Transcript Hip_PatientEd

patient education
for those scheduled for surgery
Total Hip Replacement
patient education
for those scheduled for surgery
Discussion of Arthritis
What Are The Major Causes of Joint Pain?
 Osteoarthritis
 Post Traumatic
Arthritis
 Rheumatoid
Arthritis
 Avascular Necrosis
 Paget’s Disease
 Systemic Lupus
Osteoarthritis of the Hip
Ligaments
Femur
Pelvis
Femoral Head
Healthy Hip
Diseased Femoral Head
Arthritic Hip
Total Hip Replacement: The Implant
Ligaments
Acetabular
Cup
&
Acetabular
Head
Femur
Stem
Pelvis
Femoral Head
Healthy Hip
Modular Neck
Post-Surgery, with BFH® Implant
Total Hip Replacement: Animated
1. To load animation, rightclick on the animation box.
Select “Play”.
2. Use mouse and click on
“see step-by-step” to walk
through animation.
After animation is
completed, click twice on
slide background to move
forward to next presentation
slide
Surgical Pro’s
Major Improvement:
 Pain - Less or no pain medication
 Return to normal, daily activities
 Fitness & recreation
patient education
for those scheduled for surgery
Discussion of Surgery
Preparation for Surgery
 Advance preparation helps
reduce complications both during
and after the operation
 A well informed patient recovers
quicker, and studies show this
 Medical evaluation & diagnostic
tests will be performed
 Think Ahead
 Special parking permit?
Discuss this with your surgeon
 Prepare your body
 Prepare your home
Preparing for Surgery: Your Body
 Medications: Advise your surgeon of all medications
you're currently taking, prescription or over-thecounter.
 Prepare Your Skin: Your skin should be free of any
infections or irritations before your surgery.
 Donate Blood: Although not critical, you may choose
to donate blood in case you need a transfusion after
surgery
 Finish Dental Work: If possible, finalize all dental
work before your hip replacement surgery.
Preparing for Surgery: Your Body
 Lose Weight: If you are overweight, it's a good idea
to drop some pounds before surgery if possible.
 Stop Smoking and Drinking: It's advisable to quit
smoking - or at least cut back - prior to your operation.
Don't drink alcohol for at least 48 hours prior to your
surgery.
 Urinary Evaluation: If you have a history of frequent
urinary infections, schedule a urological evaluation
before your surgery. This is especially important for
men with prostate disease.
 Exercise: Exercise prior to surgery to increase your
strength, so you will have flexibility to exercise after
your surgery.
Preparing for Surgery: Your Home
 Rearrange Furniture: Create wide traffic paths and
remove obstacles
 Check your shoes: Wear rubber-soled shoes to
prevent slipping
 Remove electrical cords: To avoid tripping, remove
them, hide them or tape them to the floor
 Pack up the throw rugs: Rugs can shift or bunch,
causing you to slip or trip.
 Watch the floor: Always keep an eye on the floor to
avoid tripping over pets or small objects.
 Purchase assistive devices: i.e. long handled grabber,
raised toilet seat, shower bench, hand grips
Preparing for Surgery: Your Home
 Stock up on food: Store all supplies
between waist and shoulder level to
avoid bending.
 Prepare a bed downstairs: Prepare
a bed on the ground floor of your
home to use temporarily
 Get help with household chores:
Arrange a short stay at an extended
care rehab facility or ask family and
friends to help out.
 Insurance: Check with your carrier
in advance to see if you need precertification for surgery, as well as
whether your insurance plan covers
a private room
Preparing for Surgery: Your Home
 Don’t forget your pets: Arrange for
someone to care for them. You don't
want to trip over them or have them
possibly knock you down, and you
may have problems picking them up
or cleaning up after them.
The Day of Surgery
Plan to arrive at the hospital 2
hours prior to surgery to fill out
pre-admission paperwork.
Make sure you bring:
 Your health insurance card
 A list of your medications and
any allergies
 Your living will or power of
attorney
 Emergency contact info
The Day of Surgery
 Don't wear jewelry or
makeup
 Remove nail polish, dentures
and contact lenses or
glasses
 Do not use lotion, perfume
or deodorant
 Don't eat or drink anything
after midnight on the night
before your surgery
 You may brush your teeth
and rinse your mouth, but
don't swallow any water
Before Surgery
 After the paperwork is completed,
your nurse will review your
personal health history and your
home medications with you. It's
important that you share any recent
changes in your health.
 You'll also be asked to remove your
clothing and put on a hospital
gown. Then you'll be assigned to a
bed in the preoperative holding
area.
Preoperative Holding
 A nurse will start an intravenous
infusion
 An anesthesiologist will
discusses with you the type of
anesthesia best for your case
 Anesthesia is designed to make
the procedure as comfortable
as possible for you
 general anesthetic (asleep)
 spinal anesthetic (awake, but
no feeling from waist down)
Preoperative Holding
 Answer questions: Regarding your medication,
allergies, medical history, and your vital signs will
be taken.
 Receive medication: You'll be given medication to
help you relax.
 Say goodbye to your family: They'll be taken to a
waiting area where they can be kept informed of
your progress during surgery.
 You'll then be wheeled into your operating room.
The Procedure – Operating Room
 In the OR, you'll be moved from your gurney onto the
operating bed
 Temperature is intentionally cool to help prevent infections
 Nursing team will cover you with blankets to keep you warm
 EKG electrodes will be placed on your chest and sides
to monitor your heart
 Then the anesthesiologist will inject medication
through your IV line.
 A nurse may insert a urinary catheter - a thin, sterile
tube inserted into your bladder to drain urine.
 The surgery itself generally takes between 45 minutes
to 2 hours.
The Procedure – Operating Room
 Surgeon determines what length of incision will be needed.
 Minimally-invasive surgery technique (2-3 inches)
 preserves vital muscles & tendons
 less pain, scarring, blood loss, and increased function
immediately after surgery.
 Traditional hip surgery (6-8 inches)
The Procedure - Recovery Room
 You'll awaken slowly in the
recovery room, where you'll
spend your first hour or two
after surgery.
 Your nurse will constantly
monitor your progress to
ensure that your vital signs
are stable.
The Procedure - After Surgery
 After the recovery room, you'll
be taken to your hospital room.
 Bulky dressing over the surgical
incision and may have a drain in
place to help decrease swelling
of your hip.
 Your heels will be elevated to
decrease pressure on the
surgically repaired hip.
 You'll also be hooked up to an
IV line, through which you'll
receive fluids and medication
(including an antibiotic).
The Procedure - After Surgery
 You'll remain in bed sitting up with nurse's
assistance
 Nursing team will regularly turn you and provide skin
care
 Be sure to tell them if you experience any tender
or burning areas
 Start your home medications as soon as you can
tolerate liquids
 Diet will be initially limited, the range of foods
available to you will increase as your appetite returns
 Medications will help reduce any nausea
Hospital Stay
 Day after your surgery
 Technician will draw blood; IV fluids and
medications will continue
 Nurse will help you to move into a reclining
wheelchair
 Second day after surgery
 Nurse will remove your incisional drain and
catheter
 IV fluids may be stopped, and social services will
discuss discharge planning with you
 Third day after surgery
 Most patients discharged
 You'll be able to visit the bathroom with walker
 Staff will show you how to maintain proper hip
alignment using the toilet
Hospital Discharge
 Your nurse will change your
dressing and teach you on
how to care for your incision
site at home
 Your pain medication pump
will also be discontinued.
 You’ll receive discharge orders
and instructions. If you are not
discharged to your home,
you'll go to a rehab unit,
extended care or skilled
nursing unit
Your Healthcare Team
During your surgery and rehabilitation, you'll work
closely with a healthcare team that includes the
following people:
 Orthopaedic Surgeon: surgery and recovery
 Nurses: Pre and post-op surgery
and pain management
 Physical Therapist (PT): Muscle
strengthening and exercise
 Occupational Therapist (OT):
Daily activity management
 Case Manager: Discharge
Pain Management
 Ask for pain management
BEFORE the pain becomes
too intense to handle
 Fatigue decreases your
tolerance for pain, so avoid
becoming overtired
 Pace your activities to allow
for rest periods
 If you're not sleeping well,
inform your nurse
 Your doctor may prescribe
medication
Patient-Controlled Analgesia.
 Patient-controlled analgesia
(PCA) provides optimal
pain relief without the use
of injections
 Intravenous, continual,
small dose of pain
medication
 Small, computerized pump
allows you to selfadminister an additional
amount of medicine as
needed
 All you have to do is push a
button
Increasing Muscle Strength
 Key to rehabilitating your hip
 A physical therapist (PT) will
visit you to
 Review essential exercises
 Cover what to expect from
your first therapy session
 Answer any questions.
 You'll begin walking and other
exercises a day or two after
surgery
 In most hospitals, therapy is
performed twice a day.
Body Alignment
 Proper body alignment
helps lessen pain
 Nursing staff will help
you change position at
frequent intervals to
maximize comfort
 Don't try to turn on your
own following surgery,
ask for help whenever
you want to shift position
 Keep a pillow between
your legs when sleeping.
Pain Medications
 Several types of anti-pain
medications: narcotic and
non-narcotic pain relievers,
muscle relaxants and antiinflammatories
 Administered through
injections, in pills or via an
IV tube
 Your doctor may prescribe
a combination
 If medication does not
successfully control your
pain, alert your nurse
Pain Medication Side Effects
 Most common side effects of pain
medications:
 upset stomach, nausea,
constipation and drowsiness
 Always take medication with
something
 Milk, juice, crackers
 Choose HIGH FIBER foods and
fruit juices
 Drink 5-6 glasses of water daily
 If no bowel movement in 3 days,
inform your nurse
Prevention of Infection
 The risk of infection following hip surgery is low,
however it's important to take the possibility seriously.
 Notify your orthopaedic surgeon if:
 The incision site has drainage, redness, swelling
and/or foul odor.
 You think that you may have an infection.
 an ingrown toenail, bladder infection, skin sores, a
tooth abscess, etc.
 You have ncreased hip pain at rest or when active.
 You undergo a procedure through which bacteria
might spread into your bloodstream.
 You have a persistent fever above 101°F for 2
days.
Deep Vein Thrombosis (Blood Clots)
 Notify your orthopaedic surgeon if you have blood
clot symptoms:
 Chest pain
 Shortness of breath
 Drainage or foul odor from the incision
 Redness at the incision site
 Redness, warmth or pain in legs
 Excessive pain or swelling in the hip, calf or feet
 Elevated temperature of more than 101ºF
Rehabilitation
 Rehabilitation can take weeks
or months
 Dependent on the state of your
health before the operation
 How well you follow the rehab
regimen
 Be cautious with your new hip
and avoid overly strenuous or
prohibited activities
 Be patient - your recovery will
take some time and effort
 You should again be able to
enjoy most of the same
activities you did before hip
pain
Rehabilitation
 Using a Walker: Start slowly by
moving the walker a few inches in
front of you, taking small, even
steps
 Using Crutches: Require a
considerable amount of upper
body strength, so their use is
advisable only for certain patients
 Exercises: Your physical therapist
will show you exercises designed
to strengthen your muscles and
increase your range of motion
When to Call Your Doctor
 If you experience swelling around the surgical
incision, or in a calf or leg
 If you have unusual hip or leg pain
 If the incision leaks fluid
 If you have trouble breathing or experience
chest pains
 If you have fever over 101ºF for 2 days
patient education
After Hip Replacement
Living With Your New Hip - Diet
 May experience some
loss of appetite
 Eat a healthy, balanced
diet
 Advisable to take an iron
supplement or eat ironrich foods to help restore
muscle strength and
promote tissue healing
 Drink plenty of fluids
New Hip – Getting Into Vehicles
 Make sure that the passenger
seat is pushed all the way
back in your vehicle
 Lower yourself carefully onto
the seat, keeping your
operated leg forward and
allowing the seat to support
you
 Slide back onto the seat in a
semi-reclining position and
pivot your body so that you're
facing the front of the vehicle
 Pull your legs into the vehicle
one at a time
New Hip - Walking Back to Health
 Walking is essential to your
recovery
 Make walking part of your
daily routine, gradually
increasing the amount of
time you spend doing it
 Focus on walking heel to
toe with a smooth motion,
spending equal weight and
time on each foot
 As your recovery
progresses, move on to
more advanced activities,
like stairs
New Hip - Aids to Assist You
 Bathing: Your therapist or nurse will show you
how to use a shower bench or chair while bathing.
Use a long-handled sponge, shower hose or handheld showerhead to make bathing easier. You may
also want to consider having grab bars installed in
your shower or bathtub to provide support as you
get in and out.
 Hand Grips: Install handrails or safety bars next to
stairs. If you already have these in place, secure
them firmly before your surgery.
New Hip - Aids to Assist You
 Toilet: Use a raised toilet seat to keep your hip in a
more stable position and minimize bending.
 Dressing: To avoid bending, try to dress while
sitting on a chair. A sock aid
and long-handled shoehorn
can assist you.
 Housekeeping and Cooking: Use
a long-handled reacher or grabber
for objects too high or low for you
to to reach without stretching or
bending.
New Hip - Best Standing Positions
 When stepping up on a curb, move as close to your
walker as possible, then put your weight on both
legs and lift it onto the sidewalk. Step onto the
sidewalk first with the un-operated leg. Using the
walker to support your weight, bring up
the operated leg.
 Use your good leg first in walking
up stairs, then bring your operated
leg up to meet it.
When going downstairs, always step
down with your operated leg first.
New Hip – Best Sitting Positions
 To sit, back up until the edge of the chair or bed
touches your leg. Then, using the armrests to support
your weight, lower yourself into a sitting position. To
stand, reverse these steps.
 Use a firm chair with a straight back, armrests and a
high seat.
 Always sit with your knees level with or lower than
your hips. (Don’t cross your legs.)
 Always sit with your back upright.
 Keep both feet on the floor and your hips 6 inches
apart.
 Don't let your hip cross the midline of your body.
New Hip – Getting Out of Bed
 Get out of bed on the side of
your prosthetic hip, keeping
your thighs apart.
 Pivot on your hips, using
your arms to help. With your
good leg, gradually scoot to
the edge of the bed. Keep
your operated leg out to the
side. Do not twist it inward.
 Sit on the edge of the bed
with your operated leg
slightly forward. With your
hands behind your hips, push
up - without bending forward
- to stand up.
New Hip – Using the Toilet
 When using the toilet, step back until you feel the
toilet touch the back of your legs.
 Place your operated leg in front of you, keeping
your weight on the other leg.
 Looking behind you, grasp the side rails and lower
yourself onto the front of the toilet, then edge back.
To stand up, reverse these steps.
New Hip - Intimacy
 Partial hip replacement
patients may resume sexual
activity when comfortable,
as restrictions are minimal.
 Total hip replacement
patients may usually
resume sexual activity 4-6
weeks after surgery.
 Always ask your doctor
first, though, as this
timeframe varies depending
on your type of prosthesis.
Frequently Asked Questions
 When will my staples be
removed?
Staples are removed
approximately 10-14 days
after your surgery.
 How long do I wear the
white support stockings?
This varies by doctor and
individual recovery times.
Generally speaking, the
stockings should be worn
during the day, but can be
removed at night. If there
is no swelling after 2-3
weeks, use can be
discontinued.
Frequently Asked Questions
 When do I start physical
therapy?
It varies by case and by
doctor. Ask your surgeon
for his preference.
 How much weight will my
surgical leg bear?
It depends on the type of
surgery and your doctor's
individual preference.
Usually, partial weight
bearing is recommended.
Frequently Asked Questions
 When can I drive?
This also varies by doctor
and also depends on the
type of surgery
performed. Usually, you'll
be able to drive within 2-6
weeks - your doctor will
let you know when it's
safe.
 When can I swim?
Most doctors agree that
you should wait 6 weeks
before beginning active
swimming. However,
walking in water is great
rehabilitative exercise.
Frequently Asked Questions
 When can I take a shower?
You may shower after surgery.
Leave the dressing in place.
Afterward, remove the
dressing, dry completely, clean
thoroughly with peroxide and
apply a clean dressing. Do not
take a bath until your staples
have been removed and your
incision is healed.
 How long after surgery will I
need to take antibiotics prior to
dental work?
For the rest of your life. It's
recommended that you have
any dental work done prior to
surgery, if possible.
thank you