Hip Surgery

The Hip

The hip is a ball-and-socket joint. Muscles, cartilage and ligaments surrounding the joint allow it to move smoothly and painlessly.

In the case of a problem hip, like those of osteoarthritis or rheumatoid arthritis, the cartilage becomes worn out and can no longer serve its purpose as a cushion. Hence, when these bones rub against each other, you will experience excruciating pain and stiffness.

On the other hand, if you have sustained a fall and fractured your hip bone, you may need to fix it. Your surgeon can replace that problem hip with an artificial hip (prosthesis). With a new hip, you will be able to regain most of your independence and become active again.

Hip Surgery

An incision is made over the affected hip. All or parts of the joint surfaces are resurfaced with manmade materials. The implant (prosthesis) type may vary according to your needs but the most common implant consists of two components.

The femoral part has a stem that extends into a canal in your thigh bone. Depending on your condition, the femoral component may be secured by bone cement.

The acetabular component is placed inside your socket and consists of high-density polyethylene, which may be backed with a metal cup. This component may be fixed with or without cement.

You will be admitted to hospital either a day before the surgery, or on the day of the surgery. If you have additional medical problems, admission may even be earlier.

Bowel Preparation

You may be instructed to take some medications to help you clear your bowels. Please seek assistance if you need to visit the toilet.

No Smoking

We strongly discourage smoking one week prior to surgery and especially on the night before the surgery. Smoking makes it difficult for you to clear your secretions after surgery, and may impede your recovery.

Exercise

A physiotherapist may also visit you to teach you some simple positioning and log rolling in bed preoperatively. She may also teach you breathing exercises and limb exercise that you may be required to perform before and after the surgery.

No Food Consumption

You must not consume any food, not even water, after midnight. This is to prevent any vomiting and subsequent inhaling of the vomitus into the lung during surgery, which could be life-threatening. Get a Good Night’s Rest Have a good night’s sleep before your operation. Do let your doctor or nurse know if you require some medication to help you to sleep. Personal Items & Valuables We advise that you leave all your valuables and personal items at home, and to keep not more than ten dollars with you during your stay in the hospital.

Day of surgery

Before you go for your operation

It is advisable for you to take a good shower, brush your teeth and rinse your mouth. You should refrain from drinking anything on the morning of your surgery. However, if you have to take medication for your medical problem, the nurse will advise you to take it with sips of water.

Shortly before the estimated time of your operation, the nurse will inform you to do the following:

• Empty your bladder
• Remove any dentures, spectacles and contact lenses, make-up, nail polish, hairpiece, jewellery and prosthesis
• Change into a gown
  

Please inform your nurse if you have any personal items requiring safekeeping.

Pre-medication

You may be given medication in the form of tablets or an injection to help you relax. This medication will make you sleepy, or cause dryness in your mouth.

You should not attempt to get out of bed after taking the medication. Our nurse or health attendant will transfer you to the operating theatre on a trolley.

Family Room

Your family members could either return to the ward or wait in the waiting area just outside the operating theatre. Please advise them not to wait along the corridor.

In the Operating Theatre

Once you have arrived at the operating theatre, the nurse there will verify and confirm your identify and also the type of surgery you are scheduled for.

After verification, you will be transferred to another trolley and wheeled into the induction room to meet the anaesthetist and the surgeon.

The anaesthetist will give you an injection to put you in a deep sleep, so that you will not feel any pain. The operation is done under general or epidural anaesthesia.

Recovery Room

After your operation, you will be taken directly to the recovery room. Your blood pressure, breathing and heart rate will be checked frequently.

Please inform the nurse if you are feeling nauseous or experiencing any pain, so that medication could be given to relieve your discomfort.

You may also be put on Patient-Controlled Analgesia (PCA) to help you control you pain. Your anaesthetist would explain to you before the surgery on the use of the patient demand button. Alternatively, you may be put on an epidural catheter for pain control.

When you are awake and your blood pressure and pulse have stabilised, you will be transferred to the ward’s High Dependency Room.

Nursing Care

In the High Dependency Room, the nurse will check your blood pressure and pulse closely for the first 24 hours. In addition, she will inspect the bandage on your hip and also check the colour, warmth, movement and sensation of your leg, heel and foot. Humidified oxygen may be given by mask to assist you in breathing and to loosen secretions in your lungs.

As you are required to rest in bed, we advise that only two visitors at one time can be with you during the visiting hours. When your condition is stable, you will be moved to the general ward.

Relief of Post-Surgery Discomfort

Some level of discomfort is to be expected after the surgery. Whilst you are in bed, your legs may be supported by a special abduction pillow. This is used to keep your hip in neutral position to prevent you from crossing your legs. However, if you find the abduction pillow uncomfortable, please inform your nurse.

It is important that you do not try to twist or turn in bed without your nurses’ help. This is because your new hip can potentially dislocate if it is in the wrong position.

You will be given medications in the form of injection or tablets to relieve any pain, as well as to help you recover from the surgery.

Diet

You will be served a light beverage like ovaltine or milk when you have recovered from the effects of the anaesthesia. An intravenous drip will be inserted into your hand or arm. This will be removed once you are drinking adequate amount of fluid and are no longer feeling nauseated. Subsequently, you can have some light food. When your appetite returns to normal, solid food will be served.

Wound Care

Your wound will be covered with a dressing, which will be changed to a lighter and more comfortable one within 48 hours. The wound dressing will be changed if it is soaked with blood or serous fluid from the incision wound.

You will have one or two drainage tubes inserted near your wound. These tubes drain the excess fluid away to prevent swelling and bruising around your hip. They are connected to drainage bottles hooked onto your bed and are removed when instructed by the surgeon.

As your wound heals, you may experience unusual sensations such as tingling, numbness or itching, which are all normal. The stitches or clips on your wound will be removed between 10 to 14 days after the surgery.

Pressure Sore Prevention

While you are confined in bed, it is very important to relieve the pressure from your buttock regularly to prevent it from becoming sore. Your nurse will help you to change position until you are able to do so yourself.

You will find a “patient helper’ attached above the bed. You can use it to lift yourself up. The nurse will show you how to use it properly.

Personal Hygiene

For the first few days when you are confined to bed, washing will take place in bed.

You will be able to have your shower once you are allowed out of bed. The nurse will assist you initially until you are confident to do it yourself.

Elimination Needs

A combination of changes in your diet, reduced activities and medications may result in a change in your usual bowel habits.

As your diet and mobility improve, your bowel actions will gradually return to normal. You should increase the amount of fibre intake in your diet, by eating more fruits, vegetables or cereals that will help to ease constipation.

You may experience some difficulties in passing urine. Should this happen, please inform the nurses and they will try to help you void normally. If this fails, the nurse or doctor may insert a urinary catheter to drain the urine from the bladder. The catheter will be removed once you are well enough to attend to your own toilet needs.

Rehabilitation

Your physiotherapist will work out a light hip exercise programme with you. You will be assisted to start walking, usually with the aid of a walking frame, when you are well enough. This normally takes place a few days after surgery. You may progress onto using a crutch if necessary.

Your exercise programme will include going to the gym once a day. In the evening and on weekends, you are encouraged to do the exercises on your own, or ask your nurse for assistance. You will also practise walking up and down the stairs before you are discharged for home.

The occupational therapist will also teach you ways to modify your activities of daily living, and provide you with some helpful tips on home safety.

Length of Stay

The average length of stay for patients undergoing hip surgery is between 10 to 14 days. However, the length of stay may vary with each individual.

Discharge Instructions

The following discharge information will help you to take care of yourself during your recuperation at home.

Activity

• Continue with the exercise regime as taught by the physiotherapist, especially straight leg raising and walking exercises.
• Use walking aids until further instructions from the doctor.
• Avoid any activity that will cause stress to your hip joint e.g. excessive bending, twisting and lifting of heavy objects.

Diet

• There are no restrictions on your diet unless prescribed.
• Control your weight, as extra weight will stress the hip joint.

Medication

• Take medication as prescribed.

Wound Care

• Keep your dressing clean and dry.
• Your appointment for removal of stitches will be given to you upon discharge.

Special Instructions

• Take special precautions to prevent dislocating your hip joint.
• Avoid sitting on a low chair.
• Keep your knees apart and do not cross legs when seated.
• Be seated when getting dressed.
• Avoid using long baths and squatting toilets.
• Use a pillow between your legs when sleeping on your side for at least 3 months.
• You may install handrails by the toilet to assist you in your movements.
• You may use a bar-type stool for showering and kitchen work.
• Use helping hands or tongs to pick items up from the floor.

When to consult the doctor

Seek medical consultation with your family doctor or at the Polyclinic if any one of the following conditions occurs:

• Swelling or redness at the operated site.
• Any other abnormal and/or prolonged symptoms which cause concern.

Follow Up Appointment

You will be given an outpatient appointment for a routine check up with your surgeon. You may also be given a letter to your general practitioner informing him/her of your treatment, if necessary.