Repairing a broken hip (Hip hemiarthroplasty surgery) An information guide

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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Repairing a broken hip (Hip hemiarthroplasty surgery) An information guide

2 Repairing a broken hip (Hip hemiarthroplasty surgery) Introduction This type of surgery is most commonly used to treat a broken (fractured) hip. This procedure is usually performed as emergency surgery so you are unlikely to have had time to prepare yourself for the prospect. It involves a major operation, and there are some risks, as with all types of surgery. The surgery In this operation part of the hip joint is replaced. The hip joint is a ball and socket joint. The ball is formed by the head of the thighbone (femur) and fits snugly into the socket (acetabulum) of the hip joint. In a hemiarthroplasty it is the ball part that is replaced by a metal ball on top of a stem. The metal stem is placed in the femur and secured either by cement or by direct contact with the bone. 2

3 What is the benefit of having this operation? When you have a fractured hip the femoral neck is often involved. This blood supply to the femoral head (the ball part of the hip joint) is often damaged when you break your hip, and this can lead to decay of the bone at the femoral head. Where there is a high risk of this blood supply being affected the surgeon will often recommend a partial joint replacement (hemiarthroplasty) rather than trying to fix the fracture, for example by using screws or pins. In this way you are less likely to need further surgery. What are the risks of having a hemiarthroplasty? Complications can occur with all major surgical procedures. Some of the complications of this surgery are: Infection Sometimes the wound is slow to heal and the stitches may need to 3

4 be left in longer than usual. Following surgery a small number of patients develop an infection in the joint. If an infection does not respond to treatment, it may be necessary to undergo further surgery (BMJ 2010). There is a small risk of developing a chest infection after surgery. This risk increases if you already have chest problems. (Parvizi et al 2007) (BMJ 2010). Thrombosis With this operation there is a reported risk of developing a blood clot in the veins of the leg (a deep vein thrombosis or DVT). This may occur with any operation and steps will be taken to prevent this. The main method of prevention is to get you mobile as soon as possible. Blood clots cause swelling in the leg, usually in the calf muscles and may be accompanied by pain or a burning sensation. In a small number of cases these clots travel to the lungs and cause a blockage (pulmonary embolism or PE), preventing normal breathing. This can occasionally be fatal. (Parvizi et al 2007) (BMJ 2010). Dislocation One in fifty people may suffer a dislocation after a hip operation (Ann R Coll Surg Engl. 1994). This is where the ball comes out of the socket. There are four basic movements that can cause dislocation: crossing your legs excessive bending of the hip twisting the leg which has been operated on, in or out lying or rolling onto your unoperated side (NB staff may however roll you onto your side for nursing purposes but will ensure a good position of the hip is maintained and this cannot be achieved alone). Limb length The operation may cause shortening or lengthening of the limb. This may be short term whilst your new hip beds in. It may persist, in which case it will be reviewed by your consultant who will decide 4

5 if a shoe raise is needed. Death Death is a risk, due to the physical stress of a major operation and the risks associated with an anaesthetic. Bleeding In all major operations a certain amount of blood loss is anticipated. In some cases a blood transfusion may be required. After the operation Points to note: you will be in bed with a wedge-shaped pillow keeping your legs apart. This is to ensure that your hip rests in the best possible position you will have a large dressing over your wound drains are sometimes placed to remove any excess fluid from the operation site you may be given oxygen via a mask for up to 24 hrs. This may be for longer if you have any respiratory problems you may be given fluids via a vein in the back of your hand. It is important that you keep on top of your pain by using the pain relief which is provided. You should inform the staff if your pain relief is ineffective and you are in pain. We have specialist pain nurses available if required. It is important that you try to move your ankles and toes, and regularly change your body position to help reduce the risk of circulation problems i.e. blood clots. You should also take 2 or 3 deep breaths every hour and you may need to try and cough to keep your chest clear. It is normal to experience some swelling after surgery so it is important to start moving, i.e. walking, as soon as you are able to. 5

6 However you should also spend some time elevating your legs by lying on your bed to help reduce swelling. Due to the fluid loss during surgery, reduced mobility and certain painkillers, you will be more prone to constipation, which can affect urine output. It is therefore vital to drink plenty of fluids, eat foods containing fibre and inform nursing staff if you are constipated so that treatment can be provided. Hip precautions The following precautions are especially important in the first three months after your operation. To reduce the risk of your new hip dislocating: Do not: cross your legs or allow your operated-on leg to cross the midline of your body bend past 90 degrees (a right angle) at your hip shuffle or swivel on your feet when turning twist your operated-on leg in or out stand for long periods of time discard your walking aid until instructed to do so by your physiotherapist or consultant. Do: wear low-heeled shoes go for regular walks (3-4 per day) instead of one long walk and try 6

7 to increase the distance gradually keep car journeys to a minimum for the first twelve weeks sleep on your back with a pillow between your legs continue to rest on your bed for a short period each day. Sitting sit in raised seats reach back for the arm rests of the chair with both hands. Bring your operated-on leg forward and slowly lower yourself onto the chair or raised toilet seat/commode do not lean forward. Your shoulders should stay behind your hips do not raise your knee higher than your hip while sitting. Sit with the operated-on leg forward. Getting in and out of bed get out of bed the same side as your operated-on leg bend your un-operated knee, push your foot into the mattress and lift your bottom, then move yourself over the edge of the bed. Allow your operated-on leg to go over the edge of the bed (the physio will help you with this initially) and allow the knee to bend slightly place your hands behind you and turn yourself so that you are sitting on the edge of the bed. Allow your un-operated leg to touch the floor. using your hands, push yourself up into a standing position, putting most of the weight through your un-operated leg 7

8 you may then reach for the frame and slide your operated-on leg back under you do not pull yourself up with the frame, as it will tip over getting back into bed is the reverse of the above, again getting in the same side as your operated-on leg. Walking with a frame The sequence is always: 1. move the frame forward 2. step into the frame with your operated-on leg 3. lean on the frame and step the un-operated leg through, placing it slightly in front of your operated-on leg 4. turning should be performed using small steps, keeping the operated-on leg on the outside of the turn. This will involve turning in a circle if you wish to turn in the opposite direction. Do not swivel on your new hip. As you become more mobile and confident the physiotherapist will progress you onto elbow crutches and eventually to walking sticks. Once the physiotherapist is happy that you are safe and walking correctly you will be able to get up and walk on your own with the appropriate walking aid. Stairs Following the advice given by your physiotherapist, most patients will manage by using walking aids in one hand and holding the banister with the other hand. Going upstairs The sequence is: unoperated leg push up on walking aid, and then bring up operated-on leg (same step) bring up walking aid (to same step). Going downstairs The sequence is: 8

9 walking aid operated-on leg unoperated leg Physiotherapy depending on your consultant s regime you will begin to mobilise on day one/two after the operation, usually after an x-ray check two physiotherapists will help you out of bed and take you for a short walk using a zimmer frame the physiotherapist will progress your mobility and exercises. The aim is to increase your mobility daily and increase your muscle strength. You may be given exercises under the supervision of a physiotherapist to help improve hip movement and strength. Daily activities The occupational therapist (OT) will assess your ability to perform activities of daily living. Advice will be given and equipment may be provided for your use in hospital and at home. Dressing dress whilst sitting down on the edge of your bed or on a chair do not bend forwards or reach beyond your knees as you may dislocate your hip use the equipment provided by the OT to dress your lower half dress your operated-on leg first and undress it last 9

10 When can I go home? The multidisciplinary team will discuss with you when you are ready to go home. However, your overall progress, the amount of pain you are experiencing, the condition of your wound and the availability of home services will determine your discharge date. A letter will be sent to your GP to inform them of your surgery. If you require support at home following surgery, the hospital social worker will assess your needs and discuss the services available to you. Social Services may provide all or part of the assistance required, but your family, friends or neighbours may also provide support. You will also be informed of any financial entitlements. Your discharge you will go home by ambulance when you are ready to leave the ward, you will be given a supply of medication an appointment will be made for you to see your consultant at the out-patient clinic. This may be given to you before you leave hospital or sent to you in the post. 10

11 What should I do at home? On returning home, help may be needed for at least two to six weeks with basics like cleaning and shopping. You may feel emotionally and physically drained. This can be normal after major surgery. Try to take things slowly spread your periods of activity over the day and take frequent rests in between. Balance periods of rest and activity. You will benefit from lying down several times a day for approximately 1 hour to reduce the build up of swelling. Remember to continue with your exercises and gradually increase your mobility by taking short walks outdoors, accompanied by someone at first. Over the next few weeks try to increase your walking as this will help you to achieve as good a result as possible. Things to remember three to four short walks are better than one long walk do use crutches or sticks when walking outside do sit on a high-seated chair do avoid crossing your legs at the knee and the ankles do use the banister when climbing the stairs do wear low-heeled shoes It is very important you do sleep on your back. You may lie on your operated side once your stitches are out and you feel comfortable. Never lie on your un-operated side do not stand for long periods do not bend at the waist do not twist your operated-on leg in or out return to sexual intercourse with care reorganise your household tasks to avoid prolonged standing. Travelling As driving would risk dislocation, your consultant will advise you against driving for at least 12 weeks after your surgery. However you may travel in the front seat of a car if your consultant allows. 11

12 Flying is not recommended in the early stages. A letter from your GP/consultant informing the airport of your partial hip replacement may prevent embarrassment with metal detectors in security systems. Getting in and out of a car Check with your consultant before attempting this. the passenger seat should be moved back as far as possible with the seat reclined slightly position yourself sideways to the car put your operated-on leg out in front of you and lower yourself onto the seat push yourself backwards towards the driver s seat leaning backwards and pivoting on your bottom slide your legs into the car, ensuring that you keep the operated-on leg straight getting out of the car is the reverse procedure. Your orthopaedic consultant will review you in the outpatient department after discharge and at regular intervals afterwards. Useful websites National Hip Fracture Database. A systematic approach to hip fracture care and prevention. A toolkit for securing resources. British Orthopaedic Association: (Explains Orthopaedic surgery) References For further information on the references used in this leaflet please visit 12

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16 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: September 2010 Date of review: March 2014 Date of next review: March 2017 Ref: PI_DS_656 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests