TOTAL HIP REPLACEMENT PATIENT … Douglas Smallwood CEO: Phil Morley TOTAL HIP REPLACEMENT PATIENT INFORMATION LEAFLET This leaflet has been produced to help answer some questions

Chairman: Douglas Smallwood CEO: Phil Morley

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TOTAL HIP REPLACEMENT

PATIENT INFORMATION LEAFLET This leaflet has been produced to help answer some questions you may have after you have a total hip replacement. If you still have any concerns or queries after reading this leaflet, ask your doctor who will explain things more fully. The Hip Joint

The hip is a ball and socket joint; the ball, at the top of the thigh bone (femur), fits into a socket in the pelvis. It is a multidirectional joint; it permits a wide range of movements. The hip is the principle joint that is used to transfer weight from the trunk to the leg and must therefore be stable. This stability is achieved by the shape of the joint, the thick ligaments, and the large muscles which surround it. Thick ligaments form part of a sleeve around the joint, called a capsule. Where the two ends of the bone meet, the surface is made up of a slippery, gristle-like substance called cartilage. The joint space is filled with lubricant called synovial fluid produced by the lining of the joint capsule (synovial membrane) The cartilage and synovial fluid help to keep the joint moving smoothly and protect the ends of the bone from rubbing due to weight which passes through the hip joint.

What is arthritis?

Arthritis is simply the wearing away of the cartilage at the bone ends within the joint. In severe cases, the cartilage is worn away completely and the bone beneath it begins to wear away too. As a result, the joint lining becomes thicker and starts to produce more synovial fluid. This leads to swelling, and the swollen joint capsule becomes stiff and painful.

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Often this affects one hip more than the other and can result in the appearance of one leg being longer than the other. What causes arthritis?

Any factor causing the cartilage to wear away more quickly than normal, can lead to the development of arthritis. For example:

Previous injury to the joint

Abnormality in the joint,

Certain diseases (e.g. rheumatoid arthritis),

Excessive or abnormal use e.g. Professional sportsmen and women can go on to develop arthritis.

However, many of the seven million people in the United Kingdom who suffer from arthritis have no obvious identifiable cause of their condition. It is thought that such cases may be the result of hereditary factors affecting the joint. Treatment There are several ways in which the symptoms of arthritis may be eased, including drug treatment or operation on the existing joint. However in the most severe and disabling forms of arthritis, a total hip replacement may be recommended. Total Hip replacement

Total Hip replacement is a major operation that takes about two hours. The damaged ball of the hip joint is completely removed and replaced by a metal stem The damaged bone of the socket in the pelvis is shaved away and a plastic socket is cemented or screwed into the bone of the pelvis. By replacing the damaged parts of the joint, the artificial hip joint relieves pain and allows a greater range of movement [than before the operation.] Although very effective, the new joint does not recreate the perfection of the original joint.

It takes about one year to recover fully from the operation, although, the speed of recovery varies from patient to patient.



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How many are done?

Around 50,000 total hip replacements are carried out in the United Kingdom each year. Over 400 hip replacement operations are carried out at the Princess Alexandra Hospital each year

Immediately after the operation

Immediately after the operation you will be in bed with a triangular pillow between your legs to keep the new hip in good alignment until you start to walk. You will also be wearing elastic stockings to help your circulation, have a drip in your arm to keep you hydrated. A physiotherapist will show you what exercises to do and how to get out of bed and start walking if you are feeling well and all observations (i.e. blood pressure) are fine. Your exercises should be carried out regularly and continued once you are at home. Day 1 after your operation

You will be shown the correct way to get out of bed and sit on a chair. You will be assisted to walk short distances with a pair of elbow crutches. Day 2 to 3 after your operation

You will be encouraged to progress onto elbow crutches and your walking distance increased. It is important to continue with the exercises you have been shown throughout the day. At this stage we aim for you to be walking independently with a walking aid. You will also be shown how to go up and down stairs safely. Discharge from hospital usually takes place between 3-5 days after your operation. Occasionally you may need to stay in hospital longer. Should this occur the reason will be explained to you. Our aim is for you to go home 3 days after your operation. Leaving Hospital

It is important to continue with the exercises that you have been doing in hospital when you get home. Your physiotherapist will advise you which exercises to concentrate on. You will probably leave hospital walking with crutches or walking sticks and you should continue to walk with these until your six week follow up with the doctor. At this point we will advise you whether you need to continue using them, which will depend on the progress you have made in that time.



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How often will you need to see the doctor after the operation?

As mentioned above, you are likely to be in hospital for around 3-5 days after the operation, although this may vary depending on your rate of recovery. Total hip replacement is a major operation, so after you leave hospital you will need to attend for several check ups during the first year after the operation. After that, you will then be invited for a routine check up once every year, .These visits are important to ensure that the new joint is functioning correctly and to check for any problems. At each check up you will be asked questions about how you are coping with the new hip, and the joint will be examined. An x-ray may be taken. If for some reason you do not hear from the hospital about the time your yearly check up is due, we would ask that you contact the hospital to make an appointment. If you experience any difficulties with your new hip outside of the times scheduled for check ups please let your G.P. know

Hip precautions to follow post operation up to 3 months

When sitting, your hip must be at 90 degree angle or less

DO NOT bend down at the waist

DO NOT twist

DO NOT cross your legs



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Exercises Name of Physiotherapist____________________________________________

The following exercises can be performed in bed or when you’re sitting in the chair. They should be done throughout the day to regain your strength following surgery. 1. Lying on your back or sitting

Bend and straighten your ankles briskly. Keep your knees straight during the exercise as this will stretch your calf muscles. Repeat for 2 minutes every half an hour, 2. Lying on your back with legs straight, or sitting with your leg up on a foot stool.

Bend your ankles and push your knees down firmly against the bed/stool. Hold 5 seconds and then relax Repeat 10 times every 1-2 hours 3. Lying on your back/sitting up in bed

Bend and straighten your leg Repeat 10 times every 1-2 hours.



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4. Lying on your back /sitting up in bed

Bring your leg out to the side then back to mid position. DO NOT take leg across the midline Repeat 10 times every 1-2 hours 5. Lying on your back/sitting up in bed

Squeeze buttocks muscles as tightly as you can counting out loud to 15. Repeat 10 times every 1-2 hours The following exercises must also be done from the first day following your hip surgery: The three exercises shown below must all be done while standing and holding onto a support – which could be a chair or walking frame.

1. Stand straight holding onto a support

Lift your operated leg sideways and bring it back keeping

your trunk straight throughout the exercise.

2. Stand straight holding onto a support. Bring your operated leg backwards. Do not lean your

body forwards.

3. Stand straight holding onto a support.

Bring your operated leg forwards.

Do not lean your body backwards.

As a general guide, do 5 to 10 repetitions of each exercise at least 3 times daily. Try to increase these as your muscle power builds up. All exercises need to be practiced for up to 3 months after your surgery, you may need to continue them for longer.



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Walking

You will usually start to walk within a few hours after your operation. You will be assisted to walk using a walking aid– frame, crutches or walking sticks You will be shown how to use the walking aid correctly by your physiotherapist. The walking pattern involves:

Move the walking aid forward first Move the operated leg forward Followed by the un-operated leg then repeat the sequence

Stairs

You will practise going up and down stairs with the physiotherapist before you leave the hospital. Remember this rule:

The non operated leg leads up The operated leg leads down Getting in and out of the car

DO NOT drive a car between being discharged from hospital and having your follow

up appointment with your doctor. If you do this your insurance could be compromised so it is best to contact your insurance company before starting driving again. As a passenger it is best to avoid long journeys. If this is not possible then regular breaks are advised. It is recommended that you always sit in the front passenger seat as you can move the seat back to give yourself extra leg room. The best way to get into and out of the car is to get in with your bottom first then carefully bring your legs into the car – Avoid bending at the hip more than 90°.



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Total Hip Replacement

Advice post operation to 6 weeks

Mobility

Weight bear as tolerated using the walking aid you were discharged with. Continue to work on good heel-toe walking pattern. Exercise

Continue with your exercises as instructed by your physiotherapist, to increase your strength. Increase your walking distance, as you are comfortable. You may commence swimming once your wound is healed (avoid breastroke for 3 months following your operation. You may use a static cycle but ensure the seat is in a high position. You may recommence playing golf and gardening by about 6 weeks. Wound

Once the clips come out and if your wound is tender to touch you may massage it firmly using a moisturising cream to de-sensitise the skin and underlying tissues. Always use a fresh towel when patting dry your wound after shower or wash. Stairs

Progress as you feel comfortable. Otherwise carry on as instructed by the physiotherapist -‘up with the good first, down with the bad first’. Housework

Increase the amount of housework that you do over the next few weeks. Be careful not to bend or twist. Driving

You will be advised when you may recommence driving at your 6-week review appointment. You must be able to safely perform an emergency stop and change gear comfortably. This applies even if you have a car with an automatic transmission and have had your left hip replaced.

Sleeping It is strongly advisable for you to lie flat on your back for 6 weeks up to 3 months. If this is very difficult, you can lie on the operated side after 6 weeks if it is comfortable for you to lie on the wound. Sexual Relationships

Resume when comfortable; be careful not to force your hip into an awkward position. Returning to work

You may be able to return to work between four and six weeks provided you have a sedentary job.



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Travelling abroad

We do not advise travelling abroad before 6 weeks. Advice from 6 weeks to 3 months

Mobility:

As soon as you can weight bear fully without pain you may start to discard walking aids. Be careful not to get into a habit of limping. If you find that without a stick/crutch you limp excessively there is no harm in using one for a few weeks longer. Exercise: Continue with the exercises as instructed by your physiotherapist; this will increase your strength. Increase your walking distance, as you feel comfortable.

Stairs: Progress as you feel comfortable and as weight bearing allows.

Housework:

Increase the amount of housework that you do over the next few months. Be careful not to bend or twist.

Wound:

If your wound is tender to touch you may massage it firmly using a moisturising cream to de-sensitise the skin and underlying tissues.

Driving:

Begin driving once your consultant has agreed that it is safe to do so. You must be able to safely perform an emergency stop and change gear comfortably. Sleeping:

You can lie on the operated side when it is comfortable lying on the scar. If you wish to sleep on the un-operated side, use a pillow between your legs.

Sexual Relationships

Resume when comfortable, but preferably with your partner on top for the next 3 months.

Restrictions

Between 6 weeks and 3 months you may return to all normal activities with the exception of high impact sports (see below). After 3-6 months the aids supplied by the Occupational Therapy Department should be returned. (See phone number below) Always try to avoid bending the hip more than 90º; if this is unavoidable move slowly.

Returning to work

You will be able to return to work between four and six weeks if you have a light job. If you have a manual job if may be 6 to 12 weeks before you can return.



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Sport/Leisure:

Most sporting activities can be resumed after 3 months, depending on comfort and level of competition. Low impact sports such as swimming (breaststroke after 3 months), cycling, doubles tennis, gym work after instruction, golf present no problem. High impact sports are not recommended, therefore are participated in at your own risk i.e. jogging, singles tennis, squash, jumping activities, football. Gardening should be done with care. If possible use a low stool and long-handled tools. Skiing should only be participated in if you are an experienced skier. Travelling abroad

Your Total Hip Replacement will probably be detected at airport x-ray machines. Useful Telephone Numbers

Orthopaedic Surgical Unit (OSU) 01279 827612

Physiotherapy and Occupational Therapy 01279 827199

Collection of Equipment for Essex Residents 01279 698914

Collection of Equipment for Hertfordshire Residents 01707 292555



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PROGRESSION EXERCISES POST TOTAL HIP REPLACEMENT

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Sitting on a chair. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold approx. 5 secs. and slowly relax your leg. Repeat 5-10 times.

Stand straight holding on to a support. Lift your operated leg sideways and hold it for 5 seconds.Bring it back keeping your trunk straight throughout the exercise. Repeat 10 times. Repeat 3 x a day

Stand with a rubber exercise band around your ankle. Pull the band by bringing your leg out to the side. Repeat 10 times. Repeat 3 x a day You can use an ankle weight instead.

Stand straight holding on to a chair. Bring your leg backwards keeping your knee straight. Do not lean forwards. Repeat 10 times. Repeat 3x a day.

Stand with a rubber exercise band around your ankle. Pull the band by bringing your leg straight backwards. Repeat 10 times. Repeat 3 x a day You can complete this with an ankle weight.



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PROGRESSION EXERCISE POST TOTAL HIP REPLACEMENT

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Stand with a rubber exercise band around your ankle. Pull the band by bringing your leg straight forward. Repeat 10 times. Repeat 3 x a day You can complete with with an ankle weight.

Lying on your back. Tighten your thigh muscle and straighten your knee. Lift your leg 20 cm off the bed. Hold 5 secs. Repeat 10 times. Repeat 3 x a day

Progression from previous exercise: Lying on your back. Put a weight around your ankle. Tighten your thigh muscle and straighten your knee. Lift your leg 20 cm off the bed. Hold 5 secs. Slowly bring your leg down. Repeat 10 times. Repeat 3x a day

*COMMENCE THIS EXERCISE FROM 6 WEEKS AS YOU ARE ABLE*

Lie on back with both legs bent as shown Tighten buttocks and raise them off floor (up to a comfortable height) Keep pelvis level. Hold 5 seconds, slowly relax

5. 5-10repetitions, 2-3 times per day

*COMMENCE THIS EXERCISE FROM 6 WEEKS AS YOU ARE ABLE*

Progression from previous exercise: 1. Lie on back with your knees bent and your arms straight, and hold your spine stable in neutral throughout the rest of the exercise 2. Pull your toes up toward the ceiling 3. Push your heels into the floor 4. Tighten your buttocks 5. Leaving your head and arms on the floor, slowly lift your

buttocks in the air until your hips are fully extended



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PROGRESSION EXERCISES POST TOTAL HIP REPLACEMENT

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*COMMENCE THIS EXERCISE 6 WEEKS AFTER YOUR SURGERY AS YOU ARE ABLE*

Lying face down. Lift your leg towards the ceiling keeping your knee straight. Repeat 10 times.

*COMMENCE THIS EXERCISE 3 MONTHS AFTER YOUR SURGERY AS YOU ARE ABLE*

1. Lie on your NON OPERATED side, with both knees bent 2. Lift top leg, keeping your heels together and ensure your spine is straight and hip not rolling back 3. Hold 5 seconds

4. 10 repetitions, up to 3 times per day


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TOTAL HIP REPLACEMENT PATIENT … Douglas Smallwood CEO: Phil Morley TOTAL HIP REPLACEMENT PATIENT INFORMATION LEAFLET This leaflet has been produced to help answer some questions