---

Issue No: 1

Date of issue: 24/04/2019

Review date: 24/04/2020

If you require any further information or have specific questions about any aspects of your care, before or after·your operation, contact:

Ward 10 (Elective Orthopaedics) - 01592 648010

Physiotherapy - 01592 643355 ext 21105

Occupational Therapy- 01592 643355 ext 21186

NHS

" • 'vi -I

- Fife

Patient Guide

Total Hip Replacement

If you have any problems with your wqund contact Pre­ Assessment Department on 01592 643355 ext. 21626

At the weekend please contact Ward 10 on ext. 28010

NHS Fife provides accessible communication in a variety of formats including for people who are speakers of community languages, who require Easy Read versions, who speak SSL, read Braille or use Audio formats.

NHS Fife SMS text service number 07805800005 is available for people who have a hearing or speech impairment.

,.

To find out more about accessible formats contact: fife­

UHB.EqualityandHumanRights@nhs.net or phone 01592 729130

issue No. Date of Issue:

24/04/2019

I Devised by NHS Fife Orthopaedic Unit, VHK

Review Date:

--- --

24/04/2020   

Waiting on a new hip or knee joint?

Download our Joint Replacement App by searching:

Health Zone UK

And select

NHS Fife Joint Replacement App

5.

--..

-=:...::::---,=b:A

SlPhvsi::>ToolsL:cl

6.

l.

:f>hvsloTools. Ud

-

7. r

t

Lying on your back place a rolled up towel under your operated leg ·

Push the back of your knee onto the towel and lift your heel off the bed

Hold for 5 seconds Repeat 10 times

Sitting in your chair

Pull your toes up, lift your leg off the floor to straighten your knee

Hold for 5 seconds Repeat 10 times

Stand straight holding onto something for support

Lift your leg sideways and bring it back to

starting position. You must keep your trunk

This app will provide you with all the relevant information to prepare you for your upcoming joint replacement and can be used to guide your recovery after your surgery

■m

.NH,_S,

a

■■

Ale

II

IIS.11

SIP.hvsi;oTools J'iA

8.

rrii

n•lsioTcols Lid

s:

straight throughout the exercise

Repeat 10 times

Stand straight holding onto something for support Bring your leg backwards keeping your knee straight. You must keep your trunk straight throughout the exercise

Repeat 10 times

Stand straight holding onto something for support Lift your leg up and out in front of you, bending your knee. You·must keep your trunk straight throughout the exercise

GETITON

'

.

, I Download on the

• Google Play • App Store

i:t=l'hvsloTool&Lu:I

Repeat 10 times

Exercise Programme What is Enhanced Recovery after Surgery (ERAS)?

We strongly encourage you to begin these exercise·s in the weeks leading up to your surgery (as your hip pain allows). After your surgery, you should complete these exercises frequently throughout the day - three or four times daily.

1. Lying on your back or in'sitting.

Bend and straighten your ankles briskly. Do this exercise for 30 seconds every half hour when you are resting in bed. Jhis will improve the circulation of blood in your lower legs

The Elective Orthopaedic Ward (Ward 10) is now operating a "short stay admission" in keeping with ERAS and discharge home as soon as possible.

The aim of enhanced recovery after surgery is to get you back to your full health as quickly as possible. The quicker you are up out of bed and resuming normal activities the better. This will get you back home sooner and avoid complications.

Prior to Hospital Admission

• &:Ph•150Tcots Ud

2.

hvsoTcol• Ud

3.

g?h•,sioToo15

4.

€)Phvs;,,Tools Ud

Lying on your back with legs straight.

Pull your feet up towards you. Push your knees firmly against the bed until you feel your thigh muscles tighten

Hold for 5-10 seconds Repeat 10 times

Lying on your back with sliding board under your leg.

Bend and straighten your hip and knee by sliding your foot up and down the board

Repeat 10 times

Lying on your back with sliding board under your leg.

Bring your leg out to the side and then back to starting position

Repeat 10 times

Healthy steps to improve your recovery before your operation:

Food & Drink

• Eat a healthy diet and have frequent drinks. You should aim to drink 1 - 1.5 litres of water a day on the weeks leading up to your surgery.

  Stay Active

• Stay active before you come into hospital. This will help you

  -get back on your feet quicker after your surgery.

  Smoking & Alcohol

  Please contact ward 10 on telephone no. 01592 648010:

  • Evening prior to admission (between 6pm and 8pm) for fasting instructions

  • Morning of admission for bed availability

• If you drink or smoke, use this as a chance to stop or cut down. This will help your recovery and reduce the risk of complications.

Generally, if your surgery is planned for the morning time you cannot have anything to eat from midnight the night before.

However, if your surgery is planned for afternoon time you may be allowed a light breakfast.

It is important to keep drinking clear fluids up until the day of your surgery. When you telephone the ward the nursing staff will advise when to stop drinking. It is beneficial to have a bottle of water with

·you to drink on the way to hospital.

Medication

Please bring all your regular medication·to hospital with you in the containers provided by the chemist (including tablets, inhalers, creams, lotions and sprays). This is so we can use your own medication during your stay, with your permission. Please note that Nomads and Dosette boxes cannot be used. On discharge from hospital you will be given. a 7-day supply of medication you will require for home.

Clothing

You will b-e able to dress in day clothes from the morning after your surgery. Please bring in comfortable, loose-fitting day clothes as well as loose-fitting night clothing. It is useful to have slippers with backs on them for good support when walking. A larger size than usual if being bought new as your feet and ankles may swell after your surgery. During the day, if preferred you may wear your shoes which should be well fitting with low heels.

Please remember to bring·in your dressing aids which were provided

How long should I continue my exercises for?

• Your exercises are very important to ensure your hip joint achieves its optimal movement and that strength returns to your muscles after surgery.

• They should been completed frequently throughout the day and continued for at least 3 months after surgery.

  How far should I walk?

• This depends on how fit you are and what your home situation is. Start by walking no further than the length of two houses in your street and back, then build this up gradually. You should feel tired when you get home but not exhausted.

  Can I go swimming?

• You can go to a pool with steps as soon as your wound heals. You can do gentle exercises and walking in the water. More serious swimming can be started after three months. You can do breast stroke if it feels comfortable, but start off gently.

  When will I get better?

• It can take up to 12 months to get the full benefit from your hip replacement. As you get better it is important to do everyday activities as . these help to improve muscle control and movement - it is important to get back to an active lifestyle.

  Can I continue to have sexual intercourse?

• Yes, but remember to adhere to your joint precautions. If you have any questions, ask a member of the orthopaedic team.

OO

We value your feedback about your

by the occupational therapist (OT) at pre-assessment.

If possible, please bring in toiletries to use for the duration of your stay (soap, flannel and shower cap, if you wish). Hand wipes can be beneficial for use until you are walking to/from the toilet.

Care

Opinion

What's your story?

patient journey

Please visit www.careopinion.org.uk

Frequently Asked Questions

Why have I got swelling?

• Healing tissues will be more swollen than normal tissues, and this swelling can last for several months. Swelling into the rest of the leg can also be normal.

  If there are any changes to your health or fitness prior to admission to hospital please inform your Consultants Secretary as soon as possible. This will include any change in medications or hospital admissions.

  Admission to Hospital

• Continue your ankle exercises and try to put equal weight  

  through each leg and "push off" from your toes when you

  walk.

  Why do I get pain lower down my leg?

• The tissues take time to settle and referred pain into the shin or behind the knee is quite common. The way you walk after surgery will also be altered and this can cause discomfort in other joints for a short time.

  Why·do I stiffen up?

• You may notice that whilst up and moving you feel quite mobile.

• Sitting down for a period of time can increase the swelling and

  stiffness in your hip. To help this it is important to walk short distances every hour and regularly complete your exercises.

  I have a numb patch - is that ok?

• Numbness around the incision is due to small, superficial (close to the skin) nerves being affected by the surgery. The patch usually gets smaller but a small amount of numbness may remain.

  Why does my joint click or clunk?

• This can be normal and it is usually a sign that the swollen tissues are moving over each other differently than before your surgery. This should not worry you, as it should improve as your hip continues to heal.

On admission, a nurse will check that all your pre-assessment information is correct. If there has been any change to your health or medication since then, please inform your nurse. The nurse will also assess your general heath by monitoring your blood pressure, pulse rate and breathing rate. The staff will also discuss any medicines, inhalers and/or herbal medicines that you use. Any allergies that you have will also be recorded.

You will meet your consultant again who will answer any questions you may have.

You will meet your anae?thetist who will discuss the type of · anaesthetic which you will have:

Spinal Anaesthetic: This will numb you from the waist down

for approximately 4 hours. It is also possible to have sedation so you feel relaxed, and may sleep during your surgery.

General Anaesthetic: This produces a controlled state of

unconsciousness during which you feel or sense nothing.

-

Following Your Surgery

In the Recovery Room

After your surgery, you will be transferred to the recovery room.

The recovery·nurse will monitor your blood pressure, heart rate and breathing regularly. You will be given fluids via a drip and will be on oxygen via a facemask.

5

The nurse will regularly assess your pain score. You will be given regular pain medication in relation to this. Anti-nausea medication will also be given if you require it.

Return to the Ward after urgery

You will be closely monitored by the ward nursing staff. Your blood pressure, heart rate, breathing and pain score will continue to be monitored.

You are strongly encouraged to ask for pain medication as required. You will also receive anti-coagulant medication to help prevent blood clots. ·

You will be encouraged to drink plenty of water and offered something light to eat (e.g. tea & toast).

You will be encouraged to begin your physiotherapy exercises once able, page 14 and 15. And once well, you will be assisted out of bed and practise walking with the physiotherapy or nursing staff. Your aim should be to sit out in your chair, and alk to the toilet if able.

Hip Precautions

It is important to remember your hip precautions for bed and chair transfers, and for dressing and washing:

other leg after surgery. This is a common complaint and is likely to resolve over a period of a few weeks. However, if you are still concerned about this you can discuss it with your surgeon at your follow-up review.

Equipment

You must continue to use your dressing aids and equipment provided by the Occupational Therapy Team for 6 weeks following your surgery, or until your Consultant tells you otherwise.

When you no longer need your equipment, please contact our Stores Department on 01592 583252, to arrange uplift of them.

Ward Information

The hospital has no set visiting times and offers a flexible approach to this.

However, it is important to note that visitors will be excused from the patient area to allow for ward staff to carry out necessary tasks, and for rehabilitation needs.

Visitors will be able to take an active part in your rehabilitation by encouraging regular walks and completion of exercises.

No bending of the operated hip beyond 90 degrees {right angle) No crossing of your legs, at the knee or ankle

No twisting of the operated leg inwards

To comply with infection control policies, we ask visitors to respect the following:

• Use of hand gels on entering & exiting ward

• Avoid sitting on patients beds or chairs

• No flowers permitted on ward

Going Up

Non-operated leg Operated leg Stick

Coming Down

Stick Operated leg

Non-operated leg

As soon as you have gained enough flexibility and strength in you-r hip you will be able to walk up and down stairs normally - usually after 12 weeks.

Things to look out for at home...

Please seek medical advice from your GP if:

• You have worsening pain and swelling in the calf muscle of the operated leg, along - wi_th redness and heat from the muscle.

  You would require a home visit as will be unable to travel

  to the GP surgery if this is the case.

• You have increasing pain around your hip joint and difficulty bearing weight (however it can be normal to experience increasing hip pain as you begin to progress your mobility).

• It can be normal for your operated leg to feel longer than the

  Continuing Care after your Operation

  On the day following your surgery you will have blood samples taken and will be reviewed by the Advanced Nurse Practitioner to assess your body's recovery following your surgery.

  It is normal to have an X-Ray of your operated hip on the day following your surgery which will be reviewed by your consultant. However, you are able to get up and moving before this has taken place.

  -

  You will be seen by both a member of the physiotherapy and

  occupational therapy teams to review:

• Exercises.

• Sed and chair transfers.

• Use of aids for dressing.

• Walking practice.

• Stair practice.

  Discharge planning from hospital begins as soon as possible, and is determined by:

• When you are medically fit - when medical & nursing staff are happy with your condition.

• When you have achieved your physiotherapy and occupational therapy goals for going home.

  Discharge Home_from Hospital

  When you are discharged home from hospital, the nursing staff will ensure you have the following: · ·

• Your routine and any additional medications (i.e. pain medication, anti-coagulants), along with instructions for their use.

• A copy of your discharge letter with advice about wound care and removal of wound clips, if appropri_ate (an electronic copy of your discharge letter will be sent to your GP)

  Routinely your surgeon will apply a dressing to your hip wound with instructions to leave it in place for 14 days after your operation. There should be no need to change· this dressing. Your wound is likely to be tender for 2-3 weeks, but do look for signs of inflammation or leaking - fiery red, painful and hot around the area of the wound. If you are concerned, use the wound care card given at pre-assessment to contact the hospital.

  Discharge Checklist: \

• Have transport arranged for getting home - hospital transport is only for people who meet specific criteria.

• Make sure you have all your belongings when leaving hospital

  - we strongly encourage that you do not bring valuables to hospital.

• Make sure you have suitable clothing and footwear at home if you are not already using them in hospital.

• Make sure you have access to your house key.

• Make sure you have a supply of food and drink at home, and if necessary ask someone to turn on your heating.

• Please let us know in advance if you require a medical certificate.

  8 ---------------------------

  Once at Home

• Follow advice from medical and nursing staff.

• Take regular pain relief.

• Do something every hour:

  • Regular walks

  • Regular exercises

• Eat and drink regularly.

• Complete your daily goals in your patient diary.

Sleeping

It is easiest to sleep on your back. When lying on your back you can put a pillow between your legs to stop crossing them at the ankles. If you are unable to sleep on your back you can lie on your non­ operated side with a pillow between your legs to keep them apart. However you may find it difficult to get into this position.

Walking

When leaving hospital you will be walking with 2 sticks. Over the following weeks (when you feel able) you can begin to walk with 1 stick. This will be used on the opposite side to your operated hip.

Stop using your walking stick when you can walk as well without it as with it. Many people choose to bring a stick outdoors for a few months after surgery as they find their limp gets worse as they get tired.

Stairs

You will be shown the correct technique for using stairs prior to discharge from hospital.

9