About Your Surgery: What to expect with Hip Surgery

What to Expect
Hip Surgery
Blood Management
Pre-Admission Testing
Day of Surgery
The Operating Theater
Post-Anesthesia Care
The Orthopaedics Ward
Your Recovery at Home

What to Expect with Your Hip Surgery
Once you have decided to undergo a total hip replacement, we will do everything we can to make your experience as comfortable and stress-free as possible. Ultimately, our goal is for you to have a painless and easy moving joint that will give you confidence in all of your activities. To achieve this you must have a successful operation and physical rehabilitation. Your surgeon is the key person in your treatment; however, many other health professionals are required to maximize your recovery. Your journey will begin with education. You will learn about the joint implant that will become part of you. You will be informed of the operation, the hospital stay, the do's and don't, and the rehabilitation. A Joint Replacement Coordinator will be assigned to you. This person will help you schedule all of your appointments and get all your needs before and after surgery. You will be enrolled in a Joint Class where you will be instructed by the physical therapist, occupational therapist, and nurses. The physical therapist will teach you exercises to strengthen your leg muscles and improve your mobility and balance. You will learn Dr. Aram 's 5-Step Hip Exercises to help you get out of bed quicker after your surgery. The occupational therapist will show you how to use your new joint in performing your daily activities. The nurse will instruct you on all the medications you will be taking. These medications manage your pain, nausea, stress, and prevent infection and blood clots. If you are a candidate for the Minimal Invasive Surgery (MIS) , then you will be enrolled in a more accelerated program.

An appointment with your internist or family doctor may be necessary to check your heart, lungs, kidneys, and blood to ensure that you can undergo the operation and rehabilitation safely.

Blood Management
Although blood products are very safe today, it is preferred that you donate two units of blood so that you can have your own blood if needed. You can safely donate one unit per week. If you are anemic and cannot donate blood before surgery, then you will receive a medication call Procrit to help you increase your blood count before surgery. As an alternative you can also have some one you trust donate blood for you if this person blood matches yours. This person is called a direct donor . Lastly, you may receive blood from a blood bank. Blood from blood bank are from anonymous donors. It is carefully screened for communicable diseases. With the new technology, the risk of hepatitis and HIV infection is extremely low. To our knowledge, disease transmission through use of donated blood has never occurred in any of our patients. If your operation is a particularly difficult one where the planned operation will be longer than three hours, then a blood collection device will be used during and after surgery. This collected blood will then be retransfused to you.

Pre-Admission Testing
Within two weeks prior to your surgery, you will be asked to undergo several laboratory tests and possibly a chest x-ray and an electrocardiogram. This is called pre-admission testing . The result of these tests will help us assess your general health and determine if you have any conditions, which might require further work-up. If necessary, Dr. Aram and your medical doctor will refer you to the appropriate specialist, i.e. cardiologist for your heart, pulmonologist for your lungs, and nephrologists for your kidneys. All this is done in order for us to minimize your risk and avoid adverse event during and after surgery.

Day of Surgery
You should fast at least 8 hours prior to coming to the hospital on your day of surgery. However, you may take your medications with small sips of water. To help decrease your pain after surgery, you should take Celebrex or a similar medication the night before and the morning of your surgery. You should let the admission nurse know what medicine you have taken. If you have diabetes, then make sure you only take half of your regular dose since you have been fasting. You should arrive at the hospital two hours before your surgery in order to register and prepare for surgery. You should wear loose fitting clothing and pack light. Pajamas, toothbrush, toothpaste, and light reading should be sufficient. Keep all valuables at home. After checking in, the admission nurse at the holding area will greet you . You will be asked to change into a hospital gown. The nurse will ask for a medical history of your condition, your planned surgery, your medications, and your allergy. You will be asked to sign an informed consent for surgery form and mark your site of surgery. You will also be given any medication that the doctors have ordered. These medications are usually an antibiotic, a pain-reliever, and anti-nausea. An intravenous (IV) catheter will also be placed in your arm.

You will also meet an anesthesiologist, a doctor who specializes in keeping you pain free and comfortable during and after surgery. You and them will decide on the best type of anesthesia for you. Dr. Aram prefers regional anesthesia to that of general anesthesia; however, the final choice will be what is best for you. Once all that is done, you will be wheeled into the operating theater.

The Operating Theater
In the operating room, you will meet the surgical team. They are your surgeon, anesthesiologist, surgical assistant, circulating nurse, and surgical technician. There may be a few other people involve as well. The operating room is kept cool on purpose to keep potential infectious agents from growing, and thus, lowers your risk of infection. The circulating nurse will keep you warm with heated blankets. The anesthesiologist will keep you pain free and comfortable by either a regional block or general anesthesia. Surgery will only begin after assessing your sensation and consciousness. The operation will take about two hours; however, to you it will be very quick. It will be like you have just taken a short nap. Once awake from anesthesia you will be disoriented, not knowing where you are or what have just been done. It is like waking up from a dream. Listen to the doctors as they orient you to where you are and what has just taken place. You will be wheeled to the p ost anesthesia care unit (PACU), also known as the recovery room.

Post-Anesthesia Care Unit
You will be there for about one hour. The nurse will connect you to monitors. She will also give you medication for pain and nausea if you need it. An x-ray will be taken of you hip. Once you have recovered from the anesthesia and fully oriented, you will be transfer to the Orthopedics Ward.

The Orthopaedics Ward
A nurse assigned to you will admit you to the ward. In most case, you will get a private room. You will be given a light meal if you are not nauseous. Pain will be controlled. The physical therapist will meet with you in late morning or early afternoon to get you out of bed and teach you how to walk. Those patient who are part of the MIS program may be discharge home the same day if your pain and nausea are under controlled, and if the physical therapist clear you to be physically capable of safely getting in out of bed and walk without assistance. Some patients will stay an extra day or two if necessary. While on the ward you will start a medication, which helps prevent blood clots ( deep venous thrombosis, pulmonary embolism ). It will be either warfarin (Coumadin) or Lovenox . Warfarin is taken by mouth and require daily blood draw in order to assess the therapeutic level. Once the therapeutic level is reached, you will need blood drawn twice weekly. You will need to take warfarin for a total of three weeks. If it is Lovenox that you are on for blood clot prophylaxis then it is taken differently. Lovenox is given as a subcutaneous injection. While in the hospital your nurse will give you the first few shots, but she will also teach you and your designated family member how to give the injection. You will continue with this for ten days at home. Unlike patients who are on warfarin, you only require one blood draw when you are at home. Those patients who go home will have had home health set up prior to discharge from the hospital. The home health nurse and physical therapist should visit you the same day or the next day when you get home. In most case you should have met and set up your home health service prior to coming to the hospital. Your Joint Coordinator should have assisted you with this arrangement. On day one after surgery, all drains, tubes, lines, etc. will be removed from you. Your transportation home is usually a regular automobile, preferably one that is roomy and comfortable, and not too high off the ground. If you are one who will be discharged to the rehabilitation facility, then you will be transported via a wheel chair van or ambulance. Your rehabilitation and nursing care will be provided by the rehabilitation facility. You will also be assigned to an internist at that facility. Dr. Aram can assist with your rehabilitation while you are there, but he won't be able to visit you. In most case, you are there for about two weeks.

Your Recovery at Home
While at home, you will continue with the physical therapist three times a week for two weeks for postoperative exercises. A nurse will also visit you twice a week to assess your incision, review your medications, and draw blood for any necessary test. There is an impervious dressing over your incision so you can shower if the site where the drain was pulled is dry. Once you are comfortable with your new hip, you can drive a car, return to sedentary work, and participate in light non-contact sports. In most case, this is usually at two weeks. You have a follow up appointment with Dr. Aram at two weeks after surgery. At that visit, your hip will be assessed for range of motion, strength, and stability. An X-ray will be taken to assess the implant and to show you what your new joint looks like! A laminated identification card with your implant will be given to you. This will help you at the airport, courtroom, and wherever metal detector is used. Dr. Aram will see you periodically to assess your joint for the remainder of your life.