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Birmingham Hip Resurfacing Surgery - Patients Guide

   
 

The anesthetist will be seeing youthe day prior to the surgery, or earlier if required. Usually a generalanesthetic is preferred for BHR due a variety of technical reasons.

 

After the Hip Surgery, the patientwill be in the recovery room for about 3 hours after which he will be shifted tothe wards.

   
 

Strict adherence of instructionsregarding visitors is mandatory. Only one person who will be known as theprimary attendant is allowed inside the patient’s room.

   
 

Should the patient have any othervisitor, the primary attendant will come outside the room to speak to them. Thepatient’s family must actively discourage visitors for the first 3 post –opdays. Only the patient is permitted to eat inside the room.

   
 

It is preferable to take onlyliquids on the day of surgery and progress to a normal diet the followingmorning. The medical team will give instructions on ‘ankle pump’ exercises. Asterile towel is kept between the dressing and the bed sheet.

   
  1st post – op day
   
 

The intravenous fluids arediscontinued if patient is taking orally .For the first 48 hours following anysurgery; pain is common due to the cutting of tissues. For this pain powerful(narcotic analgesics eg. Tramadol is given). The patient can request the nursefor these injections. These medicines also cause slight dizziness. If thepatient feels comfortable, he can start walking with a walker on the firstpost-op day. If dizzy due to medications, the walking is postponed to the nextday. The patient has to do deep breathing exercises, Static quadriceps andgluteal contraction exercises. The last dose of narcotics are given for thisnight.

   
  2nd post-op day
   
 

Usually non-narcotic painmedication like inj. Diclofenac is given on the morning and blood sample takenfor hemoglobin estimation. Drains are removed and the wound inspected. Last doseof antibiotic is given and the I/V cannula removed. All medications are changedto the oral formulations.

   
  Typically the following are given
   
 

Iron & vit preparation, chymerolforte, oral painkillers like proxyvon and gastro protective agents likepantaprazole. Patient is also fitted with a pair of below knee Ted Stockings.Some patients will receive blood-thinning injections if indicated.

   
 

Patient walks with the help of awalker with the assistance of a physiotherapist for short distances. Patientgoes to the x-ray dept for check x-rays. One can start lying on the un-operatedside with a pillow in-between the thighs (not knees or legs).

   
  Day3
   
 

Patient can walk for longerdistances as comfortable. He can also start sitting in a chair with a pillowheight. It is important to keep in mind that the capacity of recovery followingsurgery is very different among individuals. Therefore these milestones are onlyguidelines and variability is common. Patient continues the exercise programmein bed as per the instruction booklet.

   
  Day4
   
 

Dressing are done again andsticker type dressing ( Curapor or Surgiwear) is done if there is no wound ooze.Patient can start to use the western type toilet and wear normal clothes thatare comfortable like pyjamas, lungi, dhoti or baggy shorts. If the surgeonpermits a shower is possible with a special (surgiwear swimproof) dressingapplied for this purpose From this point on the mobilization programme isvariable for each individual patient.  In principle they progress to elbowcrutches when the phsyio deems fit.

   
  Day5
   
  Once they can climb stairs withthe help of elbow crutches, they are ready for discharge.
   
 

Usually the patient is fit totravel by car taking the front seat. The sitting is accomplished by firstsitting on the car seat with the feet on the road and then lifting each legindividually into the car

   
 

Patient from abroad or those whoneed to take a flight back must keep the following points in mind during theflight. 

   
 
  1. To carry a bottle of water to ensure adequate intake of fluids.
  2. Compulsory wearing of TED stockings during the flight.
  3. Requesting an aisle seat and taking a few steps in the corridor every half hour.
  4. To do the ankle pump exercises when seated.
   
  Athome
   
 

At home they walk with a pair ofcrutches usually for about 10-15 days and when completely comfortable discardthe crutch on the side of the operation first. Then when the other crutch isalso felt unnecessary, this is also discarded. Walking, climbing stairs orcycling can be done for long periods of time. Patient reports back to thehospital at about 12 days for removal of skin clips. Outstation patients can getthis removed by a doctor locally. A letter to this regard will be given at thetime of discharge. The next follow –up visit is at 6 weeks when a check x-ray isrepeated. Outstation patient can do this locally and post the x-ray to thedoctor. A request for this is also given at the time of discharge. Thesubsequent compulsory visit to the doctor is at 6 months post-op.

   
 

There is no post –op restrictionsafter a Hip Resurfacing operation and the patient can use it as a ‘normal hip’.However the soft tissues around the Hip Joint, which were contracted at the timeof the hip disease, will take time to relax following the excellent movementthat has been restored in the hip. Hence if there is pain while attempting acertain activity like sitting on the floor, it implies the patient is not yetready for that particular activity. One can give a gap of about a week and thentry it again. Like wise the activity level improves in a stepwise manner tillthe soft tissues also become normal. Patient is ready for sports (inclusive ofcontact sport) at about 3 months post-op.

   
   
 

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