HIP TABLE OF CONTENTS

ARTHRITIS OF THE HIP JOINT

WHAT TO EXPECT AFTER LEAVING THE OPERATING ROOM

You will wake up in the recovery room. You will be comfortable and usually surprisingly free of pain. You will have “calf pumps” on your legs: pneumatic pumps which help to prevent blood clots. You cannot be visited in the recovery room, but can be visited as soon as you get to your room. You will be in the recovery room for about 2 hours. Patients at the Valley Presbyterian Hospital with orthopedic problems are then usually moved to the orthopedic floor, which is 3 West. At Encino Hospital, it is the whole third floor. Some patients are admitted to the Intensive Care Unit (ICU) for 24 hours before being transferred to the orthopedic floor. This does not mean that their condition is critical, but only that Dr. Huddleston feels the need for closer monitoring because of their age or preoperative medical problems that increase risk.

PAIN CONTROL

Dr. Huddleston is fanatical about pain control, and does everything possible to keep your pain to a minimum. You will be amazed at how little pain you will have. A major development has been the PCA Unit (Patient Controlled Analgesia): a computerized device that attaches to your intravenous line. It enables you to self-administer a small dose of narcotic at the press of a button whenever you feel the slightest pain, eliminating having to call a nurse. Since only small doses of narcotic are given at a time, you will not be as drowsy as with big-dose injections every 3 hours. The PCA is pre-programmed for your weight and age, so it is not possible for you to over-dose. Most patients also receive an anti-inflammatory medication by IV for 48 hours. After 2 days, the PCA unit will be disconnected because it is cumbersome and impedes your walking progress. If necessary, it may be continued for a few more days. After it is discontinued, pain injections are ordered, to be given every 3 hours if needed. Pain pills are ordered for milder pain.

Most patients are surprised at how little pain they have after the operation.

OTHER DRUGS

Drugs are also ordered for nausea, constipation, and sleep. If you run a fever you will be given extra-strength Tylenol.

Note that practically every patient runs a temperature up to 99.5 or even a hundred degrees in the first few days after hip replacement. It is so common as to be considered “normal”. If your temperature goes over 101 degrees it starts to be a source of concern.

All patients get stool softeners, but many patients still develop constipation and need a mild laxative on the second or third day after surgery. All patients are given antibiotics to prevent infection (see Complications of Hip Replacement Surgery) starting just before the operation and for a few days after the surgery.

You must ask for sleeping pills, pain pills or pain injections because the nurses will not automatically give them. Do not restrict yourself from using the PCA machine or asking for pain medications. Dr. Huddleston does not want you to be in pain. You need not fear that you will become addicted to the pain medication.

A blood “thinner” (Coumadin) is given after surgery to prevent blood clots from forming (see Complications of Hip Replacement Surgery). The internist calculates the dose by daily blood tests. If the blood becomes too “thin”, bleeding problems can develop. If you do form blood clots, intra-venous Heparin will be started, you will be confined to bed for about three days, and then physical therapy will be resumed.

While you are in the hospital, please let the nurses or the internist know if you have calf pain, chest pain or shortness of breath. These may be signs of blood clots.

You will take Coumadin for about two weeks after your date of surgery, starting in the recovery room. You will be given a “take home” prescription for Coumadin. A fixed daily dose may be prescribed, or the visiting nurses may take your blood at home for testing, and notify the internist of the results. He/she will in turn will notify you as to the dose you should take. (After you run out of Coumadin at home, you should take a single regular Aspirin daily for a further 14 days).
Your blood count (Hemoglobin) will be monitored for a few days, and you will be given iron supplements, Epogen, and blood transfusions as necessary.

DRAINAGE TUBES

Suction drainage tubes are usually placed deep in the wound to remove blood which collects after surgery. The blood collected for the first 6 hours is usually filtered and given back to you through your intravenous tube. The drains are removed about 2 days after surgery. Removal is uncomfortable.
Many patients have difficulty passing urine right after surgery and catheterization is then necessary. For this reason, we insert urinary catheters in some of the men and all women during anesthesia, and remove them on the second postoperative day. Removal is not painful. We try to avoid catheters for longer than necessary because urinary infection can develop.

THE OPERATIVE WOUND

With the development of new instruments we can do the operation though a single “mini-incision” over the side of your thigh, or through two small incisions, one in front and one in the back of your thigh. The dressings are usually changed after the drainage tubes are removed, and as often as necessary after that. Dr. Huddleston does a “plastic” closure to make the scar look as nice as possible.

PHYSICAL THERAPY

The physical therapist will get you up on the first or second day after surgery, and will teach you the right amount of weight to put on your operated leg. You will also be taught all the necessary restrictions to prevent your hip from dislocating (see Restrictions to Prevent Dislocations).

You should pedal your feet up and down every five minutes or so while you are in the hospital to help prevent blood clots from forming.

Special pneumatic pumps will be applied to your legs in the recovery room, and will be kept in place for several days. They massage your calves every forty-five seconds. Most patients find them very comfortable. The pedaling exercise, the pumps and the Coumadin all help to prevent blood clots from forming in your legs.

If you have a cemented or hybrid hip replacement, you will be allowed to bear full weight on your operated leg from the start. However, if you have had an uncemented hip replacement,you may have to keep most of your weight off the operated leg for six weeks or longer if the implant does not fit with extreme tightness. In most cases, you will be able to bear full weight right away, even with an uncemented hip replacement.

Most patients by the second or third day after surgery no longer have an IV, and are feeling quite well. Many patients complain that the operated leg feels “too long” for the first few weeks after surgery, even when the legs are absolutely equal in length (see Problems You May Encounter at Home). It can take several months for this false sensation to disappear. We usually transfer our patients from the orthopedic floor to the rehabilitation unit approximately the second or third day after surgery.

You will be allowed to go home when your temperature is normal and you are able to get in and out of bed by yourself, and go to the bathroom by yourself. Some patients reach this goal within five days, others take as long as ten days.

EQUIPMENT YOU WILL NEED AT HOME

While you are in the hospital, the occupational and physical therapist will help you decide what equipment you will need when you get home. You will definitely need crutches or a walker. The hospital will provide these. Crutches are actually easier to handle, but most people feel more secure with a walker. The physical therapist may try you on both.

Unless otherwise instructed, try to go to a single cane (on the opposite side from your surgery) as soon as you can.
Some of Dr. Huddleston’s patients are off all walking aids by one to two weeks. Most of his patients are on one cane by three weeks after surgery. Use a walker or cane for as long as you feel the need.

A hospital bed is hardly ever needed at home, but we will be happy to order one for you if you want it. Most insurance plans cover it. We will provide a “reacher” to help you dress, or pick things up off the floor. A toilet seat extension will also be provided so that you do not sit too low on your home toilet. You will need to purchase a thermometer, a shower stool and a rubber bath mat for the shower. If you live in a two-story house, it is recommended that you move a bed downstairs and convalesce there, rather than risk using stairs.

THE REHAB OR SKILLED NURSING UNIT

Older patients, especially those who live alone, are advised to stay in the hospital’s Rehabilitation Unit for additional therapy and general care. This will, in any case, greatly speed your progress to full recovery. The Rehab Units at Dr. Huddleston’s two hospitals are superbly geared to the special needs of joint replacement patients. Medicare will cover your stay there. Some private insurance companies will not. In the Rehab Unit, a doctor who is specialized in physical medicine will see you daily. Your internist will also see you there regularly. Dr. Huddleston will visit you there once a week, unless a problem develops which needs his attention.

On to the Next Section of the Manual:
What to Expect After You Get Home

How to Become an Orthopedic Surgeon

Dr. H.D. Huddleston
The Hip and Knee Institute
5525 Etiwanda Ave., #324
Tarzana, CA 91356
Tel: 818.708.9090

Medical Website Design by HealthPresence

Site Last Updated: