Clinical Pathway

Day of Surgery

• you will return to 4 Irving after surgery
• blood pressure and pulse monitored
• bedrest with assistance to turn with pillow between legs
• do ankle pumps, glut sets and quad sets (exercises 1, 2 & 3)
• begin breathing exercises
• Intravenous catheter (IV) for fluids and medications
• oxygen if needed
• a drain will come from your surgical dressing
• you will receive pain medication; let your nurses know how your medication is working
• you can begin to drink and then eat as your stomach allows
• let us know if you are nauseated

Post Surgery Day 1

• increasing self care
• physical therapy evaluation for exercise, and hip dislocation precautions
• your physician will have you get out of bed and sit in a chair
• continue exercises
• use an inspirex and deep breathe to keep your lungs clear
• oxygen may be discontinued
• continue to eat and drink as tolerated
• review your plans for after the hospital
• weight-bearing status depends on the type of total joint replacement fixation technique used during surgery
• wear TED stockings during the day and off at bedtime

Post Surgery Day 2

• you will start on oral pain medication, which you will need to ask for
• IVs discontinued
• self care
• continue exercises and work on range of motion
• goal is to walk 20 feet with walker
• sit in an elevated chair
• physical therapy 2 times a day
• continue deep breathing
• drink extra fluids and add fiber to your diet to prevent constipation
• the incision drain will be removed

Post Surgery Day 3

• ask for your pain medication as needed
• goal is to walk at least into hallway
• physical therapy 2 times a day
• up in chair for meals
• continue coughing and deep breathing
• the discharge planner will see you regarding equipment, help at home or short term rehabilitation, if necessary

Post Surgery Day 4

• continue to increase walking endurance
• sit in chair
• total self ADLs (Activities of Daily Living)
• goal: normal bowel movement within last 72 hours; if not, medications are available
• learn stairs, if applicable
• continue exercises
• goal: to be able to walk to your bathroom, do your exercises and take care of your personal needs to go home with a family member or friend
• goal: to be able to get in and out of bed on your own

Post Surgery Day 5

• you will be discharged on an anticoagulant to prevent blood clots
• keep a pillow between your legs and maintain hip dislocation precautions
• use the pain medication for discomfort, as needed

Within 1 Week Post Hospital

• if home care services have been arranged, a home health nurse will call you within 48 hours.
• if you are going home on coumadin, blood draws will be arranged for 2 times a week with the results called to your doctor for 1 month
• take your pain medication as needed
• use a pillow or abductor pillow between your legs in bed
• continue exercises taught in the hospital
• increase your walking as tolerated
• schedule your post-op visit with your doctor
• your balance may seem unsteady at first but will improve as you progress with walking
• take your temperature daily

Weeks 2 and 3

• a visit with doctor or nurse to have staples or sutures removed
• you may shower 24 hours after staples are removed, or earlier if doctor allows
• lab technician to draw blood if you were discharged home on coumadin
• continue exercise and walking
• continue to use a pillow between your legs

Post 3 to 6 Weeks

• check with your doctor about change in weight-bearing status
• continue exercise and walking
• check return appointments with your doctor
• discuss the physical activities that you can return to after your recovery
• discuss driving an automobile when you have full, complete control over the leg and no pain with motion

Tips

1.Remove scatter rugs to avoid tripping on them.
2.Sit on a high stool or chair instead of standing for any lengthy tasks.
3.Use an apron with many pockets to transport objects. Slide objects along the countertop rather than carrying them.
4.Plan easy meals in advance to avoid frequent shopping.
5.Wear slip-on shoes, low-heeled shoes or shoes with elastic laces.
6.Use a utility cart to carry items from place to place; push it ahead of the walker.
7.Sit in chairs that have arms.
8.Get up and walk around every hour or so to prevent stiffness and increase circulation to your legs.
9.Use handicapped bathrooms at public facilities.
10.Wear loose-fitting clothing. Elastic waists are less binding on your incision.
11.Stairs with hand rails are best.
12.Store items at the height of your hip and shoulder.
13.Plan each day by setting priorities and eliminating unnecessary tasks.
14.Elevate operative leg above heart frequently to avoid swelling.
15.Walk slowly and do not rush to answer the phone.

Hip Dislocation Precautions

- DO NOT cross your legs. - Keep your legs shoulder-width apart. - Keep your toes pointing upward or forward.

- DO NOT bend your hip past 90° either by bending forward or raising your knee above your hip. Use a reacher to avoid bending.

- DO NOT bring your trunk down past 90°.

Tub Transfer

• Put a tub chair in your tub facing the faucet.
• Back up to the side of the tub and sit down on the chair.
• Keeping legs straight, swing them around and into the tub, one leg at a time.
• Use a long-handled sponge and shower hose to wash.
• May use a shower if available.

Car

• Move the seat all the way back and recline the seat.
• Back up to the car with the walker.
• Lower yourself slowly to the seat.
• Push yourself back onto the seat in a semi-reclined position.
• Turn to bring one leg at a time into the car.

Toilet Transfer

Using a raised toilet seat:

• Back up to the toilet seat until you feel it against the backs of your legs.
  
• Reach back with one hand at a time to the edges of the toilet seat.
  
• Keeping your operated leg straight out, lower yourself by bending your good leg.

A toilet transfer using a commode chair is just like using a regular armchair.

Sitting

When sitting:

Move operated leg forward, reach back for the chair, one hand at a time, and lower yourself slowly.

When standing from a seated position:

Push up from the armrests or the surface seated on. Push yourself up. Gain your balance before taking hold of the walker.

DO NOT:

Pull up on the walker when rising - it could tip.

Bed

Use a firm bed. Avoid low beds.

• Sit down on the edge of the bed.
• Slide yourself backwards on the bed. Bring one leg at a time around and onto the bed.
• Keep a pillow between your legs when lying on your back.
• Side-lying is not recommended, but if you must, keep pillows between your legs, so your legs stay apart and to prevent turning your leg inward.

Walker

• All 4 legs of the walker should be on the ground before taking a step.
• DO NOT put more weight on your operated hip than was specified by your doctor.
• Take small steps when turning; do not twist on your operated leg.

Chairs

• Use a firm, sturdy chair with armrests.
• Avoid low chairs.
• DO NOT bend your hip up past 90°
• Ask for the Hip Chair or use a standard chair with a large, firm pillow.

Exercises

1.Ankle Pumps

• Pump your foot back and forth slowly

2.Gluteal Sets

• Squeeze your buttocks together.
• Do not hold your breath.
• Hold for a count of 3.

3.Quad Sets

• Tighten muscles on top of thigh by pushing back of knee down against the table or bed.
• Hold for a count of 3.

4.Short Arc Quads

• Lie on back, towel roll under knee.
• Lift foot and straighten
• knee.
• Do not raise thigh off roll.
• Hold for a count of 3.

5.Heel Slides

• Lie on back.
• Slide heel to bottom, bending your knee.

6.Hip Abduction

• Slide leg out to the side
• Keep toes pointed up and knee straight.