With a anterior hip replacement, you must follow some safety rules to help you heal faster and keep your new joint from dislocating.

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1ContentsIntroduction 2 How Joints Work and the Need for Replacement ..3 Special Procedures .3 Potential Complications ..4 Physical and Psychological Preparation .6 Pre-surgery Tasks 7 Advance Preparations for Your Homecoming .8 Packing for Your Stay ..9 What to Expect on Surgery Day 10 Your Post-Surgery Healthcare Team 11 What to Expect After Surgery .12 A Note About Pain 14 Lower-body Exercises.15 Upper-body Exercises .21 Mobility..25 Hip Precautions ..28 Guidelines for Your Return Home 29 Expectations for Life After Joint Replacement ..31 Frequently Asked Questions 33 Exercise Worksheet ..36

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2IntroductionAs a joint pain sufferer, you™re undoubtedly used to your physical limitations dictating your decisions. Arthritis and other debilitating joint conditions cause ongoing cartilage erosion and damage to bone surfaces that can interfere with just about every aspect of life, from walking, exercising, working and enjoying time with family and friends to getting a full night of sleep.We are excited that you™ve decided to undergo total joint arthroplasty (replacement) to regain your qual- ity of life. However, any surgery is a big step, and we expect you to have questions, concerns and hopes. In response, we offer you this guide, which covers what to expect before, during and after your procedure so you have the information you need to proceed with Please read this material carefully as you prepare for pre-surgery tasks as you complete them and jot down any questions you may have. Make sure to go over pertinent information with your care team, as well. The more you know, the better prepared you™ll be to take charge of your comfort and mobility again.

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3How Joints Work and the Need for ReplacementWhen a joint has become so worn that it no longer made of metal, ceramics and plastics can take its place.The HipYour hip joint is like a ball and socket: The fiballfl at the upper end of your thighbone a rounded fisocketfl in the pelvis (acetabulum). The ends of the bone are covered with smooth cartilage for frictionless movement.A thin, smooth tissue lining called the synovium that acts as a lubricant to reduce friction and wear in the joint. When all parts of the joint work together, the hip moves easily without pain. But when the joint becomes diseased or injured, the cartilage can break down and cause escalating pain that severely limits the ability to move and work. During total hip replacement, your surgeon will remove parts of your damaged hip joint and replace them with an implant designed to function like a replacing the head of your thighbone and your hip socket.Special ProceduresSome patients require even more complex procedures beyond standard joint replacement. Below are descriptions of some of these surgeries. Adult Reconstruction SurgeryPatients with extensive joint damage due to conditions such as rheumatoid arthritis, avascular necrosis or severe trauma may require more complex surgery for joint reconstruction.Complex Revision SurgeryJust like a natural joint, even the most advanced over time and with heavy use, especially in younger, heavier and more active individuals. In such cases, revision surgery Πmuch more complicated than the prosthesis and damaged bone are removed, the surgeon may use metal wedges and bone grafts to replace lost cut the top of the thighbone into segments, remove old cement from the segments, and then wire them back together around a new component.

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4Potential ComplicationsThe complication rate for joint replacement surgery is very low. Serious complications such as joint infec- tion occur in less than 2 percent of patients. Most can be avoided or treated when addressed early. These include:Anesthesia ComplicationsAmong a very small number of patients, anesthesia can cause reactions and problems related to other medical complications. Be sure to discuss the risks and your concerns with your anesthesiologist. InfectionPost-surgery infection can occur in the hospital, after you return home or years later. While healthcare pro- viders take many steps to minimize the risk of infec- tion, it can™t be completely avoided. In the hospital, you will receive antibiotics starting with surgery and for 24 to 48 hours afterward to help clean-air environment, and your surgeon and surgical assistants will wear masks, sterilized gowns and two pairs each of sterilized gloves that they will change frequently. Just before surgery, your team will wash your limb, prepare it with antiseptic solution and cover it with sterilized drapes. For years to come after your surgery, you will need to tell your doctors and dentist about your joint replacement and take antibiotics before undergoing even minor procedures to reduce the chance of infection in another part of your body spreading to healthcare provider will have a plan to manage it.PneumoniaPneumonia is always a risk after major surgery. You will be assigned a series of deep-breathing exercises to keep your lungs clear.HematomaFluid may drain out of your hip incision after surgery. This is a common occurrence, and you should not be cause swelling. If this happens, notify your doctor. Blood Clots A number of factors can cause blood clots, including decreased mobility after surgery, which slows the movement of the blood. Symptoms include a red, swollen leg, especially in the calf area, and shortness of breath. You can prevent blood clots with: lation. pooling. then hourly. Nerve and Vessel InjuryThe sciatic nerve, located next to the hip, is vulnerable to injury during hip replacement, and, on rare occasions, this may cause weakness or loss of feeling around the foot. Dislocations and InstabilityYour natural hip is held in place with strong ligaments. It will come out of joint (dislocate) only as the result of major force such as a car accident. In the case of an depends, in part, on the post-surgery precautions your surgeon gives you and whether you properly follow them. Although uncommon (less than two per 100 hips) in motion. Therefore, you must take precautions while sleeping, washing, bending and toileting. The risks decrease with time, but you should continue to follow your precautions for a minimum of 12 weeks. After that, always be aware of the positions you get into.into place. This usually requires a very brief general the hip drops back into place.

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5Leg Length Alteration In general, leg length is maintained within 10 millimeters of ideal with hip replacement. On some occasions, particularly when a hip deformity exists, surgeons to compromise between leg length alteration and stability of the hip joint. You may not notice a minor leg length alteration of 5 millimeters or less. A simple heel raise may balance an alteration of 10 millimeters or more. Loosening joints, with many patients reporting excellent function joints eventually fail is loosening where metal or cement meets bone. If the pain of a loose joint becomes unbearable, another operation may be required to revise the joint.

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7 Pre-surgery TasksStop smoking. Breaking the habit is particularly important before major surgery to improve heal-ing and reduce the risk of post-operative lung problems.Get laboratory tests. Your surgeon may pre- scribe blood tests, urine tests, an EKG or cardio- gram, and a chest X-ray to determine whether performed within 14 days before the scheduled procedure.Confer with physical therapist. The physical therapist will record a baseline of information, including measurements of current pain levels, functional abilities, the presence of swelling and available movement and strength. You also will practice post-operative exercises using either a walker or crutches.Fast the night before your procedure. Do not eat or drink after midnight before surgery. As directed by your physician you may brush your teeth and have a few sips of water if you need to take medications. Discuss with your physician which medications you should take that morning.Bathe before your procedure. You should bathe with an antibacterial soap to clean the surgical area the night before and morning of your proce- dure to reduce the risk of infection. Do not use any after-bath lotions or perfumes. Tell the nurse if you are allergic to iodine or soap. Remove all nail polish and make-up. If possible, shampoo your hair. Do not shave your legs within three to four days of surgery. Once you™ve scheduled your total joint replacement, you will meet with or receive a call from a pre-admis- sion nurse (577-2259). The nurse will ask you ques- tions about your medical history and any allergies you may have.Once you have made a personal commitment to undergoing joint replacement surgery at Wyoming Medical Center, you should arrange a pre-operative visit with members of your care team to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control and diet. Your team will outline several tasks for you to complete during the weeks before your procedure. In general, you may be required to:Complete forms. you agree to have the operation and that you know the risks involved, as well as hospital forms about your past history, medications, previous opera- tions, insurance and billing information. Review medications. Discuss your medication list with your doctor to determine the medications, supplements that you should avoid taking before surgery,when to stop them and when you can restart them.Exercise under your doctor™s supervision. It™s important to be in the best possible overall health to promote the best possible surgical experience. Increasing upper-body strength is important to help you maneuver a walker or crutches after sur- gery. Strengthening the lower body to increase leg strength before surgery can reduce recovery time.Lose weight. For overweight patients, losing weight helps reduce stress on a new joint.Have a general physical examination. Your pri-mary healthcare provider should evaluate you to assess your overall health and identify any medi- cal conditions that could interfere with surgery or recovery.Have a dental examination. Although infections after joint replacement are not common, an infec- tion can occur if bacteria enter the bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery. Consult your surgeon for a time frame for when you should no longer have these produces done before your surgery. After your replacement let your dentist know that you had a joint replacement. As they may want to place you on an antibiotic prophylacticly.

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8Advance Preparations for Your HomecomingBeyond physically and mentally preparing for your surgery and completing tasks directly related to your procedure, you should also make preparations for your homecoming. You should: tive devices (please see the section on mobility in this guide for a list of such items). carry small items such as glasses, books, silver- ware, etc. in covered cups. for long phone or electrical cords lying across the – surfaces. they™re ready when you return. quently used foods in your most accessible cabinets. Also place these items on easy-to-reach shelves. to the counter and from the counter to the table. while preparing and cooking food.With a anterior hip replacement, you must follow some safety rules to help you heal faster and keep your new joint from dislocating. One of these rules is to always sit with your knees lower than your hips. So before surgery, you should sit: If your knees are not lower than your hips in any of these situations, you must make adjustments to achieve ideal positioning such as using pillows or installing a raised toilet seat (please see the section on mobility in this guide).

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9Packing for Your Stay own such as walker, leg lifter, reacher or incen-tive spirometer. Your physical therapist can check these for suitability to your current circum- stances. admission classes, including this guide. ing at home, including the name, dosage and how often you take each one. cine, etc.) that includes descriptions of how you react to each one. mentation from the blood bank. er of attorney. Hospital personnel are required by law to ask for these when you are admitted. They will make a copy for your medical record and return the original.Please remember the following recommendations as you pack for your stay: ables to the hospital. Bring only enough money for items such as newspapers, magazines, etc. You and your family are responsible for any items you bring. WMC is not responsible for lost or dam- aged items. lenses) on the day of surgery. Please bring a case for them. comfortable shirt, short gowns, pajamas, under- wear, socks/stockings, and slip-on non-skid shoes and slippers with closed backs. clothes to wear home. hairbrush, toothbrush and toothpaste. However, the surgical unit can provide these items.

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10What to Expect on Surgery DayAfter you arrive at the hospital at the appointed time, you will complete the admission process and undergo general health. You will be required to remove all personal belongings Πdentures, hearing aids, hairpins, wigs, jewelry, glasses, contact lenses and all clothing and leave them with your family or friends during surgery. You will wear a hospital gown and nothing else.Your care team will perform several checks to ensure replacement of the correct joint. Your surgeon will re- view your X-ray and mark the surgical site, and nursing staff will check the consent form you signed to make sure it agrees with the procedure on the operating room list.Just before your transportation to the operating room, an intravenous tube (IV) will be inserted into your medications.The anesthesiologist and surgeon speak to you before surgery. The anesthesiologist determines the type of anesthesia that will be used based on your medical his- tory.SurgerySurgery usually lasts two to four hours but varies with each person. During the procedure, your family can wait in the surgery waiting room. Many people will be with you in the operating room, including:Your orthopedic surgeon. This is the doctor who will perform your surgery. An anesthesiologist. This is the doctor or nurse who will give you anesthesia.A scrub nurse. This is the nurse who hands the doctors the tools they need during surgery. A circulating nurse. This is a nurse who brings items to the surgical team. Your surgeon and the anesthesiologist will help you choose the best anesthesia for your situation. No matter what type of anesthesia you have, be assured you will not feel the surgery. Options include:General anesthesia. You are put to sleep. Minor complications such as nausea and vomiting are common but usually can be controlled and settled within one to two days.An epidural. Medicine injected into your back numbs you from the waist down. (This is also used for women giving birth.) A spinal . Much like an epidural, medicine in- jected into your back numbs you from the waist down.After surgery, the doctor will inform your family of your condition, and you will spend about an hour in the recovery room, where staff will monitor your blood pressure, breathing and other vital signs. Pain and nau- sea medications will be available if needed.Your family may see you once you have been trans-ferred from the recovery room to your room in the surgical unit.

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