1. Preparing for your surgery
Total Hip Replacement
Pre-operative Class
Preparing for your surgery

2. Class Objectives The purpose of this presentation is to: Help you to feel more comfortable about your upcoming hospitalization To let you know what you can do to help in your own recovery

3. Preparing for your surgery

4. Education
Please try and make sure you and your family listen to all the staff providing the education and ask questions if you have them. It is important to us and for your recovery from surgery that you understand how you can help in your own recovery.
You will be getting a lot of education during your joint replacement journey.
You have already received literature from your surgeon’s office including the joint replacement book
You are here today at your preoperative class
The nurse practitioner will give you more information when you attend your pre-operative appointment
During your hospital stay you will receive information on your medications and discharge information
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5. Tips for Preparing your Home
You and your family must consider these tips before your surgery to help make your home as safe and comfortable as possible for your return after surgery:
Check every room for tripping hazards. Remove throw rugs and secure cords
Arrange furniture to have unobstructed pathways while using walker
Move items in lower drawers to height to eliminate excessive bending or reaching
Plan on using a cordless phone or cell phone that can be tucked away inside a pocket
Make sure stairs have handrails that are securely fastened to walls
In homes with steep long stairs you may need a bed, portable toilet on first level
If you have pets you may want to arrange boarding them first few days you are home
A chair with a firm back and arm rests is recommended, NO chairs on wheels
Prepare or purchase meals ahead of time to minimize cooking after surgery
Install night lights in bathrooms, bedrooms, and hallways
Avoid yard work for 10 days prior to surgery. Protect your operative site from injury
Do laundry ahead of time
Get a non-slip bathmat
Put clean linens on your bed
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6. Reduce Risks, Complications
Stay active – Exercises for before your surgery are in your book and will be explained further by PT
Healthy diet - Before your surgery, avoid foods that increase inflammation in your body. Those foods include sugar and white flour; saturated fats from red and organ meat; trans fats from commercially baked cookies, cakes and pastries; and alcohol. Aim for fresh foods, including fresh fruits, vegetables and nuts
Manage diabetes – see your PCP if needed
Reduce, eliminate tobacco. Smoking increases your risk of developing wound infection so we encourage you to try to stop before your surgery Quit-Now can offer free advice
Reduce, eliminate alcohol. Hazardous alcohol use (3 or more drinks per day) can increase your risk of postoperative infections, cardiopulmonary complications and bleeding risk
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7. Prevent Surgical Site Infection
Dental work – must be completed 1 week prior to surgery and delayed for 3 months after your surgery
Shaving – do not shave your legs or use any hair removal products near the surgical site 5 days prior to surgery
You will have various tests performed preoperatively
Hand washing – Good hand hygiene is essential. Encourage your family and friends to utilize an antibacterial cleanser and to always wash their hands to prevent spread of infection
Use the wipes as instructed by the nurse practitioner
In pre-op you will receive intranasal treatment to help prevent postoperative infection
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8. What to bring with you
If you have Advanced Directives please bring them with you
Personal care items
Robe
Good fitting slippers/shoes – your leg/foot will be swollen following surgery so make sure they are not tight before your surgery
Loose shorts, T-shirt/top
Please do not bring your own pillow
If you use a CPAP machine at home bring it with you, we have distilled water in the hospital for you to use
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9. Michigan Arthroplasty Registry Collaborative Quality Initiative - MARCQI
Your surgeon participates in MARCQI which tracks patients for quality improvement purposes
You will be asked to complete surveys before and after surgery at multiple intervals
These can be completed on paper or via
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10. Surgery and Postoperative Recovery
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11. Pain Management
Your caregiver will do everything they can to get you comfortable enough to participate in your recovery
Caregivers will often ask you to rate your pain level on a scale of 0-10
Our goal is always to keep you pain at a level of 4 or less
Your pain will be managed with different medications including spinals, IV medications and oral medications. Some of these medication are scheduled and given at set times and others are given as needed to help control your pain
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12. Anticoagulation Therapy
Your surgeon will prescribe an anticoagulant to help prevent blood clots
There are many different medications we use for this, the anticoagulation will begin to be administered on post op day one and will continue as prescribed by your surgeon
You will receive information and instructions on how to take this medication from your nurse before you are discharged home. It is important you take this medication as instructed
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13. Day of Surgery Meet anesthesiologist to discuss options for anesthesia
Only 2 members of your family are allowed in pre op with you. All family members can wait in the surgical waiting room during your surgery. It is unlikely you will be able to see your family member until you leave recovery and arrive on the unit
Surgery will take between 1-2 hours and the patient will remain in the recovery room for 1-2 hours so from the beginning of the surgery to arriving on the unit may be up to 4 hours

14. Recovery Room You will wake up after your surgery in the recovery room
Your nurse will ask how your pain is on the pain scale of 0-10, 0 no pain, 10 worst pain imagined
When you wake up you may have a urinary catheter to drain urine, a dressing over your incision, sequential compression devices (SCD’s) on your legs, oxygen in your nose and IV fluids connected to an IV in your arm
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15. Sequential Compression Devices (SCD’s)
A Sequential Compression Device (SCD) is equipment that can assist in prevention of deep vein thrombosis (DVT). It improves blood flow in the legs. SCD’s are shaped like “sleeves” that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots. You should wear your SCD’s any time you are in bed or sitting in a chair.
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16. When you arrive on the orthopedic unit
You will start to eat/drink jello, crackers, water, ginger ale and progress to your regular diet
We will show you how to use an incentive spirometer and encourage you to use it 10/hour
You will begin your rehabilitation today, either with physical therapy or nursing staff helping you to the side of the bed, walking around your room and/or sitting in the recliner
Your nursing staff will have to check on you frequently the first night
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17. Incentive Spirometer Use your incentive spirometer throughout your hospital stay, please take it home with you following your discharge and continue to use it for 2 weeks.
Sit in an upright position
Inhale slowly and deeply to raise the indictor
When you can’t breathe in any longer take out mouthpiece and hold breath for 3-5 seconds
Exhale and repeat 10 times an hour
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18. After your surgery
Your nurse will continue to assess your pain level and work on a plan with you to ensure it is controlled using scheduled Tylenol and opioid pain medication
A side effect of the pain medication is constipation so you will also be started on a bowel management program
Physical Therapy will work with you, helping you regain your strength. As your recovery progresses, you will get up for meals and go to the bathroom with help from our team. The physical therapy team will work with you to ensure a safe discharge home
Our discharge planners will meet with you to discuss your discharge and any equipment needs you may have
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19. Equipment Needed For Discharge
You will need a walker when you are discharged
If you have one at home or have borrowed one, you do not need to bring it to hospital with you unless asked to do so by physical therapy
Most insurances will pay for a walker, your discharge planner will assist you in obtaining this before you are discharged home
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20. Discharge We want you to go home after your surgery
Patients recover better in their own home environment
Please make sure you arrange to have someone available to drive you home
Home physical therapy will be provided if your care team think it is necessary to provide additional assistance with physical therapy and your mobility
Discharge instructions will be given to you by your nurse and prescriptions given to you which can be filled in our pharmacy, just ask your nurse how to do this
Your orthopedic surgeon will continue to manage your care with your PCP
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21. Possible complications following surgery
Blood clots – follow your surgeons instructions carefully to minimize this potential risk. Make sure you take your anticoagulation medication as instructed by nursing staff and continue doing your ankle exercises
Infection – follow instructions given at discharge to prevent infection. Do not remove your dressing until day 7 after your surgery. If the dressing come off, wash your incision with soap and water and pat dry. Leave open to air. Do not use any creams or lotions on your incision
Constipation – Your pain medication can make you constipated. Make sure you take laxatives following your discharge and eat a diet high in fiber and drink lots of water
Pain - Make sure you take your pain medication as instructed. Elevate your leg higher than your heart. Your leg will swell and this can add to your discomfort
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22. Post-Operative Guide It is normal for your leg to be swollen and the incision to be warm and swollen with red edges.
Elevate your leg: Lie down 4x/day for minutes and position your leg above your heart.
Ice your leg: Apply an ice pack or cold machine throughout the day (20 minutes on, 20 minutes off). Make sure you have something between your skin and the ice, unless using the prescribed ice machine.
If swelling does not improve in 24 hours, call your surgeon’s office.
IF YOUR LEG IS SWOLLEN:
Take pain medications as directed by your surgeon.
Elevate and ice your leg as instructed above.
Please refer to your Total Joint Patient Guide pages 22 and 26.
If pain does not improve in 24 hours, call your surgeon’s office.
IF YOU ARE HAVING PAIN:
Take an over-the-counter stool softener and laxative each day you are taking pain medication.
Eat a high fiber diet and drink plenty of water.
Walk as tolerated.
Please refer to your Total Joint Patient Guide page 22.
If no bowel movement by the 3rd day after surgery call your surgeon’s office.
IF YOU ARE HAVING CONSTIPATION:
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23. Surgeons Office Phone Numbers
Please call your surgeon’s office for any postoperative concerns
Office Numbers
Dr’s Masini, Schultz, Denzin, Telfer, Schueller, Chrissos
Dr’s Young, Hakim
Dr. Anderson
Dr. Travis
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24. Total Joint Help Line
If you have any questions about anything you have heard today, or have any concerns please do not hesitate to contact us on the
Total Joint Hot Line –
Please leave a message and your call will be returned as soon as possible
If you have urgent questions please call your orthopedic surgeons office
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25. Physical Therapy
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26. Pretend you just boarded a plane for California
What is the health risk of taking a long flight?
Why?
What can you do about it?
What is a health risk after your surgery?
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27. Please stand up!
Make it a habit to interrupt your sitting every 1-2 hours—esp. when flying and after a surgery
Now stay standing…..
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28. Pre-op Exercises Rise up on your toes 5 times
Squat down as if to sit in your chair, but don’t go all the way down, stand back up
Keep your head up and your back straight
Standing hip abduction--Raise ‘surgical leg’ slowly out to side and hold for a count of 1-2
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29. Pre-op Exercises
While holding on to a table/chair in front of you …
Pelvic stability--Stand on your ‘surgical leg’ and raise your other leg out to the side
- Keep your pelvis level!
- Don’t lean to the side!
Excellent exercise to strengthen the hip of the standing leg!
Chair push-ups
- Use mostly your arms
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30. Pre-op Exercises
See “Pre-op Exercise” pp. 11 & 12 of your patient guide booklet
Start with 5 reps, increase to 15 as able
We’ve targeted functional exercises
We also target your hip muscles
Straight leg raise, bridging
Do these exercises on a bed, no need to get on the floor!
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31. Try to get …. “Strong for Surgery”
Exercise Log
Look at the Hip Exercise Log pp. 13 & 14
- Write in “5x” under ‘Standing Ex’ and “chair
push-ups” for today (Tues/Wed)
Starting tomorrow, do them twice/day
Increase reps every day as you are able
Try to get …. “Strong for Surgery”
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32. Pre- op Exercises Word of Caution: Don’t hold your breath
Don’t strain or aggravate anything
Do you have a heart condition, other concerns?
you may want to check with your MD about exercise
Use the Exercise Log pp to track your progress
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33. Activity/Walking Log
Any pre-op exercise or activity can help your body to be more resilient
That will help reduce your chances of complications
It helps release the “feel good” endorphins
Helps you feel better
Improves your mood
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34. Activity/Walking Log Walking is hard to beat
No special equipment, no gym fees
Convenient
Do short walks now, bump it up after surgery
We’ll give you a pedometer to help you get started!
Use the Activity/walking log to keep track
Just write down your steps every day
Stationary bike, swim exercise, yoga, etc. are all good
Housework and yardwork count!
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35. What activities do you enjoy? Start setting goals
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36. Hip Guidelines
After surgery you will have some temporary limitations; your surgeon’s office can give you specifics
Nursing and PT will be providing individual instructions on your specific limitations after your surgery
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37. Physical Therapy in the Hospital
PT will see you . . .
Day of surgery
Post-op Day 1
Once or twice as needed
Therapy will include:
Home Exercise Instruction
Walking
Practice stairs
Family instruction
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38. Hip Guidelines
After surgery you will have some temporary limitations; your surgeon’s office can give you specifics
Nursing and PT will be providing individual instructions on your specific limitations after your surgery
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39. Post – op Walking Walkers
- Use either standard or front-wheeled walker
- Avoid 4-wheeled walkers (ok to use later)
Crutches
Weight-bearing as tolerated
Gait: step first with your surgical leg
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40. Stairs Does a walker fit on your entry steps?
This is a very good option! You will lead with the stronger leg going up and the weaker leg going down
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41. 1 rail and 1 crutch works well!
If your walker does not fit on each entry step we strongly recommend you have a railing installed
We will practice stairs in the hospital
Most people can manage stairs inside the home – assuming you have a railing
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42. Home Exercise Program We will start you with ‘circulation exercises’
Your PT will instruct you in your home exercises
Don’t start any exercises until we ask you to
Exercises and household walking will be your rehab for the first several weeks
gradually progress walking and activity
progress to using cane in your opposite hand
You may request home PT the first 2 weeks
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43. Outpatient PT
You can start outpatient PT after several weeks (you will need a prescription from your surgeon)
Outpatient PT will:
help you get a stronger, safer, more flexible hip
gait training
You can go to Probility (St. Joe’s) or a place of your choice
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44. Other Online Resources
stjoeshealth.org/ortho-help
Pre-op exercises
Post-op exercises
Post-op exercise video
PowerPoint slides of this class presentation
(all in PDF format, so you can print them)
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45. Don’t turn down offers for help!
Discharge Planning
We recommend you have someone stay with you for several days, up to a week
It does not need to be 24/7
Don’t turn down offers for help!
Help with meals is particularly helpful
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46. Equipment Front-wheeled Walker
Single crutch or cane – for stairs with a rail
Raised toilet seat – hint: try getting off your toilet without using your surgical leg
Reacher – very helpful, you may want to get one ahead of time
Pedometer—meet me at the door!!
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47. Summary Pre-op exercises Log your steps/day or some other activity
Set an activity goal—we’ll help you get there!
Get a railing for your entry steps
Visit our website
Arrange for help after your surgery
Plan your equipment needs
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48. Enjoy your new hip! Your preparation and hard work will pay off You’ll be very glad you had the surgery We wish you well!