Welcome to the Dudley Group Foundation Trust Orthopaedic Department.

Transcription

1 Total Hip Replacement Welcome to the Dudley Group Foundation Trust Orthopaedic Department. Introduction This booklet is designed to provide information about total hip replacement and what to expect before and after surgery. Instructions are provided to help you prepare your surgery, recovery and rehabilitation. It is recommended that you read this booklet before your surgery and write down any questions you may have. If you have any questions please feel free to ask a member of staff. Our aims are to ensure your hospital stay is as comfortable as possible. What are the alternatives to a total hip replacement? Osteoarthritis is a common complaint. There are many treatments for arthritis. These include: Staying active: taking regular exercise could lessen your pain. Try swimming or walking Keep your weight down: carrying extra weight puts a strain on your hip joint. This is likely to make your pain worse. If you are overweight, losing weight may be all you need to do See a physiotherapist: physiotherapists can teach you specific exercises to strengthen your hip and keep it mobile Get help with mobility: There are lots of different devices to help you move around more easily and confidently, including walking sticks and other walking aids It also helps if you ve got friends and family to support you. Anxiety and depression can make your pain worse. Keeping active and optimistic will reduce your risk of becoming disabled by your arthritis. Treatment with drugs Painkillers will help to control your pain. There are two kinds of painkillers that ease the pain of osteoarthritis: paracetamol and a group of drugs called non-steroidal antiinflammatories (NSAIDS). Your doctor will suggest the most appropriate treatment for Total Hip Replacement 2011 Page 1

2 you. Some pain killers come as a cream or gel to rub into the skin around your affected hip joint. Total Hip Replacement What is it? Total hip replacement is a surgical procedure for replacing the hip joint. The joint is composed of two parts a ball and a socket. During the surgery these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The new socket is made of high density plastic, whist the new ball and the stem are made of strong metal. Computer Navigation Your surgeon may use a computer system consisting of infrared camera s and instruments that reflect light back to the camera to create an image of the hip joint during the operation. This permits the surgeon to finely adjust the position of the new hip during surgery. When using this system, pins are required to be temporarily inserted into the bone; they are then removed once the new hip is inserted. This requires two very small cuts (half a cm long) to be made on the skin over the thigh bone and over the pelvis bone, which is in addition to the usual scar over the side of the hip. When do we consider Total Hip Replacements? Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or avascular necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over the age of 55, but the operation is occasionally performed on younger people. Circumstances vary, but generally patients are considered for hip replacements if: - Pain is severe enough to restrict not only work and recreation, but also the ordinary activities of daily living Pain is not relieved by medicines There is significant night pain leading to sleep disturbance There is significant stiffness of the hip restricting activities X-rays show advanced arthritis Total Hip Replacement 2011 Page 2

3 What are the benefits? A total hip replacement aims to provide pain relief, improve mobility and improve quality of life. It should allow you to carry out many normal activities of daily living. The artificial hip may allow you to return to active sports or heavy work under your surgeon s instructions. What are the risks of a Total Hip Replacement? Don t panic! As with all procedures this operation carries some risks and complications. All this may sound extremely gloomy when you hear it all together. However it is important that we inform you of these risks so that you may make an informed decision about your proposed surgery. Common risks (2-5%) Blood clots A deep vein thrombosis (DVT) is a blood clot in a vein. These usually present as red, painful, swollen legs. The risks of a DVT are greater after any surgery and especially after bone surgery. Although not a problem themselves, a DVT can pass in the blood stream and deposit in the lungs (pulmonary embolism PE). This is a very serious condition which affects your breathing. To limit the risk of DVT s forming, you will be prescribed medication to thin your blood. This is given through a small needle under the skin, usually into your tummy area. Unless contraindicated, you will also be provided with some elasticated stockings that are specific to your own calf and thigh measurements. Nursing staff will advise you on the application and care of your stockings. Starting to walk and getting moving is one of the best ways to stop blood clots from forming. Bleeding This is usually small and can be minimised in the operation. However, large amounts of bleeding may need iron tablets or blood transfusion (rarely associated with transfusion reactions or infection). Rarely, the bleeding may form a blood clot or large bruise within the wound which may become painful and require an operation to remove it. Total Hip Replacement 2011 Page 3

4 Pain It is normal to experience some discomfort after the operation. If you are in pain it is important to tell staff so that appropriate pain killers can be given. Pain will improve with time and is rarely a long term problem. Prosthesis wear/loosening Most hip replacements last over 15 years. The reason is often unknown. Implants can wear with over use. The reason for loosening is also unknown, however sometimes it is secondary to infection. This may require removal of the implant and revision surgery. Altered leg length The leg which has been operated upon may appear shorter or longer than the other. This rarely requires a further operation to correct the difference or shoe implants. Dislocation Your new hip will most certainly have a smaller ball and socket than your own hip. The surgeon will align the components in such a way as to minimize the risk of dislocation. Nevertheless there are a small number of patients who have problems with repeated dislocations. These usually require admission to hospital as an emergency to put the hip back and can mean more surgery to correct it. Those more likely to have problems are patients with poor muscles or patients who for any reason manage to get their hip in a bad position. Dislocation is more likely in the first 3 months. After that the forming scar usually offers some added protection, but after your hip surgery you will always need to exercise some caution to avoid problems. During your hospital stay a special cushion known as a charnley wedge will be placed between your legs when you are in bed. This position minimises the risk of dislocation. When you are at home you can use an ordinary pillow in place of the wedge when in bed. Fracture There is a risk of fracture (crack in the bone) occurring. This is usually treated with a wire loop around the bone and protected walking with crutches is needed for a few weeks. If you have a heavy fall on your implant it is possible to break the bone around it and these fractures can be tricky to sort out. Total Hip Replacement 2011 Page 4

5 Less common risks (1-2%) Infection You will be given three doses of antibiotics after your operation via the drip in your hand. This will help in the prevention of infection. If there is anything that makes you think there may be some infection, however minor, please contact the ward you stayed on so that we can check it early. Signs of infection Swelling Discharge or oozing from the wound Pain Warmth Redness around the wound Edges of any part of the wound separated or gaped open If there is evidence of infection, this is usually treated with antibiotics. An operation to washout the joint may be necessary. In rare cases, the implants may be removed and replaced at a later date. The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required. If you think you may have an infection you should contact the hospital and be seen by one of our doctors. It is very important that a decision is taken by an experienced surgeon so that you may be assessed to determine whether you require a course of antibiotics. Methicillin Resistant Staphylococcus Aureus (MRSA) and hospital acquired infections The Dudley Group is rigorous in its approach towards avoiding the spread of infections including MRSA. We screen all orthopaedic patients having planned operations for MRSA prior to admission and we emphasize the importance of handwashing and the use of hand cleansing gels, to staff, patients and visitors. Nerve damage There is a nerve called the sciatic nerve that runs very close behind the hip. If it is damaged it is usually by being stretched. Total Hip Replacement 2011 Page 5

6 This occurs very rarely, but we always mention it because those few patients who experience it are generally unhappy after their hip replacement and some do not feel they are much better off. The main consequence is foot drop. If the nerve does not recover it can be necessary to wear a splint to prevent tripping over the foot whilst walking. The femoral nerve runs in front of the hip and damage to this leads to weakness extending the leg (straightening the knee). Revision Surgery This has been mentioned several times above. The commonest reasons for requiring to revise or redo a hip replacement are: infection, dislocations, loosening, wear or a fracture. Revision surgery carries a higher risk that first time around surgery, things are more scarred up in side, the operation takes longer and the muscles are a bit weaker after the first surgery. If you are young your surgeon will have emphasized this as the chances of you requiring a revision at some stage are higher. This needs to be considered when making a decision when to go for surgery. Preparing for surgery Preparing for a total hip replacement begins as soon as the decision for surgery is made. The following issues will be addressed: Suitability for anaesthetic Patient information/education Opportunity to meet patients awaiting similar surgery/to meet people who have recovered from similar surgery Joint School It will be necessary for you to visit the hospital a few weeks before your surgery. The assessment begins with an interview by the Orthopaedic Nurse concerning your past medical history and current medications. A range of investigations will be carried out: - Routine blood test Routine ECG (heart trace test) Blood pressure, pulse and weight X-ray: if your last x-ray was over 6 months ago, a repeat x-ray will be required. You will be screened for MRSA. (A nasal and groin swab to detect infection). Total Hip Replacement 2011 Page 6

7 Following your assessment, please contact the unit if you develop any of the following: - A cold, chesty cough, throat infection Skin problems, for example abrasion / lacerations, rashes, infections, especially on the area that is to be operated on Dental abscess In growing toenail, athlete s foot, or any foot infection Any urine infections What you will need to bring into hospital Please bring night attire, toiletries etc. You will also require loose comfortable daywear, we advise ladies wear a skirt or a dress, gentlemen wear shorts, (for when you commence your physiotherapy and also your wound can be easily observed) also, please wear flat shoes/slippers. Please do not bring open back sandals or slippers. NB: Please bring in a supply of your routine medications, and remember to order your repeat prescription before you are admitted to hospital. The hospital will supply any new medications you are prescribed on your discharge home. What you will not need Ladies please do not wear any make-up or nail varnish, (including toe nails). All jewellery must be removed prior to surgery and we advise you to leave your jewellery at home. Wedding rings can be worn. Please refrain from bringing in any electrical items as these cannot be used within the hospital. Ward Admission You will be admitted to hospital on the day of surgery. Visiting times are: On admission to the ward you will be shown to your bed and locker, where personal belongings can be stored. It is important that valuables, for example, jewelry and large cash sums are not bought into hospital, as the Trust will not accept responsibility for loss or damage, (you will have signed a Trust disclaimer form during your assessment.) Total Hip Replacement 2011 Page 7

8 You will be seen by: - A member of the Nursing Team, who will complete the admission details. You will see your Consultant or Senior Doctor, prior to surgery. The Ward Doctor will examine you. The Anaesthetist will assess you. You will be seen by the theatre nurse. The Physiotherapist may see you, to explain your post-operative regime A member of the therapy team will advise you how to carry out daily activities safely. She will aim to make you as independent as possible. You may require equipment such as: A raised toilet seat. Helping hand. Long handled shoe horn If you live alone a nominated key holder will be needed to deliver equipment. Morning of your surgery: A clean theatre gown, underpants and cap are provided. A nurse may also measure you for some elasticated stockings. These are knee high or thigh length and are worn during your stay in hospital and for 6 weeks post operatively to help prevent blood clots forming in your legs, if requested by your Consultant. A nurse and porter will escort you to the operating department. Immediately after surgery: When you return from theatre you will be lying on your back with either a wedge between your legs or a foam gutter splint separating your legs. This is to prevent you from crossing your legs whilst in bed. A nurse will monitor you frequently. This is routine and nothing to be concerned about. A nurse will be: - Checking your blood pressure, pulse rate breathing and temperature, this is carried out by a machine and displayed on a screen. Checking your oxygen mask (you will probably only need to wear this for a few hours) Total Hip Replacement 2011 Page 8

9 You will have autologous blood transfusion post surgery, this is a means where blood from your wound site is collected via a drain and then transfused back into your blood system. In addition to the above, you may require a further transfusion of blood. Checking the drain sites and wound for any oozing. The drains are small tubes coming out from the wound area and remove fluid, which helps to prevent excessive swelling and bruising. A nurse will remove the drains after 24 hours. Monitoring your pain you may feel weak following the operation but you should not be in severe pain. Strong painkillers will be given either through an infusion pump or by patient controlled analgesia. If you require the toilet, a bedpan/urinal is used until you are up and out of bed, which is usually within 24hours of your surgery or much sooner. If you are back from theatre before 3pm and are feeling well may get out of bed and mobilize. Post Operative Regime Your intravenous infusion (drip) will be removed and a normal diet resumed. Occasionally some people s appetite may take longer to return. Assistance will be given with personal hygiene whilst you are in bed and a reminder to carry out your exercises. A check x-ray is carried out as a routine procedure to ensure that the hip is in a good position. Please note, depending on your consultant, the check x-ray may be carried out in Theatre. X-ray not needed to be taken or seen prior to mobilising especially with enhanced recovery. As soon as you are safe with the frame your physiotherapist will progress you to elbow crutches, this may be the same day if you are walking well. Once you have been shown how to get out of bed, you should be able to wash yourself at the sink and get dressed with your own clothes, therefore please bring into hospital some loose comfortable clothing with you. Once you feel confident on your elbow crutches, your physiotherapist will show you how to go up and down and stairs. If you do not have stairs at home it is not necessary to be taught how to climb them. You continue on elbow crutches until your out patient physiotherapy appointment, which is approximately 4 weeks post surgery. Total Hip Replacement 2011 Page 9

10 Preparing For Discharge on Day 3 The Therapy Team will continue to practice getting you on and off the bed, chair and toilet, and discuss with you the various methods to allow you to continue with normal activities of daily living, e.g: getting washed and dressed or making a drink or meal. If you do require any equipment for use at home, the Occupational Therapy Department will arrange for its delivery and will need access to your house. Please have available a nominated key holder to help us to do this. If you remain as an inpatient you will continue with your therapy as planned and continue with the exercises and mobilization. Sutures or staples are removed between the 12 th and 14 th day after the operation. An appointment will be arranged for you. You will only be discharged home when you have completed all assessments safely. If you are requiring further assistance or rehabilitation the ward staff will discuss this with you and liaise with other agencies as appropriate. So you can start making plans for home, your team will discuss your anticipated length of stay with you before or on admission. On admission, your expected date of discharge will be confirmed with you. We expect you to be fully involved in planning your own discharge. If you live alone you will be able to go home alone. We will make sure you are safe and independent in all tasks e.g. washing, dressing and kitchen activities. We advise that you may travel home in a car, where possible and that you should make arrangements for your own transport when ready for discharge home. We want to make sure that you go home as soon as you are well enough and are not kept waiting to be discharged. We have developed a service, which assesses your suitability for discharge home. A senior nurse or another member of the multidisciplinary team to include Occupational therapy or physiotherapy does this after your Consultant and medical team has completed your treatment. This is known as multidisciplinary team led discharge. Total Hip Replacement 2011 Page 10

11 On discharge you will be provided with the following: - A follow up appointment is given for a check up in 6-8 weeks. We will check you have a good supply of your routine medication prior to your discharge home and prescribe any new medications. Arrangements for Outpatient Physiotherapy the appointment will be posted to your home. Do s and Don t s Care of your new hip joint: - These precautions are for a period of 6 weeks following your surgery. Do not bend your hip beyond 90 degrees (a right angle) Do not sit on low seats/toilets Do not bend forwards to put shoes or tights on or pick up objects from the floor, or cut your toenails. Do not cross your legs at the ankles or at the knee. Do not twist when standing. Do not drive a car for at least 6 weeks Do not stand for long periods of time Do use your adaptive aids eg. Shoe horn and helping hand Do keep your knee moving to avoid stiffness Remember if all goes well, in a few months time you will not have to observe all these precautions. The new hip joints should not be subjected to rigorous sporting activity. Follow doctor s instructions. Your surgeon, physiotherapist, occupational therapist and nurses are striving to make a painless, functional hip possible for you. The real success of your hip replacement, however, depends partly on you especially how well you exercise and how well you plan your rehabilitation. Advice at home Rehabilitation at home is an extension of what you have been practicing on the ward over the last few days. Ensure that you adhere to the dos and don ts listed in the booklet over the next 6 weeks. Total Hip Replacement 2011 Page 11

12 Ensure that if you develop any minor infection or require any dental treatment it is very important you visit your own doctor or dentist. You may need a course of antibiotics to treat the infection. If you experience some swelling in the leg there is no need to be alarmed slow down for a day or two and rest the leg in an elevated position. However, If your calf swells excessively and becomes painful; consult your family doctor or contact the ward. Exercises following a Total Hip Replacement You will be given exercises on the ward to continue on discharge. When do I return to the clinic? Your first appointment is approximately 6 weeks after discharge. At your 6-week followup appointment you will be examined and your progress will be assessed. Future appointments will then be arranged as necessary. Should I have a total hip replacement? The total hip replacement is an elective operation; it is not a matter of life or death. There are always non-operative alternatives. The decision to have the operation is not made by the doctor, it is made by you. It is important that you consider the risks and possible complications before you decide to have your hip replacement. The doctor may recommend the operation; however your decision must be based upon weighing the benefits of the operation against the risks. All your questions should be answered before you decide to have the operation. Please feel free to ask any questions you have in order to make your decision easier. Total Hip Replacement 2011 Page 12

13 Further Information After reading this booklet, if you have any further questions or comments you wish to make please contact: Gail Parsons Nurse Consultant Trauma & Orthopaedics Monday-Friday 8am-4pm ext 4465 Ward B Nurse in charge (any time) Staff are pleased to offer advice and to answer any questions you may have regarding your operation. Originators: Mr. M. Ahmed Consultant Otrthopaedic Surgeon. Gail Parsons Nurse Consultant, Trauma & Orthopaedics Lisa-Anne Tanner Advanced Nurse Practitioner Nicci Plant Lead Nurse Jo McDonnell, Physiotherapist Alison Shaw, Therapy Assistant Practitioner Date Originated: February 2010 Version: 2 Date for Review: February Total Hip Replacement 2011 Page 13