Post-op proceedure

There has recently been a huge change in the immediate post-operative management of patients. With the advent of less invasive hip surgery, patients are mobilised much more quickly, thereby reducing the risk of post-operative blood clots and allowing for earlier home discharge, thereby reducing the risk of catching a hospital-related infection. Most patients in Exeter are now on their way home on the 4^th post-operative day but particularly motivated patients can be home as early as day 1 or 2. If one lives alone every effort should be made to arrange for a relative or friend to come and stay at home for a few days to allow for early home discharge. This of course releases hospital beds sooner for those who need them but also reduces the exposure to hospital-related infections, with similar risks even at local community  hospitals.  

Day 0
Immediately after the operation the patient is taken to the recovery room. Once properly awake and with stable observations, transfer back to the ward takes place.

In uncomplicated first time hip replacements patients are now being mobilised on the day of surgery. This usually involves just standing out of bed with crutches or a frame and with assistance but might involve taking a few paces. On the night of surgery regular checking of pulse and blood pressure is necessary so it is difficult to get a good night’s sleep. Pain relief can be administered in a variety of ways and is usually successful in leading to only a dull ache. In Exeter standard practice is to use a spinal anaesthetic to which diamorphine has been added. This method usually gives extremely good pain relief for at least the first 24 hours post surgery.

Day 1
Today walking with aids is encouraged under supervision and sitting out for a short period of time allowed. If walking to the bathroom is achieved, the urinary catheter (if inserted) can be removed. The blood level (haemoglobin) is checked and, if satisfactory, then the drip is removed from the arm. Occasionally a blood transfusion is required.

Day 2
More walking is encouraged with frequent walks up and down the ward. As much weight is taken on the operated leg as possible. Stair climbing is commenced in patients progressing ahead of schedule. Sitting out for meals is now allowed.

The wound is checked.

Day 3
Walking distance is increased and stair climbing commenced. If performed satisfactorily, and if able to dress and undress alone, then discharge is arranged.

Day 4
Most patients should be ready for discharge, having mobilised adequately on crutches.

At home
Progress from crutches to sticks or single crutch as soon as confident and steady enough to do so. When able, may discard walking aids in the home but should use a stick out of doors until 1^st out-patient review at 6 to 8 weeks post-surgery.

No driving for 6 weeks.