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Lahey Clinic Department of Orthopaedic Surgery
A Patient’s Guide to
Department of Orthopaedic Surgery
41 Mall Road • Burlington, Massachusetts 01805
(781) 744-8650
See The Department of Orthopaedic Surgery at www.lahey.org
HIP
REPLACEMENT
A Patient’s Guide to Hip Replacement
Dear Hip Replacement Patient,
We hope this Patient Guide to Hip Replacement provides valuable information as you
prepare for your hip replacement operation. More information about the Lahey Clinic
Department of Orthopaedic Surgery is available at www.lahey.org/OrthopaedicSurgery.
Enjoy your new hip!
Lahey Clinic Hip Replacement Surgeons
(Left to right) John F. Tilzey, M.D., Lawrence M. Specht, M.D., Richard Iorio, M.D.,
William L Healy, M.D., Michael S. Thompson, M.D., Bernard A. Pfeifer, M.D.
If you have any questions or concerns about your hip replacement operation,
please call your Orthopaedic surgeon at Lahey Clinic, (781) 744-8650.
A Patient’s Guide to Hip Replacement
• Use a pillow or two between your legs when sleeping,
especially when you turn onto the nonoperated side to
rest. This will help keep your operated hip on its side of
the imaginary line, as discussed above.
• When your surgeon prescribes strengthening
exercises, work hard to make your hip, back, and
knee muscles strong.
• Stay active. Resume many of your activities of daily living.
• Airline travel within the first 2 months after hip
replacement operation increases the risk of developing a
blood clot. Please discuss this with your surgeon.
Walking is an essential part of physical therapy. You
should take daily walks, lengthening your walking distances as
your strength improves.
FOR THE REST OF YOUR LIFE
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Your hip replacement should provide mobility, stability, and
pain free function for many years. You can participate in
many activities with your “new hip”. However, you should
protect your hip replacement from excess stress which can lead
to premature failure of the artificial joint. Avoid weight gain
which will increase stress on your new hip. High impact
loading activities such as jumping, running, jogging, and heavy
weight lifting should be avoided. Sports, such as basketball,
racquetball, squash, volleyball, and tennis, increase the risk of
implant loosening and implant wear. You may choose to
participate in these sports, but you must accept the associated
risk. Low-impact loading activities such as walking, boating,
cycling, swimming, bowling, and golf are excellent activities for
recreation and exercise after hip replacement.
CONTENTS
Choosing Hip Replacement ................................................2
What is a Hip Replacement? ..............................................3
Types of Hip Replacements ................................................4
Innovation, Technology, and Information ..........................5
Getting Ready for Surgery ..................................................6
Scheduling Your Operation ................................................6
Informed Consent ..............................................................6
Academic Medical Center ..................................................7
Physical Examination/Tests ................................................7
Blood Management ............................................................8
Case Manager......................................................................9
Anesthesia ..........................................................................9
Personal Preparations For Surgery ......................................9
Physical Therapy ..............................................................12
Final Pre-operative Visit ....................................................14
Day Before Surgery ..........................................................15
Operation and Hospital Stay ............................................16
After Surgery: Day by Day ................................................17
Leaving the Hospital ........................................................23
To a Rehabilitation Facility............................23
To Home ......................................................23
Important Information As You Leave Lahey Clinic ..........24
Follow-up Visits ............................................24
Hip Stability/Leg Positioning ........................24
Wound Care ..................................................24
Toileting ........................................................25
Bathing..........................................................25
Dressing ........................................................25
Compressive Stockings ..................................25
Driving ..........................................................26
Sexual Relations ............................................26
Dental Work..................................................26
Infections ......................................................26
Guidelines After Hip Replacement....................................27
For the First Two Months ..............................27
For the Rest of Your Life................................28
1
CHOOSING
HIP
REPLACEMENT
Hip replacement is an elective surgical procedure. This
operation is one of several non-surgical and surgical options which
are available for treatment of your arthritic hip. It is important for
you to be familiar with all possible treatments for your hip.
Non-operative treatment options for an arthritic hip include: antiinflammatory medicine, pain medication, physical therapy, weight
loss, walking aids such as a cane or crutches, nutritional supplements,
and restricting your activities. Many patients with an arthritic hip try
non-surgical treatment before choosing surgical treatment.
Surgical treatments for an arthritic hip include: arthroscopy, open
debridement, osteotomy, fusion, partial hip replacement, hip
resurfacing, and total hip replacement. Each operation has specific
indications, and all surgical treatments are not appropriate for all
patients.
2
GUIDELINES AFTER HIP
REPLACEMENT
For your safety, and to ensure a successful outcome following
your hip replacement operation, you should adhere to the
following guidelines.
FOR THE FIRST TWO MONTHS
• Maintain safe positions of your
hip. Do not bend your hip past
90° which can occur if you
bring your knee too close to
your chest.
• Do not sit on low chairs which
can force your hip to bend past
90°. It is best to sit with your
knees below your hips.
• Do not pivot or twist on the
operated leg. Avoid twisting or rotating your operated leg
inward or outward.
Generally, hip replacement is very successful. Hip pain is
relieved, and function improves. It is not clear how long a hip
replacement will last. The long-term success rate will vary,
depending on your age, your weight, and your activity. “Plan on
ten to fifteen years and hope for twenty”. If a hip replacement
becomes loose or wears out, generally it can be fixed with a revision
hip replacement operation.
• During the day time get up every half-hour or so and take a
brief walk. Prolonged sitting may allow muscles around your
hip to get stiff.
Hip replacement is major surgery. When choosing to have a
hip replacement, it is important to be aware of potential risks and
complications such as: problems from anesthesia, bleeding,
damage to nerves or blood vessels, instability, dislocation,
fracture, leg lengthening, blood clot, infection, and very
rarely, death.
• Do not cross your legs. Imagine a line drawn down the
middle of your body (from the tip of your nose to the
space between your two feet). You should not bring your
operated hip across that line.
• Avoid slippery surfaces which may allow your leg to give
way.
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3
TYPES OF HIP REPLACEMENTS
Toileting
Total Hip Arthroplasty (THA)
Most home toilet seats are low. A commode or raised toilet
seat will be helpful. Toilet grab bars may also be helpful.
Total hip arthroplasty or total hip replacement is the operation
described in this booklet. Hip implants can be fixed to bone with bone
cement or with bone ingrowth to porous metal. The goal of THA is
to relieve pain and improve function. This is the most common type
of hip replacement.
Hemi Arthroplasty/Bipolar Hip Replacement
This operation removes the arthritic hip joint and implants a
femoral stem with a large, fixed or mobile femoral head that fits
into the natural acetabulum. This operation is frequently used for
a hip fracture. It is less common than total hip replacement.
Femoral Head Resurfacing/ Total Hip Resurfacing
This operation resurfaces the arthritic femoral head and the
arthritic acetabulum without removing femoral head and femoral
neck. This operation is less common than total hip replacement.
Minimally Invasive Hip Replacement
(Minimal Incision/Less Invasive) A Minimally Invasive Hip
Replacement operation is performed through a small incision
with less tissue dissection. Some patients are not candidates for
minimally invasive hip replacement.
Revision Total Hip Arthroplasty
Revision total hip arthroplasty is an operation which revises or fixes
a hip replacement which has developed a problem such as loosening
of fixation, wear of bearing surfaces, fracture, or instability.
Bilateral Total Hip Arthroplasty
4
Some patients with two equally symptomatic arthritic hips may
be candidates for Bilateral THA on the same day, however this is
uncommon.
Bathing
While your skin staples or sutures are in your hip incision,
please use sponge baths for personal hygiene. Please do not get
your hip replacement wound wet. You may shower or bathe
after your skin staples or sutures are removed. Bathing is
best done in the shower – getting in and out of a tub can be
difficult and dangerous when recovering from hip surgery.
Grab bars in the shower/tub area may be helpful. A longhandled sponge, can be helpful for bathing your lower body.
Some patients find a tub seat in the shower to be helpful. Be
cautious when walking on slippery bathroom floors.
Dressing
Some patients will need assistive devices in order to dress
independently. A stocking aid may enable you to put on your
socks without bending over too far. A long-handled shoehorn
will assist you in putting on your shoes. Long-handled
reachers may assist you in putting on and pulling up your
pants. You will be evaluated during your hospital stay for your
particular needs at home.
Compressive Stockings
The white TED stockings should be worn on both legs when
you are up during the day. They help control swelling in your
legs (especially in your operated leg). At night, you can remove
them and launder them, if necessary. Usually, you will be asked
to wear these stockings for four to six weeks after surgery.
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IMPORTANT INFORMATION AS
YOU LEAVE LAHEY CLINIC
Follow-Up Visits
Two Weeks:
Usually, your surgeon or his assistant will see you in the outpatient
clinic to remove skin staples or sutures two weeks after surgery. If
you go to a rehabilitation hospital, they may remove your staples
or sutures.
Four to Six Weeks:
Usually, you will see your surgeon four to six weeks following
surgery for a clinical and radiographic examination.
Hip Stability/Leg Positioning
It is your responsibility to maintain safe positions during
transfers and ambulation. All hip replacements can be dislocated
if the hip is put in an unstable position.
INNOVATION, TECHNOLOGY, AND
INFORMATION
Total hip arthroplasty uses anatomically designed implants made
of high grade biomaterials to replace arthritic hip joints. As new
materials, designs, and techniques are developed to improve hip
replacement, Lahey hip surgeons evaluate new technology for
possible use with Lahey patients. Lahey Clinic orthopaedic
surgeons use the best techniques and best implants available to
provide predictably successful hip replacement operations.
Innovations that may be appropriate for some patients include:
• cemented and cementless total hip arthroplasty
• alternative bearing surfaces
• highly crosslinked polyethylene
• ceramics
• metal on metal
• hip resurfacing
• minimally invasive THA
• computer assisted surgical navigation
Wound Care
Keep your incision dry while staples are in. You should keep a
dressing on your wound if there is drainage. If the wound is clean
and dry, you can leave it open to air. Look at your wound each
day. If you notice signs of possible infection such as: increasing
redness, increasing warmth, or new drainage that looks like pus,
call your surgeon immediately. If your doctor or nurse want to
give you an antibiotic for your hip, please ask him/her to call your
surgeon first.
24
Information on total hip arthroplasty is available from many sources
including the internet and direct-to-consumer marketing programs.
Some of this information is accurate and useful. Some of this
information is not accurate. Information on clinical services,
educational programs, and orthopaedic research in the Lahey
Clinic Department of Orthopaedic Surgery is available at www.
lahey.org/OrthopaedicSurgery.
The Lahey Clinic hospital is a “high reliability organization”
committed to patient safety and prudent use of new “cutting edge”
technology in caring for our patients.
All Lahey Clinic hospital rooms are private rooms equipped with flat
screen personal computers which provide hip replacement patients
with access to television, radio, games, music, email, and the internet.
5
GETTING READY FOR SURGERY
LEAVING THE HOSPITAL
Once you have decided to have your hip replaced, there is
much to do to prepare for your operation. Lahey Clinic
provides a team approach to your care. You will have a
chance to meet members of the team before surgery. They
will answer your questions and make arrangements to insure
that your surgery, hospital stay, and post-operative recovery
will go as smoothly as possible.
To a Rehabilitation Facility
SCHEDULING YOUR OPERATION
Surgical scheduling is a complex process. Your operation
requires you, your surgeon, an anesthesiologist, surgical
assistants, nurses, an operating room, surgical instruments,
hip implants, and many pieces of equipment to be in the
same place at the same time. You will work with a surgical
scheduler to select an acceptable date for your hip
replacement operation. Please be as flexible as possible in
working with your surgical scheduler.
INFORMED CONSENT
If you choose to go to a rehabilitation facility, and if your health
plan approves this choice, you will be discharged on the second
or third day after surgery. Your case manager will assist you and
your family with discharge plans. You will bring a Lahey Clinic
Hip Replacement Post Acute Care Plan with you to the
rehabilitation facility. Follow-up with your surgeon will also be
arranged.
To Home
If you are medically stable, independent with walker/
crutches/cane, and knowledgeable in hip replacement
precautions, and if you have help available at home, you may
choose to be discharged to home. Your case manager will assist
you and your family with discharge plans. Physical Therapy at a
therapists office or at home will be arranged. You will take pain
medication and blood thinners at home. Usually, you will resume
your routine medications at home – review these medications
with your primary care physician.
You will be asked to sign an informed consent document which
gives Lahey Clinic and the Lahey Clinic professional staff
permission to give you a hip replacement operation. This booklet
will teach you about hip replacement so you will be a well
informed patient. You will also be asked to give Lahey Clinic
permission to collect information about your hip replacement in
the Lahey Clinic total joint database.
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23
Postoperative Day #4
• The dressing on your wound will be changed. If your
wound is dry, it may not be necessary to cover it.
• Activity Progresses:
- Practice independent transfers.
- Practice independent ambulation with
crutches/walker.
- Continue exercises.
- Practice stair climbing.
- Review hip safety precautions.
22
ACADEMIC MEDICAL CENTER
Lahey Clinic is an academic medical center. Lahey Clinic doctors
teach residents, students, and postgraduate fellows how to be
doctors and surgeons. Boston University orthopaedic surgery
residents train at Lahey Clinic. You will meet the students,
residents and fellows as members of the orthopaedic team.
Orthopaedic residents and fellows will participate in your
operation to help your surgeon and learn about hip replacement
surgery. Students and visiting doctors may observe your surgery.
Your orthopaedic surgeon will do your hip replacement
operation.
PHYSICAL EXAMINATION/TESTS
Generally, a physical examination by an internal medicine doctor
is recommended to ensure that you are healthy enough to
undergo major surgery. If you are new to Lahey Clinic, or if you
have a primary care physician outside Lahey, please bring a letter
from your doctor to your pre-operative visit which describes your
past medical history and your current medical condition.
Consultation with other medical specialists may also be necessary.
Several diagnostic tests, including chest x-ray, EKG, and blood
and urine tests may be scheduled. You need to bring a list of all
your current medications, including prescription drugs, over the
counter medicines, vitamins, herbs, and nutritional supplements
when you come for your preoperative visit. An up-to-date medical
history which includes current and past health problems, allergies,
hospitalizations, and surgeries
will be recorded. If you have
dental problems, please inform
us and seek appropriate care well
before your surgery date. Dental
infection can lead to hip
infection.
7
BLOOD MANAGEMENT
During your hip replacement operation, you will lose some
blood from the bone, muscle, and other soft tissues which are
moved or cut. You will also lose some blood after your
operation which may cause swelling of your hip, buttocks,
and thigh.
Some patients will require a blood transfusion after hip
replacement. Factors associated with a need to transfuse blood
include; a low hemoglobin or hematocrit (“low blood count”)
before operation, cardiac conditions, medical disease,
extensive hip reconstruction, prior hip operations on the same
hip, and unexpected post-operative blood loss.
In some cases, your surgeon may ask you to donate your own
blood for possible transfusion – autologous transfusion. This
blood is refrigerated and stored until the time of your
operation. In some cases, on the day of your surgery, your
anesthesiologist may draw off some of your blood before the
operation in order to give it back to you after surgery –
hemodilution. In some cases it may be necessary for you to be
transfused with Blood Bank blood.
Postoperative Day #3
• The dressing on your wound will be changed.
• If you have been unable to have a bowel movement (pain
medicine commonly causes constipation) and you are
uncomfortable, the nurses may offer you a suppository or an
enema.
• Activity progresses:
- You should become independent with transfers. You will
require less assistance for transferring in and out of bed.
- If it is possible, you will practice ambulating with
crutches instead of a walker. Your goal should be to
walk independently with a walker, or crutches as soon as
possible.
- Continue exercises.
• If you will be discharged to a post-acute care facility, you will
probably be transferred by ambulance today. You will bring
a Lahey Clinic Hip Replacement Post-Acute Care Plan with
you to the rehabilitation facility.
• If you will be discharged to home, the Occupational
Therapist will assist you with the performance of everyday
activities such as bathing and dressing. They will show you
techniques to assist with these activities at home.
8
21
Postoperative Day #2
• The dressing on your wound will be changed.
• A blood test will be drawn to measure the effectiveness of the
blood thinner (Coumadin). This blood test will be drawn
intermittently as long as you take Coumadin.
• If you are constipated, please tell your nurse.
• Your activities will progress:
- Practice transfers. You should be getting into a chair at least
two times a day with assistance from the physical therapy or
nursing staff.
- You will begin walking with a walker or crutches.
- Continue exercises from post-operative day 1.
• The case manager, in discussions with you, your family, your
physicians, your therapists, and your healthcare insurance
company will finalize discharge planning. Transfer to a
rehabilitation hospital may occur on postoperative day three.
Discharge to home may be on postoperative day four or five.
CASE MANAGER
Before your operation, you will be contacted by a Lahey Clinic
Case Manager who will help you plan your discharge from the
hospital to a rehabilitation facility or to home. Advance
planning helps alleviate concerns you and your family may have
about what will happen after you leave the hospital. Your health
insurance company will have input concerning where you may
go after hospital discharge. Speak to your health insurance
representative about your options.
ANESTHESIA
Most patients will meet their anesthesiologist on the day of
surgery. He or she will review your medical records and answer
questions you may have about anesthesia. If you have a preference
for a type of anesthesia, please tell your anesthesiologist. We
encourage you to follow your anesthesiologist’s recommendations.
If you have a specific condition which requires a pre-operative
consultation with an anesthesiologist, please let us know.
PERSONAL PREPARATIONS FOR
SURGERY
Prepare Yourself:
• Stop smoking. This will help your breathing, improve
wound healing, and reduce postoperative
complications. (At least cut back).
• Eat well-balanced meals. This is not the time for serious
weight loss.
• Start taking an over-the-counter iron supplement one
month prior to surgery (FeSO4 325 mg three times per
day).
20
9
• Get plenty of rest.
• Cut back or eliminate alcohol.
• Exercise to improve and maintain muscle tone and joint
motion.
• Develop a positive attitude for hip replacement!
Prepare Your Home:
• If possible, arrange a one floor living area with
kitchen/bed/bathroom to minimize stairs.
• Rearrange furniture to enlarge walking paths for
crutches or a walker.
• Remove scatter rugs.
• Make sure all doorknobs are clear and accessible.
• Install night lights.
• Obtain an apron with pockets or a backpack. Your
hands will be using crutches.
• Stock freezer and pantry.
• Obtain a cordless phone.
• Non-skid mats for shower/tub.
• Grab bars in the shower/tub, near toilet.
• Tub seat.
• Raised toilet seat or commode.
• Long handle sponge.
• Stocking aid.
• Long handle shoe horn.
• Long handle reacher.
• The therapists and the nurses will help you out of bed
and into a chair. Hopefully, you can do this two or
three times on postoperative day one.
• Your surgeon will tell you how much weight to put on
your operated leg and hip.
• Please do not “pivot” on your operated leg and hip.
- You will begin the exercises which you learned before
your operation (Page 12).
1. Ankle pumps
2. Isometric Quadriceps sets/hip straightening
3. Gluteal sets
4. Heel slides
• Safety precautions for patients with hip replacements
will be discussed.
• A case manager will visit with you and your family.
Planning for your discharge from the hospital now begins
in earnest.
Prepare For Hospital
Discharge:
• Discuss hospital and discharge plans with relatives and friends.
• Evaluate the options of home discharge or rehabilitation
facility discharge.
• Review insurance coverage as it pertains to discharge.
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19
• You will receive an antibiotic to prevent infection.
• You will receive a blood thinner medication to prevent
blood clots.
• When you are ready, and when your room is ready, you
will be transferred from the recovery room to your
hospital room. Family members and friends may visit
you in your hospital room.
Prepare A Hospital Bag:
• Personal care items.
• Loose, comfortable clothing.
• Shorts, sweatpants, t-shirts.
• Low-heeled supportive shoes or sneakers with non-skid soles.
• “Walkman” type tape/CD/MP3 player if you like music.
• Cash for newspaper, snacks, etc.
• Credit card for TV/telephone/internet access.
• Some patients will spend their first night in the hospital
in the recovery room.
Postoperative Day #1
• Use your incentive spirometer to expand your lungs.
• Several blood tests will be drawn to monitor your recovery.
• Your diet will begin with clear liquids. It will be
advanced when it is safe to do so.
• A bowel regimen including stool softeners will be instituted
to prevent constipation.
• If you have a bladder catheter, it will probably be removed.
• Early physical therapy is intended to allow you to
transfer (from bed to chair, chair to walker, ...) and
ambulate safely with walker, crutches, or cane.
• Specific strengthening and range of motion exercises
are not required for the first few weeks following hip
replacement.
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11
PHYSICAL THERAPY
AFTER SURGERY: DAY BY DAY
Successful hip replacement requires successful recovery and
rehabilitation including safe transfers out of bed and out of a
chair, careful positioning of your operated leg, safe
ambulation, healing of the soft tissues around your hip
implants, and physical therapy to strengthen your hip,
back, and knee muscles.
This schedule presents a sequence of events that usually follow hip
replacement operations at Lahey Clinic.
You will get out of bed the day after your hip replacement
operation. The physical therapist will teach you to transfer
safely and to walk with a walker. Your surgeon will tell you
how much weight to put on your operated leg.
You will not be allowed to pivot on your operated leg. When
you are safe, you will be advanced to crutches for ambulation.
During the first six weeks after hip replacement, you do not
need supervised physical therapy. Your goal will be to
transfer and walk safely. Specific physical therapy with
range of motion and muscle strengthening exercises will
begin six weeks after your hip replacement operation.
In order to maintain muscle tone, promote blood flow, and
prevent blood clots, we recommend that you practice the
following exercises before your surgery. You will perform
similar exercises after surgery. Perform each exercise 10-15
times.
Ankle Pumps:
Move your foot up and down slowly feeling a gentle stretch
in the calf muscle. This can be performed lying down in bed
or sitting in a chair. After operation, this exercise will help
prevent a blood clot.
12
Day of Surgery
• When your hip replacement operation is finished, you
will be taken to the recovery room. You will be drowsy,
and you may not recall much about the operation or
recovery room experience. Your family will be able to see
you briefly in the recovery room.
• When you arrive in the recovery room, you will have an
intravenous line for fluid replacement. Support
stockings or elastic bandages will be on your legs to
prevent blood clots.
• An abduction pillow will be strapped between your legs
to control the position of your legs and prevent
dislocation of your hip replacement.
• To control pain after surgery, you will be given
medication through an intravenous line or by injection.
The next day you will be given pills for pain.
• The nurses will give you an incentive spirometer. You
will take long, deep breaths with this machine to fully
expand your lungs. It is important that you do this at
least 10 times every hour, when you are awake.
• You may discover that when you were anesthetized, a catheter
was passed into your bladder to monitor your urine output.
This will be removed on the first day after your surgery.
17
OPERATION AND HOSPITAL STAY
Please arrive on time on the day of your operation. You will
be admitted to the hospital, and you will dress in hospital
clothes. A name band will be placed on your wrist. All jewelry
must be removed. Your family will take your personal items.
You will see your surgeon and his/her assistants prior to your
operation. Your surgeon will mark your surgical site with a
marker.
Your nurse will record your temperature, blood pressure, pulse
rate and respiratory rate. You will be asked to empty your
bladder. An intravenous line will be started. Extra blood may be
drawn for testing or blood management.
Quadriceps Sets/Knee Straightening:
With your leg out straight, tighten your thigh muscle and
push the back of your hip down into the bed. Hold for 5-10
seconds. Relax. After operation, this exercise will help gain
hip extension.
Gluteal Sets:
Squeeze your buttocks muscles together and hold for 5-10
seconds. Relax. this exercise can also be done sitting in a chair.
Heel Slides:
Lie on your back. Slide your heel towards your buttocks (as
far as you can go). Slowly straighten your leg.
When the operating room is ready, and the operating team is
assembled, you will be escorted into the operating room on a
stretcher. In the operating room, you will be transferred onto
the operating table, where anesthesia will be induced. At this
point, your hip replacement operation is ready to begin.
Family members who wish to wait at Lahey during your
surgery may do so in the Family Waiting Room. Your surgeon
will speak with them after your surgery. Otherwise, your
surgeon will call a family member or friend after surgery.
16
13
FINAL PRE-OPERATIVE VISIT:
DAY BEFORE SURGERY
You will have a pre-operative visit with a physician assistant or nurse
practitioner who will perform a history and physical, check your
tests, review your consultations, and answer questions. You will be
asked to sign an Informed Consent document regarding your
operation.
On the day before your hip replacement, you can eat or drink
anything you wish up until midnight. After midnight you
must not eat or drink anything unless directed otherwise by
your doctor. You will be asked to take one anticoagulation pill
(Coumadin) on the night before your surgery. You may have
small quantities of water up until two hours prior to your
scheduled time of arrival to the hospital.
A week before surgery please stop taking all anti-inflammatory
medications. If you are uncertain if your arthritis pain medication is
an anti-inflammatory drug, please ask your doctor.
It is possible to take acetaminophen or Tylenol for pain up until the
night before surgery.
On the day before surgery, you will be called and told what
time to report to Lahey Clinic for your operation.
Please leave all jewelry and valuables at home. Your family and
friends can bring personal items to you after your operation.
Please stop taking fish oil, vitamin E, or ginkgo two weeks before
surgery as these supplements can affect bleeding.
If you take an immune
system modifying drug such
as Methotrexate, Enbrel,
Remicaide, or Humira,
please discuss this with your
medical doctor and your
surgeon. You will need to
discontinue this drug in the
peri-operative period.
If you take anticoagulation medicine please ask your surgeon if and
when to discontinue this drug before your hip replacement.
If you get a cold, or the flu in the week or two before your surgery,
please notify your surgeon.
14
15
FINAL PRE-OPERATIVE VISIT:
DAY BEFORE SURGERY
You will have a pre-operative visit with a physician assistant or nurse
practitioner who will perform a history and physical, check your
tests, review your consultations, and answer questions. You will be
asked to sign an Informed Consent document regarding your
operation.
On the day before your hip replacement, you can eat or drink
anything you wish up until midnight. After midnight you
must not eat or drink anything unless directed otherwise by
your doctor. You will be asked to take one anticoagulation pill
(Coumadin) on the night before your surgery. You may have
small quantities of water up until two hours prior to your
scheduled time of arrival to the hospital.
A week before surgery please stop taking all anti-inflammatory
medications. If you are uncertain if your arthritis pain medication is
an anti-inflammatory drug, please ask your doctor.
It is possible to take acetaminophen or Tylenol for pain up until the
night before surgery.
On the day before surgery, you will be called and told what
time to report to Lahey Clinic for your operation.
Please leave all jewelry and valuables at home. Your family and
friends can bring personal items to you after your operation.
Please stop taking fish oil, vitamin E, or ginkgo two weeks before
surgery as these supplements can affect bleeding.
If you take an immune
system modifying drug such
as Methotrexate, Enbrel,
Remicaide, or Humira,
please discuss this with your
medical doctor and your
surgeon. You will need to
discontinue this drug in the
peri-operative period.
If you take anticoagulation medicine please ask your surgeon if and
when to discontinue this drug before your hip replacement.
If you get a cold, or the flu in the week or two before your surgery,
please notify your surgeon.
14
15
OPERATION AND HOSPITAL STAY
Please arrive on time on the day of your operation. You will
be admitted to the hospital, and you will dress in hospital
clothes. A name band will be placed on your wrist. All jewelry
must be removed. Your family will take your personal items.
You will see your surgeon and his/her assistants prior to your
operation. Your surgeon will mark your surgical site with a
marker.
Your nurse will record your temperature, blood pressure, pulse
rate and respiratory rate. You will be asked to empty your
bladder. An intravenous line will be started. Extra blood may be
drawn for testing or blood management.
Quadriceps Sets/Knee Straightening:
With your leg out straight, tighten your thigh muscle and
push the back of your hip down into the bed. Hold for 5-10
seconds. Relax. After operation, this exercise will help gain
hip extension.
Gluteal Sets:
Squeeze your buttocks muscles together and hold for 5-10
seconds. Relax. this exercise can also be done sitting in a chair.
Heel Slides:
Lie on your back. Slide your heel towards your buttocks (as
far as you can go). Slowly straighten your leg.
When the operating room is ready, and the operating team is
assembled, you will be escorted into the operating room on a
stretcher. In the operating room, you will be transferred onto
the operating table, where anesthesia will be induced. At this
point, your hip replacement operation is ready to begin.
Family members who wish to wait at Lahey during your
surgery may do so in the Family Waiting Room. Your surgeon
will speak with them after your surgery. Otherwise, your
surgeon will call a family member or friend after surgery.
16
13
PHYSICAL THERAPY
AFTER SURGERY: DAY BY DAY
Successful hip replacement requires successful recovery and
rehabilitation including safe transfers out of bed and out of a
chair, careful positioning of your operated leg, safe
ambulation, healing of the soft tissues around your hip
implants, and physical therapy to strengthen your hip,
back, and knee muscles.
This schedule presents a sequence of events that usually follow hip
replacement operations at Lahey Clinic.
You will get out of bed the day after your hip replacement
operation. The physical therapist will teach you to transfer
safely and to walk with a walker. Your surgeon will tell you
how much weight to put on your operated leg.
You will not be allowed to pivot on your operated leg. When
you are safe, you will be advanced to crutches for ambulation.
During the first six weeks after hip replacement, you do not
need supervised physical therapy. Your goal will be to
transfer and walk safely. Specific physical therapy with
range of motion and muscle strengthening exercises will
begin six weeks after your hip replacement operation.
In order to maintain muscle tone, promote blood flow, and
prevent blood clots, we recommend that you practice the
following exercises before your surgery. You will perform
similar exercises after surgery. Perform each exercise 10-15
times.
Ankle Pumps:
Move your foot up and down slowly feeling a gentle stretch
in the calf muscle. This can be performed lying down in bed
or sitting in a chair. After operation, this exercise will help
prevent a blood clot.
12
Day of Surgery
• When your hip replacement operation is finished, you
will be taken to the recovery room. You will be drowsy,
and you may not recall much about the operation or
recovery room experience. Your family will be able to see
you briefly in the recovery room.
• When you arrive in the recovery room, you will have an
intravenous line for fluid replacement. Support
stockings or elastic bandages will be on your legs to
prevent blood clots.
• An abduction pillow will be strapped between your legs
to control the position of your legs and prevent
dislocation of your hip replacement.
• To control pain after surgery, you will be given
medication through an intravenous line or by injection.
The next day you will be given pills for pain.
• The nurses will give you an incentive spirometer. You
will take long, deep breaths with this machine to fully
expand your lungs. It is important that you do this at
least 10 times every hour, when you are awake.
• You may discover that when you were anesthetized, a catheter
was passed into your bladder to monitor your urine output.
This will be removed on the first day after your surgery.
17
• You will receive an antibiotic to prevent infection.
• You will receive a blood thinner medication to prevent
blood clots.
• When you are ready, and when your room is ready, you
will be transferred from the recovery room to your
hospital room. Family members and friends may visit
you in your hospital room.
Prepare A Hospital Bag:
• Personal care items.
• Loose, comfortable clothing.
• Shorts, sweatpants, t-shirts.
• Low-heeled supportive shoes or sneakers with non-skid soles.
• “Walkman” type tape/CD/MP3 player if you like music.
• Cash for newspaper, snacks, etc.
• Credit card for TV/telephone/internet access.
• Some patients will spend their first night in the hospital
in the recovery room.
Postoperative Day #1
• Use your incentive spirometer to expand your lungs.
• Several blood tests will be drawn to monitor your recovery.
• Your diet will begin with clear liquids. It will be
advanced when it is safe to do so.
• A bowel regimen including stool softeners will be instituted
to prevent constipation.
• If you have a bladder catheter, it will probably be removed.
• Early physical therapy is intended to allow you to
transfer (from bed to chair, chair to walker, ...) and
ambulate safely with walker, crutches, or cane.
• Specific strengthening and range of motion exercises
are not required for the first few weeks following hip
replacement.
18
11
• Get plenty of rest.
• Cut back or eliminate alcohol.
• Exercise to improve and maintain muscle tone and joint
motion.
• Develop a positive attitude for hip replacement!
Prepare Your Home:
• If possible, arrange a one floor living area with
kitchen/bed/bathroom to minimize stairs.
• Rearrange furniture to enlarge walking paths for
crutches or a walker.
• Remove scatter rugs.
• Make sure all doorknobs are clear and accessible.
• Install night lights.
• Obtain an apron with pockets or a backpack. Your
hands will be using crutches.
• Stock freezer and pantry.
• Obtain a cordless phone.
• Non-skid mats for shower/tub.
• Grab bars in the shower/tub, near toilet.
• Tub seat.
• Raised toilet seat or commode.
• Long handle sponge.
• Stocking aid.
• Long handle shoe horn.
• Long handle reacher.
• The therapists and the nurses will help you out of bed
and into a chair. Hopefully, you can do this two or
three times on postoperative day one.
• Your surgeon will tell you how much weight to put on
your operated leg and hip.
• Please do not “pivot” on your operated leg and hip.
- You will begin the exercises which you learned before
your operation (Page 12).
1. Ankle pumps
2. Isometric Quadriceps sets/hip straightening
3. Gluteal sets
4. Heel slides
• Safety precautions for patients with hip replacements
will be discussed.
• A case manager will visit with you and your family.
Planning for your discharge from the hospital now begins
in earnest.
Prepare For Hospital
Discharge:
• Discuss hospital and discharge plans with relatives and friends.
• Evaluate the options of home discharge or rehabilitation
facility discharge.
• Review insurance coverage as it pertains to discharge.
10
19
Postoperative Day #2
• The dressing on your wound will be changed.
• A blood test will be drawn to measure the effectiveness of the
blood thinner (Coumadin). This blood test will be drawn
intermittently as long as you take Coumadin.
• If you are constipated, please tell your nurse.
• Your activities will progress:
- Practice transfers. You should be getting into a chair at least
two times a day with assistance from the physical therapy or
nursing staff.
- You will begin walking with a walker or crutches.
- Continue exercises from post-operative day 1.
• The case manager, in discussions with you, your family, your
physicians, your therapists, and your healthcare insurance
company will finalize discharge planning. Transfer to a
rehabilitation hospital may occur on postoperative day three.
Discharge to home may be on postoperative day four or five.
CASE MANAGER
Before your operation, you will be contacted by a Lahey Clinic
Case Manager who will help you plan your discharge from the
hospital to a rehabilitation facility or to home. Advance
planning helps alleviate concerns you and your family may have
about what will happen after you leave the hospital. Your health
insurance company will have input concerning where you may
go after hospital discharge. Speak to your health insurance
representative about your options.
ANESTHESIA
Most patients will meet their anesthesiologist on the day of
surgery. He or she will review your medical records and answer
questions you may have about anesthesia. If you have a preference
for a type of anesthesia, please tell your anesthesiologist. We
encourage you to follow your anesthesiologist’s recommendations.
If you have a specific condition which requires a pre-operative
consultation with an anesthesiologist, please let us know.
PERSONAL PREPARATIONS FOR
SURGERY
Prepare Yourself:
• Stop smoking. This will help your breathing, improve
wound healing, and reduce postoperative
complications. (At least cut back).
• Eat well-balanced meals. This is not the time for serious
weight loss.
• Start taking an over-the-counter iron supplement one
month prior to surgery (FeSO4 325 mg three times per
day).
20
9
BLOOD MANAGEMENT
During your hip replacement operation, you will lose some
blood from the bone, muscle, and other soft tissues which are
moved or cut. You will also lose some blood after your
operation which may cause swelling of your hip, buttocks,
and thigh.
Some patients will require a blood transfusion after hip
replacement. Factors associated with a need to transfuse blood
include; a low hemoglobin or hematocrit (“low blood count”)
before operation, cardiac conditions, medical disease,
extensive hip reconstruction, prior hip operations on the same
hip, and unexpected post-operative blood loss.
In some cases, your surgeon may ask you to donate your own
blood for possible transfusion – autologous transfusion. This
blood is refrigerated and stored until the time of your
operation. In some cases, on the day of your surgery, your
anesthesiologist may draw off some of your blood before the
operation in order to give it back to you after surgery –
hemodilution. In some cases it may be necessary for you to be
transfused with Blood Bank blood.
Postoperative Day #3
• The dressing on your wound will be changed.
• If you have been unable to have a bowel movement (pain
medicine commonly causes constipation) and you are
uncomfortable, the nurses may offer you a suppository or an
enema.
• Activity progresses:
- You should become independent with transfers. You will
require less assistance for transferring in and out of bed.
- If it is possible, you will practice ambulating with
crutches instead of a walker. Your goal should be to
walk independently with a walker, or crutches as soon as
possible.
- Continue exercises.
• If you will be discharged to a post-acute care facility, you will
probably be transferred by ambulance today. You will bring
a Lahey Clinic Hip Replacement Post-Acute Care Plan with
you to the rehabilitation facility.
• If you will be discharged to home, the Occupational
Therapist will assist you with the performance of everyday
activities such as bathing and dressing. They will show you
techniques to assist with these activities at home.
8
21
Postoperative Day #4
• The dressing on your wound will be changed. If your
wound is dry, it may not be necessary to cover it.
• Activity Progresses:
- Practice independent transfers.
- Practice independent ambulation with
crutches/walker.
- Continue exercises.
- Practice stair climbing.
- Review hip safety precautions.
22
ACADEMIC MEDICAL CENTER
Lahey Clinic is an academic medical center. Lahey Clinic doctors
teach residents, students, and postgraduate fellows how to be
doctors and surgeons. Boston University orthopaedic surgery
residents train at Lahey Clinic. You will meet the students,
residents and fellows as members of the orthopaedic team.
Orthopaedic residents and fellows will participate in your
operation to help your surgeon and learn about hip replacement
surgery. Students and visiting doctors may observe your surgery.
Your orthopaedic surgeon will do your hip replacement
operation.
PHYSICAL EXAMINATION/TESTS
Generally, a physical examination by an internal medicine doctor
is recommended to ensure that you are healthy enough to
undergo major surgery. If you are new to Lahey Clinic, or if you
have a primary care physician outside Lahey, please bring a letter
from your doctor to your pre-operative visit which describes your
past medical history and your current medical condition.
Consultation with other medical specialists may also be necessary.
Several diagnostic tests, including chest x-ray, EKG, and blood
and urine tests may be scheduled. You need to bring a list of all
your current medications, including prescription drugs, over the
counter medicines, vitamins, herbs, and nutritional supplements
when you come for your preoperative visit. An up-to-date medical
history which includes current and past health problems, allergies,
hospitalizations, and surgeries
will be recorded. If you have
dental problems, please inform
us and seek appropriate care well
before your surgery date. Dental
infection can lead to hip
infection.
7
GETTING READY FOR SURGERY
LEAVING THE HOSPITAL
Once you have decided to have your hip replaced, there is
much to do to prepare for your operation. Lahey Clinic
provides a team approach to your care. You will have a
chance to meet members of the team before surgery. They
will answer your questions and make arrangements to insure
that your surgery, hospital stay, and post-operative recovery
will go as smoothly as possible.
To a Rehabilitation Facility
SCHEDULING YOUR OPERATION
Surgical scheduling is a complex process. Your operation
requires you, your surgeon, an anesthesiologist, surgical
assistants, nurses, an operating room, surgical instruments,
hip implants, and many pieces of equipment to be in the
same place at the same time. You will work with a surgical
scheduler to select an acceptable date for your hip
replacement operation. Please be as flexible as possible in
working with your surgical scheduler.
INFORMED CONSENT
If you choose to go to a rehabilitation facility, and if your health
plan approves this choice, you will be discharged on the second
or third day after surgery. Your case manager will assist you and
your family with discharge plans. You will bring a Lahey Clinic
Hip Replacement Post Acute Care Plan with you to the
rehabilitation facility. Follow-up with your surgeon will also be
arranged.
To Home
If you are medically stable, independent with walker/
crutches/cane, and knowledgeable in hip replacement
precautions, and if you have help available at home, you may
choose to be discharged to home. Your case manager will assist
you and your family with discharge plans. Physical Therapy at a
therapists office or at home will be arranged. You will take pain
medication and blood thinners at home. Usually, you will resume
your routine medications at home – review these medications
with your primary care physician.
You will be asked to sign an informed consent document which
gives Lahey Clinic and the Lahey Clinic professional staff
permission to give you a hip replacement operation. This booklet
will teach you about hip replacement so you will be a well
informed patient. You will also be asked to give Lahey Clinic
permission to collect information about your hip replacement in
the Lahey Clinic total joint database.
6
23
IMPORTANT INFORMATION AS
YOU LEAVE LAHEY CLINIC
Follow-Up Visits
Two Weeks:
Usually, your surgeon or his assistant will see you in the outpatient
clinic to remove skin staples or sutures two weeks after surgery. If
you go to a rehabilitation hospital, they may remove your staples
or sutures.
Four to Six Weeks:
Usually, you will see your surgeon four to six weeks following
surgery for a clinical and radiographic examination.
Hip Stability/Leg Positioning
It is your responsibility to maintain safe positions during
transfers and ambulation. All hip replacements can be dislocated
if the hip is put in an unstable position.
INNOVATION, TECHNOLOGY, AND
INFORMATION
Total hip arthroplasty uses anatomically designed implants made
of high grade biomaterials to replace arthritic hip joints. As new
materials, designs, and techniques are developed to improve hip
replacement, Lahey hip surgeons evaluate new technology for
possible use with Lahey patients. Lahey Clinic orthopaedic
surgeons use the best techniques and best implants available to
provide predictably successful hip replacement operations.
Innovations that may be appropriate for some patients include:
• cemented and cementless total hip arthroplasty
• alternative bearing surfaces
• highly crosslinked polyethylene
• ceramics
• metal on metal
• hip resurfacing
• minimally invasive THA
• computer assisted surgical navigation
Wound Care
Keep your incision dry while staples are in. You should keep a
dressing on your wound if there is drainage. If the wound is clean
and dry, you can leave it open to air. Look at your wound each
day. If you notice signs of possible infection such as: increasing
redness, increasing warmth, or new drainage that looks like pus,
call your surgeon immediately. If your doctor or nurse want to
give you an antibiotic for your hip, please ask him/her to call your
surgeon first.
24
Information on total hip arthroplasty is available from many sources
including the internet and direct-to-consumer marketing programs.
Some of this information is accurate and useful. Some of this
information is not accurate. Information on clinical services,
educational programs, and orthopaedic research in the Lahey
Clinic Department of Orthopaedic Surgery is available at www.
lahey.org/OrthopaedicSurgery.
The Lahey Clinic hospital is a “high reliability organization”
committed to patient safety and prudent use of new “cutting edge”
technology in caring for our patients.
All Lahey Clinic hospital rooms are private rooms equipped with flat
screen personal computers which provide hip replacement patients
with access to television, radio, games, music, email, and the internet.
5
TYPES OF HIP REPLACEMENTS
Toileting
Total Hip Arthroplasty (THA)
Most home toilet seats are low. A commode or raised toilet
seat will be helpful. Toilet grab bars may also be helpful.
Total hip arthroplasty or total hip replacement is the operation
described in this booklet. Hip implants can be fixed to bone with bone
cement or with bone ingrowth to porous metal. The goal of THA is
to relieve pain and improve function. This is the most common type
of hip replacement.
Hemi Arthroplasty/Bipolar Hip Replacement
This operation removes the arthritic hip joint and implants a
femoral stem with a large, fixed or mobile femoral head that fits
into the natural acetabulum. This operation is frequently used for
a hip fracture. It is less common than total hip replacement.
Femoral Head Resurfacing/ Total Hip Resurfacing
This operation resurfaces the arthritic femoral head and the
arthritic acetabulum without removing femoral head and femoral
neck. This operation is less common than total hip replacement.
Minimally Invasive Hip Replacement
(Minimal Incision/Less Invasive) A Minimally Invasive Hip
Replacement operation is performed through a small incision
with less tissue dissection. Some patients are not candidates for
minimally invasive hip replacement.
Revision Total Hip Arthroplasty
Revision total hip arthroplasty is an operation which revises or fixes
a hip replacement which has developed a problem such as loosening
of fixation, wear of bearing surfaces, fracture, or instability.
Bilateral Total Hip Arthroplasty
4
Some patients with two equally symptomatic arthritic hips may
be candidates for Bilateral THA on the same day, however this is
uncommon.
Bathing
While your skin staples or sutures are in your hip incision,
please use sponge baths for personal hygiene. Please do not get
your hip replacement wound wet. You may shower or bathe
after your skin staples or sutures are removed. Bathing is
best done in the shower – getting in and out of a tub can be
difficult and dangerous when recovering from hip surgery.
Grab bars in the shower/tub area may be helpful. A longhandled sponge, can be helpful for bathing your lower body.
Some patients find a tub seat in the shower to be helpful. Be
cautious when walking on slippery bathroom floors.
Dressing
Some patients will need assistive devices in order to dress
independently. A stocking aid may enable you to put on your
socks without bending over too far. A long-handled shoehorn
will assist you in putting on your shoes. Long-handled
reachers may assist you in putting on and pulling up your
pants. You will be evaluated during your hospital stay for your
particular needs at home.
Compressive Stockings
The white TED stockings should be worn on both legs when
you are up during the day. They help control swelling in your
legs (especially in your operated leg). At night, you can remove
them and launder them, if necessary. Usually, you will be asked
to wear these stockings for four to six weeks after surgery.
25
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3
CHOOSING
HIP
REPLACEMENT
Hip replacement is an elective surgical procedure. This
operation is one of several non-surgical and surgical options which
are available for treatment of your arthritic hip. It is important for
you to be familiar with all possible treatments for your hip.
Non-operative treatment options for an arthritic hip include: antiinflammatory medicine, pain medication, physical therapy, weight
loss, walking aids such as a cane or crutches, nutritional supplements,
and restricting your activities. Many patients with an arthritic hip try
non-surgical treatment before choosing surgical treatment.
Surgical treatments for an arthritic hip include: arthroscopy, open
debridement, osteotomy, fusion, partial hip replacement, hip
resurfacing, and total hip replacement. Each operation has specific
indications, and all surgical treatments are not appropriate for all
patients.
2
GUIDELINES AFTER HIP
REPLACEMENT
For your safety, and to ensure a successful outcome following
your hip replacement operation, you should adhere to the
following guidelines.
FOR THE FIRST TWO MONTHS
• Maintain safe positions of your
hip. Do not bend your hip past
90° which can occur if you
bring your knee too close to
your chest.
• Do not sit on low chairs which
can force your hip to bend past
90°. It is best to sit with your
knees below your hips.
• Do not pivot or twist on the
operated leg. Avoid twisting or rotating your operated leg
inward or outward.
Generally, hip replacement is very successful. Hip pain is
relieved, and function improves. It is not clear how long a hip
replacement will last. The long-term success rate will vary,
depending on your age, your weight, and your activity. “Plan on
ten to fifteen years and hope for twenty”. If a hip replacement
becomes loose or wears out, generally it can be fixed with a revision
hip replacement operation.
• During the day time get up every half-hour or so and take a
brief walk. Prolonged sitting may allow muscles around your
hip to get stiff.
Hip replacement is major surgery. When choosing to have a
hip replacement, it is important to be aware of potential risks and
complications such as: problems from anesthesia, bleeding,
damage to nerves or blood vessels, instability, dislocation,
fracture, leg lengthening, blood clot, infection, and very
rarely, death.
• Do not cross your legs. Imagine a line drawn down the
middle of your body (from the tip of your nose to the
space between your two feet). You should not bring your
operated hip across that line.
• Avoid slippery surfaces which may allow your leg to give
way.
27
A Patient’s Guide to Hip Replacement
• Use a pillow or two between your legs when sleeping,
especially when you turn onto the nonoperated side to
rest. This will help keep your operated hip on its side of
the imaginary line, as discussed above.
• When your surgeon prescribes strengthening
exercises, work hard to make your hip, back, and
knee muscles strong.
• Stay active. Resume many of your activities of daily living.
• Airline travel within the first 2 months after hip
replacement operation increases the risk of developing a
blood clot. Please discuss this with your surgeon.
Walking is an essential part of physical therapy. You
should take daily walks, lengthening your walking distances as
your strength improves.
FOR THE REST OF YOUR LIFE
28
Your hip replacement should provide mobility, stability, and
pain free function for many years. You can participate in
many activities with your “new hip”. However, you should
protect your hip replacement from excess stress which can lead
to premature failure of the artificial joint. Avoid weight gain
which will increase stress on your new hip. High impact
loading activities such as jumping, running, jogging, and heavy
weight lifting should be avoided. Sports, such as basketball,
racquetball, squash, volleyball, and tennis, increase the risk of
implant loosening and implant wear. You may choose to
participate in these sports, but you must accept the associated
risk. Low-impact loading activities such as walking, boating,
cycling, swimming, bowling, and golf are excellent activities for
recreation and exercise after hip replacement.
CONTENTS
Choosing Hip Replacement ................................................2
What is a Hip Replacement? ..............................................3
Types of Hip Replacements ................................................4
Innovation, Technology, and Information ..........................5
Getting Ready for Surgery ..................................................6
Scheduling Your Operation ................................................6
Informed Consent ..............................................................6
Academic Medical Center ..................................................7
Physical Examination/Tests ................................................7
Blood Management ............................................................8
Case Manager......................................................................9
Anesthesia ..........................................................................9
Personal Preparations For Surgery ......................................9
Physical Therapy ..............................................................12
Final Pre-operative Visit ....................................................14
Day Before Surgery ..........................................................15
Operation and Hospital Stay ............................................16
After Surgery: Day by Day ................................................17
Leaving the Hospital ........................................................23
To a Rehabilitation Facility............................23
To Home ......................................................23
Important Information As You Leave Lahey Clinic ..........24
Follow-up Visits ............................................24
Hip Stability/Leg Positioning ........................24
Wound Care ..................................................24
Toileting ........................................................25
Bathing..........................................................25
Dressing ........................................................25
Compressive Stockings ..................................25
Driving ..........................................................26
Sexual Relations ............................................26
Dental Work..................................................26
Infections ......................................................26
Guidelines After Hip Replacement....................................27
For the First Two Months ..............................27
For the Rest of Your Life................................28
1
A Patient’s Guide to Hip Replacement
Dear Hip Replacement Patient,
We hope this Patient Guide to Hip Replacement provides valuable information as you
prepare for your hip replacement operation. More information about the Lahey Clinic
Department of Orthopaedic Surgery is available at www.lahey.org/OrthopaedicSurgery.
Enjoy your new hip!
Lahey Clinic Hip Replacement Surgeons
(Left to right) John F. Tilzey, M.D., Lawrence M. Specht, M.D., Richard Iorio, M.D.,
William L Healy, M.D., Michael S. Thompson, M.D., Bernard A. Pfeifer, M.D.
If you have any questions or concerns about your hip replacement operation,
please call your Orthopaedic surgeon at Lahey Clinic, (781) 744-8650.
Lahey Clinic Department of Orthopaedic Surgery
A Patient’s Guide to
Department of Orthopaedic Surgery
41 Mall Road • Burlington, Massachusetts 01805
(781) 744-8650
See The Department of Orthopaedic Surgery at www.lahey.org
HIP
REPLACEMENT