4Why a Total Hip Replacement? Severe hip pain while resting or pain that limits daily activitiesA hip fracture that did not heal properlyHip inflammation and swelling that does not improve with rest or medicationStiffness when walkingNo improvement with medication, cortisone injections, physical therapy or other surgeries
5What Causes the Pain? Arthritis Degenerative Joint Disease Affects the cartilage or lining on the ends of the bonesCartilage becomes worn so movement is not smooth within that joint, and the grinding is painful (bone-on-bone)Pain, stiffness and loss of function are common
7Preparing your Home Arrange for special equipment needed Remove throw rugs and other tripping hazardsMove medications, phone, remote control within reachWiden pathways for using a walkerIf living alone, arrangements need to be made for someone to assist you or to go to a Skilled Nursing Facility for a short period of time.
8Pre-Surgical Nurse Contact You will speak with the pre-test nurse prior to your pre-surgical testing appointment.The information needed is:List of physicians you see on a regular basisList of allergies and your reactions to themList of your surgical/medical history
9Pre-Surgical Testing Appointment This visit may last 1 hourMedical tests performed (EKG, chest x-ray, blood test, urine sample)Medical/surgical history will be reviewedList of medications that you need to stop taking and which you need to take the morning of surgery will be providedHibiclens Soap will be given with instructionsAssessment by an anesthesiologist
10AnesthesiaGeneral or Spinal anesthesia is required to be administered before your hip or knee surgeryA femoral block for Total Knee ReplacementsGeneral anesthesia is required to be administered before your shoulder surgeryAn Inter-scalene BlockYou will meet your anesthesiologist prior to surgery in the preoperative testing process and in the preoperative holding areaYour anesthesiologist will review your history and discuss the best option for youAn Interscalene block (ISB) is a nerve block in the neck used to either: 1) provide a heavy numbness in the shoulder and arm (in the same way that a dentist can numb a tooth) so that shoulder surgery can be carried out "awake" or under mild sedation and/ or 2) to provide excellent pain relief for shoulder surgery carried out under general anaesthesia.The benefits of an interscalene nerve block (ISB) for shoulder surgery are:Reduced risk of nausea and vomiting and sedationEarlier to leave hospitalEarly intake of food and drinkExcellent pain controlLighter general anesthetic with speedier recovery from the anestheticLess chance of an overnight stay at the hospital
11Day before surgeryDo not shave legs the day before or day of surgery for knee or hip replacementShower with the Hibiclens Soap the night before and the morning of surgeryDo not eat or drink after midnight, including water, candy or gum
13Day of SurgeryTake any morning medications that you were instructed to take, sip of water onlyArrive at the hospital 1.5 hours before your scheduled surgery timeAt Progress West: Go to the 2nd floor- you will be escorted to your room and registered bedsideAt Barnes-Jewish St. Peters: Go to the hospital’s Main Entrance (A) and register in Admitting. You will be escorted to the preoperative area.
14Day of Surgery (cont.) What to bring to the hospital: Copies of Advance DirectivesLoose comfortable clothing, enough for 4 daysFlat, supportive walking shoes that are non-slip with an enclosed heelCPAP, if applicable
15Day of Surgery (cont.) What to expect: To be admitted to the hospital by the registration clerkTo meet a member of the anesthesia team to review earlier choices and assess for any changesTo be given a mild sedativeThat family and friends will be directed to the surgical waiting area
16Day of Surgery: Preoperative The staff will prepare you for surgeryYou will change into a hospital gownA name band will be verified and appliedAn IV will be started (using Lidocaine)Your medical/surgical history will be reviewedYour completed “Patient Home Medication List” will be reviewed and recorded
17Day of Surgery: Preoperative You will meet your Surgical TeamThe surgeon, with your assistance, marks the operative legThe anesthesiologist will review your choicesProphylactic antibiotic will be administeredRelaxing medication will be administered
18Day of Surgery: Operating Room Anesthesia will be administeredCatheter will be insertedLength of time for surgery is approximately 1 to 2 hours
20Day of Surgery: Post Anesthesia Care Unit Close monitoring until you are fully awakeYou will wake up with the following:Oxygen in noseBlood pressure cuff on armPulse oximeter on fingerCatheter in bladderSurgical bandage on incisionYour surgeon will speak to family and friends in the surgical waiting areaTKR will have a CPM machine placed in Recovery room
21Post SurgeryYou will be transported in your bed to your private room from the PACUYour nurse and tech will:Monitor vital signs closelyManage your painYou will receive a clear liquid meal tray progressing to an approved dietDuring the night you may still have:Oxygen in your noseIV fluidsCatheter in your bladder (this will be removed the next day)
22Progressing toward Recovery: Pain Management Tell your doctor what pain medications have worked in the pastRequest pain relief when you begin to feel discomfortTo help the doctors and nurses better relieve your pain, report whether the pain relief measures are adequateIce packs will be in place to assist in decreasing swelling and relieve pain
23Your Hospital Stay Your stay will be several days All rooms are privateWifi is available throughout the hospitalDining on call at PW (you choose when and what you eat according to the diet allowed by your doctor)
24Recovery in the hospital In-room Physical TherapyPain medications administered by IV and then by mouthCoughing and deep breathing is importantFoot pumps and/or mechanical pumps may be used to prevent blood clots
26Common Complications Nausea First meal will be clear liquids Medication can be given if neededConstipationDaily stool softener administeredLaxative can be given if neededSwellingIce Therapy
27Serious Complications Hip joint infectionOccurs in fewer than 1% of patientsHeart attack or strokeOccur even less frequentlyChronic illnessesMay increase potential for complicationsCan prolong recoveryBlood clotsMost common complicationBlood thinners will be startedDamage to nerves or blood vessels around the hipA rare occurrenceDislocation of the Hip joint
29Discharge PlanningDepending on your physical and clinical status you will be discharged home three days after your surgery.Your progress and readiness for discharge will be assessed daily.Your case managerVisits with you the day after surgeryAssists with the discharge planMakes arrangements for needed medical equipment
30Day of DischargeWe will be sure that you have the proper equipment for your home.Your nurse will review discharge instructions with you and your care partner or family member.Your instructions will include your first postoperative appointment with your surgeon in 7 to 10 days.
31Home CareNO baths, only showers, until the incision is thoroughly healed.It is important to eat a balanced diet at this time!Exercise is critical.Home health visits will be scheduled until you have reached a point where you can go to outpatient physical therapy.Driving is usually approved about 8-12 weeks after surgery.
32After Total Hip Replacement Avoid high impact activities.Avoid heavy liftingAvoid excessive stair climbingAvoid quick start-stop motions, twisting or impact stressesAvoid low seating surfaces
33Post surgery Activity Levels DangerousJogging or runningContact sportsHigh impact aerobicsExceeds recommendationsVigorous walkingSkiingTennisLifting 50 lbs or moreExpectedRecreational walkingGolfLight hikingBallroom dancingNormal stair climbing
34Your success is very important to us Your success is very important to us. We strive to provide an excellent patient experience.Please let us know if there is anything that we can do to improve your care.