Total Hip Replacement: A Personal Perspective

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Chapter IV. Things to Do Before Surgery

Depending on how soon your surgery appointment is, either you will have plenty of time to prepare or you will have to condense the myriad little details into a very short period. It helps to have others you can rely on to help accomplish some of the things in which you do not have to be personally involved. Taking a little time to sit down, making a list of the tasks, and scheduling them is a good idea. Try to get the most important and taxing things out of the way early so that issues of lesser importance do not bog you down. While many of the preparatory steps you take will be specific to your case, in this chapter I will discuss several universally applicable measures.

Hospital pre-op education programs

In my reading, I had learned that the extent and quality of pre-operation education provided to patients ranged from nothing at all to multi-session courses. While I felt that I was fairly well versed in the particulars of the surgery, as well as the preparation for and recovery from the operation, I would still take advantage of any opportunities to amass additional knowledge of the subject.

Unfortunately, the hospital at which the surgery was to be performed was a two-hour drive from home. Furthermore, to my knowledge, they did not offer pre-operation education. I was beginning to feel as if I would skip this step when I stumbled across the solution. In the process of searching for rehab facilities, I found that one large, local healthcare organization offered an in-home consultation with a physical therapist. The consultation would cover familiarization with the operation and subsequent hospitalization, rehabilitation, and occupational therapy. The therapist would also perform a walk-through of the house to identify problem areas and help solve them. This sounded like a very valuable service and, what’s more, it was free!* How often can you get something for nothing in these days of bottom-line orientation in healthcare?

Home visits by physical therapists

The idea of a visit to my house by a physical therapist tranined and experienced in hip replacements was appealing. I quickly decided to take advantage of this service. I spoke with the therapist, Bruce, to schedule an in-home appointment. He advised me that it would be best if I did this at least two to three weeks in advance of the surgery so that I would have ample time to address needs that became apparent during his visit. Bruce had a busy schedule for the remaining three weeks before my surgery date, but he was able to commit to an appointment approximately two weeks in advance of my operation.

Bruce arrived at the appointed hour with a veritable plethora of gadgets, appliances, aids, and whatnot for show and tell. I grabbed some crutches, canes, walkers, grabbers, and stuff that I had either bought or been given, in order for Bruce to evaluate them for my use during my recovery. He asked me to take him to someplace where we could talk comfortably. We went to the living room and got right down to business.

The first thing was, of course, paperwork. Fortunately, this was relatively painless. The service was free, but I still needed to sign some forms whose purpose was to hold the hospital harmless for any consequential damage and account for Bruce’s on-site time.

Bruce asked me a number of questions about the operation, so as to tailor his presentation to the particular materials and techniques that would be used  in my operation. In your consultation with your surgeon, you should have received most of this information. For example, you will know whether the prosthesis will be cemented or cementless and you will know the composition of the joint. The one question Bruce asked that threw me a curve was the surgical approach: anterior or posterior. My self-preparation in this area was deficient. I did not know. A call to the surgeon’s office got me my answer: posterior. Bruce also asked what the bending restriction would be, knowing that each surgeon seems to have a different requirement. In my case, the restriction was to bend the joint no more than 70 degrees for the first two weeks and no more than 90 degrees thereafter. I was impressed that Bruce was able to tailor his presentation to take into account the vagaries of the particular surgeon.

He took me through what to expect on the day of the operation. With minor deviations, due to procedural differences between the hospitals involved, Bruce turned out to be right on the money. He told me that I would wake up in the recovery room with a large, wedge-shaped abduction pillow strapped between my legs, and that I would be wearing compression stockings to help keep down swelling and prevent blood clots in the deep veins of the legs. These accoutrements would become my bedtime companions for at least six weeks. I would have to sleep on my back with that big, bulky abduction pillow strapped in between my legs. Naturally, Bruce had brought along an abduction pillow for show and tell.

I expressed my concern that I had never found it easy to sleep on my back. In fact, I was a stomach sleeper. I would not be able to roll over onto my stomach because of the potential for dislocating the new joint in the process. This, of course, was the reason for using the abduction pillow. Bruce told me that I would get used to sleeping on my back. Of course, I did not believe him. However, he was right. After the first three or four days, it would turn out that I could sleep like a baby.

Next, it was practicing how I would be getting around after the surgery. My surgeon had not told me how much weight I would be able to bear with the operated leg during the first few weeks after surgery, so Bruce assumed it would be no weight at all. (It turned out to be 20-40 pounds, which is next to nothing.) The first exercise was getting out of the chair I was sitting in, for which I had to use my upper body and my good leg. Then Bruce showed me how to use a walker, which I practiced for a few minutes. We looked at several other chairs for potential use during recovery. Using the approved, post-surgery technique, I got into and out of them with varying degrees of difficulty. The most interesting chair was the big, leather LaZBoy recliner in the family room. It would almost suffice as-is, but Bruce recommended that I build a platform to elevate it by six inches or so to make it a bit easier to mount and dismount. I would eventually implement his recommendation, which would serve me well during my extended convalescence.

We visited the kitchen, where Bruce told me the occupational therapists at the rehab would show me how to organize things to avoid bending, stretching, and retracing steps.

My house has a stairway. This would be the toughest part of my hampered locomotion. Bruce acquainted me with one technique for going up and down, using a crutch in one hand and the stair rail in the other. I would learn other techniques in the rehab. If I would not be able to conquer the stairs, it would be necessary to rent a hospital bed for the first floor, so that I could sleep there. Being a stubborn person, I knew it would not happen that way. I would use my whole house and that would be that. Therefore, I struggled up the stairs. Later, I would learn other ways to accomplish the same thing.

Upstairs, Bruce looked at my bed, and pronounced it fit for rehab duty. It has a new, thick mattress, making it quite high, which makes it easier to get into and out of without violating any bending restrictions. In the bathroom, he advised me that I would have to get a 3-in-1 commode chair to provide a toilet of sufficient height. He also told me to get rid of the throw rugs, as they represented tripping hazards. Looking at the walk-in shower, Bruce recommended that I remove the glass doors and put up a shower curtain instead. This would enable me to step in forward instead of sideways. I would not need to install grab bars if I purchased a shower chair with high handholds.

A walk down to the other end of the long hall brought us to my office. Bruce gave me the go-ahead to sit in my office chair and work at my desk—but no leaning forward, which would violate the 90-degree limit.

We struggled back down the stairs (I had to do the one crutch thing again). One last thing Bruce wanted to walk me through was getting into and out of cars. Using my personal automobile, he showed me that by moving the passenger seat all the way back and lowering the back of the seat as far as it would go it was relatively easy to get into the car without violating any bending restrictions. This was to prove to be invaluable later on, obviating the need for non-emergency medical transport for my trip from the hospital to the rehab and for my trip from the rehab to home.

We were done, and I was still absorbing all the good information, for which I thanked Bruce. Even if I had been required to pay a couple of hundred dollars for his visit, I would have received much more than my money’s worth. I have been talking up Bruce’s services to medical practitioners and patients ever since. A program this good deserves to be better known.

Shape yourself up

If you are overweight, you should seriously consider shedding some of the excess weight. I realize that exercising might be difficult at this point. Your hip pain might well deter you from doing much heavy exercising that would promote weight loss. Watching your diet and doing whatever exercising you can is better than doing nothing at all. You can certainly do aerobic exercises with your upper body. I did, even though I have arthritic shoulders. In addition, you can perform many good exercises in the swimming pool. Consult your local chapter of The Arthritis Foundation for a water exercise program in your area. When you lose weight and increase your conditioning level, you will be facilitating both your surgery and your recovery.

Even if you are not overweight, it makes sense to increase your aerobic endurance and your upper body strength. You will be using your arms, your shoulders, and your abdominal and chest muscles to support your body weight during your convalescence with a walker or crutches. Believe me, this is very fatiguing, particularly for larger people. The better conditioned you are, the easier it will be to get around after surgery.

One other thing you can do in this area is start doing the exercises that you will be doing after surgery. If you are fortunate enough to have had a visit by a physical therapist as I described above, he or she probably will have briefed you about these exercises and perhaps will have given you a pictorial instruction sheet. If not, you can find many of the exercises in the three books I recommended in Chapter II. Do them. You will strengthen the muscles you will need after surgery. Furthermore, you will have a head start on learning the exercises, which will make the post-surgery physical therapists’ job much easier.

I lost about 15 pounds before surgery, and I worked on upper body strength. I should have done better with the weight loss. I also started doing as many of the post-surgery leg exercises as I could. My upper body strength training consisted only of push-ups, of which I did 45 per day. This caused pain in my arthritic shoulders from time to time, but it was something I had to do. I would like to think that these measures positively affected what eventually turned out to be an extremely rapid recovery.

Autologous blood donations

Your surgeon will probably recommend that you give one or more units of your own blood in advance of the surgery. If it is necessary to have a transfusion, the risk of viral infection will be low, because it is your own blood. This is a very desirable thing to do, so make sure it is high on your list.

You will have to phone your local blood bank for an appointment, and your surgeon’s office will supply the details the blood bank will need. There is a time limit for the useable period for whole blood: approximately 30 days. You will therefore need to consider this when scheduling appointments. Another thing to take into account is that appointments for blood donations need to be spaced sufficiently to allow regeneration of the blood lost. Expect to schedule appointments about two weeks apart.

Many people are concerned about being a human pincushion. At the very least, a fear of needles is normal. Alas, this fear will have to be surmounted long before you arrive at the hospital for surgery. Giving your own blood is too important to allow squeamishness to get in the way.

Handicapped parking permits

After you finally regain the ability to drive, it will be difficult to get into and out of cars, and you might find it difficult to walk long distances. Thus, it is advisable to have your doctor or your surgeon authorize a handicapped-parking permit. Even if you are not doing the driving, other drivers who transport you can use this permit for your convenience. You can obtain applications through your state division of motor vehicles. In my state, for a very small fee and a short wait at the local county auto tag agency, the permit will be issued the same day as you bring in the application.

If you travel frequently, you might be able to obtain a second permit to use for rental cars you will be driving or on the cars of those who will be transporting you. You will need the original permit to park appropriately at your home airport.

Dental appointments

It is very important that you complete all pending dental work in advance of your surgery. This is because of the possibility of the bloodstream carrying infections from the mouth to the new joint. Any such deep infections are a very serious matter and very difficult to treat. It is for this reason that, once your surgery has occurred, your surgeon will advise you to take antibiotics before and after any dental procedures you undergo for the rest of your life.

It was ironic that I, with all my professed organization skills, wound up with a dental dilemma immediately before my surgery. I had scheduled a checkup in May, believing that it would allow sufficient time before my June 7 surgery date to do any necessary work. I had not had a checkup that resulted in anything more than a cleaning for the past ten years, and I had no symptoms of dental problems. However, the May checkup revealed a cavity forming under an old crown, which meant that the old crown would have to be removed, the cavity excavated and filled, and a new crown cast and fitted. My dentist’s office apprised me they could not complete the work before my surgery. It took a few increasingly assertive phone calls on my part to make my point, which was like pulling teeth (pun intended), but I finally got them to cooperate. The dental work was completed on the day before my pre-op testing was to begin.

Rally friends and family and arrange logistics

It seems obvious, but somebody will have to transport you to and from the hospital or the rehab. Someone will have to look after your bills and your mail. Somebody will have to pay the household help, if you have any. If you are married, your spouse will be able to do most of these things. However, if you are single, as I am, and live alone, this requires significantly more planning.

Do not forget to begin planning for what happens when you return home. The hospital and rehab time will pass quickly, and you will need to have means of getting groceries and other necessities delivered to you. If you are lucky, as I am, you will have plenty of volunteers, and you will not have to give this much thought.

If you are a social creature, you might want to have a few get-togethers for friends to celebrate your forthcoming surgery and to let them know you appreciate their expressed willingness to help. If you are not the party type, then perhaps a nice, elegant dinner with your spouse or significant other would be appropriate. A visit with the grandchildren might be a relaxing family outing worthy of consideration. This is a time when much thought and activity centers on you. Therefore, why not turn it around for a little while and focus on those who are important to you?

Financial Affairs

I hate to plan for negative contingencies, but if you care about your family, you will want to make sure that your financial affairs are in order, just in case something undesirable happens during surgery. I should stress that life threatening complications of this surgery are increasingly rare, and I do not wish to scare you. Nevertheless, two documents that must be up to date are your Last Will and Testament and your Living Will. See your attorney or your estate planner far enough in advance of your surgery to allow for preparation and execution of any new documents or codicils to old ones. Discuss these with your loved ones to make them aware of your wishes about how to proceed if anything should happen to you.

Buy some slip-on shoes

You will not be able to tie shoelaces for quite a while. Thus, it is a good idea to have a pair or two of slip-on shoes on hand for when you return from the hospital or the rehab facility. I found that sneakers with Velcro closures were good all-around shoes for use during the recovery period. You will have been given a long-handled shoehorn and a long-handled grabber device by the rehab. Used in tandem, these make easy work of putting shoes on.

Just before the big day

If you are like me, you will find yourself with 98 things to do at the 11th hour. Now you know why I advised you to make a prioritized to-do list. At this point, the key is to relax, not to worry about the remaining tasks. You will probably have family and friends clamoring to help you (particularly if you have wined and dined them as I suggested), so this is the time to take them up on it. Do not feel guilty about taking it easy while they do the rough stuff. They care about you, and they know this is a stressful time for you.

A low-maintenance haircut

The Buzz CutI had a little fun with this one. I was thinking about the possibility of being out of commission for about six weeks, wondering what my hair and beard would look like after having been unattended to for that length of time. I had been having it trimmed every two weeks, and I knew that if waited for three it got shaggy (by my standards). Well, just because everything else was topsy-turvy and I was having fun, I told my barber of 25 years that I would do something radical. She balked at first, thinking that I would be angry with her if she did what I asked her to do. Nevertheless, I finally convinced her to give me that same, Susan Powter crew cut my old man told me to get rid of in 1958. I looked weird but the shock value was great and I did not even have to comb it. Neither did I have to worry about it getting too dirty in the hospital. I could use soap and water on it like everything else. I think I now know what women go through when they make a radical change in their hairstyles. It was somehow appropriate to make a major appearance change going into major surgery.

Prepare your house

I advised you to have a physical therapist visit your house to identify problem areas that might impede your rehabilitation. It is now time to pay heed to the recommendations made by that therapist. Remove possible tripping hazards such as throw rugs, children’s toys, and ground clutter. Rearrange things you will be using such that they are reachable without bending or stooping or reaching across your body. Make whatever modifications were recommended to living, sleeping, and bathroom areas.

In my case, the most onerous task was elevating my favorite LaZBoy recliner by about eight inches, to make it easier to get into and out of it. This took the better part of an afternoon of makeshift carpentry by a friend and me, but it was well worth the effort.

Bring your own prescription drugs

It is about time to think about what to take to the hospital. Make sure that if you are taking any prescription drugs, particularly expensive ones, you pack these in the bag you will bring to the hospital. They must be in their original bottles, or the hospital pharmacy will not accept them. The reason for bringing your own medications is to save money. There is a high probability that you paid much less for each pill than the hospital pharmacy would charge you if it were to supply the same drugs. Make certain that you tell the hospital in advance to note your chart with the names and dosages of any drugs you intend to bring yourself. Occasionally, you might have to remind nurses that the notation is there, as was the case with me, because such notations often escape nurses’ attention at changes of shifts.

Pack light!

I guess this is obvious, but I was in somewhat of a quandary as to what sort of clothes to pack for the hospital, so I shall share this exciting revelation with you. Other than what you will wear when you arrive, you will probably need no more than one change of clothing—to wear when leaving the hospital. You will be wearing that lovely, fashionable, open-backed hospital gown for four or five days. No need for keeping up with GQ or Vogue. Bear in mind that you will have some possibly bulky dressings on your hip and thigh when you leave, so your departure clothing should be loose fitting and airy.

* The service is normally supplied at no charge by the healthcare organization for its own hip replacement patients. My surgery was to be done at another hospital out of the area, but the service was nevertheless given to me at no charge. I had told them that there was a good chance that I would use their facilities for rehab, but I had made no commitment.

The “3-in-1” refers to its triple use as an over-the-toilet raised seat with handholds, a beside-the-bed stand-alone toilet, and a shower chair. You probably will not need to use it as a beside-the-bed toilet, and most probably will leave it in the bathroom to serve as a raised seat.


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