• Reference Number: HEY1107/2020
• Departments: Orthopaedics, Physiotherapy
• Last Updated: 29 April 2020

Introduction

This leaflet has been produced to give you information about how to care for your hip following your operation.  It is not meant to replace discussion between you and your therapist.  If after reading it, you require further explanation please discuss this with the therapist caring for you.

What is a Total Hip Replacement?

Total hip replacement surgery involves removing the ball and socket of your hip and replacing it with components made of metal, polyethylene or ceramic.

Why do I need a Total Hip Replacement?

Due to the nature of your hip fracture, your surgeon has decided that it necessary to replace your hip.  There is good evidence to show that replacing your whole hip joint, rather than just half of it, can mean that your recovery is quicker and less painful.

Can there be any complications or risks?

After surgery you are likely to experience pain and stiffness in your hip, however, this should gradually improve.  Most patients are able to increase their activity over time (usually a few months).  Some patients may be unhappy with the outcome, particularly if a complication has occurred.

Some post operation risks include:

• deep vein thrombosis (DVT) (blood clots)
• infection
• wear or loosening of the prosthesis
• dislocation of your new hip

We try to minimise these risks but we cannot always prevent them.

How do I prepare for a Total Hip Replacement?

Once the surgeon has decided that you are suitable for a total hip replacement, a therapist will give you a form to complete regarding the height of your furniture.  They will also help you think about your discharge plan and will discuss this with your relatives.

As appropriate the therapy team will teach you some exercises to help maintain your strength and circulation prior to having the operation.

What will happen after the operation?

The therapy team will assess you and encourage you to mobilise within 24 hours after the operation.  Research suggests that mobilising within 24 hours helps prevent post-operative complications.  To plan your discharge the therapy team will also assess your ability to perform activities in your daily life.

Reducing the risk of dislocation

DO NOT:

• cross your legs
• bend from the waist, so that the angle between your legs and chest is less than 90 degrees or at right angles.
• twist your operated leg inwards or outwards
• reach to the floor for items.
• lift heavy objects
• sit on low furniture or toilet seats.
• use the bath or climb into the bath to use the shower
• drive unless advised otherwise by your consultant. You may invalidate your vehicle insurance if you do so.

Exercises

If the discharging therapist feels that it is appropriate for you to receive follow-up therapy, this will be arranged for you.

At the time of your discharge, if you are not walking as well as you did prior to surgery, community physiotherapy will be arranged for you.  Whilst you wait for them to visit you, please perform the following exercises twice a day in order to increase your chances of recovery.

Your hospital therapist will advise which exercises are appropriate for you. Should you experience any pain or problems during the exercises it is advised you stop them and contact the therapists from the ward.  Contact numbers are available at the end of the document.

In a seated position

Ankle exercises:

• Lift your heels off the floor maintaining contact with your forefoot and then return to the starting position
• Repeat 10 times.

Thigh strengthening:

• Pull your toes up towards you.
• Straighten your knee out in front of you, hold for 3 seconds then bend again.
• Repeat 10 times

Lying in bed

Static quadriceps / knee strengthening:

• Push your knee down into a flat surface, hold for 3 seconds and relax
• Repeat 10 times

Knee movements:

• Lying on your back, bend and straighten your knee.
• Make sure that you don’t bend your leg so far that your hip flexes past 90 degrees.
• Repeat 10 times.

Ankle movements on lying

• Move your ankles backwards and forwards whilst lying.
• Repeat 10 times

In a standing position, holding onto something solid such as a work surface or chair

Calf raises:

• Push up onto your toes.
• Drop back down on your heels.
• Repeat 10 times

Knee bends:

• Slowly bend your hips and knees, trying to push your bottom back.
• Keep your knees straight, do not let them turn in or out.
• Stand up straight again
• Repeat 10 times

Leg lifts

• Keeping your knee straight, lift your leg out straight behind you
• Lower again.
• Repeat 10 times

Side lifts:

• Keep your knee straight and your bottom in.
• Lift your operated leg out to the side.
• Lower again.
• Repeat 10 times.

Walking:

• Try not to sit in one position for too long

Build up the distance of the walks gradually from walking around the house to walking in the garden or outdoors to the shops. This may not be realistic for every individual depending on how mobile you were prior to the procedure.

On discharge from the hospital

Activities of daily living

Climbing stairs:

Step with your good leg first, followed by your operated leg, then your walking aid.

Descending stairs:

Put your walking aid down first, then step down with your operated leg followed by your good leg.

Getting into a car:

• Preferably sit in the front passenger seat to allow more room.
• Ensure the front passenger seat is pushed back and reclined to give you sufficient room to get into the car. This is often easier sitting in the front seat of the car.
• Turn your back to the seat and sit down with the leg of your operated hip out straight.
• Shuffle back into the chair and bring your legs in, keeping them together.
• Remain reclined for the journey, keeping your operated leg out straight.
• If your car seat is low or if you are tall, you might find that a firm cushion added to the seat will ensure that you do not flex your hip too much.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Therapy team at Hull Royal Infirmary (01482) 675339 / 675388. Ward 12 (01482) 675012 / Ward 120 (01482) 675120

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.