Surgical Instructions
TOTAL HIP REPLACEMENT
Your Implants
We may use the MAKO robotic hip replacement platform to perform your surgery. It allows us to accurately plan the position of your implants. The implants used are made by Stryker. They have a long clinical history of success. They are either fixed to your bone using bone cement, or are designed to grow into your bone over a period of several weeks. The decision for this is based on your bone quality at the time of surgery. The components are made of titanium, ceramic and polytheylene.
What to Expect
The Day Before Your Surgery
You will get a phone call from the hospital to verify your surgery and time of arrival to the hospital. They will discuss with you bathing with a special soap to decrease the likelihood of bacterial contamination of your surgical site at the time of surgery. They will also confirm which medications you should and should not take the night before and morning of surgery. You should not eat any food or drink any liquid, except for sips for your medication, after midnight.
The Day Of Your Surgery
You will arrive to the hospital a couple of hours prior to your surgery time. You will be checked in by the nursing team who will have you change into a gown, go over your medical history, check your medications and verify your surgery. You will then meet the anesthesiologist who will then discuss with you the plan for anesthesia, any planned nerve block procedures used to decrease pain. These typically include administration of spinal anesthesia, which is administration of medication into the spinal cord much like an epidural used during child birth, and administration of medicine into the nerves around the hip to decrease the pain you feel after surgery. You will finally meet me to verify your knee is clean without any wounds, you are feeling well and understand the plan. I will also mark your limb to verify the site of surgery. Most patients go home the same day, however you may stay overnight and go home the next day.
Post-Operative Instructions
Dressings
Your wound will be covered with a waterproof dressing. It is ok to shower after surgery. It is important to keep your dressing on, do not remove the dressing. It will be removed for you at your first post-operative visit. If your dressing becomes saturated with blood or fluid, call the office to let us know so we may assess the wound. Underneath the dressing you have a removable dressing that is designed to stay on for 4 weeks. You may peel this dressing off 4 weeks after surgery. If it begins to peel off on its own, you may remove it early.
Pain
It is normal to experience pain after surgery. Twenty four hours after your surgery, it is very common to experience increasing pain after the nerve block performed by the anesthesia team has begun to wear off. You should begin taking your pain medication the evening of your surgery to ensure you have an easier transition when the nerve block wears off.
These are the medications you have been prescribed for pain:
Diclofenac
This medication is an NSAID, it is not a narcotic. It is very effective in controlling pain and the associated swelling from surgery. It is important to take this medication to reduce the swelling and to decrease the amount of narcotics that are necessary to control your pain. NSAIDs can cause stomach ulcers, so please take this with food. If you are on a blood thinning medication, you may not take NSAIDs. Also, if you have chronic kidney disease, you may not take NSAIDs.
Instructions: Take this medication twice daily (morning and night), take this with food. If you experience any stomach discomfort, stop this medication and call the office.
Hydrocodone
This medication is a narcotic pain medication. It is effective at controlling pain, however it does have side effects such as drowsiness, nausea, constipation and can be addictive. It is important to take this medication with food, and to ensure you are taking a stool softener to ensure regular bowel movements.
Instructions: Take 1-2 tablets every 4 hours as needed for pain. Take with food.
Constipation
It is normal to have some degree of constipation after surgery, this is a side effect of the anesthesia and the pain medications. It is important to stay regular by taking a bulk fiber supplement such as Metamucil, drinking plenty of water and home remedies such as prune juice. You may also take supplements such as milk of magnesia as needed. If your constipation is unresolving, you may try an over the counter suppository.
This medication has been prescribed for constipation:
Docusate
This medication is a stool softener.
Instructions: Take 1 tablet every day for constipation.
Nausea
Nausea can be common after surgery due to the effects of anesthesia, and as a side effect of the narcotic pain medication. It is important to stay hydrated during the recovery process, please ensure you are drinking plenty of water. You have been prescribed the following medication for nausea:
Ondansetron
This is an anti-nausea medication that blocks the receptors in your body that cause nausea. It is placed under the tongue and is designed to dissolve and absorb into your body.
Instructions: Take one tablet sublingually every 8 hours for nausea.
Swelling
Swelling is quite common after surgery.
It is very typical for the limb to swell due to the inflammatory response associated with surgery and the disruption of the blood flow due to the incision. It can take several months for all the swelling to go down after surgery. Things that can help early on are staying active, walking and taking the anti-inflammatory medication.
Blood Clot Prevention
Joint replacement surgery puts you at risk for developing a blood clot after surgery that has the potential to travel to your lungs. It is important to stay active and walk after surgery to prevent a blood clot. If you have increased swelling in the leg, calf pain, or fever it is important to call the office to discuss your symptoms with our team.
If you are currently taking a blood thinner, we will typically place you back on this same medication however decrease the dose for a short period of time. Otherwise, the following medication has been prescribed for you:
Aspirin
Aspirin is an NSAID that also inhibits platelet aggregation, which is why we use it to prevent blood clots. While this medication does have some pain relief effect, it’s primary use for you is to prevent a blood clot. Because it is an NSAID, it is important to take with food.
Instructions: Take 1 tablet by mouth twice daily (morning and night) to prevent a blood clot.
Physical Therapy
Physical therapy is crucial after hip replacement surgery.
Physical therapy is crucial after hip replacement surgery. Physical therapy after hip replacement surgery is designed to improve your gait, reinforce hip precautions and ensure you are walking safely. Unless otherwise stated, you are allowed to bear full weight on the leg after surgery, you may need a walker for the first few weeks to ensure you are safe and do not fall. You will follow anterior hip precautions taught to you by the therapist for the first 6 weeks.
Restrictions
After surgery, you are not allowed to submerge your leg in tubs or pools until your surgical incision is fully healed into a scar. For right hip replacements, you are not allowed to drive until 4 weeks, for left hip replacements 2 weeks. You should also not drive while you are taking narcotic pain medication. Long term, there are no specific activity restrictions for your hip.
Follow Up Appointments
You will be seen at 2 and 6 weeks post operatively
We will get x-rays to ensure the implants are in an appropriate position, and check your wound to ensure proper healing. We will also check your limb for any signs of blood clot, and ensure you are achieving your range of motion goals. Long term, we will follow you on an annual basis to ensure the components maintain their position and there are no signs of implant failure.
