Preparing for Surgery

Be prepared.  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 |

HOME MODIFICATIONS 

Prepare 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. 

In 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 CHAIRS 

I 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.   

The 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. 

Besides 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. 

You 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.   

Sitting 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.) 

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 

Getting 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.   

Place 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.   

Getting 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.

Well 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 

Because 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. 

Getting 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. 

Another 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 

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 

Cooking 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.  

You 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. 

This 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.   

PERSONAL HYGIENE 

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 

When you are sent directly home instead of to a rehabilitation center, you are usually assigned home health care:  visiting nurses and home physical therapy. 

I 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.   

In 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 the surgery. 

MISCELLANEOUS SUGGESTIONS 

Change 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. 

Don’t 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. 

Immediately 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.)  

I 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. 

You’ll 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.   

The 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. 

I 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.

At 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 elastic shoelaces. 

Unless 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 completely healed.