Anterior Hip

Rose Institute forJointReplacementPatient Care GuideHip

Rose Institute for Joint ReplacementPatient Care Guide – HipTABLE OF CONTENTSINTRODUCTION ........................................................................................................................................ 3PARKING ..................................................................................................................................................... 4DIRECTIONS ................................................................................................................................................. 6HOTEL ACCOMMODATIONS ......................................................................................................................... 7FAMILY AND FRIENDS .................................................................................................................................. 8PATIENT INFORMATION SHEET ....................................................................................................... 10YOUR CARE TEAM ................................................................................................................................. 15BEFORE YOUR SURGERY .................................................................................................................... 16CHECKLIST ................................................................................................................................................ 17UPPER BODY STRENGTHENING EXERCISES ................................................................................................. 18SURGERY DAY ......................................................................................................................................... 21ANESTHESIA .............................................................................................................................................. 22WELCOME TO PAVILION II .......................................................................................................................... 23PAIN MANAGEMENT ................................................................................................................................... 24PLANNING FOR DISCHARGE ........................................................................................................................ 26TIPS FOR AFTER DISCHARGE ....................................................................................................................... 27MEDICAL EQUIPMENT ......................................................................................................................... 28RISKS OF JOINT REPLACEMENT ...................................................................................................... 30FREQUENTLY ASKED QUESTIONS ................................................................................................... 31YOU AND YOUR NEW HIP .................................................................................................................... 33HOME EXERCISE PROGRAM .............................................................................................................. 52

Rose Knows JointsThe Rose InstituteExpertise, Experience, Knowledge, Compassion, IntegrityAt Rose, our world-class surgeons and staff provide excellentmedical care and customer service that surpasses otherhospitals. We are committed to providing the highest level ofquality, compassion and comfort for all our patients.What will you find at ROSE?• All orthopedic surgeons are board certified.• Over 5,000 joint replacements performed in the past fiveyears; more than any other Denver metro hospital.• Operative team dedicated solely to joint surgery.• Complication rates are lower than the national average.• Infection rates are lower than the national average.• A patient care team trained specifically for total jointreplacement patients.• Dedicated occupational and physical therapy staff for yourpatient care.• The highest quality prosthesis.• Free education seminars and pre-operative classes prior tosurgery.How To Use This HandbookThis book is an important part of your preparation for andrecovery from surgery. Each section is designed to help you andyour family understand your joint replacement surgery. Pleasebring this manual to all your physician and hospital appointments.Refer to it often, and please ask questions!You!Foremost in our hearts and mind isthe commitment to our patients. Weare dedicated to bringing you theservices and support needed tomake your surgery asuccess...BUT....the most importantpart of the joint replacementprogram is YOU! Your commitmentand cooperation is vital to a rapidand successful recovery.Pre-RegistrationPre-registration will save you timeand help us expedite your admissioninto the hospital. Please go to ourWeb site to pre-registerwww.rosemed.com or call our Pre-Registration number at303-320-2798.Important Phone NumbersPhysician Referral Center 303-320-2578Call us to find a Rose doctorDirector, RIJR 303-320-2153Pavilion II, Unit Manager 303-320-2866Nurse Practitioner 303-320-7200Patient Case Manager 303-320-7200Rose Switchboard 303-320-2121Pre-Registration 303-320-2798Financial Counselor 303-320-2626

Complimentary ShuttleIf you need transportation to another location onthe Rose Campus, we have a complimentaryshuttle bus to help you make the transfer.Main Hospital (9th Ave)POB II (9th Ave)Rose Founders Building (Dahlia St)Wolf Building (Hale Pkwy)Please call 303-518-5833 or ask the medical staffto call for a transfer.Vehicle Assistance ServiceComplimentary vehicle assistance is provided bythe Parking Department from 8:00 AM to 4:30PM, M-F. They provide an unlock service, jumpstart service, and will inflate or change a flat tire.Emergency ParkingEmergency Department parking spaces areavailable off Clermont Street. Please note thatthese spaces are for Emergency Departmentpatients only and that there is a two-hour timelimit. If your Emergency Department stay is longerthan 2 hours, Republic Parking staff can move yourvehicle to the Valet. To facilitate this transfer, pleasegive your keys to a staff member and receive avalet claim check.Handicapped ParkingHandicapped parking is available in all parkingfacilities. Please look for the standard ADA signsnear the elevators.Please call 303-329-5197 for assistance. After 4:30PM, please call security at 303-320-2726.TaxisIf you should need a taxi, please note the followingnumbers:Metro CabPlease call 303-333-333Yellow CabPlease call 303-777-7777

Rose Medical Center DirectionsDriving from the NorthDriving north on I-25, exit east 6th Avenue(Exit 209A) and continue on east 6th Avenueuntil you reach Colorado Boulevard. Turn northon Colorado Boulevard. Turn east on 9th Avenuefrom Colorado Boulevard and continue forapproximately 6 blocks. Rose Medical Center willbe located on the north side of the street betweenClermont and Dexter streets.Driving from the WestDriving from the west by I-70, exit at ColoradoBoulevard, south, (Route #2) (Exit 276). Go southon Colorado Boulevard until 9th Avenue. Turn easton 9th Avenue from Colorado Boulevard andcontinue for approximately 6 blocks. Rose MedicalCenter will be located on the north side of thestreet between Clermont and Dexter streets.Driving from the SouthDriving south on I-25, exit Colorado Boulevardgoing north (Exit 204) and continue on ColoradoBoulevard until 9th Avenue. Turn east on 9thAvenue from Colorado Boulevard and continuefor approximately 6 blocks. Rose Medical Centerwill be located on the north side of the streetbetween Clermont and Dexter streets.Driving from the EastDriving east by I-70, exit at Colorado Boulevard,south, (Route #2) (Exit 276). Go south onColorado Boulevard until 9th Avenue. Turn easton 9th Avenue from Colorado Boulevard andcontinue for approximately 6 blocks. Rose MedicalCenter will be located on the north side of thestreet between Clermont and Dexter streets.

Hotel AccommodationsIf you require accommodations while your familymember or friend is at our Institute, we hope thatthe following list is helpful.The Rose Information desk is available from M-F08:00-6:00 PM to assist with any further questionsyou may have regarding accommodations. Thephone number is 303-320-2396.Mark 1 Guest Suites Hotel(T)303-331-7000(F) 303-331-71714321 E Hale PkwyDenver CO*Across the street from Rose Medical CenterCherry Creek Hotel(T)303-757-3341(F) 303-756-6670600 South Colorado BlvdDenver CO*Ask for Rose Medical Center rateStaybridge Suites Hotel(T)303-321-5757(F)303-321-13174220 E Virginia AveDenver CO*Complimentary shuttle to and from Rose MedicalCenterLa Quinta Inn(T303-758-8886(F)303-756-2711I-25 and South Colorado BlvdDenver CORamada Inn - Downtown Denver(T)303-831-7700(F) 303-894-91931150 East Colfax AveDenver CO*Free shuttle service to and from Rose MedicalCenter and airportFairfield Inn Denver(T) 303-691-22231680 South Colorado BlvdDenver CORed Lion Hotel Denver Central(T)303-321-66664040 Quebec StDenver CO*Ask for the Rose Medical Center rateHoliday Select Inn(T)303-388-5561455 South Colorado BlvdDenver CO*Complimentary shuttle to Rose Medical Center.Call ahead rate for rate.Doubletree Hotel(T)303-321-33333203 Quebec StreetDenver CO*Ask for the Rose Medical Center rateHampton Inn & Suites(T)303-692-18004150 East Kentucky AvenueDenver CO*Ask for Rose Medical Center rateLoews Denver Hotel(T)303-782-93004150 E MississippiDenver CO*Call for “in-house” rate*Shuttle to and from Rose Medical CenterHomestead Studio Suites(T)303-388-38804444 Leetsdale DriveGlendale CO

Family and FriendsLocationRose Medical Center is located on East 9th Avenuejust minutes from midtown Denver and therenowned Cherry Creek area. Please see the maplocated in the “Directions” section of this book.Directions and ParkingPlease refer to the “Directions” sectionof this manual for directions and parking options.Visiting HoursFamily and friends may visit guests during thehospitals general visiting hours, which are 11 AMto 8:30 PM.Waiting AreasWaiting rooms are available on the Pavilion II(2nd floor) across from the Nursing Unitsecretary. An area located on the main floor,adjacent to Little Miss Latte is also available. Thisarea is equipped with WiFi access, a telephone, atelevision and reading material.Rose Gift ShopThe Gift Shop is located on the Main floor nearthe public elevators. Many personal and gift itemsare available within the hospital. Gift deliveries aremade by volunteers. A United Parcel Servicedelivers gift items outside the hospital. You cancontact the Rose Gift Shop at 303-320- 2297.Hospital Dining OptionsFor Visitors, meals are available at the Rose GardenCafe and Little Miss Latte.Rose Garden Cafe(located on the Ground floor):This café offers a variety of hot food choices, deliitems, a salad bar and takeaway options forbreakfast and lunch. Daily breakfast and lunchspecials are available as are meal tickets ($7).M-FSat-Sun6:30 AM - 3:00 PM6:30 AM - 2:00 PMLittle Miss Latte(located on the First floor near themain elevators):Available are coffee drinks, soups, salads, pastries,deli options, and hot meal entrees for dinner.M-FSatSun6:30 AM - 1:00 AM7:30 AM - 1:00 AM2:00 PM - 1:00 AMATM MachineAn ATM machine is located on the first floor nearthe main elevators, across from Little Miss Latte.

ValuablesPlease do not leave valuables or personalbelongings unattended while visiting your lovedone at the hospital. The Lost and Found is locatedon the Ground floor.SmokingIn the interest of this hospital’s patients, RoseMedical Center maintains a smoke freeenvironment. Smoking inside of the hospitalbuilding is strictly prohibited.Cell Phones/Two way RadiosTo provide a safe environment for our patients, thehospital asks that patients and guests do not usepersonal communication devices in any patientcare area due to possible interference with medicalequipment.Personal SafetyPatient safety is a priority for our hospital. At RoseMedical Center, we encourage patients’ activeinvolvement in their own care as a patient safetystrategy. Patients should contact their nurseimmediately should they feel concern for theirsafety or alternatively initiate a Code Yellow foremergent assistance by dialing 5555.

Patient Information SheetThis information sheet is very valuable to the patient care team at the Rose Institute for Joint Replacement.Please answer the questions truthfully. It should be completed prior to your next physician appointment.Your patient care team will be referring to it regularly.Patient’s Name: Height: Weight:ALLERGIESDo you HAVE allergies to:LatexMedicationsFoodsEnvironmentsContrast MediaOtherapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No__________If answered YES to the above, list names of known allergens:CURRENT MEDICATION LIST*List ALL prescriptions, herbals, vitamins, and over-the-counter medications*Name(i.e. Lasix)Dose(i.e. 20mg)Route(i.e. oral)Frequency(i.e. twice a day)Time & date last dose takenbefore surgeryIMMUNIZATIONSHave you had the Pnuemovax vaccine?Have you had a Flu shot? (If yes: when________)Other:apple Yes apple Noapple Yes apple No

1. NeurologicalDo you have problems with sleeping?Have you ever had a stroke?Have you ever had seizures?Do you have Parkinson’s?Do you have frequent headaches?Do you have blurred vision or double vision?Do you have substantial weakness in lower extremities?Do you have numbness/tingling anywhere in your body?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No2 . Eyes, Ears, Nose ThroatDo you wear glasses or contacts?Do you have cataracts?Are you hard of hearing or wear a hearing aid?Do you get nosebleeds?Does twisting your neck quickly cause pain, tingling or dizziness?Have you ever had lumps or swelling in your neck?Do you wear dentures?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No3. Respirator yHave you ever been diagnosed with sleep apnea?Do you use Oxygen at home?Do you use a CPAP/BIPAP machine at home?Do you have problems with shortness of breath?Do you wheeze or gasp for breath?Have you ever coughed up blood?Have you ever had emphysema?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No4. CardiovascularDo you have a pacemaker or AID?Have you ever had chest pains of tightness in your chest?Have you ever had a heart attack?Have you ever had Rheumatic Fever?Are you bothered with a pounding or racing heart beat?Have you ever been short of breath at night or with regularactivity?Have you ever been diagnosed with Congestive Heart Failure?Have you ever been diagnosed with high blood pressure?Have your ever been diagnosed with a heart murmur?Have you had recent blood pressure changes?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No

5. VascularDo you have light headedness or dizziness?Have you ever fainted or blacked out?Are your ankles or feet swollen?Have you ever had a blood clot?Do you have circulation problems in your hands or feet?Do you have varicose veins?Do you ever get leg cramps?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No6. MusculoskeletalDo you have an implant or prosthetic device? (if yes, list_____)Do you have arthritis in other joints?Have you ever had a fracture? (If yes, where:________)Are any of your extremities deformed?Do you have any muscle diseases?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No7. DigestiveDo you have heart burn?Do you feel bloated with meals?Do you have excessive belching?Do you frequently become nauseated?Have you ever vomited blood?Do you have difficulties or pain with swallowing?Are your bowel movements loose for more than a day?Are your bowel movements black and tarry or bloody?Have you ever had bleeding from your rectum?Have you had any appetite changes?Have you ever been diagnosis with an ulcer?Have you ever been diagnosed with a hiatus hernia?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No8. EndocrineAre you a diabetic?Do you use insulin?Do you use oral agents?Have you ever been diagnosed with a thyroid problem?Have you ever been diagnosed with a pituitary problem?Have you had recent weight loss (amt: ______)Have you had recent weight gain (amt:______)Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No

9. Urinar yDo you urinate more than 5-6 times a day?Do you get up at night to urinate? (If yes, how many times____)Do you have burning or pain with urination?Has your urine ever been bloody, black or brown?Do you have trouble starting your urine flow?Do you have a constant feeling that you need to urinate?Do you leak urine when you cough, sneeze, laugh or sleep?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No10. GynecologicalAre you pregnant?Are you currently breastfeeding?Number of pregnancies ______ live births_____Are you on hormones?Are you taking calcium supplements?Have you had or are you having unusual vaginal bleeding?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No11. SkinDo you have skin problems? If yes, list:________Does your skin itch or burn?Do you bruise easily?Do you have trouble stopping even a small cut from bleeding?Do you have psoriasis?Do you have any moles or birth marks that arechanging shape/color?Do you have open sores?Is your skin excessively dry?Do you have any skin rashes?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No12 . PsychosocialHave you ever been diagnosed with a psychological disorder?(Depression, anxiety, suicidal thoughts? If yes, list:_______)Do you smoke?If yes, how many per day? ____If yes, how many years? _____Do you drink alcohol?How many drinks daily? ___ Weekly?____ Weekends? ____Do you use other substances? (cocaine, marijuana etc)If yes, type of substance? _______Frequency? Daily______ Weekly_____ Weekends _____Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No

13. AnesthesiaHave you ever had anesthesia?If yes, do you have difficulty waking up after the anesthetic?Have you or any family member been told you had a high feverwith general anesthesia?Have you ever been told that the anesthesiologist had a difficulttime putting a tube in for breathing during surgery?Do you have problems with nausea or vomiting afterreceiving anesthesia?apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple NoPlease check any of the following conditions, illnesses or problems you have now or have had:___ TB ___Rheumatic Fever ___Cancer (Where:_____)___Scarlet Fever ___Polio ___Tumor (Where:_____)___Hives/Rashes ___Psoriasis ___Bronchitits___Diverticulitis ___Hemorrhoids ___High Blood Pressure___Lung disease ___Pneumonia ___Heart Attack (When:____)___Heart Trouble ___Blood Transfusion ___Hernia (Type:___)___Pancreatitis ___Gall Bladder Trouble ___Yellow Jaundice___Malaria ___Anemia ___Blood Clots/Phlebitis___Stroke ___Ulcers (Where:___) ___Drug /Substance Abuse___Psychiatric disorder___Reactions to anesthesiaOther information you would like us to know:

Your Care TeamAt the Rose Institute for Joint Replacement we are committed to providing quality health care to you andyour family. Your care team consists of different health care professionals, some who you will see every dayand others who work behind the scenes. Each health care professional takes a personal interest in your careOrthopedic Surgeon• Performs your surgery, oversees and directsyour care• Checks your progress at follow-up officeappointmentsAnesthesiologist• Administers anesthesia to you in theoperating room• Monitors your condition during surgery• May direct your post-operative painmanagementPhysician Assistant• Works closely with your surgeon toevaluate, diagnose and assist in the treatmentof your surgical condition.• Coordinates your care after surgeryOperating Team• Assists medical staff in surgical procedures• Performs preoperative and postoperativeproceduresTotal Joint Institute, Director• Ensures overall efficiency, quality anddevelopment of the joint replacementprogramNurse Manager Pavilion II• Provides administrative and clinical leadershipfor the orthopedic unit• Assists patients and staff with problems andconcerns• Serves to educate and develop the skillof the team members providing directpatient carePharmacist• Coordinates and educates you on yourmedications based on physician ordersNurse Practitioner• Plans and coordinates your care based onphysician orders• Monitors and communicates informationabout your condition to other teammembers• Educates and helps you and your family withpersonal care needsInpatient Nursing Staff• Works closely with other team membersto deliver you individualized care• Monitors your condition and communicatesinformation about your condition to otherteam members• Helps you and your family with personalcare needsPhysical Therapist• Assesses your physical status and developsan individualized care plan• Instructs and assists you with post operativeexercise programs, the use of equipment andmovement precautionsOccupational Therapist• Helps you adapt to temporary lifestylechanges that are necessary following jointreplacement• Teaches you how to perform daily tasks suchas bathing or dressing without endangeringyour new joint• Instructs you on how to use adaptiveequipmentPatient Case Managers• Helps identify any individual needs you mayhave when you leave the hospital• Coordinates your discharge from the hospitaland any follow up care required

Before Your SurgeryAppointmentsPlease ensure that these appointments have beenarranged before your surgery.RegistrationPlease register prior to your surgery atwww.rosemed.com or 303-320-2798.Primary Care Physician or HospitalistYou must complete a history and physical examwithin 30 days of your surgery. If you do not havea personal doctor, Rose Institute for JointReplacement will arrange a pre-op history andphysical for you.Surgery Date and TimeYour surgery date and time will need to bescheduled in advance.Pre-Admission Hospital Appointment (PAT)A nursing history and assessment is required forall surgeries. Please call 303-320-2802 tocomplete your health history with a member ofthe nursing staff. Have a list of your currentmedications available at this time. You will need tobe registered prior to this assessment.Pre-Education ClassPlease attend the pre-operative education class. Aschedule will be given to you by your surgeon’soffice. This class is a review of your surgicalprocedure, your hospital stay and the importanceof physical and occupational therapy exercise.Family and friends are welcome to attend.Follow Up AppointmentAfter discharge from the hospital, your surgeonwill require a follow up appointment usuallywithin seven to ten days. Please have thisappointment arranged before your surgery.Discharge ArrangementsDischarge from the hospital is 11AM. Please havearrangements made with family or friends to helpyou return home.Eating and DrinkingDo NOT smoke, eat or drink anything (includingwater) after midnight the night before yoursurgery. If you have been instructed by yourphysician to take certain medications, please takethe medications with only a sip of water.Fever/CoughCall your surgeon if you have a change in yourcondition prior to surgery, i.e. fever, cough, flu, rashor other infection. Your surgery may need to be rescheduled.Medications• Bring a list of your current medications(name, strength, dose, frequency) tothe hospital.• The hospital is unable to use the medicinesyou currently have at home. The hospitalpharmacy will provide all medications duringyour stay.• Follow your surgeon’s instructions aboutwhen to discontinue anti-inflammatory,aspirin or other herbal medicines prior tosurgery.• Check with your surgeon about diabeticadjustment for the day of surgery.What to Bring• Personal care items such as a toothbrush,toothpaste, shaving equipment, deodorant,eyeglasses, contacts.• Clothing such as knee-length gowns, robes,nightshirts. Loose fitting shorts and t-shirtsfor physical therapy.• A positive attitude and commitment to beinvolved in your care while at the hospital.• This manual.

Your Last Minute ChecklistChecklistThe 24 hours before surgery will be busy. Please use this checklist to make sure you remember everything:________________________Ensure you have travel arrangements planned ahead for your discharge day. These arrangementswill need to be made for 11 AM on the day of discharge.If you will be returning home after surgery, ensure that someone is available and able to helpyou with your daily activities.Take a shower or bath the night before surgery. This will help reduce the risk of infection.Do not shave the area of surgery. If necessary, your doctor/nurse will do this at the hospital.Do not smoke, eat or drink anything after midnight the night before surgery.Do not wear lipstick, makeup or nail polish on the day of surgery.Bring a list of current medications. (Name, strength, route, time)Bring a hospital bag including items such as:• Toothbrush/Toothpaste• Shaving equipment• Hair brush, comb• Makeup• Glasses, contact lens & solution• Comfortable shoes or slippers with non-skid soles• Knee length robe, gown or loose fitting pajamas• Loose fitting sweat suit or jogging suit for physical therapy__________________Bring items to occupy your time such as reading material, knitting, crossword puzzles.Leave anything of personal or financial value at home, such as jewelry, rings, credit cards,computers, cell phones.Leave your medicines at home unless instructed by your physician. The hospital pharmacy willsupply these while you are with us.If you do not already have a parking permit for a disabled person, please apply for atemporary permit several weeks prior to your surgery. Contact the Department of Motor Vehiclesor your surgeons office for an application form.Co-pays and deductibles will be due day of surgery.Bring this manual!

Upper Body Strengthening ExercisesThis program is to be completed prior to your total joint replacement surgery and its’ purpose isto strengthen your arms.General Guidelines1. Stretch until resistance is comfortable but not stressful.2. Start with sets of 5 repetitions and work up to 20 repetitions.3. Breathe steadily.4. Exercises should be performed slowly to achieve the maximum benefit.5. To make exercises more challenging, move your hands closer together on the theraband.Diagonal Shoulder Extension1. Start with both hands over your head as shown below.2. Keeping one hand in place and your elbows straight, pull down with the other hand diagonallyacross your body.3. Return to the start position with both hands overhead.4. After repetitions are complete, repeat exercise using your other arm.

Elbow Extension1. Start by locking your upper arms into the sides of your body. Do not move your upper armsduring this exercise. The only movement should be at your elbows.2. Bend your elbows and place your hands together at chest level.3. Hold one hand in place and pull straight down with the other hand.4. Return to start position. After repetitions are complete, repeat the exercise using your otherarm.Elbow Flexion1. Start by locking your upper arms into the sides of your body. Do not move your upper armsduring this exercise. The only movement should be at your elbows.2. Place both hands in your lap.3. Keep one hand in your lap and with the other hand, bend at the elbow and pull straight up.4. Return to start position. After repetitions are complete, repeat the exercise using your otherarm.

Chair Push Ups1. Sit in a chair with armrests.2. Place your hands on the arms of chair.3. Push down with your arms to lift your buttocks up from the chair.4. Hold yourself off the chair for 10 to 30 seconds.5. Return to start position to rest. Repeat exercise.

Surgery DayBefore SurgeryYour surgeon will ask you to arrive at Rose MedicalCenter one or two hours before your surgery. It isimportant that you arrive on time to ensure thatadditional tests or assessments can be completedbefore your surgery time. When you arrive at thehospital you can request a wheelchair or assistanceat the Information Desk. You will go to the 2ndFloor Pre-Operative department. Your family andfriends can accompany you in the Pre-Operativearea.After SurgeryYou will be taken to PACU (Post Anesthesia CareUnit) after the surgery is finished.Pre-Operative MedicationsYou will receive medications prior to surgery inorder to help prevent nausea and vomiting aftersurgery along with medications to help manageyour pain.To help prevent nausea and vomiting you mayreceive any combination of the following:PepcidUsed to decrease the stomach’s production of acidZofran Used to prevent nausea and vomitingReglan Used to prevent nausea and vomitingTo help prevent pain after surgery you may receiveany combination of the following:Tylenol A non-prescription medication used to treat painCelebrexA medication used to reduce inflammation along with treating painOxycontin A prescription medication used to treat painThe nurses in PACU are specially trained to carefor patients who are recovering from anesthesia.The medication used for your anesthesia maycause blurry vision, chills, a dry mouth and somenausea. You may also have a sore throat if a tubewas placed in your windpipe.You will stay in PACU from one to three hours,depending on the type of anesthesia you receivedand your individual response to it.Your family and friends will not be allowed inPACU. Your surgeon will be contacting the personyou identified as a “primary contact” to informthem that your surgery is over.When you are released from PACU, the nurse willtake you to Pavilion II. Your family and friends mayvisit after the nurse checks you in.

AnesthesiaAnesthesia is defined as the loss of feeling orconsciousness. During your surgery, theanesthesiologist will provide the anesthesia andconstantly monitor your medical condition.Your anesthesiologist will be assigned 24 hoursprior to your surgery. He/She will personallyinterview you and examine you the day of surgery.You will have two options for your anesthetic:general anesthesia or regional anesthesia.General AnesthesiaThe main purposes of general anesthesia are:• pain relief (analgesia)• inhibits normal body reflexes to makes thesurgery safe and easier to preform• relaxes the muscles of the body• produces unconsciousness• blocks the memory of the procedure(amnesia)With general anesthesia, you will be unconsciousthroughout the entire operation. You will receive anintravenous injection that producesunconsciousness within a few seconds and then ananesthetic gas will maintain the anesthesia until theend of the surgery. During surgery you may have atube placed in your throat to deliver inhaledanesthesia. This tube may cause you to have a sorethroat or hoarse voice for a few days after surgery.off, however if they persist or cause problems, yournurse or physician should be notified.Regional AnesthesiaRegional anesthesia such as spinal or epidural is analternative to general anesthesia and affects onlythe portion of the body that is to undergo surgery.A small area of skin is numbed by a local anestheticinjection and a needle is placed between the bonesof the lower back and the anesthetic drug isinjected. With this technique, medication isdelivered in the spinal area of the lower back tonumb the nerves that carry sensation andmovement messages from the brain to the lowerpart of the body.In addition to regional anesthesia, you will besedated to help you relax throughout theoperation. The extent of sedation is determined bythe anesthesiologist and is based on yourdiscussion with he/she before surgery.If regional anesthesia is used, patients are usuallyaware of events in surgery though they do not feelpain.We’re here for YOU!Please feel free to talk to your anesthesiologist,surgeon or nurse if you have any questions orconcerns about your anesthesia options.During the surgery, the anesthesiologist constantlymonitors your breathing, heart rate, blood pressureand body temperature. At the conclusion of thesurgery, the anesthesiologist slowly reduces theamount of anesthetic drugs so that you awakensoon after your operation is finished.Because general anesthesia affects the centralnervous system, patients may feel drowsy, weak ortired for as long as a few days after. Most sideeffects usually disappear as the anesthetic wears

Welcome to Pavilion IIYour care and return to an active lifestyle is ourprimary concern.The orthopedic nursing unit is located on the 2ndfloor. Nurses and staff support are here to care foryou 24 hours a day. Our floor has private roomsavailable for the comfort of you and your family.Our management team is available to help youwith your questions, concerns or special needs.Director 303.320.2153Nurse Manager 303.320.2866Nurse Practitioner 303.320.7200Case Managers 303.320.7200A Rose Medical Center AdministrativeRepresentative is available to help you 24/7. Youcan reach the them by calling the hospital operator(0).Call ButtonThe purpose of your call button is to contact yournursing care team. When you press your callbutton, a signal is sent to the nurse call monitor.There is a slight delay between the button beingpressed and the signal call. You may also call yournurse directly by dialing the four-digit extensionwritten on your communication board. Our goal isto answer your call and meet your needs.Visiting HoursVisiting hours are between 11 AM and 8:30 PM.We do not allow family members to stay overnightin lounges or semi-private rooms. A familymember, if over the age of 18 years, may spend thenight in your private room. If your family memberchooses to stay with you, please inform the ChargeNurse so appropriate arrangements may be made.MealsWhen you stay at Rose Medical Center, we treatyou right and you can expect the very best.Following the "Room Service" model used in finehotels everywhere, patients call when they want toeat, anytime between 7:00 AM- 6:30 PM.The "room service" number is easy to remember:Dial 5444, and food prepared by our chefs isdelivered within 45 minutes of ordering. Menus arelocated at the patient's beside. And best of all, thisservice is provided at no extra charge!Please let us know if you need a special diet.Kosher, vegetarian and calorie or fat restricted dietsare available upon request. A family pantry isavailable on Pavilion II for cold or hot drinks.ChaplainChaplains representing many faiths are available 24hours a day to provide spiritual and pastoral needs.Please notify a member of your care team if you oryour family member would like to talk with achaplain. The Charles C. and Esther WinocurChapel is located on the first floor of the mainbuilding and is open at all times.

Pain ManagementOur GoalOur goal at the Rose Institute for JointReplacement is effective pain management for allpatients.Pain Management AssessmentAssessing and evaluating are the key componentsof treating pain. Inform your nurse when you areexperiencing pain and provide as much informationas possible.Type of pain - Describe the type of pain you areexperiencing. You may use such descriptive wordssuch as dull, sharp, burning, stabbing, shooting orpins and needles.How much pain - You can describe the intensity ofpain on a scale of 0 to 10. “0” being no pain and“10” being the worst pain you can imagine.Where is the pain - Inform the nurse of thelocation of your pain.Do not wait until the pain is unbearable.The worse the pain, the more difficult it is to getunder control.Your RoleWith your assistance and cooperation, your patientcare team will work with you to establish a realisticpain relief goal. It is important that you identify anacceptable pain level which will allow you toparticipate in therapy, activities of daily living(ADLs) and be comfortable at rest. The amount ofpain a person feels varies from one person toanother. Your nurse and physician will work closelywith you to provide the best pain control possible.MedicationsThere are many effective medications availableto help control pain. Before your surgery, youranesthesiologist will discuss pain managementoptions with you. When you are on Pavilion II, yourphysician will order pain medications for your postoperativerecovery phase. If the first medicationsdo not provide relief, additional medications areavailable, as needed.Other Possible Pain SolutionsMany people are able to manage their pain throughalternative methods. Some suggestions are:• Non-opioid therapies such as ice or heat• Repositioning• Distraction - watching TV, music or reading• Listening to relaxation tapes• Imagery

AnticoagulationAnticoagulants are also known as “blood thinners”.These medications are used to help prevent bloodclots and to treat blood clots that have alreadyformed.People who are undergoing joint replacementsurgery are at a higher risk for forming blood clots.MedicationsThe two most commonly used options for bloodthinning medications are an injection or tablet.Typical medications include Fragmin, Heparin,Lovenox, Coumadin or aspirin. Your surgeon willdetermine which is best for you.CoumadinDescriptionCoumadin is a blood thinner that prevents bloodclotting. It is available in many different strengthsand in tablet form. This is an extremely effectivemedication, but needs to be monitored closely. Youwill be started on Coumadin while you are inhospital. Before you are discharged, the pharmacistor nurse will discuss with you common sideeffects, medications and foods you should avoidwhile on it.How does it work?Coumadin blocks the formation of Vitamin Kdependent clotting factors in your liver. Vitamin Kis needed to make clotting factors that help theblood to clot and prevent bleeding. Therefore, bygiving a medication that blocks the clotting factors,your body can stop harmful clots from forming orincreasing in size.Blood TestsWhile you are in the hospital, blood tests will bedone by the lab to measure how long it takes foryour blood to clot. These blood tests are calledProthrombin Time/International Normalized Ratio.(PT/INR). Based on the PT/INR, your Coumadindose will be adjusted carefully to fit yourcondition. You will need to have your PT/INRchecked on a regular basis while you are on thismedication. Your blood will be tested on yourfollow-up visit to your surgeons office once youleave the hospital.Special Precautions• Call your physician immediately if you haveany bleeding or bruising• Do not take ANY prescriptions or over-thecountermedications, including vitamins orherbal preparations (especially thosecontaining Vitamin E or K) unless ordered byyour physician• Try to maintain a consistent diet. Do notdramatically vary your dietary intake of foodshigh in Vitamin K as these foods can interferewith how you metabolize Coumadin.Examples of these foods include: spinach,broccoli, liver, cauliflower, cabbage, lentils,chickpeas, seaweed, soybean oil, green teaand other teas which contain coumarin.• Inform your doctor, dentist and pharmacistthat you are taking Coumadin, especiallybefore you start a new medication or arehaving a new medical or surgical procedure.RisksBecause Coumadin prevents blood clotting,patients taking Coumadin are at a higher risk forbleeding and bruising. People taking Coumadinmust have routine blood testing in order tomonitor its effect as well as minimize risksof bleeding.Contact InformationWhile in the hospital, if you have any questionsor notice any bleeding problems, you should notifyyour nurse and physician. If you notice any bleedingproblems while you are at home, please call yourphysicians office.

Planning for DischargeCase ManagersAt the Rose Institute for Joint Replacement, wehave specialized case managers on our Pavilion IIfloor. Our case managers are available to assist youand your family in preparing for discharge. A casemanager will not make decisions for you and yourfamily, but will provide information that will assistyou to make the best decision about your careafter discharge.Discharge TimeYour surgeon will determine when you will bereleased from the hospital. Please maketransportation arrangements to leave the hospitalby 11 AM on the day of discharge. This will allowyou to get home and settled, as well as do any lastminute things such as get prescriptions filled oracquire any needed medical equipment. If you haveany questions or if concerns arise, you will be ableto call your surgeon during office hours.Extended Care Facilities/Skilled Nursing Facilities/Rehabilitation UnitsIn some cases, you may be discharged to anextended care facility or skilled nursing facility. Weat the Rose Institute for Joint Replacementunderstand that the decision to continue yourrehabilitation in another facility may be difficult andwe are here to help you with this process. Ourgoal is to make this transition a smooth andcomfortable one. The case manager will provideyou with information on available facilities whichwill help meet your requirements.Placement in these facilities will be determined bythe level of care you need, physician orders, bedavailability and payment source. These facilitiesprovide 24 hour per day care for patients. Becausethe time for selecting a facility can be very limited,it is very important that you and your familydiscuss potential choices with the case manager assoon as possible.Your case manager will also help assist you infinding transportation to the facility. Based on yourcare needs, you may be transported by family car,wheelchair van or stretcher ambulance.InsuranceOnly your insurance company can provide youwith specific information on coverage. It isimportant that you contact your insurancecustomer service or benefits representative todetermine your covered benefits and preferredproviders. The case manager can help facilitateaccessing that information for you.

Tips for After DischargeSwelling/BruisingDue to the nature of joint replacement surgery,swelling of part or all of your surgical extremity iscommon because of the normal inflammatoryresponse the body has to the surgery. Most totaljoint patients can expect some amount of bruisingin their surgical extremity and the bruising tends toget worse a few days out from surgery. Somepatients have a lot of swelling and bruising whileothers may have just a little because everyoneresponds differently to the surgery. Both swellingand bruising can travel up and down yourextremity after surgery because of the effect ofgravity. For example, the more you stand up andwalk, the more gravity will pull the bruising andswelling down your leg. When you elevate yourleg, the reverse effect will happen.StiffnessJoint stiffness is also very common with jointreplacements. The joint stiffness will be worsewhen you have been sitting for a prolonged periodof time and when you first get out of bed in themorning. The stiffness improves with movement ofthe joint so avoiding sitting for prolonged periodsof time within the first few weeks after surgerymay be helpful. Some patients will continue to havesome stiffness in their joint for several months aftersurgery.IceIce is a very effective pain reliever so your surgeonmay order a cold therapy unit for you to use aftersurgery. If not, bags of ice or reusable ice packswork just as well to provide pain relief. Please makesure to protect the skin with a washcloth or pieceof clothing because ice directly on the skin cancause frostbite. You should avoid icing right beforeyou do your exercises because it can tighten thetissues you are trying to stretch out. If using bags ofice or ice packs, icing for twenty minutes at a timeis usually adequate. Cold therapy units can be lefton longer because they do not get as cold. Makesure that the hose on the cold therapy unit doesnot sit directly on your skin because frostbite mayoccur.ElevationThe swelling associated with joint replacementsurgery can cause significant pain or discomfortand the most effective way to reduce swelling is byelevating your surgical extremity above your heart.Placing your leg on an ottoman while sitting in achair will not be very effective in reducing yourswelling. The best way to elevate is to lay flat onthe couch or in your bed and place your surgicalextremity on several pillows so that gravity canhelp pull the fluid out of your extremity.ShowerThe majority of total joint patients will have theirfirst shower in the hospital with an occupationaltherapist one to two days after surgery. Mostincisions can get wet in the shower after you aredischarged home from the hospital. In some cases,your surgeon may want your incision to stay dryfor a few days so you should keep your dressingsdry with a plastic bag while in the shower. Look toyour discharge instructions for any specificdirections for showering. You should avoid soakingyour incision in water, like a bathtub or swimmingpool, until your surgeon tells you the incision hashealed well enough.

Medical EquipmentThe medical equipment you may need after surgery can be purchased and in place before you go to thehospital so that your transition is as smooth as possible. HOWEVER, if you wait until after you have thesurgery and begin working with your physical and occupational therapists, you will have theirrecommendations on equipment and a better idea of what you will personally need.Your therapists can order any equipment you need and have it delivered to your hospital room at noadditional charge.Walker. This device offers sturdy, stable support for about six weeks after surgery. Walkers may be rentedor purchased.Crutches. Crutches are made of either wood or aluminum and must be adjusted for proper fit and areslightly more difficult to use than a walker, but they provide swifter movement and ease of maneuvering.Crutches may be rented, purchased or borrowed.Cane. It is possible that at the time of discharge you may be able to ambulate with only the assistance of acane. This is rare and will be recommended by your physical therapist if it is appropriate.Bath or Shower Bench. This bench must be sturdy and fit securely into the tub or shower space of yourhome. The benches come in many styles and prices and may be purchased through a medical supplier orretail store. This bench may also be borrowed.Adaptive Equipment. Your occupational therapist will introduce you to a variety of smaller equipmentduring your hospital stay . You may not require this equipment but you will have the opportunity topractice using it during your therapy sessions.

Intimacy After SurgeryMany find it difficult to enjoy sex before jointreplacement surgery due to pain. Now that yourjoint has been replaced your pain should belessened and with time your range of motionshould improve.TimingSpecial Note for PartnersIf your partner has had a hip replacement:• help your partner not to actively bring theirleg out• do not put all your weight on your partnerships• control the amount and speed of movementduring sex.Your surgeon may want you to wait six to eightweeks before having sex. As a general rule, youmay begin having sex after a total joint replacementwhen you:• feel physically and mentally ready• have a clear understanding of the precautionyou should follow to protect your new joint.With a hip replacement, range of motion andcomfort are the biggest issues. You should avoidputting too much pressure on a new joint and takethe same care getting out of a position as you didgetting into it.In Case Of Severe PainIf you have a sudden onset of groin pain andproblems moving the affected hip, STOP andreposition yourself so you are lying on your back. Ifthe pain still continues, have your partner call yoursurgeon for further instructions.

Risks of Joint ReplacementOver 400,000 patients a year have successful joint replacement surgery. As with any type of surgicalprocedure there are certain risks associated with joint replacement surgery. Though complications are rareand extensive measures are taken to minimize these risks, it is important that you are aware of potentialproblems.InfectionInfection may happen while you are in the hospital or after you go home. Areas in the wound oraround the new joint are at a higher risk. To minimize the risk of infection, you will be given antibioticsbefore and after surgery. The hospital enforces strict infection control policies and procedures in everypatient care area. Your patient care team also ensures that the operating site is sterile, all instrumentshave been sterilized and the number of operating personnel entering and leaving the operating room islimited.Blood ClotsIf your blood moves too slowly it may form clots (lumps of blood). In order to prevent this you may begiven medication, special stockings to wear and instruction on exercises to help prevent this. If you havepain or swelling in your legs after surgery please call your physician. In rare cases blood clots may travelto your lungs causing shortness of breath, chest pain or even shock. Please notify your surgeon if youexperience any of these symptoms.Pain/Stiffness/SwellingAfter surgery you may experience some stiffness and swelling. As you move your new joint and yourmuscles strengthen, this pain will lessen and your flexibility will increase.DislocationIn rare occasions, the ball of the joint may come out of its socket. If this has occurred please notify yoursurgeon immediately so it can be corrected.LooseningIn rare occasions, a new joint may loosen and cause pain. If you feel this has occurred, please notify yoursurgeon as another operation may be required to help re-attach the joint to the bone.Nerve and Blood Vessel DamageIn rare occasions, nerve and blood vessels may be damaged during surgery. If this has occurred it oftenimproves over time and may disappear.Your surgeon will discuss these risks with you and answer any questions you may have. When you havediscussed the operation thoroughly with your surgeon, you will be asked to sign a consent form. Thepurpose of the consent form is to confirm that you understand the risks and complications associated withjoint replacement surgery.

GeneralFrequently Asked QuestionsQ:What is Total Hip Replacement Surgery?A: Your hip joint is composed of two parts: the round head of the femur (the ball) and theacetabulum (the cup or socket in your pelvis). In a normal hip joint these two bones are coatedwith smooth articular cartilage that allows them to move against each other without friction orpain. In an arthritic hip, the cartilage layers are destroyed and bone rubs against bone causing painand limiting motion.Hip replacement surgery replaces your arthritic hip joint with an artificial joint composed of a ballcomponent and a socket component. The metal ball is attached to a stem that fits into your thighbone. This component can be cemented or non-cemented depending on your age and thecondition of your bone. A plastic liner with an outer metal shell is secured into your pelvis. Acombination of a cemented ball and a non-cemented socket also may be used.Q: How long will a joint replacement last?A: The average time length is 15+ years, however with advancing technology the life expectancy forthese implants continues to increase. There are other factors that affect the longevity of your newjoint such as your age, weight, activity level and medical conditions.Q: What types of implants are used to replace my joint?A: Most implants are a combination of metal (to replace the worn bone surface) and polyethylene(to replace the worn cartilage surface). Other options include metal-on-metal, metal-on-ceramicand ceramic-on-ceramic. Many different manufacturers make these implants and your surgeon willdecide on the size, the type of implant and the method used.Q: What are the major risks of joint replacement surgery?A : While risks are low, they do exist with every surgery. The two most serious complications areinfection and blood clots. To avoid these problems, we use antibiotics and blood thinners. We alsotake special precautions in the operating room to reduce the risk of infections.ActivityQ:When can I start driving?A: There are two major considerations before you can start driving: you will need to be able toreact to emergency situations and you must be off your pain medications. Usually most patients areable to meet this criteria after two weeks of surgery, however this should be further discussed withyour physician.

Q:When can I fly?PainA: Since you have undergone major surgery you are at a higher risk for blood clots. You shoulddiscuss this with your surgeon.Q:How much pain will I experience?A: Thanks to advances in medication technology we are able to keep you very comfortable aftersurgery. Any temporary discomfort experienced after surgery does not compare to the painendured by most people for months or years prior to surgery.Blood TransfusionQ:Will I need a blood transfusion?A: A small percentage of people (10-20 percent) may require a transfusion post-operatively. Yourpre-operative blood level, the length of time for the surgery and the difficulty of the operation aresome of the factors that will determine if you need a blood transfusion. Patients who take certainmedications such as aspirin, anti-inflammatory or other blood thinners may lose more blood thanothers. These medications are usually stopped pre-operatively to help prevent this. This will be partof the discussion with your surgeon at your first meeting.AnticoagulationQ:What is this?A: Since you have undergone surgery, you are at a higher risk for blood clots. You will be started ona blood thinner (Coumadin/Warfarin) after surgery for approximately three to four weeks.Coumadin is a highly effective medication which needs to be regulated closely. Your blood will betested to measure how quickly your blood can clot. There are many precautions that you will needto adhere to while taking Coumadin. Please discuss these with your pharmacist or nurse.Dental ConsiderationsQ: Are there any dental precautions?A: Since you will be having major surgery, you will be at a risk for infection. Please do not scheduleany dental appointments including routine cleanings, six weeks before and after your surgery. Pleasediscuss with your surgeon the use of a prophylactic antibiotics for all dental procedures followingyour surgery.

You and Your New HipNow that you had your hip surgery, there are no precautions to follow to prevent dislocation ofyour hip. The best exercise to do is to walk! This booklet will provide information regardingtechniques and recommended adapted equipment, in conjunction with discussion, demonstrationand practice of each of these areas during your occupational and physical therapy sessions. The goalis for you to return to your normal lifestyle as safely and independently as possible.THE BENEFITS OF THE ANTERIOR APPROACH INCLUDE:1) No hip precautions to follow after surgery.2) Less pain after surgery.3) The surgery is performed with fluoroscopic image guidance, which helps to maximizecomponent positioning, and further decrease the risk of dislocation and to maximize equality ofleg lengths.4) Immediately after surgery, the patient can move their hip as they wish, they can flex as much asthey want, they can sit in a chair, on a regular toilet, and they can put full weight on their leg.

Bed TransfersPlease be sure that your bed is firm and not too low. Waterbeds are not recommended.1. Back up to the bed until you feel it with the back of your legs.2. Slide your affected leg forward as you reach back for the bed with both hands and slowly loweryourself to sit on the edge of the bed.3. Turn diagonally so you are facing the end of the bed. Lift your legs on to the bed one at a timewhile pivoting on your bottom.4. Use your arms to scoot back and up onto the bed.5. Do not lie down in the bed until you are positioned correctly. You should be in the middle ofthe bed with both legs on the bed.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Sitting1. Back up to the chair until you feel it with the backs of your knees.2. Reach back for the armrests and lower yourself slowly.3. To stand, scoot forward in the chair. Push yourself up using the armrests. When you have yourbalance, reach for your walking aid (walker/crutches).SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Toilet TransfersYou may need a raised toilet seat or a handicapped height toilet if you have difficult getting on oroff of a standard height toilet. . A specific commode chair and/or other equipment may berecommended by your occupational therapist.1. Back up to the toilet until you feel it with the back of your legs.2. Reach back for the edge of the toilet seat or safety rails and slowly lower yourself.3. To stand up, push up from the seat or safety rails using your arms.4. Be sure you have your balance before reaching for your walking aid.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Tub TransfersUse a tub seat and grab bar if possible or any other equipment recommended by youroccupational therapist. Your occupational therapist will determine which type of bath bench isneeded depending on you and your specific bathroom set-up. You cannot sit on the bottom of thetub. It is recommended to take sliding doors off and replace them with a shower curtain.1. Back up to the tub with your walking aid and make sure you are even with the tub seat. Reachback with one hand for the grab bar and with the other hand for the tub seat, slowly loweryourself to the seat.2. Swing your legs into the tub one at a time.3. Use a long-handled sponge and/or a hand-held shower to bathe your legs, if needed.4. To transfer out of the tub, swing your legs out one at a time. Push up from the tub seat and/orgrab bar.5. Get your balance before reaching for your walking aid.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Shower TransfersUse a shower seat and/or any other adapted equipment recommended by your occupationaltherapist.1. Using your walking aid, back up to the shower until you feel the shower ledge with your heels.2. Step over shower ledge with your unaffected leg first, then bring your affected leg in.3. Reach back for the shower chair with both hands and slowly lower yourself to the chair.4. Pivot on the shower seat towards the faucet. If your shower is too small for this technique,problem-solve alternative techniques/positions with your occupational therapist (i.e., steppingforward into shower with affected leg and crutches).5. Use a long-handled sponge and/or a hand-held shower to wash your legs/feet, if needed.6. Reverse the above process to get out of the shower. Step out of the shower with your affectedleg first.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DressingYou are not required to use adaptive equipment to get dressed, however you will determinewith your occupational therapist if such equipment would make getting dressed easier aftersurgery.Always dress the affected leg first and undress it last. Sit on the edge of the bed or in a firmarmchair for dressing.UNDERWEAR AND PANTS1. Using the reacher, hold the underwear at the waistband and bring it toward your affected leg.Slide the leg hole over your foot pulling it up to your knee. You can also gather the leg of theunderwear up and into the clamp of the reacher in order to better see the opening at thebottom of the underwear. While sitting, pull your underwear up above your knees as far asyou can until you are ready to stand.2. Repeat the same process with your pants bringing them to the same height as your underwear.(This way you only have to stand up once to complete the task.) You can also gather the entirepant leg in the reacher clamp in order to better see the opening at the bottom of the pant leg.3. For safety, have your walking aid in front of you and stand up pushing from the bed/armchairuntil you are balanced. Pull up your underwear and pants over your hips.4. To undress, reverse the process, remembering to remove your clothing from the unaffected legfirst.SOCKS / STOCKINGS1. Slide the sock/stocking onto the sock aid until the toe is flush to the bottom of the sock aid.Be sure the top of the sock is not over the top of the sock aid.2. Holding onto the straps of the sock aid, lower the sock aid to the floor in front of your affectedfoot. Slide your foot into the sock aid and pull on both straps until the sock comes up yourleg. Continue to pull on the straps of the sock aid until the sock aide comes completely out ofthe sock. Unhook the sock aid from your leg.3. Put your other sock on the unaffected leg by either bringing your foot up to you or using thesock aid.4. To take off your sock/stockings, hook the end of the dressing stick, reacher, or long-handledshoehorn at the top of your sock and slide it down your leg, over the back of your heel and offyour foot.

5. If your sock falls on the floor, you may pick it up with your reacher or dressing stick.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ShoesSlip-on shoes are generally recommended. If you prefer shoes that lace up, your occupationaltherapist can show you how to use elastic shoelaces.1. Slide the toes of the affected leg into your shoe. Position a long-handled shoe horn in the backof your shoe and slide your heel down the shoe horn into the shoe. This may be easier tocomplete when standing as opposed to sitting.2. Be sure not to turn your leg inward as you do this.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Home Making Tips1. Use a walker apron or plastic bag attached to your walker to transport items within yourhome. You can also spread a folded towel over the top of the walker to carry light objects.2. Carry liquids in containers with lids or covers (e.g., thermos, unopened cans of soda, waterbottles).3. Slide items along counter tops whenever possible rather than trying to carry them.4. Use a reacher to pick up items dropped on the floor or to retrieve items from low areas (e.g.,the crisper in the refrigerator, low dresser drawers).5. Sit on a high stool whenever possible (e.g., at a kitchen counter for meal preparation, a worktable).6. Remove all throw rugs in your home to avoid catching your walking aid or foot and possiblytripping or falling.7. Use a long-handled brush to clean the toilet and tub.8. Use long-handled implements (mop, broom, dust pan and feather duster) for cleaning.9. For laundry, use a pushcart or shoulder bag to transport clothing to/from your washer anddryer. You can also have friends or family assist.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vehicle Transfers1. You will need to get into the front passenger seat of the vehicle.2. Position the seat as far back as possible from the dashboard and in a semi-reclined position ifpossible.3. Back up to the vehicle as you would a chair, until you feel the seat behind your legs.4. Lower yourself to the seat, holding on to a stable surface (i.e., the back of the seat, dashboard,or if possible, lower the front and back windows and hold onto the frame between thewindows).5. Slide your bottom back on the seat as far as you can.6. Swing your legs into the vehicle one at a time. Remember when going towards your affectedside, use a leg lifter or have assistance to get your leg into/out of the car.7. You can move the seat up from the reclined position as you ride.8. To get out of the vehicle reverse the above process..

Adaptive Bending TechniquesWhen reaching for low or dropped items, hold onto something that is secure.1. With one hand hold onto a counter or table.2. Kick back your affected leg as you bend forward and reach down with your free hand. Keepthe toe of your affected leg on the ground for balance and your knee straight.3. Once you have picked up the item, stand back up and regain your balance.

Use of an Assistive Device forWalkingYour physical therapist will prescribe an assistive device for you while you are in the hospital andat home. Walkers and crutches are the most common equipment used. On rare occasionspatients are able to walk with only the assistance of a cane.If you already own a walker, crutches or cane, you may bring it to the hospital for the therapistto adjust for you. It is best to have your family bring it in the day after your surgery. If you wouldrather leave your equipment at home, you may borrow our equipment while in the hospital.If you DO NOT already own a walker, crutches or cane, they can be purchased or rented. Yourphysical therapist can provide information for you to obtain the equipment or the therapist canorder the equipment for you. Equipment ordered by your physical therapist will be delivered toyour hospital room at no additional charge. Walkers and crutches can be billed to your insuranceand may be paid for depending on your policy.Your physical therapist will train you on how to use your assistive device for walking and for goingup and down stairs.

Stair ClimbingGoing UP ONE STEP with a WALKER:1. Approach the step with your walker or crutches.2. Step into your walker, close to the step.3. Place your walker up onto the step.4. Step up onto the step with your unaffected leg.5. Step up onto the step with your affected leg.

Going DOWN ONE STEP with a WALKER:1. Walk to the edge of the step with your walker.2. Step into your walker.3. Place your walker off the step and onto the ground.4. Step down onto the ground with your affected leg.5. Step down with your unaffected leg.

Going UP ONE STEP with CRUTCHES:1. Approach the step with your crutches, one under each arm.2. Step up onto the first step with your unaffected leg.3. Bring your affected leg onto the step.4. Bring your crutches onto the step.Going DOWN ONE STEP with CRUTCHES:1. Approach the top of the step with one crutch under each arm.2. Lower the crutches down.3. Step down with your affected leg.4. Step down with your unaffected leg.

Going UP A FLIGHT OF STAIRS with CRUTCHES and a RAILING:1. Approach the stairs with your crutches.2. Hold onto the rail with your closest hand and place the crutches under the opposite arm.3. You can either place both crutches under one arm or place one upright and the otherperpendicular to it (as shown below). Your physical therapist will help you determine whichmethod is easiest for you.4. Step up onto the first step with your unaffected leg.5. Step up onto the step with your affected leg.6. Bring your crutches up onto the step.7. Continue this sequence until you reach the top of the stairs.

Going DOWN A FLIGHT OF STAIRS with CRUTCHES and a RAILING:1. Hold onto the rail with your closest hand and place the crutches on the other side.2. Lower the crutches onto the first step.3. Step down with your affected leg.4. Step down with your unaffected leg.5. Continue this sequence until you reach the bottom of the stairs.

Going UP A FLIGHT OF STAIRS with CRUTCHES without a railing:1. Approach the stairs with your crutches, one under each arm.2. Step up onto the first step with your unaffected leg.3. Bring your affected leg onto the step.4. Bring your crutches onto the step.5. Continue this sequence until you reach the top of the stairs

Going DOWN A FLIGHT OF STAIRS with CRUTCHES without a railing:1. Approach the top of the stairs with one crutch under each arm.2. Lower the crutches down onto the first step.3. Step down onto the step with your affected leg.4. Step down onto the step with your unaffected leg.5. Continue this sequence until you reach the bottom of the stairs.

Home Exercise ProgramCongratulations on successfully completing your hip replacement surgery.You have invested much time and energy into your rehabilitation and now need to continue yourefforts to further improve the strength in your new hip. Walking is a crucial part of yourrehabilitation. It is important to walk as much as you can around your home. On nice weatherdays it is encouraged to walk outside with your assistive device and a companion. Remember tojudge your distances and save energy for your return trip. Take a cell phone as a precaution.The following exercises will increase your strength and flexibility. Your physical therapist willprovide instructions on these exercises while you are at the hospital. Upon discharge from thehospital, you should perform these exercises 3 times a day, starting with 10 repetitions andworking up to 20 repetitions each. It is important to remember to breathe steadily throughoutall your exercises.

Isometric ExercisesQUAD SETS1. While lying on your back, straighten your involved leg as much as possible, tightening themuscles on the top of your thigh.2. Hold for 5 seconds and relax.3. Repeat ____ times.HAMSTRING SETS1. While lying on your back, keep one leg straight and bend the other to a height ofapproximately 6 inches.2. Tighten the bent leg by digging down and back with the heel.3. Hold for 5 seconds and relax.4. Repeat _____ times.

GLUT SETS1. Lie on your back and keep both legs straight.2. Squeeze your buttocks together as tightly as possible.3. Hold for 5 seconds and relax.4. Repeat ______ times.

Strengthening ExercisesHEEL SLIDES1. Bend your knee, sliding your heel toward your buttocks.2. Slowly lower your leg.3. Repeat ____ times.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SHORT ARC KNEE EXTENSION1. Lie on your back.2. On your operative side, place a large coffee can or rolled up blanket under your knee.3. With your thigh resting on the can, lift your heel off the bed and straighten your knee as muchas possible.4. Pause, and then lower your heel.5. Repeat ____ times.SPECIFIC RECOMMENDATIONS FOR YOU:____________________________________________________________________________________________________________________________________________________________BRIDGING1. Bend both knees up and put your feet flat on the bed.2. Squeeze and lift your buttocks off the bed.3. Lower your buttocks back down to the bed.4. Repeat ____ times.SPECIFIC RECOMMENDATIONS FOR YOU:____________________________________________________________________________________________________________________________________________________________

SEATED KNEE EXTENSION1. Sit in a chair with your feet on the floor.2. Slowly kick the affected leg out front and try to straighten the knee as much as possible.3. Repeat ____ times.SPECIFIC RECOMMENDATIONS FOR YOU:____________________________________________________________________________________________________________________________________________________________STANDING HIP FLEXION (Marching)

Standing Exercises1. Bend your knee up toward your chest while keeping your trunk straight.2. Lower the leg slowly.3. Repeat _____times.SPECIFIC RECOMMENDATIONS FOR YOU:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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