Total hip replacement
At Mater Health Services we understand that being in hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients’ needs. It explains briefly the events that may occur during your visit and the things to expect when you are discharged from the hospital.
It is, however, only a guideline as each person may require differing treatments.
If you have any questions about your treatment please ask your doctor or nurse.
Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.
What is a total hip replacement?
A total hip replacement operation replaces a hip joint that has been damaged, usually by arthritis.
No implant can make your hip feel totally normal again, but in most cases the operation will help to:
- decrease pain
- decrease stiffness
- improve your ability to get around and to do things.
The hip joint is a ball and socket joint. The ball is formed by the head of the thigh bone (femur) and the socket is formed by part of the pelvis (acetabulum). Usually the surfaces of the bones are covered with a smooth coating (articular cartilage). When arthritis occurs, this coating wears away. The joint surfaces become rough which causes pain and stiffness.
A total hip joint replacement operation removes the damaged areas of bone. The ball of the thigh bone is replaced with a metal component that is either cemented or "jammed" into the femur (uncemented fixation). Attached to this metal component, a metal or ceramic ball is used to articulate (move) with the socket. The socket is either a cemented plastic or uncemented metal component with a plastic or ceramic liner to articulate with the metal or ceramic ball.
Expected length of hospital stay
The total hip replacement surgery has an acute hospital length of stay of approximately four days.
The bone bank
You may be asked to donate bone to the Queensland Bone Bank, to help others who require bone transplantation. Bone is the second most commonly transplanted tissue (the most common is blood). The Queensland Bone Bank is a non-profit organisation that is responsible for retrieving and distributing bone tissue throughout Australia. The majority of bone retrieved by the Queensland Bone Bank is from patients having a total hip replacement. Bone transplantation is commonly used in orthopaedic, neurosurgery and plastic surgery. The nurse at the preadmission clinic will discuss the bone bank with you.
Please consider donating bone.
Surgery complications and risks
You could end up with an infection
Despite every possible precaution, including the use of antibiotics during the operation, infection occurs in approximately one per cent of hip replacements. Infection is a major potential complication, and may need further surgery and hospitalisation. This would severely affect the success of your operation.
You could develop blood clots
- The risk of blood clots occurring in the deep veins of the leg is more than 20 per cent.
- Risk is reduced through circulation exercises and medication. The risk of a clot travelling to the lungs (pulmonary embolism) is approximately one per cent, and may be fatal.
- Total hip replacement is major surgery and there is a small risk of heart attack or other generalised medical problem.
You could have problems with the anaesthetic
- Problems can occur, but serious problems are very rare.
- Most hip replacements are done under a spinal and/or epidural anaesthetic with a light general anaesthetic. If you have had previous problems with an anaesthetic please tell your surgeon or the preadmission nurse.
Your new hip could fail
Your new artificial hip will slowly wear out and/or loosen. A revision joint replacement may then be required. Your hip could also dislocate. Breakage of the artificial hip joint is possible, but rare. If this happens a second operation will be required.
There may be other complications
Many other complications are possible but the risk is only around two per cent. These include nerve injury, vessel injury, superficial infection, haematoma and others. These are not life threatening and generally are treatable. During the operation, problems may occur with weak bone breaking or nerve injury. These can usually be overcome with appropriate treatment. You may wish to discuss these with your doctor.
Anaemia due to blood loss during your operation
A blood transfusion may be needed during or after your operation. This is rare.
Signed by patient (I understand) Signed by the preadmission CN.
Home visit by the DART occupational therapist
The DART occupational therapist may visit you in your home before your operation depending on your identified needs and where you live. This is to ensure that your home environment is optimal for when you return home. They will phone you to make an appointment at an appropriate time if necessary. The occupational therapist will have some suggestions about preparing your house for when you come home from the hospital maximise your safety and independence.
Specific preparation for total hip replacement surgery
Diet, nutrition and health
A healthy diet is particularly important for you before your operation so your body is well prepared for your surgery.
If you are overweight, the strain on your joints is greater and it is much harder to get mobile after the operation. Being overweight may also increase arthritis in your joints and increase the risk of anaesthetic complications.
If you lose weight:
- your arthritis should cause you less pain
- your arthritis should progress more slowly
- your chances of long term success with joint replacement are greatly increased.
Exercises—lower limb exercise class with physiotherapy
This class is a Mater initiative to help you get the best result from your operation. These sessions are an ideal opportunity to start some gentle exercises under the supervision of a physiotherapist. The exercises specifically strengthen your muscles in preparation for your operation and assist recovery afterwards.
- Class times: Tuesday and Thursday from 11 am to 12 noon.
- Where: physiotherapy department—level 2, Mater Hospital Brisbane (phone 07 3163 8787).
Please book your class time if it has not been prearranged for you. If you are not able to make the class, please phone 07 3163 8787 during business hours.
Remember: if your joints swell or stiffen after exercising you may have done too much. It is important not to stop exercising but rather reduce the amount of exercising. If you continue to have problems discuss this with the physiotherapist. Ice packs are a good way to reduce joint swelling (please note: place a wet towel between the icepack and your skin so you do not get an ice burn.)
After your operation
- You will stay in the recovery room within the theatre suite after the operation. When you have woken from the anaesthetic and are stable you will be transferred on your bed to your room. The total time you will be in theatre and recovery will be approximately four hours.
- Your nurse will frequently monitor your vital signs (e.g. temperature, pulse, respirations, blood pressure) drains, your dressing and the colour, warmth, sensation and movement of your leg for several hours after the surgery. As you become fully recovered, these observations become less frequent but remain regular until you leave hospital.
The following exercises help prevent complications suchas chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed.
Breathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.
Circulation exercises: firmly move your ankles up and down to stretch and contract your calf muscles.
- You will be resting in bed following your surgery. There will be an abduction device (e.g. a wedge shaped pillow or gutter splint) between you legs to keep them apart. It is important to regularly do your breathing and circulation exercises. These exercises help prevent complications such as chest infections and blood clots in your legs.
- Following your surgery, because it is not possible for you to turn yourself from side to side, nursing staff will assist in doing this for you. This will help circulation to all body parts and stop sore, red areas developing, especially on your bottom or heels.
- Your nurse will assist you to have a wash sometime after you return to the ward and assist you with hygiene cares.
- Anaesthetics can cause nausea. To reduce this side effect your oral fluids and diet is introduced slowly following surgery. Begin with sucking on ice chips or sipping small amounts of water then progress slowly to eating and drinking normally.
- To maintain your fluid intake you will be receiving fluids via a drip (IV). This will be removed when you are tolerating adequate amounts of oral fluids.
- You may continue some of your usual medications as ordered by your doctor. You may also be given an injection once or twice a day of blood thinning medication. This helps to prevent blood clots.
- Pain relief:-you will have either a Patient Controlled Analgesia (PCA) or an epidural.
- A PCA allows you to manage your own pain. PCA involves specialised equipment which is connected to a drip (IV). You will have a button to push which allows a small amount of pain relieving medication to be delivered directly into your vein via the drip. The equipment has a specialised safety programme to reduce the risk of you receiving too much medication. You will remain on PCA until you are able to eat and drink. Your pain will then be managed with tablets. There is no risk of becoming addicted to strong pain relieving medication when it is used appropriately.
- An epidural delivers pain-relieving medication into the space in your spine where the nerves carry pain signals from your operation site to your spinal cord and brain. The epidural usually remains in for two to three days depending on your type of surgery. Some patients will experience little or no pain with an epidural and may feel numb around the operation site. This is quite normal as this is its intended effect and means that the epidural is working, however if pain is moderate or severe you must notify the nurses straight away. You must also notify the nurses if you have any feeling of numbness or tingling around your mouth or upper limbs.
- If you have a PCA or epidural, you will more than likely be prescribed paracetamol (Panadol) four times a day. Paracetamol works well when used on a regular basis and helps to reduce the amount of stronger pain-relieving medication you require which therefore reduces their side effects.
- You will be given oxygen via nasal prongs or a mask while you have the epidural or PCA in place. It is important to always keep this on when sleeping.
- While we try to relieve your pain as much as possible, sometimes it is not possible to take your pain away completely. However, your pain must be controlled well enough for you to move, do your physiotherapy exercises and to sleep. If your pain relief is not adequately controlled for this please speak to your nurse. Also speak to your nurse if you have an itch, you feel nauseated or feel like vomiting. These may be side effects of the pain relieving medication and are usually easily managed.
- After the operation your nurse will assist you with toileting needs.
- The stockings and compression sleeves will remain on. These also help in the prevention of blood clots in your legs.
Postoperative phase—days one to three and rehabilitation
Your discharge needs will be reviewed daily. Your nurse will continue to talk to you about any special needs you may require once you are discharged. By day three it will be determined whether you are ready for discharge home, with or without home care support, or continue with rehabilitation.
You will be ready to go home when you will have achieved the following recovery milestones:
- you will be able to walk independently and manage stairs, with a walking aid
- you will be able to transfer safely (e.g. get in and out of bed; on and off the toilet)
- your pain will be controlled with oral pain medication
- your hygiene requirements will be met by yourself, your carer or community home care assistance.
Teaching and emotional support
- Your nurse will review this booklet with you daily and discuss any concerns you may have. Pastoral carers are also available if you would like to speak with them.
- Throughout your stay and as you are ready to meet the next challenge, your nurse/physiotherapist/occupational therapist will discuss with you activities that can help you in your rehabilitation.
- Precautions for your new hip
- Exercises and techniques from you physiotherapist
- Transfer techniques
- Managing stairs safely
- Getting in and out of the car, gardening, driving
- Managing with activities of daily living
- The medical team will visit with you throughout your stay in hospital.
- Your physiotherapist will also see you the day following your surgery and will continue to see you each day, guiding you through your exercises and assisting you to progress with your walking.
- By day three the occupational therapist will have completed a shower assessment. The purpose of this is to show you how to modify your hygiene cares to protect your new hip.
Tests and procedures
You will have a check x-ray taken of your hip the day following your surgery. Blood tests will be ordered by your doctor as necessary.
The monitoring of your observations (e.g. temperature, pulse, respirations, blood pressure, drains, dressing and the colour, warmth, sensation and movement of your leg) will continue, but become less frequent, throughout your hospital stay.
- You will be given your medications as ordered by your doctor, plus any required for pain relief.
- Epidural or PCA: this will continue through day one and is usually removed on day two depending on your doctor's orders.
- Oral pain relief: it is a good idea to take pain relieving tablets regularly to ensure that your pain remains well controlled. This enables you to rehabilitate faster.
- Drip (IV): the drip will continue through day one and is usually removed on day two.
- Throughout your stay in hospital it is important for you to continue your breathing and circulation exercises regularly while resting in bed.
- You will commence the exercises at the end of this section knee extensions, straight leg raise, bridging heel slides) the first day after surgery and will continue them throughout your rehabilitation.
- When you are in bed, the abduction device will be in place, between your legs, to keep your legs apart preventing dislocation of your new hip prosthesis.
- Getting in and out of bed: It is important to get in and out of bed in the correct manner to protect your new hip.
When getting in and out of bed, remember:
- keep your legs apart so they do not cross
- do not bend your hip more than 90 degrees
- do not twist your operated leg.
- Day one: the physiotherapist and nurse will help you transfer from bed to chair. The physiotherapist will assist you in walking, using a frame, for at least 4.5 metres. You will also sit out of bed for at least 30 minutes depending on how you are feeling. A higher chair with arm rests will be provided.
- Day two: you should be able to transfer independently using the transfer techniques outlined above. Your physiotherapist will walk you at least 12 metres and you will be encouraged to sit out of bed more frequently but for no longer than one hour intervals.
- Day three: the aim today is for you to be walking independently with your walking aid for a distance of 30 metres. If you have stairs at home your physiotherapist will teach you how to go up and down stairs safely.
- Rehabilitation phase: you will be walking independently with your walking aid. The hospital staff are available to provide assistance if needed.
- With all your activities it is important to adhere to the hip precautions discussed on page 18.
- Depending on how you have recovered from your operation your nurse will either assist you with a shower or sponge the first day following your operation. By day two you will definitely be assisted with a shower and by day three you will be encouraged to shower, sitting on a chair, with minimal or no assistance from your nurse. The occupational therapist will complete a shower assessment providing you with skills to manage with hygiene care while protecting your new hip (refer to page 24).
- Rehabilitation phase: you will be encouraged to be independent with your showering and will be provided assistance as required.
You can continue with your normal diet as tolerated.
- Your nurse will assist you with your toileting needs as necessary. An over toilet frame may be recommended to make getting on and off the toilet easier. Getting on and off the toilet is the same procedure as getting on and off a chair. Use the armrests of the over toilet frame to help you stand and sit, slide your operated leg slightly forward.
- By day three and through out your rehabilitation phase you should be independent with meeting your toileting needs. Your bowel patterns should be returning to normal. If you are having trouble with constipation please let your nurse know.
- TEDS and SCDs: the stockings are to be worn continually throughout your rehabilitation. They are taken off when you shower and then replaced immediately after your shower. The foot pump or compression sleeves are to be used while ever you are on bed rest until about day three. By day three you are more independent with mobility and it is not likely they will be required.
- Drains and dressing:
- Day one: your wound drain will be removed and the dressing you have on your wound will be reduced.
- Day two: the dressing on your wound will be replaced with a lighter dressing.
- Day three and rehabilitation phase: the dressing on your would will remain in place and will only be changed if necessary.
Precautions for your new hip
- Do not bend your hip more than 90 degrees (for two to three months).
- Do not let your operated leg cross the midline of your body, e.g. crossing legs (for two to three months).
- Do not twist or rotate your new hip/operated leg.
- Avoid sleeping/lying on your operated side (you must have a pillow between your legs when lying on your non-operated side).
- Avoid sitting in low chairs or prolonged sitting.
Exercises and techniques from your physiotherapist
You will do all these exercises in hospital and when you go home after your operation. It is important to practise them every day so that your muscles will get accustomed to exercising in this way.
Remember: if your joints swell or stiffen after exercising you may have done too much. It is important not to stop exercising but rather reduce the amount of exercise you are undertaking. If you continue to have problems discuss this with your physiotherapist. Ice packs are a good way to reduce joint swelling (remember to have a wet towel between the ice pack and your skin so you do not get an ice burn).
REGIME: Do each exercise 10 times, twice per day
- Place a rolled towel under your Knee and slowly straighten your leg by lifting your heel up off the bed.
- Hold for six seconds with the knee as straight as you can.
Straight leg raise
- Tighten the muscle on the front of your thigh and pull up your toes to straighten your leg.
- Lift your leg 10 centimetres keeping your knee straight, then lower slowly.
- Bend both knees.
- Lift your bottom off the bed, hold and lower slowly.
- Slide heel towards your bottom to bend your knee.
- Straighten slowly—bend this far only.
If you have had a previous hip replacement, wait until the lower limb class before trying this exercise.
Do not attempt this exercise after your operation until advised by your physiotherapist.
- Lie on your good side with your hips and knees bent a little.
- Keep your heels together and on the bed.
- Lift your TOP knee only and hold for six seconds then lower slowly.
Hold on to something steady initially. As your confidence increases and your balance improves, try letting go.
- Bend hip and knee up and down.
- Keep standing up straight.
- Stand with your feet shoulder width apart.
- Bend your hips and lower your hips a small amount then return.
Caution: You should not bend your hips deep enough to cause pain or past 90 degrees.
- Stand with one foot forward and your feet shoulder width apart.
- Lunge forward slowly to take your weight over the front foot. Hold for six seconds.
Repeat this with the other foot forward.
- Keep your trunk straight and tall with your toes pointing forward.
- Slowly lift your leg out to the side and then lower it keeping hip straight.
You do not have to lift your leg very far.
- With your trunk straight and tall, slowly lift your leg behind you keeping your knee straight and then lower it.
- Squeeze the muscle in your bottom tightly while you do this. You do not have to lift your leg very far.
When you have arthritis your balance in this joint is disturbed. Hold onto something steady. To exercise your balance, stand on the leg that is having the operation and try to let go and balance. Aim for 10 seconds.
To get out of bed after your operation:
- get out of bed on your good (non-operated) side
- bend your non-operated leg up so that you can push into the bed and lift your bottom close to the side of the bed
- push your elbows into the bed to half sit up
- push up onto your hands as you push your legs over the edge of the bed and swing into a sitting position
- do not let your hip bend more than 90 degrees.
To sit down after your operation:
- stand so that the chair is directly behind you and touching your legs
- keep your feet apart
- slide your operated leg slightly forward
- lower yourself using your arms and legs.
To stand up after your operation:
- move your bottom forward to the edge of the seat
- keep your feet apart
- slide your operated leg slightly forward
- use the armrests of the chair and push up to standing using your arms and good leg.
Sit for short periods of time only in the first few weeks after the operation. It is important to have frequent walks during the day once you get home as well as rest on the bed a couple of times during the day. This will help to keep the swelling in your leg to a minimum. Your physiotherapist will discuss the safe use of ice packs which may also help to keep swelling down.
Managing stairs safely
Once you are walking safely the physiotherapist will teach you how to go up and down the stairs.
- step up with your good (non-operated) leg first
- then step up with your bad (operated) leg
- move the walking stick up last.
- place the walking stick down first
- then step down with your bad (operated) leg
- step down with your good (non-operated) leg.
Getting in and out of the car
You will not be driving for the initial period after your operation. The following information will help you to get in and out of passenger seat of the car safely, to protect your new hip.
Getting into the car:
- Stand facing away from the car
- Grip the door frame with your right hand and gently lower yourself down.
Remember to keep your legs apart and maintain a slightly reclined position
- Slide your bottom along the seat as far as possible. With legs apart, swing both legs in keeping your operated hip as straight as possible.
Getting out of the car:
- Reverse the above process
A total hip replacement is an extensive procedure, and it may take up to three months for you to regain full independence. However, whilst in hospital with us we will aim to:
- have you walking independently with a walking aid
- have a family/community support network in place before you leave
- discuss and help with any safety requirements needed in your home. Any home modifications or equipment recommended by your occupational therapist should be in place or arranged—see recommendations on page 26.
Advice from your occupational therapist
The occupational therapist (OT) can give you details of ways to manage around your home and equipment available to help you. These may include some long handled aids to make picking up things easier and also make showering and dressing yourself safer so that you minimise the risk of dislocating your hip or falling. You should continue to use this equipment at home after the operation until you have regained your full strength and movement.
- In keeping with the hip precautions on page 18 and avoiding bending more than 90 degrees, it is important that you use devices to assist you in putting your socks/stockings and shoes on such as a long handled shoe horn and sock or stocking aids. It is advisable to wear slip on shoes or use elastic shoe laces.
- Sit down to dress yourself.
- Use the long reaching aid (dressing stick). A dressing stick allows you to put on your trousers and underwear pulling them up to your knees/thighs and is useful for picking up clothing and other objects off the floor. These temporary devices will be shown to you at the DART preoperative visit or by the occupational therapist while you are in hospital.
- Dress the operated leg first and undress it last.
- When you stand to pull up clothes, steady yourself before pulling the garment up.
Taking a shower or bath
It is important to protect your new hip in the bathroom. The occupational therapist will have made some suggestions regarding the placement of rails in your bathroom, the use of shower chairs, or bath boards.
Below are simple suggestions that will help maintain your hip precautions while showering/bathing.
- Use a long handled brush or sponge to assist with washing below your knees.
- Soap is slippery when wet and can be dropped easily. Using a soap bag or a stocking sock tied to a tap to hold your soap will prevent this from occurring.
- Place your showering/bathing needs in a place where they will be easily reachable, where they are unlikely to be knocked over and you do not need to bend over to get to them. A chair or stool could be used to place them on.
Using a bath board
- sit on the edge of the bath board
- keep your legs apart and your new hip as straight as possible
- lean back slightly and raise both legs into the bath.
Getting off: reverse the process
Lifting and carrying
The muscles around your hip will have lost strength after the operation so you should avoid heaving lifting or carrying for the first six weeks after your surgery.
- Ensure commonly used items are stored at waist height or above.
- Move things in small loads.
- Use a lightweight kitchen trolley to move items around the home.
- Only carry loads easily managed in one hand if you are using a stick.
You should be able to do light household jobs soon after you return home. You may tire more easily when you first return home. This is normal.
- When doing housework, work in short sessions with frequent rest breaks.
- Use a washing basket and trolley when hanging out clothes. If you do not have a trolley, only carry small loads, as wet clothes are heavier than dry clothes. Place the laundry basket on a stool or table to avoid bending.
- Avoid standing on anything unstable to reach high windows or shelves.
- Avoid vacuuming or washing floors.
Recommendations (if applicable) made by your home (DART) occupational therapist
................................................................... on _____/_____/_____
Phone: 07 3163 1760 to ensure that your home environment is optimal for when you return home.
Minimum height for surfaces you sit on = .................................................. mm (________") e.g. toilet frame, chair, bed—measured when weight on surface.
(e.g. rails to be installed)
|Person to arrange details
(e.g. Home Assist)
Advice from your physiotherapist
You can still do gardening after your operation but you will need to use long handled gardening tools. Please discuss this with your physiotherapist or occupational therapist.
Your muscles will not regain full strength while you are in hospital. To strengthen your muscles it is vital to continue your exercise program at home for at least three months or as directed by your physiotherapist. These are the same exercises that you did in the lower limb class and in hospital.
A physiotherapist may visit you at home to progress your exercises and mobility. As you improve you will be able to manage more challenging exercises. Plan to exercise about half an hour after you take your usual pain medications.
Walking is one way of improving your fitness. You should find it easier with your new hip. Swimming is a good form of exercise where your body weight is supported. Seek advice from your doctor or physiotherapist before commencing swimming. Whichever activity you choose, set yourself a time or distance to aim for and try a small increase every few days.
Discharge advice following your total hip replacement
What to do:
- Maintain precautions for your new hip (refer to page 18)
- Continue your wound care:
- If your wound dressing has been removed before you go home, you can pat dry the wound with a clean towel following your shower. Remember to dry the wound before the rest of your body.
- If you have a waterproof dressing, leave it on until the clips are removed. After this you can let clean water flow over the wound area.
- Follow the instructions on the wound care sheet provided on discharge. Your staples need to be removed by your general practitioner (GP) 12 to 14 days after your operation.
- You can expect some swelling and bruising to area and some associated pain after doing your exercises in the initial period after your discharge.
- Continue to take tablets for pain relief as required.
- Maintain your daily exercise program as advised by your physiotherapist and continue regular walks.
- Maintain a well-balanced diet as good nutrition is important to the healing process and can assist in preventing constipation.
- Continue to wear your compression stockings (TEDs), as advised.
- Check with your doctor about stopping anticoagulants if you are undergoing dental or other procedures.
- Follow the advice given to you by your occupational therapist and physiotherapist regarding:
- dressing, showering, lifting, carrying, housework
- exercises, transferring, getting in and out of a car, managing stairs, gardening, getting stronger and fitness.
- Follow your doctor's advice as to when you can commence driving again. This will usually be more than six weeks after your surgery.
- Follow your doctor's advice as to when you can return to work. This will depend on the type of work you do and your recovery.
Please contact your GP (office hours) or attend your local emergency department (after hours) if you experience any of the following after discharge:
- any new wound ooze
- fever (high temperature)
- increased swelling, redness or warmth around your wound
- swollen calf or thigh that are red and warm to touch
- a dramatic increase in pain.
Down the track—get back into life!
After three months you should be back to most of your usual activities. You may find that you can return to activities you haven't been able to do for some time because of your hip pain. Make the most of these improvements by getting back to activities you enjoy.
Having prepared yourself well and participated actively in your treatment, you will be able to return quickly to a more active and independent lifestyle.
Mater Hospital Brisbane
Raymond Terrace, South Brisbane Q 4101
Telephone: 07 3163 8111
Staff of Mater Adult Hospital, South Brisbane
Domiciliary Acute Rehabilitation Team (DAART)
The Royal Brisbane Hospital Orthopaedic Transitional Care Project Sponsored by Queensland Health, A Guide to Total Hip Replacement
© 2013 Mater Misericordiae Ltd. ACN 096 708 922.
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: Hosp-001-01697 / PI-CLN-420037
Last modified 11/1/2016.