Your journey
1. Pre-op Assessment
The information you completed in your initial health screening questionnaire will be reviewed and any changes in your health status can be documented.
At this appointment your fitness for surgery will be assessed. You may have the following tests; ECG, urine sample, MRSA screen, blood tests and x-ray. You may be referred on for further tests.
You will also receive information on the operation, the anaesthetic and advice on your medications (when to stop certain medications before your surgery). You will be given advice on carbohydrate drinks to take before your operation.
If there are any issues, the pre-op nurse may contact you again. You may be asked to attend again to see an anaesthetist.
You will be asked to return to the Blood Room no more than 5 days prior to your operation for blood samples to be taken. This is explained further in the letter given to you by the pre-op nurse. Failure to attend may result in cancellation of your surgery. Please keep this letter safe as no reminder letter will be sent.
2. Preparing for your surgery
Hip Class
The scheduling team will invite you to attend the Hip Class prior to your operation. Please contact the scheduling team if you have not received this invite 2 weeks prior to your surgery.
This is a multi-disciplinary led class which will prepare you for surgery and your safe discharge home. You will have the opportunity to meet the team (Physiotherapist, Occupational Therapist & Social Worker) and to discuss any concerns you may have. Any equipment needs you may have will also be organised.
It is important that you attend this class as this will make your post-operative recovery and discharge home much easier.
Exercising and Activity Pre-Operatively
It is important that you try to be as active and fit as possible before undergoing your total hip replacement surgery. This will aid your recovery and hopefully make you feel stronger and more confident with your rehabilitation. This will include regular walking, activity and exercise. We will provide you with a list of exercises that you will be required to do post-operatively. However, it would be advisable and beneficial that you do these prior to your surgery. It is important to understand that although you may be in pain prior to your surgery and find exercising difficult, it is not harmful for you to exercise.
Travel Pre-Operatively
Travel is not recommended for 4 weeks prior to undergoing hip replacement surgery.
Personal Planning Pre-Operatively
It is very important that you begin to plan for your discharge home following your surgery, before your admission.
This may involve having family and friends readily available to assist you at home, having furniture appropriately arranged, and other such measures to make things easier for you on returning home.
It is important that you have support mechanisms in place, such as family and friends or more formal structures, to aid your recovery.
It is also advisable that you speak with your employer and make plans for appropriate time off work following your surgery.
3. Admission & Day of Surgery
You will be given a date and time for your admission. Most are admitted the morning of surgery but some are admitted the evening before surgery. On arrival to the hospital, you are asked to register your arrival at the front reception in the Emergency Department before coming to the ward.
Please bring all your medications with you to the hospital.
A nurse will check all your pre-op information is correct. If there have been any changes to your health or medications, please inform the nurse.
You will be measured for your anti-embolism stockings (TEDS).
You will meet your consultant again who will answer any questions you may have.
Your consent for the operation will be gained and you will be asked to sign a form.
You will meet the anaesthetist who will discuss the type of anaesthetic to be used during your surgery.
You may also have the opportunity to meet the multidisciplinary team (Physiotherapist, OT, SW) if you did not attend the pre-op hip class.
Discharge arrangements will be discussed and your expected day of discharge planned.
4. In the Operating Theatre
The anaesthetist will use equipment to measure your heart rate, blood pressure and the oxygen level in your blood.
A needle is used to put a thin soft plastic tube (a cannula) into a vein in the back of your hand or arm. Drugs and fluids can be given through this cannula. If needles worry you, please tell your anaesthetist. A needle cannot usually be avoided, but there are things he/she can do to help.
You will be carefully positioned on the operating table by the surgical team. Props will be used which will hold you safely and securely in place allowing the surgery to occur.
An anaesthetist will stay with you for the whole operation and watch your condition very closely, adjusting the anaesthetic as required. If you are awake or having sedation, the anaesthetist and the theatre team will stay right beside you and make sure you are relaxed and comfortable.
You can bring in your own music to listen to during the operation via CD, iPod, mobile phone or other formats if appropriate.
The operation usually takes about 2 hours. This includes the time required for the anaesthetic. After your operation you will spend time being closely monitored in Recovery. When you are stable enough, you will return to the ward. This is generally after 1-2 hours.
5. Recovery after your Operation
After you return to the ward, you will continue to be monitored closely by the nursing staff. You may have an oxygen mask in place, leads to a monitor, fluids running through a drip and compression pumps on your legs. Most people do not require a catheter.
You will have the opportunity to freshen up and have something light to eat.
If you feel well enough, the Physiotherapist may see you later on that day and get you up and out of bed for the first time. However, some patients may have to stay in bed until the following day.
It is important to start to move again as soon as possible after your surgery. This helps to reduce stiffness in the new joint and starts to build up muscle strength again. There are also well known benefits of early mobility, which include a reduction in the chance of developing complications such as blood clots and chest infections.
Early mobility promotes an early recovery and discharge home.
You will be able to start your post-op deep breathing exercises as described below:
Breathe in through your nose slowly and deeply. Pause and hold breath for 1-2 seconds. Breathe out fully through your mouth. Do 3-4 breaths in a row and then repeat this hourly.
After the operation it is important to make sure any pain you may have is well controlled. There are different types of pain killers and local anaesthetics used to manage any pain you may have. Your anaesthetist can discuss the best method of pain relief for you. Regular pain relief allows you to mobilise as soon as possible after your operation.
Please inform the nursing staff if you are in pain.
Day 1 Onwards
In the morning, you will have the opportunity to get washed / showered and clothes changed.
We recommend that whilst on the ward following your surgery, you wear your own daytime clothes (not your pyjamas). This can facilitate return to your normal daily routine and can help to aid your recovery. We also encourage you to sit out regularly during the day and for meal times, as again this can help your overall recovery.
The nursing staff will continue to monitor your progress.
You will be seen by the Physiotherapist, who will review your exercises and assess your mobility. Initially most people will use a zimmer frame to walk. If you are able, you will then progress to walking with elbow crutches.
The Occupational Therapist will assess your ability to carry out your activities of daily living and advise you on the safest ways of doing these.
You will have a check x-ray of your new joint and also blood tests taken.
The Pain Nurse will also visit you on the ward to ensure any pain you may have is controlled.
Discharge arrangements will begin – for example, ensuring any equipment you may require is in place; if you will need any help at home etc.
Over the next 1-2 days, your rehab will continue on the ward. You will become more independent with your mobility and your personal care tasks.
You will be reviewed regularly by the physiotherapist to progress your exercises and mobility.
Most people will be able to walk with elbow crutches and be able to go up and down a flight of stairs (if appropriate) safely before going home.
You may be reviewed again by the occupational therapist to ensure you can carry out your everyday tasks.
The social worker may also visit you, if this is required.
6. Discharge home from Hospital
Most people will be ready for discharge home by Day 2 after their operation.
The team will recommend when you are fit for discharge – this is usually when you have recovered medically from your operation eg. your blood levels are satisfactory and when you are safe and independently mobile with your crutches.
If you require further support or follow-up on discharge, this can be organised by the social worker & multi-disciplinary team. (See Social Work Team section)
For example, you may be referred to a discharge scheme such as Intermediate Care, Discharge to Assess or Re-ablement or you may require community social services to help you in the short term when you go home.
This is individually assessed and each patient’s personal circumstances considered. It is also based on the multidisciplinary team’s recommendations.
Very occasionally patients may require a longer time in hospital to recover after their hip replacement surgery. If this is the case, you may be transferred to another site for continuing rehabilitation.
On discharge, you will be given a letter to take to your GP.
You will be seen by the Ward Pharmacist who will explain any changes in your medications. The ward will provide you with a short supply of any new medications you require.