Arbitration Agreement
Informed Consent
Blood
Medications
Home Exercises
Weight Reduction
Home Preparation
Medical Evaluation
Pre-operative Orthopaedic Examination
What to Bring to the Hospital
Arbitration Agreement
If you did not sign an arbitration agreement at the time of your initial consultation, one will be presented to you for signature prior to surgery. The physicians will not perform surgery without a signed arbitration agreement on file. These agreements are required by the physicians’ liability insurance carriers.
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Informed Consent
It is essential that you fully understand the risks, potential complications and treatment alternatives related to joint replacement surgery. The physician will discuss these issues with you prior to surgery, usually at the time of your initial consultation. Separate "consent" forms will be presented to you by the physician’s office and the hospital’s admitting department for your signature. The physician will not perform surgery without a signed informed consent on file. Please discuss any concerns which you may have with the physician prior to surgery to ensure that you are making an informed decision regarding your health care.
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Blood
As with many surgeries, bleeding can occur during hip surgery and you may require a blood transfusion. There are several options available to replace the blood you lose during surgery and these include: 1) autologous blood; 2) banked blood.
Autologous blood is your own blood that is set aside before surgery so that it is available during or after surgery if the need for a transfusion arises. Since the blood is your own, it has the advantages over blood from other individuals in that it is incapable of causing stimulation of antibodies to its contents (transfusion reaction). It also carries no risk of transmission of infectious diseases such as hepatitis or AIDS.
Depending on the number of units estimated to be needed for your surgery, you will be advised to begin donating blood in advance of the surgery. Your blood can be kept fresh for 42 days. The interval between blood donations should be no shorter than one week, and the last unit should be drawn no later than 5 days prior to surgery. If more than six units are needed, the additional units are given further in advance and frozen. Patients who weigh less than 55 kg are eligible to give smaller amounts (e.g., only 1/2 unit at each donation) and therefore may need to start donating earlier.
The procedure of drawing blood takes about one hour each time, although the first time will take about 15 minutes longer to complete the paperwork. You will be asked to rest for 15 minutes before leaving the donor center. You can drive an automobile if you feel perfectly well but should inform the nurse if you have any doubt. One week prior to when you begin your blood donations and during the donation period until surgery, it is advisable that you take iron (ferrous sulfate FeSO4) 325 mg and Vitamin C (ascorbic acid) 500 mg - 1 of each, three times a day with meals.
Blood can be collected at the hospital or if you do not live nearby, your blood can be donated at another blood bank and transferred to the hospital prior to your surgery. Do not cut the donation schedule too close because your donation schedule can be delayed if you become ill or your blood count becomes too low. This will not allow you to give the necessary number of units.
A special fee must be paid at the time the blood is drawn. These charges pertain even if the blood is not transfused. If you donate your blood at the hospital where the surgery will be performed, then you are usually not required to pay the fees at the time of donation as the charges are included as part of the hospitalization. This autologous program has been highly successful, and in most instances has avoided the need for the use of homologous (another donor's) blood.
Banked blood (homologous blood) is donated by volunteers to local blood banks. The donors are thoroughly questioned and tested for potential transmissible diseases and the blood is carefully screened. There is a minimal risk of transfusion reactions. The risk for AIDS is estimated to be 1 in 100,000 units of blood and for hepatitis it is 1 in 20,000.
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Medications
If you are taking birth control pills, or anti-inflammatory medications such as aspirin, Indocin, Motrin, Feldene, Naprosyn, Voltaren, Lodine, etc., it is advised that you discontinue their use two weeks prior to surgery.
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Home Exercises
It is recommended that you begin a preoperative program of exercise (only if it is comfortable to do so). Easy isometrics (muscle tensing exercises) will help maintain the strength of your leg muscles in preparation for postoperative walking. The following exercises can be done in bed. Exercise each leg remembering to breathe normally throughout the exercise. Perform 2-3 times per day.
a. Gluteal Setting Exercise: Squeeze your buttocks
together tightly, hold for ten counts. Relax. Repeat
ten times.
b. Quadriceps Setting Exercise: Tighten the muscle on the
top of your thigh by pushing the back of your knee down
on the bed. Hold for ten counts. Relax. Repeat ten
times.
c. Hamstring Setting Exercises: Keep the knee bent
slightly. Push your heel down into the bed and then
pull toward buttocks. Hold for ten counts. Relax.
Repeat ten times.
d. Ankle Circles: With lower leg resting on a towel roll,
move the ankle in a circle first in one direction, then
in the other. Repeat ten times.
e. Ankle Pumps: Move the ankle up and down slowly.
Repeat 10 times.
You will be using your arms often during the postoperative period while moving in bed and with the walker or crutches. Therefore, strengthening your upper body is also important. Exercises should include:
a. Pull-ups: While sitting in a chair, hold onto a bar
that is overhead and raise your buttocks off the chair.
Repeat ten times.
b. Reverse Push-ups: While sitting in a chair, place your
arms at your side and hold onto the chair next to your
buttocks. By straightening your elbows, lift your
buttocks off the chair. Repeat ten times.
c. You can also do general strengthening exercises with
small weights.
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Weight Reduction
The stresses across the hip joint are high and can be equal to three times your body weight during normal walking. Therefore, one pound of weight reduction equals three pounds in stress reduction. These reduced stresses can be helpful both before and after your surgery.
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Home Preparation
After your surgery you will be using either a walker or crutches. You should try using these around the house and make sure important areas (bathroom, kitchen, bedroom) are easily accessible. You may need to rearrange furniture or temporarily change rooms for your convenience after your surgery. Remove all throw or area rugs that could cause one to slip. Bathroom modifications which may be helpful include a shower chair, gripping bars, flexible shower handle, non-slip floor surfaces or mats, soap bars with a string attached and a long-handled scrub brush. If you live alone, you may want to make arrangements to have a friend or relative stay with you for a short while after your surgery. This is especially useful in meal preparation, carrying various items such as plates and cups, and putting on socks. It may be helpful to wear shirts with pockets and/or to drape a small canvas or plastic bag draped over your shoulder for carrying smaller items. Occasionally, patients are sent to a rehabilitation facility after their surgery until they are stronger.
If you do not already have a disabled parking permit from the Department of Motor Vehicles, you should apply for a temporary permit several weeks prior to surgery. Our office can provide an application.
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Medical Evaluation
Hip replacement surgery is a major procedure and care must be taken that you are in the best medical condition. You must see your regular medical physician two to three weeks before your surgery. He or she will perform the necessary tests. Please arrange to have this physician send to our office, prior to your pre-operative orthopaedic examination, all test results as well as a note which clearly states that you may undergo the proposed surgery. Your surgery may be postponed if our office does not receive the test results and/or surgical clearance timely. If you do not have a regular medical physician, we can provide a referral.
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Pre-operative Orthopaedic Examination
You will be seen in our clinic one to seven days prior to your surgery. At this time we will review the proposed surgery with you and answer any last minute questions you may have. We will also review your medical evaluation, laboratory tests, x-rays, and obtain any other tests or x-rays that are necessary. If you have blood transferred from another blood bank we will check that it has arrived. You will need to sign a surgical consent. Finally, you will be directed to the hospital’s "Pre-Op" unit for pre-admission and instructions. The nurse will give you instructions for the evening before your surgery and show you where to report the morning of your surgery. If you do not live locally and wish to stay in the area on the night before surgery, please ask our office for assistance at the time you schedule surgery.
It is imperative that you not eat or drink anything after midnight (12:00 AM) the night before surgery. This helps to prevent potential nausea and vomiting from occurring during surgery which could cause complications.
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What to Bring to Hospital
The Physical and Occupational Therapy Department will provide a walker or crutches, raised toilet seat, reacher and other equipment as needed. If you already have this equipment, please bring it with you. To enhance your postoperative therapy, a knee-length robe or gown is recommended. (Do not bring floor-length robes as they make walking difficult.) Ladies may want to bring a camisole or lightweight cotton shirt to wear under the hospital gown for added warmth. Leave all jewelry at home! A package containing personal care items is provided. Loose fitting pajamas or sweats are useful to wear on the way home. Bring comfortable, sturdy bedroom slippers with non-skid soles and a comfortable pair of shoes to wear for the trip home. Program guides for television viewing are available. Of course, good reading material may help pass the time more quickly!
Total Hip Replacement
Orthes, spol. s r.o., Palackého 481, 756 61 Rožnov p./R., tel.: +420 651 757940-4, Fax: +420 651 620923, e-mail: orthes@orthes.cz
Copyright
ORTHES, spol. s.r.o. 2001