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    Total Hip Replacement: Caring for Yourself at Home

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    This guide provides you with precautions about sitting and moving safely and illustrations to help you perform your daily exercises.

    When you are at home, be sure to exercise your new hip while maintaining the precautions shown by your therapists.

    What is the Focus of Rehabilitation?
    The focus of our rehabilitation program at California Pacific Medical Center is to make you as independent as possible in your daily life activities. The following guidelines have been developed by therapists and your medical team to ensure your best possible recovery. It is important to follow these guidelines to experience a successful recovery from your total hip replacement surgery. If you have any questions, do not hesitate to ask the doctors, nurses, and therapists caring for you.

    Your Hip Precautions
    In our rehabilitation program, you will learn how to protect your new hip using 3 important hip precautions. Be sure to follow these hip precautions closely for the first 6-12 weeks after surgery. Following these hip precautions will help prevent dislocation of your new hip from your hip socket and ensure proper healing.

    Note: Dislocation is a potential complication after total hip replacement surgery. Some of these precautions will have to be followed by you indefinitely to protect your new hip over time. You and your doctor will discuss the length of time you need to follow these precautions.

    Going Home

    This guide provides you with precautions about sitting and moving safely and illustrations to help you properly perform your daily exercises.

    Many patients go home 3-4 days after their surgery. You and your surgeon will decide what is best for you. Usually, you will be discharged if:

    1. You know the signs of surgical complications.

    2. You know all the medications you are taking, their purpose and possible side effects.

    3. Your physical and occupational therapists have confirmed that you can complete a variety of daily activities while maintaining your hip precautions:

      • Get in and out of bed by yourself.

      • Walk on your own at least 50 feet with your walking device.

      • Bathe and dress yourself using special tools without help.

      • Use the toilet or commode without help.

      • Stand for 10 minutes at a counter or sink to do simple tasks by yourself.

      • Be able to get in and out of the bathtub or shower safely and correctly based on your home bathtub/shower.

      • Climb up and down 12 stairs with help standing by (if you have stairs at home).

      • Get into and out of a car with help.

      • Be able to do your home exercise program as instructed by your therapist.

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    Precautions

    To practice safe movement until your hip replacement has fully healed, you will need to take several precautions to avoid dislocating your hip:

    1. Do not bend your operated hip beyond a 90° angle.

    2. Do not turn your operated leg inward in a pigeon-toed position.

    3. Do not cross your operated leg.
    This section provides reminders about proper positions when sitting, standing and lying down. Let your therapist or your doctor know if you have questions about these precautions.

    Sitting:
    • Sit in raised seats (2 pillows) or on a raised toilet seat/commode with armrests.

    • Reach back for the arm rests of the chair with both hands. Bring the operated leg forward and slowly lower into the chair or raised toilet seat/commode.

    • Do not lean forward. Your shoulders should stay behind your hips.

    • Do not raise your knee higher than your hip while sitting. Sit with the operated leg forward.

    Do Not Bend Down at the Waist to pick items off the floor.

    • Use a long-handled reacher or other adaptive aid to pick items off the floor.

    Do Not Twist Your Torso Inward when Lying, Sitting or Standing.


    Do Not Turn Your Operated Leg Inward in a Pigeon-Toed Stance.

    • Keep this in mind when standing and lying down.

    Do Not Cross Your Operated Leg or Ankle Over Your Non-Operated Leg.

    • While sleeping or lying in bed, keep a pillow between your legs to prevent hip dislocation.

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    Activities of Daily Living

    Before you leave the hospital, you must meet the goals set by your physical and occupational therapists. They will prepare you for activities of daily living and instruct you on the best ways to move about. The following illustrations will help you maintain your hip precautions when you go home.

    Lying in Bed

    • Lie on your back with a pillow wedge or 2 pillows between your knees. Do not allow your operated leg to cross the middle of your body.

    • You may lie on your non-operated side with the pillow wedge or with 2 or more pillows between your legs to prevent crossing your legs.



    Getting Out of Bed
    • Slide your legs toward the edge of the bed, keeping operated leg with knee straight and toes pointed up.

    • Push up onto your forearms.

    • Push up onto your hands.

    • Slide legs so your heels are over the edge of the bed.

    • Scoot your hips forward until both feet are on the ground.

    • Make sure you are not bending forward and that your operated hip is not turning in.


    Getting Into Bed
    • Sit on the edge of the bed with both feet on the ground. Make sure you are not bending forward and that your operated hip is not turning in.

    • Bearing weight on your hands, scoot your hips backward onto the bed. Keep your shoulders back.

    • Lower yourself onto your forearms.

    • Carefully slide your legs onto the bed, keeping operated leg with knee straight and toes pointed up.


    Standing
    • Move your operated leg forward and push off the arm rests of the chair to stand up.

    • Once you have your balance, reach for the walker.


    Using a Walker to Begin Walking, be sure to:
    • Move the walker first.

    • Then, move the operated leg forward.

    • Push down on your hands when you step forward with your non-operated leg.

    • Do not turn (pivot) on your operated leg. Instead, pick up your feet and turn using several small steps.

    • Land on your heel and push off your toes when walking (a heel/toe pattern of walking). Take an equal number of steps with each foot. Make each step the same length.

    • Lean your back against the wall for support if you stop to talk with someone or if you become tired.

    • Frequent, short walks are recommended.


    Dressing:
    Your occupational therapist will instruct you in the use of adaptive equipment to assist you with dressing within your hip precautions.
    • Avoid bending forward when putting on pants, socks and shoes.

    • Do not cross your legs when putting on pants, socks and shoes.

    • Putting on your pants: Put the operated leg into the pant leg first. Then put the non-operated leg into the other pant leg using a reacher or dressing stick.

    • Removing your pants: First, remove the non-operated leg from the pant leg. Then, remove the operated leg from the other pant leg using a reacher or dressing stick.

    • Keep your back touching the back of the chair.

    • Tying your shoes: Use elastic shoelaces or slip-on shoes.
    Homemaking
    • Sit for rest breaks as needed.

    • Slide objects along the countertop rather than carrying them. Use a utility cart with wheels to transfer items to and from the table.

    • Attach a bag or basket to your walker or wear a fanny pack to carry small items.

    • Use a long-handled reacher ("grabber", "pick-up stick") to reach objects on the floor.

    • Remove all throw rugs and long electrical cords to avoid tripping in your home.

    • Watch out for slippery/wet areas on the floor.



    Bathing or Showering
    You may shower when approved by your doctor. You and your occupational therapist will discuss the correct technique to step into your shower stall or bathtub at home. We recommend that you install a hand held shower hose, which better enables you to bathe below your waist.
    • If you do not have non-skid strips glued to the floor of your shower stall or bathtub, carefully place a non-skid rubber bath mat on the floor of the stall or tub. Before starting the water, be sure that the suction cups on the underside of the mat are pushed down against the floor of the tub or stall.

    • Do not sit on the bottom of the bathtub to bathe during the time you are following your hip precautions. Moving in and out of this position causes too much bending of your new hip.

    • Use liquid soap to avoid dropping a bar of soap and flexing hip to retrieve it off the floor while showering.

    • A long-handled bath sponge will help in bathing below the knees.

    • During the first few showers at home, we recommend that you shower no longer than 10 minutes, using lukewarm water and keeping the bathroom well ventilated.

    • If needed, your therapist will discuss how to cover your incision for bathing.


    Climbing Up Stairs
    • Use a hand rail (if available) to climb stairs.

    • Lead with your non-operated leg, then your operated leg, and finally your crutches or cane.

    • A family member should stay one step below, standing on your operated side, when helping you climb stairs.


    Going Down Stairs
    • Use a hand rail (if available) to go down stairs.

    • Lead with your crutch or cane, followed by your operated leg, and finally your non-operated leg.

    • A family member should stay one step below, standing on your operated side, when helping you go down stairs.


    Getting Into a Car
    • Be sure the passenger seat is pushed all the way back.

    • Recline the seat back as far as possible.

    • With your walker in front of you, slowly back up to the car seat.

    • Sit on the car seat.

    • Swing your legs into the car. Lean back if you need to avoid bending at the hip more than 90°.

    • When traveling, make frequent stops and get out and walk around.
    Getting Out of Car
    • Push the seat all the way back.

    • Recline the seat all the way back.

    • Lift your legs out. Lean back if you need to avoid bending at the hip more than 90°. Place the walker up in front of you and stand up on the unaffected leg.

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    Understanding Your Medications

    • Your doctor will usually order a pain medication when you go home.

    • If you are told to take the pill(s) as needed for pain, try to take them before doing exercises and before your therapy appointments. If the pain medication does not control your pain, please let your doctor know.

    • Constipation is a common side effect. A stool softener or mild laxative, fluids and activity can all help.

    • Some medications may be expensive and insurance coverage varies. Let your doctor know if you have difficulty filling your prescriptions. There may be alternative medications that are less expensive.

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    Recognizing Danger Signals

    Call your doctor before your next appointment if you have any of the following symptoms:

    • Increasing pain in your new hip

    • Persistent or increasing pain or swelling in your calf or leg

    • Redness, heat, or drainage at the surgery site

    • Fever of 101°F or higher

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    Caring for Your Surgical Incision

    • Keep your incision clean and dry until all the staples or stitches are removed.

    • If you have staples or stitches, they will be taken out about 10-14 days after your surgery. Your doctor, a nurse or therapist will remove the staples or stitches.

    • Do not apply cream or ointment to the staples or stitches unless instructed to do so by your surgeon.

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    About Your Diet

    • A balanced diet is important for your general health and healing.

    • After hip replacement surgery, you should resume your regular diet.

    • Be sure to ask your nurse if you would like information about what foods you can eat to prevent constipation.

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    Tips for Your Recovery

    Caring for Your Hip When in Bed

    • Pump your ankles up and down 10 times every 2 hours to maintain good blood flow (circulation) to your lower legs.
    Caring for Your Hip During the Day
    • Avoid sitting and/or standing for long periods (no more than 30 minutes in one place). Changing position frequently will increase blood flow, decrease joint stiffness, and decrease post-operative leg swelling.

    • To decrease pain, inflammation and swelling, ice can be placed on your hip for 15 - 20 minutes every hour or as tolerated.

    • You must follow hip precautions during sexual activity.
    Caring for Your Hip at Home
    • Ask your doctor when:

      • You can take a shower.

      • You may start to drive.

      • Your staples will be removed.

        Note: Check with your doctor to see how long you should follow your hip precautions.
    • Beginning Your Home Exercise Program:
      An important part of your recovery is following a home exercise program. When muscles are not used, they become weak and do not work as well in supporting and moving the body. Surgery can correct the hip problem, but the muscles will remain weak unless you strengthen them with regular exercise. To start the home exercise program, your therapist will teach you how to perform these exercises. Do your home exercise program as prescribed by your physical therapist.

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    Exercises

    Your therapist will show you how to do your exercises and will tell you how often to do them (indicated by "X" below).

    Ankle Pumps
    Bend ankles to move feet up and down, alternating feet.
    Repeat "X" times. Do "X" sessions each day.



    Quad Sets
    Slowly tighten muscles on thigh of straight leg while counting out loud to "X".
    Repeat with other leg to complete set.
    Repeat "X" times. Do "X" sessions each day.



    Gluteal Squeezes
    Squeeze buttocks muscles as tightly as possible while counting out loud to "X".
    Repeat "X" times. Do "X" sessions each day.



    Heel Slides
    Make sure bed is flat.
    Bend knee and pull heel toward buttocks.
    Do not bend hip more than 90°.
    Hold for "X" seconds. Return. Repeat with other knee to complete set.
    Repeat "X" times. Do "X" sessions each day.



    Short Arc Quads
    Place a rolled towel under your knee. Raise the lower part of your leg until your knee is straight. Hold for "X" seconds.



    Hip Abduction
    Keep your toes pointed toward the ceiling. Move your leg out to the side as far as possible. Slowly return to the starting position and relax.



    Long Arc Quads
    Straighten operated leg and try to hold it for "X" seconds.
    Repeat "X" times. Do "X" sessions each day.

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    More Ways to Learn

    Visit the Community Health Resource Center at 2100 Webster Street, San Francisco, (415) 923-3155. Services include classes and written information on a wide variety of health topics.


    Produced by the Center for Patient and Community Education in association with the Department of Outcomes Management and the Communications & Marketing Department at California Pacific Medical Center. Last updated: 2/09

    Illustrations by: Troy Paiva


    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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