Hip Replacement - Operation

Usually the patient is admitted to the hospital a few hours before surgery giving them a chance to become accustomed to the room and to make the acquaintance of the staff who will be helping to take care of them.
Before the operation the Consultant will go to the room to explain again what he is going to do and the patient will sign the consent form.

After the operation the patient usually rests in bed for 24hours. They may initially have a drip and a urinary catheter. Some patients may have an abduction pillow beteen their legs to maintain the position of the operated leg. If there is no pillow it is imperative that the patient keeps their leg slightly apart and does not try to cross them. A check xray will be taken at some point –either in the theatre or first thing next morning. Their blood will also be tested to see how their body reacted to the operation. If it results that the blood count (haemaglobin) is low then they may be transfused the two units that were cross matched prior to surgery. The patient will be mobilised according to the Consultants instructions – usually in the morning after the operation. Some Consultants like to begin mobilising the hip as soon as possible after surgery and will refer the patient for CPM – continuous passive movement- which is a machine that bends the leg for the patient (passively) to a pre set degree and then straightens the leg out again. The patient may have none, one or two drains after the surgery depending on the surgeon and the technique used, and these will stay in for up to two days. The patient will begin to mobilise with a zimmer frame on the first day post op and will quickly move onto crutches or sticks depending on individual progress. Some patients will be wearing white stockings after surgery. These are another method of preventing thrombosis and should be worn for 6 weeks unless the patient is advised otherwise by the Consultant. As they are compression stockings they should be smooth all the way up and the gusset should fit over the inside of the top of the thigh. They should be firm but comfortable, and they should never be folded over. Initially they should be worn all the time, but after three weeks they can be removed at night and reapplied in the morning. They are washable but one should use warm soapy water not hot.

The Consultant will visit on a daily basis to decide patient management but the hospital doctors will be overseeing the hospital stay. It is important in the initial stages that the patient is painfree and they may have a PCA to self administer the painkiller. This is usually Morphine. It is self regulating and so the patient cannot overdose themselves with it. When this is removed the patient will be given regular pain killing tablets which they should take, as each day they be exercising more and it is important that they are free from pain. Initially the pain they experience is the wound, as the pain of the hip disappears post operatively. Moving ie exercising will help to dissipate the bruising around the wound and will help with the healing. They will also be given a daily injection of a heparinoid – usually Clexane under the skin to prevent thrombosis. The physiotherapists will visit as often as is necessary,but usually twice a day. The CPM, if used, will be done daily and the angle of bend will be gradually increased at these visits but will not exceed the safe angle at the hip (which is a right angle). The physiotherapists will also give the patient exercise programmes and walking practice so that patients gait will be normalised as soon as possible. The patient will be encouraged to be independent and the physiotherapist will show the patient the best way to get in and out of bed. Initially the patient will be taught to get out from the operated side and to get in with the good side first - this will help to maintain the leg in a good position. . In the first three months the patient will not be able to lie onto the operated side and should never turn onto it even if asked to!. However they will be able to turn towards the good side providing that they have a large pillow between the legs to support the operated leg. This is a position which will be used by the nurses when bed bathing the patient., and they will take care to ensure that the leg is properly supported. It is imperative to maintain the position of the hip especially in the weaker initial stage. Hip stability is usually maintained by the muscles that have to be cut to perform the operation – especially if the operating technique used is exactly on the side of the hip- so special care must always be taken. However I would suggest that the patient spends the first 6 weeks lying on their back and uses a pillow between the knees at night incase they inadvertently turn onto their side whilst asleep. Special raised seats are available for the toilet (it may be useful to buy one for use at home) and whilst the patient is recovering they may make us of special mattresses and monkey pole for the bed. When getting out of bed they should not use the monkey pole, as this does not help one to get up. The monkey pole is to help the patient maintain their position in bed and to help relieve pressure. Stairs are usually practiced on the 5th day. Most patients are discharged with crutches or 2sticks and the patient should use these for at least six weeks. If the patient makes good progress it may be safe to use one stick after 3 weeks and this should always be held in the hand opposite to the operation. However aids can only be discarded when the patient can walk normally without limping. If they stop using them too quickly they will walk with a ‘dip’when they stand on the operated leg and this will then persist for a long time if not permanently. Some patients may have a discrepancy in the length of their legs. This is sometimes ‘real’ and sometimes ‘apparent’. If the hip joint was very damaged then the usual space of the ball from the socket would have been lost. After the operation this space would have been regained but the patient will feel the leg is longer. In time this will sort itself out. However if the unoperated hip is gone as well then the operated leg will really be shorter than the other. In this case it may be better to have a raise put onto the shoe of the unoperated leg to equal the length. Should this hip be operated at a later stage then the raise should be removed. It is usual for the operated leg to be a little swollen after the operation and it will help if the leg is elevated on a stool at intervals during the day. Painkillers should continue for as long as the patient needs them. The patients may need to continue taking the injections to prevent thrombosis for a length of time following surgery – the Consultant will decide this upon discharge.