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This booklet has been written to advise you of our requirements prior to you coming into hospital and to provide advice about how to cope with your activities of daily living following a Hemiathroplasty (half a hip replacement) or a Total hip replacement.
The hip joint is a ball and socket joint at the top of your femur (thigh bone). The rounded upper end of the Femur is called the Head of Femur, which is connected to the Neck of Femur which is connected to the main part of your femur as shown in the diagram.
Following surgery for a fractured hip or hip replacement, the surrounding muscles and tissues require time to heal. During this period, it is essential that you avoid any harmful movements which may cause stress on your “new hip” and cause it to dislocate. Your Occupational Therapist and Physiotherapist will advise you on the safe positioning of your hip in activities of daily living.
Your occupational therapist will advise you of any specific precautions you may be required to follow.
These precautions should be followed for at least six weeks and will usually be recommended for strict or soft guidance depending on the surgery you have had.
It must be stressed that the routine rehabilitation plan after a hip replacement may vary from hospital to hospital and it is specific to the individual. Please ask your therapist if you have any concerns about coping at home after your surgery.
1. Do not bend the operated hip beyond 90° (a right angle)
To do this:
• Do not bend forwards too far or bring your knee up too far towards your chest.
• Avoid sitting on low furniture and ensure your knees are never higher than your hips. Avoid seats that slope backwards.
• Do not bend forwards to pick up objects from the floor or reach for your feet without using long handled gadgets.
2. Do not cross your legs
• Your operated leg must not cross the midline of your body.
• Do not sit with your legs crossed at the knee or the ankle and keep your operated foot straight ahead or out to the side.
• You are advised to sleep on your back and not on your side. A pillow between your legs will help you to maintain this position.
3. Do not twist or rotate your hip.
• When walking or turning, always keep your toes and kneecap pointing straight ahead.
Getting in and out of bed
Whenever possible try and get in/out of bed on the same side as your operated hip with your operated leg out in front of you. Your Occupational Therapist will advise you of the height requirement of your bed and may be able to arrange for it to be made higher if necessary. A high, firm bed is recommended.
• Sit down on the edge of the bed near the pillows with your operated leg out in front of you.
• Slide your buttocks back and towards the pillows, so that your legs start to come on to the bed.
• Slide your legs on to the bed.
• When getting out of bed reverse the technique, remembering not to roll onto your side.
Getting in and out of a chair
Remember to sit in a firm, sturdy, high chair with armrests. If your chair is too low, the Occupational Therapist may be able to have it raised. Therefore, it is important you provide the Occupational Therapist with measurements of the furniture in your home. Please note it is not possible to raise all chairs. Your Therapist will discuss any options with you.
• Back up to the chair until you feel the back of your knees touching it.
• Place your operated leg out as you reach back for the armrests. Lower yourself slowly, keeping your back straight and your operated leg out in front of you. Sit in a controlled manner.
• When standing up, come forward in the chair, keeping your hip positioned at 90°. Push up using the armrests, again keeping your operated leg out in front of you.
Do not use your walking frame to pull yourself from sitting to standing.
• Initially the operated leg may be placed on a footstool, as long as it is not higher than the chair.
Getting on and off the toilet
• Back up to the toilet until you feel the back of your knees touching it. Reach back for the edge of the raised toilet seat or the arms of a free standing toilet frame with your operated leg out in front of you. Your Occupational Therapist will arrange for you to have a raised toilet seat and/or toilet frame if required. If you have a rail at home you may be able to use this instead of a toilet frame.
• Bend your un-operated knee and hip and lower yourself onto the seat.
• Reverse the procedure when standing. Place hand on the edge of the toilet seat or arms of the toilet frame, remembering to keep the operated leg extended. If you have a toilet frame, ensure you push up evenly through both arms.
Do not use your walking frame to pull yourself from sitting to standing.
Getting in and out of a car
• Use the front passenger seat. Have the seat as far back as possible and the backrest angled so that it is partially reclined.
• With the passenger door open, back up to the car until you feel the door frame / seat against the back of your knees. Facing away from the car before sitting, put your left hand on the top of the
passenger seat for support and, with the door window fully open, grip the open-door window frame with your right hand. Have someone hold the door to prevent it closing towards you.
• Gently lower yourself down, remembering to keep your operated leg extended. Lift yourself backwards, moving your bottom towards the driver’s seat. You may find this easier with a plastic bag on the seat to reduce friction and encourage sliding / swivel of your bottom. While you are leaning backwards, carefully lift your leg and slide into the car.
• If the car seat is low or slopes backwards, raise or level it out with a cushion.
• You must get into the car from road or drive level, not from the pavement.
Bathing and Showering
It is not advisable to get into a bath, even to use an overhead shower as it involves bending and twisting movements of the hip. Even if you have a bath board, most people are unable to use it without bending their hip too far. If you do not have a walk-in shower or shower cubicle you will have to have a stripdown wash. To wash below your knees, you will either have to use a long-handled sponge or ask someone to do this for you. If you have a step into your shower cubicle, negotiate this using the way taught by your physiotherapist. If you have a seat in your shower, ensure it is the height recommended by your Occupational Therapist. If not, you will not be able to use it. Assistance from carers to wash and dress yourself may be arranged once you are admitted to the ward if required.
• Always dress your operated leg first and undress it last.
• Sit in a chair or on the bed; have all your clothing and dressing aids within easy reach.
• Place the hook of your long-handled shoehorn through the operated leg side of your underwear and hook the underwear to the shoehorn.
• Lower the long-handled shoehorn down the operated leg and feed underwear over your toes. Bring underwear up to knee level and then dress the unoperated leg in your normal manner, remembering not to bend forwards too far. You may also use the shoehorn or helping hand to dress this leg if required.
• If wearing trousers, use the long-handled shoehorn or helping hand to lower your trousers onto the floor. Slip the trouser leg over your operated leg first, then do the same for your non-operated leg. If your trousers have belt loops, put the hook of the shoehorn through the loop and then lower the trousers to the floor.
• Pull your trousers and underwear above knee level before standing to adjust clothes. If you wear braces, place these on your shoulders prior to standing.
• When undressing, remove your trousers/undergarments from the nonoperated leg first, and reverse the above steps.
As mentioned earlier in the booklet it is recommended you sleep on your back or unoperated side whilst your wound is healing. Should you have any questions, please ask your Consultant.
You will not be able to drive for a minimum of 6 weeks postoperatively. After this time please ask your Consultant for advice. You are advised to contact your insurance company to inform them of your surgery
Managing Household Tasks
As mentioned earlier in the booklet, now that you have had the hip operation, the way you carry out some activities of daily living may need to be altered temporarily. Your Occupational Therapist will not only advise you on all your hip precautions and transfers, but also domestic activities and drink/meal preparation.
• You will not be able to bend to low cupboards and drawers, or to low shelves in your fridge or freezer. Rearrange items you use regularly to higher shelves.
• Arrange your kettle, cup, saucer, coffee/tea and sugar in one designated area.
• Slide objects along the work surface rather than carrying them (i.e. hot drinks) where possible.
• If you do not have a table and chair in your kitchen, sit on a high stool when carrying out work top activities or after preparing a drink. (If you live alone you will find this more convenient).
• If you need to carry items to the table, different methods and equipment may be suggested by your Occupational Therapist.
• Remember that if you drop something, do not bend to pick it up – use a helping hand (available at The League of Friends Shop, mobility shops or larger chemists. We are not able to provide Helping Hands.
• Remove or secure all loose rugs and mats to prevent tripping.
• Move regularly used clothes and shoes out of low cupboards and drawers.
• Do not attempt any heavy housework, such as hoovering, for at least six weeks.
• If your washing machine is low down, you may need assistance with laundry.
For further information please contact the Occupational Therapy team on 01908 995 411.
Please ensure that all relevant required information is provided for the Occupational Therapy Team as requested to prevent any delay in your discharge from hospital.