When You`re Having a Hip Replacement

When You`re Having a Hip Replacement
health information
When You’re Having
a Hip Replacement
This book belongs to:
NAME:
DATE OF SURGERY:
Please keep this book with you wherever you are during
your recovery. It is a good resource for you, your family,
and your healthcare providers.
Developed by the Bone & Joint Health Strategic Clinical Network in partnership with Alberta Bone and Joint Health Institute.
What’s Inside
Safer Together.........................................................................................................3
About Hip Replacement Surgery..............................................................................5
While Waiting for Surgery........................................................................................8
Phase 1 Exercises to Build Your Strength................................................................13
What to Bring to the Hospital................................................................................18
The Day Before Surgery.........................................................................................18
The Day of Surgery................................................................................................19
After Surgery.........................................................................................................22
Movements to Avoid After Surgery........................................................................26
Going Home..........................................................................................................28
Managing at Home................................................................................................29
Activity Guidelines................................................................................................36
Safe Sex Positions After Hip Replacement..............................................................37
When You Need Medical Help...............................................................................39
Common Questions...............................................................................................40
Phase 2 Exercises to Improve Your Recovery After Surgery.....................................41
Questions for My Healthcare Team........................................................................46
Appointments and Other Information...................................................................46
Expectations and Responsibilities of the Healthcare Workforce,
Patients, and Families............................................................................................47
Website Resources................................................................................................48
Safer Together
Everyone has a part in making care safe by being an aware, informed, and involved
as a member of the healthcare team. Here are some ways you can work with your
healthcare team to make sure your care is safe.
Ask, Listen, Talk
Ask about your healthcare plan. If there’s something you don’t understand, please
ask.
Verify Your Personal ID
Your healthcare team will regularly ask you to verify who you are: They haven’t
forgotten who you are but are asking as part of providing safe care.
Wash Your Hands
Washing your hands is the best thing you can do to prevent spreading germs.
Remind others to wash their hands.
Know Your Own Medicine
Know what you take your medicine for and how to take it. Make a list of all the
medicine you take and keep the list with you.
Prevent Falls
Most falls can be prevented. Look around, slow down, hold onto something, ask for
help, and be careful.
3
What you need to know about your hip surgery
Now that you’re going to have hip replacement surgery, it’s important to know all
you can about it, including:
•
why you need your hip replaced
•
what you will have in place of your hip
•
the risks of surgery
•
what you can expect before, during, and after surgery
•
what you can do to help make your surgery a success
This guide will help answer these questions. Take the time to read it with your family
and friends, especially those who will be giving you some help.
Understanding and following the information in this guide is part of being an active
member of your healthcare team. Your healthcare team includes health providers
such as the surgeon, other doctors, nurses, physical therapists, and occupational
therapists. It also includes others that you may or may not see, such as dieticians,
spiritual care, and clerks. Your healthcare team will support you while you wait for
surgery and as you go through rehabilitation and recovery.
It’s important to have a buddy (support person). Your buddy helps you with the
things you have to do to get ready for surgery and to have a successful recovery after
surgery, including going with you to and from the clinic and the hospital.
All your appointments before and after surgery will be at the Hip and Knee
Replacement Clinic. Your Case Manager will arrange all of your care, with input from
the rest of your healthcare team.
Talk to your Case Manager if you have any concerns or questions.
Please bring this guide with you when you visit the Hip and Knee Replacement
Clinic, come for therapy, and when you’re admitted for surgery.
4
About Hip Replacement Surgery
Why do I need a hip replacement?
Most people have a hip replacement because the cartilage (or cushioning) between
the bones in their hip has worn away. This causes the bones to rub against each
other, which then causes pain and stiffness in the hip.
The pain might be keeping you awake at night. It may be causing you to cut back or
stop doing your normal, everyday activities. You may have tried other treatments like
medicine and exercise, but the pain and stiffness didn’t get better or got worse.
A hip replacement means that the damaged hip joint is taken out and replaced with
parts made of metal, plastic and metal, or ceramic and metal. The pain should stop
or be much less. Your hip should have more movement with the new parts.
What types of hip replacement surgery are there?
There are 3 types of hip replacement surgery. Your surgeon will tell you which type
you need.
1. Total hip replacement: The entire hip joint is taken out and replaced with new
parts.
2. Hip resurfacing: Only the damaged surfaces in the hip joint are taken out and
replaced with new parts.
3. Hip revision: The parts used to replace the hip have become damaged or loose
and have to be taken out and replaced with new ones.
There are many types of hip replacement parts. The type you need depends on
the condition of your hip, your age, weight, and the activities you like to do. Your
surgeon will speak with you about the type that’s best for you.
5
Healthy Hip
Hip socket
Ball of thigh bone
Stem of thigh bone
Damaged Hip Joint
Damaged ball and socket
Hip Replacement
Hip socket
New ball and stem
Thigh bone
6
Does the surgery have risks?
While hip replacements are usually safe, there are some risks. Your surgeon and
healthcare team will talk to you about the risks. Some of the risks of surgery and
what’s done to decrease them are listed below:
•
Infection: Germs can enter your body from anywhere (e.g., teeth, skin, or throat)
and cause an infection. Antibiotics are given before and after surgery to prevent
infection. Make sure to tell your surgeon or Case Manager if you have or think you
have an infection.
•
Blood clots: A blood clot happens when blood collects into a clump. You’ll be
given a blood thinner to help prevent a blood clot. Another way to prevent a
blood clot is to get up and move around as soon as possible after surgery. A blood
clot can be serious if it moves to the lungs. Make sure you tell your surgeon or
Case Manager if you’ve ever had a blood clot.
•
Heart attack, breathing or lung problems, stroke, allergic reaction to medicine,
or death: These are risks with any surgery. You and your healthcare team will
work together to lower your risk.
•
Dislocation: This is when the ball of the new hip joint pops out of the socket.
You can help prevent this by following the steps in this guide and using your
equipment and aids until your healthcare team says you don’t need them
anymore.
•
Your operated leg may be longer after surgery: If this happens, it’s usually only a
small increase and doesn’t need to be treated. A shoe lift can help if you need it.
•
A break in the bone around your new joint: You may need to put less weight on
the leg or have another surgery.
•
Nerve damage, bleeding, or injury to a blood vessel: You may notice a loss of
feeling or movement after surgery. Be sure to tell your healthcare team about
any changes.
•
The new hip parts become loose: Your new hip joint may become loose over
time. It’s important to go to all your follow-up clinic visits after surgery. Make sure
you tell your doctor if you have any new pain in your hip. You may need surgery
again if your hip joint becomes too loose.
7
While Waiting for Surgery

Be as healthy as possible: Eat healthy foods, drink lots of fluids, and get lots of
rest, and remember to exercise. Use Eating Well with Canada’s Food Guide to
choose the type and amount of food you need for good health. Healthy eating
before surgery will help you:
• lower the chance of getting sick, which can delay your surgery
• build up iron in your blood to give you more energy and help you heal faster
• reach and stay at a healthy weight

Improve the health of your blood: You may be asked to join a program to make
your blood healthier. Studies show that people with healthy blood before surgery
are less likely to need a blood transfusion during surgery, spend less time in the
hospital, and recover faster.

Quit (or cut down) smoking: It takes longer to heal when you smoke. If you need
help to quit, call 1-866-710-QUIT or go to www.albertaquits.ca. Note: Smoking is
not allowed on hospital property.

Look after health problems before surgery: This especially includes problems
with your teeth, eyes, and bladder. Men need to also make sure any problems
with their prostate are being managed. Make sure you fill your prescriptions and
take them as prescribed.

Get dental work done: You must have any problems with your teeth taken care of
at least 6 to 8 weeks before surgery to lower your risk of infection after surgery.
Get your teeth cleaned. Your surgery will be delayed if you’re having problems
with your teeth at the time of surgery.

Stay active and do your exercises: Keep doing your regular activities. Begin right
away to build strength in your legs, arms, and stomach by doing the Phase 1
exercises. Doing these exercises before surgery will help you get moving again
after surgery.
8

Have help when you go home: You’ll likely be in the hospital for 1 to 2 days.
Here are some of the ways your support person (buddy) , family, or friends can
help you once you’re home:
• doing housework and yard work, driving, shopping, and making meals
• taking you to and from appointments
• staying with you if you live alone
• giving your blood thinner injection
• helping with your bandages

Arrange care: If someone depends on you for care, arrange for someone else to
give the care while you’re recovering.

Get your home ready: Make your home as safe as possible:
•
Arrange items in the kitchen and other areas of your home so you can reach
them without having to bend more than 90˚ (see Movements to Avoid After
Surgery).
•
Adjust your bed so that the top of the mattress is 5 to 10 cm (2 to 4 inches)
above your knee.
•
Position your furniture so that you have space to move around safely using a
walker or crutches.
•
Remove loose mats or clutter that could cause you to trip or slip.
•
Install handrails on stairways or arrange to have your buddy, family, or a friend
help you go up and down the stairs when you first get home.
•
Make sure you have the right type of chair (see Managing at Home).
•
If you have a tub with a shower door, take off the door and replace it with a
shower curtain.
•
Have all of the equipment you’ll need for your recovery ready 1 to 2 weeks
before surgery (see Equipment You Need After Surgery). Having the equipment
ahead of time gives you time to practice with it before surgery.

Have the heavy housework done ahead of time: Do laundry, vacuuming, and
other heavy work around the house before your surgery.

Plan for your food needs: Stock up on groceries and make frozen meals.
9

Arrange a ride: You could be released from the hospital at any time of the day so
make sure your buddy, family, or a friend can pick you up with little notice.

Ask questions: Be sure you understand what’s being done and what you’re
agreeing to when you sign the consent form for surgery. Read this guide before
going to your Hip and Knee Replacement teaching class and write down your
questions or concerns. Make sure you understand the risks of surgery. Don’t use any lotions or creams: Stop using any kind of lotion or cream on your
legs starting 5 days before surgery. Do NOT shave your legs 2 weeks before surgery.
Taking Medicine Before Surgery
Your physicians and Case Manager will tell you which of your prescription and
non‑prescription medicine to stop taking before surgery.
Tell your Case Manager before surgery if:
•
you’re allergic to any medicine, latex, or metals
•
there’s a change in your medicine (for example, your dose changes or you start a
new medicine)
•
your health changes
Make sure your healthcare team knows what pain medicine you take before your
surgery.
10
Equipment You Need After Surgery
It’s important to use the equipment in the list below to protect your hip and lower
your risk of falling after surgery and once you’re home. Have the equipment ready
1 to 2 weeks before surgery so you can practice with it. You may need this
equipment below for 3 months after surgery:

walker, cane, crutches

raised toilet seat

reacher

toilet arm rests

chair with armrests

long-handled sponge/brush

sock aid, elastic shoe laces, and a
long‑handled shoehorn

bathtub or shower seat, and bathtub
transfer bench (if you take baths)

non-slip bath mat

removable tub grab bar (not
recommended for fibreglass tubs)

other equipment your healthcare
team suggests:
_______________________________
You may be able to:
•
buy or rent equipment from a pharmacy
•
borrow equipment from a medical equipment loan program if there’s one in your
area
•
borrow equipment from friends or family as long as the items are in good working
order, safe, and the right type for your height and weight
•
borrow equipment from the Community Health Unit or Home Care
11
My Checklist Before Surgery

All my dental work has been done.

I am exercising every day to get ready for surgery.

I have a buddy.

I have someone to take me home from the hospital.

All heavy housekeeping activities (vacuuming, laundry, etc.) have been done
ahead of time.

I have arranged for help after surgery with:
 housework
 banking
 making meals
 other ____________________________
 yard work

I know what medicine I have to stop taking.
 I have stocked up on groceries.
 I have the equipment and walking aids I will need after surgery.
 I can easily reach the things I need at home.
 I have the space to move around safely with my walker or crutches at home.
 I have the right type of chair.
 My hospital bag is packed and my name is on all my things.
 I’ve packed my “When You’re Having a Hip Replacement” booklet.
 All my prescription and non-prescription medicine, herbal products, and inhalers are packed in their original containers.
12
Phase 1 Exercises to Build Your Strength
Begin these exercises now, and keep doing them after surgery. Exercise is part of a
successful surgery and getting back to normal, everyday living.
Do them on both legs so both legs are strong. Do all exercises slowly and with
control. Repeat each exercise at least 5 times. You can increase the number of times
as long as it doesn’t hurt too much.
Exercise #1 Makes back thigh muscles stronger and your hips more
flexible
1. Bend your knee by sliding your heel along the bed toward your buttocks
(backside).
2. Make sure your knee faces the ceiling.
3. Hold for a count of 3 to 5.
4. Slowly straighten your knee by
sliding your heel back to your
starting position.
5. Repeat.
Exercise #2 Makes your legs stronger and your hips more flexible
1. Slide one leg out to the side. Keep your knee straight and toes pointed to the
ceiling while sliding your leg. Don’t go any further than shown in the picture.
2. Hold for a count of 3 to 5.
3. Slide your leg back again so that it’s
in line with your bellybutton.
4. Repeat.
13
Exercise #3 Makes your front thigh muscles stronger
1. Place a firm roll under your knee.
2. Straighten your leg, lifting your foot
off the bed.
3. Hold for a count of 3 to 5.
4. Slowly lower your foot.
5. Repeat.
Exercise #4 Makes your stomach muscles stronger
1. Lying on your back, bend both knees
and keep your feet flat.
2. Tighten your lower stomach muscles
by pulling your bellybutton down
towards your spine.
3. Breathe normally while holding for
a count of 3 to 5.
4. Relax and repeat.
Exercise #5 Makes your front thigh muscles stronger
1. Sit on a steady chair with your thigh supported.
2. Lift your foot and straighten your knee.
3. Hold for a count of 3 to 5.
4. Slowly lower your foot to the floor.
5. Repeat.
14
Exercise #6 Makes back thigh muscles stronger and your leg more
flexible
1. Sit on a steady chair with your feet flat on the floor.
2. Slowly slide your foot back as far as you can.
3. Hold for a count of 3 to 5.
4. Slowly slide your foot back to the starting position.
5. Repeat.
Exercise #7 Makes your upper arms and shoulders stronger
1. Sit on a steady chair, with your feet flat on the
floor.
2. Push up with both arms to lift yourself a few
inches off the seat.
3. Hold for a count of 3 to 5.
4. Slowly lower yourself onto the chair.
5. Repeat.
15
When doing these exercises, stand straight, tuck in your stomach, and
tighten your buttocks.
Exercise #8 Makes your legs stronger and your hips more flexible
1. Hold on to a table or counter for support.
2. Slowly move your leg out to the side, and then back.
Keep your leg straight at all times.
3. Repeat.
Exercise #9 Makes your legs stronger and your hips more flexible
1. Hold on to a table or counter for support.
2. Keeping your back and legs straight, slowly
move one leg behind you. Keep the leg straight.
Be careful not to lean forward.
3. Repeat.
Exercise #10 Standing knee lift
1. Hold on to a table or counter for support.
2. Lift your knee, as if you were going up a step.
3. Hold for a count of 3 to 5.
4. Slowly lower your foot to the floor.
5. Repeat.
16
Exercise #11 Makes your back thigh muscles stronger
1. Hold on to a table or counter for support.
2. Keeping your back and legs straight, bend one knee
by lifting your heel towards your buttocks. Be careful
not to move your thigh forward.
3. Hold for a count of 3 to 5.
4. Slowly lower your foot to the floor.
5. Repeat.
Exercise #12 Makes your front thighs and buttock muscles stronger
1. Hold on to a table or counter for support.
2. Stand with your legs shoulder-width apart and your toes
pointed forward.
3. Keeping your weight on your heels, slowly bend your knees,
keeping your heels on the floor and your knees apart.
Make sure not to bend forward at the waist. Make sure
your knees don’t bend past the tips of your toes.
4. Hold for a count of 3 to 5.
5. Slowly return to your starting position.
6. Repeat.
17
What to Bring to the Hospital

This book.

Personal care items like a toothbrush and toothpaste, hair brush, soap and
shampoo, deodorant, shaving items.

Loose-fitting clothing that’s easy to put on (e.g., robe, pajamas, pants, shorts,
underwear, and socks).

Adjustable, non-slip shoes that will give you good support and can be loosened
if your feet swell.

All the medicine you take, including all prescription and over-the-counter
medicine, herbal products, and inhalers. Bring these in their original containers
or in the pharmacy package. Don’t use your own medicine while you’re in the
hospital. You’ll be given the ones you need to take while in hospital.

Walker, crutches, dressing aids.

Your CPAP machine if you use one.
There’s not much storage space in hospital rooms so please pack only what you
need in a small overnight bag.
Alberta Health Services isn’t responsible for lost or stolen items. Don’t bring
anything of value, such as jewellery or credit cards.
The Day Before Surgery
•
Be sure you have everything you need for your stay in the hospital.
•
Go over the agreement you signed with your healthcare team.
•
Follow the eating and drinking instructions you received from your healthcare team.
•
If you have questions, phone the clinic and speak with your Case Manager.
18
The Day of Surgery
Using the Sponge at Home
When you shower, use the sponge the clinic
may give you.
1. Rub the sponge over the skin in the shaded
areas in the picture.
2. Rub for 3 minutes, until it’s foamy.
3. Rinse, then towel dry.
Phone your Case Manager if you have any questions.
When You Get to the Hospital
A nurse will check you in, make sure that you’ve followed all instructions you were
given, and get you ready for surgery. Tell the nurse or doctor of any changes in your
health since your last visit to the clinic.
Before you go into the operating room, an intravenous (IV) will be put into a vein
(usually in your hand or arm). Medicine and fluids are given to you through the IV
during and after surgery.
You will also meet the doctor (anesthesiologist) who will give you medicine to
control pain during surgery.
Someone may stay with you until you go into the operating room.
19
In the Operating Room
Once you’re in the operating room, you’ll see different types of equipment. This
equipment is used to closely watch your condition during surgery. This includes a
machine to monitor your heart, a cuff to monitor your blood pressure, and a sensor
that’s attached to your finger to monitor your oxygen level.
A plastic tube, called a catheter, may be placed in your bladder to drain urine so that
you don’t have to go to the toilet.
You’ll be given one of these anesthetics:
1. Spinal anesthesia: You won’t have any feeling in the lower part of your body.
You’ll also be given another medicine so that you’ll be sleepy during surgery. This
type of anesthesia is used more often because it doesn’t make you feel sick to
your stomach very often and you’re able to get up sooner after surgery. The feeling
in the lower part of your body will start to come back slowly after surgery.
2. General anesthesia: Medicine is given to make you sleep during surgery. A tube is
passed through your mouth and into your windpipe to help you breathe. The tube
is taken out once you’re awake and breathing on your own.
Once your surgery is finished, a pillow will be placed between your legs to keep your
hip in the right position and keep your legs apart. This is to decrease the chance of
your new hip dislocating.
In the Recovery Room
You’ll go to the recovery room after surgery. Here, a nurse will check the blood flow
and feeling in your legs. The nurse will also:
•
check your breathing, heart rate, temperature, and blood pressure
•
ask about your pain level
•
have you take deep breaths
•
have you do foot and ankle exercises
20
In Your Hospital Room
Once you’re in your hospital room, your nurse will check your breathing, heart rate,
temperature, blood pressure, and the blood flow in your leg again. You’ll still have
an IV.
Your nurse will show you where the call bell is and how to use it to call for help. The
side rails on your bed will be up for your safety until the effects of the anesthetic
have worn off.
You’ll be reminded to breathe deeply and cough often to prevent lung problems
after surgery.
Your nurse or physical therapist will help you change your position in bed, get out
of bed, sit at the edge of the bed, sit in a chair, and begin walking for the first
few times after surgery. Don’t try to change your position or get out of bed on
your own.
You’ll stand and take some steps on the day you have surgery.
You’ll be able to have visitors once you’re settled into your hospital room.
21
After Surgery
Managing Pain after Surgery
You can expect to have pain after surgery, even if you’ve been given medicine for
pain. It’s important that your pain is well managed so that you can stand, walk, and
start your physical therapy.
How You Can Help Manage Your Pain
Tell the nurse when you’re feeling pain and ask for pain
medicine. If possible, take pain medicine 30 to 45 minutes
before your physical therapy sessions, so it has time to work.
Tell your surgeon or nurse if the pain medicine isn’t
managing your pain or if you think you’re having side effects.
Make sure to tell
your nurse about
any pain medicine
you were taking
before surgery.
Ask for ice to put on your hip and for pillows to keep your operated leg raised to help
lower the pain and swelling.
Pain Scale
You’ll be asked to rate your pain level using this scale. The number you choose helps
your nurse or surgeon know how well the pain medicine is working for you.
012345678910
No Pain Worst Pain Possible
Tell your nurse if your pain reaches a 4 or isn’t being helped by the medicine.
Don’t wait until the pain is bad.
22
Deep Breathing, Coughing, and Moving After Surgery
•
You’ll have to breathe deeply and cough at least once an hour after surgery to
clear your lungs.
•
You’ll be shown foot and ankle exercises to do once every hour to help prevent
blood clots.
Preventing Blood Clots
You’ll need to take a blood thinner after surgery to lower the chance of getting a
blood clot. Your surgeon will decide how long you should be on a blood thinner.
You’ll be given a prescription for a blood thinner to take for a few weeks after you go
home. If the blood thinner is given by needle, your nurse will show you how give the
injection before you leave the hospital.
Replacing Blood Lost during Surgery
Everyone loses blood during hip replacement surgery. Losing too much blood may
leave you feeling dizzy, tired, short of breath, sick to your stomach, and you may
have a headache.
Losing too much blood can slow your healing and recovery. Your surgeon may start
you on iron pills or give you a blood transfusion to build up your blood levels.
Diet
It’s important to eat healthy foods and drink lots of fluids after your surgery.
After surgery, you’ll get fluids by IV until you can eat and drink enough on your own.
Once you’re able to eat and drink, you can start eating your regular diet. Follow the
guidelines in Canada’s Food Guide. If you aren’t eating well, ask your healthcare
team about taking a nutrition supplement.
Healthy eating after surgery helps you feel better sooner because it:
•
helps repair muscles and tissues
•
builds up the iron in your blood
•
gives you the strength and energy to do activities
23
Managing Your Bathroom Needs
To prevent constipation:
•
drink at least 8 cups (2 litres) of water every day
•
eat foods with fibre
•
walk
•
do your exercises every day
If you’re constipated, a nurse will offer you something to help your stools pass. It’s
important to tell the nurse when you’ve had a bowel movement.
If a tube was inserted to drain your urine during and after surgery, it will be taken
out the morning after surgery. The nurses will make sure you can urinate (pass
water) without the tube.
Washing, Brushing, and Other Personal Needs
You’ll be expected to do your personal hygiene on your own. Please ask your nurse if
you need help. Make sure all the items you need are within reach before you start.
You’ll be allowed to shower after the bandages around the area of surgery are
changed for the first time or when your surgeon tells you it’s okay to shower. Don’t
put any lotions or creams on your operated leg for the first 6 weeks after surgery.
Rest and Activity
You need both rest and activity to recover. You’ll tire easily the first few weeks after
surgery. You may find that your normal sleep patterns also change. Let the way you
feel be your guide to what you can and can’t do.
Stop what you’re doing and rest when you begin to feel tired. It’s better for you to
do shorter activities (like walking) more often, rather than doing one long activity.
Remember to do your foot and ankle exercises every hour.
24
Leg Swelling
Your leg will swell as you become more active after surgery. It’s normal for your hip
to be warm and swollen for many weeks after surgery.
•
To control the swelling, don’t sit for
more than 30 minutes at a time.
•
Lie on your back, with your operated leg
resting on pillows so that your foot is
above the level of your heart. Keep your leg as straight as you can. Make sure
the pillow isn’t under the back of your knee.
Raise your operated leg this way 2 to 3 times a day for 45 minutes each time.
•
Put a cold pack on warm or swollen areas after you’re done your exercises. Use
crushed ice in a bag, an instant cold pack, or a bag of frozen peas or corn. Make
sure you have a thin towel between your skin and the cold pack to protect your
skin. Don’t leave the cold pack in one place for more than 20 minutes at a time.
Tell your nurse or surgeon right away if you have pain in your calf or chest.
Rehabilitation
You’ll be helped to move from your bed to a chair. You may be standing and walking
within 4 to 8 hours after surgery. Your activity level will go up every day. You’ll also
begin a program to help improve the flexibility or range of movement in your new
hip and make the hip stronger.
•
Most people are allowed to put as much weight on the operative leg as they can
tolerate. Your healthcare team will let you know if your surgeon wants to limit the
amount of weight you can put on the operated leg.
•
Your physical therapist will teach you to use a walker. You’ll also be shown the
exercises you must do. Use your walking aid until your surgeon or physical
therapist says you can stop.
•
Your healthcare team will check how well you can do the exercises on your own
and move around. They will also see if you have the skills you need to manage at
home. The team will use the results to recommend when you should leave the
hospital and what community services you may need at home.
25
Movements to Avoid After Surgery
While you should increase your activities after surgery a little at a time, there are
some movements you should not do.
Bending
Don’t bend your hip more than 90°.
Do not bring your knee
higher than your hip.
Do not reach forward
towards your feet.
90° looks like this:
Do
26
90°
Do not reach down for
objects on the floor.
Twisting and Turning
Don’t:
•
twist your operated leg when standing, sitting, or lying down
•
twist your leg when turning
Do:
•
•
take small steps while turning
keep your toes facing the same direction
Don’t
Crossing Your Legs
Don’t:
•
bring your leg across the mid-line of your body
•
cross your legs at the knee or ankle when sitting, standing,
or lying down
Do:
•
sit up straight with your back touching the back of the chair
Do
Sleeping
You can sleep on either side, but you must always have pillows between your legs
to prevent them from crossing.
Do
Don’t
If you sleep on your back, don’t put a pillow under the knee of your operated leg.
It can cause a blood clot to form. It can also cause a permanent bend in your knee.
27
Going Home
You’ll go home 1 or 2 days after surgery if the doctor thinks you’re ready. Before you
go home, your healthcare team will check that you’ve met the goals for your new hip:

You can get into and out of a bed and chair without help.

You can stand and walk safely with your walker or crutches.

You can go up and down stairs safely.

You can walk the distance you will need to walk in your home.

You can do your home exercises and daily living activities safely.

You know what movements are safe and not safe for your operated leg (see
Movements to Avoid After Surgery).

You’re eating and going to the bathroom normally.

Your incision is healing. If you have to change your bandage, you and your buddy
will be shown how. Note: It’s normal to lose some feeling in the skin around the
incision. The feeling should be back in a few months.

Your pain is under control. You’ll be given a prescription for pain medicine. If you
get constipated, talk to your pharmacist about over-the-counter stool softeners.
Your healthcare team may decide you need more help before you can go home.
How you do after your surgery depends mainly on you.
•
Do your home exercises regularly. Increase the number of times you do them
each day. The sooner your leg muscles become strong enough, the sooner you can
get back to your normal activities.
•
Take pain medicine at least 30 to 45 minutes before exercising if you find the
exercises make you too sore.
•
Use your walking aids until your surgeon or physical therapist tells you that you
can stop.
•
Walk often but don’t go further than you can manage safely and comfortably.
Short walks done often are better than a single long walk. Have someone come
with you on the first few walks in case you run into a problem. Make sure to bring
your cell phone in case you need to call for help.
You may still have some discomfort for a long time after surgery. If so, talk to your
Case Manager about the best way to manage it.
28
Managing at Home
You’ll learn new ways to do your everyday activities safely and lower the risk of
dislocating your new hip while you’re recovering. Do a little more at a time, being
careful not to do any movements or positions that could dislocate your hip (see
Movements to Avoid After Surgery).
Sitting in a Chair or on the Toilet
Chair: Choose a sturdy chair with a firm seat and armrests. You can raise the seat
height by adding a firm cushion. Don’t sit on low or soft chairs and couches.
Don’t use chairs that have wheels or that rock or swivel.
Toilet: You may need a raised toilet seat and toilet armrests. Make sure the toilet
paper is within easy reach.
To sit:
1. Back up until you feel the chair or toilet seat at the
back of your legs.
2. Slide your operated leg forward slightly.
3. Bend both knees and gently lower yourself onto
the chair or toilet, using the armrests, countertop, or
sink for support.
Do the reverse to stand.
Don’t use your walker to raise yourself from the chair
or toilet. Always push up with your hands from where
you’re seated.
29
Getting In and Out of Bed
•
Make sure the top of your bed is 5 to 10 cm
(2 to 4 inches) above your knee.
•
Don’t use soft mattresses or waterbeds.
•
Don’t reach forward to pull up the covers—use a
reacher instead.
Support your operated leg with pillows when lying
on your other side.
To get into bed:
1.Sit on the bed the same way you would sit on
a chair.
2. Slide your buttocks back until your knees are on
the bed.
3. Pivot on your buttocks as you lift your legs onto
the bed. Remember to keep your legs apart and
not to twist.
4. Use a pillow to keep your legs apart when lying in
bed on your back.
Do the reverse to get out of bed.
Getting Dressed
Use special equipment to help dress yourself
(for example: a reacher, long-handled shoehorn,
dressing stick, elastic shoelaces, or sock aid) so that
you don’t bend more than 90°.
•
Choose loose-fitting clothing, including socks.
•
Wear low-heeled shoes with elastic laces.
•
Dress your operated leg first and undress it last.
30
Bathing
You won’t be able to sit in the bottom of the tub to bathe for about 3 months.
You should bathe from a sitting position at the sink, in the tub, or in a walk-in shower
with a chair for the first 3 months. Have someone help you get in and out of the tub
and with showering until you can do this safely on your own.
Once you’re in the tub, don’t reach forward for the faucet. Instead, have your buddy,
family, or a friend turn the faucet on and off. If you’re steady enough, you can stand
up to turn it on and off yourself.
To get into the tub:
1. Back up slowly and carefully 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.
2.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 so you
don’t lean forward or bend more than 90˚.
Do the reverse to get out of the tub.
31
Showering
Have your buddy, family, or a friend help you get into the shower
and keep your walker steady, if needed. If there’s a grab bar on
the wall, use it instead of the walker. A grab bar is more stable.
To get into the shower:
1. Walk to the lip of the shower and turn so that you’re facing
away from the shower stall.
2. Reach back with your hand for the back of a seat placed in
the shower, leaving your other hand on the walker.
3. Move your operated leg forward.
4. Sit on the seat.
5. Lift your legs over the lip of the shower stall and turn to sit facing the faucet.
Do the reverse to get out of the shower.
Note: You can stand in the shower if it’s too small for a seat and you’re steady on
your feet. Install grab bars and use a rubber bath mat to prevent slipping.
Doing Laundry
•
•
•
Have someone do laundry for you. If this isn’t possible, do smaller loads. Make
sure you carry your loads in a plastic bag, backpack, or wheeled cart.
Use a reacher to get your laundry in or out of front-loading machines.
Sit on a high stool if ironing.
32
Getting In and Out of a Car
•
You may find a higher vehicle easier to get in and out of (depending on your height).
•
Avoid small cars, low bucket seats, and vehicles that you have to step up into, if
you can.
•
Sit in the front seat whenever possible. Your therapist will tell you how to do car
transfers depending on the car.
•
Have your driver park the car about 1 metre (3 feet) away from the curb. Have the
driver slide the passenger seat back as far as it will go. You may find that placing a
large plastic bag on the seat makes sliding into and out of the car much easier. You
can also put a pillow on the seat to make it higher if needed.
1. Back up slowly and carefully with your walking aid until you can feel the edge of
the car against the back of your legs.
2.Hold the back of the seat and the car frame for support. Slide your operated leg
forward slightly, bend both your knees, and lower yourself onto the car seat.
Watch your head!
3.Slide your buttocks toward the middle of the car then pivot on your buttocks as
you lift your legs one at a time into the car.
Do the reverse to get out of the car.
Driving
Your surgeon will tell you when it’s safe to start driving again. Most people can drive
starting 6 weeks after surgery. Your healthcare team will give you information about
transportation services in your area.
33
Working in the Kitchen
•
Keep the items you use often within easy reach. Use a
long‑handled reacher if items are out of reach. Try not
to store food on low shelves so you don’t have to bend
to reach them.
•
Use prepared meals, frozen meals, a service like
Meals on Wheels, or order in food.
•
Use the oven only if you can do so without bending
your hip more than 90˚ or twisting. A microwave or
stovetop is best.
•
Slide objects along the countertops instead of lifting
them.
•
Use a wheeled trolley or cart to move items when
using your walking aid.
•
Carry things in an apron with large pockets, a waist
pouch, backpack, or a bag attached to your walker.
•
Sit on a high stool when working at the counter.
•
Use containers with tight-fitting lids to move foods and
liquids (like a Thermos® or thermal mug with lid) to
prevent being burned.
Shopping
•
Have your buddy, family, or a friend help you with shopping.
•
Shop at stores that have elevators and parking that’s close by.
•
Bring your walking aid with you.
•
Bring your reacher to pick up items from the lower shelves.
•
Use a backpack to carry the things you buy.
•
Buy canned or frozen goods to cut back on the number of times you have to shop.
Note: Some grocery stores will deliver. Check with the store you shop at.
34
Doing Housework and Yard Work
•
You should be able to do light housekeeping, such as dusting and washing dishes.
•
Have your buddy, family, or a friend help with heavy work, such as vacuuming,
washing floors, changing bed sheets, cutting the grass, and shovelling snow.
•
Take out small amounts of garbage at a time or have someone take out garbage
for you.
•
Hire help if possible.
Having Dental Work
Make sure you speak with your surgeon or Case Manager about using antibiotics
before any dental work.
Activities and Sports
Some activities and sports are harder on the hips than others. Talk to your surgeon
about when you can start doing the ones you enjoy. As a guideline, you should walk
every day, beginning with short walks taken often. Increase your distance a little at a
time and be careful not to overdo it. Be careful not to fall and injure your hip.
You may feel some stiffness in your new hip, especially when doing activities or
sports where you have to bend your hip. One of the goals of surgery is to improve
your hip’s range of movement, and reduce the stiffness. How much hip movement
you have often has to do with how much stiffness you had before surgery.
Travel
Your new hip may set off the metal detectors at the airport. Before you go through
the security check, tell the security agent you had a hip replacement and have metal
parts in your hip.
35
Activity Guidelines
Ask your surgeon about any sports or other activities you want to do. The following
are only guidelines for what you may do.
The First 3 Months after Surgery

Walking

Phase 1 exercises

Phase 2 exercises – start when your Case Manager or physiotherapist tells you to.
After 3 Months

Swimming and other pool exercises: Careful not to do any twisting motions such
as a whip kick.

Low-impact fitness exercises that don’t involve jumping, twisting, quick starts or
stops, or other movements that put sudden force on your hip

Walking on a treadmill

Golfing

Cycling: The seat and handlebars must be set high enough so that you don’t have
to bend your hip more than 90°

Slow, gentle dancing

Light hiking

Gardening: Use raised beds or long-handled tools so that you don’t have to bend
your hip more than 90°
Activities NOT to Do

Do not lift and push heavy objects (25 lbs. or 11 kg)

Do not do any activities involving jumping, twisting, quick starts or stops, or
other movements that put sudden force on your hip

Do not do contact sports
36
Safe Sex Positions After Hip Replacement
Many people have questions about intimate relations after a hip replacement.
While it’s usually safe for your hip joint about 4 to 6 weeks after surgery, you also
have to feel ready and be comfortable.
For the first 3 months you have to protect the new joint. This brochure shows you
the positions that are safe and the ones that aren’t safe for your new joint.
•
Make sure you let your partner know what’s comfortable or if a position causes pain.
•
Make sure you’re comfortable before you start. Using pillows may help.
•
No sudden movements.
•
Make sure your partner doesn’t put their full weight on your hips if you had a
hip replacement.
Safe Positions for the Hip Joint
37
Positions NOT Safe for the Hip Joint
Hip twists too much.
Hip bends and twists too much.
Hip bends too much.
Hip bends too much.
*Illustrations from Returning to Sexual Activity following Joint Replacement Surgery (Vancouver Coastal Health, 2013)
and Sex after Joint Replacement Surgery (London Health Sciences Centre, 2013)
38
When You Need Medical Help
Call 911 or have someone take you to the nearest emergency department if
you have:
• pain in your chest
• trouble breathing or are short of breath
Call your Case Manager if:
•
you have more pain, swelling, and tenderness in your leg (lying down with your
leg raised in a straight position for at least 20 minutes doesn’t help)
•
your incision becomes red, hard, hot, and swollen, or is draining
•
you have redness or pain in your lower legs, even when resting
•
you have a temperature over 38.5 °C or chills
•
you have a painful “click” in your hip or you suddenly have less movement in
your hip
•
you have blood in your stool, urine, or in the fluid you cough up
•
you have a nose bleed that won’t stop
•
you have a lot of bruising that doesn’t seem to be going away (Bruising is normal
above and below the incision for 2 to 3 weeks after surgery.)
If you can’t reach your Case Manager or someone else on your healthcare team,
call your family doctor or call Health Link at 811
Call your family doctor if:
•
you have diarrhea that doesn’t stop after a few days
•
your prescription medicine changes after surgery
•
you have any other medical concerns not related to your surgery
Please make sure you tell your Case Manager if you see your family doctor or go to
the emergency department about anything related to your hip surgery.
39
Common Questions
How long before I can stop using my walker or crutches?
You must use your walking aids until your healthcare team says you can stop. Most
people need to use walking aids for the first 6 weeks after surgery.
When can I drive?
Most people aren’t allowed to drive for 6 weeks after surgery. Your surgeon will tell
you when it’s safe to drive. To drive safely, your strength and reflexes need to be as
good as before your hip surgery. If you’re in an accident, your insurance may not
cover you if you’re not safe to drive.
Do I need to see my family doctor after surgery?
Your family doctor will be sent a report about your surgery and your recovery. You
don’t need to follow-up with your family doctor unless your surgeon tells you to. If
you have a concern or problem related to your hip surgery, call your Case Manager.
Do I need to tell healthcare providers about my new hip?
Be sure to tell your dentist or other healthcare providers that you’ve had hip
replacement surgery. You may need to take antibiotics before having dental or other
medical work done to lower the risk of infection.
When can I travel?
You shouldn’t travel long distances in the first 3 months after surgery. This is because
sitting for too long while travelling increases the risk of blood clots. Speak with
your Case Manager or surgeon about planned or unexpected travel you do in the
3 months after surgery.
When can I go back to work?
When you can go back to work depends on how well and how quickly you heal after
surgery and the kind of work you do. Your surgeon will tell you when you can go back
to work.
Will I need physical therapy once I am home?
You must keep walking and exercising when you go home. Whether or not you need
physical therapy will depend on how well you recover on your own. Your healthcare
team will tell you if you need physical therapy after you leave the hospital.
40
Phase 2 Exercises to Improve Your Recovery After Surgery
Start these exercises after you have seen your surgeon or physiotherapist.
Exercise is important after surgery to make your new hip stronger and more flexible
and to help prevent blood clots. The exercises may feel uncomfortable at first, but
exercising will help you to get back to your normal everyday activities sooner.
Your healthcare team may suggest you add some or all of the exercises below to the
ones you were doing before surgery. Remember to slowly increase the number of
times you exercise each day, how often you repeat each exercise, and the amount of
pressure you can put on your new hip.
Your team will tell you how often to do the exercises, how many times to repeat
each one, and how much force or pressure you can put on your new hip.
Do the exercises on both legs to make them equally strong and flexible. Do them
slowly and with control. Make sure not to force your new hip into a position that
causes you pain or discomfort.
Exercise #1
1. Lie on your side with hips and knees bent and a pillow between your knees.
2. Keep your feet together. Remember not to twist or use your back muscles.
3. Lift the top knee off the pillow like a
clam shell opening.
4. Hold for a count of 3 to 5 and slowly
lower the knee to the pillow.
5. Repeat.
41
Exercise #2
1. Lie on your back and bend one leg.
2. Tighten your stomach muscles and
lift your bent leg, being careful
not to bend it more than 90°.
3. Keeping your stomach muscles tight, slowly
lower the leg back to the starting position.
4. Repeat.
Exercise #3
1. Lie on your stomach. Put a small flat pillow under your stomach.
2. Tighten your buttocks and lift one leg.
3. Hold for a count of 3 to 5 and slowly
lower your leg.
4. Repeat.
Exercise #4
1. Lie on your stomach, with your legs straight.
2. Bend one leg, lifting the heel toward your
buttocks.
3. Slowly lower your leg to the starting position.
4. Repeat.
42
Exercise #5
1. Sit in a steady chair and put the elastic loop
around both ankles.
2. Lifting your foot, straighten your leg while keeping the
other foot on the floor as you stretch the elastic loop.
3. Slowly lower your foot back to the starting position.
4. Repeat.
Exercise #6
1. Sitting in a steady chair, put the elastic loop
around both ankles.
2. Put one foot on a stool and pull the opposite foot
back under the chair, stretching the elastic. Keep
the other foot steady as you stretch the elastic.
3. Slowly return to the starting position.
4. Repeat.
Exercise #7
1. Sit in a steady chair, put the elastic loop around
both thighs, and keep both feet flat on the floor.
2. Pull your legs apart, sliding your feet along the
floor to stretch the elastic loop.
3. Hold for a count of 3 to 5 and slowly move your
legs together to the starting position.
4. Repeat.
43
Exercise #8
1. Place one end of the elastic loop around a table leg
and the other end around one ankle.
2. Hold onto the table for balance and stand straight.
3. Keep your leg straight. Squeeze your bum muscles as
you pull your ankle sideways away from the table to
stretch the elastic loop.
4. Hold for a count of 3 to 5 and slowly return to the
starting position.
5. Repeat.
Exercise #9
1. Put one end of the elastic loop around a table leg
and the other end around your ankle.
2. Hold onto the table for balance and stand straight,
facing the table.
3. Keeping your leg straight, pull your ankle back and
away from the table to stretch the elastic loop.
4. Hold for a count of 3 to 5 and go back to the
starting position.
5. Repeat.
Exercise #10
1. Put one end of the elastic loop around a table leg
and the other end around your ankle.
2. Hold onto the table for balance and stand straight,
with your back to the table.
3. Keeping your leg straight, push your ankle forward,
away from the table to stretch the elastic loop.
4. Hold for a count of 3 to 5 and slowly go back to
the starting position.
5. Repeat.
44
Exercise #11
1. Place a solid object 5 to 10 cm (2 to 4 inches) thick on the floor
to use as a step.
2. Hold onto a table or counter for balance, and step forward and
up onto the object.
3. Slowly step back down.
4. Repeat.
Exercise #12
1. Place a solid object 5 to 10 cm (2 to 4 inches) thick on the
floor to use as a step.
2. Holding onto a table or counter for balance, step sideways,
and up onto the object.
3. Slowly step back down.
4. Repeat.
Exercise #13
1. Holding onto a table or counter for balance, shift your weight
onto your operated leg as you lift the other foot off the floor.
Stay level—try to keep your knees apart. Don’t lean or tip
to one side as you move.
2. Try to balance on your leg for 30 seconds.
3. Lower your foot to the floor.
4. Repeat 5 times.
Exercise #14
1. Lie on your side, with the bottom leg bent to
stop you from rolling onto your back.
2. Keeping the top leg straight, lift it toward
the ceiling making sure not to roll forward or
backward. Keep your knee facing forward.
3. Slowly lower the leg.
4. Repeat
45
Questions for My Healthcare Team
Question
Answer
Appointments and Other Information
46
Expectations and Responsibilities of the Healthcare
Workforce, Patients, and Families
Alberta Health Services is committed to providing a respectful environment in which
everyone is committed to safe, quality care. We believe that when we work together
and live our values, we honour our rights and responsibilities.
Anyone who works for or
volunteers for AHS is
responsible for…
Everyone has the
right to…
If you’re a patient or
family member, you’re
responsible for…
•
treating others with respect
and dignity
• being respectful and
understanding
• being prepared to hear, listen,
and understand
•
be treated with
respect.
• be listened to
and heard.
•
using a calm tone of voice and
non-threatening body language
• reporting unsafe or potentially
unsafe conditions
• educating patients and families
about their role in safety
•
a safe physical,
emotional, and
psychological
environment.
•
•
giving information in simple
• be part of a
language, and including patients
healthcare team
and families in developing and
(patients, families,
following the care plan
and healthcare
workforce).
• communicating with your
team—which includes the patient
and family—by giving feedback
and talking about concerns
• knowing and respecting each
healthcare team member’s role
and scope of practice
•
sharing information relevant to
patient care
• giving timely responses to
questions and concerns
• maintaining confidentiality
•
information to give
or receive care.
• confidentiality.
•
47
treating others with respect
and dignity
• recognizing that other patients
may also need help
using a calm voice and
non‑threatening body language
• reporting unsafe or possibly
unsafe conditions
• understanding your role in your
safety and how you contribute
to ensuring a safe environment
understanding your healthcare
needs
• letting your healthcare
team know when you don’t
understand, asking questions,
and talking
about concerns
• understanding your role in
your care plan
•
giving relevant information to
your healthcare team
• maintaining patient
confidentiality
•
Website Resources
•
Alberta Bone and Joint Health Institute: albertaboneandjoint.com
•
Arthritis Society: arthritis.ca
•
Canadian Orthopaedic Foundation: http://whenithurtstomove.org/
•
Inform Alberta: informalberta.ca (for programs and services)
•
MyHealth.Alberta.ca
For 24/7 nurse advice or general health information, call Health Link at 811.
605073 (2017-01)
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