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Patient Information Leaflet : Total Hip Replacement
Below you will find answers to the following typical questions
What Happens In Hospital? Most patients undergoing hip replacement will be admitted the day prior to surgery to allow them to settle into hospital and will be seen by the anaesthetist to discuss the anaesthesia involved and then also by myself. The anaesthetist will discuss the types of anaesthetic to involve general anaesthetic usually, or regional anaesthetic such as nerve blocks or spinal block. When seen by myself I will go through the operation again with you, discuss any queries or points you may raise. Once you understand the procedure and the various risks and benefits have been explained to you, I will place a mark on your leg with a marker pen to indicate the site and type of operation to be undertaken. Before the operation you will be given an injection of heparin, which is a drug used to slow down the clotting mechanism and is useful in helping to prevent deep vein thrombosis following surgery. This will usually be given the evening prior to operation the next day. These injections will continue following discharge from hospital. You will be clerked in by the nursing staff and you should remember to bring in with you suitable clothing for a 7-10 day stay, any medication which you are taking prior to coming into hospital and any notes and xrays which you may have in your possession (particularly with regard to your hip). You will also be seen by the physiotherapists and instructed in the use of exercises and aids, such as crutches. The operation will usually be undertaken mid morning and can last 1½-2 hours. You will wake in recovery (an area in theatre where monitoring of blood pressure and breathing will take place) until you are stabilised and then returned to your own bed. Occasionally patients may need to go to an area of more intensive monitoring, called the High Dependency Unit, usually for just one night. This is normally the case for patients who have significant medical problems such as heart or lung conditions which need closer monitoring than is usual. such as crutches. The operation will usually be undertaken mid morning and can last 1½-2 hours.
Once back on the ward, you will be encouraged to move around as much as comfort allows. This is true for both your legs and you should try and move your feet and ankles, as well as your hip, within the limits of the dressings, etc. You will notice that you have a drain or tube coming out of the hip area to take away any excess bleeding. This drain will normally be left in place for 24 hours. You will also notice that there is a small plastic needle in the veins in the back of your hand, (an intravenous cannula) which is left in place in case you need drugs or fluid. Once a decision has been made regarding any requirement for intravenous fluids or blood, then the fluids will be taken down but the needle is left in place for another day or two in case further fluids are required. Apart from moving your operated leg you should also try to move around in bed to avoid pressure sores on your bottom and heels, and also practice deep breathing exercises to encourage good lung function. You will be able to sit up in bed and begin taking fluids and food within three-four hours of the operation. Normally, patients who have had a hip replacement are in hospital for seven days in total and begin getting out of bed within 24 hours of surgery. You should be independently mobile, getting in and out of chairs, getting in and out of bed, and walking around the ward within a few days. Prior to leaving hospital you will be asked to ascend and descend stairs just to ensure that you are capable of doing this comfortably and safely. When you leave hospital you will still be using your crutches but will be encouraged to put as much weight through your operated leg as possible. You may also be asked to use TED stockings (support stockings) which help blood flow both in and out of the leg, and also prevent deep vein thrombosis. They will be used most of the time over the six weeks following surgery, although you can take them off for sleeping at night and for bathing purposes
Post Operative Progress On discharge from hospital you will be given a note to keep at home which summarises your hospital treatment in case you have any requirement for emergency GP visits over the first two-three days. A separate letter will be sent by the hospital to your GP and a more detailed letter will be sent by myself summarising your hospital stay and post operative progress. However, this often takes a few days before it arrives. Your wound will normally be covered by a wound dressing and underneath will be a series of metal clips or staples which will need to be removed 12-14 days after surgery. This will be arranged by the hospital for you to either come back to the hospital or preferably in liaison with your GP where the district nurse will come and see you at home. Once home you can shower or bathe and get the wound wet, even with the clips in, but you should not let the wound soak until the clips have been removed. You should be given any
medication which you brought in to the hospital, to continue using at home, as
directed by myself and the nursing staff. Also, any extra drugs such as pain
killers or anti inflammatories which you require, will be given to you to ensure
an adequate supply over the next few days before you can get repeat
prescriptions from your GP or before these drugs are no longer required. How Mobile Will I Be After Discharge? Before you are allowed to leave the hospital you should be independently mobile with your crutches and be safe, even walking up and down stairs. For this reason some patients need to stay somewhat longer than normal. The average hospital stay for a hip replacement patient is around seven days, but it can vary between five days and up to two weeks. Although you will be encouraged to get outdoors for short periods, for most of the first six weeks you should be indoors. Walking would be encouraged outside but you should be using your crutches at all times, and in non crowded areas unless you are with friends or family.
Normally patients are advised to refrain from driving completely for at least six weeks, i.e. until the first clinic review with myself. After that time, once you are able to walk without your crutches, you are considered safe enough to drive but this would normally involve short journeys only for the first couple of weeks, before progressing to normal driving. If the operated leg is your right side it is often harder to recover sufficient strength and confidence to allow safe operation of the brake. Therefore it could be 9 or 10 weeks before you are safe to drive following a right sided hip replacement. As a general rule, once you are able to walk without crutches and sticks without a limp you are able to drive.
Most patients will be off work for around three months. If your work is sedentary or supervisory you can return to work in a part time capacity and/or on light duties from around six weeks following surgery. However, this would only be if you have a degree of control over your working environment. Normally, return to work will be discussed more formally at the six weeks post operative clinic visit.
What Drugs Will I Need Following Discharge? As mentioned above you will be given the medication which you brought into hospital to take home with you. If you are on medication for medical conditions such as diabetes, asthma, blood pressure treatments, etc. these should be continued up to coming into hospital and then re-commenced on discharge from hospital. Specifically with regard to the hip operation, you may require a few weeks supply of pain killers or anti inflammatories and this supply will be given by the hospital. You will also be instructed in the use of Heparin (a drug used to reduce the risk of thrombosis) such that you can give yourself injections of the medication once a day for up to four weeks following the operation, i.e. around three weeks after discharge from hospital. Beyond the medication provided by the hospital, simple analgesics such as Paracetamol, Nurofen (a mixture of Panadol and Ibuprofen) or stronger pain killers such as Distalgesics, Co-dydramol, etc. can be used. However, more prolonged excessive use of these medications would suggest a review by your GP or myself is required to ensure there is no complication
Prior to discharge from hospital you will be seen by the physiotherapists and given an exercise programme to follow. This is important, first of all to get your hip working properly following the operation and secondly to help recover any muscle loss which has occurred as a result of the prolonged wear and tear process which led to the necessity for a hip replacement. Usually
the physiotherapist will arrange for you to be reviewed either by the
physiotherapists at the hospital or a more local physiotherapy unit. On
average this would be once per week during the first few weeks following
discharge from hospital. This will allow the physiotherapist to monitor
progress and give further advice and encouragement as required. The amount of
physiotherapy will be dependent on individual circumstances Most insurance policies fully cover the cost of surgery and I do not charge over the recommended medical insurance guidelines. If you are not insured, the Fitzwilliam Hospital has a Fixed Price Package for most procedures, including total hip replacement. This price includes all surgeons fees, anaesthetists fees, theatre fees, etc. Total hip replacement surgery usually costs in the order of £8,500.00 - £9,000.00 at the present time.
What Happens If Things Go Wrong? Should you be unfortunate enough to develop a complication either as an in patient or following discharge from hospital this will be dealt with either by your own GP or myself. If the problem develops at home you can phone the hospital ward and speak to the nursing staff on duty for advice. They would normally be able to deal with most queries or suggest suitable alternatives such as phoning your GP, attending the local accident and emergency department or returning to hospital depending on the circumstances.
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For more information contact varleysecretary@aol.com This site last updated 7th December 2008 |