Total hip replacement - Before your operation

Between being seen in the outpatient clinic and the time of your operation, there are several things you should do to prepare yourself.

• Perform the exercises you have been shown by the physiotherapist to keep your hip as mobile as possible and your muscles in shape (These are shown in detail in appendix 1.).
• If you are overweight, as explained above, it is important that you do what you can to lose weight. (see Non Surgical Treatments. 3. Weight Loss)
• Stop smoking for several weeks before your operation. This helps to reduce the increased risk of chest complications in smokers. Cigarettes also slow wound healing and may increase the chance of blood clots.  If at all possible, therefore, try not to smoke in the first weeks after your operation.
• To reduce the risk of an infection occurring around your new hip, it is important that any possible sources of infection elsewhere are eradicated prior to your hip operation. Common areas of concern are the teeth or gums, skin infections, bladder infections, leg ulcers, in-growing toe nails and athletes foot. Any source of infection, however seemingly minor, must be rectified or your operation will have to be postponed. See your dentist for a check up and arrange treatment or see your GP for advice for any other problems.
• Plan how you will cope at home. Most people go home 4 or 5 days after their operation. You will normally need crutches or a stick for the first 6 weeks and you are not allowed to drive during this time. If you normally live alone, it is usually best to arrange for a friend or relative to come and stay for a few weeks, or for you to stay with them, whilst you recover. If you anticipate problems, please discuss your arrangements with your GP well in advance.

Assessment clinic
A week or two before your operation you will be asked to attend the hospital for a pre-operative assessment  (unless you are called in at short notice). Staff will go over the details of your general health and medications with you. Some drugs should be stopped in advance of your operation. These include clopidogrel (plavix) (at least 2 weeks) the contraceptive pill (preferably 6 weeks), aspirin (1-2 weeks) and warfarin (usually 5 days, but varies – please discuss with staff in the clinic). HRT is not normally a problem  and can be continued. You will have a number of blood test and x rays and a heart trace (ECG). You will also see a physiotherapist and occupational therapist. They will explain how you will mobilise after the operation, organise any adaptations that may be needed in your home and discuss your discharge plans with you (see the Hip Tip Book).

The Bone Bank
Either at the Assessment Clinic, or when you come in for your operation, you may be asked if you are willing to donate bone from your worn joint  to the bone bank. At the time of your hip replacement, the worn ball (head of the femur) is removed & was traditionally discarded. However we have learnt with experience that it can be very useful.in reconstructing hips with worn out hip replacements. However donation involves some extra blood tests, which if you agree, the whole process will be carefully explained to you by the bone bank co-ordinator.

Admission to hospital.

• Normally admission takes place the day before surgery although there is a move towards admission on the day of surgery.
• A nurse will go through your personal details and plan your individual nursing care with you.
• The ward doctor will examine your general health, mark the correct hip with an indelible pen, and ask you to sign the Consent for Surgery Form (if you didn’t do so in the assessment clinic). Please feel free to ask any further questions you have, or raise any concerns, at this time.
• The anaesthetist will see you and perform a further final check of your heart, lungs and general health. He/she will also review any medication you are taking, and the need for any pre-medication. He/she will discuss with you the type of anaesthetic planned.. This usually involves a spinal or epidural anaesthetic to numb the legs and hip area, combined with a light general anaesthetic.
• A physiotherapist will instruct you in the appropriate exercises, including breathing exercises to lower the risk of chest complications and leg exercises to improve circulation and maintain muscle tone. Crutches will be supplied to you and you will be shown how to use them. Further details of these and other aspects of your post-operative rehabilitation are detailed in the Hip Tip Book.
• You will not be allowed to eat for 6 hours nor drink any fluids for 4 hours before the scheduled time of your operation  . Relatives are encouraged to ring in on the day of surgery rather than visit. We have an open policy for visiting, other than the rest hour after lunch.

Appendix 1Hip

Exercises to perform BEFORE having surgery.

These exercises are to maintain muscle strength and movement prior to surgery. Different exercises are used after hip replacement surgery, which will be shown to you by the physiotherapist whilst you are in hospital (see the Hip Tip Book).

• Put one foot on the lowest or second stair or a kitchen stool (hold on to the banister or other firm support). Lean forward to bend the top leg whilst stretching the front of the standing leg. Hold this for about 30 seconds, then repeat with the other leg.
• Stand on the affected leg for short periods, lifting the good leg off the floor. Concentrate on holding the pelvis level. Use a support as necessary for balance.
• Lie on your back. Pull your legs alternately up onto your chest, keeping the other leg flat down on the bed. NB. This should only be done of you have not already had a hip replacement on one side.
• Lie on your back. Bend your knee up so that your foot rests flat on the bed, Allow the bent knee to fall out to the side as much as is comfortable.
• Lie on your stomach and then flat on your back for approximately 20 minutes once or twice a day (early morning or late at night whilst in bed is often a good time), to stretch the front and back of your hip.