OVERVIEW

Total Hip Replacement

Hip joint

  • Helps with your balance and supports your weight
  • Composed of two bones: Pelvis acetabulum and thighbone (femur)
  • Thighbone(femur) has a rounded head that fits into a socket (acetabulum) to form the hip joint.
total-hip-replacement

Hip replacement

In normal joints, smooth cartilage covers the end of each bone and provides a smooth gliding surface for movement and acts as a cushion between the bones. In osteoarthritis, the most common condition affecting joints, the cartilage wears away and bone rubs against bone causing loss of motion and pain.

With a hip replacement the damaged parts are replaced with components that are made from titanium,
plastic, ceramic and chromium cobalt.

The choice of implants varies from person to person. Your doctor will look at your needs and choose the implant that is best for you.

Total Knee Replacement

Knee joint

  • Largest joint in the body
  • Knee joint is where the thigh bone (femur) and the shin bone (tibia) meet.

Knee replacement

Modern knee replacements are made from titanium, chromium cobalt and a polyethylene (plastic). Your doctor will look at your needs and choose the
implant that is best for you

total-knee-replacement

IT IS VERY IMPORTANT TO TELL YOUR DOCTOR IF YOU HAVE AN ALLERGY TO NICKEL

PREPARING FOR YOUR SURGERY

PRE-OPERATIVE VISIT AT THE PATIENT ASSESSMENT CENTER (P.A.C.)

PAC team

  • Doctor
  • Nurse
  • Occupational Therapist
  • Pharmacist, if needed
  • Physiotherapist
  • Spiritual care, if needed

The Doctor will:

  • Examine you
  • Send you for certain tests (e.g. blood test, x-rays, etc.)

The Nurse will:

  • Review the heath questionnaire
  • Explain what you need to know in order to help you manage before and after your surgery
  • Provide you with the disinfectant sponge that you will need to wash with before surgery to decrease the risk of infection

The Physiotherapist will:

  • Review rehabilitation plans
  • Notify your local CLSC of your surgery
  • Request a pre-operative home evaluation (may not be applicable in certain areas)

The PAC team will prepare you for your surgery and answer any questions.

Group teaching session

Nurse, physiotherapist, occupational therapist:

  • Will review the important information
    about your surgery

ONE (1) OR TWO (2) WEEKS
BEFORE YOUR SURGERY

CLSC HOME VISIT

  • CLSC will contact you to schedule a home visit or phone
    evaluation.

If you live in Montreal:

  • CLSC may do a preoperative home visit
  • This visit will ensure that your home is appropriate for your return home after your surgery
  • This visit will help determine the medical equipment you may require. Below are some examples:
equipment-required-before-surgery
  • Some CLSCs will ask you to rent or purchase equipment prior to your surgery (see equipment suppliers list at the end of this document).

If you do not live in Montreal:

  • Some CLSCs will ask you to rent or purchase equipment prior to your surgery (see equipment suppliers list at the end of this document).
  • HOME PREPARATION

  • Notify your family, caregiver, friends, etc., about your upcoming surgery.

  • Arrange for transport to and from hospital.

  • Arrange for meals. Prepare and/ or buy frozen foods in individual portions that can be easily reheated/cooked.

  • Arrange for help with groceries, bathing, housekeeping, banking, pet care, etc.

  • Arrange for someone else to provide assistance for the person that you may be caring for at home.

  • Arrange for someone to be with you for the first couple of nights after you are discharged from hospital.

  • Notify any support services about your upcoming surgery (CLSC, Meals on Wheels, etc.)

  • Ensure that medical equipment is properly installed. Familiarize yourself with the equipment.

  • Clear hallways and spaces around bed, kitchen and bathroom.

  • Remove rugs, this will allow you to move freely and safely with your walker.

  • Consider the use of nightlights in hallways etc.

  • Place items that you will use often within your reach (waist level or shoulder level).

  • If you do not already have a staircase railing, you may consider installing one.

  • Consider a hand-held shower head. Make sure you have a good quality, non-slip bath mat in the bathtub and on the bathroom floor.

  • You may be asked to buy compression stockings. These help to decrease the risk of blood clots.

  • WHAT TIME DO I ARRIVE FOR MY SURGERY?

  • You will be admitted to the hospital on the same day of your surgery.

  • The admitting offce will call you one (1) to two (2) days before to confirm the time you must come to the hospital. Please expect this call and be available.

YOUR HEALTH BEFORE YOUR SURGERY

If you notice any changes in your health, for example:

  • Fever
  • Cough
  • Sore throat
  • Skin infection, infected ingrown toenail, etc.

Call your doctor or call the surgery booking office at St. Mary’s hospital before 14:30 (2:30 pm) 514 345-3511 extension 3692 or 3673

PLEASE MAKE SURE TO BUY THE COMPRESSION STOCKINGS AND BRING THEM TO THE HOSPITAL WITH YOU.

NUTRITION RECOMMENDATIONS

In preparation for your surgery and following your surgery, eat a well-balanced diet.

Special emphasis is placed on promoting healing (protein) and preventing constipation (fiber and fluids).

FIBER & FLUID
Constipation after surgery is common due to the side effects of medications, anesthesia and decreased movement. Include foods that contain dietary fiber and drink plenty of fluids to help keep bowel movements regular and prevent constipation. Increase dietary fiber in your diet.

nutrition-recommendations-wheel
  • Vegetables
  • Fruits
  • Legumes (beans)
  • Whole grains (i.e. brown rice and quinoa)
  • Whole grain breads and pasta
  • Unsalted nuts and seeds

PROTEIN
Protein is the most important nutrient for muscle growth and wound healing. High-quality protein is found in Milk & Milk Products and Meat & Alternates groups. Choose lean or low fat options more often.

  • Eggs
  • Cheese
  • Cottage cheese
  • Nuts & seeds
  • Legumes (beans)
  • Tofu
  • Fish
  • Meat
  • Milk

CALCIUM
Calcium is needed for bone healing and maintenance. Milk and milk products are the best source of easily
absorbable calcium. Choose low fat or skimmed versions. Aim for 3-4 servings daily.

  • Milk
  • Cheese
  • Sardines (with soft bones)
  • Yogurt
  • Cottage cheese
  • Frozen yogurt or ice cream
  • Tofu
  • Canned salmon (with soft bones)

VITAMIN D
Vitamin D is essential for calcium absorption. This vitamin is made in the skin when it is exposed to sunlight.
The best food sources of Vitamin D include:

  • Fatty fsh (salmon and mackerel)
  • Margarine
  • Milk
  • Margarine
  • Fish liver oils

Canada’s Food Guide recommends that adults over 50 consume a daily vitamin D supplement.

ALWAYS CONSULT WITH YOUR PHYSICIAN BEFORE TAKING ANY NEW SUPPLEMENTS TO AVOID INTERACTIONS WITH OTHER MEDICATIONS

IRON
Iron is a mineral that is needed to carry oxygen to all cells in the body. Enough iron is needed before and after
surgery to prevent anemia due to blood loss. Iron in foods come in two forms:

  • Heme iron is found in meat, poultry, and seafood. This iron is the most easily absorbed by the body.
  • Non-heme iron is found in plant foods like vegetables and legumes. This form of iron is less well absorbed.

It can be better absorbed if eaten with vitamin C-rich foods like oranges and peppers or other sources of
heme iron.

nutrition-recommendations-iron

THE EVENING BEFORE
YOUR SURGERY

PACK YOUR OVERNIGHT BAG

BRING:

Toiletries (soap, toothpaste, toothbrush, denture case, etc.)

Closed heel non-slip shoes/slippers

Underwear, socks, short robe,comfortable/weather appropriate clothing (for your discharge home)

CPAP machine, hearing aid, glasses, compression stockings

Your medications in their original containers

If you are taking blood thinners, like Coumadin, please write down the name of the doctor and phone number of the doctor that follows you for this medication. Bring the doctor’s name and phone number to the hospital.

DO NOT BRING:

 Valuables

 Jewelry

 Credit cards

 Large sums of money

SURGERY PREPARATION CHECKLIST

THE EVENING BEFORE YOUR SURGERY

Shower with the disinfectant sponge provided by the hospital. Wash body from neck to toes, including back. Wash hair with shampoo.

DO NOT eat after midnight.

You can drink clear liquids such as water, fruit juice (no pulp), Gatorade, black coffee (no milk), black tea (no milk) up until 4:00 AM the day of your surgery.

THE DAY OF YOUR SURGERY

Take a second shower with the disinfectant sponge provided by the hospital. Wash body from neck to toes, including back. Wash hair with shampoo.

DO NOT apply any makeup, nail polish, deodorants, lotions, perfumes, hair products.

Take only the medications that your doctor instructed you to take.

ARRIVAL AT HOSPITAL

DAY OF YOUR SURGERY

 Please present yourself at the Admitting offce (Main Pavilion, Ground Floor, Room G-310).

 You will be directed to the Surgical Day Center (Main Pavilion, 2nd floor, Room 2324).

 You will be asked to change into a hospital gown and the nurse will go over a preoperative checklist with you.

 The nurse may administer some medications that your doctor may have prescribed for pain and nausea before surgery.

 An orderly will walk with you to the operating room. Family members will not be allowed to accompany you.

 An anesthesiologist will discuss your anesthesia with you.

AFTER YOUR SURGERY

 In the recovery room, the nurse will monitor you.
 You will have:

  • Intravenous for fluid
  • Surgical dressing covering your operated site (hip/ knee)

 You may have:

  • Oxygen through a nose piece or mask
  • Urinary catheter
  • Compression stockings on your legs

 Pain control:

  • Epidural (in your back)
  • Nerve Block (in your groin/ thigh)
  • Patient controlled analgesia (a button that you press for pain medication through IV)
  • Medication pills

TRANSFER TO THE POST-OPERATIVE CARE UNIT – DAY OF SURGERY

 You must ask for pain medication as soon as you feel the need

 You must do your respiratory exercises every hour (incentive inspirometer)

 You must do your circulatory exercises every hour

 You must change position in your bed every two (2) hours (prevent pressure ulcers)

 You may be allowed to sit at the edge of the bed, or pivot into a recliner (nurse evaluation required)

DAY AFTER YOUR SURGERY UNTIL THE DAY YOU GO HOME

 You must ask for pain medication as soon as you feel the need

 You must do your respiratory exercises every hour (incentive inspirometer)

 You must do your circulatory exercises every hour

 You must walk with a walker and with the assistance of a healthcare professional

 You must do your exercise program three (3) times a day

 You must walk to the bathroom with assistance to wash yourself

 You must prepare for your discharge home two (2) to three (3) days after your surgery

inspirometer-opt

PATHS TO HOME GUIDE:
TOTAL HIP ARTHROPLASTY
TOTAL KNEE ARTHROPLASTY

paths-to-home-guide

YOUR REHABILITATION

READY FOR DISCHARGE HOME

 The hospital liaison nurse will contact the CLSC to inform them of:

 Discharge date
 Dressing changes to incision (if applicable)
 Removal of staples to incision (if applicable)
 Medication administration (if applicable)

 The frequency of home visits will be decided by the CLSC

YOUR REHABILITATION PLAN AFTER SURGERY

It is critical to understand that motivation and participation in your physical therapy program is a vital element in the success of your overall recovery. The more committed and enthusiastic you are, the quicker your improvement will be. Remember, you make the difference!

Day 0

(THE DAY OF YOUR SURGERY)


  Start ankle pump exercises (Figure 1 see next page).

 Quad sets-controlling the thigh muscle to push the knee straight (Figure 2 see next page).

 We will help you sit at the edge of the bed.

 You will get up for the first time with the help of a healthcare professional and a walker. You may put as much weight as you can tolerate on your operated leg (unless) otherwise indicated by your doctor.

 Wait until Day 1 to start bending your operated knee.

Day 1

(THE DAY AFTER YOUR SURGERY)

You will:

  Begin your exercice program

 Practice your transfers (bed, chair, toilet)

 Practice walking for a minimum of 10 meters

 Get up for lunch and supper

 Practice walking in your room

Day 2/3

You will:

 Continue your exercise program.

 Practice your transfers (bed, chair, tub/shower, toilet seat, car).

 Practice going up and down the stairs.

 You will get up for the frst time with the help of a healthcare professional and a walker. You
may put as much weight as you can tolerate on your operated leg (unless) otherwise indicated by your doctor.

 Wait until Day 1 to start bending your operated knee.

_

We will:

 Teach you how to become more independent in your transfers and your daily activities. If all is well, you will be discharged from the hospital.

CRITERIA REQUIRED FOR A
DISCHARGE FROM THE HOSPITAL

Your discharge will be on DAY 2 or 3 if the healthcare team determines that you have met the following criteria:

You are:
Safe with transfers and walking with walkerIndependent with your exercise program
Safe using the stairsSafe to take your medication

YOUR EXERCISES AFTER YOUR
TOTAL HIP REPLACEMENT

exercises-after-total-hip-replacement

YOUR EXERCISES AFTER YOUR
TOTAL KNEE REPLACEMENT

exercises-after-total-knee-replacement

TOTAL HIP AND KNEE PRECAUTIONS
(FOR 6 WEEKS)

Precautions are necessary to prevent the new joint from dislocating and to ensure proper healing.
These restrictions are for a period of 6 weeks. Here are the most common:

KNEE

 DO NOT put a pillow or roll directly under your knee, always keep the knee as straight as possible while in bed.
 DO NOT kneel or squat.

HIP

 DO NOT bend your hip past 90 degrees.

 DO NOT bend at the waist beyond 90 degrees (i.e. DO NOT try to pick up something from the floor while you are sitting or standing).

 DO NOT bring your knee up higher than your hip.

 DO NOT cross your legs.

 DO NOT rotate your leg inwards.

hip-precautions

GETTING AROUND
AFTER SURGERY

WALKING WITH A WALKER

A walker is often used for the frst several weeks after your surgery.

 Move walker forward.

 Take a step with your operated leg.

 Shift weight onto walker and take a step forward with the non-operated leg.

 DO NOT take sharp turns with a walker.

WALKING WITH A CANE OR SINGLE CRUTCH

A cane or single crutch offers a minimal degree of support while walking. It is usually used for several months after the use of a walker until your full strength and balance have returned.

 Hold cane or crutch in the hand opposite the operated leg.

adjusting-cane-walker-height

TRANSFERS (CHAIR/TOILET)

 To sit, slide the operated leg forward while holding onto the armrests and go down slowly.

 To get up from the chair/toilet seat, bring your buttocks to the edge of the chair/toilet seat and slide your operated leg forward, pushing with your hands on the armrests. Get up slowly.

SITTING POSITION TO STANDING POSITION

 Place hands on bed/armrests of chair.

 Move buttocks to edge of bed/chair.

 Slide your operated leg forward, pushing with your hands on the armrests.

 Get up slowly.

 Put your weight onto non-operated leg and push off with both hands from bed/armrests of chair.

 Once standing, place your hands on walker and slide your operated leg back at the same level as non-operated leg.

STANDING POSITION TO SITTING POSITION

 Use your walker for support as you back up until you feel the edge of bed/chair behind your knees.

 Slide the operated leg forward.

 Place one hand at a time on the armrest of the chair

 Slowly sit down.

standing-to-sitting-position

BED

Getting into bed.

 Position yourself close to the head of the bed.

 Move back so the back of your knees touch the bed.

 Slide your operated leg forward.

 Place one hand at a time on the bed and slowly sit down.

 Using your arms for support, start turning your body and lift one leg at a time.

YOU MAY USE YOUR HANDS, A TOWEL OR YOUR NON-OPERATED LEG TO ASSIST YOUR OPERATED LEG UP ON THE BED.

getting-into-bed

Getting out of bed.

 Lying on your back, bend your non-operated leg and move yourself to the edge of the bed.

 Use your arms to push yourself up in a sitting position as you start turning your body and legs towards the floor.

If needed, the therapist will assist your operated leg until it reaches the floor safely.

getting-out-of-bed

STAIRS

To go up.

 Put the good leg up first.

 Bring up the operated leg and crutch or cane together.

To go down.

 First lower the operated leg and the crutch or cane.

Lower the good leg using the crutch or cane.

CAR

To get into the car.

 Always sit in the front seat on the passenger side.

 Ensure that the car seat is positioned as far back as possible so that you can straighten out your leg. Recline the back of the car seat.

 Standing on the street (and not on the sidewalk), turn your back to the car and give your walker or crutches to your family member/friend.

 Position yourself with your right hand on the back of the car seat and your left hand on the car dashboard.

 Put your weight onto non-operated leg and push off with both hands from bed/armrests of chair.

 Sit and keep your feet on the ground.

 Slide your buttocks as far as you can on the seat.

 Bring your legs into the car, use your hands or a towel underneath your thigh to lift your operated leg.

 DO NOT attempt to swing your operated leg inside the car in one motion.

To get out of the car.

 Follow the above steps in reverse order.

getting-into-a-car

SELF CARE

TOILETING

Use a raised toilet seat with or without armrests (A and B).

 Use the armrests or grab bars to assist you when sitting down and getting up from the toilet.

 DO NOT twist your body to reach the toilet paper or to flush.

self-care-toileting

BATHING

Use grab bars to help you sit and stand.

 Use a transfer bath bench (C), a bath seat with or without (D) back, or transfer bath board (E).

 Use a long-handled sponge to reach your back and feet.

self-care-bathing

DRESSING

Use a long-handled shoe horn (F) to put on and take off shoes.

 Use a sock aid (G) to put on socks or ask someone to put them on for you.

 Use elastic shoelaces that convert laced shoes to slip-ons; this eliminates excessive bending while tying a knot and bow.

 Use a long-handled reacher to help you put on and take off your pants and underwear; always begin with your operated leg when putting on pants and start with your non-operated leg when
taking your pants off.

 Wear loose and comfortable clothing.

self-care-dressing
self-care-icon-op

DISCHARGE HOME INSTRUCTIONS

MEDICATIONS

Ensure you understand the medications that your doctor prescribed.

Blood thinning medication – To prevent blood clots

Caution: Blood thinning medication may cause bleeding.

Pain medication – To control your pain so you can continue to walk/ physiotherapy

 A good way to get pain relief is to take the pain medication as soon as the pain starts.

 Pain medication taken by mouth takes at least 30 to 45 minutes to start working.

Caution: Pain medication may cause drowsiness.

medications

REST PERIODS AND SUPPORT

Schedule rest periods throughout the day.

 The CLSC will call you to plan their home visits.

 Ensure that someone will stay with you for the first couple of nights.

LEG SWELLING

Most patients develop leg swelling in the operated leg. This varies from patient to patient and may be accompanied by “black and blue” bruising that resolves over a few weeks.

 The more swelling you have, the more diffcult it will be to bend, straighten or even lift your leg. It is therefore important to minimize swelling to enhance your recovery.

To reduce swelling in the frst two (2) weeks:
Apply cold therapy to your joint frequently for 10- 15 minutes at a time.

After two weeks:
If you advance your activity too quickly or overdo it, your operated joint may become more swollen.

Here are some suggestions that will help reduce swelling if it occurs:
Move your ankles up and down (ankle pumps).

Ice for 10 – 15 minutes after long walks, if painful, or after exercise. Ice may be in the form of ice wrapped in bags or towels or commercial cold packs.

Lie in bed for 20 minutes periodically during the day.

Limit your sitting time to 45 minutes to one (1) hour. Walk around, then return to sitting.

Wear your support/ compression stockings as prescribed by your surgeon.

SHOWERS AND BATHS

You may shower after your staples from your incision have been removed.

 You may bathe one (1) week after your staples have been removed.

showers-and-baths-icon

PREVENTING INFECTION AFTER A TOTAL HIP AND KNEE REPLACEMENT

Current guidelines DO NOT recommend routine antibiotic use for dental procedures. Antibiotics are recommended only in high risk patients. If you think you may be at risk, please discuss it with your doctor (the one who did your surgery) before any procedure.

FOLLOW-UP WITH YOUR DOCTOR

 Post-operative follow-up is in 6 weeks at your doctor’s offce where you saw him before your surgery.

 Hip surgery: A hip x-ray is needed. Knee surgery: No x-ray is needed.

 Resume driving when instructed by your doctor which is usually 4-6 weeks after your surgery.

RECOVERY AFTER SURGERY

You will likely feel tired and fatigued for several weeks and this is normal. You may experience numbness around your incision and this is normal. You may notice clicking: This is due to the plastic and metal surfaces moving together and this is also normal. The benefts of a joint replacement usually become fully evident by 4-6 months after the surgery.

TRAVEL

Must do:

Inform the airport security that you have a hip or knee implant. No medical certifcate or note by your surgeon is needed.

 Modern airport security will detect all joint replacements. To minimize the inconvenience and avoid a full body pat down, you must go through the body scanner.

If you walk through the metal detector doorway, the alarm will go off and you will have to wait for a security agent to do a full body pat down.

POTENTIAL COMPLICATIONS

SURGICAL INCISION INFECTION

Some signs of infection:

More redness or darkening of incision

 Swelling

Chills

More pain

 Fever

Foul-smelling or pus-like drainage from incision

If any of these symptoms occur, contact your doctor’s offce immediately or return to the Emergency Department.

BLOOD CLOTS

Some signs of a blood clot:

Pain and/or redness in your calf

 Increased skin temperature

 Chest pain or pain when breathing

Increased swelling of your thigh, calf, or ankle

 Shortness of breath

If you develop any of these symptoms, go to the nearest Emergency Department or call 911.

CONTINUE WITH YOUR GREAT PROGRESS!

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