Total Hip Replacement

Pre and post-operative patient guide

What is a Total Hip Replacement?
Total Hip Replacements are performed for people who have severe
osteoarthritis that is making daily activities difficult and is no longer
responding to other treatments.
A Total Hip Replacement involves the surgical removal and replacement of
the damaged femoral head and acetabulum of the hip joint with a
prosthetic implant. Total Hip Replacements can be performed through
different surgical approaches based on the decision of the Orthopaedic
Surgeon. Depending on the type of surgical approach, different wound
areas and post-operative precautions will apply.
All joint replacements are major, planned 1-2 hour surgeries requiring
admission to hospital, anaesthesia and post-operative hospital recovery.
The recovery process begins immediately post-operation and is guided by
Medical, Nursing and Allied Health Teams to help people improve their
function and ability to participate in daily activities.

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Hip precautions
Following surgery, the muscles and soft tissues around the hip are weaker and
unable to stabilise the hip as usual. Because of this, there are recommended hip
precautions post-operatively to limit certain movements and positions that
increase the risk of hip joint damage and dislocation. Different hip precautions
will apply based on the surgical approach taken. The Orthopaedic team will
provide advice on how long to follow the recommended hip precautions.

Anterior approach
Not all surgeons recommend the same precautions for an anterior approach.
The Physiotherapist will clarify the correct hip precautions on Day 1.

Do not excessively rotate leg Do not lift leg straight up in the air
inwards or outwards

Do not force leg backwards

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Hip precautions
Posterior approach

Do not bend hip past 90 degrees

Activities that may place the hip past 90 degrees include: reaching towards the
ground, picking things up, and sitting on low surfaces.

Do not cross legs whilst sitting, lying or standing

Do not excessively rotate leg inwards or outwards

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Patient journey
The order and attendance of appointments and services may vary depending on
scheduling and individual patient circumstances.

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Checklists (please tick off completion steps)
Pre-admission
Attend Pre-Admission Clinic
Attend Education Class
Community Home Visit
Implement Home Visit recommendations
Organise any recommended equipment
Attend Pre-Admission Check
Stock fridge and prepare meals for return home
Organise for family or friends to pick-up and assist on discharge

What to bring
Usual mobility aid with name marked (if applicable)
All current medications
Toiletries
Well fitting, closed in shoes
Loose fitting clothes
Hearing aids & glasses
This patient guide

Typical Mobility Aid

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Personal and practical considerations
When preparing for surgery it is important to plan ahead to reduce any
anxiety or impact during the recovery process. Considerations include:

Managing financial impacts

• Sick Leave & Superannuation Income Protection: For further information
on eligibility contract the HR or Payroll of your employment.
• WorkCover QLD: If the surgery performed is related to a workplace
injury, work cover may apply. To confirm eligibility contact WorkCover
on 1300 362 128, or visit www.worksafe.qld.gov.au
• Centrelink Sickness Allowance: To confirm eligibility, contact Centrelink
on 132 717 or visit www.humanservices.gov.au

Community care arrangements

If assistance with domestic tasks such as meal preparation, cleaning,
transport or personal care will be required on return home, it is important to
organise support from family, friends and/or community services.
For information on accessing aged care services (aged 65 and over), call
My Aged Care on 1800 200 422 or visit www.myagedcare.gov.au

Carers
For patients who are carers for someone at home, it is important to make
arrangements prior to hospital admission. If emergency respite care is
required, call the Commonwealth Respite and Carelink Centre on 1800
052 222, or 1800 059 059 outside of business hours.

Advanced Care Planning

For persons of all ages it is important to consider appointing and
completing an Enduring Power of Attorney (EPOA) and/or an Advanced
Health Directive (AHD). For further information contact the Public Trust on
1300 360 044, visit http://www.pt.qld.gov.au, or contact your Solicitor.

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Pain management
Nerve block
Nerve blocks involve using a local anaesthetic agent to numb the targeted
area. The affected leg may feel numb after surgery, but feeling will return
quickly as the block wears off. It is important to ask for pain relief as the
block starts to wear off. Staff should be informed if the numbness remains.

Patient-Controlled Analgesia (PCA)

A PCA is a device that contains strong pain medication. By pushing the
button that is attached to the device, pain medication is delivered directly
into the bloodstream. A PCA allows for patients to control their own pain
relief. The device has inbuilt safety mechanisms to prevent overdoses.

Oral pain relief

Oral analgesics (tablets, capsules or liquid) will usually be provided post-
operatively to assist with pain relief. In addition to analgesics like
Paracetamol and anti-inflammatory medications, patients can also request
stronger, short-acting pain tablets that can take up to 30-minutes to start
working. It is advisable to take pain medications prior to commencing
mobility and exercise. Long-acting pain tablets may also be prescribed for
a short period of time following surgery.

Side effects
Some pain medication can cause side effects such as nausea, vomiting,
itchiness, drowsiness and constipation. Patients are asked to report any
side effects they are experiencing to nursing staff.

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Day zero
After the operation, patients are transported to the Orthopaedic or Surgical
ward. It is common post-operatively to have multiple attachments on the
body, such as: oxygen nasal prongs, blood pressure cuffs, intravenous
drips and in-dwelling catheters.

Deep breathing and circulation exercises

Post-operatively it is very important to reduce the risk of developing blood
clots by performing deep breathing & circulation exercises every hour.

Ankle pumps Static contractions

Move feet up and down Tense thigh and bottom muscles for a
short duration and release slowly

Deep breathing
With or without the Incentive Spirometer, breathe slowly
and deeply into bottom of lungs, relax and exhale out slowly

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Day 0
Mobilise with Physiotherapist (if requested by surgeon)

Day 1
Mobilise with Physiotherapist
Perform prescribed exercises
Occupational Therapist review
Have a shower
Sit out in armchair

Continue to ensure pain relief is adequate, and that self-directed exercises

are performed as instructed by the Physiotherapist.

Day 2 and 3
Progress mobility with Physiotherapist
Stairs Assessment (if required)
Perform prescribed exercises
Occupational Therapist review (if not performed Day 1)
Sit out in armchair

Continue to perform self-directed exercises and mobilise as instructed by

the Physiotherapist.

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Physiotherapy exercises
Perform exercises as instructed by the Physiotherapist to promote the
recovery of strength and movement following your joint replacement.

Hip abduction/adduction Heel slide

Lying flat, lift and move your leg out Lying flat, slide your heel
to the side and then back towards your bottom

Inner range quad Bridge

Keep knee resting on towel roll, Push through feet to lift
lift foot to straighten your knee hips off bed

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Advanced exercises
Perform these more advanced standing exercises only when instructed or
advised by the Physiotherapist. All standing exercises should be performed
safely whilst holding onto a supportive surface.

Hip abduction
Lift leg out to the side,
and then back slowly

Hip flexion
Lift knee upwards, and
lower back down slowly

Hip extension
Keeping body straight, lift leg
backwards and bring back slowly

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Advanced exercises
Perform these more advanced standing exercises only when instructed or
advised by the Physiotherapist. All standing exercises should be performed
safely whilst holding onto a supportive surface.

Heel raise
Stand onto tip-toes

Mini-squat
Slowly bend both knees and
stick bottom out

Sit to stand
Lean forwards, push through
both heels to stand up

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Discharge checklist
Able to mobilise safely with mobility aid
Able to negotiate stairs safely (if applicable)
Able to get in and out of bed
Performing exercise program independently
Home services organised to assist with self-cares (if required)
Essential home equipment organised
Recommended mobility aid purchased/hired (except crutches)
Community Physiotherapy referral organised

Most patients are ready to safely return home after 2-4 days to commence
the next phase of their recovery process.

Bathroom aid

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Post discharge
Pain management
Patients may be prescribed medications upon discharge from hospital to
assist with pain relief. It is important that patients understand what
medications have been prescribed and how to take them – ward
Pharmacists can provide further information in this area.
Patients should continue to ensure pain is well controlled to allow
completion of everyday activities, Physiotherapy exercises and regular
walking. As pain levels improve, the usage of pain medication should be
reduced accordingly. Patients are encouraged to see their GP for ongoing
pain management.

Swelling management
It is important to continue managing swelling following discharge.
Excessive swelling will delay healing, result in more pain, limit the
completion of exercises and could result in wound problems. The amount
of post-operative swelling varies greatly between individuals, so it is
important for patients not to compare themselves to others.
Some swelling is expected but large amounts that involve the whole leg
may indicate that more rest is required. Resting is ideally performed lying
flat in bed and can be assisted by applying ice packs for up to 20 minutes
at a time. It is not uncommon to require a rest in bed between meals.
Concerns with swelling following discharge should be discussed with a GP.

Physiotherapy exercises
It is very important to continue performing the exercises prescribed by the
hospital Physiotherapist regularly, to promote the recovery of strength and
movement. On discharge, patients will be referred to Community
Physiotherapy and will be contacted by telephone (usually within a
fortnight) for ongoing follow-up as required.

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Managing daily activities
Sitting
Avoid low chairs and chairs without arms. When
sitting down or standing up, grasp chair arms and
keep operated leg in front.

Getting into bed

1. Sit down on the bed bottom first
2. Slide bottom backwards into the bed
3. Pivot and lift legs carefully onto the bed
4. Reverse the procedure to get out of bed
Assistance or equipment may be required to
complete this task.

Getting into a car

1. Ensure the front passenger seat is adjusted to provide enough space
2. Holding the door frame, sit down on seat facing away from the car
3. Slide bottom backwards in direction of the driver’s seat
4. Leaning back, swivel legs into car without crossing legs
5. Reverse the procedure to get out of the car

Tip: A plastic bag on the seat may assist with swinging legs into the car.
A firm cushion can be used to raise the seat height.
For personal safety and insurance purposes, it is extremely important to
gain medical clearance prior to returning to driving.

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Getting dressed
Patients will be provided with and educated on the use of a long handled
shoehorn and dressing stick during their hospital admission.
To dress the lower body:
1. Sit on a chair or the edge of a bed with clothes nearby
2. Dress the operated leg first. Use the hook on the dressing stick to slide
pants over the feet and above the knees. At this stage, the pants may
be pulled up by hand.

Showering and toileting

Patients may require equipment such as an over toilet frame and shower
chair to ensure safety and compliance with hip precautions. Patients
should store toiletries up high to prevent the need for bending. Strategies
and equipment can be discussed with the Occupational Therapist.

Picking items up from the floor

Long handled reaching aids or BBQ tongs may be useful to
retrieve items safely without bending past 90 degrees.

Sexual activity
Sexual activity may be recommenced once the wound is well
healed. Adopt positions that protect the hip and maintain all
recommended hip precautions.

Returning to work
It is important that patients and their employers understand what work
tasks will be safe on returning to the workplace. Returning to work should
be discussed with the surgeon and the GP. It is best to ease back to
normal work activities after receiving advice from a medical professional.

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Contact Us
Gold Coast University Hospital
1 Hospital Boulevard,
Southport, QLD 4215
Ph: 1300 744 284

Robina Hospital
2 Bayberry Lane,
Robina, QLD 4226
Ph: (07) 5668 6000

Helensvale Community Health Centre

105 Lindfield Drive,
Helensvale, QLD 4212
Ph: (07) 5580 7800

Robina Health Precinct

2 Campus Crescent,
Robina, QLD 4226
Ph: 1300 668 936