2. Overview What is Total Hip Replacement (THR)?
Preparing for a Total Hip Replacement
Surgery Day
Postoperative and Recovery
Discharge

3. Your Hip

4. Why a Total Hip Replacement?
Severe hip pain while resting or pain that limits daily activities
A hip fracture that did not heal properly
Hip inflammation and swelling that does not improve with rest or medication
Stiffness when walking
No improvement with medication, cortisone injections, physical therapy or other surgeries

5. What Causes the Pain? Arthritis Degenerative Joint Disease
Affects the cartilage or lining on the ends of the bones
Cartilage 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

6. Preparing for Total Hip Replacement

7. Preparing your Home Arrange for special equipment needed
Remove throw rugs and other tripping hazards
Move medications, phone, remote control within reach
Widen pathways for using a walker
If 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.

8. Pre-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 basis
List of allergies and your reactions to them
List of your surgical/medical history

9. Pre-Surgical Testing Appointment
This visit may last 1 hour
Medical tests performed (EKG, chest x-ray, blood test, urine sample)
Medical/surgical history will be reviewed
List of medications that you need to stop taking and which you need to take the morning of surgery will be provided
Hibiclens Soap will be given with instructions
Assessment by an anesthesiologist

10. Anesthesia
General or Spinal anesthesia is required to be administered before your hip or knee surgery
A femoral block for Total Knee Replacements
General anesthesia is required to be administered before your shoulder surgery
An Inter-scalene Block
You will meet your anesthesiologist prior to surgery in the preoperative testing process and in the preoperative holding area
Your anesthesiologist will review your history and discuss the best option for you
An 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 sedation
Earlier to leave hospital
Early intake of food and drink
Excellent pain control
Lighter general anesthetic with speedier recovery from the anesthetic
Less chance of an overnight stay at the hospital

11. Day before surgery
Do not shave legs the day before or day of surgery for knee or hip replacement
Shower with the Hibiclens Soap the night before and the morning of surgery
Do not eat or drink after midnight, including water, candy or gum

12. Surgery Day

13. Day of Surgery
Take any morning medications that you were instructed to take, sip of water only
Arrive at the hospital 1.5 hours before your scheduled surgery time
At Progress West: Go to the 2nd floor- you will be escorted to your room and registered bedside
At Barnes-Jewish St. Peters: Go to the hospital’s Main Entrance (A) and register in Admitting. You will be escorted to the preoperative area.

14. Day of Surgery (cont.) What to bring to the hospital:
Copies of Advance Directives
Loose comfortable clothing, enough for 4 days
Flat, supportive walking shoes that are non-slip with an enclosed heel
CPAP, if applicable

15. Day of Surgery (cont.) What to expect:
To be admitted to the hospital by the registration clerk
To meet a member of the anesthesia team to review earlier choices and assess for any changes
To be given a mild sedative
That family and friends will be directed to the surgical waiting area

16. Day of Surgery: Preoperative
The staff will prepare you for surgery
You will change into a hospital gown
A name band will be verified and applied
An IV will be started (using Lidocaine)
Your medical/surgical history will be reviewed
Your completed “Patient Home Medication List” will be reviewed and recorded

17. Day of Surgery: Preoperative
You will meet your Surgical Team
The surgeon, with your assistance, marks the operative leg
The anesthesiologist will review your choices
Prophylactic antibiotic will be administered
Relaxing medication will be administered

18. Day of Surgery: Operating Room
Anesthesia will be administered
Catheter will be inserted
Length of time for surgery is approximately 1 to 2 hours

19. Post Surgery and Recovery

20. Day of Surgery: Post Anesthesia Care Unit
Close monitoring until you are fully awake
You will wake up with the following:
Oxygen in nose
Blood pressure cuff on arm
Pulse oximeter on finger
Catheter in bladder
Surgical bandage on incision
Your surgeon will speak to family and friends in the surgical waiting area
TKR will have a CPM machine placed in Recovery room

21. Post Surgery
You will be transported in your bed to your private room from the PACU
Your nurse and tech will:
Monitor vital signs closely
Manage your pain
You will receive a clear liquid meal tray progressing to an approved diet
During the night you may still have:
Oxygen in your nose
IV fluids
Catheter in your bladder (this will be removed the next day)

22. Progressing toward Recovery: Pain Management
Tell your doctor what pain medications have worked in the past
Request pain relief when you begin to feel discomfort
To help the doctors and nurses better relieve your pain, report whether the pain relief measures are adequate
Ice packs will be in place to assist in decreasing swelling and relieve pain

23. Your Hospital Stay Your stay will be several days
All rooms are private
Wifi is available throughout the hospital
Dining on call at PW (you choose when and what you eat according to the diet allowed by your doctor)

24. Recovery in the hospital
In-room Physical Therapy
Pain medications administered by IV and then by mouth
Coughing and deep breathing is important
Foot pumps and/or mechanical pumps may be used to prevent blood clots

25. Hip Precautions

26. Common Complications Nausea First meal will be clear liquids
Medication can be given if needed
Constipation
Daily stool softener administered
Laxative can be given if needed
Swelling
Ice Therapy

27. Serious Complications
Hip joint infection
Occurs in fewer than 1% of patients
Heart attack or stroke
Occur even less frequently
Chronic illnesses
May increase potential for complications
Can prolong recovery
Blood clots
Most common complication
Blood thinners will be started
Damage to nerves or blood vessels around the hip
A rare occurrence
Dislocation of the Hip joint

28. Discharge

29. Discharge Planning
Depending 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 manager
Visits with you the day after surgery
Assists with the discharge plan
Makes arrangements for needed medical equipment

30. Day of Discharge
We 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.

31. Home Care
NO 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.

32. After Total Hip Replacement
Avoid high impact activities.
Avoid heavy lifting
Avoid excessive stair climbing
Avoid quick start-stop motions, twisting or impact stresses
Avoid low seating surfaces

33. Post surgery Activity Levels
Dangerous
Jogging or running
Contact sports
High impact aerobics
Exceeds recommendations
Vigorous walking
Skiing
Tennis
Lifting 50 lbs or more
Expected
Recreational walking
Golf
Light hiking
Ballroom dancing
Normal stair climbing

34. Your 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.