Your Pathway to Recovery

Hip Resurfacing

Division of Nursing

Patient Education Programs

Patient Educators

Lisa Briskie, BS, RN, ONC

Briana Damora, BSN, RN

Kelsey Vukov, MSN, RN

Jack Davis, MSN, RN, ONC

(212) 606-1263

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Welcome to HSS!

Top ranked in U.S.

Teaching institution

Research oriented

IRB approved

Voluntary

Magnet designation

Patient-centered care

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Your Healthcare Team

Multidisciplinary team input

Surgeon, Medical MD, Anesthesia,

Physician’s Assistant, Nurse, Physical

therapist, Case Manager, Dietician and

other support staff

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Webinar Objectives

Highlight topics to prepare you for surgery & your

hospital experience (typically a 1 night stay)

Identify areas of focus to reduce potential risks

Safety & falls prevention

Infection & blood clots

Immobility & pain

Describe self-care management tips to optimize

recovery

Patient & Family Involvement = Best Results

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Overall conceptual goals

Provide information

Facilitate understanding

Encourage you to take action and

participate in your care

Provide a highly satisfactory

experience

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Safety & Falls Prevention

Hospital environment

Equipment & Medications

Falls brochure highlights

safety

“Call don’t fall”

ALWAYS use call bell

Safety brochure

RRT, Speak up,

Identification checks

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Hip Anatomy

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Hip Arthritis

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The preserved bone is

sculpted to accept a

metal cap with a short

stem.

Pre-op Pathway

Surgeon consultation

Specific issues & protocols

Medical doctor appointment

Reduce risk of complications

Health history and list of medications

Pre-op education class/webinar

Pre Surgical Screening appointment

Health history, medication & instruction

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Pre-Surgical Screening (PSS)

3rd Floor of Hospital

aka Pre Admission Testing

(PAT)

Nurse consult (database and

paperwork)

EKG, blood and urine

specimen

X-rays?

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Pre-Surgical Screening

Paperwork

Information materials

“Your Rights” booklet and

Healthcare Proxy/Living Will

Packet of pre-op prep

materials

Fleet enema

Surgical wash

Participation & self-care management

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General Information

Important Number that You Call

212 606-1630

– No less than 48 hours before

surgery

– Recording

– Instructions to prepare you

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Nurse Call Center

Nurse will call you with instructions

between 1p-7p day before surgery

Diet reminder

No solid food after Midnight before

surgery

Clear liquid diet up to 3 hours before

surgery

Nothing to drink or eat after arrival to

HSS

Medication review

Final instructions and time to report

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What to Bring?

Photo ID

Credit card

Shoes

Flat supportive

Non-slip walking shoes

Closed toe

Paperwork

Should all fit into 1 small bag

No luggage please!

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Day of Surgery

Check in Main Lobby- Patient Access Services

4th Floor Family Atrium

1 family member / support person

Generally 3 hours before surgery

5:30am arrival for 1st case

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Same Day Surgery Unit

Team approach

Prep nurses, IV start, OR team

Anesthesia team

Surgical team

All checking for correct patient

All checking for correct site

Safety first

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Anesthesia Consult

Epidural/spinal

IV sedation

Pain management

Antibiotics

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You are taken to the OR

Surgical team (infection prevention)

Space suits

Surgery takes about 90 minutes

Bulky ace dressing

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Transferred to the PACU

Wake up from sedation

Still probably numb from

waist down

Pain consult

Vital signs monitored

Visitation is limited

Start your exercises

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Inpatient Units

Patients transferred to

floors: 6, 7, 8, 10 or 11

Hourly Comfort Rounds

Vital Signs routinely

White Board for

communication in each

room

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Pain Management Team

Goal is to keep you comfortable

Pain Scale 0-10 (aim for 5 or

less)

Cold therapy and positioning

Decrease swelling

Local injection in OR

Oral tablets

Discharge meds

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Managing Side Effects

• Goal is comfort and able to do physical therapy

• Balance medication dose to reduce adverse

effects

– Nausea

– Itch

– Drowsiness

– Constipation

– Dizziness

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Need to Keep You Moving!

Immobility can increase risk of complications and delay

recovery

Skin irritation and breakdown

Digestive system

Blood clots

Muscle weakness

Call for assistance before getting out of bed

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Constipation Prevention

Pain medication and immobility

Stool softener & laxative

Colace 100mg 3 times a day

Senna 374 mg 2 times a day

Increase fluid intake

Fresh fruits and vegetables

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Physical Therapy Goals

Regain independence with mobility

Teach an independent walking/exercise

program

Teach proper body mechanics

Safely return to functional activities

Assist with meeting discharge criteria within

the 1 night hospital stay

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Ambulation/Walking

Walking will begin with a rolling walker and

progress to crutches when you are comfortable

and safe

Walk 2 to 3 times a day

Stairs will be reviewed using crutches and a

handrail before you leave the hospital

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Exercise Programs

Ankle pumps

Isometric quad strengthening

Heel slides

Gluteal sets

Hip rotation to neutral

Heel slides

Dangle stretch and Figure 4 leg crossing

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Ankle Pumps

Isometric quad strengthening

Gluteal Setting (“Glut Sets”)

Hip Rotation (to neutral)

Heel Slides

Dangle

A simple exercise to help

increase flexion

Use a stool or lower chair

Place knees at shoulder width

Bring hands down towards

your ankles and hold when you

feel the stretch

Don’t bounce or continue if you

have a lot of pain

Repeat for a set of 10

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Figure 4 crossing of legs

Designed to increase the

rotation in your hip joint

In a sitting position, gently

grab your operated foot and

bring it to rest on your un-

operated knee

It will be difficult at first, and

you may feel some pain

around the incision site

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Figure 4 crossing of legs

If it is too stiff to accomplish this early on, you may turn your body at an angle to the chair/bed, and bring the foot onto the chair/bed instead of your opposite knee

Gently press on your operated leg to flatten it.

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Hip precautions?

You may hear staff remind you to maintain hip

precautions as they apply to many hip

replacement patients, but not to you

Dr. Su’s hip resurfacing patients are allowed to sit

up and bend greater than ninety degrees as

tolerated

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Reduce risk of complications

Although they do not occur frequently we

are always on look out for signs of

Infection & Blood clots

You should be aware and participate in care

to prevent them

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Keeping Lungs Clear

Deep breathing

Incentive spirometer helps

expand lungs

Increases oxygen to tissues

Promotes circulation

Lowers risk of pneumonia

Relaxation technique

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Measures taken to prevent blood clots

include…

Timely surgery

Regional anesthesia

Early mobility and exercises

Mechanical compression devices

Medication

Buffered aspirin 325mg, twice a day

6 weeks or as per doctor

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Things to Look Out For…

Symptoms of blood clots that should be reported to

the doctor include:

Unexpected swelling, especially in the calf

Continuous low-grade fever

Unexpected pain, especially in the calf

Chest pain/shortness of breath

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Help prevent infection

Wound care

Observe wound for signs of infection

– Drainage, increased redness?

– Temperature >101

Keep incision area clean and dry

Have everyone wash hands

If absorbable stitches then ok to shower

If staples then No showers until staples are removed

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Long Term Protection Against Infection

Remember that you need to take antibiotics before

Dental & urologic procedures

– Antibiotics 1 hour before procedure

– This is for the rest of your life

Alert all your health providers about hip resurfacing

– Infections in other areas need to be treated promptly to

protect your new hip

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Discharge Instructions

Pain management

Take medications as needed and prescribed

– Usually every 4hrs and then taper

Use icepack or cold therapy

– 15 minutes 4 times a day

Follow PT instructions and do not overdo activity

Leg swelling

Normal in leg, knee, ankle & foot

Take frequent rest periods

– Avoid sitting longer than 30-45 minutes

Use support hose (TEDs)

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Follow-up Care

Surgeon appointment

Appointment about 4 weeks

Communicate any needs, keep in touch if any

complications or issues

Nurse will call you following your return home to

check on progress

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Discharge Planning at the Hospital

Case manager support

212 606-1271

– Pre-op call & ongoing evaluation

– Daily updates on rounds

– Get any necessary equipment PRIOR to day of

discharge

– Parking out front for family pick up

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Discharge Plan to Home

Home exercise program to be provided

Home care services

RN: evaluation & staple removal if needed

PT: 2-3x’s a week

Transportation home typically not covered by insurance so plan for family to pick up

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Day of Discharge Process

Family member or friend can

pick you up in front of the

hospital

Discharge instructions

reviewed

Prescriptions and instructions

provided

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At Home Recovery

Walking is # 1 exercise for recovery

Use both crutches 2-3 weeks after surgery

Wean to 1 crutch (opposite arm) for short

distances at 4-6 weeks after surgery

Early stretching exercises recommended to regain

motion

Be safe and prepare home environment and

assistance before surgery

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Conclusion

Read & Review information in the slides

Ask questions! Speak up!

Prepare yourself and your home

Focus on

Increasing Safety “falls prevention” and “risk reduction”

Preventing infection

Preventing blood clots

Managing Pain

Keep moving

You are a partner in Your Pathway to Recovery

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Patient Education Programs

(212) 606-1263

Thank you and Questions?

Your Pathway to Recovery

Hip Resurfacing