ARTHRITIS OF THE HIP JOINT

Hip Replacement Recovery. 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, 4 West in the New Tower. 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. There are two major reasons for this.

The first is that the surgery is minimally invasive, and less tissue is cut that can cause pain.

The second is the use of the pain cocktail, also known as the “Magic Cocktail”, which is a mixture of medications that is injected into all the deep soft tissues around the wound prior to closing the skin. The mixture consists of a long acting anesthetic, morphine and an anti-inflammatory medication. The pain-cancelling property of this technique is truly “magical”. Many patients have absolutely no pain at all after the operation.

As a back-up, in case you do have some pain, you will also have 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.

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

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.

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.

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 in the front 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 morning 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).

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.

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 weeks (sometimes months) for this false sensation to disappear. We usually transfer our older patients from the orthopedic floor to the rehabilitation unit approximately the second or third day after surgery.

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.

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.

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 may cover your stay there. Most 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. If you need facility care, and your insurance does not cover the Rehab Unit we can transfer you to Lake Balboa Convalescent Hospital which is covered by all insurance programs including Medicare.

 

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Arthritis of the Hip Joint copyright © 2005 Herbert D. Huddleston, MD.
Arthritis of the Knee Joint copyright © 2005 Herbert D. Huddleston, M.D.

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