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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.
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. |
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.
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.
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.
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
Home | Hips | Knees | About Dr. Huddleston | Testimonials | Newsletter | Contact | Links
How to Become an Orthopedic Surgeon
Arthritis
of the Hip Joint
copyright © 2005 Herbert D. Huddleston,
MD.
Arthritis of the Knee Joint copyright
© 2005 Herbert D. Huddleston, M.D.
Dr. H.D. Huddleston
The Hip and Knee Institute
5525 Etiwanda Ave., #324
Tarzana, CA 91356
Tel: 818.708.9090
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