PATI ENT ED U C ATI O N MAN UAL

Total Hip
Replacement
Copyright © 2018 by National Association of Orthopaedic Nurses. All rights reserved.

This publication, in its entirety or specific pages, is intended to be printed and distributed as
needed to patients undergoing Total Hip Replacement Surgery. Content may not be copied and
reproduced without written permission of the National Association of Orthopaedic Nurses.

National Organization of Orthopaedic Nurses

330 N. Wabash Avenue, Suite 2000
Chicago, IL 60611
800.289.6266 | [email protected]
www.orthonurse.org
 Contents
What is Total After Surgery 8
Hip Replacement
When to call the
(THR) surgery? 4
doctor after surgery 8
Before Surgery 5
 How should I take
What medical my medicines after
appointments and surgery? 8
tests do I need
Pain Management 8
before surgery? 5
Constipation
What should I do to
Management 9
get my home ready? 5
Diet 10
What activity can I do
before my surgery? 5 Bathing after Surgery 10
How should I take my What activity can I
medicines before surgery? 5 do after my surgery? 10
Bathing before Surgery 6 Help at Home after
Surgery 11
How to prevent
infection before surgery 6 Stress and Coping
after Surgery 11
When to call the
doctor before surgery 6 Intimacy after Surgery 12
Day of Surgery and
Hospital Stay 6

What must I do on the

day of surgery? 6

What activity can I do

in the hospital? 7

What can I do to prevent

getting a blood clot? 7

Total Hip Replacement | 3

 What is Total Hip
Replacement
(THR) surgery?
Total hip replacement surgery replaces the
damaged parts of the hip joint. This is done to
improve pain and movement.

oY
 our doctor will replace the ball and
socket of your hip joint.

• T
 he ball is at the top part of your long
thigh bone (femur).

• T
 he socket is part of your pelvic bone.

oT
 he replacement ball and socket are
made of metal, ceramic, or plastic. Osteoarthritic Hip. Public Domain

oA
 n incision (cut) will be made over your
hip area. Your incision will be closed with
stitches, staples, and/or glue.

oY
 our doctor will decide which type of
incision and replacement parts are best
for you.

Normal Hip. No machine-readable author provided.

Scuba-limp~commonswiki assumed (based on copyright claims).,
Hueftgelenk-gesund, CC BY-SA 3.0

After Total Hip Replacement. No machine-readable author

provided. Scuba-limp~commonswiki assumed (based on
copyright claims)., Hueftgelenk-Endoprothese, CC BY-SA 3.0

4 | Total Hip Replacement

 Before Surgery oP
 lace a rubber mat or non-skid adhesive
on the floor of the tub or shower.

oC
 heck handrails to make sure they are
What medical appointments and tests
sturdy.
do I need before surgery?
oM
 ake sure you have chairs with arms and
You may need medical appointments and a firm seat.
tests to get ready for surgery.
o Install night-lights to help you see.
oH
 istory and physical from your primary
doctor. oK
 eep things within easy reach.

oB
 lood work, Urinalysis, EKG, Chest x-ray. oM
 ake meals that can be frozen and
reheated.
oA
 ppointment with a specialist if you have
health problems such as heart or lung oP
 lan to have household chores done by
disease, or diabetes. someone else while recovering.

oD
 iscussion about substance abuse with oP
 lan for pet care, if needed.
your doctor.
oM
 ake arrangements for a walker and cane
• W
 hat do I need to do if I smoke? to use after surgery.

– Smoking can cause breathing

problems. It can also slow healing What activity can I do before
and increase the chance of my surgery?
infection. Stop smoking. Contact
The most important thing to do is to keep
your primary care doctor to talk
active by doing:
about ways to stop.
oU
 sual activities.
• W
 hat do I need to do if I drink alcohol
and use drugs? oE
 xercises as instructed by your doctor.

– Be honest about alcohol and drug

use including pain medicines. How should I take my medicines
Discuss this with your surgeon. before surgery?
This will help plan for the care you
need after surgery. Give the health care team a list of your
medicines (prescription and over the counter).
Also tell them about your allergies and bad
What should I do to get my home ready?
reactions to medicines.
Getting your home ready before surgery is
Before surgery, your doctor will review
important. It will help you keep safe and make
your medicines.
coming home easier. Here are some things you
can do to get your home ready: oT
 he doctor may tell you to stop taking
some medicines before surgery.
oC
 lean your house and vacuum carpets,
rugs, and the floor. A clean house reduces oT
 he doctor may tell you to take some
bacteria and chance of infection. medicines with a sip of water the morning
of surgery.
oR
 emove anything you might trip over
(cords, rugs, shoes) from all walkways. oH
 ave enough of your daily medicines so
you do not run out while recovering from
oM
 ove furniture and other things to make a
surgery.
clear walkway.
oD
 o not bring any medicines to the
hospital (unless instructed to).

Total Hip Replacement | 5

 Bathing before Surgery Day of Surgery and
You may be asked to shower with a skin cleanser
called Hibiclens or CHG (chlorhexidine gluconate).
Hospital Stay
oT
 his skin cleaner can prevent infections. What must I do on the day of surgery?
o It should be used from the neck down. At home
oD
 o not get in your eyes, ears or There are several things you need to do at
private areas. home before you come in for surgery.
oY
 ou may be asked to shower with it oS
 top eating, drinking, and chewing gum
the night before as well as the morning before surgery as instructed.
of surgery.
oT
 ake only the medicines your doctor instructed
How to prevent infection before surgery you to take with a small sip of water.

oS
 hower as instructed – do not use deodorant,
To prevent an infection, you need to do a few
things before surgery. powders, perfume, lotion or makeup.

oS
 hower with a special soap as told by oR
 emove all jewelry including body piercings.
your doctor or the hospital. oR
 emove nail polish
oC
 hange your bed sheets right before you
oW
 ear comfortable clothing that is easy to
come in for surgery.
put on and take off.

When to call the doctor before surgery oB

 ring the items below to the hospital.

Before surgery, call the surgeon if • Driver’s license or other identification (ID).

oY
 ou have any problems with getting to • Insurance card.
your doctor appointments and tests
• Copy of Living Will and/or Advance
done for surgery.
Directive, if you have one.
oH
 ave a problem with any of the things you
• List of all medicines you take,
need to do before surgery (showering,
including vitamins and other over-
medicine).
the-counter. Leave medicines at home
oY
 ou are sick. For example, fever, unless told to bring them.
flu symptoms, sore throat.
o If you plan on spending the night in the
hospital, also bring:

• Toothbrush, toothpaste, deodorant.

• Glasses and case with your name.

• Hearing aids and case with your name.

• Dentures.

• CPAP machine, if you use one.

• Loose-fitting clothing.

• Comfortable shoes that have a back

(no slip-ons or heels).

oA
 rrive at the hospital on time. Remember
to allow for traffic.

6 | Total Hip Replacement

At the hospital or surgi-center oY
 ou will be helped out of bed by the staff.

There are several things you will do when you • You will walk with the nurse or the
arrive for surgery at the hospital or surgi-center. therapist.

oC
 heck-in. • Do not try to walk on your own.

oG
 o to the pre-operative area. • Please let someone know when you
need help getting out of the bed.
• The nurse will go over information to
make sure records are up-to-date.
What activity can I do in the hospital?
This includes your name, date of birth,
the surgery you will be having, and After surgery, you will slowly increase what you
your medical history and allergies. do each day. It is also important to plan time to
rest. This will help you recover.
• You will change into a hospital gown.
o In the hospital, most people get out of
• An IV (intravenous) line will be placed.
bed on the day of surgery. A nurse or
• Your surgeon and anesthesiologist therapist will help you.
may meet with you and answer any
oM
 oving around early helps you recover.
questions you have.
oP
 hysical and/or occupational therapists
• Your consent for surgery will be
will teach you exercises. These will make
reviewed.
you stronger and help you walk safely.
oA
 fter surgery, you will move to the
oY
 ou will be given exercises based on your
recovery room.
surgery and health.
oY
 ou may go home or be admitted to the
oY
 ou may have limits on your movement.
hospital after you recover.
This depends on the type of surgery.
In your hospital room Your surgeon will give you instructions.

If staying at the hospital, you will be taken to What can I do to prevent getting a
your room.
blood clot?
oY
 ou may have
oT
 ake medicine to prevent blood clots.
• An IV to give you fluids.
oW
 alk around.
• A tube going into your bladder to
oW
 ear compression pumps on your legs or
drain the urine.
feet during hospital stay.
• A drain that helps remove blood from
oW
 ear elastic hose if ordered by your
your surgery site.
doctor, in the hospital and at home.
• Special pump on your feet or legs to
help prevent blood clots.

oT
 he staff will take your blood pressure,
pulse, and temperature often. They will
also give you medicine to ease the pain.

oY
 ou need to do breathing exercises to
keep your lungs clear.

Total Hip Replacement | 7

 After Surgery oC
 ontact your doctor if you notice too
much bruising or you cannot stop
bleeding.
When to call the doctor after surgery
Tell your doctor or nurse right away if you
When to call 911 think you are having an allergic reaction to
a medicine.
oH
 ard to breathe.
oS
 igns of an allergic reaction are itching,
oC
 oughing up blood. rash, hives, breathing, face or throat
swelling.
oC
 hest pain.
oO
 ther problems (nausea, vomiting,
o Increased anxiety when trying to take diarrhea, dizzy) can be side effects or
a breath. adverse reactions to medicines. Call your
doctor if these signs do not stop.
oF
 all to the ground.

When to call the surgeon’s office Pain Management

oR
 edness, heat or drainage from your What can I do to lessen the pain?
incision.
There are many ways to lessen pain. Below is a
o Incision opens. list of options. Work with the health care team
to find the best ways.
oP
 ain even with taking pain medicine.
o Ice
oF
 ever or chills – your surgeon will tell you
when to call. • Ice is a good way to lessen pain.

oN
 ew rash anywhere on your body - • Ice should be used right after surgery
rash can occur with medicine, bandage around the incision.
or tape.
• Ice should never be placed directly on
When to call your primary care office bare skin. Keep ice packs wrapped in
a towel or placed over clothing.
o Illness not part of your surgery.
• Ice should be continued as long as
oS
 ore throat, high blood pressure, and
you have pain from surgery.
sinus pain.
• Ice for 20 minutes at a time. Ice
How should I take my medicines after should be off at least 20 minutes.
surgery? oS
 tay active
Your doctor will prescribe medicines to ease • Get up and move around as
the pain. instructed.
oT
 ake these medicines as instructed.
• Change positions to help reduce pain.
oT
 ell the doctor about your pain level.
Your doctor may prescribe medicines to help
prevent blood clots.

oT
 ake these medicines as instructed.

oY
 ou may bleed or bruise easily while you
take these medicines.

8 | Total Hip Replacement

oR
 elaxation • Acetaminophen (Tylenol®) controls
pain differently from narcotics and
• Rest - Make sure you are getting NSAIDs.
enough, good quality sleep.
– Talk with your doctor about
• Breathing exercises - Slow, deep taking acetaminophen if you have
breathing can reduce stress and pain. a history of liver problems, or
acetaminophen allergy.
• Guided imagery - A method to guide
your mind and help you relax. – Acetaminophen can be taken with
narcotics and NSAIDs. It can help
• Meditation - This can help focus your
decrease narcotic used (opioids).
mind and let you relax.
– You can take up to 3,000 mg of
• Music - Find music that is calming or
acetaminophen each day.
enjoyable to you. This can also help
with relaxation. – Some opioids contain
acetaminophen (Percocet®,
oP
 ills
Norco®, etc.). Be sure to count
• Narcotic pain medicine (opioids). any acetaminophen in your
narcotics toward your daily
– Use right after surgery. 3,000 mg dose limit.

– S
 top using as soon as possible
Constipation Management
after surgery.
Constipation can be uncomfortable and may
• Non-steroidal anti-inflammatory drugs
prevent eating a healthy diet. Constipation can
(NSAIDs).
be caused by:
– T
 he most common are ibuprofen
oN
 ot drinking enough fluids.
(Advil®) and naproxen (Aleve®).
oU
 se of opioids.
– Talk with your doctor if you have
a history of kidney problems, oD
 ecreased activity or mobility.
bleeding problems, or NSAID
allergy. To help prevent constipation, you should use a
combination of things.
– A safe dose of ibuprofen is
600-800 mg (3-4 tablets), oD
 rink plenty of fluids, up to 8 glasses of
three times daily (morning, water per day.
afternoon, evening).
• Soda, coffee, and alcohol do not
– A safe dose of naproxen is 440 count toward your daily water intake.
mg (2 tablets), two times daily
(morning and evening). oD
 ecrease the use of opioid pain medicine.

– Choose either ibuprofen or oS

 tay active. Get up and move as you
naproxen. Don’t take both at the are able.
same time.
oE
 at prunes or drink prune juice. These
– NSAIDS can be taken with are natural laxatives. Try this before using
narcotics. NSAIDS can help medicines.
decrease use of narcotics
(opioids).

Total Hip Replacement | 9

 If you are still constipated, a stool softener or What can I do to prevent infection after surgery?
laxative may help. There are many types of
these medicines. To prevent infection, you need to do a few
things after surgery.
oS
 ome are medicines like bisacodyl
(Dulcolax®), senna (Senakot®), or oS
 leep in clean pajamas and wear clean
docusate sodium (Colace®). clothes at home. This makes sure fabric
that is close to your incision is clean.
oS
 ome contain extra fiber like Metamucil®.
oK
 eep pets off of your bed or chairs and
oT
 ake these medicines as directed. away from your incision.

If these ideas have not helped, contact your  • Pets can carry germs.
doctor. If you reach a point that you stop
passing gas, this may be a medical emergency.  • Pets like to lick wounds so keep your
incision covered when around them.

Diet Care of incision

A healthy diet helps your body heal. What oC

 hange/remove dressing as told.
should you eat?
oY
 ou or a family member should look at
oY
 ou should eat a variety of foods like your incision daily or when you change
protein and vegetables. the dressing to make sure it looks healthy.
oD
 rinking water and eating fiber helps oS
 hower when your health care team says
prevent constipation. Eat high fiber foods it is OK.
like fresh fruits, vegetables, and whole
grain breads and cereals. oD
 o not soak in a bathtub, go swimming,
or sit in a hot tub until your health care
oS
 ome people don’t feel like eating after team says it is OK.
surgery. Although not hungry, try to eat
healthy foods or drink nutritional shakes.
What activity can I do after my surgery?
Call your doctor if your appetite does
not get better. At home activities

oA
 t home, increase your activity over time
Bathing after Surgery
(walking, exercises, chores).
oD
 o not shower alone. Have someone
close by until you feel safe. • Do more activities each day.

oU
 se grab bars for balance. – Increase walking.

oU
 se non-slip bathmat on bathroom floor – Do your exercises.
and in shower/tub.
– Slowly start doing chores.
oS
 it on a shower seat/chair.
• Rest during the day.
oU
 se hand held shower to wash areas
– Plan rest periods into your day.
more closely.
– Use help with chores around the
oU
 se a long-handled scrub brush to wash
house (laundry, cleaning, errands,
hard to reach areas.
cooking and pet care).
oU
 se liquid soap.
• Discuss when you can return to work.

– Most people return to work in 4

to 6 weeks. Time off from work
depends on your job.

– Talk with your doctor about work.

10 | Total Hip Replacement

 Mobility with Medical Equipment/
Assisted Devices

You may need equipment to help you with

everyday activities.

oY
 ou may need equipment to help you
move around, bathe, dress, and reach
things.

oY
 our therapist will recommend what
equipment you need.
Reacher, or Grabber. Reproduced with permission from
oH
 ere are some examples of common OrthoNebraska
equipment used: walker, crutches, cane,
shower seat, shower chair, grabber.

oY
 ou can purchase, rent or even borrow Help at Home after Surgery
most equipment. Before surgery, you After surgery, you need helpers at home.
can call your insurance company for
equipment coverage. Some may not be oY
 ou may need help with many things like
covered by insurance. bathing, dressing and moving around
safely.

oY
 ou may also need help with chores and
errands.

oT
 ell us who your helper(s) will be and how
long they will be with you.

Helper(s):

Length of Time:

Appointments and Transportation

You need to see your surgeon after you go home.

oM
 ake an appointment as instructed.
Walker with Tray. Reproduced with permission
from OrthoNebraska oA
 rrange for transportation to the
appointment.

Stress and Coping after Surgery

Surgery can cause stress for you and your
family. Have a plan for help and how to cope
with stress.

Remember to ask for help.

oA
 sking for help is temporary! As you get
stronger you will be able to do more for
yourself and others.

oF
 amily and friends are often willing to
help. Talk to them about what they can do.
Shower Chair. Reproduced with permission from OrthoNebraska

Total Hip Replacement | 11

 Do things to help you relax. Intimacy after Surgery
oP
 rayer. oA
 sk your doctor when it is safe for you to
have sex.
oM
 editation.
oA
 sk what precautions you should follow.
oA
 ctivities in your community (senior
center, church or worship). oY
 ou may need to try new positions. Some
positions are more comfortable and safer.
oD
 eep breathing.

oD
 o things you enjoy.

oM
 ake sure you get enough sleep. Many
people will take a nap during the day.

Make a list of what you have done every week.

oH
 ow much you walked.

oE
 xercises done.

oF
 un things you did.

oC
 hores done.

Breathing Exercises

Quiet time can help you relax. Breathing slowly

a few times a day can help you focus better and
increase energy.

oS
 it in a comfortable chair or lay down in
your bed.

oP
 ut your hand on your belly just above
your belly button.

oN
 otice your belly going up and down.

oW
 hen you breathe in, it will feel like a
balloon filling up.

oW
 hen you breathe out, it is like all the air
coming out of the balloon.

oR
 elax your shoulders.

oD
 eep breath in, count to 3 and try to think
RELAX.

oL
 et your breath out, count to 3 and try to
think RELAX.

12 | Total Hip Replacement

Total Hip Replacement | 13
 National Organization of Orthopaedic Nurses
330 N. Wabash Avenue, Suite 2000 | Chicago, IL 60611
800.289.6266 | [email protected] | www.orthonurse.org