Patient Education for Hip Replacement

Transcription

1 University of Maryland Charles Regional Medical Center for Orthopedics Joint Replacement Program University of Maryland Charles Regional Medical Center for Orthopedics Joint Replacement Program University of Maryland Charles Regional Medical Center Patient Education for Hip Replacement 5 Garrett Avenue P.O. Box 1070 La Plata, MD

2 WELCOME TO UNIVERSITY OF MARYLAND CHARLES REGIONAL MEDICAL CENTER JOINT REPLACEMENT PROGRAM WHAT IS A TOTAL HIP REPLACEMENT? YOUR PATH TO A MORE ACTIVE LIFESTYLE APPENDIX A A. Frequently Asked Questions APPENDIX B F B. Anesthesia C. Pain Management D. Potential Complications E. Patient Rights/Advance Directives F. What to Bring to the Hospital APPENDIX G J G. Total Hip Precautions H. Physical and Occupational Therapy I. Home Safety/Self Care J. Helpful Telephone Numbers

3 Welcome to University of Maryland Charles Regional Medical Center Joint Replacement Program Our goal is to provide the highest quality and innovative care to you in a safe, comfortable and healing environment. The Joint Replacement Program at UM Charles Regional Medical Center is a unique program combining state of the art care with clinical expertise and efficiency, all in your community and with a focus on service excellence. Choosing UM CRMC means access to multidisciplinary care delivered to meet your individual needs. This guide should answer many questions you may have about the care you will receive while at UM CRMC. Having the appropriate information you need, can ease concerns you may have about your joint care and rehabilitation. The UM CRMC Joint Replacement Program was conceived to bring patients with joint problems new hope for greater mobility and painfree living. Our center represents the best of a community hospital environment combined with the talent, skill and compassion of a dedicated group of health professionals. We are proud of the personalized care we provide and the hospitality for which we are known. Best wishes for your improved health.

4 The UM Charles Regional Medical Center: Joint Replacement Program The Joint Replacement Program brings together a variety of disciplines to provide patients access to a full range of services related to joint care and joint replacement. Your team includes a network of physicians, nurses, physical therapists, case managers and occupational therapists specializing in total joint care. Our goal is to transition you from chronic joint pain and/or degenerative joint disease to living pain-free with greater mobility and independence. To achieve this, you, the patient will be involved in all aspects of your care. It is your responsibility, as well as ours, to work toward your independence. About this Guide The Total Hip Replacement Guide will help prepare you for your surgery and recovery. The Guide is designed to give you helpful information on what to expect every step of the way with your total hip replacement. If you have any questions on subjects that are not covered, please ask your doctor, nurse, therapists, or case manager for further information. Remember: This is just a guide. Your physician, nurse, therapists or case manager may add to or change the recommendations. Always use their recommendations first and be sure to ask questions if any information or instructions are unclear.

5 What is a Total Hip Replacement? In order to understand what a total hip replacement is, it is necessary to understand how a healthy hip works. The hip joint is one of the body s largest weight bearing joints. It is a ball and socket joint. The ball is at the top of your thigh bone (the femur) and the socket is at the base of your pelvis. There is cartilage covering the head of the femur. This allows the ball to move smoothly in the socket during motion. The muscles surrounding the hip add support so you are able to be active without pain. An unhealthy or painful hip usually results from wear on the cartilage. Without the cartilage, there is no protection between the bone surfaces of the ball and the socket. The surfaces of the bone become rough and grind against each other. The result is stiffness and discomfort during movement. Conditions that may lead to an unhealthy or painful hip are: Osteoarthritis, Rheumatoid arthritis, previous hip injury, metabolic bone disease and abnormality of growth. Total hip surgery is done to replace a hip joint that has been damaged by injury or arthritis. Generally speaking, the total hip procedure will replace both the ball and the socket of the joint. When your surgeon recommends a total hip replacement, he or she will choose the best artificial hip components (prosthesis) for you. Your surgeon will provide you with specific information based on his or her recommendations. Ask your surgeon if you have specific questions about your surgery or the types of implants available to replace your hip.

6 Your Path to a More Active Lifestyle Modern medicine has made it possible for a stiff and painful hip to be replaced with one that will function nearly the same as a normal healthy hip. It is important for you to realize that you will be responsible for a major portion of your postoperative rehabilitation. Rest assured that there will be many health care professionals to guide you through your rehabilitation step by step. As long as you follow the instructions of your physicians, nurses and therapists, and are willing to follow through with recommended rehabilitation and exercises, you will soon be on your way to a more active lifestyle. If, at any time, you do not understand any of the tests or devices we use, please ask us to further explain.

7 Pre- Operative Visits Before Surgery Pre-Operative visits: your Orthopedic Surgeon and hospital for testing and education. Tests Labwork, x-ray and/or EKG studies as ordered by your physician. Pre-operative nasal swab. Medication s Bring all of your medications to your pre-operative appointments. Be sure to include all prescriptions, over-thecounter medications and vitamins or herbal supplements all in their original containers. You may be instructed by your doctor or nurse to stop some of your usual medication prior to surgery. Preparatio n for Surgery Hospital Visit Planning Your Discharge Pack Your Bag Diet: You will receive instructions to not eat or drink beginning at midnight the night before your surgery. Shower: To reduce the risk of infection, you will receive a bottle of chlorhexadine wash and pre-operative showering instructions. During your pre-operative visit, you will meet with a Nurse, a Physical Therapist and a Case Manager to gather your health history, receive specific pre-surgery instructions,review what to expect in therapy and to begin planning for your discharge. Your Case Manager will help arrange for equipment and post discharge services that you may need following surgery. *Refer to Appendix Home Safety/ADL s for tips on preparing your home for your return from the hospital. The following items must be brought to the hospital with you: ü Total Hip Replacement Guide ü Medications in their original containers or a list with the name of the drugs, how much you take and when you take them. Case Manager: Notes

8 Tests Medications Diet Support Equipment Activity Exercise Self Care Planning Your Discharge Day of Surgery Labwork, x-ray and/or EKG studies as ordered by your physician the morning of surgery and following your surgery. Your physician will review your home medications and continue the appropriate medications while in the hospital. You will not be allowed to keep your personal medications at the bedside. Your physician will also order new medications for pain management, prevention of infection, prevention of blood clots. Nothing by mouth the morning of surgery. (You may be instructed to take a pill with a sip of water before coming to the hospital.) Following surgery, a diet will be started once you are awake. For surgery and recovery you may have one or all of the following: IV, pain management pump, urinary catheter, elastic stockings, sequential compression device for non-operated leg, wound drain, oxygen devices, trapeze on your bed. Abduction wedge in place when in bed. Turn, cough and deep breathe exercises as instructed by nurse. Use overhead trapeze on bed to help with movement. If you have a morning surgery, PT may begin this afternoon. Begin ankle pumps when awake. Staff will assist you with repositioning and personal hygiene. Case Manager will follow-up with plans made during preoperative visit. Notes

9 Tests Medications Diet Support Equipment Activity Exercise Self Care Day 1 After Surgery Labwork and any other x-ray or EKG studies as ordered by your physician. Pain Management continues, preventive antibiotics, anticoagulant therapy based upon daily labwork, stool softeners and sleeping pill may be added to your medications. Advance diet as tolerated. Try to drink plenty of fluids to prevent constipation. Wound drain and urinary catheter may come out today. Continue with IV, sequential compression device, elastic stockings and oxygen as needed. Follow Hip Precautions. Abduction wedge in place when in bed. Physical Therapy (PT) twice a day: Out of bed to a chair; Walk with a walker. Leg exercises with PT. Breathing exercises with incentive spirometer, every 2 hours to help prevent pneumonia and to maintain good lung function. Begin own self care with instruction and assistance from Occupational Therapy (OT) and Nursing. Feed yourself and bathe face and upper body. Begin use of bedside commode. Notes

10 Planning Your Discharge Case Manager will follow-up with plans made during pre-op visit. Tests Medication s Diet Support Equipment Activity Exercise Self Care Labwork Day 2 After Surgery Pain Management switches to oral form, anticoagulants continue based on daily lab results. Continue your regular diet. To help prevent constipation, eat plenty of fresh fruits and vegetables and drink several glasses of fluids daily. Continue as needed, with IV, oxygen and elastic stockings. Follow Hip Precautions. Abduction wedge in place when in bed. PT twice a day: Out of bed to a chair; Walk in hallway with a walker or crutches; Practice on stairs, if needed for home; Discuss getting in and out of a car. Leg exercises with PT. Breathing exercises with incentive spirometer, every 2 hours to help prevent pneumonia and to maintain good lung function. Advance with own self care with instruction and assistance from OT and Nursing. Begin use of bathroom. Notes

11 Planning Your Discharge Case Manager will confirm plans for home to include any equipment and ongoing therapy needs. Tests Medications Diet Support Equipment Activity Exercise Self Care Labwork Day 3 After Surgery Continue oral pain medications as needed, anticoagulants based on daily lab results. Continue your regular diet. To help prevent constipation, eat plenty of fresh fruits and vegetables and drink several glasses of fluids daily. Stockings as ordered, orthopedic devices. Follow Hip Precautions. Abduction wedge in place when in bed. PT twice a day: Out of bed to a chair; Walk around hallways with a walker or crutches; Practice stairs if needed. Leg exercises with PT. Breathing exercises with incentive spirometer, every 2 hours to help prevent pneumonia and to maintain good lung function. Advance with own self care with supervision from OT and Nursing. Use bathroom. Notes

12 Planning Your Discharge You and your family will receive verbal and written discharge instructions: medications, care of your incision, signs of infection, signs of blood clots, nutrition. PT and OT will continue at home, as an outpatient or in a Rehab Center. Tests Medications Diet Activity Exercise After Discharge From the Hospital Labwork to monitor therapeutic range of anticoagulant. Anticoagulant, pain medications and home medications as ordered by physician. Continue regular diet. To help prevent constipation, eat plenty of fresh fruits and vegetables and drink several glasses of fluids daily. Follow Hip Precautions. Abduction wedge in place when in bed. Continue to use walker or crutches until advanced by your PT or Orthopedist. Your Orthopedist will let you know when you can return to driving and to work. Continue with leg exercises as instructed by your PT. Your exercise program will be advanced as you continue in PT. Notes

13 Self Care Follow-Up Continue with your own self care using adaptive equipment as instructed by your OT. Begin to resume your normal responsibilities in the household. Follow-up with your Orthopedist. PT and OT will continue at home, in a Rehab Center or as an Outpatient.

14 Appendix A. Frequently Asked Questions 1. What are the major risks of surgery? Infection an blood clots are two serious complications of joint replacement surgery. These risks are minimized by the use of antibiotics and blood thinner medication. Please read more in the Appendix on Complications. 2. How long is the surgery? Approximately 2-2 ½ hour is reserved. Some of this time is preparation in the operating room. 3. Will I be asleep during surgery? Some patients hav a general anesthetic, commonly called being put to slee Others have an epidural or spinal to numb the legs. The is still some level of sedation with each method. These w be discussed between you and your anesthesia care providers. 4. Who will perform my surgery? Your orthopedic surgeon and a team of operating room staff. 5. How long will the scar be? Usually about 6 long, along the hip and thigh. This can vary from person to person. Ask your surgeon what to expect. 6. Will I need blood? You may need blood during or afte your surgery. Please read more in the section Blood Transfusions 7. How long will the hip last? Most prosthetic hips last years or longer. There are no guarantees and a second replacement may be needed when the artificial surface loosens from the bone or the cup liner wears dow over time.

15 8. Will I have any pain? As with any surgery, there will be some discomfort from the incision and placement of the prosthesis. Medication will be provided through an IV or epidural catheter initially. After the first day, your medication will be changed to an oral form preparing you for discharge. You may still have pain for several weeks as you heal but this should be different from the pain you had prior to surgery. Eventually, the prosthesis will relieve the pain and stiffness that led to your surgery. 9. Is there anything that will damage the new hip? Yes, please refer to the section Total Hip Precautions. 10. How long will I be in the hospital? Average stay is 3-4 days, but may vary depending on your general health before surgery. Before leaving you should be able to: a. Walk safely with a walker or crutches. b. List precautions for your new hip. c. Perform activities of daily living (i.e. bathing, dressing, using the bathroom, etc.). d. Do your own exercises. 11. Will I need help after I leave the hospital? Yes. Your individual needs will be discussed with your case manager. The amount of assistance will vary depending on the preparations you made prior to surgery and your progress as you leave the hospital. 12. How long will I need a walker or crutches? This varies by each person, but the average use is 4-8 weeks following surgery. Thereafter a cane may be recommended. Your physical therapist will work with you until you are safe and confident with ambulating. Your physician will also check the healing process of the joint with X-rays and tell you when it is safe to discontinue the assistive device.

16 13. Will I need any special equipment? Yes. You will need a shower/tub chair and grab bars to make bathing easier and safer. Other devices that may be helpful are a reacher, a long-handled shoehorn, a sock aid, elastic shoelaces and a long handed sponge. 14. When can I resume my normal activities? a. Work: This time frame will depend on the type of work you do and your physical progress. The actual timing should be discussed with your orthopedic surgeon. b. Physical/recreational activities: Avoid high-impact activities and injury-prone sports (running, tennis, skiing, etc.) Low-impact activities such as walking, dancing golf, swimming, bowling and gardening are fine. c. Sexual activity: You should wait at least 3-6 weeks, or as directed by your physician, before resuming sexual intercourse. d. Driving: You may not drive until cleared by your surgeon usually at least 6 weeks.

17 B. Anesthesia 1. What types of anesthesia are available? The risks and benefits of each type of anesthesia as they pertain to your medical history will be discussed with your anesthesia provider before surgery. a. General anesthesia provides total loss of consciousness, a breathing tube is required b. Regional anesthesia provides numbness, loss of pain or sensation to a region of the body through a localized injection sometimes referred to as blocks, spinal, or epidural. Other medications may be given to help you relax and not be aware of your surroundings. 2. Who administers the anesthesia? Board certified or Board-eligible physician anesthesiologists and certified nurse anesthetists (CRNA) work together to oversee your anesthesia care. 3. Are there side effects? Nausea and vomiting are common side effects of anesthesia. Medications can be given to help prevent and treat this if necessary. Anesthesia staff will discuss risks, benefits, and side effects of the different types of anesthesia you decide upon. It is important to share all medical history with your anesthesiologist to include: any medications (prescription or over-the-counter), herbal or vitamin supplements, recreational drugs, smoking/tobacco use, alcohol use, previous complications with anesthesia (either yourself or an immediate family member) as these may all impact your treatment and recovery.

18 C. Pain Management As with any surgical procedure, there is an incision and a great deal of tissue manipulation that leads to pain and soreness post-operatively. Medications, positioning and exercise will help manage this pain while in the hospital and, over time, the pain will decrease. Pain medication may be offered through different methods. Your Orthopedist and Anesthesiologist will decide on the best methods to meet your individual needs. 1. IV (Intravenous): Puts fluids including medications into the blood stream through a small tube over a period of time. 2. PCA (Patient-Controlled Analgesia): The PCA attaches to an IV infusion and allows the patient to push a button when pain level is increasing. The pump is programmed to only deliver a certain amount, regardless of the times pressed. 3. Epidural Pain Control: A catheter inserted by the anesthesiologist into the epidural space along the spine. A pump will attach to the catheter to deliver the medication. The epidural also has a patientcontrol setting. 4. Intra-Operative Injection: During the surgery, the Orthopedist injects pain medication directly into the surgical site. 5. Medication by mouth: Pain management medication may be started prior to surgery or soon after surgery. A side effect from many pain medications is constipation. Coupled with the reduction in activity due to surgery and pain, this could be bothersome for some individuals. To prevent the side effect of constipation and to promote healing of your wound, drink plenty of fluids and eat wellbalanced meals.

19 D. Potential Complications As with any major surgery, there are potential complications. Below is a list and description of some common complications. Bleeding Prior to surgery, lab work will be drawn to determine your blood levels are stable enough to undergo surgery. Daily labs will be drawn after surgery to monitor these blood levels. If your blood count becomes too low, a transfusion may be needed. Blood can be obtained from the local blood bank supply at the hospital. This is the quickest access to blood replenishment. Other options for transfusions would be an autologous or directed donation. Both of these options require more time and testing. An autologous donation is your own blood donated weeks before surgery that is saved for your use only if needed. If your surgeon suggested you donate your own blood for your upcoming surgery, you may be prescribed an iron supplement to maintain a healthy iron level in your blood. A directed donation is someone you select to donate their blood for you provided their blood is compatible with yours. The donated unit(s) would be reserved for you in the event you need it. The amount of drainage on the dressing or through the drain and lab values and vital signs will indicate the need for a blood transfusion.

20 D. Potential Complications As with any major surgery, there are potential complications. Below is a list and description of some common complications. Bleeding Prior to surgery, lab work will be drawn to determine your blood levels are stable enough to undergo surgery. Daily labs will be drawn after surgery to monitor these blood levels. If your blood count becomes too low, a transfusion may be needed. Blood can be obtained from the local blood bank supply at the hospital. This is the quickest access to blood replenishment. Other options for transfusions would be an autologous or directed donation. Both of these options require more time and testing. An autologous donation is your own blood donated weeks before surgery that is saved for your use only if needed. If your surgeon suggested you donate your own blood for your upcoming surgery, you may be prescribed an iron supplement to maintain a healthy iron level in your blood. A directed donation is someone you select to donate their blood for you provided their blood is compatible with yours. The donated unit(s) would be reserved for you in the event you need it. The amount of drainage on the dressing or through the drain and lab values and vital signs will indicate the need for a blood transfusion.

21 Blood Clots Surgery may slow the blood flow in your body. When the blood is not circulating adequately it begins to coagulate creating clots. Thrombophlebitis or deep vein thrombosis occurs when the blood clots form in the large veins of the legs. Symptoms include swelling in the leg that does not go away with elevation, pain, tenderness, redness or warmth in the calf and calf pain while performing ankle pumps. If these signs of blood clots in the legs go unnoticed, the clot may dislodge and travel through the body and become stuck in the lungs causing a pulmonary embolus (PE) which is now an emergency. Signs of a PE include: sudden chest pain, difficulty and/or rapid breathing, shortness of breath, sweating, confusion and unexplained fever. The following treatments are steps to avoid or prevent thrombophlebitis: Blood-thinning medications (anticoagulants, aspirin) Elastic stockings (TED hose) Pneumatic compression device on feet Foot elevation Foot and ankle exercises Infection Infection occurs in a small percentage of patients despite efforts of prevention. Signs of infection include increased swelling, redness or pain at the incision; change in color, amount, or odor drainage; increased pain in hip; or fever greater than 101. Antibiotics are given during surgery and the day after to prevent infection. You may need to take preventative antibiotics for dental work and other potentially contaminating procedures for at least 2 years.

22 Hand hygiene is the single most important step in preventing the spread of infection. Please wash your hands frequently and before changing your dressing. E. Advance Directive We will ask if you have an Advance Directive. This is a means of communicating to your caregivers your wishes regarding health care issues in the event you are unable to communicate your wishes. If you have an Advance Directive, please bring a copy with you to the hospital so that they may be added to your medical record. Types of Advance Directives: Living Wills are written instructions that explain your wishes for health care if you have a terminal condition or irreversible coma, and are unable to communicate. Health-Care Proxy names a representative to make health-care decisions, if you cannot. A Health-Care Proxy may also be called a Medical Power of Attorney or Health Care Agent. Health Care Instructions are your specific choices regarding use of life sustaining equipment, hydration and nutrition and use of pain medications.

23 F. What to Bring to the Hospital Your Total Hip Replacement Guide Your medications in their original containers or a list with the name of the drugs, how much you take and when you take them including non-prescription medications and any supplements if these were not shared with the nurse during your pre-operative appointment Your insurance cards A copy of your Advance Directives A pair of well-fitting shoes suitable for walking Loose-fitting pajamas or a robe Personal hygiene items (toothbrush, deodorant, comb, etc.) Any medical support devices given at your pre-op appointment such as a walker or Incentive Spirometer Please do not bring: electrical items jewelry valuables cash or checks wallet with credit cards

24 G. Total Hip Precautions To help you progress after your total hip, please follow these precautions: DO NOT bend your hip greater than 90 (for at least 3 months). DO NOT cross your legs at the knee or ankle (for at least 3 months). Place a pillow between your legs when in bed to remind yourself not to cross your legs. DO NOT rotate your knee or foot inward (for at least 3 months). DO NOT lean forward more than 90 (this includes reaching forward to engage a recliner) or lift your knee when seated. DO NOT sit in low or overstuffed chairs or sofas, rocking chairs, chairs that swivel, or have wheels. DO NOT pivot or twist on your operated leg while standing or walking. Take small steps when you turn. DO follow the instructions about how much weight you can put on your operated leg when standing and walking. DO use your walker or crutches until your Orthopedist or Physical Therapist instructs you to stop. DO complete your exercises as instructed by your therapist. DO hold on to the arms of your chair or the bed surface when standing and sitting. Avoid pulling on your walker. DO use a raised toilet seat at home and the handicap toilet in public restrooms. DO use the safety equipment recommended by your Occupational Therapist when bathing, dressing and toileting.

25 G. Total Hip Precautions To help you progress after your total hip, please follow these precautions: DO NOT bend your hip greater than 90 (for at least 3 months). DO NOT cross your legs at the knee or ankle (for at least 3 months). Place a pillow between your legs when in bed to remind yourself not to cross your legs. DO NOT rotate your knee or foot inward (for at least 3 months). DO NOT lean forward more than 90 (this includes reaching forward to engage a recliner) or lift your knee when seated. DO NOT sit in low or overstuffed chairs or sofas, rocking chairs, chairs that swivel, or have wheels. DO NOT pivot or twist on your operated leg while standing or walking. Take small steps when you turn. DO follow the instructions about how much weight you can put on your operated leg when standing and walking. DO use your walker or crutches until your Orthopedist or Physical Therapist instructs you to stop. DO complete your exercises as instructed by your therapist. DO hold on to the arms of your chair or the bed surface when standing and sitting. Avoid pulling on your walker. DO use a raised toilet seat at home and the handicap toilet in public restrooms. DO use the safety equipment recommended by your Occupational Therapist when bathing, dressing and toileting.

26 H. Physical and Occupational Therapy Physical and Occupational Therapy will begin the morning after or the afternoon of your surgery. The focus will be on getting out of bed, walking with a walker, activities of daily living (bathing, dressing, toileting, etc.), and exercise. We encourage your family/care supporters to attend the therapy sessions for training in how to safely provide support while in the hospital and after discharge. Your exercises are an important part of your Rehabilitation Program. The exercises will help you regain motion/flexibility and strength. The exercise sheets that follow may be modified for your individual needs. You should continue your exercises after your discharge from the hospital. The Physical Therapist you see after discharge will update your exercise program as you make progress. *Your Physical Therapist and Occupational Therapist can be reached at Physical Therapist Name Occupational Therapist

27 I. Home Safety and Activities of Daily Living Suggestions for home safety modifications to consider before returning home. 1. Have a light within easy reach or set up nightlights in the bedroom, bathroom, and hallways to maintain good lighting at night. 2. Arrange furniture to allow easy passage with a walker or crutches. 3. Have a firm and supportive chair with arm rests available to sit in. If the seat is too low, place a pillow in the seat of the chair to raise it to the correct height. 4. Check your home for cords, toys, pets, throw rugs that can increase your risk to trip and fall. Remove or relocate items as needed. 5. If possible have a cordless phone available in case of emergency. 6. Use a tub seat or shower bench when showering. 7. Use special devices for bathing and dressing: long handled sponge, shoe horn, sock aid. 8. Use a reacher for reaching and retrieving light objects from the floor or overhead. 9. Review your fire / emergency exit plan at home. Have a plan for a safe and unobstructed exit from your home.

28 J. Helpful Telephone Numbers Medical Center Medical Center/Toll Free Billing/Patient Accounts Discharge Planning Financial Counseling Gift Shop/Snack Bar Information Desk Laboratory Services Notary Services Nutritional/Menu Services Pain Management Pastoral Care Services Patient Information Patient Registration Physician Referral Quality Management Radiology Services Rehabilitation Services Safety and Security For more information about University of Maryland Charles Regional Medical Center, visit our website:

29 Questions for my Physician

30 5.