Precautios for Total Hip Replacemet Patiets Oly The followig is a list of precautios to keep you from dislocatig your hip. Dislocatig meas to move a body part out of its usual positio. Durig your stay at the hospital, your therapists ad urses will help remid you of your specific hip precautios. You will follow these precautios util your doctor tells you otherwise. Your therapist or surgeo will check the hip precautios that are right for you. Posterior Hip Precautios Do ot bed your hip past 90 degrees Your kees must be lower tha your hips while sittig. Whe goig to stad up or sit dow, do ot lea forward. Do ot reach toward the floor to pick up objects or to put o socks/shoes. While sittig, do ot reach forward if you have to bed at your waist. Keep objects you may eed close by. While sittig i bed, do ot lea forward to pull up covers. Do ot sit o a low toilet seat, couch or chair. Istead, use a raised toilet seat or place pillows or blakets o the chair/couch to raise your hips above your kees. This is also importat while ridig i a car. Your ew hip Flexio precautio 53
Precautios for Total Hip Replacemet Patiets Oly Posterior Hip Precautios cotiued Do ot tur your kee or foot iward Do ot reach across your body whe reachig for items such as the phoe or to faste your seat belt. Do ot pivot o your operated leg. Make sure you are pickig your feet up ad takig small steps to tur. Be careful ot to let your leg tur iward while gettig ito or out of a bed or car. Do ot cross your leg past the middle of your body Do ot cross your kees or akles. You may put a pillow betwee your kees as a remider. Do ot brig your kees together at ay time. While sleepig or turig o your side, keep pillows betwee your kees to keep them from touchig each other. Do ot lie o your operated hip without talkig to your doctor first. 54
Aterior Hip Precautios Do ot tur your kee or foot outward Do ot twist ad reach across your body toward your o-operated side (especially while stadig). Do ot walk with your foot/toes tured outward. Do ot pivot o your operated leg. Make sure you are pickig your feet up ad takig small steps to tur. Do ot exted your hip backward beyod the eutral positio Whe backig up, step back with your o-operated leg first. Do ot take large steps forward with your o-operated leg. Additioal Hip Precautios (Trochateric) Followig some surgeries, the additio of extra precautios may be ecessary. The followig precautios may be added to your aterior or posterior precautios. Your physicia ad therapists will istruct you i which precautios to follow. No active abductio You should NOT use your ow muscle power to move your operated leg out to the side (especially while gettig out of bed). You may eed to use a leg lifter or have someoe assist you. Do ot tur your kee or foot outward Do ot reach or twist across your body toward your o-operated side (especially while stadig). Do ot walk with your foot tured outward. Do ot pivot o your operated leg. Make sure you are pickig your feet up ad takig small steps to tur. 55
Mobility After a Total Joit Replacemet It s a good idea to practice these activities before your surgery. Practicig them before surgery will help you do them by yourself after surgery. Bed Mobility After hip replacemet, you will probably be most comfortable lyig o the o-operated side. While lyig o your side, you should have a pillow betwee your legs i order to maitai your hip precautios. You should place the pillow betwee your legs before rollig oto your side. After a kee replacemet, DO NOT place a pillow uder your kee. You ca place the pillow uder your calf. Gettig i ad out of bed: If you have had a total hip replacemet, you must keep your kees shoulder-width apart util your hip precautios have bee lifted. 56
Gettig ito bed Follow these istructios to get ito bed: 1. Sit dow o the side of the bed. If possible, get ito bed o the side of the bed that will allow you to put your o-operated leg i bed first. 2. Scoot your hips back o the bed. 3. Brig your o-operated leg up oto the bed first. As you cotiue to scoot i the bed, brig your operated leg up oto the bed. You may eed someoe to help you with this immediately followig surgery. 4. Oce both legs are i the bed, scoot toward the head of the bed util you are comfortable. 57
Mobility After a Total Joit Replacemet Gettig out of bed Follow these istructios to get out of bed: 1. Whe gettig out of bed, push yourself ito a sittig positio with your elbows first. Support yourself o your hads. 2. If possible, get out of your bed o the side of your operated leg. Move your operated leg toward the edge of the bed. You may use your o-operated leg to push o the bed if eeded. 3. Pivot your buttocks o the bed, slidig your o-operated leg toward the side of the bed. Lower the foot of your operated leg to the floor. 4. Slide your o-operated leg over the side of the bed. Use your arms to steady yourself as you come to a sittig positio. 58
Usig a Walker Walkig with a walker 1. Move walker forward about a step so the back legs of the walker lie up with your toes. 2. Take a step forward ito the walker with your operated leg. Do ot step past the frot of the walker. 3. The take a step forward with your other leg. 4. Repeat steps. Usig stairs, your therapist will go over this after surgery ad focus o your particular eeds. Goig up stairs 1. Have someoe help by stadig beside you or oe step behid you util you are comfortable doig them o your ow. Rest oe had o the hadrail ad the other had o the had of your helper while you take your steps. 2. Always take the first step up with the o-operated leg. 3. Follow with the operated leg. 4. Do oe step at a time. Goig dow stairs 1. Have someoe help by stadig beside you or oe step i frot of your side opposite the rail util you are comfortable doig them o your ow. Rest oe had o the hadrail ad the other had o the had of your helper while you take your steps. 2. Always take the first step dow with the operated leg. 3. Follow with the o-operated leg. 4. Do oe step at a time. 59
Mobility After a Total Joit Replacemet Usig a Walker Sittig ad stadig after a total hip replacemet If you have had a total hip replacemet, you must keep your kees shoulder-width apart util your hip precautios have bee lifted. You should always check two thigs prior to sittig dow: 1. The height of the chair seat. 2. Does the chair have armrests? It will be more difficult for you to get out of a low chair ad/or a chair without armrests, so avoid these whe possible. Ofte, you ca raise a chair to a easier height by placig a firm pillow or seat cushio o the seat. Avoid chairs with wheels uless the wheels ca be firmly locked. Do ot pull o the walker for leverage whe stadig. The walker may tip backward causig you to fall. To sit dow, you should back up with the walker util you feel the chair behid your legs. 1. As you reach back for the armrest with oe had, slide your operated leg forward. 2. Reach back with your secod had ad slowly lower yourself ito the chair. Cotiue to keep your operated leg out i frot of you. 3. Use your arms to scoot yourself further back i the chair. 60
To stad up from the chair: 1. Scoot your body to the edge of the seat. 2. Keep your leg out i frot of you. 3. Use your arms to push yourself up from the chair. 4. Do ot lea forward as you stad. This ca cause you to be off balace. 5. Reach for your walker oe had at a time. Sittig ad stadig after a total kee replacemet You will follow the same istructios for sittig ad stadig with your walker as listed previously. You will be ecouraged to bed your kee whe sittig ad stadig istead of keepig it straight. Follow the same istructios for sittig ad stadig from a toilet seat. Remiders If you have had a total hip replacemet, be sure that you do ot rotate your leg iward whe you are completig hygiee after toiletig. Use a elevated toilet seat. If there is a grab bar preset, make sure you have oe had o the grab bar ad oe had o your walker durig your toilet trasfers. 61
Bathig Gettig Ito ad Out of a Tub Shower With a Bech/Chair Make sure the bech is set i the tub. It should ot move whe you sit dow ad get up. Have all of your supplies close. Do ot put aythig where you eed to lea forward so you ca maitai your hip precautios. Usig a Tub Bech i a Tub Shower Followig a Total Hip Replacemet 1. Stad with your back toward the bathtub. Be sure to have your operated leg out i frot ad have someoe with you to hold the bech steady. 2. Lower yourself slowly oto the tub bech, slidig your operated foot forward as you sit. Avoid ploppig dow. 3. Lea your truk back as someoe helps you lift your operated leg over the edge of the tub. If you have posterior hip precautios, keep your leg straight ad do ot brig your kee up toward your face. 4. Slide back ad make sure you are i a safe sittig positio. Have someoe lower your foot to the floor of the tub. 5. To get out of the tub, have someoe lift your operated leg out of the tub. Lift your o-operated leg out of the tub ad place your feet flat o the floor before you stad. If you have posterior hip precautios, keep your operated leg straight ad do ot brig your kee toward your face. 62
Gettig Ito ad Out of a Shower With a Shower Chair 1. Stad with your back to the etrace of your shower with your walker i frot of you. 2. Take a step backward ito your shower with your o-operated leg first, while takig pressure off of your operated leg by pushig dow through your walker with both hads. 3. Brig your operated leg ito the shower ad tur with your back to the shower chair. Do ot twist. Lower yourself slowly oto the chair, slidig your operated foot forward as you sit. Avoid ploppig dow. 4. Whe exitig the shower, slowly stad from the shower chair usig a grab bar (NOT towel rack), if accessible. Tur toward exit of shower. 5. Have someoe place your walker at the shower etrace for you. Holdig oto the walker with both hads, step out of the shower with your operated leg first, while pushig dow through the walker with your hads. 6. Brig your o-operated leg out ad regai balace before walkig i the bathroom. If you have had a total kee replacemet, you ca follow the same guidelies as listed above, but you do ot have to worry about maitaiig hip precautios. You will be ecouraged to bed your kee istead of keepig your leg straight. 63
Gettig Ito the Car Gettig Ito ad Out of a Car After a Total Joit Replacemet It is easiest to ride i a mid-size to large-size car or va. You ca ride i the frot or back seat. You may have to try both to see what works best for you. Whe ridig i the frot seat, it helps to move the seat all the way back ad reclie the back of the seat. For a total hip replacemet: Place a firm pillow or cushio o the seat to raise the height. Maitai your hip precautios. For a total kee replacemet: You may bed your kee to get i the car. The followig pictures show a perso gettig i the back seat of a car. Follow the same directios to eter the frot seat of a car or va. 1. Before gettig ito a car I the frot seat, move the seat back as far as it will go. I the back seat, move the frot seat as far forward as it will go. Reclie the seat back if possible. Place a firm pillow or cushio o the seat. 64
2. Sit dow o the seat Stad with your back to the car. Keep your operated leg straight ad the foot slightly forward for a total hip replacemet. Feel the car touch the back of your other leg. Hold o to the side of the car with oe had ad your walker with the other had. Slowly lower yourself oto the car seat. 3. Brig your legs ito the car Slide your bottom back ito the seat. Lift your legs, oe at a time, ito the car. As you lift your legs, move your body ito the car; do ot twist. Someoe may have to help lift your operated leg the first few times. 65
Usig a Cae Whe you are puttig very little weight through your hads while walkig with your walker, you are ready to start usig a cae ad should cosult with your physical therapist. This typically takes about two to three weeks. Do Not progress to the cae util you feel safe. Try it the first time with someoe aroud, preferably your physical therapist. Cae height Adjust cae so that the top of cae hits your wrist whe you are stadig with your arms dow at your sides. Cae use Cae should be placed i the had opposite your operated leg. Walkig With the Cae Opposite had ad operated leg should work together. Move cae forward about a step. Take a step forward with your operated leg. The step forward with your other leg. Repeat these steps. 66
Usig a Cae o Stairs Goig up stairs Have someoe help by stadig at your side or right behid you util you are comfortable doig them o your ow. Rest cae o the floor while steppig oto the step with your o-operated leg. Lift your cae oto the step. Step up with your operated leg. Do oe step at a time. Goig dow stairs Have someoe help by stadig at your side or directly i frot of you util you are comfortable doig them o your ow. Put your cae o the step below. Step dow with your operated leg. Step dow oto the same step with your o-operated leg. Do oe step at a time util you reach the bottom of the stairs. 67
Equipmet There is helpful equipmet available durig your recovery. You will most likely require the use of at least some of them. The therapists at the hospital will help you decide which will be helpful for you. Not all of these devices are covered by isurace. You ca borrow some of these items from a relative or fried who o loger use them. Walkig Aids You will eed to use walkig aids for a while after surgery. The legth of time required to use a walkig aid varies from perso to perso. A physical therapist ca help you determie which aid is best for your situatio ad whe to progress to a differet oe. These aids: Provide support for the leg that had the joit replaced Help provide balace Steady your gait Walker Crutches Cae Elevated Toilet Seat Havig a elevated toilet seat makes it easier for you to get o ad off the toilet. It allows you to maitai your hip precautios if you had a total hip replacemet. Your therapist ca help determie if oe would be beeficial for you ad which type would work best with your home situatio. 68
Tub Bech or Shower Chair Follow your surgeo s directios about showerig ad bathig. Permissio to shower does ot iclude takig a bath. Submergig your icisio i a bathtub, hot tub, pool, lake or ocea is geerally ot allowed for a miimum of four weeks after surgery ad util your icisio is completely healed. A bech or chair may be helpful, oce you are allowed to begi showerig after surgery. It ca help if you tire easily or are uable to stad safely i the shower. Make sure the chair or bech is positioed properly ad is stable before usig. Your therapist will show you how ad will recommed the correct type of seat for your situatio. Reacher The reacher ca be used to pick thigs up you have dropped. It ca assist you with puttig o uderwear ad pats. Pull the trigger back to close the tooth ad grab the article. Dressig Stick The dressig stick ca help you dress yourself. The hook ed ca be used to reach articles of clothig. The combiatio ed ca be used to get pats o ad off, as well as help you remove socks or stockigs. 69
Equipmet Sock Aid Usig the sock aid may be helpful util you are able to reach your feet. Pull the sock aroud the outside of the plastic ed. Lower it to your foot while holdig oto the strap. Place your foot ito the opeig of the sock ad pull the strap util the sock slides all the way o. Oce the sock is aroud your foot, pull the sock aid out the top of the sock. Log-Hadled Shoehor Use this just like you would ay shoehor. The oly differece is the exteded hadle to decrease the eed to reach completely to your foot. Place it iside the back of your shoe ad slide your heel ito the shoe. Log-Hadled Spoge This helps you to bathe yourself by allowig you to reach your legs ad back. 70
Returig to Activities The goal of total joit replacemet surgery is to reduce pai ad retur you to a more active lifestyle. You must ow select activities, rememberig a balace betwee ejoyig your ew joit ad wearig it out. We wat you to have a active lifestyle, ad we wat this joit replacemet to last a log time. We ecourage low-impact sports such as walkig, bicyclig ad doubles teis. Aythig that icludes ruig, jumpig, cuttig ad/or pivotig are high-impact activities. For example, sigles teis, basketball ad football are high-impact activities. There are cocers that high-impact activities could be detrimetal to your ew joit ad lead to premature failure. Discuss with your surgeo which activities are appropriate for you, ad whe is the right time to retur to these activities. Returig to a Normal Walkig Patter Gettig back to walkig ormally after surgery will take some time ad cocetratio o your part. Most people with hip ad kee arthritis have ofte chaged the way they walk or avoid puttig all of their weight o that leg i order to miimize their pai. This occurs slowly over time, ad you may ot eve realize that you are favorig that leg. Your therapist will help you focus o heel-to-toe walkig as you progress through usig a walker, the a cae ad the off all assist devices. Returig to Work This varies with each perso based o what type of work you do. People who have active, physically demadig jobs will be off work loger tha those with less active jobs. It is best to discuss this with your surgeo before your surgery so you ca pla your time off with your workplace. Please Note The ext page discusses resumig itimacy followig total joit replacemet surgery. The iformatio icludes drawigs to illustrate the safest ways for you to be itimate with your parter. If you prefer ot to review this iformatio, please skip to the ext sectio. 71
Resumig Itimacy Beig itimate with your parter followig joit replacemet surgery is a questio early everyoe has, but few ask. Withi oe to two moths after surgery, most people are able to resume sexual activity. As time passes ad your recovery cotiues, sexual activity should become more comfortable. Face to face works after hip or kee replacemet. Sittig i a chair positio is safe for ma or woma after hip or kee replacemet. Woma lyig ad ma keelig/ stadig works for a woma after hip or kee replacemet. Side-lyig positio works for ma after kee replacemet or woma with either kee or hip replacemet. Remember Do ot cross your legs. Do ot twist your operated leg. Do ot bed your hip more tha 90 degrees for total hip replacemet. 72