Contents

PART I: hip Replacement This section contains general information you will need to fill out as well as tasks to complete prior to surgery. It also contains checklists and reminders for you.

What Is a Hip Replacement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4The Process at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Joint Replacement Program Orientation Session . . . . . . . . . . . . . . . . . . . . 6Hospital Preop Clinic Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Important Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8General Hospital Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Medical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Packing for the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Part II: Patient Guide to Hip Replacement Surgery This section explains the surgical process—from the day of admission to the day of discharge.

Surgery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Understanding the Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14The Night before Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15The Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16The Remainder of Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . . 17Physical Therapy and Occupational Therapy . . . . . . . . . . . . . . . . . . . . . . 18General Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Total Hip Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Physical Therapy Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Self-Care after Hip Replacement Surgery . . . . . . . . . . . . . . . . . . . . . . . . 26Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29After Discharge from the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Living with Your New Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

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Part I:A Joint Approach

HipReplacement

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Part

I

A hip replacement is a surgical procedure in which a hip joint that is worn out

or injured and painful is replaced with an artificial joint . The surgery will benefit you by reducing hip pain, increasing leg strength, and providing easier movement .

How long will the surgery take?The surgery will take about two hours .

How is the hip replaced?The orthopedic surgeon makes an incision down the side or in front of the hip and removes the damaged joint . The surface of the old socket is smoothed, and the new socket is put into the pelvis . The surgeon then inserts the new ball-and-stem component into the head of the femur (thighbone), and the new ball and stem are joined with the socket .

Healthy hip Arthritic hip Hip replacement component

Acetabulum

Femur

Femoral component

Acetabular component

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WHAT IS A HIP REPLACEMENT?

THE PROCESS AT A GLANCE

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Outlined below is an overview of the process of having total joint

replacement surgery . This summary is to help you understand the general progression of events and the stages of the surgical and recovery process .

1 . You and your doctor have agreed that you need surgery . Understanding what is happening to you will make your hospital visit more pleasant and improve your recovery .

2 . Your doctor’s office obtains medical clearance for surgery .

3 . You must read all the educational information provided by your doctor and the hospital . The information in this Hip Replacement Handbook is for you to read prior to surgery; it will help you understand what will happen once you come to the hospital .

4 . You may attend the Joint Replacement Program orientation session . A preop clinic session will be scheduled at the hospital . A date and time will be set and communicated to you by the hospital scheduling office .

5 . On the day of surgery, come to the hospital at the time reserved for you .

6 . Have surgery .

7 . Begin recovery and rehabilitation in the hospital .

8 . Be discharged from the hospital .

9 . Take care of your new joint . Go to all appointments set or suggested by your doctor .

A partnership among you, the orthopedic surgeon, the hospital, and your support team is vital to the success of the surgery . As a partner you need to be informed and knowledgeable about every aspect of the surgical and recovery process . Your understanding, participation, and commitment are important to the success of the procedure .

Please bring this handbook with you to all of your related appointments as well as to the hospital on the day of surgery . You may receive various instructions, information booklets, and copies of forms as well . That information should be kept in this handbook . It is important that you have at your fingertips all the information you require when you need it .

Our goal is to help you have good results, and we are committed to assisting you on this successful journey .

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T he Joint Replacement Program coordinator will call you to schedule an educational session to review the equipment you will need after surgery, how to prepare your home for the

equipment, what to expect during your hospital stay, and the role of physical therapy in your recovery .

JOINT REPLACEMENT PROGRAMORIENTATION SESSION

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JOINT REPLACEMENT PROGRAM ORIENTATION SESSION

The Joint Replacement Program Coordinator will call you during the week, prior to your session, with classroom location

East Barnett Road

Siskiyou Blvd.

Blac

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Mur

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Road

Med

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CardioPulmonaryDiagnostics

Cardiac andPulmonary Rehab

Emergency Parking

Security

NorthElevators

PatientRegistration

Rambling Rogue Café

Ground Floor

SouthElevators

Cath Lab and PediatricAssessment Clinic

WAIT AREA

Cath Lab

Cath Labs

CardiovascularRecovery

DubsLibrary

WestElevators

Gi� Shop

Short StaySurgery

ImagingServices

LaboratoryServices

InfusionServices

Endoscopy

NICU

Pediatrics

FamilyBirthCenter

Lab Outpatient ServicesPre-Surgery Clinic

Emergency Entrance

ATM

SpiritualCare

Mustard Conference Room

Rogue Credit UnionConference Room

VolunteerServices

Administration

Emergency

MainEntrance

EmployeeHealth

Family Birth Center and Women’s Services Overflow

Cashier

Patient Experience Conference Room

ICU Elevators

WestBuilding

SouthBuilding

EastBuilding

NorthBuilding

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HOSPITAL PREOP CLINIC SESSION

Before having joint replacement surgery, you will attend an orientation session

that is designed to provide you and your caregiver with important information to make your surgery and recovery successful . The orientation session will last about two hours . You may have your hospital preop clinic session on the same day or return another day to complete the process . This is set and communicated to you by the hospital scheduling office .

What will I do at the orientation session?Please bring this handbook to the orientation session . You will be given a DVD to take home and watch . The DVD is designed to provide you with information about anesthesia, post-op exercises, precautions, and infection prevention . Please bring it back when you

return for surgery and give it to one of the nurses or certified nurse assistants .

• Snack food, juice, coffee, and water will be provided during the orientation session .

• In this classroom setting, you will meet with members of your health-care team:n A nurse will review information

regarding your hospital stay, answer any questions you may have, and discuss equipment you may need and where to obtain it . The nurse will also discuss the occupational therapy role in your rehab .

n A physical therapist will briefly outline the therapy you will undergo after surgery .

REGISTRATION• On the day of your scheduled hospital

preop clinic session, you will meet with an admissions representative to complete your registration paperwork . This may or may not be on the same day as the orientation session .

PREOP CLINIC• You will meet with a registered nurse, who

will review your current medication list, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements .

• You will have lab tests drawn, an electrocardiogram (EKG), and any other tests your physician has ordered .

• You will meet with a nurse practitioner, who will discuss your options for anesthesia

and review your medical history, allergies, and medications . You will be instructed as to which medications to take the morning of surgery .

WHAT TO BRING• Insurance/Medicare cards• Identification• This Hip Replacement Handbook . Please

complete the medical information on page 10 or bring a printed medication list if you already have one . Be sure to include prescription and over-the-counter medication s as well as any vitamins or herbal supplements you take . Include doses and how often you take them .

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Please feel free to make photocopies of this completed page and share them with yourfamily, friends, and caregivers .

EMERGENCY CONTACT PERSONName ________________________________________________________________________________Relationship __________________________________________________________________________Home phone _________________________________________________________________________Cell phone ___________________________________________________________________________

PHYSICIAN INFORMATIONSouthern Oregon Orthopedics, Inc .2780 East Barnett Road, Suite 200 Medford, OR 97504Telephone: (541) 779-6250

Physician name _______________________________________________________________________

HOSPITAL INFORMATIONAsante Rogue Regional Medical Center2825 East Barnett RoadMedford, OR 97504 Telephone: (541) 789-7000 or (800) 944-7073Primary contact: Joint Replacement Program coordinator Telephone: (541) 789-7548

ASANTE ORTHOPEDICS AND SPORTS MEDICINE Asante Rogue Regional Medical Center, fifth floor, Nurses’ Station C2825 East Barnett RoadMedford, OR 97504Telephone: (541) 789-7530

IMPORTANT TELEPHONE NUMBERS

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GENERAL HOSPITAL INFORMATION

PARKING AT THE HOSPITALPatients are encouraged to use the valet parking service located at the North Lobby Entrance facing Siskiyou Boulevard . This free service is available from 7 a .m . to 5 p .m .

VISITING HOURSYour caregiver or family member may stay with you, if you desire, and may be an active participant in your recovery .

Please inform the Joint Replacement Program coordinator if you wish for your caregiver to stay overnight . Most of our rooms have a couch that converts to a single bed, and we will make every effort to accommodate you .

Post-surgery therapy is very important to your recovery . In an effort to avoid interrupting your therapy sessions, please advise your visitors that they may remain during these sessions but that the therapist will continue the treatment; your visitors will be asked to wait until the therapy session is finished .

DIRECTIONS TO THE HOSPITAL

Map is not to scale.

I-5

Exit27

Siskiyou Blvd.

East Barnett Road

Hig

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Garfield St.

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ASANTE ROGUE REGIONALMEDICAL CENTER

Med

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Parking

Parking

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MEDICAL INFORMATION

Please fill out unless you already have this information completed. If you do, please attach a copy.

Do you have any allergies? If so, please list what you are allergic to and your reaction:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List all prescription medications are you taking, including strength and amount:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List all over-the-counter medications you take, including vitamins and herbal supplements, e .g ., aspirin, Tylenol, Motrin, glucosamine, chondroitin, MSM (methylsulfonylmethane), saw palmetto, fish oil, and flax seed oil:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What pharmacy do you use? _______________________________________________________________________________Your prescriptions must be filled at a local pharmacy rather than at the hospital.

Have you had surgery before? If so, what surgery have you had and when? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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PACKING FOR THE HOSPITAL

THINGS TO BRING TO THE HOSPITAL •This Hip Replacement Handbook•CPAP machine if you have and use one•DVD• Ice machine if you have purchased one•Comfortable attire for exercise

if you desire, or you may wear hospital attire

n Shoes that you can slip in and out of easily, such as tennis shoes,

walking shoes, or slippers as suggested by the nurse during the orientation session; no high heels n Socks/undergarments if you desire

(not required) n Loose clothing, such as shorts and

T-shirts (elastic waist only)•Knee-length nightgown and a

robe that opens all the way down, if desired (not required)

•Toiletries (be sure to include eyeglass case, contact lens case, hearing-aid batteries, and other necessities)

•Cell phone, if desired (there are phones available for each patient for local calls)

•A minimal amount of money—no more than $5 or $10 (unless you need money for transportation at discharge)

•Walker (you may bring yours to the hospital if you desire, and the therapist will check for correct height and good repair status)

THINGS WE ASK THAT YOU DO NOT BRING • Medications unless requested by the

nurse practitioner . This is for your safety .• Valuables, jewelry, credit cards, insurance

card, and large amounts of cash . A wedding ring will be covered with tape for surgery if you decide to leave it on; all other jewelry must be removed . Please be aware that if your hand swells and it is deemed unsafe, we may need to cut off a wedding ring .

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NOTES

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Part II:A Joint Approach

Patient Guide toHip Replacement

Surgery Part

II

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SURGERY INFORMATION

Your surgery has been scheduled for a specific date and time, but sometimes

it is necessary to change your arrival time to the hospital due to circumstances over which we have no control . If the surgeon has a cancellation, for example, the lineup has changed since you were scheduled, or there is an emergency, your surgery and arrival times may be changed .

To enable us to maintain the schedule as efficiently as possible, a nurse from the hospital preop clinic will call you the day before your scheduled surgery if the times have changed . If you do not receive a call, please come at the time given to you at the preop clinic session .

What kind of anesthesia will I have?This depends on the type of surgery, your health history, and what the anesthesiologist feels is best for you .• Spinal anesthesia is given through a

catheter that the anesthesiologist inserts into your spinal column . It numbs from the midchest to the toes . You will be asleep during the operation .

• General anesthesia is given through an intravenous (IV) line or by breathing from a mask . It is like a deep sleep that happens very quickly .

• Other medications for pain and relaxation will be given .

UNDERSTANDING THE RISKS

As with any major surgery, there are certain risks . This section outlines

some of the common complications associated with hip replacement surgery and the precautions you can take to help prevent them .

INFECTIONWith any surgery there is a risk of infection . Presurgery test results will affirm that you have no active infections, and antibiotics administered to you before and after surgery will further help prevent infection .

BLOOD CLOTSWith hip replacement surgery, circulation is impaired during the healing process . To counter this effect and promote circulation, you may be asked to pump your feet and exercise your ankles following surgery and during your recovery . While in the hospital, you will wear pneumatic air socks on both legs while in bed; these help prevent blood clots . A blood-thinning medication

that helps prevent blood clots will also be prescribed for you . Each day in the hospital, blood may be drawn to check levels .

PNEUMONIATo help prevent pneumonia, you may be asked to either use an incentive spirometer or take several very deep breaths to prevent fluid from pooling in your lungs . For the same reason, it is important to get out of bed often . Breathing deeply after surgery and using an incentive spirometer are important measures to prevent congestion in the lungs, which can lead to pneumonia .

BLADDER INFECTIONSBladder infections may also occur, especially if you had a catheter . It is important to drink plenty of fluids to help prevent infection . If a catheter is placed, it will be removed the first day after surgery .

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NUMBNESSYou will experience some numbness on both sides of your hip following surgery . This is normal and should not be cause for concern . During surgery the nerves around the hip are disturbed; as these nerves heal, you may experience tingling sensations . You may have permanent numbness in the area around the incision, but this will not affect the function of your new hip . In only rare situations is there permanent numbness or weakness in the hip as a result of trauma to a nerve .

DISLOCATION OF THE PROSTHESISThere are certain positions and activities associated with some surgical approaches that are dangerous to the safety of your new prosthesis, especially for the first few months . You will be informed after surgery if you have these precautions .

The physical therapist will teach you how to sit, rise from sitting, and turn onto the unoperated side safely; the therapist will also discuss precautions you should take . See pages 19 and 28 for the general hip dislocation precautions . If these precautions are applicable to you, the occupational therapist will help you incorporate them into your activities of daily living .

SEVERE COMPLICATIONSAs with any major surgery, there is the possibility that any of the foregoing complications, as well as complications from the anesthesia, could be severe enough to result in death . If you have any questions or concerns regarding complications, please discuss them with the orthopedic surgeon .

Understanding the Risks continued

THE NIGHT BEFORE SURGERY

We recommend that you eat a light meal the night before

surgery . Unless the anesthesiologist, nurse practitioner, or registered nurse tells you otherwise, you should have nothing to

eat or drink after midnight . This includes but is not limited to water, coffee, food, and any kind of gum or mints . If you have any questions, please call the Joint Replacement Program coordinator .

THE DAY OF SURGERYBEFORE COMING TO THE HOSPITAL• Unless told otherwise, do not eat or drink

after midnight before surgery . You can brush your teeth and rinse your mouth, but do not swallow .

• Take only the medications that the doctor or nurse practitioner has told you to take, using just enough water to swallow them .

WHEN AND WHERE TO REPORT You will be given a specific time to arrive at the hospital . We recommend that you use the free valet parking at the North Lobby Entrance, which opens at 7 a .m . From the North Lobby, walk to the surgery wait- ing area on the left, located next to the gift shop . If an Auxiliary volunteer is at the desk, give him or her your name . If no one is at the desk, pick up the red phone, and you will be given instructions . Someone will escort you to the area where you will be prepped for surgery .

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THE DAY OF SURGERY continued

ONCE YOU ARRIVE AT THE HOSPITAL• A nurse will complete your paperwork and

finish the orders your doctor has written . You will have one or two IV lines started . You may have additional lab work done as ordered by your doctor .

• An orderly will come with a gurney to bring you to a holding area or directly to the operating room (OR) .

• If you are wearing dentures, hearing aids, socks, or jewelry, please remove them unless arrangements have been made to keep them with you . You will be given a hat to cover your hair .

• The OR is bright and noisy . We can provide you with a warm blanket . The OR nurse will be with you throughout the surgery . There will also be an anesthesiologist, a scrub nurse or technician, and an assistant for the surgeon .

When the surgery is over, you will be taken to the Post-Anesthesia Care

Unit (PACU) . You will be cared for by specially trained registered nurses, who will monitor your vital signs (heart rate, blood pressure, and temperature) and pain level . A good indication of how much pain you may be experiencing can be determined on a scale of 0 to 10, with 0 being no pain and 10 being the highest level of pain .

Your family is encouraged to stay in the waiting area outside of surgery if they wish to speak with the surgeon after the surgery is over . A volunteer will escort them to a private room, where the surgeon will apprise them of your condition . Family members are not permitted in the PACU, but you can see them when you return to your room on the fifth floor .

You will be in the PACU for one to two hours, depending on the type of anesthetic you had and how you are feeling . The nurses will keep you warm and comfortable .

EQUIPMENT YOU MAY SEE WHEN YOU WAKE UP Intravenous Line An IV line is a tiny catheter that is inserted into a vein in your hand or arm . Attached to the catheter is a small tube that connects to a bag of fluid . The bag will hang from a pole near your bed .

OxygenYou will receive oxygen through a nasal cannula or an oxygen mask . The presence of oxygen does not mean that there is a problem or that you are having difficulty breathing . The nursing staff will check your oxygen levels with a finger sensor . Foley Catheter This tiny catheter is inserted into your bladder to drain your urine . If a Foley catheter is used, it will remain for a day or two .

AFTER SURGERY

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AFTER SURGERY continued

Blood Retrieval System If the surgeon advises, there may be a drainage tube inserted into your hip through two sites next to the incision . The purpose of the tube is to capture blood draining from your hip, filter it, and return it to your bloodstream through the IV line, unless you do not want to receive it . This is a closed system, and the blood is reinfused for only six hours after surgery . At that time it becomes a collection chamber only and will be removed on the second day .

Abduction PillowIf ordered by the surgeon, you will have a soft, triangle-shaped foam pillow that straps between your legs and is secured with Velcro . If you have hip precautions, you may wake up with this between your legs . At your doctor’s recommendation, the pillow will be used to keep your legs in the correct position when you are turning in bed or sleeping . You will be turning with pillows between your legs when you go home .

THE REMAINDER OF YOUR HOSPITAL STAY

• For safety reasons the staff will ask you to repeat your name and birthday before any procedure or medication .

• The nursing staff will closely monitor your heart rate, blood pressure, temperature, and oxygen level .

• The staff will ask you to rate your pain on a scale from 0 to 10 . This enables the nurses to assess the effectiveness of the pain medication .

• You will have a large dressing after surgery to keep the wound clean and absorb any fluid . Two days after surgery, this will be changed to a small dressing, and any drains will be removed .

• You will have an IV line in your hand or arm for fluids until you are taking them well by mouth . At that time the IV site will be capped; it will be removed before you are discharged .

• After surgery you will be given ice chips, then water, clear liquids, and full liquids . The nursing staff will monitor you for nausea and provide medication as needed . If you are not nauseated and have good abdominal sounds (as determined by the nurse), you will progress to solid food and a normal diet .

• The nursing staff will monitor your oxygen levels using a finger sensor . You may have oxygen on the night of surgery through a nasal cannula . This will be discontinued when you can maintain good oxygen levels on room air .

• Lab work will be drawn early every morning or every other morning, depending on your doctor’s orders .

• You will wear pneumatic air stockings on both legs while you are in bed . These assist the blood flow back to your heart and help prevent clot formation and blood pooling in your legs .

• If you would like to turn onto your side, please use the nurse call system so that staff may assist you .

• Please ask nursing staff, therapists, your doctor, the discharge planner, or the Joint Replacement Program coordinator any questions that may arise . We are here to help you .

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LEVEL IPhysical Therapy• Lying exercises: ankle pumps, quad sets,

gluteal sets, short-arc quads, hip abductions, and heel slides (active/passive)

• Instruction regarding position precautions and weight-bearing restriction

• Bed mobility and transfer training• Walking with walker, as tolerated

LEVEL IIPhysical Therapy• Lying exercises: ankle pumps, quad sets,

gluteal sets, short-arc quads, hip abductions, and heel slides (active/passive)

• Review of position precautions and weight-bearing restriction

• Progress transfer training, including a toilet transfer

• Progress walking, including to the bathroom with staff (if safe) and stair training (if able)

Occupational Therapy• Evaluation of activities of daily living

(ADLs) and home needs, incorporating the appropriate hip precautions for your type of surgery

• If needed, instruction and practice in the use of lower-extremity adaptive devices

• Toilet transfer training and recommendation of appropriate durable medical equipment (DME) for home setting

• Instruction in upper-extremity strengthening program, as needed

• Review of ADL procedures; patient handout provided

LEVEL IIIPhysical Therapy• Lying exercises: ankle pumps, quad sets,

gluteal sets, short-arc quads, hip abductions, and heel slides (active/passive)

• Reinforcement of position precautions and weight-bearing restriction; patient handout provided

• Progress transfer training• Assess need for a leg-lifter, and issue if

needed• Progress walking toward goal of 200 feet;

practice stair climbing• Instruction in car transfers and assisting

patient into car at time of discharge if you have hip precautions

Occupational Therapy• Issue self-care devices and reinforce

proper use • Practice shower/tub transfer and

recommend needed DME• Reinforce hip precautions with general

patient-specific ADLs• Reinforce upper-extremity strengthening

program• Provide caregiver training in adaptive

devices, equipment needs, and home accessibility and safety (if needed)

Nursing • Sit in a chair for meals and walk to

bathroom with staff

FREQUENCY OF TREATMENTPhysical therapy: Twice a dayOccupational therapy: Once a day, usually one to two treatments

Note: Additional visit needed only if problems with learning are present .

PHYSICAL THERAPY AND OCCUPATIONAL THERAPY

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The time frame for healing will vary, depending on the type of surgery, the approach used, and the individual . Whether you have hip precautions depends on the surgical approach and muscle involvement used by the surgeon . If you have precautions the therapist will instruct you in them . Your body needs to heal around your new hip to provide proper support and control of leg movement .

FOR THE DIRECT INTERIOR (FRONTAL) APPROACH• Do not extend the hip by stepping backward with the operated leg .• Do not allow the operated leg to turn outward .

FOR THE LATERAL OR POSTERIOR APPROACH (SIDE OR BACK)If you move your hips beyond the limits of motions set by the surgeon, your new hip could dislocate . The surgeon will tell you how long you must follow these precautions .

Hip precautions include the following.• Do not bend your hip more than

90 degrees. Your knee on the operated leg should come no closer to your chest than 90 degrees . This means no reaching farther than your knees .

• Do not cross your legs at the knees or ankles . Do not allow your knees to come together while sitting or lying in bed . When lying on your side or sitting, place a pillow between your legs .

• Do not rotate the operated leg inward or outward to extremes . When turning, do not pivot; take small steps to turn .

GENERAL PRECAUTIONS

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Do exercises three times per day, 10 repetitions each, to start . Gradually increase to three sets of 10 repetitions each .

TOTAL HIP EXERCISES

LYING SUPINE

Ankle Pump Quad Set

Short-Arc QuadGluteal Set

Heel SlideHip Abduction

Move your foot back and forth as if pressing on a gas pedal .

Tighten muscles on top of the thigh by pushing the knee down . Hold for 5 seconds .

Squeeze bottom together . Do not hold breath . Hold for 5 counts .

With knee bent over a bolster, straighten knee by tightening muscles on top of the thigh .

Keeping your toes pointed at the ceiling, slide the operated leg out to the side as far as possible . Return to starting position .

Slide heel up toward bottom . Hold for 3 seconds, then slide heel down .

Routine for: Created by:

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TOTAL HIP EXERCISES continued

SteppingHip Extension (backward movement)

Sitting slumped, straighten your knee and hold for 5 seconds . Return knee to bent position .

Stand while holding on to a counter or table . Slowly raise leg out to the side, keeping toes pointed straight ahead .

Stand while holding on to a counter or table . Lift leg backward with knee straight; avoid leaning forward .

Stand while holding on to a counter or table . Slowly raise knee as if to lift your leg onto a step, keeping your hip bent less than 90 degrees .

Hip Abduction (sideways movement)

Long-Arc Quad

SEATED AND STANDING

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Physical Therapy Visit Log

Date AAROM PROM Swelling (mild/moderate/severe)

Gait Assist Level/Device Wound Health Comments

This tool is used to document your therapy progress and will be reviewed by your doctor. Please bring this handbook with you to all therapy and doctor appointments.

PHYSICAL THERAPY LOG

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Physical Therapy Visit Log

Date AAROM PROM Swelling (mild/moderate/severe)

Gait Assist Level/Device Wound Health Comments

This tool is used to document your therapy progress and will be reviewed by your doctor. Please bring this handbook with you to all therapy and doctor appointments.

PHYSICAL THERAPY LOG

24

DURABLE MEDICAL EQUIPMENT

JACKSON COUNTYApria Healthcare, Inc . . . . . . . . . . . . (541) 245-2400 765 South Riverside Drive, Medford, ORAshland Drug . . . . . . . . . . . . . . . . . (541) 482-3366 275 East Main Street, Ashland, ORBlack Oak Pharmacy . . . . . . . . . . . . (541) 773-5356 2924 Siskiyou Blvd ., Suite 102, Medford, ORBlack Oak Pharmacy . . . . . . . . . . . . (541) 690-1130 4800 Crater Lake Avenue, Medford, ORLincare, Inc . . . . . . . . . . . . . . . . . . . (541) 773-2211 918 Chevy Way, Medford, ORMajors Medical Supply . . . . . . . . . . (541) 665-0133 540 East Vilas Road, Suite B, Central Point, ORNU Motion . . . . . . . . . . . . . . . . . . . (541) 772-1771 4823 Industry Drive, Central Point, ORPacific Medical . . . . . . . . . . . . . . . . (541) 292-5483 2780 East Barnett Road, Suite 110, Medford, ORPhoenix Pharmacy . . . . . . . . . . . . . . (541) 535-1561 404 North Main Street, Phoenix, ORQuest Health Care . . . . . . . . . . . . . (541) 665-4018 540 East Vilas Road, Central Point, ORSouthern Oregon Medical Equipment . . . . . . . . . . . . . (541) 773-5994 1600 East Barnett Road, Medford, OR

Medical Equipment Loan ClosetsAccess . . . . . . . . . . . . . . . . . . . . . . . (541) 779-6691 Monday through Friday, 8 a .m . to 5 p .m . (extension 305) 3630 Aviation Way, Medford, ORRogue River Community Center . . . (541) 582-1482 Monday through Friday, 9 a .m . to 4 p .m . 132 Broadway, Rogue River, ORSalvation Army . . . . . . . . . . . . . . . . (541) 772-8149 Tuesday through Friday, 9 a .m . to 3 p .m . 922 North Central Avenue, Medford, OR

JOSEPHINE COUNTYApria Healthcare, Inc, . . . . . . . . . . . (541) 479-6919 1700 Nebraska Avenue, Grants Pass, ORGrants Pass Pharmacy . . . . . . . . . . . (541) 476-4262 414 SW 6th Street, Grants Pass, ORLincare, Inc . . . . . . . . . . . . . . . . . . . . (541) 479-3743 1610 NE 7th Street, Grants Pass, ORSouthern Oregon Medical Equipment . . . . . . . . . . . . . (541) 471-0026 705 SW Union Avenue, Grants Pass, OR

Medical Equipment Loan ClosetsHASL . . . . . . . . . . . . . . . . . . . . . . . (541) 479-4275 Monday through Thursday, 9 a .m . to 3 p .m . Friday, 9 a .m . to 2 p .m .; closed 12 to 1 p .m . 305 NE E Street, Grants Pass, ORIllinois Valley/Cave Junction Lions Club . . . . . . . . . . . . . . . . . . . (541) 592-4135 333 S Redwood Highway, Cave Junction, ORRogue River Community Center . . . (541) 582-1482 Monday through Friday, 9 a .m . to 4 p .m . 132 Broadway, Rogue River, OR

Daily Living Device CatalogsNorth Coast Functional Solutions . . . . . . . . . . . . . . . . . . . . . (800) 235-7054Sammons Preston Enrichments . . . . . . . . . . . . . . . . . . (800) 323-5547

25

DURABLE MEDICAL EQUIPMENT continued

YREKALincare, Inc . . . . . . . . . . . . . . . . . . . (530) 841-0503 1530 Lucas Road, Yreka, CAMadrone Hospice Shop . . . . . . . . . (530) 842-6025 Monday through Friday, 9:30 a .m . to 5 p .m . Saturday, 10 a .m . to 4 p .m . 209 West Miner Street, Yreka, CAM C Medical Equipment . . . . . . . . (530) 842-4304 742 S Main Street, Yreka, CAScott Valley Respiratory Home Care Inc . . . . . . . . . . . . . . . . (530) 841-3000 1714 S Oregon Street, Yreka, CA

BROOKINGSApria Healthcare, Inc . . . . . . . . . . . . (541) 469-6674 624 Railroad Avenue, Brookings, ORLincare, Inc . . . . . . . . . . . . . . . . . . . (541) 469-3989 16290 Tolman Lane, Brookings, OR Medical Equipment Loan ClosetsElks Lodge . . . . . . . . . . . . . . . . . . . (541) 469-2169 Monday through Friday, 8 a .m . to 2 p .m . 800 Elk Drive, Brookings, OR

CRESCENT CITYApria Healthcare, Inc . . . . . . . . . . . . (707) 464-4242 630 G Street, Crescent City, CA Medical Equipment Loan ClosetsVeterans Service Office . . . . . . . . . . (707) 464-2154 810 H Street, Crescent City, CA

KLAMATH FALLSApria Healthcare, Inc . . . . . . . . . . . . (541) 273-5451 2815 Laverne Avenue, Suite E, Klamath Falls, ORLincare, Inc . . . . . . . . . . . . . . . . . . . (541) 882-2325 2795 Anderson Avenue, Suite 107, Klamath Falls, ORNorco Medical . . . . . . . . . . . . . . . . (541) 885-2996 3310 Washburn Way, Klamath Falls, OR Medical Equipment Loan ClosetsSenior Center . . . . . . . . . . . . . . . . . (541) 883-7171 Monday through Thursday, 8 a .m . to 5 p .m . Friday, 8 a .m . to 2 p .m . 2045 Arthur Street, Klamath Falls, ORVeterans of Foreign Wars . . . . . . . . (541) 882-0057 515 Klamath Avenue, Klamath Falls, OR

ROSEBURGDouglas Medical Equipment Supply . . . . . . . . . . . . . (541) 229-4530 1813 West Harvard Avenue, Suite 212, Roseburg, OR Lincare, Inc . . . . . . . . . . . . . . . . . . . (541) 957-0907 1810 NW Mulholland Drive, Roseburg, OR Parkway Mobility & Medical Supply . . . . . . . . . . . . . . (541) 677-2438 2475 Stewart Parkway, Roseburg, ORRick’s Medical Supply . . . . . . . . . . . (541) 672-3042 482 NE Winchester Street, Roseburg, OR

26

GENERAL RECOMMENDATIONS• Attach a reacher to your walker with

sticky-backed Velcro to retrieve objects from the floor or high cupboards .

• Cut the handles on a plastic grocery bag and tie it to the front of the walker . You can also use a purse or tote bag .

• To reduce bending and reaching, move most-used items in each room of your home within easy reach (shoulder to waist level) . Leave items used daily out on counters .

• If you are alone part of the day, carry a phone, personal alarm, or whistle with you in the walker bag to call for help in case of an emergency . Consider a contract with Asante Lifeline, a local emergency alert system . Call (541) 789-4440 or e-mail lifeline@asante.org .

• A rolling cart or four-wheeled walker with a seat helps move heavier or multiple items from room to room .

• Remove throw rugs to avoid tripping . When a throw rug is unavoidable, use one that lays flat and has a rubber backing .

• Use a high nonswivel or rolling stool in the kitchen during meal preparation . Slide objects across countertops instead of carrying them .

• Move pet bowls up on a box, low table, or other raised surface to decrease the need for bending to the floor .

• For laundry, a reacher helps with loading and unloading clothes from the washer and dryer . A rolling cart helps move clothes to and from the laundry room . Store detergent for easy access that allows dispensing without lifting, bending, and reaching .

• Acquire help to complete house cleaning and chores as needed (family, friends, or hired help) . Vacuuming, making beds, and lifting more than 20 pounds should be avoided .

TRANSFERS The occupational therapist will make specific recommendations for your situation . The following are general recommendations .

Chairs• Do not sit in any chair that rocks,

swivels, or rolls until cleared by your physician . If you have hip precautions, do not sit in low or soft chairs .

• Sit in a firm chair with armrests . Use the armrests to sit and rise; do not pull yourself up on the walker .

• Use a firm cushion, folded blankets, or blocks to raise the surface of low chairs .

• Use your knee crease to determine if a surface is high enough to sit on . If the seat of a chair hits below the bend in your knees, it is usually too low .

Toilet• Use an elevated toilet seat or bedside

commode to raise the height of the toilet .

• After toileting, stand by pushing up from the seat, reaching forward with one hand at a time to your walker . Do not attempt to use the walker to pull up to stand .

• When out in the community, use the handicapped bathrooms, which provide grab bars and higher toilets .

BATHING Tub bathing, swimming, and sitting in a spa are not allowed until the hip has totally healed . You can shower when the doctor approves and the incision is healed with no drainage . Initially, you may need adaptive devices for safety and independence . The following are recommendations to improve the safety of bathing .

SELF-CARE AFTER HIP REPLACEMENT SURGERY

27

Shower StallIf the walker fits into the shower stall, step in with the weak leg first (the walker supports the weak leg) . If unable to fit the walker into the stall, step in backward with the strong leg first . In both situations when transferring out of the shower, have the walker outside the shower stall and step into it with the weak leg .• A shower bench with a back and

adjustable legs is recommended . At times you can substitute the bench

with a commode chair . A rubber mat will decrease the risk of slipping while bathing .

• A handheld showerhead allows you to control the water flow while seated for a shower .

• A grab bar placed vertically (shoulder to waist height) just inside the shower helps with your transfer in and out of the shower and provides support while standing .

• Make sure that surfaces both inside and outside the shower are nonskid to decrease the risk of slipping .

Shower over Tub• A tub transfer bench or shower

bench with a back and a large seat is recommended . Adjust the tub transfer bench to a comfortable height and lower the inside legs one level . This slight inward slope will help drain water into the tub and not onto the floor .

• A handheld showerhead allows you to control the water flow while seated for a shower .

• To better accommodate a tub transfer bench and promote ease of transfers, remove sliding doors from the track and hang a curtain on a spring tension rod inside the track .

• To transfer onto the tub transfer bench, turn with your back to the tub, with your legs touching the tub wall; put one hand on the back of the bench and the other on the walker, then slowly sit on the bench . Lean back when lifting legs over tub edge (knee on weak leg straight) to maintain hip precautions .

• Placing a hand towel on the bench will assist with the transfer by preventing wet skin from sticking to the plastic surface .

• Make sure that surfaces both inside and outside the shower are nonskid . Use a rubberized bath mat in the shower and a rubber-backed rug outside the shower .

• For safety, have someone assist you with the first few transfers to the tub .

TED HOSE/SUPPORT STOCKINGS If you were given TED hose in the hospital, they must be worn until you see the surgeon after discharge . He will tell you when you can discontinue their use . TED hose should be removed at least once per day for bathing and skin care. They are to be worn about 20 hoursper day and should be hand-washed and hung to dry . To speed up the drying time, you can wring them dry in a towel or place in a dryer on the “air” setting (no heat) .

LOWER BODY SELF-CARE The occupational therapist will instruct you in the use of all adaptive devices issued . The following are general guidelines for maintenance of hip precautions .• Use adaptive devices for all care below

your knees . Use a reacher for foot care, including washing and drying between your toes .

• Always use adaptive devices from between your knees . Reaching from the outside causes your leg to rotate inward .

• When dressing your lower body, put clothing onto the weak leg first and off that leg last .

SELF-CARE AFTER HIP REPLACEMENT SURGERY continued

28

SELF-CARE AFTER HIP REPLACEMENT SURGERY continued

• When using a sock aid following your shower or when your feet are damp, sprinkle powder into the sock aid before putting your foot in .

• Wear slip-on shoes or use elastic shoelaces to prevent the need to reach your feet . High-heeled shoes are not recommended .

• Safety-pin a clean washcloth over a long- handled bath sponge to apply creams or powder to your legs and back .

• Use soap on a rope or liquid soap, which is less prone to fall to the shower floor .

• Complete dressing while seated, to prevent falling due to loss of balance (because of the shift in your center of balance following surgery and decreased vision as clothing is pulled over your head) .

KEY REMINDERS IF YOU HAVE HIP PRECAUTIONS• Do not bend your hip more than 90 degrees . • Do not cross your legs .• Do not roll your leg inward or outward .

PRECAUTION DO’S• Turn only with a thick pillow between your

legs while in bed .• Get in and out of bed as instructed by the

therapist . • Allow for adequate room at the side of your

bed to walk with a walker .• Continue your exercises as instructed—

three times each day .• Walk frequently, keeping the weight-

bearing restrictions in mind .• Continue to use an elevated toilet seat until

told to discontinue by your doctor .• Use a walker or crutches until seen by your

doctor at your post-surgery follow-up visit .• Lie on your unoperated side (pillow

between your legs) or your back .

• When sitting, keep your knees lower than your hips .

• If compression stockings are ordered, continue to wear them for six weeks or until your doctor tells you to discontinue wearing them . Do not roll them down your leg, as this will cut off the blood supply to your leg . Remove all wrinkles . If you are able to tolerate, please wear them at night as well . You may remove them at night if needed . Take them off for one hour each day and when bathing . Have someone help you put them on or use a sock aid .

• Avoid small pets, remove throw rugs, and secure electrical cords on the floor where you may walk .

PRECAUTION DON’TS• Do not cross your legs .• Do not bend your hip more than

90 degrees .• Do not attempt to put on your own shoes

or socks without a long-handled device .• Do not pick up items from the floor

without a reacher .• Do not sit in low chairs or on sofas .• Do not bend your leg so that your knee

is higher than your hip .• Do not turn your leg inward or outward .• Do not pivot, squat, or kneel on your

weak leg .• Do not put a pillow under your leg when

lying on your back .• Do not sit for more than one hour at a

time, as this contributes to stiffness .• Do not sleep on your new hip until

approved by the surgeon .• Do not lift or carry things while using

a walker

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DISCHARGE PLANNINGWhat is discharge planning?Medicare defines discharge planning as “a process used to decide what a patient needs for a smooth move from one level of care to another .” Discharge from a hospital does not mean that a patient is fully recovered . It simply means that a doctor has determined that the patient is stable and no longer needs hospital-level care .

Who can assist me in planning for my discharge?Only a doctor can authorize a hospital discharge, although many other people are involved in working out the details of the discharge plan . You and your significant others are the most important people involved, as you understand the home situation and the available support system . The discharge planner is a nurse who can help make some of the arrangements for your care following discharge .

I live alone and will need help cleaning my home and preparing meals. Can the discharge planner arrange for this?There are many services that may be of benefit to you, such as housekeeping and meal preparation, but your insurance company does not cover these . The discharge planner can give you lists of providers, but the actual arrangements for the services and the payment need to be made by you or your representative . If you have long-term-care insurance, it may include a provision for in-home care that is not covered by Medicare or your medical insurance .

My neighbor had surgery, and a nurse came to her home to check on her a couple of times a week. Could I have this same follow-up care?Medicare and most private insurance companies pay only for care that is considered “medically necessary .” There are specific requirements that also must be met . For instance, home health care is covered only if the patient is “homebound” and has care needs that can be provided only by a professional, such as physical therapy or dressing changes . A doctor’s order is required for home health care .

Is there help for patients who are unable to pay for their prescription medications?If you do not have money to purchase your medications upon discharge, please tell the nurse that you wish to speak with the social worker . There are several agencies in Southern Oregon that can help with accessing drug assistance programs as well as discount prescription drug cards .

Will I need a hospital bed or other medical equipment when I return home?Most patients will not need any special medical equipment upon discharge from the hospital . Remember, Medicare and most private insurance companies will pay only for equipment that is “medically necessary .” Some items such as grab bars for your bathroom or a shower bench, although helpful, are considered “comfort or convenience” items and are not reimbursable . If your doctor and therapist recommend certain medical equipment, the discharge planner can assist with the arrangements for delivery to your home .

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DISCHARGE PLANNING continued

I have no one to assist me at home, so I prefer to go to a rehabilitation facility to continue my recovery after discharge. Will Medicare pay for this level of care?Medicare provides payment for care in a skilled-nursing rehabilitation facility if the following requirements are met:• The admission to the rehabilitation

facility must occur within 30 days of a hospital stay of three or more days . The three-day stay in the hospital must meet Medicare criteria for inpatient hospital admission . For example, a night spent in outpatient status for observation does not count toward the three-day qualifying stay .

• The care received in the facility must be an extension of treatment of a condition requiring daily skilled-nursing care .

• After the first 20 days of care in a rehabilitation facility, there is a co-payment . Some insurance supplements cover the co-payment amounts .

Other options available for those who live alone and do not feel comfortable about returning directly home from the hospital include the following .• Assisted-living facilities provide

various levels of help, from medication management to dressing and bathing .

• Foster homes are privately owned homes providing different levels of assistance .

The patient is responsible for payment unless eligible for other coverage . Please ask to speak with a discharge planner if you have any questions .

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AFTER DISCHARGE FROM THE HOSPITAL

After discharge from the hospital, whether you go home or to a

rehabilitation facility, the following factors will be important for the care of your new joint .

PHYSICAL THERAPYYou will be responsible for following a daily exercise program that will be outlined by the physical therapist while you are still in the hospital . The success of your hip replacement surgery depends largely on your diligence, cooperation, and attentionin adhering to your physical therapyprogram . Remember to take your pain medication at least 30 minutes prior to your planned activity .

If your doctor wants you to go to outpatient physical therapy after your hospital stay, the nursing staff will communicate this with your discharge plan .

BLOOD-THINNING MEDICATIONYou will be on blood-thinning medication or aspirin after you are discharged from the hospital . Depending on the specific medication ordered, you may need to have blood drawn to check your blood-thinning level .

There are warning signs that your bloodmight be too thin, such as nosebleeds,bleeding gums, excessive bruising, and blood in the urine . Please call the doctor if you have any of these symptoms . It is also dangerous to take aspirin, ibuprofen (Advil, Motrin, or Nuprin), and any

over-the-counter or prescription arthritis medicine while you are taking blood-thinning medication . You may take acetaminophen (Tylenol) or pain pills that have been prescribed for you . You will be able to resume arthritis medicine and aspirin as needed after the blood-thinning medication is discontinued .

YOUR HIP INCISION• Leave the dressing in place, as instructed .• After the adhesive skin closures fall off,

keep the scar clean and dry .• Report to your doctor any redness, increased warmth to the touch, wound separation, or increase in localized pain, bruising, or drainage .

DRIVINGYou will not be able to drive for the firstsix to eight weeks following surgery .Although you may feel capable, youwill need written approval from yourdoctor; otherwise your insurancecoverage may be jeopardized and thesafety of your new joint compromised .Your safety and well-being are of primeconcern during the healing process .

SEXUAL ACTIVITYOnce cleared by the surgeon, you mayresume sexual activity, observing your hip precautions . If you have specific questions, please do not hesitate to ask the doctor, nurse, or other staff member .

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LIVING WITH YOUR NEW HIP

INFECTIONYour new hip is a metal and plasticprosthesis, so the body considers it aforeign object . If you become sick witha serious infection, bacteria can circulatein your body, go to the prosthesis, andcause a bacterial infection in your newjoint . For this reason, if you become illwith an infection or a high fever, yourdoctor should evaluate you immediately .

SURGICAL PROCEDURESIf you are scheduled for a medical procedure, even a minor one such as dental cleaning or surgery for an ingrowntoenail, you may be asked to takeantibiotics before the procedure inthe first two years after hip replacement surgery . If the doctor is not sure of the appropriate antibiotics for you, please ask him or her to call your orthopedic surgeon . This may also apply to invasive procedures using a scope, such as a cystoscopy, bronchoscopy, or gastroscopy .

DENTAL WORKYou may be asked to take antibioticsbefore dental work; this includesroutine cleanings . The reason for takingantibiotics is that bacteria are presentin the mouth that are not presentanywhere else in the body . When youhave your teeth cleaned, bacteria gainentry into the bloodstream and cancirculate to the hip prosthesis, causingit to become infected . Antibiotics killthe bacteria that cause this type ofinfection, so it is imperative that younotify your dentist of your prosthesis .If your dentist is not familiar with thecorrect type of antibiotics to give you,ask him or her to call your orthopedicsurgeon prior to scheduling the dental

procedure . Routine daily flossing, twice-a-day brushing, and cleanings every sixto 12 months are strongly advised .

We recommend the followingguidelines.• If you have rheumatoid arthritis, systemic lupus erythematosus, insulin-dependent diabetes, previous total joint infection, malnourishment, or hemophilia, or if you have had radiation or drugs to decrease your immune system, you may need to take antibiotics before certain dental procedures .• If you are otherwise healthy, for two years after surgery you may be asked

to take antibiotics briefly if any dental work being done could cause bleeding in the mouth .

The suggested use of antibiotics isas follows:• Patients not allergic to penicillin: Take four 500-milligram amoxicillin

tablets one hour before the procedure .• Patients allergic to penicillin but able to take cephalexin: Take four 500-milligram cephalexin tablets

one hour before the procedure .• Patients allergic to penicillin and cephalexin: Take 600 milligrams of clindamycin one hour before

the procedure .

If oral medications cannot be taken,intramuscular or intravenous drugsshould be given .

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LIVING WITH YOUR NEW HIP continued

This relates only to preventing the spread of bacteria from your mouth to your

prosthesis during dental work . If youdevelop a bacterial infection of the skin,lungs, gastrointestinal tract, urogenitaltract, or other site, it should be treatedfor as long as it takes to eliminate thesource of the infection . Viral infectionssuch as colds and flu do not requireantibiotics to protect your new joint .

Your dentist is ultimately responsible for making the decision for or againstantibiotics based on his or her knowledge of the dental work to be done . If you or your dentist have any questions, please have him or her call your orthopedic surgeon .

SKIN CONDITIONSIt is important that you advise yourorthopedic surgeon of any skin conditions or problems prior to surgery . These mayinclude athlete’s foot, dermatitis, nail bitingwith or without bleeding, and rashes or skinbreakdown in skin folds, under the arms, orin the groin . Your doctor can instruct you inthe care needed to heal these conditions .

If you have foot problems, it is importantthat you dry your feet well after bathing orswimming, wear well-ventilated shoes andabsorbent socks, and apply anti-fungalointment or powder as directed .

Use a first-aid cream on minor cuts andabrasions to prevent infection, before and after your surgery, indefinitely .

Do not razor-shave your legs, armpits,or face within two days of surgerybecause this can contribute to woundinfection of your new joint .

FOLLOW-UP CAREAlthough your hip may feel fine, it is important to remember that your new joint has artificial components and for this reason you must see your surgeon at the routine six-week, three-month, six-month, and annual visits thereafter . Routine examinations to continually monitor your prosthesis are recommended because certain minute changes apparent only on an X-ray or in an examination may be detected . It is important to stay up-to-date on your health immunizations, especially flu shots, Pneumovax, and tetanus booster .

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