Health and Safety

Planning for your hip surgery prepares you for the operation and helps to ensure a smooth surgery and easier recovery. Here are certain pre-operative and post-operative guidelines which will help you prepare for hip surgery.

Pre-operative guidelines

When your surgeon decides that surgery is the best option to overcome hip pain and restore movement, you will be briefed about the procedure and can start preparing yourself for the surgery.

• Prior to surgery, you should inform your doctor about all the medications you are taking, so that your doctor can decide if any medications can interfere with the procedure and ask you to stop using it. You will be asked to stop using aspirin, inflammatory and herbal medications before surgery as they can lead to bleeding.
• You will be asked to quit smoking prior to surgery.
• Your doctor will explain all the possible risks and complications involved with the surgery.
• You may also be advised to consult your general physician to confirm on any other health conditions that may cause complications during surgery.
• Based on your medical history, ongoing medications and physical examination, the different options for anesthesia will be explained to you.
• Your surgeon may also recommend a strengthening program, which includes exercises to improve your strength and flexibility prior to surgery to help you in your post-operative recovery.

Before you go for your surgery, it is advisable to plan for coming home from the hospital.

• Remove loose rugs and anything that can obstruct your walking path and cause falls or accidents. If necessary, you can widen the walking path to accommodate your walker or cane that you will be using during your recovery period.
• Place all items that you regularly use, such as remote controls and medications, in easy-to-reach places.
• Un-tuck your bedding so that it is easier to move in and out of bed. If your bedroom is situated in one of the higher floors, it is advisable to relocate to the lower floor to avoid climbing stairs.
• Opt to have some assistance after your surgery for a few days.
• Prepare single serving meals so that they can be quickly heated and easily cleaned.

Post-operative guidelines

After your surgery, you will be shifted to the recovery room where your vitals will be monitored. X-rays will be taken to determine the success of the surgery. Once you are in a stable condition, you will be shifted back to the ward. Drains will be removed and you can start walking depending on your comfort and surgeon’s advice. Your physiotherapist will help you move around better by teaching you certain post-operative hip exercises. You will be discharged around 5 to 7 days after the surgery. Your doctor will give you a recovery plan that you should follow.

During the first few weeks at home, you should take care of your operated hip. You should avoid crossing your legs while sitting or standing, and do not allow your knees to come higher than your hips. Also, avoid sitting in low sofas or chairs. It is always helpful to have some assistance while walking. Your doctor may recommend you continue the post-operative exercises until your complete recovery. It is important to keep up your, six month, and annual follow-ups with your surgeon.

When your friend or loved one has undergone a hip replacement surgery, as a caregiver, you will play an important role in his/her recovery. There are various aspects you need to be aware of to ensure the safety, comfort and recovery of the patient. Some of these include:

Home safety

Some of the changes you would need to make around the house include:

• Pick up rugs lying around, secure loose carpets and place carpet on slippery surfaces.
• Place all items that you regularly use well within reach.
• Ensure that there is good lighting throughout the house and avoid floor hazards such as small objects lying around, pets, cords and uneven surfaces.
• Do not allow the patient to lift heavy weights for about 3 months after the surgery.
• Rearrange furniture to provide more walking space to accommodate a cane or walker.
• Un-tuck bedding to make it easier for the patient to move in and out of bed.

Body changes

Some of the factors you may have to keep in mind about the patient’s changes in bodily functions include:

• The patient may have a poor appetite, so ensure that they take in more fluids until their desire for solid food increases.
• The patient may have difficulties in sleeping, but do not allow them to sleep too long during the day.
• Provide the patient with laxatives or stool softeners to combat constipation, which is a common side effect of certain pain medications.
• You may be advised to give your patient blood thinners to avoid blood clots in the leg.

Stocking care

Patients are prescribed special stockings to compress the veins in the legs, which will help reduce swelling and lower the chances of blood clot formation. Factors that you need to be aware of about these stockings include:

• Make sure the patient wears the stockings continuously, removing them twice a day, for one or two hours.

• If swelling persists, help the patient raise the leg above heart level on pillows, while lying down.
• Inform the physician when pain or swelling in the legs increases.

Incision care

Some of the instructions that you will be given about incision care include:

• Keep the incision dry and covered with a light dressing until the staples are removed.
• Inform the physician if there is increased redness, drainage, odor or pain around the incision.
• Inform the surgeon immediately if the patient’s temperature rises above 100.5°F.

Controlling pain and discomfort

Caring for the patient will include various methods of helping the patient control post-surgical pain.

• Pain medications should be given at least 30 minutes before physical therapy.
• You can encourage the patient to gradually reduce pain medications.
• Use ice for about 20 minutes every hour to control pain.
• Encourage the patient to change position every 45 minutes.

Recognizing and preventing complications

A few complications, such as dislocation, blood clots and pulmonary embolism, can be identified and prevented in the following ways:

• Dislocation: can be identified by severe pain, shortening of leg or difficulty in walking. This can be prevented by avoiding crossing the legs, twisting and bending the hip past 90 degrees.
• Blood clots: can be identified by swelling in the ankle, calf or thigh, and heat, pain and tenderness in the groin, back of knee or calf. This can be prevented by using compression stockings, blood thinners and walking.

Pulmonary embolism: A blood clot formed in a leg vein can break away and travel to the lungs causing pulmonary embolism. This is identified by sudden chest pain, rapid breathing, shortness of breath, sweating and confusion. It can be prevented with anticoagulant medications, compression stockings and physical activity which can help reduce blood clots and speed up the recovery process.

Hip fractures refer to any kind of breakage or damage in the thigh bone (femur). People over the age of 65, especially women, are highly vulnerable to hip fractures. You will require assistance after hip fractures from family members as well as health professionals and may also be required to be admitted to the hospital for further assistance. Hip fractures can be caused due to weak bones (osteoporosis) or from a fall. Osteoporosis is due to various factors such as age, gender, nutrition, life style or heredity.

Prevention of hip fractures

Healthy lifestyle choices in early adulthood help in building high bone mass and reduce risk of bone related diseases in later years. Some of the methods of prevention of hip fractures are:

Home safety: Most hip fractures occur due to falls. Fall can be prevented by taking care of small things such as removing clutter from the floor, clearing out excess or unwanted furniture, keeping electric cords away from the floor, using enough lighting in the house, using grab bars in the bathrooms and removing throw rugs.

Exercise: Exercise helps to maintain muscle strength and can slow bone loss. It also improves your balance and coordination. Exercises such as walking increase bone density in your body. Some other exercises include climbing stairs, jogging, dancing, swimming, and weight training. Balance training can be used to decrease falls and the risk of hip fractures as balance tends to reduce with age.

Reduce smoking and drinking: You can maintain your bone density by avoiding excessive use of alcohol and by reducing smoking. Too much alcohol can impair your balance and increase the risk of falls.

Check your eyes: Get your eyes tested every year if you have any eye disorders or diabetes.

Watch your medications: Certain medications can have side effects, such as weakness or dizziness and can make you more prone to falls. Please consult with your doctor regarding the medications you take.

Hip protectors: These are designed to decrease the impact of a fall and prevent hip fractures in older people. The device has padding and plastic shields to help absorb the shock of the fall and divert the impact away from vulnerable areas of the hip.

As you grow older your bones may become weak due to hormonal loss, genetic factors exercise or nutrition. However, you can maintain your bone health with good nutrition and appropriate activity levels. You can also take osteoporosis medications if required.

Hip replacement is a surgery performed to replace parts of a diseased hip joint with an artificial prosthesis. The goal of hip replacement is to eliminate pain and return you to your normal activities. You can help in recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.

After the surgery, you may experience pain and swelling, which can be controlled with medication that your doctor will prescribe. You are discharged from the hospital once you have sufficient pain control and can perform basic activities on your own, such as getting in and out of bed, going to the bathroom and walking with an assistive device such as crutches or walker. If you are unable to achieve these, you will be transferred to a skilled nursing or rehabilitation center.

On reaching home, have a family member or caregiver assist you with your activities for a few weeks. Taking care of someone following hip replacement surgery requires compassion, awareness and patience. Basic points to follow by your caregiver:

Helping with basic movement and functions as well as provide emotional support

Having a clear understanding of your medication and ensure they are administered in a timely manner

Assisting you with household chores, paperwork and traveling to keep your appointments

Keeping emergency numbers ready

Helping and motivating you to perform your rehabilitation exercises

Ensuring that furniture is rearranged so as not to interfere with your movement and cause falls.

To avoid bending or reaching out, items that you use frequently can be placed easily within reach.

Certain instructions that your doctor will brief you about are:

• A shower chair or gripping bar may be helpful in the bathroom.
• Make use of long shoehorns, long-handled sponges, and other devices that can help you reach objects without bending.
• Your doctor will advise you on correct sleeping positions.
• Keep the wound clean and dry. Your doctor will let you know when you can shower or bathe.
• Swelling may be present for 3 to 6 months following hip replacement and can be controlled with ice and elevating your legs slightly.
• Follow your physical therapy program for at least 2 months. Walking, stationary bicycling and swimming are good exercises, but ensure that your wound is completely healed.

You and your caregiver must be aware of the signs of infection or blood clot formation and quickly return to the hospital should you develop more than normal pain, swelling, redness, fever, chills or drainage from the wound.

You can usually return to driving once you have adequate pain control, strength and reflexes, and require no narcotic pain medications. Your doctor will decide on this and advise you regarding other activities, work and sexual activity depending on your condition and progress with therapy.