Baptist Health Total Hip Book by Baptist Health

Your Total Hip Surgery

7/11

Table of Contents Welcome to Baptist Hospital East ........................................................................... 2 What to do between now and your surgery ............................................................. 2 Exercise program ..................................................................................................... 3 Pre-operative visit .................................................................................................... 4 Education Class........................................................................................................ 5 Packing for your hospital stay.................................................................................. 5 Day before surgery................................................................................................... 5 Day of surgery.......................................................................................................... 5 Surgery ..................................................................................................................... 5 Your hospital room .................................................................................................. 6 Pain control .............................................................................................................. 7 Activity and care during your stay .......................................................................... 7 Hip precautions ........................................................................................................ 8 Physical and occupational therapy........................................................................... 9 Discharge................................................................................................................. 10 Follow-up therapy ................................................................................................... 10 Do list ...................................................................................................................... 11 Do not list ............................................................................................................... 12 Important phone numbers ....................................................................................... 12 Baptist Hospital East Home Health Agency........................................................... 13 Baptist Outpatient Therapy Services ...................................................................... 13 Campus Map ........................................................................................................... 14 1

Welcome to Baptist Hospital East Thank you for choosing Baptist Hospital East for your surgery. Baptist East has been named a Top 100 Orthopedic Hospital. We do more joint replacement surgeries than any other hospital in Kentucky and are in the top 10 in the nation. As a future surgery patient, we realize you may have many questions. This booklet was written to answer questions and to help you prepare for your hospital stay and your discharge home. What to do between now and your surgery: 1. Select a family member or friend to serve as your coach to help you during your hospitalization and recovery at home. Your Coach is encouraged to attend as many therapy sessions with you as possible to learn how to help you at home. 2. Plan for someone to help you when you go home. You may need this help a few days or possibly a couple of weeks, depending on how well you progress after your surgery. You will be in the hospital 2-4 days. 3. Register prior to coming for your pre-operative visit either online at: www.baptisteast.com or call (502) 896-7559.

4. Prepare your home now:  Remove any throw rugs or clutter that may be in your way as you walk.  Make your bedroom, bathroom and living area on the same floor if possible.  Arrange furniture so pathways are wide enough for a walker.  Be cautious of pets that may interfere with your walking with a walker  Obtain grab bars and non-skid mats for the shower.  Install sturdy handrails along stairs both inside and outside of your home.  Choose a chair with armrests and a firm, high seat to sit in when you return home.  Place items frequently used at waist level.  Obtain a portable phone or cell phone to keep with you at all times.  If you plan to borrow equipment, such as a walker, cane or bedside commode, please have those items in your home prior to coming to the hospital. 2

Exercise program It is important that you maintain and possibly improve your strength and range of motion while you await your surgery. You can do this by:  Walking frequently for short intervals  Using a cane or walker to allow you to walk safely and with less limping  Trying not to sit for long periods of time as this tends to cause cramping and swelling and can lead to even more discomfort. Joint Power Water Exercise Class You may want to take advantage of a warm water exercise class, Joint Power, designed specifically for patients preparing for Total Joint Replacement surgery. This class is offered at the Baptist East/Milestone Wellness Center. Please call (502) 896-3900 for class days and times. You are encouraged to begin the following exercises before your surgery. Do the exercises either on your bed or in a chair as indicated (DO NOT do them on the floor).  Start with 10 repetitions of each exercise and increase to 30 if able.  If any of the exercises cause you pain, either eliminate that exercise or decrease the motion or repetitions.

1. Ankle pumps  Move foot up and down as if you are pumping a gas pedal. 2. Quad Sets  Lie down with leg straight.  Tighten muscles on the front of the thigh, trying to push the back of knee downward.  Hold 5 seconds. 3. Gluteal Sets  Lie on back with legs straight.  Squeeze buttocks together.  Hold 5 seconds. 4. Heel Slides  Lie on back with legs straight.  Slide heel towards buttocks.  Return to start position.  Repeat with other leg.

5. Hip Abduction  Lie on back with legs together.  Move leg out to side, keeping knees straight and toes pointed toward ceiling.

6. Knee Flexion-Extension Sitting  Sit with bad leg bent as shown.  Straighten leg at knee.  Hold 5 seconds.  Return to start position.

7. Chair Push-up  Place hands on armrests.  Straighten arms, raising bottom up.

8. Breathing exercises It will be important to practice deep breathing and coughing before your surgery to keep your lungs free from congestion and to prevent pneumonia.  Breathe in through your nose and out through your mouth.  On the second breath in, try to cough (from deep down in the lungs) as you begin to breathe out. If you smoke, try to decrease the number of cigarettes you smoke. Better yet, stop altogether. Your recovery from anesthesia will be much easier. If you would like more information on area programs on quitting smoking, please call the Baptist East Information Center at (502) 897-8131.

Pre-operative Visit When you and your coach come in for your pre-operative visit, you will have tests that may include bloodwork, urinalysis, X-ray and cardiogram (EKG). Generally, bloodwork does not require you to fast unless your surgeon specifically tells you to do so. Bring all your medications from home in their original containers, including herbals, over-the-counter drugs and vitamins. When coming for your pre-operative visit, go to the main entrance where valet parking is available. Follow the signs to Pre-Admission Testing (PAT). Your testing will take approximately 1 ½ to 2 hours. 4

Education Class You and your coach are strongly encouraged to attend a class about your surgery and recovery. The class starts at 9:15 a.m. on every Tuesday and Thursday and lasts about an hour. If you are having your pre operative testing AND attending class on the same day, plan on being here 3-4 hours. Packing for Your Hospital Stay Bring:  This book  A notepad and pencil  Medicare or insurance cards  Bring all your medications from home in their original containers, including herbals, over-the-counter drugs and vitamins.  Walking shoes or tennis shoes, but no slippers  Brush, comb, toothbrush, toothpaste, deodorant, lotion  Pajamas or gown and robe (short length) that opens down the front  Tee shirts and shorts or loose fitting pants that can be raised above your knee  If you use a machine for sleep apnea, please bring it with you to the hospital Do Not Bring:  Equipment such as walker, crutches or cane  Rings (remove all rings, even wedding bands)  Jewelry, money and other valuables

Day before surgery  DO NOT eat or drink anything, even water, after midnight. Your stomach must be empty for surgery or your surgery may be delayed or cancelled.  DO NOT shave your legs the night before surgery Day of surgery DO NOT take your medications unless you are told by hospital staff or your doctor. If you use a sleep apnea machine, bring it with you in case you require it before or after surgery. Please arrive promptly and report to the registration area. A map of the Baptist East campus is shown on the last page.

Your hospital stay Surgery In the Surgery/Pre-op area, you will be seen by an anesthesiologist and will receive intravenous medicine and fluids. Your family will be allowed to stay with you in this area. When the surgical team is ready, you will be taken to the operating room. The actual surgery will take one to two hours. In the operating room, you will be given anesthesia. An incision will be made on your hip. The ball is 5

cut from the thigh bone, and the surface of the old socket is smoothed. The new hip stem is inserted into the thigh bone and the new socket is placed. When the new joint is in place, the incision is closed with stitches and/or staples. After your surgery you will be sent to the recovery area for approximately 13 hours. Your condition will be watched closely and you will be given pain medication as needed. When your condition is stable, you will be taken to your hospital room. Your family/friends will wait in the surgical waiting area. After the surgery is complete, the surgeon will talk to your family. Your family will then be directed to your hospital room to greet you when you arrive from the recovery room.

Hip Resurfacing Unlike traditional hip replacement, hip resurfacing doesn’t replace the “ball” of the hip. Instead the damaged hip ball is reshaped and “capped” with a metal prosthesis.

 Intended for patients under 60 with good bone health  Preserves most of the head of the femur and all of the neck of the femur  Joint is less likely to dislocate  Allows for more strenuous activity Your doctor will discuss this with you if it is a viable option. Your hospital room No one is guaranteed a private room, however if you would like a private room, please have your family give your name to the secretary on the nursing unit when they arrive. Once you arrive in your hospital room: 1. You may have ice chips and progress to your regular diet. 2. Your surgeon may order your routine medicines. 3. It may be necessary for your doctor to order a laxative or stool softener, as pain medication can cause constipation. 4. It is important to drink enough fluids to maintain proper hydration. Try to increase your fluid intake during your hospital stay. Drink 6-8 glasses of water/fluids daily. 5. Limit caffeine and eat foods high in fiber and low in sugar. 6. Special stockings and compression devices will be placed on both of your legs to assist circulation. 7. You will be on oxygen for the first 6

day or so and you will use an incentive spirometer to assist you in deep breathing. 8. Your nurse will frequently check your blood pressure, pulse, dressing and pain rating. You will be repositioned every 2 to 3 hours the first day.

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Pain control Our goal is to make you as comfortable as possible to allow you to participate in your therapy to the fullest. It is not realistic to expect to be pain-free following surgery, but we will work with you to manage your pain. You can help by telling staff when you are having pain. We use a 0-10 rating scale to measure pain, with 0 being no pain and 10 being the worst pain possible. Only you know how you feel, so we rely on this “self-report” of your pain to help us plan your care.

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help you sit up in a chair. Staff will help you get to the bedside commode. You will be encouraged not to use a bedpan. Most patients will not need a catheter after this surgery. Staff will help you bathe and dress in regular clothes daily. You may use special equipment to assist you with bathing and dressing. Staff will show you how to complete these tasks safely. You will sit in a chair and walk several times a day with the help of staff. Your blood will be drawn daily between 3 and 4 a.m. Your surgeon will visit every day. Some surgeons come as early as 5 a.m.

We will make every effort to coordinate your pain medicines around your therapy schedule. With less pain, it will be easier to participate in your therapy and get your strength back more quickly. Activity and care during your stay  For your safety and to prevent falling DO NOT get up by yourself or with your family. Please make sure you get up only with hospital staff.  On the day of surgery, staff will 7

Hip Precautions The location of your incision will determine any hip movement restrictions you may have. These are called “hip precautions.” You should avoid bringing your knees together or crossing the midline of your body with your bad leg while in HiporPrecautions bed, sitting standing. It will be best for you to put a pillow(s) between your knees when you lie on your side in bed. Posterior approach: If your incision is on the back or side of your leg, follow the guidelines below:  DO NOT sit on a low chair, stool, or toilet seat.  DO place a pillow in the chair or stool and obtain an extended toilet seat or bedside commode for use at home. Always sit so your hip is higher than your knee.

Anterior approach: If your incision is in the front of your leg, follow the guidelines below:  DO NOT roll your leg/foot outward.  DO NOT extend your leg behind you.

 DO NOT roll your bad leg/foot inward.  DO NOT bend way over.  DO use a reacher to pick up objects that are difficult to reach. If you must pick something up from the floor, place your bad leg behind you as shown above right. 8

Physical Therapy Occupational Therapy Your day will be full and start very early. You will have therapy twice a day, in the morning and the afternoon. The times of your therapy will be posted on the board at the end of your bed. Your therapy will consist of:  Walking with a walker or crutches,  Climbing stairs,  Performing exercises to increase your strength and range of motion  Identifying equipment you may need for use at home. You and your Coach will learn to: Use a walker  Move to the edge of the chair before getting up. Your good leg should be well under the chair and your bad leg should be out in front of you.  While getting up, push up from the arms of the chair to assist in getting to a standing position.  Your walker should be adjusted so the handles of the walker are at wrist level when your arms are at your side. (if you already have a walker, you may be asked to bring it in on the day of your discharge).  To walk: a. Move the walker forward, make sure all four legs of the walker are on the floor before moving your leg. b. Step to the middle of the walker

with your bad leg. c. Push down on the walker with your hands. d. Then take a step with your good leg.

Climb Stairs using handrails Going up:  Hold onto the handrail(s). Step up with your good leg.  Then step up with your bad leg. Going down:  Hold onto the handrail(s). Step down with the bad leg.  Then step down with good leg. Climb stairs using a cane Going up:  Step up with your good leg.  Bring the cane and the bad leg up together. Going down:  Put cane down onto the step.  Step down with the bad leg.  Step down with the good leg. Helpful hints:  Go up the steps leading with the good leg.  Go down the steps leading with the bad leg.  The bad leg always goes with the cane. Transfer to commode You may need an elevation on your commode to make it easier to get on and off of the commode (bedside commode or raised toilet seat). 9

 Back up to the commode with the walker until you feel the commode at the back of your legs.  Reach back for the armrests of the commode and lower yourself, keeping bad leg in front of you.  Keep walker in front of you; do not use the walker to get up. Push down on the armrests of the commode to stand. Once you get your balance, you may reach for the walker. Transfer to tub/shower Check your discharge instructions for when you will be able to shower. Remember, you won’t be able to take a bath in a tub or get in a whirlpool or swimming pool until your doctor tells you. If you have a walk-in shower, it will be easier for you. However, with the assistance of another person or by using a grab bar, you can step into the tub to take your shower. Usually the safest way to accomplish this is to first step into the tub with your good foot and follow with your bad leg. An adjustable height bath seat and hand-held shower might also be helpful for you if you don’t wish to stand while taking your shower. If you need these items, the therapist can order them for you and teach you how to use them. Bathe and Dress To be able to safely bathe and dress your lower body, you may need some

of the following equipment:  Long-handled sponge  Long-handled shoe horn  Reacher  Sock-aide  Elastic shoe laces If you need any of these items, the therapist can order them for you.

Discharge Staff will work with you and your family throughout your stay to determine your discharge needs.  Your nurse will give you final instructions and prescriptions.  Equipment arrangements will be made for you.  Take your compression stockings and ice pack home with you.

Follow-up Therapy You may need Therapy following your surgery.  Baptist Hospital East Home Health Agency can provide therapy in your home.  Baptist Hospital East also has multiple locations where you can receive Outpatient Physical Therapy when you are ready.  Some patients may need to continue their therapy at a nursing home. You and your surgeon will decide the best option for you. Discharge planners on the unit will help you and your family with these arrangements before you leave the hospital. 10

While everyone heals at a different pace, it may take 3-6 months to fully recover from your surgery. It is very important that you continue to do your exercises when your physical therapy is discontinued.

DO list DO check your incision every day for the following signs:  Increase in redness.  Increase in swelling around incision and of the entire leg.  Increase in pain.  Increase in your body temperature (greater than 100.5 degrees).  Pulling apart of the incision.  Drainage or oozing from incision. Call your surgeon if any of the things listed above occur after discharge from the hospital. Do not wait until the next office visit to inform your surgeon.

DO your exercises at least twice a day as directed in your home program. DO put ice on hip incision for 15-20 minutes 2-3 times a day to decrease swelling and pain (especially after exercise sessions) DO follow your hip precautions closely until your surgeon tells you differently DO wear the elastic stockings as directed by your surgeon. DO take medicines as prescribed by your surgeon. You will be taking a pain medication and a blood thinner (i.e., Coumadin). A blood test called a Protime may be ordered by your surgeon to monitor you while on the blood thinning medicine. DO check for bruises and bleeding gums daily.

DO use the walker or crutches as you were instructed until the surgeon or therapist says they are no longer needed.

DO continue to insure proper nutrition and hydration: Drink 6-8 glasses of water/fluids daily, eat food high in fiber and low in sugar, and limit caffeine.

DO walk at least three to four times daily, using your walker or crutches as instructed. Gradually increase your walking distance as you are able.

DO ask your surgeon when it is safe for you to resume driving or other activities

DO keep the same weight-bearing status until changed by your surgeon. DO walk on paved, flat surfaces to prevent loss of footing. Be extremely careful on ramps.

DO inform your dentist or any other doctor you may see in the future of your total hip replacement surgery so they may use antibiotics, if necessary.

DO NOT list DO NOT let your knee bend over a pillow for prolonged periods of time.

DO NOT let yourself become overfatigued. DO NOT sit with your foot on the floor for longer than an hour at a time.

Important phone numbers If you should have any questions after your discharge, please call: Your physician Orthopedic Nursing Units: 7 Park: (502) 259-4700 or 8 Park (502) 259-4800 Physical Therapy: (502) 897-8137 Occupational Therapy: (502) 896-7445 Baptist East Home Health Agency: (502) 454-5656

Baptist Hospital East Home Health Agency Baptist Hospital East’s Home Health Agency can care for you or your loved ones in the comfort of your home. Our team of rehabilitation professionals stays in close contact with your physician while you are under our care, and includes:  Physical therapists, occupational therapists and speech-language pathologists who will continue your rehabilitation program in your home.  Registered nurses  Home health aides  Social workers  Chaplain  Dietitian The Baptist Hospital East Home Health Agency serves patients in Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties in Central Kentucky. It is a statelicensed agency and is certified by both Medicare and Medicaid. At Baptist Hospital East, Home Health staff members are available to help you plan, explain home health services and make arrangements for your return home. Ask to speak to a Home Health intake planner.

Baptist Physical Therapy Services Baptist Physical Therapy Services are offered at several convenient locations in Jefferson and Oldham counties. Services include the evaluation and treatment of:  Orthopedic and sports injuries  Stroke and neurological conditions  Work-related injuries, including functional capacity evaluations  Foot pain, including fabrication of custom orthotics  Children with physical, occupational or speech therapy needs  Hand injuries  Lymphedema  Wound care  Pre-/post-partum and pelvic pain  Incontinence (men and women) Aquatic physical therapy is offered at Baptist East/Milestone Wellness Center. See page 14 for Baptist Physical Therapy Services locations, maps, hours and phone numbers. Please call (502) 896-7559 to register prior to your outpatient physical therapy appointment.

To find out more about home health care, call (502) 454-5656 or toll-free 1-800-248-0289.

When coming to Baptist Hospital East for your pre-admission testing visit, please drive to the hospital entrance to make use of the valet parking. Come in the hospital entrance and proceed straight ahead and take the first hallway to the right to the PreAdmission Testing department. On the day of your surgery, park on the second floor of the parking garage and cross the pedway into the Surgery registration area.