YOU AND YOUR HIP REPLACEMENT

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1 YOU AND YOUR HIP REPLACEMENT PLEASE BRING THIS BOOKLET WITH YOU TO THE HOSPITAL N/19/Surg/Ortho/-/HipReplacement/Any/10-06/V1/booklet

2 The Niagara Health System (NHS) and Hamilton Niagara Haldimand Brant Community Care Access Centre (HNHB CCAC) Niagara branch will partner with you in your successful recovery after your hip replacement operation. The development of this booklet was a combined effort between the NHS, HNHB CCAC and the following rehab service providers: Community Rehab (CR), and St. Elizabeth Health Care. TABLE OF CONTENTS Introduction Household Safety Check List What is a Total Hip Replacement? Exercises After Surgery Standing Exercises Activities of Daily Living Mobility Stairs What does Weight Bearing Status Mean? Getting Dressed Safety in the Bathroom Getting In and Out of the Car Questions

3 HOUSEHOLD SAFETY CHECKLIST Plan ahead- prepare easy meals in advance. Put away throw rugs. Create clear pathways for walking. Tuck in corners of bedspread. Remove or tie up long telephone cords and/or electrical cords. Have outside paths and walkways cleared of ice and snow. Arrange to have help with heavy housework (i.e. vacuuming). Place commonly used items within easy reach. Carry objects in apron pockets, bag, or walker basket. Use nightlights, especially between your bedroom and bathroom. Wear footwear with adequate support and non-slip soles. If you are using a cane, crutches or walker, check the rubber tips and replace if worn. 3

4 WHAT IS A TOTAL HIP REPLACEMENT? The hip joint is like a ball and socket. On the top of the long thigh bone (femur) is a round head which fits snugly into a cup-shaped space (acetabulum) in the hip (pelvis). The head or ball is replaced with stainless steel. A matching plastic-lined cup is placed into the socket. These parts fit together and move smoothly to allow easy movement. The skin and muscles are cut during the operation and are stitched back together. The diagram below shows the location of and the type of implant used in the surgery. YOUR ROLE IN RECOVERY Your progress will depend on your active participation in the exercise program and your commitment to following the rules provided for you. Continue to do your prescribed exercises, not only with your Physiotherapist, but also on your own. By doing so, you can return to your normal activities as soon as possible. Your family and friends can work with you to help you meet your goals. If you have access to the internet, you may be interested in the detailed information that is available on the website: http//www.myjointreplacement.ca A copy of this information will also be available at the pre-op clinic and at the hospital unit nurse s station. 4

5 EXERCISES AFTER SURGERY 1. ANKLE/FOOT Range of Motion 2. TRUNK STABILITY Gluteal Sets Relax leg. Gently bend and straighten ankle. Move through full range of motion. Do times Do times per day 3. QUAD SETS Push Knee Down Tighten buttock muscles. Hold for 5 seconds; then relax. Do times Do times per day 4. HAMSTRING SETS Push Heels Down Tighten muscles on top of thigh by pushing knees down into the bed. Hold 5 seconds. Do times Do times per day Push your heel into the bed without letting your knee bend. Hold 5 seconds. Do times Do times per day 5

6 5. SLIDE HEEL UP 6. SLIDE LEG OUT TO SIDE: Heel Slides: With your affected leg out straight, slowly slide your heel up towards your buttocks, then slowly straighten the knee. Do times Do times a day 7. HIP AND KNEE STRENGTHENING Gently slide affected leg out to the side and back into the midline. Keep the knee / foot straight. Do times Do times a day 8. KNEE FLEXION/EXTENSION With knee bent over roll, straighten knee by tightening muscle on top of thigh. Be sure to keep bottom of knee on the roll. Hold 5 seconds. Do times Do times a day Sitting well back on a chair, making sure that you don t lean forward, slowly straighten your knee, hold position for 5 seconds. Do times Do times a day 6

7 STANDING EXERCISES 1. Marching 1. Lift knee up and down. Do times Do times a day 2. Leg Swing 2. Lift leg out to the side and back to centre (don t cross over centre). Do times Do times a day 3. Knee Flexion 3. Bend knee, bring heel to your bottom. Do times Do times a day 7

8 Activities of Daily Living Following Total Hip Joint Replacement For at least six weeks following your operation you will have to be careful not to bend or twist your new hip too much. The following rules will help to keep your hip in place while you are healing. Your surgeon will tell you when you can increase your hip movement. Rule 1: 4 BASIC RULES FOR PROTECTING YOUR HIP DO NOT bend your hip more than 90 degrees. For example, when sitting, your knee should not be raised above the level of your hip and you should not bend forward at the waist. Do not crouch or squat. Rule 2: Do not twist your body while you are standing. 8

9 Rule 3: DO NOT cross your legs at the ankles or knees. Rule 4: DO NOT let your operated leg turn inward or outward too far. Try to keep your leg in a middle position. Your therapist will be able to explain the reasons for these precautions. 9

10 ACTIVITIES OF DAILY LIVING (continued) Now that you understand the basic rules for protecting your new hip, you will want to understand how they apply to everyday activities. When you are in the hospital, your Occupational Therapist (O.T.) will review the safest way to manage these activities. You must be careful whenever you change positions. This is the time when you are most at risk for dislocating your hip. Always think about how you are going to move and the position your hip will be in. Lying Down Make sure your bed is high enough so that when you sit down your knees are lower than your hips. The best way to lie in bed is on your back with a pillow between your legs. Avoid water beds. You may lie on your side but be sure to have pillows between your legs to prevent them from crossing. Your nurse or therapist will show you how to turn onto your side safely. 10

11 MOBILITY Lying and Sitting: Your therapist will instruct you on the easiest way to transfer. Keep your body straight and your operated leg out to the side. Move from lying to sitting at the edge of the bed. Do not twist your leg. You may use a strap to assist with this movement 11

12 MOBILITY (continued) Bed to Chair: Sit on the edge of the bed with your operated leg straight out in front. Place your hands on the bed. Use your hands and the good leg to push yourself up from sitting to standing and then reach for the walker. Do not lean forward or grab the walker when moving from sitting to standing. Move the walker forward, first making sure that all four of its legs are flat on the floor. Move the operated leg forward into the walker, remembering the right amount of weight on your operated leg. 1. Walker 2. Operated leg 3. Good leg This pattern is repeated for walking with the walker (i.e. to the bathroom doorway). 12

13 MOBILITY (continued) Standing to Sitting: Feel the back of the chair touching your good leg. Slide your operated leg forward reaching for the arms of the chair behind you. Lower yourself down into the chair. Your knee should always be lower than your hip. Follow the same steps when sitting on a commode chair or raised toilet seat. Never sit down on anything where your hip would be lower than your knee. (See Rule #1 on page 7) Walking the Hall with a Walker: Walk halfway into the walker, with your operated leg first, then your good leg, keeping your hip straight. Avoid twisting your hip or foot. (Rule # 2 on page 7) 1. Walker 2. Operated leg 3. Good leg 13

14 STEPS /STAIRS If there is a safe handrail on the steps, you should use it. The cane will then go in the other hand. Going Up the Stairs 1. Stand close to the bottom step. 2. Hold onto the handrail if there is one. 3. Lift your good leg up first. 4. Lift your cane and the operated leg up to the first step (use the handrail to help lift you up). 5. Climb one step at a time using this pattern Going Down the Stairs 1. Stand close to the edge of the first step. 2. Hold onto the handrail if there is one. 3. Lower your cane and the operated leg onto the first step. 4. Lower your good leg onto the same step. 5. Go down one step at a time using this pattern.. 14

15 WEIGHT BEARING STATUS After your operation, your doctor will advise you how much weight can be placed on your leg and foot for the operated side. Be sure to follow your doctor and physiotherapist s instructions. DO NOT increase the weight on the leg and foot until they have advised you to do so. The following terms will help you understand your weight bearing status. a. Non-Weight Bearing: DO NOT place any weight through your leg on the operated side. b. Feather Weight Bearing or Toe Touch Weight Bearing: Place the toes of your operated leg down on the floor for balance but do NOT put any weight through that leg. c. Partial Weight Bearing: Place less than half your body weight through your operated leg. d. Weight Bearing as Tolerated or Full Weight Bearing: Place as much of your body weight on the operated side as you can tolerate. This means that you can use your full foot. If the pain is too much, you can reduce the amount of weight that you put through your operated leg. Your weight bearing status recommended by your doctor is: Incision 1. Keep it clean and dry 2. Only let it get wet if your doctor says you can. 3. Watch for any increase in pain, redness or swelling around the wound, or drainage from the incision. 4. If any of these symptoms appear, CALL YOUR DOCTOR. Circulation If you have been told to wear elastic stockings, continue to wear them as instructed on during the day and off at night once you are home. 15

16 TIPS FOR GETTING DRESSED Pants/Underwear 1. Sit to get dressed (preferably on a firm back chair with arms). 2. Dress the operated leg first. 3. Use long handled reacher or dressing tabs to bring the pants up past your knees. 4. Pull underwear and pants up over hips while standing and holding onto the walker. Socks 1. Use a Sock Aid 2. Use knee high or higher socks 3. Sit down, keeping knees apart. Pull sock on the sock aid. 4. Drop sock aid to floor and insert foot. 5. Pull up all the way to your knee. Shoes: 1. Slip-on shoes are more practical than laced shoes. 2. Use a long handled shoehorn to position shoe. 3. Place foot in shoe using long shoehorn. 4. Avoid twisting your foot. Elastic shoelaces are available from the Occupational Therapy Department at the hospital or in department stores. 16

17 REMEMBER! Do not bend down to reach below the knee Do not use one foot to push the shoe off the other foot. Do not use a foot stool when putting on shoes or socks IMPORTANT! Chairs, stools, beds should be at least 19 from seat to floor height. Heights may be increased by: Using a firm foam cushion Folded blankets Raising chairs or beds with blocks (wooden or cement blocks) Armrests make getting in and out of a chair easier. Avoid soft or low chairs.. Do NOT bend your hip more than 90 degrees. Sexual Relations: Ask your doctor when you may resume sexual relations. It is advised to assume a passive role while positioned on your back. 17

18 HOW TO USE THE BATHROOM Using the Toilet Follow the same pattern as for getting up/down properly from a chair. You may need to use a raised toilet seat. It fits on the rim of the toilet with the toilet seat up. You may find grab bars or toilet arms helpful to help you get up from a sitting position. Bathing (Tub/Shower) Adjust water flow and temperature before getting in. With walker/crutches, turn your back toward the tub. Sit sideways on the tub chair. Bring your legs into the tub, one at a time, leaning back slightly, keeping legs apart. When bringing in the operated leg, straighten your knee and do not bend your hip more than 90 degrees. Helpful Hints Do not sit on bottom of tub. Your walker should be left outside the tub/shower. Place rubber-backed bath mat under bath chair/bench to prevent slipping. Do not bend forward to adjust water flow once in the tub. Dry yourself before leaving the tub and be sure the floor is dry before standing up. Sit sideways to the sink, rather than facing it. This prevents too much bending at the hip. Aids that will help you Sturdy bath chair/bench with rubber footing. Safety strips on floor of tub. Long handled bath sponge, unless you have help Grab bars. 18

19 Getting In: GETTING IN AND OUT OF A CAR 1. Back up to the car with a walker. 2. Lower slowly and sit sideways on the seat. 3. Slide back into the car until knee crease touches seat. 4. Bring one leg in at a time. 5. Keep knees moderately apart. Getting Out: 1. Bring one leg out at a time, keeping knees apart. 2. Slide forward toward the edge of the seat. 3. Stand up on your strong leg. Remember! Roll down your window part way to assist with positioning. Place a garbage bag or slippery material over the seat to ease with transfers. Enter the car from street level rather than next to the curb. Front seat should be moved back as far as possible. Use firm cushion or folded blankets to raise car seat to a good height before getting in. If car has bucket seats, recline seat slightly. Car travel and driving Check with your doctor. Always remember your 4 BASIC RULES (see pages 8 and 9). 19

20 Please use this space for any questions you may think of and want to ask If you have questions or concerns about your hospital stay you may contact the Utilization Department at your hospital. The numbers are listed below. Welland County General Site Ext Greater Niagara General Site Ext St. Catharines General Site Ext For questions about your care once you are home you may contact HNHB CCAC at and speak to your case manager or call your physiotherapist directly. 20

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