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Preparing for Surgery
That’s the Boy Scout motto, but it’s also good advice for
anyone planning hip replacement or hip surface replacement surgery.
What follows here is some practical advice for preparing yourself
and your home for the ordeal you are about to undergo, and it is
applicable to either type of surgery. I developed it from a series of emails I sent to others who
asked for advice or tips on how to prepare for surgery. This information was formulated from what I had done and what
I wished I had done prior to my own surgery.
It is written from the perspective of someone who lives alone and
had to depend mostly on himself during the recovery process.
| Home Modifications | Crutches, Walkers & Chairs | Traveling in Cars | Other Tools of the Trade | Sleeping | Cooking & Eating | Personal Hygiene | Home Health Care | Miscellaneous Suggestions |
your home for your return from the hospital.
That means making everything reachable.
It may also mean putting grab rails by the toilet and in the
shower. A shower stall is preferable because a tub is difficult and
dangerous to get into, but it can be done.
If you must climb into a tub to shower--you will not be able to
sit in a tub and soak--purchase a railing support that attaches to the
tub to aid you when stepping into it.
Also purchase a shower stool whether you intend to use a tub or
shower stall. (Standing on
one leg is too tiring, and it can be dangerous in a wet tub or shower.)
You can’t shower for two weeks until you get your staples out,
but it is possible to lean into the shower to wash your hair and rinse
off our upper torso. You
need grab bars in the shower to accomplish this feat.
addition to grab rails in the bathroom, you’ll need handrails along
any stairs you must climb. You
will be going up and down the stairs using one crutch and the handrail.
Stairs are not very difficult, so don’t be intimidated by them.
Even in my most weakened condition, I could climb the stairs
without any difficulty or pain.
CRUTCHES, WALKERS, AND
had two walkers in the house: one for upstairs and one for downstairs.
If you are alone, you’ll want to use a walker.
Crutches are too easily dropped, and you can find yourself
standing alone with two crutches on the floor and no way to pick them
up. Before the surgery,
practice going through your house on crutches.
It will seem easy, but everything changes when the pain variable
is introduced. Also,
practice walking with the walker to see where it will fit and where it
will not. It might require
that you rearrange your furniture.
You won’t be able to move the furniture after the surgery, so
do it beforehand.
therapist at the hospital gave me a nice set of aluminum crutches that
were very light. I also had two sets of wooden crutches that I kept at
strategic places around the house.
I once accidentally dropped the one crutch down the stairs after
I went upstairs, but luckily I had one of the spare sets of wooden
crutches at the top of the stairs.
practicing with crutches before surgery, also practice walking with one
crutch and a cane. I had
never used crutches or a cane before so I didn't realize that you use
the crutch/cane on the opposite side from your bad leg.
Also, if you purchase a wooden cane and have to cut it to size,
here's how you determine the correct length.
Stand with you hand at your side beside the cane.
The top of the cane should come to the crease in your wrist.
cannot sit on anything less than 19 inches high, and you cannot sit on
couches or chairs into which you sink.
You will also need a chair with arms.
You will not be allowed to lean forward, so to get off a chair,
you must straighten your back as you slide to the edge.
With your good leg cocked back underneath you and your bad leg
out in front, you push yourself straight up using your arms on the chair
armrests, and you lift yourself using your good leg.
down just reverses the process. Back
up until you feel the chair on the back of your legs.
Reach back to the armrests while you lower yourself with your
good leg as your bad leg slides out in front of you.
You never allow your torso and the thigh of your bad leg bend
less than 90 degrees. That
is why you can never lurch forward with your body to get up off a chair.
You should practice getting on and off a chair in this manner
before your surgery so it becomes an automatic series of movements for
you. If chairs in your home
are too low, you can try sitting on pillows.
(Some people put their chairs on wooden platforms or pallets to
raise them higher, but if you do that, make sure they are secure and
stable.) I found a recliner to be the perfect solution.
It allowed me to sleep during the day without having to struggle
back to bed.
(Be sure to get a recliner that has a hand lever on the side and not one
that requires body motion to make the chair recline. You should
also avoid ones that rock and glide because you need stability and
support when getting on and off the recliner.)
(Be sure to get a recliner that has a hand lever on the side and not one that requires body motion to make the chair recline. You should also avoid ones that rock and glide because you need stability and support when getting on and off the recliner.)
You climb stairs with one crutch. To do so, you place the one crutch on the side opposite the hand rail--either side will work. You use a combination of the crutch and hand rail to support the bad leg. Remember: good leg up, bad leg down. Step up with the good leg, and bring the bad leg and crutch up to meet the good leg on the same step. Step down with the bad leg and crutch, and bring the good leg down to meet them on the same step.
TRAVELING IN CARS
in and out of a car is similar to sitting in a chair, but it is more
difficult and quite painful if you have to do it three days after
surgery when you leave the hospital.
If you are relatively young and strong you will be sent directly
home and not to a rehabilitation center after three to four days.
Even if you don’t practice sitting on a chair, I’d advise
that you practice getting in and out of a car.
Whoever picks you up at the hospital should bring two pillows and
a garbage bag. The pillows make the seat higher, and the garbage bag makes
it easier to swing around once you’re seated.
one or two pillows on the seat with the garbage bag on top.
Have someone slide the seat all the way back and partially
recline it. You then back
up to the open car door until you feel it against your legs.
Hand your crutches to someone.
Place one hand on the dashboard and one hand on the headrest of
the seat. Lower yourself
onto the seat using your good leg (with your bad leg extended out in
front of you) and your head bend down but your body NOT bent forward.
Recline back on the seat as your slowly bring your legs around
and into the car. This is
easier said than done. You’ll
have to bring your knee up to get the leg into the car, and that is why
your recline back--so you don’t break the 90 degree rule with the hip.
your legs up into the car will be extremely difficult and painful right
after surgery. Those with
you will try to help you by trying to move or lift your leg for you.
You will be yelling at them not to do it, but when you cry out in
pain, they will usually stop. You
might need their help to actually raise and move the leg, but direct
them every step of the way. They
don’t really understand your movement restrictions (i.e. 90 degree
rule, not allowing the leg to cross the center line of your body, etc.)
so you must tell them exactly how and when to move it.
This is difficult because you are in a lot of pain at that point.
That is why you want to practice this beforehand.
Getting out of the car just reverses the whole process except that it might hurt a little more when you contend with gravity pulling your leg to the ground. Gravity doesn’t stop when you scream at it or cry out in pain. As time passes, you no longer have to contend with the pain, but getting into and out of a car still remains difficult for a few months.
before you undergo surgery, you should apply for a handicap parking
placard from your state's Department of Transportation. That way
it will be available to you when you start driving after a few months
and for others who will be transporting you before you start
driving. You will come to really appreciate those handicap parking
spots after your surgery.
OTHER TOOLS OF THE TRADE
of the movement restrictions, you need a “reacher” to pick up
things. Actually, I think
you need two: one to pick up things and one to pick up the main reacher
when you drop it. It’s
amazing what you can do with those things.
They also are real handing in helping you dress.
During my recovery, I had three reachers: one upstairs and two
downstairs. (You might want
to take your reacher to the hospital because they don't provide one, and
nurse's aids are notorious for placing things outside your reach.)
You also need a raised toilet seat on every toilet you use. At the hospital, they gave me one, but I also had several in my house from when my father lived with me. For a joke, someone bought me the “Clapper”—clap on, clap off—and this turned out to be a real convenient tool. I needed light to get into bed at night, and the Clapper allowed me to then turn out the lights.
in an out of bed in the beginning is a real chore because of that whole
gravity thing again. It
always wants to pull the leg in a way that really hurts.
To make getting in and out of bed easier, try sliding onto the
bed using a garbage bag. I
entered the bed from the bottom corner and slid up.
For a while I even attached a rope to the headboard so I could
pull myself up. At the hospital they gave me a “leg leash” that enabled
me to lasso the leg and move it while getting into bed. A lot of blankets made it difficult to move, so I turned up
the heat in my house and used only a sheet and a light blanket.
necessary piece of equipment is a good portable phone with a clip to
attach it to your belt. I
always carried it with me in case I’d fall and have to call for help.
Also, I didn’t move too fast with the walker, and I never
seemed able to catch the phone in time.
Sleeping is difficult and uncomfortable for a long time. Since it’s necessary to sleep on your back, your lower back tends to start hurting after awhile. Deep in my subconscious I knew not to move at night, so I remained almost motionless each night after the surgery. This led to lower back spasms after several hours and caused me to rise early each day. Because of the lower back discomfort, I couldn’t lie in a bed during the day, but a recliner in my living room didn’t bother my back and it allowed me recline and get some additional sleep. (I wholeheartedly recommend a recliner. If you don’t have one, purchase one or rent one for your recovery.) The bed in the hospital never bothered my back, but that could be because the hospital bed would incline. You actually need to sleep at night flat in the bed so the hip will heal properly and allow you to stand straight.
While recovering from my revision surgery, I began using one of those large pillows with the arms that allow you to sit up in bed. I had it around the house during my first recovery, but I never thought to use it. It proved helpful in alleviating some of my back discomfort. When I'd awaken in the middle of the night because my back was hurting, I'd pull the pillow in behind me and sit up slightly. I'd usually then fall asleep again in the inclined position. When I'd awaken again in a few hours, I'd pull the pillow out, lie flat, and sleep that way for the remainder of the night.
COOKING AND EATING
dinner is a chore. You
don’t realize how much you must move around the kitchen when cooking.
The girls who work with me made a lot of food and froze it, so I
only needed to defrost and reheat the dinners.
I enjoyed making breakfast, but I just hated cooking and eating
dinner. I did it only
because I needed the sustenance. The
day of the surgery I was 160 pounds.
A few days after I returned home I weighed myself and I was 145
pounds. The healing process really burns up the calories.
Not a very nice way to lose weight however.
can’t carry things when you are using two crutches or a walker.
(If you attach a bag to your walker, you can carry certain things
however.) You especially
can’t carry plates. Therefore,
wherever you prepare your meals, it is at that location you will be
eating them. I ate most of my meals on the kitchen counter by the stove
and sink because I could not move the plates to the kitchen table.
I couldn’t sit on the kitchen table chair anyway—too low and
no arms. What I sat on was
a medium sized bar-type stool. (I
placed a small pillow on it to make it more comfortable.)
Once you are able to use one crutch, you can begin eating
wherever you want.
really doesn’t have to do with eating, but it results from it.
At the hospital, they will be giving you stool softeners (Colace)
so you won't be straining when you have bowel movements.
You'll probably want to continue taking this after you come home
for at least a month, so you should buy about 20 boxes of Colace before
the surgery to have on hand. The
medicines you take will make you constipated, and you're going to need and
want this stuff.
I knew I wouldn’t be able to bend over and pick things off the ground for a while; therefore, I looked for “soap-on-a-rope” before surgery. I wasn’t able to find any. I complained about it after I was home from the surgery, and a friend of my asked why I hadn’t just taken a regular bar of soap and drilled a hole in it to make my own. Why hadn’t I thought of that? So that’s something to consider. Also, I’d advise that you trim your toenails on the foot of your operative leg the morning of the surgery. You won’t be able to reach that foot for months after the surgery. Also, you might want to purchase a long handled sponge; that is, if you want to be able to wash below your knees.
HOME HEALTH CARE
you are sent directly home instead of to a rehabilitation center, you
are usually assigned home health care:
visiting nurses and home physical therapy.
was only allowed to put 25% weight on my leg for eight weeks, so there
was not a lot the therapist could do for me other than teach me some
stretching exercises. She
did show me how to determine if I was placing too much weight on the
leg. To do that yourself,
take 25% of your body weight and then place your leg on a scale to see
what pressure you can put on it to reach that amount.
That was the first thing the therapist did when she came to my
house. She visited only
three times because all I could do was stretching exercises until I
could put 100% weight on the leg. After
that, the real therapy started.
addition to the physical therapist, visiting nurses came three times a
week to look at the incision and to test my blood for the Coumadin.
They only come for as long as the Coumadin is prescribed.
Since they don’t come everyday, you’ll want to have someone
at the hospital show you how to change your own dressing. Besides the incision, there is a drainage hole where the
drainage tube was attached. It
continues to drain for about a week, so you’ll have to change the
dressing daily. (If you
sleep on the plastic bag, you won’t have to worry about the dressing
leaking and ruining your mattress.)
They gave me some surgical dressings and tape at the hospital
(5X9 inch Surgipads for the incision, 4X4 inch Post-Op Sponges for the
drainage hole), but I had to send someone to the drug store for more.
It was a visiting nurse who took my staples out two weeks after
all the ceiling light bulbs in your house.
You won't be able to get to them after the surgery, and I
guarantee they are going to start burning out.
You're going to want a lot of light, and you'll be leaving a lot
of the lights on in your home, so have plenty of spare light bulbs.
look at films or photographs of the surgical procedure beforehand.
They’re too scary, and they may make you change your mind about
having the procedure done. I’ve
already had the surgery, and the pictures scare me now.
However, they are good to view afterwards because they make you
realize why you hurt so much and why it takes so long to recover.
after the surgery, you will be placed on a liquid diet.
You will stay on that diet until you start experiencing gas. Don't be embarrassed, and tell the nurse when you experience
it. Sometimes they don't
tell you about this, but it is a sign they look for because it tells
them that your intestines are working again.
Once you experience gas, it means you can have solid food again,
and this usually occurs by the second day.
Of course, I think this only applies if you have general
anesthesia like I had. (I
told them I wouldn't have the surgery without general anesthesia, but
that didn't matter because my doctor preferred it.
He's learned that the patients are more relaxed that way.
I think it has something to do with all the power equipment that
is used during the surgery.)
put a trashcan on my porch just outside of the front door.
I also moved my recycling bin there.
That way I had only a short distance to go to put out the trash. In my town, we purchase city trash bags that we then put out
on the curb weekly for pick up. On
those days, I was able to pull the trash bag out of the can and tie it.
I then left it on the porch. My
neighbor would usually see it and take it to the curb for me, or I’d
ask someone who was visiting to do it on his or her way out.
also need to have a table next to the recliner or wherever you intend to
park yourself during your recovery.
It should be easily reached from the chair and big enough to hold
most of your world that will eventually find its way there.
I had so much of my stuff surrounding me that I looked like a
homeless guy with his shopping cart.
house will get cluttered and dirty.
Eventually, when you are able to move around more, you’re going
to want to clean up a bit. Make
sure the vacuum cleaner has already been moved to the floor where it
will be need. Also, if it
is sitting out and visible, sometimes visitors will volunteer to run it
around the house once or twice.
mentioned something about attaching a bag to the walker to carry things.
I also had a light nylon backpack that I would wear to carry
things up and down the stairs with me.
I’d only come down the stairs one time in the morning and go up
the stairs one time at night, so I wanted to be able to carry everything
I needed for the day or night in that one trip.
the hospital I purchased a “sock cone” which is really slick, and it
allowed me to put on my socks without bending over.
I was really surprise how well it works.
They gave me--though I was supposed to purchase it--a long
handled shoehorn that also proved handy.
They didn’t have any left while I was there, but they sell
I was going out in public, I wore sweatpants and a T-shirt.
Usually I just wore some deck shoes that I could slip into. (I also purchased tennis shoes with Velcro straps because I
couldn’t reach my shoes to tie them--of course, it was also an ordeal
trying to fasten the Velcro straps using long handled pliers or my other
foot and the end of the crutch.) Sweatpants
are nice and soft against the incision, but regular clothes are a little
abrasive. When I dressed to
go out, I wore loose fitting pants, usually the khaki pants I wore to
work. Jeans were too tight
against the incision. As
for underwear, I wore boxer shorts.
I would not advise wearing briefs until the incision is