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Contents
PART I: hip Replacement
This section contains general information you will need to fill out as well as tasks to
complete prior to surgery. It also contains checklists and reminders for you.
What Is a Hip Replacement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Process at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Joint Replacement Program Orientation Session . . . . . . . . . . . . . . . . . . . . 6
Hospital Preop Clinic Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Important Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
General Hospital Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Packing for the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part II: Patient Guide to Hip Replacement Surgery
This section explains the surgical process—from the day of admission to the day of discharge.
Surgery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Understanding the Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Night before Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
The Remainder of Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . 17
Physical Therapy and Occupational Therapy . . . . . . . . . . . . . . . . . . . . . . 18
General Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Total Hip Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Physical Therapy Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Self-Care after Hip Replacement Surgery . . . . . . . . . . . . . . . . . . . . . . . 26
Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
After Discharge from the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Living with Your New Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2
Hip
Replacement
Part I
Part I:
A Joint Approach
3
WHAT IS A HIP REPLACEMENT?
A
hip replacement is a surgical procedure
in which a hip joint that is worn out
or injured and painful is replaced with an
artificial joint. The surgery will benefit
you by reducing hip pain, increasing leg
strength, and providing easier movement.
How long will the surgery take?
The surgery will take about two hours.
How is the hip replaced?
The orthopedic surgeon makes an incision
down the side or in front of the hip and
removes the damaged joint. The surface of the
old socket is smoothed, and the new socket is
put into the pelvis. The surgeon then inserts
the new ball-and-stem component into the
head of the femur (thighbone), and the new
ball and stem are joined with the socket.
Acetabulum
Acetabular
component
Femur
Femoral
component
Healthy hip
4
Arthritic hip
Hip replacement component
THE PROCESS AT A GLANCE
O
utlined below is an overview of
the process of having total joint
replacement surgery. This summary
is to help you understand the general
progression of events and the stages
of the surgical and recovery process.
6. Have surgery.
1. You and your doctor have agreed
that you need surgery. Understanding
what is happening to you will make
your hospital visit more pleasant and
improve your recovery.
9. Take care of your new joint. Go to
all appointments set or suggested
by your doctor.
2. Your doctor’s office obtains medical
clearance for surgery.
3. You must read all the educational
information provided by your doctor
and the hospital. The information in
this Hip Replacement Handbook is
for you to read prior to surgery; it will
help you understand what will happen
once you come to the hospital.
7. Begin recovery and rehabilitation in
the hospital.
8. Be discharged from the hospital.
A partnership among you, the orthopedic
surgeon, the hospital, and your support
team is vital to the success of the surgery.
As a partner you need to be informed
and knowledgeable about every aspect
of the surgical and recovery process.
Your understanding, participation, and
commitment are important to the success
of the procedure.
4. You may attend the Joint Replacement
Program orientation session. A preop
clinic session will be scheduled at
the hospital. A date and time will be
set and communicated to you by the
hospital scheduling office.
Please bring this handbook with you to
all of your related appointments as well
as to the hospital on the day of surgery.
You may receive various instructions,
information booklets, and copies of forms
as well. That information should be kept
in this handbook. It is important that you
have at your fingertips all the information
you require when you need it.
5. On the day of surgery, come to
the hospital at the time reserved
for you.
Our goal is to help you have good results,
and we are committed to assisting you on
this successful journey.
5
JOINT REPLACEMENT PROGRAM
ORIENTATION
SESSION
JOINT
REPLACEMENT
PROGRAM
ORIENTATION SESSION
T
T
he Joint Replacement Program coordinator will call you to schedule an educational session
to review the equipment you will need after surgery, how to prepare your home for the
he
Jointwhat
Replacement
Coordinator
will and
call you
during
the week,therapy
prior to
equipment,
to expectProgram
during your
hospital stay,
the role
of physical
inyour
yoursession,
with classroom location
recovery.
Siskiyou Blvd.
North
Building
Main
Entrance
Emergency Entrance
Emergency
Emergency Parking
N
Gi Shop
Security
North
Elevators
Endoscopy
Rambling
Rogue Café
Ground Floor
Patient
Registration
Cashier
Short Stay
Surgery
Lab Outpatient Services
Pre-Surgery Clinic
ICU Elevators
Family
Birth
Center
West
Building
Dubs
Library
Cardiovascular
Recovery
Laboratory
Services
Medical Center Drive
Cath Lab
Infusion
Services
South
Elevators
Cath Lab and Pediatric
Assessment Clinic
WAIT AREA
West
Elevators
Cath Labs
Cardio
Pulmonary
Diagnostics
Employee
Health Administration
NICU
Family Birth Center
and Women’s Services
Overflow
Cardiac and
Pulmonary
Rehab
South
Building
East Barnett Road
6
Spiritual
Care
Rogue Credit Union
Conference Room
Mustard
Conference Room
Patient Experience
Conference Room
Volunteer
Services
Pediatrics
East
Building
Murphy Road
Black Oak Drive
ATM
Imaging
Services
B
efore having joint replacement surgery,
you will attend an orientation session
that is designed to provide you and your
caregiver with important information to
make your surgery and recovery successful.
The orientation session will last about two
hours. You may have your hospital preop
clinic session on the same day or return
another day to complete the process. This
is set and communicated to you by the
hospital scheduling office.
What will I do at the orientation session?
Please bring this handbook to the
orientation session. You will be given a
DVD to take home and watch. The
DVD is designed to provide you with
information about anesthesia, post-op
exercises, precautions, and infection
prevention. Please bring it back when you
return for surgery and give it to one of the
nurses or certified nurse assistants.
• Snack food, juice, coffee, and water
will be provided during the orientation
session.
•In this classroom setting, you will meet
with members of your health-care team:
A nurse will review information regarding your hospital stay, answer
any questions you may have, and
discuss equipment you may need and
where to obtain it. The nurse will also
discuss the occupational therapy role in
your rehab.
n
A physical therapist will briefly outline
the therapy you will undergo after
surgery.
n
HOSPITAL PREOP CLINIC SESSION
REGISTRATION
• On the day of your scheduled hospital
preop clinic session, you will meet with an
admissions representative to complete your
registration paperwork. This may or may
not be on the same day as the orientation
session.
PREOP CLINIC
• You will meet with a registered nurse, who
will review your current medication list,
including prescriptions, over-the-counter
drugs, vitamins, and herbal supplements.
• You will have lab tests drawn, an
electrocardiogram (EKG), and any other
tests your physician has ordered.
• You will meet with a nurse practitioner,
who will discuss your options for anesthesia
and review your medical history, allergies,
and medications. You will be instructed as
to which medications to take the morning
of surgery.
WHAT TO BRING
• Insurance/Medicare cards
•Identification
•This Hip Replacement Handbook. Please
complete the medical information on
page 10 or bring a printed medication
list if you already have one. Be sure to
include prescription and over-the-counter
medication s as well as any vitamins or
herbal supplements you take. Include
doses and how often you take them.
7
IMPORTANT TELEPHONE NUMBERS
Please feel free to make photocopies of this completed page and share them with your
family, friends, and caregivers.
EMERGENCY CONTACT PERSON
Name ________________________________________________________________________________
Relationship __________________________________________________________________________
Home phone _________________________________________________________________________
Cell phone ___________________________________________________________________________
PHYSICIAN INFORMATION
Southern Oregon Orthopedics, Inc.
2780 East Barnett Road, Suite 200
Medford, OR 97504
Telephone: (541) 779-6250
Physician name _______________________________________________________________________
HOSPITAL INFORMATION
Asante Rogue Regional Medical Center
2825 East Barnett Road
Medford, OR 97504
Telephone: (541) 789-7000 or (800) 944-7073
Primary contact: Joint Replacement Program coordinator
Telephone: (541) 789-7548
ASANTE ORTHOPEDICS AND SPORTS MEDICINE
Asante Rogue Regional Medical Center, fifth floor, Nurses’ Station C
2825 East Barnett Road
Medford, OR 97504
Telephone: (541) 789-7530
8
GENERAL HOSPITAL INFORMATION
.
u Blvd
o
y
i
k
s
i
S
Road
Be
lkn
ap
Garfield St.
Exit
27
ASANTE ROGUE REGIONAL
MEDICAL CENTER
N
Murphy Road
ett Road
East Barn
1 mile
Parking
Medical
Parking
Black Oak Drive
e
Avenu
d
n
a
l
High
I-5
Ce
nter
Drive
DIRECTIONS TO THE HOSPITAL
Map is not to scale.
PARKING AT THE HOSPITAL
Patients are encouraged to use the
valet parking service located at the North
Lobby Entrance facing Siskiyou Boulevard.
This free service is available from 7 a.m.
to 5 p.m.
VISITING HOURS
Your caregiver or family member may stay
with you, if you desire, and may be an
active participant in your recovery.
Post-surgery therapy is very important
to your recovery. In an effort to avoid
interrupting your therapy sessions, please
advise your visitors that they may remain
during these sessions but that the therapist
will continue the treatment; your visitors
will be asked to wait until the therapy
session is finished.
Please inform the Joint Replacement
Program coordinator if you wish for
your caregiver to stay overnight. Most of
our rooms have a couch that converts to a
single bed, and we will make every effort to
accommodate you.
9
MEDICAL INFORMATION
Please fill out unless you already have this information completed. If you do, please attach
a copy.
Do you have any allergies? If so, please list what you are allergic to and your reaction:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
List all prescription medications are you taking, including strength and amount:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
List all over-the-counter medications you take, including vitamins and herbal supplements,
e.g., aspirin, Tylenol, Motrin, glucosamine, chondroitin, MSM (methylsulfonylmethane),
saw palmetto, fish oil, and flax seed oil:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
What pharmacy do you use?
_______________________________________________________________________________
Your prescriptions must be filled at a local pharmacy rather than at the hospital.
Have you had surgery before? If so, what surgery have you had and when?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
10
PACKING FOR THE HOSPITAL
THINGS TO BRING
TO THE HOSPITAL
THINGS WE ASK THAT
YOU DO NOT BRING
• This Hip Replacement Handbook
• Medications unless requested by the
nurse practitioner. This is for your safety.
• CPAP machine if you have and use one
• DVD
• Ice machine if you have purchased one
• Comfortable attire for exercise
if you desire, or you may wear
hospital attire
n
Shoes that you can slip in and out of easily, such as tennis shoes,
walking shoes, or slippers as
suggested by the nurse during the
orientation session; no high heels
• Valuables, jewelry, credit cards, insurance
card, and large amounts of cash. A
wedding ring will be covered with tape
for surgery if you decide to leave it on;
all other jewelry must be removed. Please
be aware that if your hand swells and it is
deemed unsafe, we may need to cut off a
wedding ring.
n Socks/undergarments if you desire (not required)
n Loose clothing, such as shorts and
T-shirts (elastic waist only)
• Knee-length nightgown and a
robe that opens all the way down,
if desired (not required)
• Toiletries (be sure to include eyeglass
case, contact lens case, hearing-aid
batteries, and other necessities)
• Cell phone, if desired (there are phones
available for each patient for local calls)
• A minimal amount of money—no more
than $5 or $10 (unless you need money
for transportation at discharge)
• Walker (you may bring yours to the
hospital if you desire, and the therapist
will check for correct height and good
repair status)
11
NOTES
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
12
Patient Guide to
Hip Replacement
Surgery
Part II
Part II:
A Joint Approach
13
SURGERY INFORMATION
Y
our surgery has been scheduled for a
specific date and time, but sometimes
it is necessary to change your arrival time
to the hospital due to circumstances over
which we have no control. If the surgeon
has a cancellation, for example, the lineup
has changed since you were scheduled, or
there is an emergency, your surgery and
arrival times may be changed.
To enable us to maintain the schedule as
efficiently as possible, a nurse from the
hospital preop clinic will call you the day
before your scheduled surgery if the times
have changed. If you do not receive a call,
please come at the time given to you at
the preop clinic session.
What kind of anesthesia will I have?
This depends on the type of surgery,
your health history, and what the
anesthesiologist feels is best for you.
• Spinal anesthesia is given through a
catheter that the anesthesiologist inserts
into your spinal column. It numbs from
the midchest to the toes. You will be
asleep during the operation.
• General anesthesia is given through an
intravenous (IV) line or by breathing
from a mask. It is like a deep sleep that
happens very quickly.
• Other medications for pain and
relaxation will be given.
UNDERSTANDING THE RISKS
A
s with any major surgery, there
are certain risks. This section outlines
some of the common complications
associated with hip replacement surgery
and the precautions you can take to
help prevent them.
INFECTION
With any surgery there is a risk of infection.
Presurgery test results will affirm that you
have no active infections, and antibiotics
administered to you before and after surgery
will further help prevent infection.
BLOOD CLOTS
With hip replacement surgery, circulation
is impaired during the healing process. To
counter this effect and promote circulation,
you may be asked to pump your feet and
exercise your ankles following surgery and
during your recovery. While in the hospital,
you will wear pneumatic air socks on
both legs while in bed; these help prevent
blood clots. A blood-thinning medication
14
that helps prevent blood clots will also be
prescribed for you. Each day in the hospital,
blood may be drawn to check levels.
PNEUMONIA
To help prevent pneumonia, you may be
asked to either use an incentive spirometer
or take several very deep breaths to prevent
fluid from pooling in your lungs. For the
same reason, it is important to get out of
bed often. Breathing deeply after surgery
and using an incentive spirometer are
important measures to prevent congestion
in the lungs, which can lead to pneumonia.
BLADDER INFECTIONS
Bladder infections may also occur, especially
if you had a catheter. It is important to
drink plenty of fluids to help prevent
infection. If a catheter is placed, it will be
removed the first day after surgery.
Understanding the Risks continued
NUMBNESS
You will experience some numbness
on both sides of your hip following
surgery. This is normal and should not
be cause for concern. During surgery
the nerves around the hip are disturbed;
as these nerves heal, you may experience
tingling sensations. You may have
permanent numbness in the area around
the incision, but this will not affect the
function of your new hip. In only rare
situations is there permanent numbness
or weakness in the hip as a result of trauma
to a nerve.
DISLOCATION OF THE PROSTHESIS
There are certain positions and activities
associated with some surgical approaches
that are dangerous to the safety of your
new prosthesis, especially for the first few
months. You will be informed after surgery
if you have these precautions.
The physical therapist will teach you
how to sit, rise from sitting, and turn
onto the unoperated side safely; the
therapist will also discuss precautions you
should take. See pages 19 and 28 for the
general hip dislocation precautions. If
these precautions are applicable to you,
the occupational therapist will help you
incorporate them into your activities of
daily living.
SEVERE COMPLICATIONS
As with any major surgery, there is the
possibility that any of the foregoing
complications, as well as complications
from the anesthesia, could be severe
enough to result in death. If you have
any questions or concerns regarding
complications, please discuss them
with the orthopedic surgeon.
THE NIGHT BEFORE SURGERY
W
e recommend that you eat a
light meal the night before
surgery. Unless the anesthesiologist, nurse
practitioner, or registered nurse tells you
otherwise, you should have nothing to
eat or drink after midnight. This includes
but is not limited to water, coffee, food,
and any kind of gum or mints. If you
have any questions, please call the Joint
Replacement Program coordinator.
THE DAY OF SURGERY
BEFORE COMING TO THE HOSPITAL
• Unless told otherwise, do not eat or drink
after midnight before surgery. You can
brush your teeth and rinse your mouth,
but do not swallow.
• Take only the medications that the doctor
or nurse practitioner has told you to take,
using just enough water to swallow them.
WHEN AND WHERE TO REPORT
You will be given a specific time to arrive at
the hospital. We recommend that you use
the free valet parking at the North Lobby
Entrance, which opens at 7 a.m. From the
North Lobby, walk to the surgery waiting area on the left, located next to the
gift shop. If an Auxiliary volunteer is at the
desk, give him or her your name. If no one
is at the desk, pick up the red phone, and
you will be given instructions. Someone
will escort you to the area where you will
be prepped for surgery.
15
THE DAY OF SURGERY continued
ONCE YOU ARRIVE AT THE HOSPITAL
•A nurse will complete your paperwork and
finish the orders your doctor has written.
You will have one or two IV lines started.
You may have additional lab work done as
ordered by your doctor.
• An orderly will come with a gurney to
bring you to a holding area or directly
to the operating room (OR).
• If you are wearing dentures, hearing aids,
socks, or jewelry, please remove them unless
arrangements have been made to keep them
with you. You will be given a hat to cover
your hair.
• The OR is bright and noisy. We can provide
you with a warm blanket. The OR nurse
will be with you throughout the surgery.
There will also be an anesthesiologist, a
scrub nurse or technician, and an assistant
for the surgeon.
AFTER SURGERY
W
hen the surgery is over, you will be
taken to the Post-Anesthesia Care
Unit (PACU). You will be cared for by
specially trained registered nurses, who will
monitor your vital signs (heart rate, blood
pressure, and temperature) and pain level.
A good indication of how much pain you
may be experiencing can be determined on
a scale of 0 to 10, with 0 being no pain
and 10 being the highest level of pain.
Your family is encouraged to stay in
the waiting area outside of surgery if they
wish to speak with the surgeon after the
surgery is over. A volunteer will escort
them to a private room, where the surgeon
will apprise them of your condition. Family
members are not permitted in the PACU,
but you can see them when you return to
your room on the fifth floor.
You will be in the PACU for one to
two hours, depending on the type of
anesthetic you had and how you are
feeling. The nurses will keep you warm
and comfortable.
16
EQUIPMENT YOU MAY SEE
WHEN YOU WAKE UP
Intravenous Line
An IV line is a tiny catheter that is inserted
into a vein in your hand or arm. Attached
to the catheter is a small tube that connects
to a bag of fluid. The bag will hang from a
pole near your bed.
Oxygen
You will receive oxygen through a nasal
cannula or an oxygen mask. The presence
of oxygen does not mean that there is a
problem or that you are having difficulty
breathing. The nursing staff will check your
oxygen levels with a finger sensor.
Foley Catheter
This tiny catheter is inserted into your
bladder to drain your urine. If a Foley
catheter is used, it will remain for a day
or two.
AFTER SURGERY continued
Blood Retrieval System
If the surgeon advises, there may be a
drainage tube inserted into your hip
through two sites next to the incision.
The purpose of the tube is to capture
blood draining from your hip, filter it,
and return it to your bloodstream through
the IV line, unless you do not want to
receive it. This is a closed system, and
the blood is reinfused for only six hours
after surgery. At that time it becomes
a collection chamber only and will be
removed on the second day.
Abduction Pillow
If ordered by the surgeon, you will have
a soft, triangle-shaped foam pillow that
straps between your legs and is secured
with Velcro. If you have hip precautions,
you may wake up with this between your
legs. At your doctor’s recommendation,
the pillow will be used to keep your legs
in the correct position when you are
turning in bed or sleeping. You will be
turning with pillows between your legs
when you go home.
THE REMAINDER OF YOUR HOSPITAL STAY
• For safety reasons the staff will ask you
to repeat your name and birthday before
any procedure or medication.
• The nursing staff will closely monitor
your heart rate, blood pressure,
temperature, and oxygen level.
• The staff will ask you to rate your pain
on a scale from 0 to 10. This enables the
nurses to assess the effectiveness of the
pain medication.
• You will have a large dressing after
surgery to keep the wound clean and
absorb any fluid. Two days after surgery,
this will be changed to a small dressing,
and any drains will be removed.
• You will have an IV line in your hand or
arm for fluids until you are taking them
well by mouth. At that time the IV site
will be capped; it will be removed before
you are discharged.
• After surgery you will be given ice
chips, then water, clear liquids, and full
liquids. The nursing staff will monitor
you for nausea and provide medication
as needed. If you are not nauseated
and have good abdominal sounds (as
determined by the nurse), you will
progress to solid food and a normal diet.
• The nursing staff will monitor your
oxygen levels using a finger sensor. You
may have oxygen on the night of surgery
through a nasal cannula. This will be
discontinued when you can maintain
good oxygen levels on room air.
• Lab work will be drawn early every
morning or every other morning,
depending on your doctor’s orders.
• You will wear pneumatic air stockings
on both legs while you are in bed. These
assist the blood flow back to your heart
and help prevent clot formation and
blood pooling in your legs.
• If you would like to turn onto your side,
please use the nurse call system so that
staff may assist you.
• Please ask nursing staff, therapists, your
doctor, the discharge planner, or the
Joint Replacement Program coordinator
any questions that may arise. We are
here to help you.
17
PHYSICAL THERAPY AND OCCUPATIONAL THERAPY
LEVEL I
Physical Therapy
• Lying exercises: ankle pumps, quad sets,
gluteal sets, short-arc quads, hip abductions,
and heel slides (active/passive)
LEVEL III
Physical Therapy
• Instruction regarding position precautions
and weight-bearing restriction
• Bed mobility and transfer training
•Reinforcement of position precautions and
weight-bearing restriction; patient handout
provided
• Walking with walker, as tolerated
• Progress transfer training
LEVEL II
Physical Therapy
• Lying exercises: ankle pumps, quad sets,
gluteal sets, short-arc quads, hip abductions,
and heel slides (active/passive)
• Review of position precautions and weightbearing restriction
• Progress transfer training, including
a toilet transfer
• Progress walking, including to the
bathroom with staff (if safe) and stair
training (if able)
Occupational Therapy
• Evaluation of activities of daily living
(ADLs) and home needs, incorporating the
appropriate hip precautions for your type
of surgery
• If needed, instruction and practice in the
use of lower-extremity adaptive devices
• Toilet transfer training and recommendation
of appropriate durable medical equipment
(DME) for home setting
• Instruction in upper-extremity
strengthening program, as needed
• Review of ADL procedures; patient
handout provided
•Lying exercises: ankle pumps, quad sets,
gluteal sets, short-arc quads, hip abductions,
and heel slides (active/passive)
• Assess need for a leg-lifter, and issue if
needed
• Progress walking toward goal of 200 feet;
practice stair climbing
• Instruction in car transfers and assisting
patient into car at time of discharge if you
have hip precautions
Occupational Therapy
• Issue self-care devices and reinforce
proper use
• Practice shower/tub transfer and
recommend needed DME
• Reinforce hip precautions with general
patient-specific ADLs
• Reinforce upper-extremity strengthening
program
• Provide caregiver training in adaptive
devices, equipment needs, and home
accessibility and safety (if needed)
Nursing
• Sit in a chair for meals and walk to
bathroom with staff
FREQUENCY OF TREATMENT
Physical therapy: Twice a day
Occupational therapy: Once a day, usually
one to two treatments
Note: Additional visit needed only if problems
with learning are present.
18
GENERAL PRECAUTIONS
The time frame for healing will vary,
depending on the type of surgery, the
approach used, and the individual.
Whether you have hip precautions
depends on the surgical approach and
muscle involvement used by the surgeon.
If you have precautions the therapist
will instruct you in them. Your body
needs to heal around your new hip to
provide proper support and control of leg
movement.
Hip precautions include the following.
FOR THE DIRECT INTERIOR
(FRONTAL) APPROACH
• Do not rotate the operated leg
inward or outward to extremes. When
turning, do not pivot; take small steps
to turn.
• Do not extend the hip by stepping
backward with the operated leg.
• Do not bend your hip more than
90 degrees. Your knee on the operated
leg should come no closer to your chest
than 90 degrees. This means no reaching
farther than your knees.
• Do not cross your legs at the knees
or ankles. Do not allow your knees to
come together while sitting or lying in
bed. When lying on your side or sitting,
place a pillow between your legs.
• Do not allow the operated leg to turn outward.
FOR THE LATERAL OR POSTERIOR
APPROACH (SIDE OR BACK)
If you move your hips beyond the limits
of motions set by the surgeon, your new
hip could dislocate. The surgeon will
tell you how long you must follow these
precautions.
19
TOTAL HIP EXERCISES
D
o exercises three times per day, 10 repetitions each, to start. Gradually increase to three
sets of 10 repetitions each.
LYING SUPINE
Routine for:
20
Created by:
Ankle Pump
Quad Set
Move your foot back and forth as if
pressing on a gas pedal.
Tighten muscles on top of the thigh
by pushing the knee down. Hold for
5 seconds.
Gluteal Set
Short-Arc Quad
Squeeze bottom together. Do not hold
breath. Hold for 5 counts.
With knee bent over a bolster, straighten
knee by tightening muscles on top of
the thigh.
Hip Abduction
Heel Slide
Keeping your toes pointed at the ceiling,
slide the operated leg out to the side
as far as possible. Return to starting
position.
Slide heel up toward bottom. Hold for
3 seconds, then slide heel down.
TOTAL HIP EXERCISES continued
SEATED AND STANDING
Long-Arc Quad
Hip Abduction
(sideways movement)
Sitting slumped, straighten your knee
and hold for 5 seconds. Return knee
to bent position.
Stand while holding on to a counter
or table. Slowly raise leg out to the side,
keeping toes pointed straight ahead.
Hip Extension
(backward movement)
Stepping
Stand while holding on to a counter or
table. Lift leg backward with knee straight;
avoid leaning forward.
Stand while holding on to a counter or
table. Slowly raise knee as if to lift your leg
onto a step, keeping your hip bent less than
90 degrees.
21
Physical Therapy Visit Log
PHYSICAL THERAPY LOG
Date
Swelling (mild/
AAROM PROM moderate/severe)
Gait Assist
Level/Device
Wound Health
Comments
This tool is used to document your therapy progress and will be reviewed by your doctor.
Please bring this handbook with you to all therapy and doctor appointments.
22
Physical Therapy Visit Log
PHYSICAL THERAPY LOG
Date
Swelling (mild/
AAROM PROM moderate/severe)
Gait Assist
Level/Device
Wound Health
Comments
This tool is used to document your therapy progress and will be reviewed by your doctor.
Please bring this handbook with you to all therapy and doctor appointments.
23
DURABLE MEDICAL EQUIPMENT
JACKSON COUNTY
Apria Healthcare, Inc. . . . . . . . . . .
Ashland Drug . . . . . . . . . . . . . . . . .
Black Oak Pharmacy . . . . . . . . . . .
Black Oak Pharmacy . . . . . . . . . . .
Lincare, Inc. . . . . . . . . . . . . . . . . . .
Majors Medical Supply . . . . . . . . . .
NU Motion . . . . . . . . . . . . . . . . . .
Pacific Medical . . . . . . . . . . . . . . . .
Phoenix Pharmacy . . . . . . . . . . . . .
Quest Health Care . . . . . . . . . . . . .
Southern Oregon
Medical Equipment . . . . . . . . . . . .
(541) 245-2400
(541) 482-3366
(541) 773-5356 (541) 690-1130
(541) 773-2211
(541) 665-0133
(541) 772-1771
(541) 292-5483
(541) 535-1561
(541) 665-4018
(541) 773-5994
765 South Riverside Drive, Medford, OR
275 East Main Street, Ashland, OR
2924 Siskiyou Blvd., Suite 102, Medford, OR
4800 Crater Lake Avenue, Medford, OR
918 Chevy Way, Medford, OR
540 East Vilas Road, Suite B, Central Point, OR
4823 Industry Drive, Central Point, OR
2780 East Barnett Road, Suite 110, Medford, OR
404 North Main Street, Phoenix, OR
540 East Vilas Road, Central Point, OR
1600 East Barnett Road, Medford, OR
Medical Equipment Loan Closets
Access . . . . . . . . . . . . . . . . . . . . . . (541) 779-6691 (extension 305) Rogue River Community Center . . (541) 582-1482
Monday through Friday, 8 a.m. to 5 p.m.
3630 Aviation Way, Medford, OR
Monday through Friday, 9 a.m. to 4 p.m.
132 Broadway, Rogue River, OR
Salvation Army . . . . . . . . . . . . . . . (541) 772-8149
Tuesday through Friday, 9 a.m. to 3 p.m.
922 North Central Avenue, Medford, OR
JOSEPHINE COUNTY
Apria Healthcare, Inc, . . . . . . . . . .
Grants Pass Pharmacy . . . . . . . . . . .
Lincare, Inc.. . . . . . . . . . . . . . . . . .
Southern Oregon
Medical Equipment . . . . . . . . . . . .
(541) 479-6919
(541) 476-4262
(541) 479-3743
1700 Nebraska Avenue, Grants Pass, OR
414 SW 6th Street, Grants Pass, OR
1610 NE 7th Street, Grants Pass, OR
(541) 471-0026
705 SW Union Avenue, Grants Pass, OR
Medical Equipment Loan Closets
HASL . . . . . . . . . . . . . . . . . . . . . . . (541) 479-4275
Illinois Valley/Cave Junction
Lions Club . . . . . . . . . . . . . . . . . . . (541) 592-4135
Rogue River Community Center . . (541) 582-1482
Daily Living Device Catalogs
North Coast Functional
Solutions . . . . . . . . . . . . . . . . . . . . (800) 235-7054
Sammons Preston
Enrichments . . . . . . . . . . . . . . . . . . (800) 323-5547
24
Monday through Thursday, 9 a.m. to 3 p.m. Friday, 9 a.m. to 2 p.m.; closed 12 to 1 p.m.
305 NE E Street, Grants Pass, OR
333 S Redwood Highway, Cave Junction, OR
Monday through Friday, 9 a.m. to 4 p.m.
132 Broadway, Rogue River, OR
DURABLE MEDICAL EQUIPMENT continued
YREKA
Lincare, Inc. . . . . . . . . . . . . . . . . . . (530) 841-0503
Madrone Hospice Shop . . . . . . . . (530) 842-6025
1530 Lucas Road, Yreka, CA
Monday through Friday, 9:30 a.m. to 5 p.m.
Saturday, 10 a.m. to 4 p.m.
209 West Miner Street, Yreka, CA
M C Medical Equipment . . . . . . . . (530) 842-4304
742 S Main Street, Yreka, CA
Scott Valley Respiratory
Home Care Inc. . . . . . . . . . . . . . . . (530) 841-3000
1714 S Oregon Street, Yreka, CA
BROOKINGS
Apria Healthcare, Inc. . . . . . . . . . . (541) 469-6674
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 469-3989
624 Railroad Avenue, Brookings, OR
16290 Tolman Lane, Brookings, OR
Medical Equipment Loan Closets
Elks Lodge . . . . . . . . . . . . . . . . . . . (541) 469-2169
Monday through Friday, 8 a.m. to 2 p.m.
800 Elk Drive, Brookings, OR
CRESCENT CITY
Apria Healthcare, Inc. . . . . . . . . . . (707) 464-4242
630 G Street, Crescent City, CA
Medical Equipment Loan Closets
Veterans Service Office . . . . . . . . . . (707) 464-2154
810 H Street, Crescent City, CA
KLAMATH FALLS
Apria Healthcare, Inc. . . . . . . . . . . (541) 273-5451
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 882-2325
Norco Medical . . . . . . . . . . . . . . . . (541) 885-2996
2815 Laverne Avenue, Suite E, Klamath Falls, OR
2795 Anderson Avenue, Suite 107,
Klamath Falls, OR
3310 Washburn Way, Klamath Falls, OR
Medical Equipment Loan Closets
Senior Center . . . . . . . . . . . . . . . . . (541) 883-7171
Monday through Thursday, 8 a.m. to 5 p.m.
Friday, 8 a.m. to 2 p.m.
2045 Arthur Street, Klamath Falls, OR
Veterans of Foreign Wars . . . . . . . . (541) 882-0057
515 Klamath Avenue, Klamath Falls, OR
ROSEBURG
Douglas Medical
Equipment Supply . . . . . . . . . . . . . (541) 229-4530
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 957-0907
Parkway Mobility
& Medical Supply . . . . . . . . . . . . . (541) 677-2438
Rick’s Medical Supply . . . . . . . . . . . (541) 672-3042
1813 West Harvard Avenue, Suite 212,
Roseburg, OR
1810 NW Mulholland Drive, Roseburg, OR
2475 Stewart Parkway, Roseburg, OR
482 NE Winchester Street, Roseburg, OR
25
SELF-CARE AFTER HIP REPLACEMENT SURGERY
GENERAL RECOMMENDATIONS
• Attach a reacher to your walker with
sticky-backed Velcro to retrieve objects
from the floor or high cupboards.
• Cut the handles on a plastic grocery bag
and tie it to the front of the walker. You
can also use a purse or tote bag.
• To reduce bending and reaching, move
most-used items in each room of your
home within easy reach (shoulder to
waist level). Leave items used daily out
on counters.
• If you are alone part of the day, carry
a phone, personal alarm, or whistle with
you in the walker bag to call for help in
case of an emergency. Consider a contract
with Asante Lifeline, a local emergency
alert system. Call (541) 789-4440 or
e-mail [email protected].
•A rolling cart or four-wheeled walker
with a seat helps move heavier or
multiple items from room to room.
• Remove throw rugs to avoid tripping.
When a throw rug is unavoidable, use one
that lays flat and has a rubber backing.
• Use a high nonswivel or rolling stool in
the kitchen during meal preparation.
Slide objects across countertops instead
of carrying them.
•Move pet bowls up on a box, low table,
or other raised surface to decrease the
need for bending to the floor.
•For laundry, a reacher helps with loading
and unloading clothes from the washer
and dryer. A rolling cart helps move
clothes to and from the laundry room.
Store detergent for easy access that allows
dispensing without lifting, bending,
and reaching.
• Acquire help to complete house cleaning
and chores as needed (family, friends, or
hired help). Vacuuming, making beds,
and lifting more than 20 pounds should
be avoided.
26
TRANSFERS
The occupational therapist will make
specific recommendations for your
situation. The following are general
recommendations.
Chairs
• Do not sit in any chair that rocks,
swivels, or rolls until cleared by your
physician. If you have hip precautions,
do not sit in low or soft chairs.
• Sit in a firm chair with armrests. Use
the armrests to sit and rise; do not pull
yourself up on the walker.
•Use a firm cushion, folded blankets, or
blocks to raise the surface of low chairs.
• Use your knee crease to determine
if a surface is high enough to sit on. If
the seat of a chair hits below the bend in
your knees, it is usually too low.
Toilet
• Use an elevated toilet seat or bedside
commode to raise the height of
the toilet.
• After toileting, stand by pushing up
from the seat, reaching forward with
one hand at a time to your walker.
Do not attempt to use the walker to
pull up to stand.
• When out in the community, use the
handicapped bathrooms, which provide
grab bars and higher toilets.
BATHING
Tub bathing, swimming, and sitting in a
spa are not allowed until the hip has totally
healed. You can shower when the doctor
approves and the incision is healed with no
drainage. Initially, you may need adaptive
devices for safety and independence. The
following are recommendations to improve
the safety of bathing.
SELF-CARE AFTER HIP REPLACEMENT SURGERY continued
Shower Stall
If the walker fits into the shower stall,
step in with the weak leg first (the walker
supports the weak leg). If unable to fit
the walker into the stall, step in backward
with the strong leg first. In both situations
when transferring out of the shower, have
the walker outside the shower stall and
step into it with the weak leg.
• A shower bench with a back and
adjustable legs is recommended. At
times you can substitute the bench
with a commode chair. A rubber mat
will decrease the risk of slipping
while bathing.
• A handheld showerhead allows you to
control the water flow while seated for
a shower.
• A grab bar placed vertically (shoulder
to waist height) just inside the shower
helps with your transfer in and out
of the shower and provides support
while standing.
• Make sure that surfaces both inside
and outside the shower are nonskid to
decrease the risk of slipping.
Shower over Tub
• A tub transfer bench or shower
bench with a back and a large seat is
recommended. Adjust the tub transfer
bench to a comfortable height and lower
the inside legs one level. This slight
inward slope will help drain water into
the tub and not onto the floor.
• A handheld showerhead allows you to
control the water flow while seated for
a shower.
• To better accommodate a tub transfer
bench and promote ease of transfers,
remove sliding doors from the track and
hang a curtain on a spring tension rod
inside the track.
• To transfer onto the tub transfer bench,
turn with your back to the tub, with
your legs touching the tub wall; put
one hand on the back of the bench and
the other on the walker, then slowly sit
on the bench. Lean back when lifting
legs over tub edge (knee on weak leg
straight) to maintain hip precautions.
•Placing a hand towel on the bench will
assist with the transfer by preventing wet
skin from sticking to the plastic surface.
• Make sure that surfaces both inside and
outside the shower are nonskid. Use a
rubberized bath mat in the shower and a
rubber-backed rug outside the shower.
• For safety, have someone assist you with
the first few transfers to the tub.
TED HOSE/SUPPORT STOCKINGS
If you were given TED hose in the hospital,
they must be worn until you see the
surgeon after discharge. He will tell you
when you can discontinue their use. TED
hose should be removed at least once per
day for bathing and skin care. They are to
be worn about 20 hoursper day and should
be hand-washed and hung to dry. To speed
up the drying time, you can wring them dry
in a towel or place in a dryer on the “air”
setting (no heat).
LOWER BODY SELF-CARE
The occupational therapist will instruct
you in the use of all adaptive devices
issued. The following are general guidelines
for maintenance of hip precautions.
• Use adaptive devices for all care below
your knees. Use a reacher for foot care,
including washing and drying between
your toes.
•Always use adaptive devices from
between your knees. Reaching from the
outside causes your leg to rotate inward.
• When dressing your lower body, put
clothing onto the weak leg first and off
that leg last.
27
SELF-CARE AFTER HIP REPLACEMENT SURGERY continued
• When using a sock aid following your
shower or when your feet are damp,
sprinkle powder into the sock aid before
putting your foot in.
• Wear slip-on shoes or use elastic shoelaces
to prevent the need to reach your feet.
High-heeled shoes are not recommended.
• Safety-pin a clean washcloth over a longhandled bath sponge to apply creams or
powder to your legs and back.
•Use soap on a rope or liquid soap, which is
less prone to fall to the shower floor.
•Complete dressing while seated, to prevent
falling due to loss of balance (because of
the shift in your center of balance following
surgery and decreased vision as clothing is
pulled over your head).
KEY REMINDERS IF YOU
HAVE HIP PRECAUTIONS
• Do not bend your hip more than 90 degrees.
• Do not cross your legs.
• Do not roll your leg inward or outward.
PRECAUTION DO’S
• Turn only with a thick pillow between your
legs while in bed.
• Get in and out of bed as instructed by the
therapist.
• If compression stockings are ordered,
continue to wear them for six weeks or until
your doctor tells you to discontinue wearing
them. Do not roll them down your leg, as
this will cut off the blood supply to your
leg. Remove all wrinkles. If you are able to
tolerate, please wear them at night as well.
You may remove them at night if needed.
Take them off for one hour each day and
when bathing. Have someone help you put
them on or use a sock aid.
• Avoid small pets, remove throw rugs, and
secure electrical cords on the floor where
you may walk.
PRECAUTION DON’TS
• Do not cross your legs.
• Do not bend your hip more than
90 degrees.
• Do not attempt to put on your own shoes
or socks without a long-handled device.
• Do not pick up items from the floor
without a reacher.
• Do not sit in low chairs or on sofas.
• Do not bend your leg so that your knee
is higher than your hip.
• Do not turn your leg inward or outward.
• Allow for adequate room at the side of your
bed to walk with a walker.
• Do not pivot, squat, or kneel on your
weak leg.
• Continue your exercises as instructed—
three times each day.
• Do not put a pillow under your leg when
lying on your back.
• Walk frequently, keeping the weightbearing restrictions in mind.
• Do not sit for more than one hour at a
time, as this contributes to stiffness.
• Continue to use an elevated toilet seat until
told to discontinue by your doctor.
• Do not sleep on your new hip until
approved by the surgeon.
• Use a walker or crutches until seen by your
doctor at your post-surgery follow-up visit.
• Do not lift or carry things while using
a walker
• Lie on your unoperated side (pillow
between your legs) or your back.
28
• When sitting, keep your knees lower than
your hips.
DISCHARGE PLANNING
What is discharge planning?
Medicare defines discharge planning as “a
process used to decide what a patient needs
for a smooth move from one level of care
to another.” Discharge from a hospital does
not mean that a patient is fully recovered.
It simply means that a doctor has
determined that the patient is stable and
no longer needs hospital-level care.
Who can assist me in planning for my
discharge?
Only a doctor can authorize a hospital
discharge, although many other people are
involved in working out the details of the
discharge plan. You and your significant
others are the most important people
involved, as you understand the home
situation and the available support system.
The discharge planner is a nurse who can
help make some of the arrangements for
your care following discharge.
I live alone and will need help cleaning
my home and preparing meals. Can the
discharge planner arrange for this?
There are many services that may be
of benefit to you, such as housekeeping
and meal preparation, but your insurance
company does not cover these. The
discharge planner can give you lists of
providers, but the actual arrangements
for the services and the payment need
to be made by you or your representative.
If you have long-term-care insurance, it
may include a provision for in-home care
that is not covered by Medicare or your
medical insurance.
My neighbor had surgery, and a nurse
came to her home to check on her a
couple of times a week. Could I have
this same follow-up care?
Medicare and most private insurance
companies pay only for care that is
considered “medically necessary.” There
are specific requirements that also must
be met. For instance, home health care is
covered only if the patient is “homebound”
and has care needs that can be provided
only by a professional, such as physical
therapy or dressing changes. A doctor’s
order is required for home health care.
Is there help for patients who are
unable to pay for their prescription
medications?
If you do not have money to purchase your
medications upon discharge, please tell
the nurse that you wish to speak with the
social worker. There are several agencies
in Southern Oregon that can help with
accessing drug assistance programs as well
as discount prescription drug cards.
Will I need a hospital bed or
other medical equipment when
I return home?
Most patients will not need any special
medical equipment upon discharge from
the hospital. Remember, Medicare and
most private insurance companies will
pay only for equipment that is “medically
necessary.” Some items such as grab bars
for your bathroom or a shower bench,
although helpful, are considered “comfort
or convenience” items and are not
reimbursable. If your doctor and therapist
recommend certain medical equipment,
the discharge planner can assist with the
arrangements for delivery to your home.
29
DISCHARGE PLANNING continued
I have no one to assist me at home,
so I prefer to go to a rehabilitation
facility to continue my recovery after
discharge. Will Medicare pay for this
level of care?
Medicare provides payment for care in a
skilled-nursing rehabilitation facility if the
following requirements are met:
• The admission to the rehabilitation
facility must occur within 30 days of a
hospital stay of three or more days. The
three-day stay in the hospital must meet
Medicare criteria for inpatient hospital
admission. For example, a night spent
in outpatient status for observation
does not count toward the three-day
qualifying stay.
• The care received in the facility must be
an extension of treatment of a condition
requiring daily skilled-nursing care.
30
• After the first 20 days of care in a
rehabilitation facility, there is a copayment. Some insurance supplements
cover the co-payment amounts.
Other options available for those who live
alone and do not feel comfortable about
returning directly home from the hospital
include the following.
• Assisted-living facilities provide
various levels of help, from medication
management to dressing and bathing.
• Foster homes are privately owned
homes providing different levels
of assistance.
The patient is responsible for payment
unless eligible for other coverage. Please
ask to speak with a discharge planner if
you have any questions.
AFTER DISCHARGE FROM THE HOSPITAL
A
fter discharge from the hospital,
whether you go home or to a
rehabilitation facility, the following factors
will be important for the care of your
new joint.
PHYSICAL THERAPY
You will be responsible for following a
daily exercise program that will be outlined
by the physical therapist while you are still
in the hospital. The success of your hip
replacement surgery depends largely on
your diligence, cooperation, and attention
in adhering to your physical therapy
program. Remember to take your pain
medication at least 30 minutes prior to
your planned activity.
If your doctor wants you to go to
outpatient physical therapy after
your hospital stay, the nursing staff
will communicate this with your
discharge plan.
BLOOD-THINNING MEDICATION
You will be on blood-thinning medication
or aspirin after you are discharged from
the hospital. Depending on the specific
medication ordered, you may need to
have blood drawn to check your bloodthinning level.
There are warning signs that your blood
might be too thin, such as nosebleeds,
bleeding gums, excessive bruising, and
blood in the urine. Please call the doctor
if you have any of these symptoms. It is
also dangerous to take aspirin, ibuprofen
(Advil, Motrin, or Nuprin), and any
over-the-counter or prescription arthritis
medicine while you are taking bloodthinning medication. You may take
acetaminophen (Tylenol) or pain pills that
have been prescribed for you. You will
be able to resume arthritis medicine and
aspirin as needed after the blood-thinning
medication is discontinued.
YOUR HIP INCISION
• Leave the dressing in place, as
instructed.
• After the adhesive skin closures fall off,
keep the scar clean and dry.
• Report to your doctor any redness,
increased warmth to the touch, wound
separation, or increase in localized
pain, bruising, or drainage.
DRIVING
You will not be able to drive for the first
six to eight weeks following surgery.
Although you may feel capable, you
will need written approval from your
doctor; otherwise your insurance
coverage may be jeopardized and the
safety of your new joint compromised.
Your safety and well-being are of prime
concern during the healing process.
SEXUAL ACTIVITY
Once cleared by the surgeon, you may
resume sexual activity, observing your hip
precautions. If you have specific questions,
please do not hesitate to ask the doctor,
nurse, or other staff member.
31
LIVING WITH YOUR NEW HIP
INFECTION
Your new hip is a metal and plastic
prosthesis, so the body considers it a
foreign object. If you become sick with
a serious infection, bacteria can circulate
in your body, go to the prosthesis, and
cause a bacterial infection in your new
joint. For this reason, if you become ill
with an infection or a high fever, your
doctor should evaluate you immediately.
SURGICAL PROCEDURES
If you are scheduled for a medical
procedure, even a minor one such as
dental cleaning or surgery for an ingrown
toenail, you may be asked to take
antibiotics before the procedure in
the first two years after hip replacement
surgery. If the doctor is not sure of the
appropriate antibiotics for you, please
ask him or her to call your orthopedic
surgeon. This may also apply to invasive
procedures using a scope, such as a
cystoscopy, bronchoscopy, or gastroscopy.
DENTAL WORK
You may be asked to take antibiotics
before dental work; this includes
routine cleanings. The reason for taking
antibiotics is that bacteria are present
in the mouth that are not present
anywhere else in the body. When you
have your teeth cleaned, bacteria gain
entry into the bloodstream and can
circulate to the hip prosthesis, causing
it to become infected. Antibiotics kill
the bacteria that cause this type of
infection, so it is imperative that you
notify your dentist of your prosthesis.
If your dentist is not familiar with the
correct type of antibiotics to give you,
ask him or her to call your orthopedic
surgeon prior to scheduling the dental
32
procedure. Routine daily flossing, twicea-day brushing, and cleanings every six
to 12 months are strongly advised.
We recommend the following
guidelines.
• If you have rheumatoid arthritis,
systemic lupus erythematosus,
insulin-dependent diabetes, previous
total joint infection, malnourishment,
or hemophilia, or if you have had
radiation or drugs to decrease your
immune system, you may need to
take antibiotics before certain dental
procedures.
• If you are otherwise healthy, for two
years after surgery you may be asked
to take antibiotics briefly if any dental
work being done could cause bleeding
in the mouth.
The suggested use of antibiotics is
as follows:
• Patients not allergic to penicillin:
Take four 500-milligram amoxicillin
tablets one hour before the procedure.
• Patients allergic to penicillin but
able to take cephalexin: Take four
500-milligram cephalexin tablets
one hour before the procedure.
• Patients allergic to penicillin and
cephalexin: Take 600 milligrams of
clindamycin one hour before the procedure.
If oral medications cannot be taken,
intramuscular or intravenous drugs
should be given.
LIVING WITH YOUR NEW HIP continued
This relates only to preventing the spread
of bacteria from your mouth to your
prosthesis during dental work. If you
develop a bacterial infection of the skin,
lungs, gastrointestinal tract, urogenital
tract, or other site, it should be treated
for as long as it takes to eliminate the
source of the infection. Viral infections
such as colds and flu do not require
antibiotics to protect your new joint.
Your dentist is ultimately responsible
for making the decision for or against
antibiotics based on his or her knowledge
of the dental work to be done. If you
or your dentist have any questions, please
have him or her call your orthopedic
surgeon.
SKIN CONDITIONS
It is important that you advise your
orthopedic surgeon of any skin conditions
or problems prior to surgery. These may
include athlete’s foot, dermatitis, nail biting
with or without bleeding, and rashes or skin
breakdown in skin folds, under the arms, or
in the groin. Your doctor can instruct you in
the care needed to heal these conditions.
Use a first-aid cream on minor cuts and
abrasions to prevent infection, before
and after your surgery, indefinitely.
Do not razor-shave your legs, armpits,
or face within two days of surgery
because this can contribute to wound
infection of your new joint.
FOLLOW-UP CARE
Although your hip may feel fine, it is
important to remember that your new joint
has artificial components and for this
reason you must see your surgeon at
the routine six-week, three-month,
six-month, and annual visits thereafter.
Routine examinations to continually
monitor your prosthesis are recommended
because certain minute changes apparent
only on an X-ray or in an examination
may be detected. It is important to stay
up-to-date on your health immunizations,
especially flu shots, Pneumovax, and
tetanus booster.
If you have foot problems, it is important
that you dry your feet well after bathing or
swimming, wear well-ventilated shoes and
absorbent socks, and apply anti-fungal
ointment or powder as directed.
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