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SPECIAL RESTRICTIONS

Total hip arthroplasty post-operative patients have several unique and specific restrictions. These instructions and precautions are initially introduced during the preoperative class and continue for as long as you live. Specific precautions for total hip patients include restrictions on position of the hip after surgery. The hip should not be flexed, adducted, and internally rotated at the same time or a dislocation may occur.

This set of positions of the hip is best illustrated in the seated position with the hip flexed or bent at the waist. Adduction is when the leg crosses the midline of the body towards the other leg. Internal rotation is what happens when you try to move your foot to the side while your knee stays next to the other knee. Common situations during which this may arise include sitting on the toilet, getting in and out of the car, and just sitting down and trying to tie your shoes. You will need an elevated toilet seat.

Activities after a total hip are explained at the following link: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=274&topcategory=Hip

GENERAL POST-OPERATIVE INFORMATION

Home health personnel will follow up with you after you have arrived home. The nurses will help you with wound care and follow up laboratory work. Wounds will typically turn a little red around your staples or sutures. Some swelling is expected. Bruising may extend down the leg into the calf. These things are common after such a major surgery. Home health nurses are trained to look for excessive swelling, redness and drainage, which could indicate an infection.

Computer navigated total hip arthroplasty patients will have small incisions in several places other than the hip. The crest of the pelvis around the belt line will have a small incision as will the lateral aspect of the leg. These incisions allow placement of pins that allow the computer to “see” the hip and aid in the positioning of the hip and adjustment of length if needed in your legs. These wounds should be treated like any other wounds and should heal uneventfully. An ace wrap may be used for the first week or so around the thigh to prevent potential swelling of the thigh after these pins are removed in the operating room. (This is done before you leave the operating room at the time of your hip replacement.)

PHYSICAL THERAPY AND EXERCISE

Be aware of the special precautions for hip replacement patients, which are listed above. Shortly your actions will become second nature and you won't have to think about them so hard. The most common time a dislocation occurs is in the first three months after surgery. Although it is much less likely to happen after this time period, in rare circumstances it may still occur later on in the life of your hip.

Physical therapy was started in the hospital and will continue until you are walking well without aids. Much of the therapy will be this transition from walking with a walker and then cane, if needed. Emphasis on hip precautions will be reinforced during this period as well. Any questions should be directed to your physical therapist. Many questions can be answered with the physical therapy link listed below. Of course, any concerns you may still have should be directed directly to the office. See the following link for specific instructions.

Post Operative Total Hip Arthroplasty Physical Therapy: http://orthoinfo.aaos.org/booklet/view_report.cfm?Thread_ID=20&topcategory=Hip

MEDICATION

Pain medication
Pain medication will be prescribed for you during the postoperative period. Narcotics are used for the first three weeks if needed. Please direct all medication needs to me during office hours or during our first postoperative visit. Some medicines cannot be “called in” to the pharmacy and require a prescription from me to be filled by your pharmacist.

Antibiotics 
Joint arthroplasty patients are given antibiotics before surgery and for twenty four hours after the surgery. In rare cases, antibiotics may be given for a longer time period after the surgery while you are in the hospital. This is usually done for patients who are obese or have wound healing properties that are diminished because of chronic medical problems. Very rarely, short courses of antibiotics by mouth may be administered after the surgery for continued wound drainage. As noted below, antibiotics will also be needed prior to dental cleanings or any other invasive procedures for the first two years after your surgery.

INSTRUCTIONS AND CONCERNS

Compression Stockings
You will be taking blood thinners after your surgery. Compression stockings on each leg should remain in place until your blood thinning medication is discontinued. Lab work is done to ensure that the medicines given to thin the blood are adjusted to the correct dose. I will monitor these values and adjust your dose accordingly during the post-operative period. You will begin taking the blood thinner immediately after your surgery and continue for a period of twenty-one days. Some patients will be given injections to take. These may be administered by a home health nurse or a family member. These medicines help prevent the development of blood clots, but do not eliminate this potential complication.

Swelling of the Calf 
Calf swelling may indicate a blood clot, and you should contact me immediately if you notice this. I may order an ultrasound to look for this. Again, our office should be called if you have any questions or concerns.

Post-Operative Infections 
Any infection of the sinuses, urinary tract, skin, teeth or other area requires prompt medical attention to avoid the complication of a late joint infection. Contact your primary care provider immediately if you suspect you are suffering from one of the above conditions.

Dental Care 
You will need antibiotics prior to dental cleanings or any other invasive procedures for the first two years after your surgery. Communicate to your dentist that you have a new joint and you require antibiotics prior to your visit. A protocol of antibiotic coverage for dental procedures is listed on the following link: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=364&topcategory=Patient%20Safety