Hip Replacement: The Day of Surgery
Morning of surgery
Report to the outpatient surgery area of the hospital at the time designated on your surgery checklist. A nurse will review your medical history.
Take only the medications your health care provider tells you to take.
After you are admitted to the hospital, your temperature, pulse, respiration rate and blood pressure will be checked.
Your surgeon or another health care provider will write your surgeon's initials on the hip to be operated on. This safety measure ensures that everyone in the operating room knows which hip is to be replaced. If you are not sure which hip will be replaced, ask your health care provider.
Support stockings (TED™) or a compression device may be placed on the leg that will not be operated on. This is to promote blood circulation and lower the risk of blood clots.
An intravenous (IV) line may be started to give you fluid and medication through a vein.
You will meet the anesthesiologist, and he/she will discuss the type of anesthesia to be used. There are two options: A spinal anesthetic, which numbs you from the waist down. Sedation will also be given with a spinal, so you won't hear the sounds of surgery. The other form is a general anesthetic, which involves a breathing tube placed through your mouth.
You will be dressed in a hospital gown, and an IV will be started in your arm. You will receive a preop dose of antibiotics. Your family/friends may wait with you, until you are taken to the Operating Room.
You will be asked to empty your bladder.
Remove all jewelry (including rings), contact lenses and nail polish.
You may wear your glasses, hearing aid or dentures. These will be removed in the surgical area before your surgery. They will be available to you right after surgery.
Your family members and friends will be shown where to wait while you are in surgery.
You will be taken to the preoperative waiting area.
The anesthesiologist will talk with you about the type of anesthesia you will have.
Before you go to surgery
After surgery, you are moved to the PACU. The unit is brightly lit with a lot of equipment. Your family members and friends will be told when you are in the PACU. They will get the approximate time you will return to your room.
Post-Anesthesia Care Unit (PACU)
Pain and nausea are managed as you wake up from the anesthesia.
Your blood pressure, pulse, alertness, pain or comfort level and need for medications are monitored.
You may get oxygen through nasal prongs or a facemask to help you breathe.
As you wake up, noises may sound louder than normal
If you feel cold, blankets are available.
How long you stay is determined by the anesthesia team based on your safety. Most patients stay for 2 hours.
Do not try to get up without help.
The following will be checked often during the first 24 hours after your surgery:
Blood pressure and pulse.
The color, warmth, movement and sensation of your leg, heel, and foot.
The bandage on your hip.
The side rails on your bed may be raised for your safety.
You will be encouraged to drink liquids. When you can tolerate liquids, you may eat small portions of solid food. Gradually, your diet will include larger portions of solid food. You and your nurse can decide how quickly your eating and drinking should progress.
The nurses will check your vital signs and pain control. If you are uncomfortable or have nausea, medications will be given to help.
A therapist will evaluate you and begin therapy, including sitting, standing, and walking. Patients who return to the Joint Center in the late afternoon will begin therapy the next morning.
The staff at the Center for Joint Replacement specialize in the care of patients with joint replacement surgery. They will make sure your recovery goes as smoothly as possible.
There may be several things connected to you:
IV (intravenous line): This is a tiny catheter which is inserted into a vein in your hand or arm. It will be connected to a tubing and a bag of fluids.
OXYGEN: You will have oxygen through a tubing with two small prongs into your nose. This doesn't mean that you are not breathing well. The oxygen may be discontinued the evening of surgery or the following morning.
FOLEY CATHETER: A catheter may be inserted into your bladder during surgery. It will stay in for approximately one to two days.
DRAIN: You will have a drain tube into the hip after surgery. This removes excess blood from the hip after surgery. It will be removed the day after surgery.
Our nurses will be asking you to take deep breaths and to use your spirometer, which is a small machine that you breathe into in order to clear your lungs.
After you return to your room at the Center for Joint Replacement
First 24 hours after surgery
After the first 24 hours, headed home soon!
Most people can expect to stay in the hospital for one night. For example, if you have surgery on a Monday, you would likely stay Monday leave on Tuesday.
You may have blood samples taken
Your health care provider will work with you to finalize plans for your dismissal from the hospital and your transportation home.
Removal of the things connected to you:
IV (intravenous line): This is removed the day after surgery. Fluids will be turned off once you are drinking enough fluids and not requiring any IV medications
Your surgeon will prescribe medication to help prevent infection (antibiotic). You will get this medication through the IV.
OXYGEN:As long as your oxygen levels are staying up on their own, supplemental oxygen is no longer needed.
FOLEY CATHETER: If this was placed it will be removed the morning after surgery. After you urinate the first few times, your bladder may be checked to see if it is emptying completely. If you cannot empty your bladder completely, a catheter is inserted temporarily to remove urine. Emptying the bladder completely helps prevent infection.
DRAIN: Removed the day after surgery.
Preparation for home:
You, a family member, or a friend will help with your personal care such as brushing your teeth and bathing. Before you return home, you will learn how to care for yourself. Your participation is key to increasing your independence.
You will work with a physical therapist trained in rehabilitation. Your physical therapist and surgeon will prescribe a personal exercise program for you.
An occupational therapist trained in special needs after hip replacement surgery may talk with you about your activities of daily living such as dressing, bathing and using the toilet. The occupational therapist may review the equipment you may need at home for these daily tasks. An occupational therapist may talk with you about your daily self-care activities.
You may use a toilet seat riser or commode to urinate or have a bowel movement. A commode is a chair set on wheels with an opening in the seat.
You may have a final physical therapy session before you leave the hospital.
Your family members will be asked to show that they understand your exercise program and incision care.
Your health care team will talk with you about your dismissal needs. You will get written instructions to take home with you.
Answer your questions
Help you with all aspects of your care as you learn to care for yourself.
Help you do your self-care activities. Self-care allows you to be as independent as possible. It is meant to improve your confidence. You will learn how to care for yourself before you leave the hospital. Your participation is very important in increasing your independence.
Show your family and friends ways to help with your care after you leave the hospital. This may include dressing changes and using assistive devices.
Help you plan for the day you leave the hospital.
Suggest resources to help you and your family as you recover at home.
While you are in the hospital, your health care team members can:
Pain and discomfort
For pain relief after hip surgery, most people get a local anesthetic to numb the set of nerves for the hip that was operated on. This is given at the time of surgery.
You will also be given oral pain medication. Usually this works well. Although pain medication can help ease your discomfort, your pain may not be relieved completely. You will do best if you take pain medication before your pain gets bad. Stay ahead of the pain. Tell your nurse promptly if your pain is getting worse.
Members of your health care team routinely ask you to rate the level of pain you feel. The scale is 0 to 10, with 0 = no pain and 10 = the worst pain you can imagine.
Tell your nurse if you have any other discomfort or think the pain medication is causing nausea or other symptoms.
You can use cold packs to help reduce swelling and discomfort around your incision.
You may be encouraged to cough and breathe deeply every hour you are awake for the first few days after surgery. This clears your airways of mucus.
You may be given a device called an incentive spirometer to help you with deep breathing exercises.
An abduction pillow may be used to help remind you to keep your legs apart (Figure 2). This helps you stay in the position your surgeon recommends. Usually, this is a regular pillow and the pillow is used during the first one or two nights after surgery with a posterior approach.
You will wear circulation aids on both legs while you are in the hospital and until your follow-up appointment. Circulation aids help promote blood circulation and lower your risk of getting blood clots while you are less active after surgery. Support stockings (TED™) are one kind of circulation aid (Figure 3).
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A member of your health care team will take off your stockings for about 30 minutes twice a day.
Your family members will learn how to help you put on and take off your stockings.
You may want to buy a second pair of stockings so that you can wash one pair while you wear the other.
While you are in the hospital, you also will wear a compression device, another kind of circulation aid. One kind is a sequential compression device (SCD). The SCD is a fabric sleeve that wraps around each lower leg or foot to promote circulation (Figure 4).
YOU are the most important player on your team of caregivers. Your doctor, or one of his assistants, will see you daily, and your nurses and therapists will play their roles in supporting your care. Only YOU can do what needs to be done to make your new hip its best.
Coughing and deep breathing
DEVICES YOU MAY ENCOUNTER
Abduction pillow
Circulation aids
