GENERAL GUIDELINES FOR RETURNING HOME
In these past days or weeks, you experienced a period of anticipation : waiting to enter the hospital, to undergo surgery, to walk with your new joint, and to go home. Now you are beginning a period of readjustment. You are now sufficiently stable to return home. For the next six to eight weeks, your new hip will continue to heal. You must balance exercise periods and rest periods. Don’t try to overdo or push yourself beyond the limit of pain!
You will be discharged approximately five to seven days after surgery. Your discharge date will be determined by all of your team members including doctors, nurse clinicians, physical therapists and occupational therapists. Time of discharge is mainly determined by the type of surgery : 3 – 5 days after a BHR resurfacing procedure, 7 – 14 days after a classical total hip replacement and 14 – 21 days after revision surgery. You will be given prescriptions for medications you will need at home. A follow-up appointment will be scheduled. Your follow-up appointments are very important. It is also very important to stay on your walking devices as instructed. You may need some help when you go home. We will assist you in deciding what is needed and in making the arrangements. Some patients need to enter an extended care facility for additional therapy.
If you need such therapy, the social worker and nurse clinician will assist with your arrangements. While you are in the hospital, you may be given a prescription for special equipment for home use to obtain the equipment from your local medical supplier. Our hospital does not provide such equipment for home use.
PREVENTION OF DISLOCATIONS
During your stay at the hospital, a special triangular pillow (called “Jef”)will be placed between your legs after the operation, in order to prevent dislocations. One exception is the BHR resurfacing procedure : a pillow is not necessary because of the intrinsic stability of the prosthesis. It is extremely important to take in mind following precautions during minimal 6 – 8 weeks (except for BHR prostheses), just to prevent dislocations of the hip :
- During sitting, keep in mind that your knees have to be lower than your hips, so avoid deep seats or put a pillow in your seat.
- Avoid crossing the legs. Do not move your operative leg across the midline of your body.
- Do not bend forward at a sharp angle. Maintain an angle of maximally 90°.
- During sitting, keep your legs somewhat outward.
- Do not turn onto your side until physician approval is given.
- Be careful not to twist at the hip. When you turn, be sure to move your entire body around.
A dry aseptic bandage is applied during 2 weeks. The staples of the wound will be removed after 14 days in two sessions during 2 consecutive days, either in hospital or by your physician at home. One day after removing the staples, you are allowed to take a shower. Two days after removal, you can take a bath.
SIGNS OF INFECTION
Signs of infection include redness, swelling and /or drainage at the incision. These signs may be coupled with fever. If you experience one of these signs, contact your general physician or orthopaedic surgeon or go to the emergency service of the hospital.
PREVENTION OF INFECTION AND DENTAL CARE
An infection in another part of your body (lungs, kidneys, mouth, skin, teeth etc.) could possibly spread to the new joint through the bloodstream. Contact your family doctor for general medical problems such as these types of infections. As a preventive measure, you will need to take an antibiotic. You will also require antibiotics before having any other surgical procedure. If you have a dental appointment, contact your dentist to prescribe a preventive antibiotic. Dental care on a regular basis is important to prevent infection.
Swelling (edema) is common following total joint replacement. Some people experience swelling while still in the hospital. Others may notice it once they are home and become more active. Still others never have swelling. Areas most likely to become swollen are the foot, ankle, knee, and at times, thigh. To counter swelling, elevate your feet higher than the heart level while you are lying down. “Toes should be higher than the nose.” Do this during your rest periods for 45 minutes to 1 hour, 2-3 times a day. If swelling does not decrease after sleeping all night and elevating your legs during the day, please contact your family doctor, orthopaedic surgeon or go to the emergency service of your hospital.
ANTICOAGULATION THERAPY (Blood thinner)
Most patients will need subcutaneous injections once a day with Low Molecular Weight Heparine during 3 weeks after the operation, in order to prevent cloth formation in the veins of the leg. Prescriptions are given when discharged from hospital. A nurse will visit you daily to give the injection or you can do it yourself. Other precautions consist of TED stockings during 3 weeks in combination with exercises, learned during your stay in hospital.
Do not sit longer than 30 minutes at a time. You must get up, walk, and change your position. During long car trips, stop at half hour intervals, get out and move around. If you don’t take breaks, you will become uncomfortably stiff and experience swelling, which may lead to blood clot formation.
WALKING WITH CRUTCHES OR AMBULATOR
Do not walk without your walker or crutches until your physician tells you that it is permissible. Although you may feel you can do without these devices, remember that healing is occurring. Healing needs to be protected by the use of a supportive device. Walk frequently, on ground level. Go out of doors if weather permits, or choose a large area such as a shopping mall. Patients with BHR prosthesis are allowed earlier to ambulate without devices.
Stair climbing is allowed in moderation. Follow the directions you have been given for doing these exercise. During the initial weeks at home after your surgery, limit the use of a flight of stairs to one round trip per day.
DRIVING A CAR
You may drive a car in approximately 4-6 weeks after your release from the hospital, but only drive if you can completely control your operative leg.
Do not participate in any sports during the first three months after your release from the hospital, in case of a classical total hip prosthesis. Sports activity may eventually include golfing, swimming, bowling, bicycling, and dancing. Please ask about other sports in which you are interested. Do not use exercise equipment, whirlpools, or spas until approved by your physician.
In case of BHR resurfacing procedure or ceramic-on-ceramic couples, higher levels of activity and intensity of sports are allowed, but always discuss this first with your surgeon. In case of BHR, very quick return to sport activities is allowed!
Do not use a water bed for the six to eight weeks following your surgery or until given approval by your doctor.
SEXUAL ACTIVITY FOLLOWING TOTAL HIP ARTHROPLASTY
Many patients and their partners experience a great deal of anxiety with respect to sexual activity following total hip arthroplasty. This section is designed to address these issues and, hopefully, allay your anxieties.
- What effect will total hip arthroplasty have on sexual relations? Patients undergoing total hip arthroplasty generally have a great deal of preoperative pain and stiffness, which not only interferes with their ambulatory ability but also with their ability to have enjoyable intercourse. Total hip arthroplasty will alleviate a significant amount of the pain and stiffness and, therefore, assist patients to enjoy comfortable intercourse.
- When should total hip arthroplasty patients resume sexual intercourse? The soft tissue envelope about the hip, namely the skin incision and the muscular elements, require approximately four to six weeks for satisfactory healing. Therefore, it is generally safe to resume sexual intercourse in approximately four to six weeks following surgery. However, patients who have a totally unremarkable and uneventful postoperative course with little to no hip pain or patients with a BHR resurfacing procedure may resume sexual activity at an earlier time.
- What positions are safe and what precautions should be followed during sexual intercourse? Total hip arthroplasty precautions have been outlined to you by your surgeon, nurse, and/or physical therapist. These precautions should be followed in all activities of daily living. Remember to avoid excessive hip flexion (bending), adduction (movement of the leg toward the midline), and internal rotation (inward rotation of the leg). Certainly combination moves such as bending and twisting of the leg should be avoided. It is generally advised that the patient assume the more passive role of being in the “bottom position”. As the hip heals, the patient may assume a more active role. After several months following arthroplasty, the patient can resume sexual activity in any comfortable position.
- What should be told to your partner? Your partner should be advised with respect to hip precautions and should have an understanding of the effect of excessive flexion, adduction and rotation. Communicate openly and freely with your partner with respect to your level of comfort, your concerns and your anxieties.
- Sex following total hip arthroplasty is possible and can resume quickly provided you are aware of your hip precautions and avoid excessive combination manoeuvres. Initially, the “bottom position”, maintaining your legs abducted (spread apart) and slightly flexed will be the most safe and comfortable position, which will also require the least energy expenditure for you, the patient. As you progress further from your hip arthroplasty, you will be able to pursue a more active role in sexual intercourse. Remember, if there are any questions or concerns that you or your partner may have, feel free to query your surgeon, nurse and/or physical therapist.
- In case of BHR procedure, all these precautions are of less importance because of the intrinsic stability of the prosthesis and faster rehabilitation process.