BIRMINGHAM HIP Resurfacing Surgery
HIP RESURFACING PRE-OP AND SURGERY DAY
Once you and your orthopedic surgeon decide that Birmingham hip resurfacing is right for you, the days and weeks leading up to surgery, as well as the day of surgery, require preparation. The following is a description of what you may expect.
Pre-operative Procedure
You and your orthopedic surgeon may participate in an initial surgical consultation. This appointment may include pre-operative X-rays, a complete medical and surgical history, physical examination, and a comprehensive list of medications and allergies. During this visit, your orthopedic surgeon will likely review the procedure and answer any questions.
Your orthopedic surgeon may require that you have a complete physical examination by your internist or family physician, as you will need to be cleared medically before undergoing this procedure. Your surgeon may suggest that you consider donating your own blood to save in case you require it during surgery or in the event of a post-operative blood transfusion.
Preparation for the Hospital
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You may want to bring the following items to the hospital:
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Clothing underwear, socks, t-shirts, exercise shorts for rehabilitation
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Footwear walking or tennis shoes for rehab, slippers for hospital room
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Walking aids walker, cane, wheelchair, or crutches if used prior to surgery
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Insurance information
Before Surgery, You Should Adhere to the Following:
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You should follow your regular diet on the day before your surgery.
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DO NOT EAT OR DRINK AFTER MIDNIGHT the night before surgery.
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On the morning of surgery, you may brush your teeth and rinse your mouth, but do not swallow any water.
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Follow your doctor's instructions regarding use of medication in the days leading to surgery. In some cases, a blood thinner may be ordered a few days before surgery. Generally, aspirin and non-steroidal anti-inflammatory medications should not be taken seven days prior to surgery.
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Try to get long, restful nights of sleep. A sleeping medication may be ordered the evening before surgery.
Day of Surgery
On the morning of surgery, once you are admitted to the hospital, you will be taken to the appropriate pre-surgical area where the nursing staff will take your vital signs, start intravenous (IV) fluids, and administer medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, etc. (Rings not removed will be taped.) Once you change into a hospital gown, you will be placed on a stretcher, and transported to the operating room. The anesthesiologist will meet you and review the medications and procedures to be used during surgery.
Surgery and Recovery
When surgery is completed, you will be taken to the recovery room for a period of close observation. Your blood pressure, heart rate, respiration, and body temperature will be closely monitored by the recovery room staff. Special attention will be given to your circulation and sensation in your feet and legs. When you awaken and your condition is stabilized, you will be transferred to your room.
Although the protocols may vary from hospital to hospital, you may awaken to some or all of the following:
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A large dressing may have been applied to the surgical area.
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You may see a hemovac suction container with tubes leading directly into the surgical area. This device allows the nurses to measure and record the amount of drainage from the wound following surgery.
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An IV will continue post-operatively in order to provide adequate fluids. The IV may also be used for administration of antibiotics or other medications.
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A catheter may have been inserted into your bladder as the side effects of medication often make it difficult to urinate.
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An elastic hose may be applied to decrease the risk of deep vein thrombosis (DVT). A compression device may also be applied to your feet to further prevent DVT.
- A patient-controlled analgesia (PCA) device may be connected to your IV, allowing you to control the relative amount and frequency of pain medication. To prevent overdose, the unit is programmed to deliver a pre-defined amount of pain medication anytime you press the button of the machine.
HIP REHABILITATION AFTER SURGERY
One of the critical success factors for a positive outcome is following the physical rehabilitation process. In order to help achieve the goals for a successful hip resurfacing procedure, you must actively participate in the rehab process and work diligently on your own, as well as with the physical therapists, to achieve optimal results.
Early Rehabilitation
Your recovery program usually begins the day after surgery. The rehabilitation team will work together to provide the care and encouragement needed during the first few days after surgery.
You may be given a device called an incentive spirometer that you inhale and exhale into. It measures your lung capacity and assists you in taking deep breaths. These exercises reduce the collection of fluid in the lungs after surgery, preventing the risk of pneumonia. Coughing is an effective tool for loosening any congestion that may build in the lungs following surgery.
The physical therapist will begin as early as 1-2 days after surgery. They will teach you some simple exercises to be done in bed that will strengthen the muscles in the hip and lower extremity. These exercises may include:
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Gluteal Sets Tighten and relax the buttock muscles.
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Quadricep Sets Tighten and relax the thigh muscles.
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Ankle Pumps Flex and extend the ankles.
Your physical therapist will also teach you proper techniques to perform such simple tasks as:
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Moving up and down in bed.
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Going from lying to sitting. Going from sitting to standing.
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Going from standing to sitting.
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Going from sitting to lying.
Although these are simple activities, you must learn to do them safely so that the hip does not dislocate or suffer other injury.
Another important goal for early physical therapy is for you to learn to walk safely with an appropriate assistive device (usually a walker or crutches). Your surgeon will determine how much weight you can bear on your new hip, and your therapist will teach you the proper techniques for walking on level surfaces and stairs with the assistive device. Improper use of the assistive device raises the chance for accident or injury.
The occupational therapist will also visit with you to teach you how to perform activities of daily living safely. They will provide you with a list of hip precautions which are designed to protect your new hip during the first 8-12 weeks following surgery.
Precautions
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Do not bend forward to reach your feet. You must maintain a 90 degree angle between your torso and legs.
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Do not lift your knee higher than your hip on the operated side.
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Do not cross your legs.
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Do not allow your legs to internally rotate (feet turned in).
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Do not twist while lying or standing.
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Sleep on your back with a pillow between your knees to prevent crossing.
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Strictly observe your weight bearing precautions during standing or walking.
Also, the occupational therapist will instruct you in the proper use of various long-handled devices for activities of daily living. These devices may include the following:
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A reacher to dress and pick things up from the floor.
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A sock-aid that will assist in putting on socks.
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A long-handled sponge to wash your legs and feet.
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A leg-lifting device to move the operated leg in and out of the car or bed.
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An elevated toilet seat so that you don't violate your hip precautions when using the bathroom.
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An elevated bathtub chair to fit in the shower or tub.
At Home
Following surgery, a physical therapist may help you with your rehabilitation protocol. In addition to the exercises done with the therapist, you should continue to work on the hip exercises in your free time. It is also important to continue to walk on a regular basis to further strengthen your hip muscles. An exercise and walking program helps to enhance your recovery from surgery and helps make activities of daily living easier to manage.
While at home, you will continue to walk with the assistive device unless directed by your surgeon to discontinue use. You must also remember to strictly follow the hip precautions and weight bearing instructions during the first few months following surgery. It is recommended that you not drive unless you have been approved by your doctor.
Life After Hip Resurfacing Surgery
After you have completed your hip rehabilitation, you should experience improved range of motion and have strength in your hip to return to most everyday activities. Below are a few warnings to keep in mind after your hip resurfacing surgery. Remember to listen to what your body tells you. If you begin to have pain or swelling, contact your physician for advice.
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Take care to protect your new hip from too much stress and follow your surgeon's instructions regarding activity level.
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Do not perform high impact activities such as running and jumping during the first year following your surgery to allow your hip bones to heal properly. While that same study of 2,385 BIRMINGHAM HIP resurfacing patients found that less than one-half of one-percent of patients experienced a femoral neck fracture in the first five years after surgery, the average time this fracture took place was just two and a half months after their surgery. Other studies have shown a fracture rate of up to 1.4 percent.
- Early device failure, such as breakage or loosening, may occur if you do not follow your surgeon's limitations on activity level. Early failure may occur if you do not protect your hip from overloading due to activity level or fail to control your body weight. Accidents such as falls may also cause early device failure.
PREVENTING BIRMINGHAP HIP RESURFACING COMPLICATIONS
As with any major surgical procedure, post-operative complications can occur following hip resurfacing surgery. Below is a list of some of the more common complications that can occur after hip resurfacing surgery. This list is not meant to be all-inclusive.
Thromboembolism
This condition, which includes two interrelated conditions-deep vein thrombosis and pulmonary embolism-occurs when blood clots are formed in the large veins of the legs. In some cases, these clots can become dislodged from the veins, travel through the circulatory system, and become stuck in the critical arteries of the lungs. This scenario, called a pulmonary embolism, is a serious medical condition.
The following steps may be taken by you and your physician to avoid or prevent thrombois:
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Blood-thinning medication (anticoagulants, aspirin)
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Elastic stockings (TED hose)
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Foot elevation to prevent swelling
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Foot and ankle exercises to optimize blood flow.
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Pneumatic devices placed on the feet to improve circulation.
IMPORTANT: If you develop swelling, redness, pain and/or tenderness in the calf muscle, report these symptoms immediately to your physician.
Infection
Infections occur in a small percentage of patients undergoing hip resurfacing surgery. Unfortunately, infections can occur even when every effort is made to prevent them.
The following steps may help to minimize the risk of post-operative infections:
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Closely monitor the incision and immediately report signs of redness, swelling, tenderness, drainage, foul odor, increasing pain or persistent fever.
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Always wash your hands before and after handling your incision site, especially when the sutures are still in place.
Pneumonia
A possible side effect of surgery is the development of pneumonia.
The following steps may help minimize this risk:
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Deep breathing exercises A simple analogy to illustrate proper deep breathing is to: "smell the roses...and blow out the candles." In other words, inhale slowly and deeply through your nose, and exhale slowly through your mouth at a slow and controlled rate. A simple rule of thumb may be to perform these deep breathing exercises 8-10 times every waking hour.
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Coughing This activity helps to loosen the secretions in your lungs and excrete them from your pulmonary system.
- Incentive spirometer This simple device provides visual feedback while performing deep breathing exercises. Your nurse or respiratory therapist will demonstrate the proper technique.
Since the BIRMINGHAM HIP Resurfacing implant is new in the United States, is it clinically proven? While the BIRMINGHAM HIP Resurfacing implant is new to the United States, it is not a new implant or technique. It has been in use worldwide since 1997, and the US Food and Drug Administration reviewed a tremendous amount of resulting clinical data before approving it for use in this country.
Who is a candidate for the BIRMINGHAM HIP Resurfacing System? The typical patient will be physically active, under 60 years of age, and suffering from hip arthritis, hip dysplasia or avascular necrosis of the hip. The implant can be used in patients over 60 whose bone quality is strong enough to support the implant. Your surgeon will make the determination if you are a candidate for hip resurfacing.
How long will the BIRMINGHAM HIP Resurfacing implant last? It is impossible to say how long your implant will last because so many factors play into the lifespan of an implant. In the case of resurfacing, for instance, the metal-on-metal bearing surfaces of your new joint may extend its life longer than that of a traditional total hip replacement, but failure to comply with your physical rehabilitation regime may cause your implant to fail within months. A clinical study showed the BIRMINGHAM HIP Resurfacing implant had a survivorship of 98.4 percent at the five-year mark, which is comparable with the survivorship of a traditional total hip replacement in the under-60 age group.
How long will my scar be? Your surgeon will use an incision of between six and eight inches in length. While some surgeons may use a slightly smaller incision, most will fall in that range.
What are my physical limitations after surgery? Most surgeons will tell you that after the first year, you can return to whatever physical activity you enjoyed before hip pain limited your mobility. For instance, unlike total hip replacement, you will be able to return to jogging or singles tennis after your first year after surgery. During your first year, more conservative, low-impact activities like walking, swimming and bicycling are recommended for strengthening your femoral neck and the muscles around your resurfaced joint.
How can I receive more information about hip resurfacing and the BIRMINGHAM HIP implant? Ask your surgeon for BIRMINGHAM HIP Resurfacing System patient information.
