Once the decision has been made by patient and surgeon to proceed with Total Hip Replacement (THR), what should be done to prepare for this surgery?
Optimisation of Medical Conditions
Touching base with your GP is important. Your surgeon will have written to your GP informing him/her of impending THR surgery. Ensure your medical conditions (eg hypertension, asthma, diabetes) are controlled as best possible.
In some circumstances, your surgeon may recommend seeing a specialist physician for an evaluation of fitness for surgery and anaesthesia. This doctor can help in planning for management of diabetes and anti-clotting medications which are often interrupted at the time of surgery. They can also drop in each day whilst you are in hospital to make sure that your chronic medical conditions are adequately treated through the peri-operative period.
If you have any infections (dental, skin or other) – these need to be treated and controlled before surgery. Skin sores, ulcers or breaches in the skin particularly on the operative leg must be healed before proceeding with surgery.
Obesity is a significant issue which increases the risks associated with THR surgery and anaesthesia. There is increased risk of infection, blood loss, deep vein thrombosis and post operative chest infection. Obesity also reduces the longevity of any implant inserted through increased wear of bearing surfaces with activity. Weight reduction is an important pre THR strategy – seeing your GP and coming up with a dietary and light exercise plan is important. For those who are markedly overweight, sometimes undertaking bariatric/gastric reduction surgery is important before proceeding to THR.
Smoking is also a significant health issue that can impact on the risks of surgery and anaesthesia. Cessation of smoking before surgery is vital and giving up for good as part of your preTHR workup will help your recovery and general health long term.
Blood thinning medications will need to be stopped prior to THR. Common examples are Warfarin/Coumadin, Clopidogrel or Plavix/Iscover. Often these medications have been prescribed to treat heart conditions or to reduce the risk of stroke. Your surgeon will often contact the prescribing doctor or arrange for you to see a physician to work out a plan to safely stop these medications and when to restart them if required. Anti-inflammatories and aspirin also have blood thinning properties and these need to be stopped 7 – 10 days before surgery. If you have any concerns about any medication you are taking and whether you need to stop/alter this, please contact your surgeon for clarification.
Pre-operative tests are mandatory before THR surgery. You will need blood taken in the week before surgery. This is to determine haemoglobin, white cell and platelet levels, electrolyte levels and renal function and to undertake a blood grouping and cross match, so that blood is available if required. An ECG is performed to check for basic heart abnormalities. A urine test is performed to ensure no infection is present. If you haven’t had a recent hip xray (in the last 6 months), then this may be undertaken as well. Occasionally other tests – chest xrays, clotting profiles etc may be required.
Generally those who are fitter before surgery will recover faster. Unfortunately hip arthritis generally leads to deconditioning, which can be difficult to address pre-operatively. Touching base with a physiotherapist who can offer a “Prehab Program” can be really helpful and give insights as to the types of exercise/techniques required to get moving after surgery.
This usually takes place a week or two before surgery at the hospital concerned. You will meet nursing staff and sometimes ward physios who will explain what will happen in hospital – before and after surgery. They will also organize for equipment – a toilet seat raise, a higher sitting chair with arms, a pick-up stick and sometimes walking frames and crutches – to be supplied. It is important that you attend this session.
By the time you arrive home after THR surgery you should be able to walk a reasonable distance with crutches or a suitable walking aid and be able to shower/toilet and dress independently. You may need assistance with cooking, shopping and household chores – planning ahead for these events is important. Having a chair where you can sit comfortably with your knees below the level of your hips is essential. Arms on this chair will assist with rising from a seated position. Handrails in the bathroom can be helpful as can a long handled shoe –horn and sock aid. You should be supplied with a pick up stick that will allow you to grab objects without excessive bending of your new hip. Removing rugs and loose electrical cords from areas where you walk can prevent an unwanted fall. Setting up a “recovery centre” near a favourite chair where you may spend a significant amount of time each day is sensible – having things like the phone, TV remote, reading material and medications/drink (preferably non-alcoholic) within easy reach.
Planning ahead and preparation for THR surgery can make recovery faster and easier, minimize the potential for post-operative complication and provide a healthy and safe platform for a return to normal life activities.