty of fluids – at least 8 cups every day.

High Protein FoodsProtein is a nutrient needed by the body for normal growth, wound healing and the ability to fight infection. After having a surgery it is especially important to make sure you eat enough high protein foods. Protein canbe found in meat as well as many other foods.

Sources of Protein• Beef • Milk • Peanut butter

• Fish • Cheese • Nuts

• Poultry • Yogurt • Beans

• Eggs

A high fiber diet

is used to help

prevent constipation

after surgery.

N O T E S

I-35 and Armour 210North Kansas City, MO

(816) 691-2000www.nkch.org

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