In the Hospital

5. Admission to Hospital
On the day of your operation you will check into the hospital at the reception desk at the time given to you during your pre-op visit. This time is dependant on the time your operation is scheduled. Again, you will be directed to the admitting office to complete registration, then will be escorted to the AM Admission pre-op unit. Your family may accompany you to this unit. While in the pre-op unit an I.V. will be started by the I.V. therapist. Your family can remain with you until you are taken to surgery and then they will be directed to the waiting room close to the surgery suite. If you are from out of town and you are the first case of the day, the hospital extends the invitation to be admitted at 8:00pm the night before your surgery.

6. Just Prior to Surgery
If you are the first case, you will be taken to the pre-op holding area in surgery at approximately 6:30am. If you are a second or later case, you will be taken there approximately one hour prior to your scheduled surgery. Your surgeon will see you there to answer any last minute questions. You will also be seen by the anesthesiologist. The type of anesthetic to be used is a joint decision between yourself, your surgeon and your anesthesiologist. Usually a spinal anesthetic is recommended in addition to a light, general anesthetic. This type of spinal anesthesia is advantageous because it decreases blood loss at the time of surgery and also decreases the chance of clots forming in the large veins. It numbs your from the waist down, so the amount of general anesthesia required is much less. In addition, pain mediation is also given in the spinal that will last approximately 18 hours. This allows you to awaken after surgery free of pain. A general anesthetic is required because the surgery must be done with you lying on your side and a tube must be placed into your throat to breathe for you during the procedure. A spinal anesthetic alone is not recommended for hip surgery. The advantage of this combined technique of general and spinal anesthesia is that the amount of general anesthesia required is significantly less and upon emergence from general anesthesia, there are less breathing difficulties and usually no pain.

7. In The Operating Room
After you have been seen by the operating room nurse and the anesthesiologist, you will be taken to the operating room. After induction of anesthesia you will be turned on your side and the leg and hip will be prepared with sterilizing solution and the surgical drapes applied. The surgery itself takes between three and five hours depending upon the complexity of the surgery. Counting the time for insertion of lines, positioning, and emergence from anesthesia, this usually represents a total time of four to six hours.

8. Immediately After Surgery
After surgery, you will be taken to the recovery room where you will gradually become more and more awake. The usual stay in the recovery room is two hours. Occasionally this is longer due to excessive bleeding into the drain. While you are in the recovery room, that blood can be recycled to you. From there, you will either go to the orthopaedic floor or to the intensive care unit (ICU). Occasionally r one or two days is required in the intensive care unit either because of blood loss, pre-existing medical problems such as heart or lung disease.

When you are fully awake, you will be aware of the fact that you have a dressing on your leg from the thigh to the knee. Coming out of the dressing, will be one or more drains which will be left in place for two to four days. you will also have pneumatic compression stockings on both legs that have been applied after the induction of anesthesia but before the start of surgery. They help to prevent blood clots in the leg. you will also have a blue triangular foam pillow between the legs with each leg strapped to the pillow. This will avoid unwanted movements of the leg in the early postoperative period that might result in dislocation of the hip. After the first 24 hours, the opposite leg may be unfastened from the blue pillow to allow increased mobility in bed.

9. The Post Operative Hospital Stay
On the first postoperative day, the physiotherapist will help you out of bed and you will stand at the bedside for a few moments. If you feel up to it, several steps may be attempted only touching the foot down to the floor on the operative leg. The therapist will also instruct you on certain exercises to perform in bed. To prevent problems with the lungs postoperatively you will be given an "incentive spiromster", an exercise machine for your lungs, which you should use at least once an hour while you are awake in the first 24 to 36 hours after surgery. This helps you to reinflate your lungs and avoid pneumonia. On the second postoperative day you will begin walking, using a walker only touching the foot down on the operated leg. Each day you will progress farther and you will begin to work on getting in and out of bed by yourself, sitting in a chair and arising and using the bathroom.

10. Re-Learning Activities of Daily Living
Initially, after surgery you will most likely have a catheter in your bladder so that urination will not be a problem. After this is removed, you will need either a bedpan or use of the bathroom with an elevated toilet seat. Occasionally, a bedside commode will be necessary. By the end of six to eight days, you usually will become independent getting in and out of bed, using the bathroom and performing routine activities of daily living. In addition to the physical therapist, and occupational therapist, the nursing staff will work with you on these functions. The key to going home is being functionally independent, having a dry, well healing wound with no temperature elevation and adequate pain control using oral medication. If you are unable to achieve independence in the activities of daily living in that time frame, or if you have insufficient help at home (see below), you may require a short term stay in a rehabilitation unit at a convalescent home for additional therapy.