CAREGIVERS GUIDE FOR HIP SURGERY PATIENTS

A caregiver plays an important role in assisting with the recovery of a patient who has undergone hip replacement surgery, and there are a number of aspects that you need to be aware of to ensure a safe and comfortable recovery of the patient, which include:

Home Safety

 A number of changes may be needed in the home environment:

• Pick up rugs lying around, secure loose carpets that may cause a trip hazard, and place carpet over slippery surfaces.
• Ensure that there is good lighting throughout the house and avoid floor hazards such as small objects lying around, pets, cords and uneven surfaces.
• Rearrange furniture to provide more walking space to accommodate a cane or walker.
• Place all items that will be regularly used by the patient well within easy reach so as to avoid bending or twisting.
• Un-tuck bedding in order to make it easier for the patient to move in and out of bed.  It also may be necessary to obtain bed blocks to raise the height of the bed.
• The bathroom should be addressed to look at the need for access to the shower or need for a shower chair, toilet raise, or perhaps even instillation of any railings.
• Do not allow the patient to lift heavy weights for about 3 months after the surgery.

Body Changes

There may be a number of changes in the patient’s normal bodily functions to bear in mind:

• The patient may have a poor appetite, so ensure that they drink more fluids until their desire for solid food increases.
• The patient may have difficulties in sleeping, but they should not be allowed to sleep too long during the day – try to re-establish a more normal wake-sleep pattern.
• A common side effect of certain pain medications (especially the opioids) is constipation. Provide the patient with laxatives or stool softeners, or appropriate dietary modification, to combat this problem.
• You may need to assist with giving the patient blood thinners (e.g. Clexane injections) to avoid blood clots (DVT) in the leg.

Stocking Care and Use

Patients are prescribed special (TED) stockings whilst in hospital to compress the veins in the legs, which helps reduce swelling and lowers the chances of blood clot (DVT) formation. Factors that you need to be aware of with regard to these stockings include:

• The patient wears the stockings continuously for a period of 6 weeks post hip surgery. They are only removed for washing (they dry very quickly), during showering, and during rehabilitation hydrotherapy sessions.
• If leg/foot swelling persists, raise the patient’s leg above heart level on pillows while they are lying down.
• A/Prof Woodgate must be informed if pain or swelling in the legs increases.

Incision/Wound Care

Care of the patient’s wound/incision include:

• The wound incision should be kept dry and covered with a light waterproof dressing until any sutures are removed.  The dressing in usually transparent and allows easy inspection to confirm no local complications are developing.
• Inform A/Prof Woodgate if there is increased redness, drainage or discharge collecting under the dressing, odour, or increasing pain around the incision.
• Inform A/Prof Woodgate immediately if the patient’s temperature rises above 38.0^oC (100.5°F).

Pain Management

Various methods can be used to aid with control of post-surgical pain and discomfort:

• Use ice packs to the hip region for about 20 minutes every 2 hours to control pain and swelling for the first 2-4 weeks.
• Encourage the patient to change position every 45 minutes.  This will also include encouraging frequent short walks.  Sitting or lying for too long in one position results in contraction of the healing tissues, which will then be acutely stretched when mobilisation is attempted.  Moving frequently limits the extent of this contraction.
• Pain medications should be given at least 30 minutes before physical therapy and exercise episodes.
• The patient should be encouraged to gradually reduce pain medications.

Complications

Unfortunately, complications such as dislocation, blood clots (DVT), pulmonary embolism (PE), and infection can occasionally develop after hip surgery.  Prevention and/or early identification may help address these unwanted problems:

• Dislocation: - This can be identified by severe pain, shortening of leg or difficulty in walking. It can be prevented by avoiding crossing the legs, twisting, and bending the hip past 90 degrees, and often continuing with the use of the triangular (abduction) pillow for 6 weeks post surgery.  A/Prof Woodgate will also personally instruct both the patient and caregiver in techniques to avoid “at-risk” activities, such as drying the feet, putting on shoes and sock, and picking up items from the floor or out of low drawers.
• Blood clots (DVT) – These can be identified by swelling in the ankle, calf or thigh, and heat, pain and tenderness in the calf, occasionally extending into the back of the knee, thigh, or groin. DVT can be prevented (or the risks lowered) by using compression stockings for the prescribed 6-week period, blood thinners agents (typically for 4 weeks), and walking/moving regularly.
• Pulmonary embolism (PE) - A blood clot formed in a leg vein can break away and travel to the lungs causing pulmonary embolism. This is identified by sudden onset of chest pain, rapid breathing, shortness of breath, sweating, often increase in pulse rate, and sometimes confusion. It can be prevented with anticoagulant medications, compression stockings and physical activity, which can help, reduce blood clots and speed up the recovery process.   If a PE develops, it usually requires readmission to hospital and more protracted treatment with blood thinning agents.

• Infection – The measures noted in the section on wound/incision care above are important to help reduce the risks of wound or deep infection.  If there is any doubt, it is very important to notify A/Prof Woodgate immediately.