Ranawat Orthopaedics
 
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Frequently Asked Questions

Total Hip Replacement

Click here to open Total Hip Replacement Booklet

Before You Come To The Hospital

Your Surgery and Hospital Stay

Final Steps: At Home


Important Telephone Numbers

Ranawat Orthopaedics (646) 797-8700
Hospital Patient Information (212) 606-1377
Social Work Department (212) 606-1271
Same Day Surgery Admission (212) 606-1489
Private Nursing Service (212) 606-1231
Home Care Department (212) 606-1124
Local Pharmacy (212) 606-1372
Internist (212) 774-2835
Other Important Numbers http://www.hss.edu/contact.asp

Schedule of Follow-Up visits

Expect to have routine follow-up visits at the Ranawat Orthopaedics as follows:

  • Suture removal 10-14 days from surgery
  • 6 weeks following day of surgery
  • 3 months following total hip replacement
  • 1 year following total hip replacement
  • 3 years following total hip replacement
  • 5-6 years following total hip replacement
  • 8-10 years following total hip replacement

This follow-up schedule may vary from patient to patient. You must call the Ranawat Orthopaedic Center Staff to schedule all appointments. Please notify us if you have a change of name, address, telephone number or insurance carrier.


A Closer Look at Total Hip Replacement

To understandtotal hip replacement, you should be familiar with the structure of the hip joint, a ball-and-socket joint. The ball component is attached to the top of the femur (long bone of the thigh). The socket is part of the pelvis. The ball rotating in the socket permits you to move your leg forward, backward and sideways, i.e. in all planes of motion.

With a healthy hip, smooth cartilage covering the ends of the thigh bone and pelvis allows the ball to glide easily inside the socket. With a problem hip, the worn cartilage no longer serves as a cushion. As the diseased or damaged bones rub together, they become rough, and the resulting pain causes difficulty in walking.

Total Hip Replacement consists of replacing the worn out socket with a durable plastic or polyethylene cup with or without a metal titanium shell. The ball is replaced with a chromium-cobalt alloy metal ball that is attached to a metal stem of titanium or chromium cobalt metal alloy.

There are several ways to fasten the components during the hip replacement procedure (implant to the bone). With a cemented total hip replacement, the prosthesis is held in place by bone cement. In a non-cemented total hip replacement, fixation occurs as the bone grows on and into the implant surface. With a hybrid total hip replacement, the femoral component in the thigh bone is cemented, and the acetabular component is affixed by bone growing on and into the implant surface, which consists of a titanium or cobalt chromium shell and a polyethylene liner.

Bearing surfaces include metal-on-polyethylene, ceramic-on-ceramic and metal-on-metal. The most commonly used FDA approved bearing surface is metal with highly cross-linked polyethylene. The best bearing surface for you will be decided in consultation with your surgeon.

Clinical and biomechanical research has steadily improved the methods and materials available for total hip replacement. Prosthesis durability varies with the usage demands of each patient.


Before You Come to The Hospital

Total Hip Replacement at Ranawat Orthopaedics / ROC

Total Hip Replacement can enhance your quality of life by providing many years of improved mobility and reduced pain. Each year over 200,000 Americans benefit from Total Hip Replacement.

In the last decade remarkable improvements in technology have transformed total hip replacement into an efficient and widely performed procedure. Before, during, and after your hospital stay, Ranawat Orthopaedic Center (ROC) is committed to your well-being and satisfaction.

Chitranjan S. Ranawat, M.D. and his associates are supported by a large staff of fellows, residents, physician assistants, anesthesiologists, physical therapists, social workers and administrative personnel.

In bringing you the latest advances in total hip replacement, the Hospital for Special Surgery, the #1 ranked hospital for Orthopaedics in the US, combines world-class medical professionalism with personalized care. The hospital's outstanding diagnostic, surgical and rehabilitation sections offer a complete array of services.

Dr. Ranawat and the Staff of Ranawat Orthopaedics are here to serve you. Help us help you; any medical concerns should be discussed with your surgeon, and any unresolved administrative issues with our office manager. Active participation in treatment, with full understanding of the issues, is vital to his or her full and uneventful recovery.

A Checklist of Things To Do

  • You may be asked to donate your blood for the surgery. If the donation is required, the Ranawat Orthopaedics staff will make an appointment for you at the Hospital's Blood Donor Center
  • The ROC staff will make an appointment for you for pre-surgical testing fourteen (14) days prior to surgery
  • Social workers will help facilitate your discharge planning. The Home Care staff will help you plan your home care and physical therapy needs following discharge from the hospital. If you wish to consult a social worker or a member of the Home Care staff to help plan for your return home, you may call the Social Work Department or the Home Care Department before your admitting date to the hospital
  • The ROC Staff will make an appointment for your examination with an internist at the Hospital before your surgery. The internist will
    • Review and/or perform any necessary diagnostic tests
    • Provide medical clearance for the surgical procedure
  • Unless you are told otherwise, continue to take medicines already prescribed by your own physician. Fish oils should be discontinued two (2) weeks prior to surgery. Also, anti-inflammatory medications and anti-oxidant vitamins such as C and E should be discontinued ten (10) days prior to your Admission
  • you may be advised to take an iron pill/ ferrous sulphate 325mg 1 month before your surgery to improve blood count
  • Prepare for your return home from the hospital (see Preparing to Return Home)
  • Before your admission, please complete the Health Care Proxy form authorizing another person designated by you to make decisions with your physician about your care, should this become necessary
  • To obtain your admission time and location, please call Same Day Surgery Admissions at (212) 606-1489 between 2pm and 4pm one business day before your scheduled surgery. When you arrive at the hospital, use the main entrance at 535 East 70th Street,between York Ave and the East River
  • If possible, give yourself a Fleet enema the night before surgery
  • EXTREMELY IMPORTANT: PLEASE BRING A LIST OF YOUR CURRENT MEDICATIONS AND THEIR DOSAGES SO THAT THE CORRECT MEDICATIONS AND DOSAGES CAN BE ORDERED FOR YOU WHILE YOU ARE IN THE HOSPITAL. ALSO BRING MEDICAL INFORMATION FROM YOUR PHYSICIAN, INCLUDING INFORMATION ABOUT ANY PAST REACTIONS TO ANESTHESIA
  • DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT ON THE NIGHT BEFORE YOUR SCHEDULED SURGERY, UNLESS OTHERWISE INSTRUCTED

Be sure you understand all pre-operative instructions. If you have questions or concerns, please discuss them with your surgeon or call the Ranawat Orthopaedic Center at (646) 797-8700.


When you come to the Hospital

A Checklist of Things To Bring

For a stay of approximately three to five days, please bring the following:

  • Your hospitalization insurance cards
  • X-rays (if instructed by the ROC staff)
  • Laboratory reports (if instructed by the ROC staff)
  • Health Care Proxy
  • Any paperwork, including Consent Forms, sent to you by Ranawat Orthopaedic Center, unless you have already returned them. Also bring a list of your current medications with dosages, and medical information from your physician.
  • This manual, Total Hip Replacement: Your Journey to Recovery
  • Non-slip, flat, supportive athletic or walking shoes
  • A pair of pajamas or a short nightgown
  • A short, light-weight bathrobe (shorter clothing can prevent trips ands falls)
  • Personal toiletries
  • A small amount of money for newspapers, and TV and telephone rental
  • A book, magazine or hobby item to occupy time
  • Eyeglasses, NOT contact lenses
  • One blank check or credit card to purchase needed physical therapy equipment

Please do not bring:

  • Medications
  • Valuables
  • Jewelry

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..

Surgery

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.

After Surgery

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.


Recovering in the Hospital

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.

Exercise

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.

Deep Breathing

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

  1. With the unit in an upright position, place your lips tightly around the mouth-piece and exhale normally

  2. To achieve a deep and sustained breath, inhale at a rate sufficient to raise the ball in the chamber

  3. Exhale. After performing the exercise, remove the mouthpiece from your lips

  4. Relax and breathe normally for a moment after each deep breath

Repeat this exercise 10 times every hour.


Managing Pain

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

Cold Therapy

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.


Rehabilitation in 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.


Do's and Don'ts After Your Total Hip Replacement

Below is a general list of precautions to follow after your total hip replacement. If additional precautions are necessary, the staff will provide instructions.

Lying Down

  • 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


Sitting

Your surgeon or therapist will tell you when to start sitting in a high chair.

Do:

  • 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

Don't:

  • 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.

Showering

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

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


Preventing Blood Clots

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.

Ultrasound Doppler

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.

Leg Swelling

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

Diet

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

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.


Preparing to Return Home

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.


FINAL STEPS: AT HOME

Guidelines for Home Recovery

Please do not hesitate to contact the Ranawat Orthopaedic Center (ROC) with any questions you have about the following instructions.

Consult with your internist about duration and dosage of iron (ferrous sulfate) after your discharge.

Caring for Surgical Site

  1. Leave the Primapore Dressing on if drainage occurs, if not take of the dressing and leave the wound open to air
  2. After removal of your sutures, leave the incision open unless instructed otherwise
  3. Please inform ROC of increasing redness of or drainage from your incision

Pain Medication

  1. Take your pain medication as prescribed

  2. To control pain, take your pain medication before the pain becomes severe

  3. If your pain medication seems weak, or if you are experiencing unpleasant side effects, do not hesitate to call the Ranawat Orthopaedics

  4. If you are taking pain medication, avoid alcoholic beverages and recreational drugs

  5. If you experience discomfort during your ongoing physical therapy, take your pain medication at least 45 minutes prior your subsequent therapy sessions to allow enough time for the medication to take effect

Preventing Infection

Having undergone surgery increases your risk of infection. However, antibiotics can help protect you and should be used in the following situations:

  • With any medical or surgical procedure, performed by your physician or dentist

  • During certain diagnostic procedures, such as catheterization and endoscopy, or those involving intestines, lungs, bladder and kidney

  • With serious infections elsewhere in your body

Tell your internist and dentist that you have an artificial joint so that they can prescribe antibiotics. If you have questions or concerns, please call the Ranawat Orthopaedics.

Total hip replacement patients who require dental work on gums or roots must adhere to the following antibiotic procedure:

For patients not allergicto Penicillin: Cephalexin, Cephradine or Amoxicilin: 2 grams orally 1 hour prior to the dental procedure

For patients allergic to Penicillin: Clindamycin: 600mg orally 1 hour prior to the dental procedure.

Patients should adhere to this regimen for the first two years following joint replacement. Immunocompromised patients, including those with inflammatory arthropathies, rheumatoid arthritis, drug or radiation-induced immunosuppression, insulin-dependent diabetes or any other major medical problem should follow this antibiotic routine indefinitely.

Antibiotics can reduce the risk of infection but cannot completely eliminate that risk. Preventing infection must be the concern of all the healthcare professionals who treat you. MAKE SURE YOU INFORM YOUR PHYSICIAN AND DENTIST THAT YOU HAVE HAD A TOTAL HIP REPLACEMENT.


Sports Activities

After full recovery, some patients enjoy light sports activities. Activities you can enjoy after total hip replacement include walking, bicycling, bowling, swimming, golf and doubles tennis. Avoid high impact activities, such as:

  • Jogging
  • Running
  • Jumping
  • Skiing

Do's and Don'ts During Home Recovery

Precautions for home recovery are, with slight modification, the same as those you followed in the hospital. However, based upon various factors such as health history, type of implant, etc., your physician or physical therapist may give you additional guidelines.

Lying Down

Do:

  • 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
  • Turn on the non-operated side with the abductor pillow between your knees. Avoid crossing your legs

Don't:

  • Raise the head of your bed more than half upright (45 degrees) Lie on your operated side
  • Cross your legs Roll your legs inward; your feet should be pointed up or outward


Sitting

Do:

  • Keep your knees lower than or equal to your hips
  • Sit on a firm chair (preferably with arms) using two pillows
  • Use a high toilet or a raised toilet seat on a standard toilet

When traveling by car:

  • Enter from street level to avoid bending your hip too far
  • Sit on a firm cushion or pillow with the seat in an upright position as far back as possible

Don't:

  • Sit in low, soft chairs such as sofas
  • Bend to pick up any objects from the floor
  • Bend to clean or dry your feet

Other positions to avoid following Total Hip Replacement


Sexual Relations

The following questions, answers and illustrations respond to the common concerns of patients and their partners after hip replacement surgery.

Will I be able to resume sexual relations now that my hip has been replaced?

The vast majority of patients are able to resume safe and enjoyable sexual intercourse after hip replacement. Patients whose sexual function had been impaired by preoperative hip pain and stiffness welcome their new pain-free mobility. However, gaining full confidence with your new hip may take several weeks.

When can I resume sexual intercourse?

In general, intercourse can be resumed safely approximately eight weeks after surgery. Though individual recovery time varies greatly, this timeframe allows the incision and the muscles around the hip to heal. If you recuperate rapidly, you will be able to resume sooner, as long as you are free of pain.

What positions are safe during intercourse?

Total hip replacement precautions need to be observed during all activities, including sexual intercourse. In general, follow the do's and don'ts on pages 26-27 and the positions illustrated on page 29. As advised in the discharge instructions, you should avoid excessive hip flexion (knee toward chest), adduction (leg towards center of body), and internal rotation (toes turned inward).

Most patients, male and female, prefer 'passive' intercourse in the 'bottom' position, an option some find less fatiguing. As your hip heals, you may resume a more active role. After a few months, patients can resume sexual activities in any comfortable position.

What should I tell my partner?

As good communication is essential, you may want to share information in this booklet with your partner. In addition, you can discuss the hip precautions that the hospital staff reviewed with you.


Sexual Positions Recommended Following Total Hip Replacement

Pillows placed under your knees can provide extra support and comfort

Sexual Positions to avoid Following Total Hip Replacement


Home Recovery Program

Our specially-designed Home Recovery Program, a series of basic instructions and exercises, will help you regain your mobility and, thus, speed your recovery. Tested and refined at the Ranawat Orthopaedics, the program is straightforward and effective. You do not have to do every exercise at each session. Though you do not have to follow a particular order, doing the lying exercises in sequence is easier and more convenient.

The Home Recovery Program allows you to choose from the four exercises you were taught in the hospital. The number of times you do each exercise depends on your capacity, which will increase as you progress towards recovery. Recovery doesn't happen overnight, so don't be discouraged, and don't try to do too much too soon. The exercises should not cause pain. If they do, eliminate them from your program.

Continue to follow precautions outlined by your physical therapist until told otherwise by your surgeon.

Climbing Stairs

The following are instructions (NOT exercises) for climbing and descending stairs.

If you have one (1) total hip:

UPSTAIRS

  • The non-operated leg goes first
  • The operated leg goes second
  • The crutches go last (at the same time as the operated leg)

DOWNSTAIRS

  • The crutches go first
  • The operated leg goes second
  • The non-operated leg goes last

If you have two (2) total hips:

UPSTAIRS

  • The stronger leg goes first
  • The weaker leg goes second
  • The crutches go last(at the same time as the weaker leg)

DOWNSTAIRS

  • The crutches go first
  • The weaker leg goes second
  • The stronger leg goes last

Getting In and Out of Showers and Tubs

Following a total hip replacement, precautions must be observed in all daily activities, including bathing. Stall showers are preferred over tubs. Do not sit in a tub until instructed by the Ranawat Orthopaedics. We recommend you install a grab bar in your shower for safety. During your 'Activities of Daily Living' class, your therapist will instruct you on the proper way to transfer in and out of shower or tub. If necessary, we can order a transfer bench or chair for the tub or shower to assist you at home.

Putting on Socks and Stockings

During your recovery, many otherwise ordinary tasks, such as getting dressed, will require special attention. One of the most difficult is putting on socks and stockings; this simple activity normally requires you to bend past a 90-degree angle, which can dislocate your new hip. Men should use knee-high socks, and women, knee-high socks or stockings. For your comfort, your physical therapist can order a sock aid, a device that has two cords which you hold in your hands and pull up to put on a sock or stockings.

To put on a sock or stocking, place sock around rim of sock aid. Slide sock up halfway so that the toe of sock is secure against the sock aid. Stick foot in so that toe is making contact with the toe of the sock. Pull up on the cords of the sock aid to pull on sock. You may put the sock on your non-operated foot in your usual manner. To take off a sock or stocking, use either your reacher or your long handled shoehorn to push sock off foot.

Homemaking Tips

  • Use an apron with several pockets
  • Carry hot liquids in containers with covers
  • Slide objects along the countertop, rather than carry them
  • Sit on a high stool when doing countertop tasks
  • Use a reacher for objects on the floor. DO NOT bend down to pick up objects
  • If you are discharged with a walker, a walker bag is available. The bag fits in your walker and can be used to carry items including plates, silverware and food in sealed containers
  • Remove scatter rugs from the floor to avoid tripping over them

Home Recovery Exercise Program

Quad Set

Lying on your back:

  1. Tighten thigh muscles by pressing knees down into the bed
  2. Hold for a count of 6. Do not hold your breath
  3. Relax
  4. Repeat

Gluteal Set

Lying on your back:

  1. Squeeze buttocks together
  2. Hold for a count of 6. Do not hold your breath
  3. Relax
  4. Repeat

Ankle Pumps

Lying on your back:

Keeping legs flat on bed, move both your ankles up and down.

Leg Rotation

Lying on your back:

  1. Roll your operated leg inward so that your kneecap and foot are pointed toward the ceiling. Do not internally rotate your operated leg past this neutral point
  2. Relax
  3. Repeat

Heel Slides

Lying on your back:

  1. Bend hip and knee of operated side to about 40-45 degrees
  2. Hold for a count of 6. Do not hold your breath
  3. Relax
  4. Repeat

Advanced Exercises

These exercises place slightly greater demands on your hip. Progress to them only after you are seen by your surgeon on your first post-op visit.

Straight Leg Raise

To build muscle strength perform this exercise twice each day. Work up to 20 lifts each time.

Lying on your back with your non-operated leg bent and your foot flat on the bed:

  1. Raise your operated leg 12-18 inches
  2. Hold for 2 counts
  3. Lower leg slowly
  4. Repeat

Side Leg Raise

To improve your hip's range of motion, perform this exercise twice each day. Work up to 20 lifts each time.

Lying on your non-operated side

  1. Raise your operated leg 12-18 inches
  2. Hold for 2 counts
  3. Lower leg slowly
  4. Repeat

Stationary Bicycle

If you have a stationary bicycle, use it at no resistance for 15-20 minutes each day.

Swimming

Swim as much as you like. It is an excellent exercise and will help in your recovery.

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Chitranjan S. Ranawat, M.D.
Orthopaedic surgeon
Chitranjan S. Ranawat, M.D.
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Amar S. Ranawat, M.D.
Orthopaedic surgeon
Amar S. Ranawat, M.D.
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Anil S. Ranawat, M.D.
Orthopaedic surgeon
Anil S. Ranawat, M.D.
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