HIP REPLACEMENT SURGERY TIPS

These tips are a collection of helpful hints submitted by dozens of hip replacement patients. These are not strict guidelines but simply suggestions to help make your recovery period more comfortable and enjoyable.

Seating
When sitting after surgery, keep your knees apart a bit, particularly if you bend over past a 90-degree angle.  A tall, padded straight-backed chair with armrests is best initially as it is easy to sit down and get up from.  Desk chairs can often be adjusted, are usually padded and have an ergonomic design, which makes them comfy for sitting after surgery.  However, if you do use a chair with wheels, brace it against something when sitting down to make sure it will not slide out from underneath you.

La-Z-Boy recliners may require some forward leaning movement to get out of the deep cushion.  If you plan on using a La-Z-Boy chair after surgery, prior to surgery practice getting out of the chair without leaning too far forward.  A La-Z-Boy lift chair may be appropriate if you have difficulty getting up, but they are fairly costly.  If you feel you may enjoy this type of chair in the future, the investment may be worth it.

Boat cushions (Type IV Personal Flotation Device) are handy to have around so that you can make low or soft chairs high enough and firm enough to meet your needs.  They are inexpensive (about $10) and have straps that make them easy to carry.  Some people put their favorite chair or sofa up on blocks for the post-operatively period.  If you are going to be traveling shortly after your THR, a wheelchair may be useful for long distances. 

If the season permits, you may want to have an appropriate chair outside so that you can have some fresh air and new vistas.  Inexpensive resin porch chairs are fine but may be more comfortable with a cushion. 

Bed
Check the height on your bed as well.  The old types can be quite low.  Hospital beds can be rented quite inexpensively, if your bed is a problem.  Some people put their bed up on blocks.  Soft side waterbeds that are on a frame will usually be the appropriate height.  Standard waterbeds may be too low and too difficult to get in and out of.  Test yourself getting in and out of your bed prior to the surgery.  If you need to do a big heave-ho to get out of the bed it probably will not be appropriate.  Some people buy egg crate foam to put on top of the mattress for extra comfort.  You will want to have your non-operated leg on the outside of the bed as it will be easier to get in and out of bed.  You may want to rearrange your bed accordingly.  Be prepared to have someone change your sheets quite often in the early post-operatively days; you will be spending quite a bit of time in bed and many people find they sweat profusely in the first weeks following surgery.

Cupboards
You won't be able to reach very low or very high items.  Organize one easy-to- reach shelf in your kitchen with the pots your use the most, several dishes and storage containers.  Stock up on frozen food and other favorite easy-to-eat food before you leave for the hospital. 

Drawers and Closet
Put together a wardrobe of loose, casual clothing that is appropriate for the season and place it in the front of the closet.  Rearrange your drawers so that the clothes you will use most often are in the top drawer.

Stairs
Your ability to walk up stairs after surgery will be determined by Dr Swanson's post-operatively precautions for you and your own strength.  Although usually unnecessary, some people who have two-story homes choose to move their bed downstairs, or to rent a hospital bed and place it downstairs until they feel stronger.  Other patients have found that they can manage stairs several times a day, as long as the majority of their day is spent on one level.  It will be beneficial if your bed is on the same level as a bathroom and the kitchen.  The early post-operatively period will require resting in bed for regular periods each day, having to walk up stairs to get to a bed each time you need to rest may add to your exhaustion.

Bathroom
Considering installing grab bars in your bathroom, especially on the walls of the tub or shower stall.  Make sure you know how to find wall studs for secure installation.  Prior to surgery, make sure that a walker will fit through your bathroom door.  Take rugs out of the bathroom so you don't have to worry about tripping on them.  If you have glass shower doors on your tub you may want to take them off to accommodate a shower seat.  There are two types of shower seats.  A tub transfer bench straddles the wall of the tub, and the other type sits inside a shower stall.  (A resin porch chair can be used, with a rubber mat underneath to prevent skidding.) With the type that straddles the tub, you will have to have someone to help you lift your operated leg up and over the side of the tub, until you get stronger and can do this yourself.  Shower seats are typically supplied by the hospital prior to discharge and paid for by your insurance.  You may want to check with your insurance company prior to surgery so you aren’t without this essential piece of equipment when you leave the hospital. 

You may want to have a hand held showerhead, for easy showering while seated.  These fit over the faucet in the tub and have a long hose that leads to a small showerhead.  You may want to use liquid soap, or put your soap into a nylon stocking and tie it to a faucet handle.  That way, you will avoid the danger of trying to bend in a slippery shower to retrieve a dropped bar of soap.  Don’t forget about having a good supply of wash clothes in the bathroom for sponge baths when no one is available to help you shower.  You will be able to wash your hair in the kitchen sink alone.  Women can tape a razor to a long handled wooden spoon to shave their legs while seated on the shower seat.

You will need an Elevated Toilet Seat.  This item is typically issued at the hospital and paid for by your insurance.  Again, you may want to check with your insurance before your surgery.  Some people replace their old low toilets with permanent higher toilet. 

It is handy to have baby wipes or flushable wipes available in the bathroom.  You can do quick clean ups of the bathroom with disinfectant wipes to keep the environment sanitary. 

Finances
Take care of all of your finances and paperwork before surgery.  Pay all your bills far ahead of your surgery.  If you don't have the money to send them, put dates on the outside of your envelopes that indicate when they can be mailed.  Energy and attention span will be low, and you may not feel like getting back to business for some time.  Buy some thank-you cards in advance so that you have them at hand.  It's a good idea to have some cash available.  That way if you need to ask a neighbor or friend to pick something up for you, you can pay them back right away.

SELF-PREPARATION

Exercise
Exercising is typically very painful for patients preparing for hip surgery.  However, a moderate program of exercises targeting the hip area will be beneficial in hastening post-operatively recovery.  Some exercise to try include:
1) Glut squeezes - Lying on back, isolate and squeeze butt muscles.
2) Heel slides - Lying on back, bend the knee and slide the foot towards body and back down again.
3) Side leg slide - Lying on back with legs together, move one leg out to the side and back or spread both legs out and in (similar to making snow angels).

Standing hip exercises are usually difficult for hip patients to do, as most cannot tolerate weight bearing on the affected leg.  Quite a few exercise machines target the hip muscles.

Access to a heated pool is beneficial in that you will be able to get good, aerobic exercise without causing too much discomfort to your hip.  Swimming or even walking and moving the body against the resistance of the water are beneficial to increase your endurance.

Grooming
For women: Plan ahead for your last haircut and/or color, as you will have a long period when it may be difficult to get out and get a trim.  Likewise, have your legs waxed or shave before surgery if you follow those grooming habits.  After surgery, you can tape a razor to a long handled wooden spoon for shaving without breaking precautions.  You may not be able to reach your feet for quite a while after surgery.  You may want to have a pedicure prior to surgery. 

Sleeping
It is really important to sleep well before the surgery.  Many people find that the anxiety about their upcoming surgery and increased pain caused by ceasing NSAIDs keeps them awake.  If you have trouble sleeping you many want to take a sleeping aid like Tylenol PM or Benadryl (diphenhydramine).  Tylenol can help with pain control in lieu of NSAIDs.  Check with Dr Swanson or his staff before adding any medications. 

Dental Appointments
You should do any pending dental work well in advance of surgery.  Dental work, even cleaning, can be a potential risk of infection afterwards.  The American Dental Association and the American Academy of Orthopedic Surgeons recommends dentists use antibiotics prophylactically for two years following hip replacement surgery to prevent oral bacteria from entering the blood stream and coating the hip implant.  After two years, the implant is surrounded by new bone or fibrous tissue, and the risk of infection is reduced.  Patients with diabetes, inflammatory arthritis, using steroids or immunosuppressant medication, or anyone else prone to infection should plan on using prophylactic antibiotics before dental work for the rest of their lives.  Check with Dr. Swanson if you are unsure. http://www.aaos.org/wordhtml/papers/advistmt/1014.htm

Avoid Blood Thinning Agents
Do not take any aspirin or anti-inflammatory medications for 10 days prior to surgery.  This includes Advil, Aleve, Motrin, Mobic, Voltaren, Relafen, Daypro, etc.  All of these items thin the blood and may cause excessive bleeding during surgery.  Vitamin E may also thin your blood and should be discontinued prior to surgery.  Any herbal supplementation should be discussed with Dr Swanson’s staff.  Many herbs are known to thin the blood.

Jane provided the following list of supplements and foods associated with blood thinning.
Supplements:
Vitamin E - ask your doctor what amount you may take *
Vitamin C- ask your doctor what amount you may take*
Omega 3 Fatty Acids (oil supplements made from the fat of salmon, sardines, mackerel and herring) like EPA Eicosapentanoic
Acid) and DHA (docosahexanoic acid) **
Flaxseed oil (also known as linseed oil) in a supplemental dose like 1 or more Tablespoons per day**
Systemic oral enzymes that clean up the blood and make it less likely to clot***
Herbs:
St. John's Wort*
Kava-Kava*
Ginko Biloba*
Tree ear or wood ear or mo-er ear fungus-all names for a Chinese mushroom also known as Auricularia pollytricha, a rubbery
brown species cultivated on logs.  A common ingredient of Chinese soups and stir-fries, it has a crunchy texture and no taste.**
Foods:
Garlic*
Onion**
Ginger*
Ginseng*
Drugs:
Coumadin, persantine, aspirin and other blood thinners, as well as all routinely taken medications -- ask your doctor which ones you need
to stop before surgery.
* Cedar-Sinai Institute for Joint Replacement
** Natural Health, Natural Medicine, by Andrew Weil, M.D.
*** The Aspirin Alternative,- by Michael Loes, M.D.
**** A Prescription for Nutritional Healing, by James F.  Balch, M.D.

Recommendations For Nutrition Before Surgery
Provided by Jane

Eliminate processed foods from the diet as far in advance of surgery as possible.  Processed foods overwork the body.  Drink at least 8 glasses of water per day.
Eat protein foods like meat, chicken and fish and if desired, take protein supplements in the form of amino acids and protein powders.  Rice protein powder is a sugar-free protein that is highly digestible, rarely causes indigestion or allergies like milk and soy protein powders and stirs up easily in water.  Protein is needed for mending wounds and growing new tissue.  Get plenty of it in your body before surgery! Have plenty of fiber in the diet to keep the colon clean.  An ounce or two of pure Aloe Vera juice night and morning keeps the digestive tract clean.  Acidophilus supplements promote a healthy environment in the digestive tract.  Take any supplements your doctor recommends and check with him on the above recommendations.

Dealing with Fear and Anxiety
It is perfectly normal and perfectly appropriate to feel fear and anxiety prior to surgery.  Avoid caffeine and stimulants.  Make you sure you sleep each night even if it requires taking sleeping aids.  It is not helpful to lie awake and worry, exhausting your body and mind.  Many people find that once they stop taking their NSAID medication, they are acutely aware of just how bad their condition is and feel a renewed commitment to ending the pain.  It helps to be intellectually convinced of your decision.  Examine for yourself if there is convincing evidence that you have made a wise selection of prosthetic type and surgeon. 

EQUIPMENT AND SUPPLIES

Walking Aids
Nearly all patients are allowed full weight bearing immediately after surgery, using a walker or crutches initially and advancing to a cane or no support at all when able to walk without a limp.  If you can borrow a walker or crutches before your surgery, you can practice.  If you will be allowed only partial weight bearing, you can walk over a bathroom scale to see how many pounds you are actually bearing.

Many patients find walkers much more stable than crutches.  Some prefer crutches if they are already used to them.  Post-operatively medication may make you feel dizzy and heighten the risk of a fall.  If you have young children or dogs moving frenetically about your house, the walker will provide a “safe cage”.  The hospital PT will order a walker for you prior to discharge from the hospital.  Most insurance companies will pay for your walker.  Again, you may want to check with your insurance company prior to your surgery to confirm this.  Otherwise, you will have to make arrangements to buy or borrow one to take to the hospital upon discharge and for use at home.

Many people attach carrying bags or baskets to their walker to make carrying things with them easier.  Experiment with tie on bags, fanny packs, trays and wire baskets.  You may want to put Velcro on the front leg of the walker and the corresponding piece on your reacher.  Some people prefer to wear an apron with pockets or a fanny pack around their waist.

Reachers
You will be given a reacher prior to discharge from the hospital.  A reacher is a long stick with a mechanical grabber on the end.  It will aid you in picking up items off the floor and getting dressed.  The Occupational Therapist in the hospital will teach you how to use your reacher before discharge.  There are two types of reachers: one type has a claw extension at the end, and the other has two suction cups on each pincher.  Both types are useful for different things.  See if the PT or OT at the hospital will let you play with the assortment of reachers to decide which one works for you.  If you get home and find you need a second one or the other type, you can get them delivered from the medical supply house you are using.  They are not expensive at all.

A cordless phone is handy for convenience and safety.

A bed-writing table is useful for sitting up and eating or doing projects in bed.

Pain Control
Most people prefer to use the painkillers they have become accustomed to using prior to surgery.  Using a painkiller with which you are familiar helps you avoid unpleasant side effects and dosing unfamiliarity.  Ice packs are helpful for swelling around the incision.  Alternating heat and ice can be helpful for muscle soreness.  Massage should be avoided, because it can dangerous if an undiagnosed blood clot exists.  Rest and relaxation techniques are helpful to release muscle tension.

Clothing
You will want to avoid clothing that is tight or rubs on the incision and requires extensive bending and pulling to put on or take off.  The incision site is sore at first, so some people buy boxers or very loose underwear that won’t irritate the incision.  Loose clothes or dresses are easy to put on and essential if you experience post-operatively swelling.  You can use your reacher to help pull on your clothing, but don’t set yourself up for a daily struggle.

You will need to have a pair of comfortable shoes with non-skid soles to wear post-operatively.  They should adjust to accommodate any swelling in your foot.  You will not be able to tie your shoes and you will tire of needing someone to help you.  Athletic clogs and backless slip-on tennis shoes are popular choices.  Regular tennis shoes can be fitted with curly elastic laces to become slip on shoes.  Long handled pliers can be used to pull Velcro straps closed, and long handled shoehorns can be useful.  Make sure you try the shoes out before you get to the hospital.  They need to feel secure, as you will be taking your first steps post-operatively in them, at a time when you won’t be feeling too secure.  Do not wear heels, slippery soles or sandals. 

HOUSEHOLD ITEMS TO HAVE ON HAND
Stock-up on non-perishable household items before your surgery.  You won’t be able to drive for 2-4 weeks.  You may want to make meals ahead of time and freeze them, or stock up on frozen meals.  The short checklist below may jog your memory for items you may need post op.
· Shampoo, toothpaste, deodorant, baby wipes, disinfectant wipes
· Paper towels, toilet paper, paper plates, paper cups, dishwashing liquid, laundry detergent and dryer sheets
· Nutritious snacks and easily prepared foods
· Pet food and treats

WHAT TO TAKE TO THE HOSPITAL
Don’t over pack for the hospital.  Hospitals request that you don’t bring valuables with you, although out-of-town patients may be allowed to deposit items in a safe.  You won’t be in any condition to watch over your valuables, nor will you be able to carry them along if you need to leave the room.  Give your overnight bag to a friend or family member who can carry it to your hospital room after surgery.  Popular items to bring to the hospital include:

· Phone numbers of family, friends, insurance company and doctor
· Phone card to the hospital for long distance calls
· Medications, vitamins or laxatives, which you take daily and have been approved by Dr Swanson  (most of your medications will be administered by the nursing staff—let them know if you are taking any medications in addition to what they are giving you.)
· Basic grooming supplies - brush, comb, toothpaste, toothbrush, robe, and maybe a hand mirror
· Lip balm for dry lips
· Ear plugs and a sleep mask
· Small bills so you can send visitors to the candy machine, gift shop, etc.
· Very light reading material
· Comfort Bath wash cloths (no water needed) and No Rinse Shampoo
· Personal CD player and CD’s for relaxing and blocking out hospital sounds
· Fanny pack to strap to the hospital bed rail to have things close at hand
· Mints and hard candies
· Insurance card or number
· Robe
· Socks - the kind with the grip soles are nice
· Shoes for PT and going home
· Loose comfortable clothing for PT and to wear home
· A pillow from home

After surgery you may be exhausted and uncomfortable.  Most people don’t care about grooming and clothing during those days.  Make it easy on yourself, plan on using the hospital gowns. 

POST-OPERATIVE CARE
You may be tired post-operatively and require help getting into and out of bed for at least the first week.  It is very helpful if someone can stay with you during the first week to cook, bring you things, help with TED's, help you shower and shampoo your hair, do laundry, etc.  Many people get a baby monitor so that they can communicate easily with each other.  After the first week post-operatively, you may only need someone to come for a short period twice a day, to do little things like help with pets, bring in mail and for the inescapable TED’s slavery.  Churches and charitable organizations often have volunteers willing to assist people after surgery. 

A cleaning person is helpful during the early weeks.  The sheets will need to be changed quite frequently and you will definitely not be capable of cleaning the house.  A lawn service may also be helpful as you won’t be able to complete regular yard responsibilities.  Make a list ahead of time of all the places that deliver meals and possibly groceries.  Some stores will take call-in grocery orders, which they will gather for someone to pick up.  This greatly reduces the time required of the person doing your shopping.

Most people clearly state that they preferred to be alone in the early period post-operatively.  This often seems unbelievable to loving family and friends who want to dote, and neighbors who feel you crave company.  This is not a time to err on the side of being polite.  If it is difficult for you to assert yourself with visitors, make a pact with a family member.  Employ them to usher people out at your signal, or have them help you excuse yourself to go rest.  You will be exhausted post-operatively, and sitting for any length of time is painful and unadvisable.  Ask your comrade to encourage guests to return in several weeks when you will be feeling much stronger, able to sit for longer periods and ready for some diversion from the monotony.  Unfortunately, typically, just when you feel better and would like a lively chat, no one comes visiting anymore.  By this point, you will look just fine and people don't get that you are still very much convalescing. 

Most insurance companies will allow you to have in home health care.  These nurses and nurse’s aids can assist you with showering and incision care.  Taking your first shower is a learning experience, often somewhat frightening and requires competent personnel.  Dr. Swanson routinely discharges patients with home health care nursing and physical therapy.

You will sleep better at night if you haven't spent the whole day in bed.  Be sure to have a change of scenery.  Get up and move about regularly, reserve bed for naps and times you just cannot get comfortable anywhere else.  Get some fresh air on an appropriate chair outdoors if the season allows.  You may find you sleep better if you aren’t sharing a bed with someone in the early post-operatively days.  Fear of protecting your leg from someone moving in the night may keep you awake.  The person sharing your bed will probably sleep better if they aren’t on guard for your well being and listening to you rustling about trying to get comfortable.  They will also be able to help a lot more if they aren’t worn out themselves from lack of sleep.

FAMILY PREPARATION
If you have a family, sit down with them and have a clear discussion of what your condition is going to be and how household responsibilities will be handled and for how long.  Many people report that their family was very giving and helpful for the first week, but after that because you look fine, they expected you would be able to do more and return to your "duties".  I highly advise if you can afford it, to hire outside help ahead of time for the heavy work.  Your family can then be utilized for the multitude of small favors and the pleasure of their company.

Preparing Young Children for Your Surgery
Provided by Elisabeth

I had THR in July, and my daughter is seven.  Both of my friends who had promised to take turns having her over to play, every day, had family crises and were unavailable; and other friends were out of town at that point.  That was the hardest part of my recovery.  My daughter is very talkative and social--which is the last thing I needed during convalescence! On several occasions, I phoned my husband at work and begged him through tears to come home early, because I was so exhausted.  I did find friends to take her for a few hours a week, but it was nowhere near enough, and she got terribly bored
at home with me.

If at all possible, find a way to farm out your children for at least part of every day, for the first three weeks or so.  I experienced sudden waves of exhaustion, chilling, and hunger for the first three weeks post-operatively, which is pretty typical.  After that, I was on a more even keel.  I'm 44.

I traveled from California to have surgery with Dr Swanson.  We were able to take my daughter along for my pre-op visit, so she got to meet the surgeon and his assistants and see the hospital.  I think she was very comforted to be able to picture approximately where I was, and with whom.

She stayed behind with neighbors when my husband and I flew out for my surgery.  My husband was with me for the first four days, then returned home to go back to work and retrieve her during evenings and nights.  I came home after eight days.

I prepared Madelaine by telling her about the surgery over and over, a bit at a time, starting months in advance.  I showed her my x-rays, the model skeleton in her school, photos of the implants--and even let her watch a movie about THR that we got on loan (when she was just six).  She was entirely unfazed by the gore--which is typical for children that age and younger.  I also explained about the incision, bruising, and swelling--and that she would NOT be allowed to run and crash into me, jump onto me, etc.

I also spent time explaining the likely scenario after surgery--a day of nausea and vomiting--and rehearsing how I would sound on the phone.  I told her about "fall-asleep medicine" and explained that it would make my voice high and make me mumble and fall asleep in mid-sentence.  We rehearsed pretend phone conversations, and I did my part-- mumbling in a weak, high voice and lapsing into sudden snoring.  She thought this was great entertainment!

The happy result of all this preparation was that she was well pleased when we phoned her after my surgery.  I sounded pretty much how she expected, and she said as much.  She was also happy to learn that I had thrown up on schedule, gotten it in my hair, and that Papa had been obliged to jump out of the line of fire--a detail she found hilarious!

My neighbor told me afterward that she had been worried how Madelaine would react--and was astonished to hear how cheerfully she reported my unsavory status at the dinner table, that evening.

One thing my daughter wasn't prepared for was my bad "hospital" smell, when I returned home after eight days.  I assume some of it was from drugs, because she kept complaining, even after I had showered at home.

Another thing that proved useful for my daughter--was making a calendar.  I printed out two months from Microsoft Office, and together we filled in some key dates already passed--a birthday party, the county fair.  We decorated those squares with little drawings.  Then I filled in my likely dates of absence (I ended up returning home sooner than expected), my surgery date, the date I might be off crutches, the date I might be able to start driving and take her someplace, etc.).  This really helped her grasp that we were talking about a long period of time.

I would try to have your children meet Dr Swanson and his assistants.  You can even consider sneaking a couple lollipops to the surgeon, and asking him to give those to your children as a goodwill gesture.  With frequent reminders, your younger children might be able to keep the surgeon in mind.  Then, while you're in the hospital, your husband can explain simply that you're with nice Dr Swanson who gave the lollipops.  One precaution: You'll have to find some way to explain that the surgeon is going to give you a VERY big "boo-boo" to fix the inside of your hip.

By the way, Playmobil has a great surgery set, suitable for a five year old.  Younger children might enjoy a toddler's doctor kit.

As for babies--the best you can do is to get her used to substitute
caregivers, starting now.

Toys all over the floor are a hazard while you're on crutches.  In fact, you might be well advised to stick to a walker indoors.  A walker provides good "crash" protection against rambunctious children. 

PET PREPARATION

Most pet owners report that their pets were a great source of comfort and companionship post-operatively.  However, you will want to make arrangements for someone to feed them, as you won’t be able to reach bowls on the floor.  Likewise, you won’t be able to take them for walks for quite some time.  It is helpful to get your pets accustomed to crutches and walkers before surgery. 

You will not want them bustling around threatening to knock you over in their enthusiasm to see you again upon your return from the hospital.  For your first post-operative meeting with your pets you may want to be seated securely in a stable chair with a pillow between your legs to avoid being jostled.  It will not be appropriate for your pets to sleep with you post-operatively.  You may want to be sure to shut your door at night to keep them out or rent a hospital bed that is higher.  Teach them that this bed is off limits.

To ensure they are not going to knock you over going down the stairs, stop at the top of the stairs and let them proceed down ahead of you. 

Disclaimer:The information provided here is intended to educate the reader about certain medical conditions and certain possible treatment. It is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional. If you believe you, your child, or someone you know, suffer from the conditions described herein, please see your health care provider immediately. Do not attempt to treat yourself, your child or anyone else without proper medical supervision.

©2006 Todd Swanson, M.D.
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The minimally invasive total hip replacement was developed by Dr. Swanson after being introduced to the concept in early 1997. Dr. Swanson began using the technique in May of 1997 and has continued to make improvements that now allow reliable surgery and reproducibly good results in most patients. Standardization of the technique has allowed teaching to other surgeons. Numerous physicians and orthopedic companies have shown interest in promoting “minimally invasive surgery” for total hip replacements.

The minimally invasive technique utilizes a 3-4 inch incision, much smaller than the 8-10 inch approach historically used for hip replacement. Patients require less anesthesia and pain medication, and mobilize more quickly. This results in both quicker recovery for the patient and a lower incidence of complications.

Patients typically recover from minimally invasive surgery in about half the time it takes to recover from standard incision surgery (6 weeks vs. 12 weeks).

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