You're in great hands with Dr. Rogerson and Orthoteam
Dr. Rogerson and his team are with you every step of your total hip replacement procedure. Here is an outline of how your THR procedure and recovery will proceed.
Ask about your medications
Ask Dr. Rogerson's PA at your pre-op discussion whether or not you should take your routine prescription medications the morning of your surgery.
If deemed necessary, we will begin instruction on your exercise program prior to the surgery. We will also give an overview of the rehabilitation process after surgery. This will better prepare you for postoperative care.
Loose-fitting clothing is recommended. Please bring the following three pieces of information with you to the hospital: 1) Insurance, 2) A list of all your medications and dosages, and 3) a list of all your drug allergies.
Evening Before Surgery
Do not eat or drink after midnight the night before surgery. You may also be asked to take some of your routine prescription medications with only a small sip of water.
You will check in at patient registration in Stoughton Hospital.
Your vital signs, such as blood pressure and temperature, will be measured.
A clean hospital gown will be provided.
All jewelry, dentures, contact lenses, and nail polish must be removed.
An IV will be started to give you fluids and medication during and after the procedure.
Dr. Rogerson or a team member will meet you before your surgery just to say “Hi” and to answer your last minute questions. Dr. Rogerson will also initial the correct surgical hip.
Your hip will be scrubbed and shaved in preparation for surgery.
An anesthesiologist will discuss the type of anesthesia that will be used during your surgery.
Most patients will be allowed and encouraged to get out of bed the afternoon of surgery or the next morning. The increased activity in the upright position of sitting encourages the lungs to expand fully and helps eliminate any fever. You may be given an incentive spirometer device to help expand your lungs every 2 hours during the day if indicated.
On the first postoperative day, you will begin the important rehabilitation process. The success of this program depends greatly on the cooperation and enthusiasm of the patient. The goals of therapy are to increase hip range of motion, increase strength in the hip and thigh muscles, learning to walk with crutches and become independent with daily activities such as climbing stairs and using the bathroom.
The muscle strengthening exercises include attempts to tighten the thigh muscle (quad sets), as well as tighten your gluteal muscles (glute sets), and then lifting your leg off the bed with the knee straight (straight leg raise). These exercises should eventually be done in sets of 10, at least 6 to 10 times daily, if possible.
Your nurses, therapists, and doctor can help you with these exercises. Don’t be discouraged. It takes most patients several days before they are able to independently lift the operative leg off the bed. Physical therapists will instruct you and assist you in walking with crutches or walker. The therapist will also direct you as to how much weight you can put on the operative leg. Most patients start with a walker and then progress to crutches. By the time you are discharged from the hospital, you should be able to walk with the walker or crutches without assistance. You should also be able to handle a few stairs. Your therapist will work with you at least twice daily on these activities.
Several other important points about your hospital stay should be noted. Following major lower extremity surgery, there is a risk of blood clots forming in the leg. To minimize the risk of this occurrence, most patients are placed on oral blood thinners and also placed in special sequential compression stockings that continually assist in externally pumping the blood through the legs while in the hospital, as well as thigh high compression stockings for three weeks following the surgery.
The oral blood thinner is usually continued for 3 weeks after surgery followed by one bay aspirin (81mg) per day for an additional 4 weeks depending on your risk factors.
Thigh high elastic stockings (TED hose) are also used to minimize risks of blood clots and control swelling in the lower leg and foot. If possible, we like these stockings worn during the day but they may be removed at night for comfort for a total of 3 weeks following your surgery.
A sub-cuticular stitch reinforced with Prineo tape and Dermabond is used for skin closure. This tape should be left in place for 2-3 weeks post-op and then peeled off as it starts to loosen.
It is important for several weeks following total hip replacement surgery that care be taken to keep from dislocating the hip prosthesis. For six weeks following surgery, the patient should not bend at the hip past a 90° position. A pillow may need to be placed in a soft chair to add support so that bending does not pass 90°. For at least six-eight weeks following surgery, the patient should not cross his or her legs. It is important that the hip is not internally rotated while in a flexed position. The abduction splint or a pillow should be placed between the legs while sleeping for the first 6 weeks after the time of surgery.
Most patients are discharged from the hospital either directly home or to a short term rehab facility 3-4 days after surgery. To go home, we expect you to be able to walk independently with crutches (or walker), get in and out of a chair or bed and to lift your leg with the knee extended straight. The following instructions are intended to make your return home as comfortable as possible. Please read them carefully and ask either my Physician Assistants or myself if you have any further questions.
We encourage you to be as active as possible. You should not spend much time in bed other than at night to sleep. You should walk several times daily. These walks are by far the most important exercise you can do. As your recovery progresses, you should be able to walk longer distances and with less fatigue. Be careful not to push yourself too hard, too quickly. Conversely, remember not to sit for extended periods of time, as this tends to retard the venous drainage from your leg. It is better to get up and move around, walking every 30 to 45 minutes. Exercise as noted previously. Walking is the most important exercise. You should also continue to do straight leg raises. Try to lift your leg with the knee straight and hold it up for 10 seconds (do this 10 repetitions, 6 to 10 times a day).
You may begin to shower as soon as you return home. Bathing in a tub is difficult and should be avoided for the first two months.
Usually the incision does not require any special care at home. If the incision becomes excessively swollen, red or begins to drain, you should call us. It is not unusual for the thigh and hip to remain swollen and feel warm for several months after surgery.
Elastic Stockings (TEDS)
Please continue to wear the elastic stockings while you are awake for the first 3 weeks after discharge.
Your first return examination in our office will occur after about 2 weeks for a wound check with one of the Physician Assistants. This appointment time and date will be included in your hospital discharge paperwork. If you are unsure of this appointment time please call our office during the normal office hours to verify. (608-231-3410).
We do not recommend that you drive a car until after your first office appointment after surgery or until you can walk well without crutches.
It is reasonable to travel by car or plane soon after leaving the hospital, however you will need a pillow under your buttocks so that you do not sink down and flex the hip greater than 90°. When traveling long distances, you will be more comfortable if you stop and walk a little every hour. Standard airport security metal detectors are generally set off by these artificial joints. Let the TSA agent know you have a total hip and request to go through a body scanner if available.
Most patients still require the use of pain medication for a period of time following discharge from the hospital. We will provide a prescription for an appropriate medication. In addition, you should resume any other medication you were taking prior to hospitalization unless otherwise instructed by a physician.
Dental or Urologic Care
If you require dental work (including regular cleaning) or any urologic evaluation after surgery, you should take a short course of antibiotics. Many of the bacteria in the mouth are susceptible to Penicillin. There may be a number that are resistant, so at the present time I am utilizing Amoxicillin 500 mg 4 tablets 1 hour prior to dental work. If the patient is allergic to Penicillin, Clindamycin 600 mg orally 1 hour prior to dental work would be substituted.
It is extremely important after total joint replacement to be very careful regarding infections. There have been reports of infections elsewhere in the body that have shed bacteria into the blood stream which then infect the joint replacement, even years after the initial procedure. Therefore, it is imperative after a total joint replacement that infections are treated aggressively. This includes pneumonias, bronchitis, urinary tract infection or external skin sores that may become infected. The usual sore throat associated with some nasal drainage is frequently a viral infection and of no major concern. However, if you develop marked sore throat or fever, suggestive of a strep throat, you should see your family doctor immediately to be tested for strep throat and placed on antibiotics if your culture is positive. In general, if you have questions as to whether or not you may have an infection that should be treated, please call my office so that we can discuss this with you.
Don’t forget that you have a new hip but it is not a completely normal hip. Your healing pattern will be somewhat cyclical. It is common for you to feel very good for several days, overdo it and then have the leg swell or stiffen up slightly. This will improve and go through a number of cycles until you are finally healed. Don’t look at your progress on a day by day basis, but more on a week to week basis. Don’t get too excited or depressed by the cyclical variations.
If you find when you go home that there is something new or different that you have a question about, please feel free to contact me. I am concerned about you as a person as well as a patient and would be happy to answer any questions that you may have.
Good luck with your new hip!
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of the bursa.
The hip is a "ball-and-socket" joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.