The enhanced recovery programme is composed of a number of factors designed to help speed
up your recovery after your operation. This class is the first stage of the process in
encouraging you to be active participants in your own care and recovery, from your joint
replacement. By explaining the journey you're all about to embark on, we aim to better prepare
you for your operation and post-operative recovery, and to help you understand what
as a healthcare team we are trying to achieve.
We hope you will have a better understanding of the goals we are all aiming for you to
achieve. So that you are able to return home sooner, than would otherwise been expected.
In a healthy hip joint the surfaces of the ball and socket are covered in a smooth, slippery
material called articular cartilage, enabling smooth, pain free movement. In an arthritic
joint, this cartilage becomes worn, exposing the bone underneath and making the joint surfaces
roughened and deformed. This makes movement and walking painful. Often the joint will
stiffen and the thigh muscles can become weak. The pain can become severe enough to disrupt
sleep and significantly reduce overall quality of life.
A hip replacement involves removal of the worn out hip joint replacing it with an artificial
joint. A variety of different bearings are used depending on your age, level of activity
and size and shape of your hip joint. Here for example we have a metal ball with polyethylene
socket and here we see a ceramic head with ceramic socket. Your new hip joint will be
either cemented in place or secured with a tight press-fit, otherwise known as uncemented.
Both methods provide secure fixation allowing you to fully weight bear immediately post
operation. You will have a scar on the side of your hip
which will be covered with a dressing for the first few days.
To reassure you, hip replacement surgery is in general extremely successful, with high
levels of satisfaction and low complication rates.
You will be asked to attend a pre-operative assessment appointment approximately two weeks
before your operation to assess your general health, well-being and fitness for surgery.
Routine blood tests, an ECG heart tracing and a urine sample will be taken.
You will be seen by the surgical team and the risks and the benefits of the operation
will be explained and you will be asked to sign a consent form. If you take any medication
please bring your prescription with you to this appointment. We also need to know if
you are likely to need some help when you leave hospital, if you already receive support
from social services, a district nurse visits or you are struggling with any daily activities.
This enables us to make the necessary arrangements to support you on discharge.
You will be given two cartons of a carbohydrate drink which is designed to minimise the effect
of starving you before your operation. Please take one the night before your operation and
the second drink before 6am on the day of your operation. You should have a shower at
home before you come to hospital.
An occupational therapist will see you at your pre-operative assessment. The OT's
role is to see how you will manage at home after your operation. They will gather information
on your home environment and what equipment you may have in place already. They will also
look at your furniture heights to assess if they are suitable for you after your operation
and organise any necessary equipment. The OT will collect your completed home information
sheet at the end of this presentation. The OT will discuss the precautions you will
need to follow post-operatively to protect your new joint whilst it is healing. Due to
the nature of the operation, some of your muscles around your new hip will be weaker
and the ligaments will have been temporarily stretched. As a result of this there are four
movements that you should avoid to limit the chances of your hip dislocating.
The four pre-cautions to follow are: No crossing the legs.
Do not lie on your un-operated side in bed. No twisting at the hip.
Do not bend beyond a right angle .
These should apply until your outpatient appointment. As you will not be able to reach your feet,
you may need to obtain dressing aids to help with this. These will be demonstrated at the
end of the presentation. It would be helpful to plan for your discharge
by doing things like organising your kitchen so that frequently used items are to hand.
Ensure rooms will be easily accessible while using a walking aid by taking up any loose
rugs and moving bulky furniture. Ensure you have support for shopping or have stocked
up your freezer and cupboards prior to coming in.
On the day of your operation you will be admitted to the ward by the nursing staff and prepared
to go to theatre. Nursing staff will record your observations, a doctor will draw an arrow
on the limb you are having operated on and your consent form will be checked. A theatre
gown and paper pants will be given for you to wear. You will be able to speak to an anaesthetist
before the operation if you have any concerns about the anaesthetic. You will be given further
pain killers designed to be working in your system for pain control after your operation.
The operating theatres either run for half a day or a full day. If your operation is
planned for an afternoon list you will be encouraged to have a light breakfast before
7am so that you are not starved all day.
A porter will escort you to theatre reception on a trolley about twenty minutes before your
operation where you will wait before being taken into the anaesthetic room.
In the anaesthetic room you will be attached to some routine monitors by the theatre staff
and a drip will be placed in the back of your hand by the anaesthetist.
You will be sat upright to allow a spinal anaesthetic to be injected into your lower
back. This will numb your legs for the duration of the operation and for a short time after.
We will then lie you down and you'll be given an injection to make you feel sedated
or asleep.
After your operation you are moved to the recovery room where the recovery nurses continue
to check your observations. The anaesthetic wears off quite quickly once you are in recovery.
You may need extra pain killers or treatment for feeling sick whilst in there and once
fully recovered a ward nurse will collect you and escort you back to the ward.
Once on the ward your observations will be taken regularly and the sensation, circulation
and movement to your feet will be checked. You will have a pair of boots on your feet
which will pulsate every thirty seconds and possibly elastic stockings. These reduce the
risk of developing a deep vein thrombosis. The boots are removed once you are walking
however the stockings should be worn for six weeks post operatively. You will be given
a second pair on discharge so you have one to wear and one to launder. You will need
assistance to get these on and off at home so please have a think about friends or relatives
that can assist you with them. If you don't have any one to support you with this on discharge
please let us know.
The nurse will monitor your pain and nausea and vomiting score and give you pain relief
and anti-sickness medication as required. You will be given pain relief regularly, if
you need further pain relief let the nurses know. Pain from hip surgery generally is fairly
easy to control with the regular pain relieving tablets.
The nurses will encourage you to eat and drink as soon as possible and drips will be taken
down when your blood pressure is stable. After surgery it is advisable to drink a mixture
of drinks tea, coffee and juices rather than just water. Drinking too much water at this
stage can affect your recovery.
Urinary catheters are avoided if possible after surgery and you will be encouraged to
mobilise onto a commode. This is a good way of starting early movement in your new joint,
helping to reduce stiffness and swelling. Some patients with mainly heart or kidney
problems may need production of your urine closely monitored and you will have a catheter
placed during your anaesthetic. If you have difficulty in passing urine after your operation
a catheter may also be placed on the ward.
The numbness in your legs will be short acting this will allow you to mobilise within four
to six hours of returning to the ward.
Providing that you feel well and your blood pressure is stable, a physiotherapist or member
of the nursing team will assist you out of bed to stand up, take a few steps and then
sit back on your bed. If you feel ok you can sit out in your chair or take a short walk.
You will be given a zimmer frame at this point but as soon as you are able we will progress
you onto elbow crutches.
Early movement of the new joint is important in reducing stiffness and swelling which in
turn will improve your long term recovery. We also know early mobilisation reduces the
risk of deep vein thrombosis, chest infections and pressure sores.
A physiotherapist or a physiotherapy assistant will see you daily to encourage you with your
exercises and independence with mobility. It is vital that you take pain killers regularly,
in order to perform your exercises and mobilise successfully. Whilst on the ward you will
be offered regular pain relief, however if you experience pain which is not relieved
by these, please tell one of the nursing staff.
Ideally we would like you to do 5 to 10 repetitions of each exercise 3 to 5 times a day- increasing
the number of repetitions as you are able. Generally frequent short bursts of exercise
are best. It is important to find a happy balance- performing too many exercises may
aggravate swelling and pain, performing too few will cause stiffness and loss of movement.
All these leg exercises will: Minimize the risk of blood clot formation,
Strengthen the muscles, Regain hip joint flexibility,
and improved walking.
A member of the physiotherapy team will check your progress whilst you are in hospital.
Regaining strength and movement is hard work and takes determination and dedication. So
it is really important to keep yourself motivated and do your exercise to get the best outcome.
Before going home the therapists will also ensure you can manage steps or stairs as well
as independently get in and out of your bed and chair. It is normal to experience swelling
in your operated leg. Therefore it is important to keep your feet and ankles moving. Having
a rest on the bed for an hour in the afternoon is also a good way to drain the swelling from
the leg.
On occasions you may hear clicking or clunking sounds from your new hip. Unless it causes
significant pain or feelings of instability in your hip, it is nothing to worry about.
A sensation of the hip stiffening up can also occur if you have been sitting or standing
in one position for too long. It is important to change position regularly and keep active
to prevent this from happening.
Following discharge home we advise that you continue exercises that are provided in your
booklet and will be demonstrated at the end of the DVD.
Muscular ache is normal and is expected after exercising but this should decrease over time.
Outpatient Physiotherapy is not normally required following this surgery, as long as you're
walking regularly and doing your exercises. When you feel comfortable you can start to
use only one crutch or a walking stick if you prefer for short distances and gradually
build up to walking unaided over a 6 week period.
Occupational therapists will also see you on the ward after your operation to ensure
you can do everything that you need to do in order to manage at home.
Discharge arrangements are commenced early on in your care and this will be discussed
with you. We aim to get you as independent and as mobile as possible before you leave
the hospital so that you feel confident to manage your own care.
Your discharge home is led by the nurses on the ward working closely with the physiotherapist
and occupational therapist. Your estimated date of discharge will be two to three days
after your operation. This gives you and your relatives a date to aim for so that preparations
can be made. This date is an estimate; some of our patients go home sooner than this and
some patients need a little bit longer.
A letter will be sent to your GP to inform him/her of your discharge and the nurse will
make arrangements for the care of your wound, your stitches are dissolvable and you will
be given a supply of pain relief. A side effect of the pain relieving tablets is constipation
to prevent this you will be given some laxatives to take home.
Eating fresh fruit and vegetables and drinking water will also help. You will be given an
outpatient appointment to see your consultant or team at six weeks post operatively. You
will be given contact numbers for the ward if you have any concerns once at home.
You should be able to go home by car. Please arrange for a relative or friend to take you
home. Ambulances are not usually required.
When you get home it is very important to continue to take your pain relief regularly,
to allow you to do your exercises and daily activities. It is important to gradually increase
the number of exercises you are doing throughout the day. But please make sure you pace your
activities; don't do all your jobs at once. We advise that you do exercises at least 3
times a day, it is better to do short but frequent bursts of exercises.
Swelling is to be expected and can be managed by resting your leg on the bed in the afternoon
and regular walking. Continue to progress your exercises, walking and build up your
activities gradually. Remember you have had a major operation, you are likely to feel
tired and it may take several weeks to fully recuperate.
You will be contacted by telephone within 5-7 days of discharge by the enhanced recovery
sister or one of the nursing team to check on your progress and offer support and reassurance.
In the longer term the benefits of having a total hip replacement are less pain, a functional
range of movement, a better walking pattern, improved ability to carry out daily activities,
being able to return to work if appropriate for you and to return to those leisure and
social activities you've not been able to do because of your arthritis. We hope this
DVD has been informative and wish you well for your operation.