Patient Discharge Guide for Hip Fracture Patients

Ortho Spine Unit 405-515-3700 Physical Therapy 405-515-1712 Orthopedic Nurse Navigator 405-664-6696 3300 HealthPlex Parkway Norman, OK 73072

NormanRegional.com

Contents

6 Vital Factors...... 3 Safety ...... Section D Sleeping Positions...... 26 Caring for Yourself at Home...... Section A Home Safety...... 27 Managing your Pain...... 6 Bathroom Safety...... 28 Anti-coagulants...... 6 Bathing...... 29 Constipation...... 6 Kitchen Tips and Safety...... 30 Positioning your Leg...... 7 Car Transfers...... 31 Homemade Ice Pack...... 8 Curb/Stair Training...... 32 Hip Precautions...... 9 Preventing Dislocations...... 12 Energy Conservation...... Section E Weight Bearing Status...... 13 Incision Care/Dressings...... 14 Energy Conservation...... 36 Body Changes...... 14 Coping with Stress...... 14 Activity Guidelines...... Section F Intimacy...... 14 Activity Guidlines...... 38

Preventing Potential Follow Up Care...... Section G Complications...... Section B Follow Up Care...... 40 Medication Precautions...... 16 Infection...... 17 Blood Clots...... 17

Exercise Guide...... Section C Exercise Guide...... 20

1 2 6 Vital Factors for a Successful Recovery

1. ELEVATION is for swelling. It is normal to have increased swelling in your legs once you are home. You need to elevate your leg above the level of your heart for at least 30 minutes two times a day.

2. ICE is for pain. It is normal to have some increase in pain after you are at home. You need to ice your knee for 20 minutes while you are elevating your leg, at least two times a day. Remember to protect your skin by placing a layer of cloth between the ice and your skin (such as a towel or pillow case).

3. BLOOD CLOT PREVENTION. Your surgeon has prescribed a blood thinner for you. This medication must be taken as prescribed at the same time every day.

4. CONSTIPATION. Constipation is normal after surgery. If you have not had a bowel movement in 2 days, you need to take Miralax twice a day until you have a bowel movement.

5. ACTIVITY AS TOLERATED. It is very important to move and stay active once you

Please tear this page out this page and keep tear handy somewhere Please are at home. You need to be up and moving as tolerated. If you feel you have over exerted yourself, your first step needs to be to rest, ice and elevate your leg.

6. NUTRITION. Calorie and protein needs are higher after your surgical procedure. Proper nutrition is important for optimal healing and recovery. Aim to eat 3 well balance meals a day with 2 snacks as tolerated.

*If you have any questions or concerns regarding these 6 factors, call Melanie Garner at #405-664-6696* Please tear this page out and keep somewhere handy

3 4 Caring for Yourself at Home Section A

5 . 3 If you miss a dose of this medication, take it as soon as you remember—unless it’s Caring for almost time for your next dose. In that case, just wait and take your next dose at the Yourself at Home normal time. Do not take a double dose. . 4 Use an electric razor to shave. MANAGING YOUR PAIN . 5 Anticoagulant medication can make bleeding harder to stop. It is normal to have moderate pain after a major surgery such as this. Pain medication will be CONSTIPATION prescribed for you; with pain under control, you’ll be able to get back to an active life sooner. Take Constipation is one of the most common issues pain medication, with food, only as directed, taking patients face after surgery. Surgical anesthesia, each dose before pain becomes severe. Plan lack of appetite, limited physical activity and opioid ahead by taking pain medication an hour prior to pain medications can all cause constipation. While physical therapy or strenuous activities such as you were staying in the hospital you were given bathing. Icing and elevating your leg is extremely stool softeners: Colace (docusate sodium) and important to managing your pain, make sure you Miralax (polyethylene glycol). Continue these at are following your icing and elevating protocol. home unless you are having diarrhea. Eating fiber If you develop sudden pain—rest with ice and rich foods and drinking plenty of water will also elevation should be your FIRST step to manage help. High fiber containing food groups include this. whole grains, beans, fruits, and vegetables. IF you have not had a bowel movement in two days, take Miralax twice a day. If you still don’t have a bowel ANTI-COAGULANTS movement within another two days, and you have Your surgeon will prescribe medication that helps no history of kidney/renal problems then drink ½ prevent blood clots from forming in your blood. bottle of magnesium citrate. If no bowel movement This may be aspirin or another medication in pill after 4 hours drink the remaining 1/2. Do not or shot form. It is very important that you take this let constipation go on too long. IF still no bowel medication for as long as directed by your surgeon. movement after these interventions, contact your Your nurse will review any specific instructions primary care physician or ortho surgeon. for the medication you surgeon has prescribed for you. Do not strain to have a bowel movement. Guidelines for use: When straining or bearing down to have a bowel 1. Don’t take any new medications, including movement it is common to hold your breath, this over-the-counter medications, like naproxen combination can trigger a vasovagal response. or ibuprofen, without checking with your Symptoms include dizziness, tunnel or blurred surgeon first, because they may affect your vison, sweating, fainting and can trigger a sudden blood thinner. increase in blood pressure and/or an abnormal . 2 Take your anti-coagulation medication at the heart rhythm. If you are unable to pass stool same time every day. without straining increase the stool softeners to twice daily. 6 POSITIONING YOUR LEG 1. Change your position at least every 45 minutes during the day to avoid stiffness. . 2 Do not sit with feet on the floor for more than 30 minutes at a time. . 3 Change positions frequently, do not sit still too long. It is better to get up more often for short periods then to wait and get up less, but for longer periods. . 4 When you are elevating your leg, do your ankle pumps. They will reduce swelling and improve circulation.

7 Homemade Ice Pack

1. Fill the plastic freezer bag with 1 cup of rubbing alcohol and 2 cups of water. 2. Try to getIce as For much 20 Minutesair out of at the LEAST freezer bag before sealing it Twiceshut. A Day 3. Place the bag and its contents inside a second freezer bag to contain any leakage (zipper size in first). 4. Leave the bagHomemade in the freezer Ice Pack for at least an 1. Fill the plastic freezer bag with 1 cup of rubbing alcohol and 2 cups of water. hour.2. Try to get as much air out of the freezer bag before sealing it shut. 3. Place bag and its contents inside a second freezer bag to contain any leakage (zipper side in first). 4. Leave the bag in the freezer for at least an hour.

Remember to ice and elevate your leg after activity and physical therapy. Remember to ice and elevate your leg after activity and physical therapy. 8

ICE for 20 minutes at LEAST twice a day. Hip Fracture: Hip Fracture: Hip HipPrecautions Precautions after surgery After Surgery

If your hip fracture was repaired with a Partial (Hemi or Bipolar Arthroplasty), a Total Hip ReplacementIf oryour you hip fracturehave been was repaired instructed with ato Partial follow (Hemi Hip or BipolarPrecautions Arthroplasty), on your a Total discharge Hip Replacement or you have been instructed to follow Hip Precautions on your discharge paperwork. paperwork.

Total Hip Replacement

The Following Sections apply to you: The Following 1. PSectionsreventing Dislocations apply to you: 2. Total Hip Precautions

1. PreventingIf your fracture Dislocations was repaired with plates and screws or a rod, and your discharge instructions to do not include hip precautions please disregard the sections listed above. 2. Total Hip Precautions

If your fracture was repaired with plates and screws or a rod, and your discharge9 instructions to do not include hip precautions please disregard the sections listed above.

please talk to your occupational or physical therapist so they can provide and review the Totalproper Hip positions you can use to maintain your hip precautions during sexual activity.

Replacement PrecautionsTotal Hip Replacement Precautions

To practiceTo safe practice movement safe until movement your hip replacement until your has hip replacement has fully healed, you will need to take fully healed,several you will precautions need to take several to avoid precautions dislocating to avoid your hip: 1. dislocating your hip: 1. Do not bend your operated hip beyond a 90° angle. Do Not Bend Down at the Waist to pick items off the floor. . 1 Do not bend your operated hip beyond a 90° angle. 1. . 2 Do not2. turn yourDo notoperated turn legyour inward operated in a leg inward in a 1.pigeon Use-toed a longposition.-handled reacher or other adaptive aid to pick items off the floor. to pick items off the floor. pigeon-toed position. Do Not Bend Down at the Waist Do Not Bend Down at the Waist to 3. Do not3. cross Do your not operated cross yourleg. operated leg. 1. pickUse items a off long the- floor.handled Use a reacherlong- or other adaptive aid to pick items off the floor. handled reacher or other adaptive This section provides reminders about proper positions when aid to pick items off the floor. sitting, standingThis sectionand lying provides down. Let remindersyour therapist about or your proper positions when sitting, standing and lying down. doctor knowLet if youyour have therapist questions or about your these doctor precautions. know if you have questions about these precautions.

Sitting: Sitting: 1. Sit in raised seats (1-2 pillows if necessary) or on a raised toilet seat/commode with 1. Sit in raised seatsarmrests. (1-2 pillows if necessary) or on a raised toilet seat/commode with armrests. 2. Do not2. raise Doyour not knee raise higher your than knee your higher hip than your hip while sitting. Sit with the operated leg forward. while sitting. Sit with the operated leg forward. . 3 Reach back for the arm rests of the chair with both hands.3. BringReach the back operated for legthe forward arm rests and slowlyof the chair with both hands. BringDo the Not operated Twist Yourleg Torso Inward when Lying, Sitting or Standing. Do Not Twist Your Torso Inward lower into theforward chair or raised and slowly toilet seat/commode. lower into the chair or raised toilet seat/commode. 4. Do not lean forward. Your shoulders should stay when Lying, Sitting or Standing.

behind4. your hips.Do not lean forward. Your shoulders should stay behind yourDo Nothips. Twist Your Torso Inward when Lying, Sitting or Standing. 10 12 13

1. Do Not Turn Your Operated Leg Inward in a Pigeon-Toed Stance.

1. Keep this in mind when standing and lying down. 1.

Do Not Turn Your Operated Leg Inward in a Pigeon-Toed Stance. Keep this in mind when standing and lying down.Do Not Turn Your Operated Leg Inward in a Pigeon-Toed Stance.

1. Keep this in mind when standing and lying down.

Do Not Cross Your Operated Leg or Ankle Over Your Do Not Cross Your Operated Leg or Ankle Over Your Non-Operated Leg. While sleeping or lying in bed, keep a pillow between your legs to prevent hip dislocation. Non-Operated Leg. 11 1. While sleeping or lying in bed, keep a pillow between your legs to prevent hip dislocation.Do Not Cross Your Operated Leg or Ankle Over Your

Non-Operated Leg.

1. While sleeping or lying in bed, keep a pillow between your legs to prevent hip dislocation. 14

Preventing How can I help prevent it? Proper body positioning is the key factor in Dislocations preventing dislocation. In the early post-operative period, learning total hip precautions, or the positions of potential instability to avoid are What is a “total hip dislocation”? critical. As surgical incision pain decreases beyond the immediate post-operative period, Total hip replacement dislocation is a painful it is important to remember the presence of condition in which the prosthetic femoral head, the prosthetic joint and not to become too or the “ball” on the proximal end of the femur of careless about your activities. Follow your total thigh bone, no longer articulates, or “comes out of hip precautions until your physician tells you joint”, with the socket in the acetabular cup of the otherwise. pelvis. Sexual Activity and Intimacy with Hip How often does it happen and when does it Precautions happen? Generally, most people wait to resume sexual The incidence of dislocation can vary from less activity for a few weeks after surgery. Your than 1% to as high as 4%. Up to one third of incision, muscles and body need time to heal. dislocations occur within 6 weeks after surgery When you feel ready to resume sexual activity and the rest happen after 6 weeks. please talk to your occupational or physical therapist so they can provide and review the What are the signs and symptoms of a hip proper positions you can use to maintain your hip dislocation? precautions during sexual activity. Signs and symptoms of a hip dislocation include severe pain in the leg, inability to move leg, Preventingshortening Dislocations and external rotation of the leg.

12 What is a “total hip dislocation”? Total hip replacement dislocation is a painful condition in which the prosthetic femoral head, or the “ball” on the proximal end of the femur of thigh bone, no longer articulates, or “comes out of joint”, with the socket in the acetabular cup of the pelvis.

How often does it happen and when does it happen? The incidence of dislocation can vary from less than 1% to as high as 4%. Up to one third of dislocations occur within 6 weeks after surgery and the rest happen after 6 weeks.

What are the signs and symptoms of a hip dislocation? Signs and symptoms of a hip dislocation include severe pain in the leg, inability to move leg, shortening and external rotation of the leg.

How can I help prevent it? Proper body positioning is the key factor in preventing dislocation. In the early post-operative period, learning total hip precautions, or the positions of potential instability to avoid are critical. As surgical incision pain decreases beyond the immediate post-operative period, it is important to remember the presence of the prosthetic joint and not to become too careless about your activities. Follow your total hip precautions until your physician tells you otherwise.

Sexual Activity and Intimacy with Hip Precautions Generally, most people wait to resume sexual activity for a few weeks after surgery. Your incision, muscles and body need time to heal. When you feel ready to resume sexual activity

Hip Fracture: Understanding Weight Bearing Status Hip Fracture: Understanding Weight Bearing Status

Non-Weight Bearing 1. Your leg must not touch the floor and is Hip Fracture: Non- Weight bearing not permitted to support any weight at 1. NonYour-Weight leg must bearing not touch theall. floor and is not permitted to support any weight at all. Hip Fracture: UnderstandingUnderstanding Weight Bearing 2.Status1. Always Your leg keep must yournot touch leg in . the front2 Afloorlways of and you,keep is yourusingnot permittedleg the in frontwalker ofto you,support for support any weight to hop at on all. non - 2. Always keep your leg in front of you, using the walker for support to hop on non- operative leg. using the walker for support to hop on operative leg. non-operative leg. Weight Bearing How much weight shouldStatus I put on my Leg? Weight bearing is the amount of weight your physician has instructed that you are able to safely put on the legHow upon much which weight surgery should has been I put performed. on my Leg? Please refer to your discharge instructionsWeight for your bearing weight is the bearing amount status of weight as ordered your physicianby your physician. has instructed that you are able to safely put on the leg upon which surgery has been performed. Please refer Understanding Weightto your bearing discharge status instructions for your weight bearing status as ordered by your physician.

Weight bearing as ToleratedWeight Bearing as Tolerated Touchdown Weight Bearing

1. When you stand or walk,1. When place you only stand as muchor walk, weight place as only feels as comfortable much on your injured1. The foot or toes may lightly touch the leg. Touchdown Weight bearing weight as feels comfortable on your injured leg. floor (to help maintain balance), but not 1. Let pain be your guide. If you feel pain, place1. Touchdown lessThe weight foot oron Weighttoesthe leg may or arm.bearinglightly touch the floor (to help maintain balance), but not support . 2 Let pain be your guide. If you feel pain, place support any weight. Do not place actual 1. Theany weight.foot or Dotoes not may place lightly actual touch weight the on floor the affected(to help leg. maintain balance), but not support less weight on the leg or arm. 2. anyImagine weight. you haveDo not an placeegg under actualweight your weighton foot the a that ffectedon theyou leg. affectedare not to leg. crush. 2. Imagine you have an egg . 2 under Imagine your you havefoot anthat egg you under are your not to crush. foot that you are not to crush.

Partial Weight Bearing

Partial weight bearing 1. When you stand or walk, you may lightly place

1. When you stand or walk,some you of mayyour lightlybody weight place some on your of yourinjured body leg. weight The on your injured leg. The amount amou of weightnt of weight usually is measuredusually measured in a percentage in a and will have been explained and demonstrated percentage by physical and will therapy have been staff. explained and 2. Always keep the operative demons legtrated alway tos in you front by physicalof you, using therapy your staff arms and the walker to 16 help support some of your weight. . 2 Always keep the operative leg always in front of you, using your arms and the walker to help 15 16

support some of your weight. 13 INCISION CARE/DRESSING CHANGES COPING WITH STRESS

A Mepilex/ Silver dressing has been placed on Undergoing surgery can be a very stressful event your incision. You are to wear this dressing for 7 for anyone. It can also be stressful to rely on days and then it can be removed. If it comes off others to help while you are healing. However, before then, and your incision is dry and has no having support from friends and family is needed drainage, you may leave it off. It is OK to shower for full rehabilitation. Having realistic goals and with the dressing on. keeping a positive outlook helps. Make note of small achievements. Some people find that deep You may shower. Your dressing is water proof and breathing and relaxation techniques help. does not need to be covered while you shower. Do not submerge your incision in bathtubs, SEXUAL ACTIVITY AND INTIMACY swimming pools, hot tubs or any form of standing water for at least one week following staple Generally, most people wait to resume sexual removal. activity for a few weeks after surgery. Your incision, muscles and body need time to heal. You should have a follow up appointment When you feel ready to resume sexual activity scheduled with your surgeon for 10 to 14 days the bottom or missionary position is usually the after discharge. At this follow up appointment, most safe and comfortable. If you have specific or your staples will likely be removed. additional questions please feel free to ask your occupational or physical therapist. BODY CHANGES

You may have less than your usual appetite for a while. Your energy level may be low for a few weeks after surgery. Your nutrition needs increase after surgery. Consume foods high in protein to enhance wound healing. High protein foods include meat, poultry, fish, beans, soy, tofu, eggs, nuts, seeds, and nut butters. Also be sure to consume 2-4 servings of fruit and 3-5 servings of vegetables daily. This will help you obtain adequate vitamins and minerals for you optimal recovery. If your appetite is poor and you are struggling to meet your nutritional needs, consider over the counter nutrition supplements.

Your new hip may cause your leg to feel longer. The joint likely gained some height that was lost prior to surgery.

14 Preventing Potential Complications Section B

15 It’s important to know that while acetaminophen Preventing is safe and effective when used as directed, there is a limit to how much can be taken in Potential one day: 4,000 milligrams (mg) daily limit for most adults. Taking more acetaminophen than Complications directed is an overdose and can lead to liver damage or even cause death.

MEDICATION PRECAUTIONS It is important to always read and follow Acetaminophen, frequently known as medication labels. Please note that when Tylenol® is found in many post-operative knee checking labels acetaminophen may also be list replacement pain medicines. Acetaminophen as Tylenol®, APAP® or Acetam®). may be combined with a narcotic medicine to increase its effectiveness. Examples of these To help you take acetaminophen safely, please medicines include Norco®, Lortab®, and Percocet®. follow medication labels and avoid making these Additionally, many over-the-counter (OTC) common acetaminophen dosing mistakes: medicines also contain acetaminophen. These medicines include sleep aids, fever reducers, pain relievers, as well as cold and allergy medicines.

COMMON ACETAMINOPHEN DOSING MISTAKES:

Taking the next dose too soon

Using multiple acetaminophen-containing products at the same time

Taking more than the recommended dose at a single time

16 WARNING SIGNS OF INFECTION

Notify your physician or primary care physician if you have any of the following symptoms.

1. Persistent fever (greater than 101.5 degrees) . 2 Shaking, chills . 3 Increasing redness and heat of your wound . 4 Yellow or green drainage from your wound . 5 Increasing pain at rest

WARNING SIGNS OF A BLOOD CLOT

Take your blood thinners as prescribed. If unable to get prescriptions, notify your surgeon or primary care physician immediately. Notify your surgeon or primary care physician if you have any of the following symptoms:

1. Severe pain or tenderness in your leg or calf unrelated to your incision, which is not improved by rest, ice and elevation. . 2 Severe swelling of your thigh, calf, ankle or foot; which is not improved by rest, ice and elevation.

In very rare cases, a blood clot may travel to your lungs and become life-threatening. Seek medical attention immediately if you develop any of the following symptoms.

1. Shortness of breath . 2 Sudden onset of chest pain . 3 Localized chest pain with coughing

17 18 Exercise Guide Section C

19 Total Hip Replacement Exercise Guide

Regular exercise to restore your normal hip motion and strength and a gradual return to everyday activities are an important part in your full recovery. These exercises are important for increasing circulation to your legs and feet in order to prevent blood clots and decrease swelling. These exercises also are important to strengthen muscles and improve your hip movement.

You will begin these exercises the day after surgery. It may feel uncomfortable at first, but these exercises will speed up your recovery and help reduce your post-operative pain. Your orthopedic surgeon and physical therapist recommend that you continue to perform this exercise program twice a day (once in the morning and once in afternoon/evening) at home during your early recovery.

Do not forget to apply ice to your hip for 20 minutes following each exercise session.

Please do these exercises 40 Times each Twice daily.

If you have any questions once you are home, please feel free to contact the Physical Therapy Department at (405) 515-1712

1. Ankle Pumps

1. Ankle Pumps 1.Gently “pump”Ankle both ankles up Pumpsand down, so that your toes point first up and toward you, then down.

Gently “pump” both ankles up and down, so that your toes point first up and toward you, then down.

2. Quad Sets Slowly tighten muscles of the thigh pushing knee into the bed with your leg straight. Hold for a count of three to five seconds then relax the muscles.

2. Quad Sets

Slowly tighten muscles of the thigh pushing knee into the bed with your leg straight. Hold for a count of three to five seconds then relax the muscles.

Slowly tighten muscles of the thigh pushing knee into the bed with your leg straight. Hold for a count of three to five seconds then relax the muscles. 22

3. Ham Sets Push your heel into the bed with your legs straight or knee slightly bent hold for five seconds, relax and repeat. 3. Ham Sets

3. Ham Sets

Push your heel into the bed with your legs straight or knee slightly bent hold for five seconds, relax and repeat.

4. Gluteal Sets Squeeze your buttock muscles as tightly as possible. Hold for a count of three to five seconds then relax the muscles.

4. Gluteal Sets

Squeeze your buttock muscles as tightly as possible. Hold for a count of three to five seconds then relax the muscles. 22 Squeeze your buttock muscles as tightly as possible. Hold for a count of three to five seconds then relax the muscles.

5. Heel Slides Slide your heel up toward your body by bending your knee. Keep your heel in contact with the bed. 3. Ham Sets 5. Heel Slides

5. Heel Slides

3. Ham Sets

Push your heel into the bed with your legs straight or knee slightly bent hold for five seconds, relax and repeat.

Push your heel into the bed with your legs straight or knee slightly bent hold for Slide your heel up toward your body by bending your knee. Keep your heel in contactSlide your with heel the up bed. toward your body by bending your knee. Keep your heel in five seconds, relax and repeat. contact with the bed.

6. Hip Abduction With your knee straight and keeping your toes pointed toward the ceiling. Slide your leg out to the side as far as possible then back in. Do not cross midline of the body.

6. Hip Abduction

4. Gluteal Sets

With your knee straight and keeping your toes pointed toward the ceiling. Slide yourWith legyour out knee to the straight side as and far keeping as possible your then toes back pointed in. Dotoward not crossthe ceiling. midline Slide of the Squeeze your buttock muscles as tightly as possible. Hold for a count of three to body.your leg out to the side as far as possible then back in. Do not cross midline of the five seconds then relax the muscles. body.

23 Squeeze your buttock muscles as tightly as possible. Hold for a count of three to five seconds then relax the muscles.

24 24 23

7. Straight Leg Raises

7. Straight Leg Raises Straighten leg as much as possible by tightening the muscles on top of your thigh. Raise your heel approximately 4 inches, relax and repeat. Remember to keep your leg straight during this exercise.7. Straight Leg Raises

Straighten leg as much as possible by tightening the muscles on top of your thigh, Raise your heel approximately 4 inches, relax and repeat. Remember to keep your leg straight during this exercise.

8.Straighten Hamstring-Glut8. Hamstring leg Bridge as much as possible-Glut by Bridge tightening the muscles on top of your thigh, Place feet hip width apart and knees slightly bent. (Figure A) Press down with the heels of the feet and lift theRaise buttocks and your lower back up.heel (Figure B).approximately Keep abdominal and lower back tight 4 so inches spine stays neutral., relax and repeat. Remember to keep your leg straight during this exercise.

8. Hamstring-Glut Bridge 24

Place feet hip width apart and knees slightly bent. (Figure A) Press down with the heels of the feet and lift the buttocks and lower back up. (Figure B). Keep abdominal and lower back tight so spine stays neutral.

Safety Section D

25 Safety

AFTER HIP REPLACEMENT: SLEEPING POSITIONSSafety After Hip Replacement: Sleeping Positions Your new hip needs extra care while it heals. Remember if you have had a partial or total hip replacement to follow your “hip precautions” to help you avoid injuring it. Use the tips on this sheet to help keep your newYour hip safenew while hip sleeping. needs extra care while it heals. Remember if you have had a partial or total hip replacement to follow your “hip precautions” to help you avoid injuringHave an emergency it. Use planthe in tips case on of a thisfall. Consider sheet keepingto help a telephonekeep your close new by or carryinghip safe a cell while sleeping. phone.

If YouIf You Lie Lie on on Your Your Back Back If If YouYou Lie onon YourYour Side Side

Remember Your Hip Precautions 1. Remember Keep the angle Yourat your hip Hip greater Precautions than 90°. (Don’t move your knees and chest too far toward each other.) 2. 1. D o notKeep cross your the legs angle or ankles at oryour let your hip operated greater thigh thancross the 90°. middle (Don’t of your body.move your knees and 3. Do notchest turn your too operated far toward hip or knee each inward. other.) 2. Do not cross your legs or ankles or let your operated thigh cross the middle Safe Sleepingof your body. 1. Find a position that keeps your hip safe and comfortable. 2. 3. U se pillowsDo not to keep turn your your hip in a operated safe position. hip or knee inward. 3. Follow your health care provider’s instructions about which side to sleep on. Safe Sleeping 1. Find a position that keeps your hip safe and comfortable. 262. Use pillows to keep your hip in a safe position. 3. Follow your health care provider’s instructions about which side to sleep on.

Safety After Total Joint Replacement: Home Safety Becoming more aware of hazards in your home can help make your recovery safer. You might wantAFTER TOTAL to have HIP REPLACEMENT: furniture HOME rearranged SAFETY so it’s easier to get around. Don’t forget to watchBecoming out more foraware hazardsof hazards in your like home canwet help floors make your recoveryor uneven safer. You might surfaces. want to have furniture rearranged so it’s easier to get around. Don’t forget to watch out for hazards like wet floors or uneven surfaces.

1. Clear away throw rugs, cords and anything else that could cause you to trip, slip or fall.

2. Be very careful around pets and small children. They can be unpredictable and get in your path when 1. Clear away throw you least rugs, expect it.cords and anything else that could cause you to trip, slip 3. Keep hallways clear. or fall. 4. Have good lighting; a night light can make a big difference. Use them in the bedroom, bathroom and hallways. 2. Be very careful 5. Avoidaround long pants, pets night robes and or nightgowns; small these children. could cause you They to trip. can be unpredictable and get in your path 6when. Do not wear you loose fittingleast or backless expect shoes. it.Wear well-fitting shoes, with backs and non-skid soles. 3. Keep hallwaysHave clear. an emergency plan in case of a fall. Consider keeping a telephone close by or carrying a cell phone. 4. Have good lighting; a night light can make a big difference. Use them27 in the bedroom, bathroom and hallways. 5. Avoid long pants, night robes or nightgowns; these could cause you to trip. 6. Do not wear loose fitting or backless shoes. Wear well-fitting shoes, with backs and non-skid soles.

Have an emergency plan in case of a fall. Consider keeping a telephone close by or carrying a cell phone.

After Total Joint Replacement: Bathroom Safety

Becoming more aware of hazards in your bathroom can help make your recovery safer. Aids AFTERlike a TOTAL shower HIP REPLACEMENT: hose and BATHROOM a raised SAFETY toilet seat can help you stay safe. Don’t forget to watchBecoming out more awarefor ofhazards hazards in your like bathroom wet can floors help make or your uneven recovery safer. su Aidsrfaces. like a shower hose and a raised toilet seat can help you stay safe. Don’t forget to watch out for hazards like wet floors or uneven surfaces.

. 1 Place non-skid decals or mats in shower or tub. It may be helpful to install grab bars. Shower benches and elevated toilet seat can be very helpful as well. 1. Place . non2 Do- notskid use thedecals soap or towel or holdermats as ain grab shower bar or handrail: or it istub. not designed It may to hold be the weighthelpful of to install grab bars. a h umanShower being. benches and elevated toilet seat can be very helpful as well.

2. Do not28 use the soap or towel holder as a grab bar or handrail: it is not designed to hold the weight of a human being.

AfterAfter Hip Hip Replacement: Replacement: Bathing Bathing

SpecialSpecial shower shower chairs chairs and and tub tub benches benches are are available available for for use use while while bathing. bathing. These These After Hipchairs chairsReplacement: help help you you bathe bathe Bathing safely. safely. Note:Note: Try Try to tomake make sure sure surfaces surfaces are are dry dry before before you you walk walk on on them. them. Non Non-skid-skid mats mats After Hip Replacement: Bathing Special showercancan help help chairs prevent prevent and falls falls tub. . benches are available for use while bathing. These chairs helpSpecial you shower bathe chairs safely.Getting Gettingand tub benches Into Into are a available aShower Shower for use Stall while Stall bathing. These chairs help you bathe safely. Note: TryAFTER to HIP make REPLACEMENT: sure BATHING surfaces are dry before you walk on them. Non-skid mats Note: Try to make sure surfaces are dry before you walk on them. Non-skid mats can helpSpecial prevent shower chairs falls and tub benches. are available for use while bathing. These chairs help you bathe cansafely. Note:help Try toprevent make sure surfaces falls are. dry before you walk on them. Non-skid mats can help prevent falls. GettingGetting Into Into a a ShowerShower Stall Stall GETTING INTO A SHOWER STALL

Lower yourself onto the 1. Back1. Back up upover over the the lip lipof theof the shower shower 2. 2. Lower yourself onto the stallstall with with your your non-surgical non-surgical leg leg chair.chair. Lift Lift each each foot foot and and turn turn (strong(strong leg) leg) first first until until you you feel feel the the to faceto face the the faucet. faucet. showershower chair chair behind behind you. you. Reach Reach back back 1. Backfor upfor the over the theshower lipshower of the chair shower chair first stall first with with yourwith one one 2. Lower yourself onto the chair. non-surgical1.hand, Backhand, thenup leg then over(strong the thethe leg)other, firstother,lip until ofas the you youas feel youshower begin the begin shower to to2. Lift Lower each foot yourself and turn to ontoface the the faucet. chair behind you. Reachsit back sitdown. for down. the shower chair first chair. Lift each foot and turn with stallone hand, with then your the other, non-surgical as you begin to legsit down. (strong leg) first until you feel the 2. Lowerto faceyourself the faucet. onto the 1. Back up over the lip of the showerGETTING INTOGetting GettingA TUB Into Into a aTub Tub shower chair behind you. Reach backchair. Lift each foot and turn stall withfor your the showernon-surgical chair first leg with one (strong leg)hand, first then until the other,you feel as you the begin to to face the faucet. shower chair behind you.sit down. Reach back for the shower chair first with one Getting Into a Tub hand, then the other, as you begin to sit down. Getting Into a Tub

1. Back up with your non-surgical leg (strong leg) 2. Lower yourself onto the bench and turn to until you3. feel Back3. the Back tub up bench upwith withbehind your youryou. non- Reach non- 4.face Lower4. the Lower faucet. yourself Useyourself your handsonto onto tothe help the bench lift bencheach leg back surgicalfor the bench leg first (strongwith one hand, leg) then first the andover theturn side to of theface tub. theA hand-held faucet. shower Use can other, as yousurgical begin to sitleg down. (strong leg) first makeand bathing turn on toa bench face easier. the faucet. Use until you feel the tub bench your hands to help lift each leg until you feel the tub bench your hands to help lift each leg29 behindbehind you. you. Reach Reach back back for for the the over over the the side side of theof the tub. tub. A hand-A hand- benchbench first first with with one one hand, hand, then then heldheld shower shower nozzle nozzle can can make make

3.the Backthe other, other, up as with youas youyour begin begin non- to sitto sit 4. Lowerbathingbathing yourself on ona ontobench a bench the easier. bench easier. surgical leg (strongdown.down. leg) first and turn to face the faucet. Use until you feel the tub bench your hands to help lift each leg behind you. Reach back for the over the side of the tub. A hand- 29 29 bench first with one hand, then held shower nozzle can make the other, as you begin to sit bathing on a bench easier. down. 3. Back up with your non- 4. Lower yourself onto the bench surgical leg (strong leg) first and turn to face the faucet. Use 29 until you feel the tub bench your hands to help lift each leg behind you. Reach back for the over the side of the tub. A hand- bench first with one hand, then held shower nozzle can make the other, as you begin to sit bathing on a bench easier. down.

After Hip Replacement: Kitchen tips and safety

1. Keep your walker with you.

2. Get as close as you can to the counter, sink or refrigerator.

After Hip Replacement: Kitchen3. tips andDo safety not reach beyond arm’s length or lean on your walker. This can cause the walker to tip and you to fall. 1. Keep your walker with you.

4. 2. SlideGet items as close along as you can counter to the counter, to stove sink or orrefrigerator. microwave if needed.

After Hip Replacement: Kitchen tips and safety 5. 3. Sit downDo not reach to openbeyond arm’scontainers, length or lean prepare on your walker. or mix This food . AFTER HIP REPLACEMENT: KITCHEN TIS AND SAFETY can cause the walker to tip and you to fall.

1. Keep your walker with you. 1. Keep your walker with you. 6. 4. KeepSlide frequently items along counter used to or stove heavy or microwave items if on needed. the counter or lower

2. Get as close as you can to the counter, sink or refrigerator. 2. Get as close as you can to the counter,cabinet sink or refrigerator. shelves. 5. Sit down to open containers, prepare or mix food.

3. Do not 3.reach beyondDo not arm’s reach length beyond or leanarm’s on length your walker.or lean on your walker. This This can causecan the causewalker the to7. tipwalker and6. you toDo tip to Keepnot andfall. youfrequentlybend to fall. over used toor heavy pick items up itemson the counter from or lower lower cabinets or floor.

cabinet shelves. 4. Slide items along counter to stove or microwave if needed. 4. Slide items along counter to stove or microwave if needed. 5. Sit down to open containers, prepare7. orDo mix not food. bend over to pick up items from lower cabinets or floor.

5. Sit down to open containers, prepare or mix food. DO NOT carry items in your6. Keep hands frequently when used walking or heavy items with on your the counter walk orer. Use a walker bag, walker tray, small handled plastic/paper bag Lower or apron. cabinet Be shelves. cautious not to overload bags, this can cause the walker to tip and you to 6. Keep frequently used or heavy items on the counter or lower Use a walker bag, walker tray, small fall. Liquids and foodDO should NOT7. Do carry notbe items bend carried inover yourcabinet toin hands pick watertight shelves. up when items walking from withlower your cabinets walker. or floor. handled plastic/paper bag or apron. Be cautious not to overload bags, this can cause the walker to tip and you to fall. Liquids and food should be carried in watertight 7. Do not bend over to pick up items from lower cabinets or floor. DO NOT carry items in your hands when walking with your walker. Use a walker bag, walker tray, small handled DOplastic/paper NOT carry bag items or apron.in your Be hands cautious when not towalking overload with your walker. Use a walker bag, walker tray, small handledbags, this plastic/paper can cause the bag walker or apron. to tip and Be youcautious to fall. not to overload bags, this can cause the walker to tip and you to fall.Liquids Liquids and and food food should should be carried be carried in watertight in watertight containers.

To use the refrigerator: 1. To use the 1. Position the walker at the side of refrigerator so that you are facing refrigerator: 1. To use the the door. Place one hand on the counter or side of appliance then reach to open the door with the1. other hand.Position the walker at the side of refrigeratorrefrigerator: so that you are facing the door. Place one hand on the counter or side of 2. You may need to move1. your walkerPosition insideappliance thethe door walkerthen slightly, reach at toso open thethat theside door of with refrigerator the other hand. so that you are you are close enough to reach items and so that the door does not shut before you retrieve your items.facing2. You the may door. need toPlace move yourone walker hand inside on the door counter slightly, or side of 1. so thatTo you use are closethe enough to reach items and so that the appliancedoor doesrefrigerator: then not reachshut before to youopen retrieve the your door items. with the other hand. 3. Have a friend or family member organize your most frequently used 3. Have a friend or family member organize your most 1. items onPosition the top shelvesthe walker so that at thethey side are ofwithin refrigerator easy reach so tothat you are 2. You mayfrequently need used to items move on theyour top shelveswalker so thatinside they arethe door slightly, prevent you from bending over too far. facing the door. Placeso one that handwithin you on easy theare reachcounter close to preventor enough side youof fromto reach bending items over too and far. so30 that the appliance then reach to open the door with the other hand. 30 door does not shut before you retrieve your items. 2. You may 3.need to moveHave your a walker friend inside or family the door member slightly, organize your most so that you are close enough to reach items and so that the door does not shut beforefrequently you retrieve used your items items. on the top shelves so that they are 3. Have a friend or familywithin member easy organize reach your to mostprevent you from bending over too far. 30 frequently used items on the top shelves so that they are within easy reach to prevent you from bending over too far. 30

Hip Safety: Getting Into and Out of a Car After hip surgery, getting into or out of a car can be difficult. To keep your hip safe, follow your “hip precautions” and the tips on this sheet. The steps HIP belowSAFETY: helpGETTING you INTO get AND into OUT a OF car. A CAR Reverse them to get out of a car.

After total joint surgery, getting into or out of a car can be difficult. The steps below help you get into a car. ReverseBefore them Gettingto get out of Into a car. a Car 1. Have someone move the seat as far back as it will go. 2. BeforeRecline Getting the Into back a Car of the seat if possible. 3. 1. HPlaceave someone a pillow move on the the seat seatas far backto keep as it will your go. hips above your knees, especially if 2. Rtheecline seat the backis low of the seat if possible. 3. Place a pillow on the seat to keep your hips above your knees, especially if the seat is low.

SitSit Down Down

1.1. StandStand withwith youryour back back to theto thecar. Keepcar. Keepyour your operated operated le gleg straight straight and that that foot foot slightly slightly forward. Feel f orward.the car Feel touch the carthe touch back the of back your of other your other knee. knee. 2. Hold onto the side of the car and the walker or dashboard.2. Hold onto the side of the car and the walker or dashboard. 3. Lower yourself slowly onto the seat. Watch your 3. Lower yourself slowly onto the seat. Watch your head head.

Bring Your Legs Into the Car

1. Slide back into the center of the seat.

2. Lift your legs one at a time into the car. As you do so move your body. Do not twist.

31 Negotiating one step or a curb: When climbing up and down a step or a stair, remember this rule: Up with the good (uninjured leg) and down with the bad (injured/surgery NEGOTIATING ONE STEP OR A CURB: leg). When climbing up and down a step or a stair, remember this rule: Up with the good (uninjured leg) and down with the bad (injured/surgery leg).

UP CURBS DOWN CURBS

Negotiating one step or a curb: When climbing up and down a step or a stair, remember this rule: Up with the good (uninjured leg) and down with the bad (injured/surgery When climbing up and down a step or a stair, remember this rule: leg). Up with the good (uninjured leg) and down with the bad (injured/surgery leg).

UP STAIRS

When climbing up and down a step or a stair, remember this rule: Up with the good (uninjured leg) and down with the bad (injured/surgery leg).

DOWN STAIRS

34 34

Energy Conservation Section E

35 Energy Conservation

THE FOUR P’S OF TJR ENERGY CONSERVATION You should be feeling up to resuming many of your activities of daily living within a few weeks after surgery, but it is important to utilize principles of energy conservation throughout your day. Remember the 4 P’s of energy conservation to plan out your day and activities.

1. Planning- Plan out your day so that you have periods of activity alternated with periods of rest. Space out difficult tasks throughout the day. Plan downtime (30 minutes, twice a day) to elevate and ice your postoperative leg to prevent/reduce pain and swelling.

2. Pacing- Do not rush or “push through” tasks. Give yourself plenty of time to complete activities.

3. Prioritizing- Only perform tasks that are necessary or enjoyable. Arrange for help from family and friends to assist with all other activities.

4. Positioning- Perform as many tasks as possible from a seated position. Keep items that you use most often at counter top height in the kitchen and bathroom to prevent repetitive stooping and bending.

Using these energy conservation techniques will allow you to regain your independence while also allowing your body to heal.

36 Activity Guideline Section F

37 Activity Guidelines

Please note, these activity guidelines only apply if your surgeon has approved weight-bearing as tolerated through your operative leg.

Activity goals for week 1-2: • walk at least 50 more feet by the end of week two. For example, if you were walking 50 feet in the hospital, you should be able to walk 100 feet by the end of week two. • shower and dress by yourself. • gradually resume light home duties with help as needed.

Activity goals for week 3-4: • complete any remaining goals from week 1-2. • complete weaning off of your assistive device as instructed by your physical therapist. • walk at least 150-200 feet at a time. • resume all light home duties with help as needed.

Activity goals for week 5-6: • complete any remaining goals from week 3-4. • try to walk at least 200 feet + at a time. • resume all light home duties by yourself. • resume any light impact activities that you enjoy.

38 Follow Up Care Section G

39 Foods that are high in calcium are the preferred Follow Up Care way to get the calcium that you need. Foods

include: low-fat dairy, canned fish with soft bones (i.e. salmon), and some dark green, leafy OSTEOPOROSIS vegetables. Some foods have calcium added such Osteoporosis is a disease in which bones as orange juice, breads, and cereals. become fragile and more likely to break. There are usually no symptoms of osteoporosis, and Vitamin D: Without Vitamin D, you will not be it is sometimes referred to as the silent disease. able to adequately absorb the calcium you eat. Bones may weaken so much that a break Most bodies are able to make Vitamin D if they can occur with very little impact. are out in the sun without sunscreen for 10-15 minutes at least twice a week. Vitamin D is Causes naturally present in very few foods. Some sources The bones in patients with osteoporosis have of Vitamin D include fatty fish, liver, egg yolks, been losing strength for many years leading up mushrooms and foods fortified with Vitamin D to the break. To keep your bones strong, your such as some dairy products, orange juice, soy body breaks down old bone and replaces it with milk, and cereals. The current recommended new bone tissue. As you age, more bone may be intake levels for Vitamin D vary by age: For broken down that what is being replaced. Also, women and men aged 1-70—600IU. For women the outer shell of the bone gets thinner. and men aged 71 years and older---1200 mg. Some causes of osteoporosis may be related to: 1. Aging Exercise . 2 Heredity When you are physically active, your bones and . 3 Nutrition or Lifestyle muscles will become stronger. Participating in . 4 Medications or other illnesses weight-bearing exercises at least three to four times a week, is one of the best ways to maintain Prevention bone density. Examples of exercises you could Prevention of weakened bones can begin at any do include: walking, gardening, golf and dancing. age. Eating foods that are rich in calcium and Challenge yourself to try light strengthening and vitamin D is important, as well as regular weight- balance exercises too. Just please make sure you bearing exercise. have someone there to spot you.

Calcium: getting enough calcium throughout Medicines your life helps to build and keep strong bones. Make sure to discuss with your primary care The current recommended intake levels for provider the medications that you are currently calcium vary by age: for adults 19-50 years old- taking. Some medications can make your bones 1000 mg. For women aged 51 to 70—1200 mg. For weaker. Also, an overactive thyroid gland or using men aged 51-70—1000 mg. For women and men too much thyroid hormone for an underactive age 71 and over—1200 mg. thyroid can become a problem for osteoporosis. 40 Lifestyle People who smoke have an increased risk of breaking a bone. Drinking too much alcohol can put you at risk for falling and breaking a bone.

Management of Osteoporosis Treating patients with osteoporosis means stopping the bone loss and rebuilding bone to help prevent breaks. As discussed, diet and exercise can help make your bones stronger. However, that may not be enough if you have lost a lot of bone density. If you have bone density loss, starting medication may be the next option. Some medications will slow your bone loss, while others can help rebuild bone. Speak with your primary care physician about which medications may be appropriate for you.

41 Notes

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JANUARY 2021