Your Surgery and Hospital Stay
The Day of Surgery
Traveling to the Hospital for Special Surgery
The hospital is located at 535 East 70th Street on the Upper East Side of Manhattan, between York Avenue and the East River. Two New York City Bus Lines operate near the hospital with one stopping at 72nd Street and York Avenue and the other on 68th Street and York Avenue. For physicians, patients and families visiting from out of town, the hospital is readily accessible by automobile and taxi via all of the major bridges and tunnel routes. Garage parking is available nearby; street parking is subject to local restrictions..
You and your family, or the person accompanying you, should come to the Same Day Surgery Admission Unit on the 4th Floor of the hospital. For your arrival time, please call Same Day Surgery Admissions at (212) 606-1489 between 2pm and 4pm one business day before your scheduled surgery. When you arrive, the admitting staff will process your admission. You will also meet the ROC physician assistant who will take your history and perform a physical exam. A nurse, ensuring your readiness for surgery, will arrange to transport you to the pre-operative waiting area, where you will be introduced to the surgical team. Unless instructed otherwise, relatives wait at the Surgical Atrium on the 4th floor or at Ranawat Orthopaedics on the 6th floor of the hospital.
The anesthesiologist will see you before the surgery to discuss the appropriate anesthesia, either epidural or general. The majority of our patients receive epidural anesthesia, in which a narrow catheter (tube) inserted between the shoulder blades allows a continuous flow of anesthetic medication to block all pain during the surgery. In addition, a sedative is administered to dull sensation and awareness, while keeping the patient awake. If you would rather be asleep, the sedation can be adjusted.
Though the actual hip replacement procedure usually takes between one and two hours, the actual elapsed time, from entering the operating room to reaching the recovery room could be three hours or more.
In the Recovery Room, you may be given oxygen, your heart will be monitored, and an intravenous (IV) line will be attached. You will receive your own donated blood. Also, pain management will begin. Once you have arrived in the Recovery Room, the Ranawat Orthopaedics's office staff or physician assistant will inform your family and friends about your operation. To maintain patient privacy, as well as to reduce the risk of infection, Recovery Room visits are restricted.
When the anesthesiologist determines that you are ready, approximately 4 to 5 hours after surgery, you will be transported to an inpatient unit. While most patients are discharged to in-patient units, some remain overnight in the Recovery Room for observation. If you remain overnight in the Recovery Room, parents, guardians and other family members can coordinate limited visiting hours with the Recovery Room nursing staff. We understand your need to remain informed and will make every effort to provide you and your family with the most up-to-date information.
Private Nursing Service
If you wish to have a private nurse during your hospital stay, the hospital can arrange this service for you. Please call (212) 606-1231.
After surgery, your IV (intravenous) line will remain in your arm for approximately 48 hours. The IV line delivers fluids, antibiotics and other medications. Should you need a blood transfusion, the IV line can also deliver blood.
The surgical site will be bandaged. A thin tube inserted into the site and attached to a drain prevents blood from accumulating around the hip. This tube is removed the day after surgery and the bandage is removed the second post-surgical day.
A pillow between your legs will help maintain the proper position of your hip. A nurse will position you in bed and help you turn until you are able to move on your own.
Because anesthesia may temporarily inhibit urination after surgery, a catheter may be inserted into the bladder to remove urine. When the patient regains function, usually within one to two days after surgery, this catheter is removed.
In collaboration with you and your family, the hospital staff, including a physician, physician assistant, nurse, physical therapist, and social worker will plan, provide and monitor your care.
Gentle exercise to improve your range of motion can help prevent circulation problems as well as strengthen your muscles. As soon as you are able after surgery, a physical therapist will teach you the necessary exercises.
After surgery, regular deep breathing, to rid your air passages of mucus, is vitally important. Normally, you take deep breaths almost every hour, usually without being aware of it, whenever you sigh or yawn. When you are in pain, or are drowsy from anesthesia or pain medication, your breathing may be shallow.
To ensure that you breathe deep daily, the nursing staff will provide you with a device called an Incentive Spirometer, along with instructions on its use.
How to use the Incentive Spirometer
- With the unit in an upright position, place your lips tightly around the mouth-piece and exhale normally
- To achieve a deep and sustained breath, inhale at a rate sufficient to raise the ball in the chamber
- Exhale. After performing the exercise, remove the mouthpiece from your lips
- Relax and breathe normally for a moment after each deep breath
Repeat this exercise 10 times every hour.
How does it feel?
Recovering from any surgery involves pain and discomfort. The hospital's team approach to pain management can help reduce your discomfort and thus speed your recovery.
Pain management, however, begins with you. Since there are no objective tests to measure what you are feeling, you must help the staff by describing the pain, pinpointing its location, and judging its intensity, as well as reporting any changes in these. Sometimes pain is constant. Other times it is sporadic. It can be sharp, burning, tingling or aching.
The Pain Scale
Worst Pain No Pain
10 9 8 7 6 5 4 3 2 1
Always report any increases or changes in pain. As we discuss below, there are several approaches to pain relief. To fully reap their benefits, you must use them before pain becomes severe.
Pain management will be decided by the surgeon and the surgical team. The main methods of pain control after surgery include:
- Approach 1: Epidural Anesthesia
Epidural anesthesia, for one to two days post-surgery, will keep your pain at a low level on the pain scale. However, after the epidural is discontinued, your pain can be managed by oral or injectable medication. An epidural pump and a PCA pump look similar
- Approach 2: Patient Controlled Anesthesia (PCA) Patient controlled anesthesia (PCA) will be provided if requested, or if the epidural wears off or is stopped for medical reasons
- Approach 3: Oral Medication
Approximately 24 to 48 hours after surgery, as pain decreases, you will begin to increase your activity, at which time you will switch to oral or injectable pain medications, which control discomfort and do not restrict activity or mobility
During your hospital stay, ice packs applied to the surgical site by the nursing staff while you are at bed-rest, will aid in reducing swelling and pain.
All pain medications are carefully prepared by hospital pharmacists to assure quality and safety. Medications used include Fentanyl and Morphine, which are narcotics, and Bupivacaine, also known as Marcaine, which is a local anesthetic.
PLEASE INFORM THE ANESTHESIOLOGIST OF ANY PREVIOUS UNUSUAL REACTIONS TO PAIN MEDICATION. THIS INFORMATION SHOULD ALSO BE INCLUDED IN THE MEDICAL INFORMATION YOU BRING TO THE HOSPITAL.
Your participation in a physical therapy program is essential to the success of your surgery. The more committed and enthusiastic you are, the speedier your improvement will be.
The day after surgery, a physical therapist will visit you with an exercise program to increase your hip's range of motion and strengthen your leg muscles. In the first few days after surgery, you may benefit from taking pain medication one hour prior to your physical therapy session. Check with your nurse and/or therapist. Also, the therapist will review necessary precautions to prevent hip dislocation.
The physical therapist will assist you in the following activities:
- Sitting at bedside with your legs dangling
- Standing with the aid of a walker
- Climbing stairs
- Arranging attendance to Activities of Daily Living Class, where you will learn how to live and thrive with your total hip replacement
Before leaving the hospital, most patients progress to forearm crutches and can get in and out of bed unassisted.
Below is a general list of precautions to follow after your total hip replacement. If additional precautions are necessary, the staff will provide instructions.
- Keep the abductor pillow between your knees when you lie on your back
- Keep the bed flat when you exercise or get out of bed
- You may turn on the non-operated side with the help of your nurse
- Avoid crossing your legs
Your surgeon or therapist will tell you when to start sitting in a high chair.
- Keep your knees lower than or equal to your hips
- Use a high toilet or a raised toilet seat on a standard toilet
- Sit on a firm chair (preferably) using two firm pillows
- Sit in low, soft chairs such as sofas
- Bend to pick up any objects from the floor
- Bend to clean or dry your feet
If you leave the hospital by carpenter the car from street level to avoid bending your hip too far; sit in the front seat, making sure the car seat is all the way back and in an upright position. Sit on two pillows.
You may take a shower only after sutures have been removed. Also, use a grab bar or shower chair for added safety, comfort and stability.
- Don't take a tub bath
Sutures should be removed 10 to 14 days following surgery. Please call the Ranawat Orthopaedics at (646) 797-8700 for an appointment or they can be removed by VNS.
Hip angle is always equal to or greater than 90 degrees
After total hip replacement surgery, clots, called deep vein thromboses (DVT), may form in the leg veins. In rare cases, these leg clots travel to the lung, where they may cause symptoms. To prevent and reduce the incidence of clot formation, mechanical devices are used to squeeze the leg muscle, thus maintaining blood flow in the veins. Also, a medication to minimize clot formation, such as Coumadin, Heparin, Aspirin or Persantine, is prescribed.
Before your discharge from the hospital, you will receive a noninvasive test to detect blood clots. The test relies on sound waves generated by moving blood cells. You will be asked to lie in a semi-upright position. The procedure causes no discomfort, and no special preparation is required. If no clots are found, you will be discharged on Aspirin 325 mg a day for one (1) month. If your doppler results are positive, your surgeon will determine the necessary treatment.
Following hip replacement, most patients develop swelling in the operated leg. Although the amount of swelling can vary from patient to patient, the swelling itself in the leg, knee, ankle or foot is normal, and will usually resolve gradually over several weeks.
For the first month after your operation, the amount of time spent in a sitting position should be 30 TO 45 MINUTES ONLY, as sitting tends to worsen the swelling. Periods of walking should be alternated with periods of elevating the swollen leg. When elevating the leg, the ankle should be above the level of the heart. You should lie with one pillow under your head and four to five pillows under your foot and leg to elevate your leg above your chest.
DO NOT ELEVATE YOUR FEET while sitting in a chair.
It is often helpful to spend an hour in this elevated position in the early afternoon to help diminish the swelling which may have developed during your morning walks.
To prevent or reduce leg and ankle swelling:
- Elevate the operated leg
- Avoid sitting for more than 30 to 45 minutes at a time
- Perform ankle exercises
- Use elastic compression socks
During your hospital stay, eat balanced, nutritious meals with adequate calories and protein to enable your body to replenish proteins depleted by surgery, and to reduce the risk of complications such as infection or poor wound healing. Being adequately nourished is an important component of your overall health and promotes your recovery.
During your hospitalization, your physician is responsible for ordering the appropriate diet for you.
There is no 'special' diet for total hip replacement patients.
After surgery, most patients will be placed on a liquid diet for 3 or 4 days, as appetite may be poor and the effect of anesthesia on intestinal function can last a few days. We encourage you to eat only when you feel hungry, to prevent nausea. Not having a bowel movement for 4 to 5 days following surgery is normal.
The Food Guide Pyramid outlines daily nutritional needs and helps you choose a healthy diet. Based on the recommended dietary guidelines for Americans, the pyramid recommends a varied diet, which provides the necessary nutrients you need and the right amount of calories to maintain a healthy weight.
A Guide to Daily Food Choices
FOOD GUIDE PYRAMID
The Food Guide Pyramid emphasizes foods from the five food groups shown in the lower three levels of the Pyramid. Each of these food groups provides some, but not all, of the nutrients you need. No one food group is more important than the other; for good health you need to eat a balanced diet.
How the Hospital Can Help
As soon as you decide to have a total hip replacement, you must look ahead, and plan for discharge and home recovery. Preparing enables you to concentrate on your main task, getting well. To help you plan for discharge and home recovery, the Social Work Staff or Home Care Department of the hospital is available at your request.
You and a family member or companion should consult with a social worker BEFORE YOU COME TO THE HOSPITAL. The consultation should take place THE DAY YOU SIGN UP FOR SURGERY. Your social worker will answer any questions or concerns you may have about your discharge from the hospital. He or she will review the alternatives available to you based on your medical condition, home and healthcare needs, care giving arrangements you have already made, geographic location and financial situation.
The majority of patients who undergo a total hip replacement are usually discharged from the hospital within four to five days after the surgery.
Some of the ways the hospital social worker can assist you include:
- Counseling to help you cope with illness or disability
- Discharge planning
- Long term planning
- Assessing your eligibility and helping you apply for benefits, including SSI (Supplemental Security Income), SSD (Social Security Disability), Medicaid, and New York State Disability
The social worker will discuss your post-discharge needs in consultation with your internist and other members of your primary healthcare team. Your involvement is essential in formulating a discharge plan to suit your needs.
Please ask your social worker for more details on the range of services that can help in planning your discharge.