Before, During and After Your Shoulder Surgery



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After your Hip Fracture Surgery

Information for Patients Who Have Had

Hip Fracture Surgery

Prepared by:

Interior Health Orthopedic Working Group

Draft – December 6, 2011

Introduction____________________________________________

This booklet is to provide patients who have had Hip Fracture Surgery with the information needed for a comfortable and successful recovery.

The information in this booklet is intended solely for the person to whom it was given by the health care team. It does not replace the advice or directions provided to you by your surgeon.

Table of Contents________________________________________

Introduction - The Hip

About Hip Fractures

What is a fractured hip?

Causes

What is Osteoporosis?

Main Types of Fractures

Treatment Options

What is a An Artificial or Total Joint Replacement?

If you have had An Artificial Joint Replacement

Special Precautions After Surgery

Your Health Care Team and Clinical Pathway

Admission and Acute Care Stay

Clinical Pathway – see Appendix A

What to Expect Before Surgery

What to Expect Immediately After Surgery

Post-op Days One through Five

On the First Day After Surgery

Pain Control

Postoperative Exercises

Constipation

On the Second Day After Surgery

Sitting

Walking

On the Third Day After Surgery

On the Fourth Day After Surgery

On the Fifth Day After Surgery

Going Home

Checklist

Managing Your Pain At Home

Follow-up

While at Home After Your Surgery

Preventing Falls

Complications

Nutrition

Daily Activities

Home Exercise Program

Resuming Activities

How to Obtain Equipment

Home Support Services

The Hip______________________________________________

The hip is a ball and socket joint where the thigh bone (femur) meets the pelvis (socket). The hip joint provides movement in all directions (forward, backward, sideways, and rotation). The femoral head is the “ball” (or top part of the femur) which fits into the “socket” (or acetabulum) which is located in the pelvis.

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What is a Fractured Hip?__________________________________

A fractured hip is a partial or complete break in the upper portion of the thigh bone (femur).

About Hip Fractures______________________________________

Causes

Hip fractures are usually caused by:

• an injury to the hip (i.e. a fall), or

• a disease called osteoporosis

What is osteoporosis?

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. As you age, it takes your body longer to replace lost bone mass and this leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine, and wrist.

Osteoporosis is most common in people who:

• are thin

• exercise very little

• smoke or drink alcohol

• don’t have enough calcium in their diets

• are post menopausal

If you have osteoporosis, it is important that you try to prevent bone loss. You can do this through diet, medication, and exercise. It is also important that you learn how to prepare yourself and your home so that you can prevent a fall that could result in a broken bone(s).

Main types of Hip Fractures

There are three main types of hip fractures:

• Femoral Neck – a fracture occurring across the neck of the femur, just below the head (ball)

• Intertrochanteric - a fracture occurring between the femoral neck and the shaft of the femur (most common type of hip fracture)

• Subtrochanteric – a fracture occurring across the shaft of the femur (least common type of fracture).

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Treatment______________________________________________

Depending on the type of hip fracture that you have (see above), your fracture will be (or has been) repaired using one of the following special techniques:

• Femoral Neck Fracture

Femoral neck fractures may be repaired using either:

a) Metal pins/screws- which are inserted across the fracture line to hold the femoral neck together and in proper alignment.

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or,

b) An artificial hip prosthesis or component. This type of surgery is known as a “hemi-arthroplasty” and involves replacement of the “ball” portion of the hip joint with an artificial (metal) component. This may be done when the blood supply to the head of the femur has been interrupted or cannot be repaired using other methods.

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• Intertrochanteric Fracture

To repair this type of fracture, a special metal screw is inserted through a plate into the bone and across the fracture line. This plate and screw system helps to align the fracture and bring the edges of the bone back together so that it may heal.

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• Subtrochanteric Fracture

Subtrochaneric fractures may be repaired by inserting a metal nail down the shaft of the femur to hold the broken bone in place. Special screws (known as compression screws) are also inserted into the bone and through the nail which help to bring the fracture edges back together and ensure proper bone alignment.

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What is An Artificial Total Hip Joint Replacement?____________

If your hip joint has been badly damaged due to trauma or arthritis, your surgeon may decide to replace all of the hip joint components (or parts) including the actetablum or “socket”. This type of surgery is called a “total hip replacement” or a “total hip arthroplasty”. It is similar to a hemi-arthroplasty (see above) except that all of the components (or parts) of the hip joint are replaced with artificial ones.

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Your Health Care Team and Clinical Pathway________________

The health care team has put together a Clinical Pathway which will act as your guide so that you will know what will happen on a day-to-day basis. A summary of this Clinical Pathway is found in Appendix A of this booklet.

Please be sure to keep and read this information as the team members will refer to these instructions throughout your stay.

A number of health care professionals may be involved in your care. These include:

• Nurses

• Doctors (family physician, surgeon and anesthesiologist)

• Physiotherapists (PT)

• Occupational Therapists (OT)

• Others (Social Workers, etc)

If You Have Had An Artificial Hip Joint Replacement _________

If you have had an artificial hip joint replacement (either partial or all components), the muscles and soft tissue of your surgical leg will be very weak after your surgery. Until they strengthen, your hip may “dislocate” (slide out of it’s socket).

It is therefore VERY important that you follow these special precautions:

For the first three (3) months after your surgery:

Do NOT:

• cross your legs or feet.

• twist at the waist.

• sit on any surface lower than your own knee height

• bend in the hip past 90 degrees or lean forward to reach things.

Do:

• sit on a high chair or cushion and use a raised toilet seat.

• use long-handled aids (such as a shoe horn and “reacher”) to help you dress and reach things.

• sleep with pillows between your legs for the first three (3) months after your surgery.

What to Expect Before Surgery_____________________________

• You will be interviewed by nurses, doctors, and other health care team members to find out about your overall health, past health problems, previous surgeries, etc. and the help that you may need when you go home.

• You will have blood work done and x-rays taken of your hip and chest.

• You will have a small tube or catheter (known as an IV) inserted into your hand or arm. Pain medication may be given to you through this small tube to help keep you comfortable. The anesthesiologist will also use this small tube to give you an anesthetic (medication which will put you to sleep for your surgery).

• You will not be allowed to have anything to eat or drink before your surgery. This is an important safety measure to ensure that you do not choke (or aspirate). Please follow the directions given to you regarding eating and/or drinking before your surgery.

What to expect immediately after surgery __________________

• When you wake up, you will be in a special area (called “The Recovery Room”) where patients who have had surgery are monitored until they are awake and medically stable.

• The nurse will check your temperature, heart rate, blood pressure, circulation, hip dressing, and movement of your operated leg. She will do this a number of times.

• The nurse will also give you pain medication on a regular basis through the small tube (IV) in your hand/arm. Please tell your nurse if you begin to feel any pain or discomfort.

• If you are feeling sick to your stomach, the nurse may also give you some anti-nausea medication.

• Your nurse will help you turn from side-to-side every three (3) hours while you are in bed. This is important to prevent pressure areas and sores from developing on your skin and also helps your breathing and circulation.

• You will be encouraged to do some deep breathing and coughing exercises to help clear your lungs.

• Your family can visit with you when you are transferred to your in-patient bed (approximately 3-4 hours after your surgery).

• For your diet, you will start with clear fluids (water, juice, tea) and slowly progress to a regular (high fiber) diet when you are feeling better.

• You may also have had (or will wake up with) a small tube (or catheter) in your bladder to help empty your urine.

• If you have had an artificial joint replacement, you may also have a large splint placed between your legs. This is to help keep your hip in proper alignment.

Pain Control____________________________________________

After your surgery:

Most patients report moderate pain after their hip surgery. It is possible however to relieve much of the pain with medication and comfort measures such as ice, relaxation exercises, and repositioning.

It is important that you are comfortable so that you can rest, heal, and start some gentle exercises. Don’t be afraid to ask for pain medication. Some patient’s don’t ask because they do not want to bother the nurses; others fear becoming addicted to the drug. For most patients, there is virtually no chance of addiction. Preventing severe pain in the early stages after surgery will also prevent the pain from persisting later on, allows the body to relax and heal, and speeds overall recovery.

Pain management is therefore a priority.

Your nurse needs to know when you hurt and feel pain. Constant and severe pain can hamper your recovery and prevent you from moving, doing your exercises and sleeping – all of which could lead to severe complications and delayed healing.

Types of Pain Medication:

After your surgery, you may receive pain medication in a variety of ways: These include:

• Through a special computerized pump and tubing called a PCA pump (Patient Controlled Analgesic Pump).This pump will allow you to safely manage your pain. By using a hand-controlled button, you can press the pump and it will deliver a safe pre-programmed dose of pain medication. The pump has special safety measures built in so that you cannot give yourself more medication than is safe.

• Through the intravenous (IV) catheter and tubing

• By epidural injection – medication is injected into the spinal column during surgery to provide pain relief for a number of hours

• By injection

• By mouth (i.e. pills)

• By suppository

Managing your pain while in the hospital:

Your nurse will explain how your pain will be managed and how to use a pain scale. This scale helps you to identify or measure intensity of pain (i.e. no pain, a little pain, worst pain).

| | | | | | | | | | |0 1 2 3 4 5 6 7 8 9 10

No pain Moderate pain Worst pain

It is recommended that you keep your pain at a level four (4) or lower (on the pain scale) or whatever level is most comfortable for you. You should be comfortable at both rest and with activity or movement.

Be sure to notify your nurse when you start to become uncomfortable or before any expected activity (i.e. post-op exercises/physiotherapy). Do not wait until the pain is severe. Pain medications work more quickly and effectively when taken at regular intervals and when you are relaxed (i.e. not in too much pain).

Relaxation techniques(such as deep breathing, distraction, and also imaging) help to control pain.

Notify your nurse immediately if:

• your hip pain increases sharply, or if

• your calves feel tender or painful

On the First Day After Your Surgery_________________________

• Your nurses will help you to turn and reposition yourself in bed.

• You will be encouraged to do deep breathing and coughing exercises as well as some foot and ankle exercises.

• You may have some more blood work done.

• The incision on your hip will be examined and the dressing changed.

• You will be encouraged to sit on the side of your bed (or in a chair). Before you do this however, your nurse will give you some pain medication so that you will be a little more relaxed and comfortable.

• You may also be given a high-protein/high caloric drink twice a day to help your body tissues heal.

Getting out of Bed:

The nurse (or physiotherapist) will help you to get out of bed for the first few times.

To do this:

• Move your body towards the same side of the bed as your surgical hip. (i.e. move towards the left if your surgery was on your left hip).

• Slide your surgical leg to the edge of the bed.

• Push up from your back, using your elbows and hands to get into a sitting position.

Getting into Bed:

Again, the nurse (or physiotherapist) will help you to do this the first few times.

• Position yourself half way down the bed so that your surgical side (leg) will move/slide first on the bed.

• Sit on the edge of the bed like you would in a chair.

• Lean back on your elbows.

• Slowly slide your surgical leg onto the bed until you are flat.

• When moving, try to move your body as a whole (keeping your trunk straight and your legs apart).

Post-operative Exercises__________________________________

The following exercises will help to prevent post operative complications (such as fluid in the lungs, pneumonia, or blood clots) which can occur due to the anesthetic and prolonged bed rest.

Deep Breathing and Coughing

Deep breathing and coughing help to clear your chest after surgery. They also help to improve circulation, breathing, and prevent pneumonia.

• Take 4 deep slow breaths, then cough loudly

• Repeat 4 times

Practice deep breathing and coughing every hour for the first three (3) days after your surgery.

Exercising in Bed

After surgery, a physiotherapist will help you with simple exercises that can be done in bed (see page XX for post-op exercises). These exercises will help to restore circulation, prevent blood clots, and to strengthen your muscles.

Relaxation Exercise

This exercise will help you to relax. Relaxation will help your pain medication to be more effective and will also help you to sleep.

• Breathe in and out slowly to the count of three (3)

o Breathe in (1-2-3)

o Hold (1-2-3)

o Breathe out (1-2-3)

• As you do this exercise, concentrate on feeling pleasantly warm and heavy. Let your jaw go loose and your head sway gently and slowly from side to side. Think about feeling loose and limp all over. Continue to breathe in and out slowly. As you breathe in, think relaxing, soothing thoughts. As you breathe out, blow pain, discomfort, or tension away.

• Repeat 10-20 times.

Constipation____________________________________________

While pain medication is important for your comfort and recovery, it may lead to constipation. Here are some suggestions to keep you “regular”.

• Drink at least eight (8) glasses of water or juice a day (unless not recommended by your doctor)

• Eat fibre (such as prunes, bran, fruit, and vegetables)

• Move around as much as you can comfortably.

Be sure to let your nurse know if you are feeling uncomfortable or “full” as a laxative or stool softener may be necessary.

On the second day after your surgery_____________________

• You will be encouraged to get up and sit in a chair for at least 1 meal on this day.

• If you have had an artificial joint replacement, you may have pillows placed between your legs to remind you not to cross your legs while in bed.

• If you have a urine catheter, the nurse may remove it.

• You may use a commode (portable toilet) or bedpan/urinal. Note: If you have had an artificial joint replacement, you will need to use a commode with a raised seat.

• The physiotherapist will teach you appropriate exercises for your hip and legs.

Sitting:

For meals (and for short periods of time), you may sit in a firm and sturdy high-seated chair that has arm rests.

To Sit:

• Back up to the chair with your walker (or crutches) until you feel the back of your knees touching the chair.

• Move your surgical leg forward, keep your trunk straight , and reach for the arm rests.

• Lower yourself slowly into the chair.

• Be sure to ask for help if needed.

• If you have had an artificial hip joint replacement, sit only on a raised/high chair.

Walking:

The physiotherapist will show you how to use a walker (or crutches) and help you to walk short distances. Be sure to ask for help if needed.

On the third day after your surgery______________________

• You will be offered pain medication (that is taken by mouth on a regular basis) for the rest of your hospital stay. Be sure to tell the nurse if you are feeling any pain or discomfort.

• The nurse will check your dressing and will change it if needed.

• You will be up and sitting in a chair twice for meals.

• You will be up and walking twice a day (using a walker or crutches).

• You will continue to do your hip exercises.

• You may use a commode (portable toilet) during the day and a bedpan/urinal at night.

• An Occupational Therapist may visit to discuss any home needs or equipment that you may require. These will need to be in place before you go home.

On the fourth day after your surgery_______________________

• The nurse will again check your hip dressing and change it if needed.

• You will be given pain medication (by mouth) if needed. Be sure to let your nurse know if you are feeling any pain or discomfort.

• You will continue to get up, sit for meals, and walk (using your walker or crutches) at least two times during the day.

• You may be taught how to safety manage stairs if needed.

• You may walk to the bathroom (using your walker or crutches) during the day and may use a commode (portable toilet) at night.

• You will continue to do your hip exercises.

• The Occupational Therapist may visit again to:

o teach you how to use long handled aids (such as a “reacher”, sock aid, and shoe horn) that will make getting dressed at home easier.

o teach you how to safety complete daily activities such as dressing and bathing yourself

o ensure that you have made arrangements to have any needed equipment at home. These may include:

▪ raised chair for sitting

▪ extra-firm cushion (4 in X 16 in X 18 in).

▪ raised toilet-seat

▪ tub transfer equipment (raised bath-board, tub transfer bench, shower chair/stool)

▪ hand-held shower hose attachment

▪ long-handled aids for dressing and bathing

• long-handled “reacher” or grabber

• long-handled bath sponge

• long-handled shoe horn

• sock aid

▪ grab bars

▪ safe-supportive shoes – either slip on or with elastic laces or Velcro straps (purchase laces at a medical supply store)

▪ loose comfortable clothes

▪ crutches / walker

See page XXXX for How to Obtain Equipment

On the fifth day after your surgery_________________________

You may be going home soon!

• You will be up walking in the hallway (with a walker or crutches) twice and you may practice stairs with the help of a physiotherapist.

• You will continue your hip exercises.

• The nurse will review the following with you:

o Pain management

o Relaxation techniques

o Signs of infection

o Signs of blood clots

o Constipation

• Your incision will be examined and the dressing on your hip will be changed before you go home.

• The nurse will also review how to arrange to have any staples (in your incision) removed.

• A follow-up physiotherapy appointment will be confirmed.

• You will be given a prescription for pain medication before you go home.

Going Home____________________________________________

A checklist:

• You will go home 5-7 days after your surgery. Discharge time is 10:00 am .

• Please arrange for family or a friend to pick you up at the hospital. You will NOT be allowed to drive home.

• Please arrange for a support person that is able to remain with you for 24 hours a day for 3 days and who is then readily available for 10 days should you need help and assistance with meals, homemaking, daily activities, etc.

• Before you leave, please make sure you have:

o All of your belongings, including any medication that you may have brought with you.

o Your house keys.

o A prescription for pain medication and blood thinners.

o Made arrangements to have your staples removed.

o All of the equipment and mobility aids to help you move around safely.

o Made a follow-up appointment with your surgeon.

o Made a follow-up appointment with the physiotherapist.

Managing your pain at home:

The pain will subside gradually over the next six (6) weeks following surgery. Yet, some days you may feel more uncomfortable than others and you will need to take pain medication. Use this guide to help you get comfortable:

• Do not push yourself beyond your limit. Rest, if you feel fatigued and/or uncomfortable.

• Take pain medication when it interferes with rest and/or prescribed activities.

• Use relaxation techniques (such as deep breathing exercises, progressive relaxation, and imaging) – a warm shower may also help.

• Distract yourself from the pain. Listen to music, visit with friends, write letters, read, watch TV.

• Use an ice pack to help relieve pain.

o Lie down (on your bed) and elevate your surgical leg.

o Place an ice pack (wrapped in a towel) on your hip area for fifteen (15) minutes, up to three (3) times a day. A packet of frozen vegetables (wrapped in a towel) also works well.

• If doing your exercises is painful, take pain medication and wait 30 minutes before starting the exercises.

• Think positively. You will become more comfortable and feel better with time.

Follow-up____________________________________________

Physiotherapy:

A follow-up physiotherapy appointment will be made for you before you go home. These appointments should continue for about six (6) weeks after your surgery.

It is important to attend these physiotherapy sessions as they will help you to regain your strength, balance, movement, and flexibility.

Home Care:

Home care and/or occupational therapy are available on recommendation by your doctor (or physiotherapist).

Tell your Dentist and Other Medical Practitioners About Your Hip Surgery________________________________________________

It is important to tell your dentist and other medical practitioners that you have had hip surgery. As an infection may travel in the blood, you may need antibiotics to prevent getting an infection in your hip – especially if you are having minor surgery or any dental work done.

While at home after your surgery___________________________

• Do NOT have a tub bath until your hip is strong and flexible and you are allowed to put full weight on your leg. Use the tub transfer bench or a raised bath-board.

• Shower with the waterproof dressing still on over your staples. Once your staples have been removed, you won’t need a dressing.

• Do NOT attempt to drive for approximately six (6) weeks after your surgery. Consult with your surgeon prior to driving.

• Continue your home exercise program as directed by your physiotherapist/surgeon.

Preventing Falls:

As the surgery will affect your balance and strength, you will be at greater risk for falling. Follow these guidelines to help prevent falls at home:

• Always get up slowly after sitting or lying down. Take your time and make sure you have your balance.

• Be especially careful if you are taking sleeping pills, tranquillizers, and/or high blood pressure medication. These medications may make you feel dizzy and/or affect your balance.

• Have all hazards (such as clutter, electrical cords, scatter rugs) removed from your walking path and stairs.

• Wear your eyeglasses when walking, if needed.

• Keep the inside of your home well lit. Use night lights.

• Wear non-skid supportive footwear at all times.

• Use handrails when available, especially on stairs.

• Have grab bars or hand rails installed in the shower or bath.

• Use your walking aids (walker, crutches, or cane) at all times.

• Do not lean against unstable furniture or objects.

• Sit in a sturdy chair when you are getting dressed.

Note: Many falls occur during a visit to the bathroom.

• Make sure the route from your bedroom to the bathroom is clear, uncluttered, and well lit. Use nightlights.

• Have grab bars/hand-rails installed in the shower or bath.

• Be sure that your shower or tub has a non-slip coating or mat.

• Use your walking aids.

• Avoid rushing. Plan to use the toilet on a frequent and regular basis.

• Stay on the toilet for a minute or so after urinating as you may feel a little faint or dizzy afterwards.

• Older men should sit to urinate as blood pressure may drop during urination.

Complications________________________________________

After surgery, a small percentage of people have complications that require medical treatment. These include development of blood clots and/or infection.

Blood Clots

A small number of people develop blood clots, usually in the deep veins of their legs. Patients who already have problems with their heart, circulation, and/or are inactive have a higher risk of developing these clots.

• If you notice pain, redness, heat, or swelling in your calf area notify your doctor immediately.

• If your doctor has prescribed an anticoagulant (a blood thinning medication to prevent clots from forming), it is important that you follow the instructions when taking this medication. Anticoagulants may continue after you are discharged from the hospital.

• Doing the ankle pumping exercises, wearing compression stockings, and walking as soon as possible are also things that you can do to prevent blood clots from forming in your legs.

Infection

Despite preventative measures, a small number of people may get an infection in the surgical area. An infection elsewhere in the body (i.e. tooth) may also be transmitted to the surgical area by the blood. These infections need to be treated immediately with antibiotics.

• Notify your doctor immediately if you have any of the following signs of infection:

o Redness and swelling around the surgical area.

o Increased local pain and warmth in the hip area.

o Yellow or green foul-smelling drainage from the incision area.

o A persistent increase in your temperature above 38°C (100° F).

• Report any infection such as a urinary tract infection, wound infection, or sore throat to your family doctor.

Nutrition______________________________________________

Good nutrition after your surgery is very important. It can promote rapid recovery, reduce the risk of infection, and help you maintain good heath. All nutrients will help you to heal, however protein and calcium are especially important.

Protein

Protein promotes healing and helps to build and maintain muscles. Meat and meat-alternatives are a good source of protein. Adults should have two-three (2-3) servings of protein per day. One protein serving equals one of the following:

• 2 – 4 ounces of meat, poultry, or fish

• 1 – 2 eggs

• ½ - 1 cup of beans

• 1/3 – 1 cup of tofu

• 2 tablespoons peanut butter

Calcium and Vitamin D

Calcium is essential to bone health and healing. Vitamin D helps the body to absorb calcium. Adults should have two to four (2 – 4) servings of calcium products (containing Vitamin D) per day. One serving of a calcium product equals the following:

• 1 cup of milk

• 2 ounces of cheese

• ¾ cup of yogurt

Other products to include in your diet include: soy, tofu, green vegetables, and vitamin supplements.

Vitamin C also helps to promote healing. Eat plenty of fresh fruits and vegetables.

Do NOT diet while you are healing from a fracture and surgery. Your body needs the right amount of calories to make sure that the wounds and fracture(s) heal properly and as quickly as possible.

Fiber and Water. You may be constipated after surgery due to the anesthetic, pain medications, and decreased movement. Prevention of constipation is the key – eat plenty of fiber such as grains and bran and drink lots of water.

Talk to a dietitian. Your nurse can arrange for you to talk to a registered dietitian/nutritionist during your hospital stay. It is a good idea to talk to the dietician if you:

• have a poor appetite

• have lost a lot of weight recently without trying

• are underweight

• are unable to eat a wide variety of food

Nutritional supplements (such as Ensure™, and Boost™) are also available if you are struggling to eat a well-balanced diet.

If needed, your doctor can refer you for special therapeutic diets for weight gain, allergies, low cholesterol, high calcium, and high iron.

If You Have Osteoporosis_________________________________

Osteoporosis is a condition where bone becomes weak, brittle and at risk of breaking. If you have osteoporosis, it is important to:

• eat a well-balanced diet including foods high in calcium

• avoid smoking and drinking excessive amounts of caffeine and/or alcohol

• reach and maintain a healthy weight

• start a regular weight-bearing activity (when your doctor says it is safe to do so)

• talk with your doctor about other therapies

Daily Activities__________________________________________

Standing up

• Move yourself to the front edge of the chair or toilet and keep your operated leg extended in front of you.

• Slide your other foot back slightly and lean forward slightly while pushing yourself up using the arm rests, grab bars, or other secure surface.

• Make sure you feel steady before starting to walk.

Sitting down

• Sit on a chair where the seat is high (not low to the ground) or add a firm cushion to a regular chair.

• Use a firm sturdy chair with arm rests.

• When sitting, back up to the chair until you feel the back of your legs touching it. Move your surgical leg forward and keep your body straight as you reach back for the arm rests, grab bars, or other secure surface.

• Slowly lower yourself into the chair.

• If you have had an artificial joint replacement, do NOT bend your hip forward more than 90 degrees for the first three (3) months after your surgery. Do not bend forward too much or sit in a low seated chair.

Getting dressed

• Sit on a high bed or firm chair with arm rests.

• With your operated leg extended forward, use long-handled aid such as a “reacher”, sock aid, and shoe horn to help you put on pants, socks, shoes, etc.

Toilet transfer

• Use a secure raised toilet seat until you are able to put full weight on your leg and your hip is strong and flexible.

• Transfer onto the seat as you would for a chair:

o Back up to it until you feel the edge behind your legs.

o Bend your non-surgical knee and hip as you lower yourself onto the seat.

o Keep your surgical leg straight.

• Reverse the procedure when standing up.

Shower transfer

• Use a secure raised shower chair/stool in your shower stall.

• Walk into the stall with your walker (or crutches).

• Without twisting your trunk, move the walker (or crutches) out of the stall.

• Back up to the edge of the seat and reach back for the seat with one arm while holding onto a grab bar or other secure surface with the other hand.

• Slide your operated leg forward and sit down slowly.

• Use a hand-held shower attachment.

• Dry off as best as possible before getting out of the shower.

• Use a non-slip bath mat inside and outside of the shower stall to prevent slipping on the wet surface

Tub transfer

• Do NOT take baths in the tub.

• Use a secure raised bath-board or tub transfer bench.

• Transfer onto the seat by backing up to it until you can feel the edge behind your legs.

• Reach back with one hand for the seat while holding onto a grab bar or other secure surface with the other hand.

• Sit down slowly sliding your operating leg forward and slide back on the seat.

• Slide as far as you can back onto the seat and then slowly lift your legs over the edge of the tub. Use a leg lifter if necessary.

• Do not bend your hip past 30 degrees if you have an artificial joint.

• Use long-handled aids and a shower hose attachment to clean your feet and other hard to reach places.

Car transfer

• Have the car parked well away from the sidewalk or curb so that you have lots of room to move.

• If you are going home in a high vehicle, you may need a footstool to get into and out of the vehicle.

• Have the front passenger seat moved back as far as possible and roll the window down.

• If you have an artificial joint, place a wedge cushion on the seat (with the thick portion at the back of the seat).

• Back up to the seat and place one hand on the window ledge and the other hand on the back of the car seat.

• Lower yourself slowly onto the seat and slide back across the seat until you can comfortably swing your legs into the car.

• Note: a piece of plastic or a large garbage bag (placed onto the seat) may help you to slide in more easily.

• Reverse the process to get out of the car and have your walker or crutches read when you stand up.

Sexual Activity

• Resume sexual activity when you are feeling comfortable.

• Be sure to keep your surgical hip in a safe position (that is, keep the leg straight or slightly bent) during intercourse.

• Avoid any position that causes pain (you may feel more comfortable lying on your non-surgical side).

Home Exercise Program__________________________________

These exercises will help improve your mobility and muscle strength. Your physiotherapist will tell you which ones you should do first and how often.

Keep in mind that you should:

• Continue to use your walking aid (walker/crutches) until your physiotherapist tells you not to.

• If you have an artificial joint, do NOT cross your legs, bend past 90 degrees, or lean forward when doing these exercises.

• Hold all exercises for the count of five (5).

• Consult with your physiotherapist/doctor if any of the exercises increase your joint pain, swelling, or stiffness.

1. Foot and Ankle Exercise

• Lie on your back (on your bed) with your legs straight.

• Pump your feet up and down.

• Move your feet in circles

Repeated _________ times

Do _________ sessions per day

2. Static Quadriceps Exercise

• Lie on your back (on your bed) with your surgical leg straight and the non-surgical leg bent.

• Push the back of your straightened surgical leg down into the bed.

• Tighten the muscles at the top and front of your thigh.

Hold _________seconds

Repeat ________ times

Do _________ sessions per day

3. Static Gluteals

• Lie on your back (on your bed).

• Tighten and squeeze your buttock muscles.

Hold ________seconds

Repeat _______ times

Do _________sessions per day

• Progression: bend both knees, keep your feet flat on the bed, then raise your buttocks and squeeze the buttock muscles.

4. Static Abdominals (Pelvic Tilt)

• Lie on your back (on your bed) with your hips and knees bent and your feet flat on the bed.

• Place your fingertips on each side of your abdomen just above the pelvis and below the rib cage.

• Pull your abdomen up and in as if to tuck it under your ribs. Your stomach will be flat or concave. The arch in your back should be reduced.

Hold ________seconds

Repeat _______times

Do _________sessions per day

5. Knee Extension

• Lie on your back (on your bed) with a rolled-up towel under your knees.

• Straighten the knee of your surgical leg by lifting your foot off the bed.

Hold ________seconds

Repeat _______times

Do _________sessions per day

6. Hip Abduction

• Lie on your back (on your bed).

• With both legs straight, slide your surgical leg out to the side.

• Keep your knee straight.

• Keep your knee cap and toes pointing to the ceiling.

Hold ________seconds

Repeat _______times

Do _________sessions per day

7. Hip and Knee Flexion

• Place a sliding board at the bottom of the bed.

• Lie on your back (on your bed).

• Bend your knee by sliding your heel along the sliding board towards your buttocks.

Repeat _______times

Do _________sessions per day

8. Hip Extension

• Stand on your non-surgical leg and hold onto something sturdy (kitchen counter).

• Swing your surgical leg backwards keeping your knee straight.

• Keep your back straight and abdominal muscles pulled in. Do not lean sideways.

Repeat _______times

Do _________sessions per day

9. Knee Flexion

• Stand on your non-surgical leg and hold onto something sturdy (kitchen counter)

• Bend the knee of your surgical leg, pulling the heel up towards your buttock.

• Keep your back straight. Do not lean forward from the waist.

Repeat _______times

Do _________sessions per day

10. Walking

Daily walking is an important part of your exercise program. Increase the distance you walk each day as tolerated.

Resuming Activities______________________________________

After your surgery, you can start to resume your normal activities. It is important though to follow these guidelines:

• For the first six (6) weeks, rest and continue to slowly increase your tolerance. Do your exercises as instructed.

• If you have had an artificial joint (hip) replacement, continue to follow the “Special Precautions for an Artificial Hip” for at least three (3) months after your surgery – see page XXXX

• Slowly increase your activities.

• Consult your surgeon if wanting to start a sport activity.

Do:

• Walk, swim, or cycle with minimum resistance.

• Golf, but use a golf cart.

• Keep your weight under control.

• Protect your hip by:

o Using a “reacher” to pull pants on, to get clothing or food from high shelves.

o Using a sock aid and a long handled shoe horn when putting on socks and shoes.

o Wearing low heeled shoes.

o Sleeping with pillows between your legs

o Sitting in a high chair (versus one lower to the ground).

Driving a car:

In general driving your vehicle within six (6) weeks of your surgery is NOT recommended. Driving requires sufficient hip flexion so you can sit comfortable and good muscle control to ensure adequate reaction time for braking and accelerating. Check with your surgeon to determine your readiness to resume driving.

Other Transportation:

HandyDART Custom Transit *

HandyDART service is available throughout some communities in the province. Book a minimum of 3 working days in advance for transportation during the week and 7 days in advance for weekend service.

Disabled Parking Placards (SPARC)*

Tel: 604-718-7744

E-mail: permits@sparc/bc/ca

sparc.bc.ca

Application process takes 2-3 weeks if mailed in or 10 minutes if done in person. The placard is good for use throughout B.C.

How to Obtain Medical Equipment__________________________

Medical supply stores have most of the equipment you will need if you choose to purchase.

Red Cross Depots or service clubs/health units have a limited supply of crutches, walkers, canes, raised toilet seats, and grab bars that can be loaned to you free of charge for up to three (3) months. You may require a referral from a medical professional to borrow equipment.

If possible to arrange before your surgery, purchase or call and arrange to pick up your equipment from the Red Cross or service club/health unit. There are Red Cross loan service depots throughout Interior Health. Look in the white pages under “Canadian Red Cross Society” for the depot nearest you.

The elastic shoelaces may be purchased at a medical supply store. The cushion may be purchased at a foam shop or at a medical supply store. Check the Yellow Pages for a shop nearest you.

Home Support Services__________________________________

If you are unable to manage tasks necessary for safe day-to-day functioning after your surgery (and if your family and friends are unable to help), special home support workers may be able to provide assistance so that you can continue to live in your own home while you are recuperating.

Home support workers can help with tasks such as bathing and personal care, cleaning, laundry, meal preparation, and respite care (care while your spouse or main support person is away).

To get Home Support Services: the following may be contacted:

1. Private Home Support Agencies – These are listed in the yellow pages and can be directly contacted with your request for services. Cost and policies between agencies differ so it is important to phone around and compare.

2. Continuing Care Home Support Program – This program provides limited hours of homemaking/home support service at a subsidized cost to eligible clients. To be eligible, the person must have a medical condition that is chronic (more than three (3) months and disabling in nature), have immigration/citizenship status, and meet B.C. residency requirements. A financial assessment based on income will be completed to determine your portion of cost. A signed consent for release of information from Revenue Canada is also required.

Please note that the Continuing Care Program no longer approves homemaking if the only service needed is cleaning.

If you are presently receiving homemaking services through the Continuing Care Program, you can restart your service by contacting your homemaking agency directly. If you require a short-term increase in services, contact your Long-Term Care Coordinator directly at 1-604-986-7111. If you need any clarification of the above, please ask to see the social worker while in hospital.

3. Department of Veteran Affairs (DVA) – If you are a Canadian veteran and have a Blue Cross card/number, you can call your DVA’s representative at 1-604-666-3776 to find out what services are available to you. This could include homemaking and special equipment. Funding is dependent on your eligibility.

4. Worker’s Compensation Board and ICBC – If you are the victim of an accident, file your claim as soon as possible. Obtain a file number as well as a contact person’s name and number. Arrangements for any needed equipment and homemaking services should be made with the contact person before you leave the hospital.

If you require a home Occupational Therapy Assessment before and/or after your surgery (or Physiotherapy), you must contact WCB or ICBC to arrange this. If there are any questions or concerns, please talk to your nurse so that you can be referred to the appropriate service while in hospital.

Airport Metal Detecting Devices_____________________________

The pins, screws, and/or metal components used to fix your hip, may set off metal detecting devices in airports and some buildings. Tell the security officer that you have had surgery to repair a fractured hip. A hand-held device/wand may then be passed over the hip area to confirm its presence. If you are concerned about this when travelling, ask your doctor for a letter stating that you have had hip fracture surgery and metal device implantation.

References

Interior Health, Before During & After Hip Joint Replacement Surgery, 826305, October 14, 2009.

Orthopedic Health Care Team, Lion’s Gate Hospital and North Shore Health, Fractured Hip Surgery, Vancouver Coastal Health Authority.

Reviewed By:

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Physical activity and movement is an important part of your recovery. It helps to clear your lungs, prevent blood clots in your legs, eases the pain, and starts your bowels moving.

Increase the amount of your activity as directed every day to help speed recovery and prevent complications.

Do NOT do any activities with “stop-start” twisting or impact stresses. These include: singles tennis, badminton, squash, contact sports, running, jumping, horseback riding, modern dance, skating and skiing.

See also:

Interior Health’s Before, During & After Hip Joint Replacement Surgery Patient Information Brochure. Available on the IHA public website - interiorhealth.ca

* An application must be completed to qualify for these services. After completing the form, have your doctor or therapist confirm your need and then submit it to the appropriate office.

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