Lancashire Teaching Hospitals NHS Foundation Trust Advice on Activities of Daily Living For: Total Hip Replacement or Hemi-arthroplasty This booklet has been designed as a guide, which you can refer to, especially when you are discharged from hospital. Occupational Therapy - Orthopaedics. Professional Support Services. Produced by: Occupational Therapy Review date: January 2011 1
Sources of further information: www.lancsteachinghospitals.nhs.uk www.nhsdirect.nhs.uk www.patient.co.uk [Other sources of information and help e.g. websites, telephone numbers of departments, wards, or specialist nurses] Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of external internet sites. English Please ask if you would like help in understanding this information or need it in a different format 2
Introduction After a hip replacement operation the surrounding muscles and tissues take some time to heal. To avoid the risk of your hip replacement dislocating it is recommended that you follow hip precautions. These are outlined in this book. The hip precautions last for 6 to 12 weeks after your operation (unless otherwise advised by your Consultant). After the operation you will need to alter the way in which you perform some of your daily activities. You may also need help from other people to complete your daily tasks. During your hospital stay the Occupational Therapist will provide you with advice on the safest way to carry out your every day tasks. You, your relatives or friends, may be asked to complete a form. This form asks for the heights of your bed, chair and toilet at home. This information is to help the Occupational Therapist to decide if you will need any assistive equipment at home. 3
Your bed Your bed should be high enough for you to get in and out of easily without the risk of you dislocating your hip. When you sit on the side of your bed, with your feet on the floor, your bottom should be higher than your knees. Getting into and out of bed You should get into bed leading with your un-operated leg. You should get out of bed leading with your operated leg. When getting into and out of bed remember to keep your operated leg straight out in front of you. Push up from the bed (mattress) with your hands and take your weight through your un-operated leg. As far as possible do not allow your legs to move too far away from each other while getting into and out of bed. When getting into and out of bed fold your bedclothes to one side rather than down the bed. It will be easier for you to manage this way and will avoid you having to bend your hip beyond 90 degrees to reach your covers. You may also need some help to re-organise your bedroom to ensure you can get into and out of your bed as described. Sleeping Sleep on your back, not on either side. Put a pillow between your legs so that your hips are kept in a good position while you are asleep. 4
Dressing and Personal Hygiene Dressing When you are getting dressed it is best to sit on your bed with your feet on the floor. Have your clothes and dressing equipment, e.g. long handled helping hand, on the bed at your side. Dress your operated leg first and undress it last. Sit up straight, use your long handled helping hand to put on your knickers, underpants, shorts or trousers, as demonstrated by the Occupational Therapist. Remember not to bend down and do not bring either foot up towards you. To put your socks/stockings or tights on you should use a sock or tights gutter. Skirts should be put on over your head; you should avoid twisting when you do this. The most suitable type of shoes/slippers for you to wear is well fitting, slip on, low-heeled ones with backs. Use a long handled shoehorn to assist you to put on your shoes/slippers. When using the long handled shoehorn keep your foot and knee pointing forwards. Bring the shoehorn round to the back of your heel, approaching from the outside of your leg. When getting dressed please remember not to twist round to pick up objects from behind you whilst sitting. Do not bend forward to an extent that the angle between your body and your legs is less than 90 degrees. Undressing When you are getting un-dressed it is also best to sit on your bed with your feet on the floor. Undress your operated leg last. Use the rubber end of the long handled helping hand to push down your trousers and underwear. Use the pincers of the helping hand to pick the clothes up off the floor. When undressing, again please remember not to twist round to pick up objects from behind you. Do not bend forward to an extent that the angle between your body and your legs is less than 90 degrees. 5
Personal Hygiene You are advised not to step over into or to sit down in the bath for at least 12 weeks following your hip replacement. Use a stool or chair of a suitable height placed in front of the washbasin so that you can sit to have a wash. The Occupational Therapist will advise you how high your chair or stool needs to be. You may need assistance to position your chair. Be careful not to twist when you are having a wash. You can use a long handled brush to wash your back. Change hands when using it in order that you do not twist when reaching to the lowest part of your back. To wash below your knees you can also use a long handled brush. Again do not bend forward to an extent that the angle between your body and your legs is less than 90 degrees. If you have a walk-in shower and can use it safely you may do so. To avoid slipping, you can put a rubber mat on the shower cubicle floor. Do not twist when using the shower. Do not bend over too far at your hips when washing your hair. You may find it easier to have help with personal hygiene discuss this with your family or the nursing staff/occupational Therapist in the hospital. Toilet If your toilet is too low, the Occupational Therapist will assess you for a raised toilet seat and toilet frame. 6
Household Activities In the Kitchen It may be helpful to make some preparations prior to your operation. It is a good idea to stock up your freezer/store cupboards with easy to prepare, convenience foods, which only need heating through when they are required. Bring out any pans or dishes from high/low cupboards that you will need and keep them to hand on the worktops. If possible, slide objects along the worktops rather than carrying them but do not twist when doing this. Use the top shelves in the fridge to avoid bending. Plan to use the top of the cooker, the grill or microwave rather than using the oven, if it is low. Remember do not stand for too long, do not over reach and do not twist. It may be a good idea for you to have a stool or chair of suitable height in your kitchen to use when you are preparing food. You will need to ensure that your stool/chair does not cause you to trip up over its legs or hamper your ability to walk around your kitchen. You may need assistance to position a stool or chair. Do not kneel down. Do not bend forward from the hips to pick an object from the floor. 7
Eating and Drinking After the operation you will be using two crutches or walking sticks when walking so you will not have your hands free to carry things. If you have to carry food, a bag with a shoulder strap can be very useful. Put the strap over your head bringing it across your body, allowing the bag to sit at the opposite hip to your replaced hip. Then food and drink, in suitable containers, can be placed in your bag and carried safely. Hot drinks can be made and stored in a flask. It is easier to transport liquids in a flask than in a cup. It is a good idea to stand the flask in the sink when you are filling it with hot liquid in case of spillage. Domestic Tasks Ask a friend or relative to change your bed and load/unload the washing machine for you. You will also need help with the ironing. If you have no one who can help you, Social Services can advise you on what care is available. Talk to the Occupational Therapist or one of the nurses about what help you will need whilst you are in hospital. 8
Functional Mobility Sitting It is important to sit in a chair, which has arms, and is not too low. A chair is better than a settee as you have two chair arms, which you can push up on. Try to have your bottom higher than your knees when you are sitting in a chair. It may be necessary to have your chair raised if it is not high enough, sometimes adding an extra cushion to your chair may suffice. When sitting down step backwards to the chair, (using your walking equipment), until you can feel the chair on the back of your legs. If you are using elbow crutches take your arms out of them before you attempt to sit down. Feel for the arms of the chair with your hands. When sitting down slip your operated leg out in front of you. Gently lower yourself by bending your knees and taking your weight evenly through the arms of your chair and your un-operated leg. Standing Before you attempt to stand up make sure that you have your walking equipment near to hand. When standing up from a chair slip your operated leg out in front of you on the floor. Take your weight through your un-operated leg and arms. Push up using the arms of the chair. Once standing, place your arms into your elbow crutches or take hold of whatever walking equipment you are using. Stand with both feet facing forward so that you are not twisting at your hips. Walking The physiotherapist will advise you on how to walk and will prescribe the most suitable walking equipment for you. 9
Stairs When going up steps or stairs, always step up with your un-operated leg first. This means that your un-operated leg bears your weight while you move from one step to another. Coming down steps or stairs, always step down with your operated leg first. This means that your un-operated leg bears your weight while you transfer from one step to another. 10
Driving If you drive, you are legally obliged to notify your insurance company that you are having or have had a hip replacement operation carried out. You will not be able to drive for approximately 12 weeks after your operation or as directed by your Consultant. If you are aged over 70 you should also inform the DVLA that you are having a hip replaced. This allows them to add it to your records. You are also advised to avoid, as far as possible, travelling in a car as a passenger for the first few weeks after you operation. Getting into and out of a car as a Passenger When you are getting into a car as a passenger ask the driver to park the car away from the pavement. This allows you to approach the passenger seat on the same level as the tyres. If you access the passenger seat from the pavement level it could cause you to over flex at your hips. With fabric-covered car seats you can lower the friction on the seat (the resistance when you slide into the seat) by placing, for example, a piece of plastic or nylon over the seat to allow you to slip into it more easily. Have the passenger seat pushed back as far as possible. Back up to the car using your walking equipment until you can feel the car behind your legs. Put your hands on the car doorframe for support. Avoid twisting! Slip your operated leg out in front of you while you lower yourself onto the passenger seat. Slide your bottom straight back until it is near the driver s seat. Bring both your legs into the car together, keeping your head and operated leg in line with one another. You may need a little help with this. To get out of the car, reverse the procedure ensuring that you avoid twisting or over flexing at your hips whilst exiting the car. 11
Public Transport If possible avoid using public transport for the first 12 weeks after your operation. Trains and buses can have high steps and narrow seats and often have an uneven ride. If you have to use public transport, negotiate steps on and off as stairs and try to sit on the seats designed for elderly or disabled people with your back well supported. Tell the bus driver that you have had a recent hip replacement and that you need to be seated before the vehicle pulls away. If you wish to travel in an aircraft you should ask your Consultant for advice. 12
General Activities Mail You can use your long handled helping hand to pick your mail up off the floor. Milk If you have milk delivered, ask your milkman to leave it in a higher place to avoid you having to bending down. You can carry your milk bottles in from the door in your shoulder bag. Pets If you have a dog it will be very pleased to see you when you arrive home from hospital, so be prepared! Try to sit down first before the dog comes to welcome you. If possible have the dog approach you on your un-operated side. Always be careful that your pet does not catch you off balance and cause you to trip over it when you are walking around. Also, with cats and dogs avoid bending down to pet them or to put down or pick up feeding bowls. If possible ask someone to put your pet s food and water bowls onto the floor for you. If you need to do this task by yourself, try placing the bowls in the lower edge of an upturned cardboard box; the type of box in which lettuces are delivered to shops, long and low. Then lower the box to the floor with the bowl inside. Long handled dustpans can also be used for this task. Use a long handled brush to move the bowl in and out of the box edge. In addition, there are long handled dog and cat feeders available commercially. 13
Additional Information Forward plan! Think about how you will cope when you come home from hospital after your operation. Make some changes now before you come into hospital. After your operation you will be walking with two crutches or sticks. It is a good idea to have a look around your home and think about moving furniture/objects that might be in the way. It is a good idea to try and do this before you come into hospital. Also remember to remove or tape down loose rugs or pedestal mats to avoid tripping over them. Notes 14