Hip Surgery

WHAT YOU SHOULD KNOW

Risks

IF YOU'RE HEADING FOR THE HOSPITAL...

Before You Go

• The Week Before Surgery:
• You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take any over-the-counter medicines.
• Your doctor will tell you whether you need to have blood drawn.
• You may need traction to pull the bones into place before surgery. If so, a pin will be placed in the bone and hooked to ropes and a pulley. Sand bags attached to the ends of the ropes will provide the force needed to keep the bones in place.
• The Night Before Surgery:
• Your physician may suggest you take a sleeping pill.
• Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.

When You Arrive

• Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
• Do not wear contact lenses to the hospital. You may wear glasses.

What to Expect While You're There

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Blood Tests: You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
• Chest X-ray: The doctor will check this picture of your lungs and heart to make sure they can handle the stress of surgery.
• Heart Monitor: (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Typically, three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
• Pulse Oximeter: With a little clip connected to your ear, finger, or toe, this machine measures the oxygen in your blood.
• Anesthesia: You'll need a pain-killer during the operation. For this type of surgery, the following options are available:
• Spinal Anesthesia: This type of anesthesia requires an injection in the spine. You will be awake during surgery but will be numb below the waist. Feeling will return in about 2 hours.
• Epidural Anesthesia: For this type, a tiny tube is positioned near the spine, allowing administration of additional medication during the operation. You will be awake during surgery but will be numb below the waist. Feeling will return to your legs when the anesthesia wears off.
• General Anesthesia: This alternative puts you completely to sleep throughout the operation. The anesthetic is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.

During Surgery

After Surgery:

• Oxygen: After the operation, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
• Deep Breathing and Coughing: These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
• Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Incentive spirometer (spy-ROM-uh-tur): This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
• Drains: Thin rubber tubes may be put into the area around your incision to drain off excess fluid. They will be taken out when no longer needed.
• Ice: For pain or swelling, you may put ice in a plastic bag, cover it with a towel, and place it over the incision for 15 to 20 minutes out of every hour as long as necessary. Do not sleep on the ice pack. Treatment with ice is most effective when started right after the operation and used for 24 to 48 hours.
• Heat: After the first 24 to 48 hours you may use heat for pain or swelling. Apply a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need relief. Do not sleep on the heating pad or hot water bottle. Heat brings blood to the area of the operation and helps it heal faster.
• Activity: You may need to rest in bed for a while. But even if you are confined to bed, it's important to exercise your legs in order to stop blood clots from forming. Lift one leg off the bed and draw big circles with your toes, then repeat with the other leg. You can also try lying on your side and pretending to pedal a bike. When you're told it's OK to get out of bed, make sure someone is with you the first time you try. If you feel weak or dizzy, sit or lie down right away.
• Pressure Stockings: These tight elastic stockings keep blood from collecting in the legs and causing clots.
• Pneumatic Boots: For extra insurance against blood clots, these plastic boots or leggings are applied over pressure stockings or ace wraps and connected to an air pump machine. The pump rhythmically tightens and loosens different parts of the boots, helping to push the blood back up to the heart.
• Turning: After surgery, you will need to learn a special way of turning in bed without hurting your hip. It's done with the help of pillows between your legs to keep them apart.
• Physical Therapy: A physical therapist will help you start special exercises after the surgery. These exercises are designed to make your hip stronger and keep it flexible.
• Eating: When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
• Bowel Movements: Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran, cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
• Bathroom: Until you're able to get out of bed, you'll have to use a bedpan. The nurses will show you how to get on and off the bed pan without hurting your hip.
• Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O."
• Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
• Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
• Medicines:
• Antibiotics: These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
• Pain Medicine: To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
• Anti-Nausea Medicine: This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
• Stool Softeners: These medications make bowel movements softer so you won't need to strain.

After You Leave

• Always take your medicine exactly as directed. If it doesn't seem to help, let the doctor know, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up, even if you're feeling better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
• When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water. Then put on a clean, new bandage. Change the bandage any time it gets wet or dirty.
• Unless instructed otherwise, drink 6 to 8 large glasses of liquid, such as water, juices, and milk, each day. Limit caffeinated beverages, such as coffee, tea, and soda.
• To help stop bone loss, your doctor may want you to take calcium supplements and eat foods high in calcium, such as milk, cheese, ice cream, fish, and dark green vegetables, like spinach. For women with osteoporosis, doctors often prescribe estrogen or other bone-strengthening drugs such as Fosamax, Calcimar, and Evista.
• For the first 3 months after the operation, you must take the following precautions when using your legs:
• • Do not cross your legs when you are sitting, lying, or standing.
  • Keep the affected leg facing front at all times, even in bed. Do not turn your hip or knee in or out.
  • Keep a pillow between your legs when lying on your side.
  • Do not bend at the hips to reach into cupboards or drawers or to pick things up from the ground.
  • Do not sit on low chairs, stools, or toilet seats, and avoid reclining chairs. When sitting, you should always have your knees lower than your hips. You may need to use a firm cushion to raise chair seats. Consider renting or buying a raised toilet seat.
  • Sit only in chairs that have arms. When you need to get up from the chair, move to the front edge, place the injured leg in front of your stronger leg, and push up with the stronger one only. Push on the chair arms with your hands to finish bringing yourself upright.
• Slowly start to do more each day, resting as needed. Once the hip is stronger, your doctor may prescribe physical therapy and a regular exercise program. Do check with your doctor first, however, before starting any exercise; and don't lift anything heavy until your doctor says it's OK.
• Until you can spend more time walking, you may need to wear support hose to reduce swelling in the legs.
• Once the hip is better, you'll probably be able to swim, play golf, walk, and bicycle. Do not play tennis, jog, or do other exercises that jar the hip joint.

Call Your Doctor If...

• Your incision is swollen and red, or you see any pus. These are signs of infection.
• Your stitches or staples come apart.
• Your bandage becomes soaked with blood.
• You are running a high temperature.
• Pain in your hip doesn't go away or becomes worse.
• You suffer a fall.

Seek Care Immediately If...

• You develop chest pain or sudden trouble breathing.