Your Total Hip Replacement
A total hip replacement is a surgical procedure that replaces your hip with an artificial hip or prosthesis. This booklet will help you better understand the total hip replacement procedure and what will happen during your stay at the Hospital of Saint Raphael Joint Restoration Center.
Important Telephone Numbers
Priority Testing Center (203)789-4063
Verdi 4 North (Orthopedic Floor) (203)789-3258
Blood Bank (203)789-3071
Lorraine Novella, Patient Care Manager (203)789-3329
Joint Restoration Center Business Office (203)867-5462
Introduction
Please call the Hospital of Saint Raphael Joint Restoration Center at (203)789-3258 as soon as you get your surgery date to make an appointment for the pre-op class.
Please review this booklet prior to attending the pre-op class. Feel free to write down any questions or comments you have and bring them to class so they may be answered.
Your Total Hip Replacement
We want you to know as much as possible about your hip surgery. The following provides a brief explanation about the hip and the hip replacement operation.
The hip is a weight-bearing ball and socket joint. When walking, the force on this joint is two to three times your body weight. For you to walk painlessly, the head of the ball (femur) needs to be round and smooth so it can glide and rotate easily in the socket (acetabulum). Conditions such as arthritis, old fractures, infection and aging may cause changes in the joint surfaces, creating pain and stiffness when moving the hip joint. A hip replacement is an effective method of alleviating the pain and restoring the motion in hips damaged by disease and injury.
The prosthesis used to replace your hip has two components, the femoral head and the acetabular cup or socket. There are several types of surgery involving the use of these components. The surgery recommended will depend upon your age, the amount of damage and your medical history. Your physician will explain his or her recommendations.
The results of the surgery depend in part upon your general health and age. It is important to follow the medical advice during your hospital stay and after going home. Please remember this surgery will not produce a healthy, normal hip but an improved functional alternative. The goal of surgery is to provide you with a functional hip so you can walk without pain, climb stairs, and maintain independence in your daily activities.
Surgery Preparation
Before being admitted to the hospital, it is important to assess your current health. This may include:
visiting other physicians (e.g. primary care doctor, cardiologist, and/or coming to Saint Raphaels Priority Testing Center
(203)789-4063)
electrocardiograms (EKG)
blood and urine tests
chest X-rays
blood bank visit for direct donation of your own blood
attending a preoperative teaching class at the hospital offered every Wednesday
home physical therapy evaluation
When packing for your stay, please bring the following:
knee length robe with front opening
walking shoes with low heels and rubber soles; i.e. sneakers
a complete list of all your medications, including dosages; as well as a list of your physicians (i.e. cardiologist, internist, etc.). This will assist the nurse when taking your history on admission.
Anesthesia Care and Post-Operative Pain Management
You will meet with your anesthesiologist at the Hospital of Saint Raphael Priority Testing Center or the Same Day Care Unit prior to your joint replacement surgery. Your surgical anesthesia and post-operative pain management options will be fully discussed. Most patients have two options for their anesthesia care: general anesthesia, where you are put to sleep during the operation, or spinal anesthesia, where just the lower half of your body is anesthetized. You, your surgeon, and your anesthesiologist can discuss which option is best for you. At this time, you will also discuss post-operative pain management options with your anesthesiologist. This usually includes a choice of epidural analgesia or patient controlled anesthesia (PCA). The following are answers to some of the most frequently asked questions for epidural analgesia and PCA.
Epidurals
What is epidural analgesia?
Epidural analgesia is an excellent technique for relief of postoperative pain after your joint replacement surgery. A narcotic is delivered into the epidural space in your back via a small plastic catheter.
Who inserts the catheter?
An anesthesiologist inserts the epidural catheter into the epidural space in your back after anesthetizing the area with a local anesthetic. The small catheter is then securely taped in place.
How much medication will I receive?
Administration of epidural narcotics is based upon individual patient needs and will be monitored closely after surgery by the Pain Management Team. Medications may be given as an intermittent dose or continuously. The amount is based on your medical history, weight, and height.
How long will the epidural be in place?
The epidural catheter is typically left in place for 48 hours after your total joint replacement. During this time, you will be able to walk around with the epidural catheter in your back.
Who will monitor the epidural?
The orthopedic nurses will perform ongoing assessments and evaluations of the epidural and your level of pain. The Pain Management Team will work in tandem with the orthopedic nurses to evaluate your level of pain and will adjust your medications to keep you as comfortable as possible.
What are the benefits of epidural anesthesia?
The benefits include longer pain relief, earlier post-operative
ambulation, earlier restoration of your pulmonary function, and improved mental alertness post-operatively.
Patient Controlled Anesthesia (PCA)
What is Patient Controlled Anesthesia?
Patient controlled anesthesia is a type of post-operative pain control device that administers pain medication through an intravenous (IV) line in your arm. This device gives you control over any pain you may be experiencing. Instead of ringing for the nurse when you need pain medication, youll push the PCA button instead. When you push the button, youll receive a very small dose of pain medication. Just the right amount, no more, no less.
How much medication will I receive?
The amount of medication prescribed by your doctor to relieve the pain. Your doctor and nurse will make sure the PCA is set to deliver exactly the right dose. If you feel some discomfort and want relief, just push and release the PCA button.
Can I give myself too much medicine?
No. The PCA infuser is a precision instrument, specially engineered and designed, so that you cannot give yourself more medication than your doctor thinks is right for you.
Blood Transfusions and Your Total Joint Replacement
By now, you have probably discussed with your physician the possible need for a blood transfusion during or after your surgery. Different options for receiving blood are available, including donating your own blood prior to your surgery. In the event that you cannot donate your own blood beforehand, we have provided the following information on receiving blood from the Blood Bank.
Safer than ever
Blood transfusions have never been safer. New techniques, knowledge and tests make your risk of infection from transfusion extremely low. However, transfusion is never entirely risk free; no medical therapy is.
Compare the risks
Most people travel by car every day. For every 60 miles you travel, you have a one in a million chance of dying in an automobile accident. If you are a male over 60 years of age, you have a one in a million chance of dying from any and all causes every 20 minutes you are alive. Few of us alter how we act or what we do based on such large risks. The following is a list of the most serious complications from blood transfusion:
HIV exposure-1/700,000 (probably less)
Hepatitis B-1/100,000
Hepatitis C-1/100,000
Fatal hemolytic reaction-1/100,000
Your own blood is best
While the risk of complications is low, your own blood is still the safest for you. Thats why, at the Hospital of Saint Raphael, we recommend that you donate your own blood prior to your joint replacement surgery, a procedure known as autologous donation. There may, however, be reasons why you may not be able to donate blood for your anticipated surgery; or, you may choose not to. There are other techniques we use, such as blood collection and reinfusion during and after the surgery, which help to minimize the amount of donor blood we use.
Put your mind at rest
While there are some risks to receiving donor blood, the Hospital of Saint Raphael, the American Red Cross, and others in the blood banking community have employed up-to-date administrative and scientific methods to make blood transfusion as safe as possible, and to minimize potential risks. Therefore, your chance of incurring complications is extremely small.
Further Questions
If you have any further questions about blood donation and
transfusion, please call the Hospital of Saint Raphaels Blood Bank
at (203) 789-3071.
The Day of Surgery
After being admitted, you will be escorted to the Same Day Admission suite for surgery preparation. There you will be seen by a nurse who will take your admission history, and you will be seen by an anesthesiologist.
Surgery
Surgery generally lasts several hours. The time varies with each case. While you are in surgery your family may relax in the surgical waiting room on the second floor.
After surgery, you are transported to the recovery room to wake up from the anesthesia. The physician will inform your family of your condition and what has happened. You will generally be in the recovery room one to three hours. Your family may see you once you are transferred from the recovery area to your room on the orthopedic unit.
After Surgery
For the first forty-eight hours, a nurse will check your blood pressure, pulse, temperature and breathing every four hours. You may have sips of water and ice chips. Your first meal is liquid. Generally, regular meals will be served the next day.
You may have an autovac which collects blood through a tube from your hip incision and enables retransfusion of the drainage. Another device that may be used is a hemovac which collects this drainage. After two days the bleeding stops and your doctor will remove the tube.
Coughing and deep breathing are important during this time. To help with your breathing, an incentive spirometer will be provided
for your use ten times every hour while you are awake. Using this
will help prevent fluid from collecting in your lungs and prevent pneumonia.
An ice bag will be placed against your hip dressing for several days to relieve pain, prevent swelling and bleeding. Your dressing changes will be removed after two days, at which time dressing changes will be done daily or more often as needed until drainage stops.
To relieve pain after your surgery you may have:
An epidural
Patient Controlled Anesthesia (PCA)
Oral medication
(Please refer to the Anesthesia Care and Post Operative Pain Management Section.)
An indwelling bladder catheter may be present the first 48 hours; followed by intermittent catherizations if required.
Your will have intravenous fluids until you can take and retain fluids in a acceptable amount. Antibiotics, to prevent infection, will be administered intravenously for the first 48 hours.
In addition to routine medications that you may take at home, you may also be placed on the following:
Stool softener
Iron supplement
An anticoagulant or "blood thinner" such as Coumadin, Lovenox or aspirin to prevent blood clot formation; Lab values (PT/PTT) will be monitored daily if you are on Coumadin and your dosage adjusted accordingly.
Your blood count and blood chemistries will be monitored for
the first three days. Transfusions may be ordered depending on the results of your blood count. Please note that the blood that you receive may be self donated and/or bank blood.
You will be seen early each morning by one of the orthopedic
residents or a physician assistant who will check your incision(s) and order medication changes. This is in addition to being visited by your attending physician.
The visiting hours for the orthopedic unit are from 11 AM to 8 PM. Your family may feel free to call the nursing unit at any time to inquire about your condition, but it is requested that this be limited to one family spokesperson. The phone number is 789-3258.
Equipment
There are several items which are constant companions during your stay in the hospital. These include:
Air Mattress This is placed on your bed to provide comfort and prevent pressure sores.
Intermittent Compression Devices These are devices that massage your feet or legs by inflating and deflating automatically. This helps to prevent blood clots.
Abduction Pillow This triangular foam pillow is kept between your legs while you are in bed for the first six weeks. This prevents you from bringing your legs close together, possibly causing a dislocated hip. The nurses will help you turn on your side with this pillow in place.
Physical Therapy
On the first day after surgery you will be getting out of bed into a reclining chair. Your physical therapist will help you stand with a walker. You will also begin some simple exercises, exercises #1-#3 on next page. You will be seen twice a day during the week and on the weekend by physical therapy. Your physician decides how much weight you can put on your operated leg. This varies from no weight bearing to weight bearing as tolerated. It is important to follow these weight bearing restrictions to allow proper healing of your new hip. Please take care not to overdo it.
On the second day you will begin walking with a walker and will perform this at least twice a day. On the third day and continuing until discharge, you will work on transfers from the bed, chair and toilet, as well as learning to walk with a walker. If you are going home, you will do stairs before you leave the hospital. If you have received a cemented total hip, you begin exercises with the therapist to raise your leg, bend your hip and strengthen the leg muscles. If you have an uncemented hip, you may be restricted in the amount of weight you can place and the type of exercises you do after surgery. The physical therapist, after consulting with your physician, will instruct you on what is appropriate for you.
Therapy Goals
After completing physical therapy, you should be able to:
Walk safely with crutches or a walker for a reasonable distance (100.)
Perform exercises properly.
Transfer in/out of bed and toilet.
Go up and down stairs.
Understand what you should avoid doing and knowledge about your hip precautions.
If you have any further questions please call 789-3258.
Exercises
To maximize your range of motion, strength and endurance, please try to do the following exercises 10 times each, 2-3 times a day. If any exercise causes severe pain, avoid the exercise or do only the exercise to your tolerance.
1. Quad Setting: Lie on back with knee straight. Tighten your thigh muscle. Kneecap should move toward the hip. Push the back of the knee into the bed and lift heel off bed. Hold 5 seconds, then relax.
2. Gluteal Setting: Lie on back. Squeeze the buttock muscle together holding tightly 5 seconds, then relax.
3. Ankle Pumps: Move foot up, down, in, out and in circular motions.
4. Move leg out side ways. Keep knee pointing straight up and avoid rolling foot outward. (Patients with uncemented hips are excluded.)
5. Gently slide heel of foot towards your buttock region, only bending knee to tolerance.
Sitting
6. Support thigh with pillow or towel. Straighten knee fully. Avoid leaning backwards.
7. Raise knees alternately as though marching. You may put hands under thigh to help stretch hip.
Occupational Therapy
If you are returning directly home, an occupational therapist will instruct you in dressing, bathing and other self care skills. Equipment to help is provided.
Long Handle Sponge for washing operated leg and foot. Towel may be wrapped around sponge to dry leg.
Dressing Stick for putting on slacks or underwear. Hook dressing stick in waistband, then lower down to foot and pull up.
Sock Aide/Stocking Dresser for pulling on socks or stockings.
Long Handled Shoe Horn for putting on shoes.
Elastic Shoe Laces changes a lace-up shoe into a slip-on shoe. Lace in shoe as usual and tie in bow.
Reacher for picking up objects from the floor. May also be used for lower body dressing. There is a small magnet on tip for small metal objects. Dressing should be done while sitting to conserve energy.
Guidelines and Precautions
Follow the exercise program as instructed.
Walk the distance you can tolerate each day.
Keep the operated leg in good alignment with your body. Avoid turning your leg in, bending it past 90 degrees and crossing it past midline.
Sit on chairs with arms and a seat height of 18 inches. If necessary, use a hard cushion to increase the seat height.
Do not bend forward past 90 degrees to stand up or to sit down.
When walking, move crutches or walker first. Then step forward with your operated leg while supporting yourself with your arms. Then step through with your good leg.
When going upstairs, remember to step up with the good leg first. When going downstairs, take your first step with your operated leg.
When standing up, keep your operated leg out in front. Scoot forward to the edge of the chair and use your arms to help you.
Use a reacher to get objects on the floor when sitting or standing and to reach the sheets when laying in bed.
Use a high rise toilet seat. Do not lean forward to wipe.
Use abduction pillow between your legs when sleeping on
your side.
Do not lean over to put on your shoes or socks. Use an assistive device.
Do not cross your legs while sitting or lying on your back.
Discharge Planning
Before your surgery you will be asked to decide your plans for discharge. There are options available and we want you to think about your own unique needs and home situation. For example:
Do you live alone?
Do you have stairs?
Are you nervous about going directly home?
Are you the type of person who bounces back quickly or one who needs a little more time?
Options to Consider
1. Short-term rehabilitation facility.
2. Home care services, in your own home or that of a family
member or friend.
Please refer to the Discharge Planning Guide for further information.
A Guide to Recovering at Home
During the first few weeks at home, you will adapt what you learned at Saint Raphaels to your own setting. Your family and friends can assist you at this time, and help you make your home safer.
Your family support is especially important while you recover and readjust. By reminding you of what you have learned and assisting you, they can help you make the transition to your home environment. Ask them to encourage you to do things for yourself. They can also cheer you on and celebrate when you walk a little further, or accomplish a new task.
A discharge planner will be meeting with you before you are discharged to arrange for continued therapy and any equipment you may need at home.
Things to Think About
When you return home you will be walking with either a walker or crutches. Do you have:
Stairs?
How many?
To where?
Are there railings?
If not, can they be installed?
Things to Consider
1. Setting up a temporary bedroom on the first floor and renting a bedside commode.
2. Staying with a family member or friend.
3. Home care services: Physical therapy, home health aide, nursing, occupational therapy.
Housekeeping and Cooking
Plan ahead:
1. freeze home cooked meals for future use.
2. stock freezer with nutritious frozen dinners.
3. Meals on Wheels
In the Kitchen
Move pots, pans, dishes, and frequently used items to a convenient height that you can safely reach. Remember you will be using a walker or crutches.
Small items can be carried in an apron with pockets, or get a bike basket to attach to your walker.
Also consider and plan for the care and feeding of any pets.
Home Safety
Becoming aware of hazards can help make your recovery easier and safer. You might want to have your living room rearranged so it's easier to get around. And dont forget about hazards in the bathroom, like a wet or uneven floor.
Add pillows to a low chair.
Move electrical cords out of the way.
Remove throw rugs.
Store items within easy reach.
Use a cart to move items.
Watch for small pets or objects on the floor.
Install a rail along stairs or grab bars in the bathroom.
Insurance Coverage
Since medical insurance policies vary widely, you should check with your policy for exact coverage or contact your insurance agent or personnel department at your place of employment.
If you have any questions, please call 789-3497.
Care Management Department
1450 Chapel St.
New Haven, CT 06511
Care of Your Incision
You may be discharged with staples in your hip, which will be removed at the rehab facility or at your doctors office. When removed, steristrips will be applied to the incision. These will fall off on their own. If your incision continues to be draining, your physician will give you instructions regarding the care.
Call Your Surgeon if You Have
1. Signs and symptoms of infection, i.e., elevated temperature above 101.5, redness, swelling, increased drainage, or increased pain not relieved by pain medicine.
2. Drainage from your incision or any kind of an infection. If at any time you develop a bacterial infection, you should be treated with an antibiotic to prevent spread to your total joint replacement. Some of these infections include boils, infected ingrown toenails, bladder infections, strep throat or abscessed teeth. Antibiotics are also necessary for dental cleaning, any work on the gums, and for procedures such as cystoscopy or proctoscopy.
3. Sudden sharp pain, accompanied by clicking and popping sound at the joint. These signs may indicate your hip has dislocated:
Marked swelling at the hip.
Shortened leg with toes pointing outward.
Loss of control over leg motion or complete loss of leg motion.
Directions to Saint Raphaels
From I-91 South
Leave I-91 south at Exit 1 (Downtown New Haven). Continue straight on the exit expressway, where it merges with Frontage Road. Continue through four lights and then turn right at the fifth light, onto Orchard Street. After the first light, you will see a garage to your left and another to your right.
From I-95 South
Leave I-95 south at Exit 47 (Downtown New Haven) and follow directions "From I-91 South" beginning at "Continue."
From Route 8 South
Take Route 8 south, to Route 34 east, to Ella Grasso Boulevard. Continue straight ahead to Derby Avenue. Derby Avenue changes to George Street. Once past Sherman Avenue, a hospital garage is on your left.
From Bridgeport and New York City areas [ south ]
Leave I-95 north at Exit 47 (downtown New Haven) and follow directions "From I-91 South" beginning at "Continue."
From Tweed New Haven Airport [ east ]
Exit airport onto Fort Hale Road and turn right onto Route 337 (Townsend Avenue), to I-95 South to Exit 47 (Downtown New Haven). Follow directions "From I-91 South" beginning at "Continue."
From New Haven Train Station
From the front entrance of the train station, turn right onto Union Avenue. Go past the City of New Haven Police Department (on your left), and at the second light from the train station, turn left onto North Frontage Road. At the seventh traffic light, turn right onto Orchard Street. After the first light you will see a garage to your left and another to your right.
When You Arrive
Visitor parking is available in the 850-space garage at the corner of Orchard and George streets, or in a 500-space complex at the corner of Orchard and Chapel streets.