Total hip replacement - College of Occupational Therapists

Introduction
functional readiness and restricted resources, and the fact that some needs related to
roles and occupations may be more appropriately responded to within the service user’s
usual home environment. It is also anticipated that by empowering service users to
understand principles of safe movement, fatigue management and graded return to
activity, they can as an ‘expert service user’, apply these principles to tasks within their
individual lifestyle, returning to meaningful activity as soon as possible following
surgery.
Assessment prior to surgery provides an opportunity for the service user to discuss their
goals and desired outcomes with the occupational therapist. The timing of that
assessment varies nationally, although the majority of service users awaiting a hip
replacement are usually seen about four weeks prior to surgery (Drummond et al 2012).
The assessment may include discussion of any concerns or anxieties the service user may
have regarding their current functional abilities in relation to self- care, productivity and
leisure, within the context of their roles, occupations and environment. Drummond et al
(2012) identified within a national survey that those daily living activities most
commonly discussed with service users are kitchen activities, bath or shower transfers,
car transfers, strip washing and dressing techniques. Activities most practiced are bed,
chair and toilet transfers, followed by dressing practice. Assessment needs to be
sensitive and mindful of the cognitive functioning of the service user, and delivery of all
stages of intervention adapted accordingly. Goals can then be developed and a
treatment plan jointly agreed.
The home situation is discussed from the perspective that the service user is expert in
this domain and their specific needs and choices. The service user can inform the
occupational therapist about specific heights of their furniture (chair, bed and toilet) so
that equipment may be prescribed to compensate for lack of function, or to enable
activities to be continued while observing hip precautions that restrict certain
movements (should this be required by team protocols). The general layout of the
home, position of bathroom and toilet, and any potential areas of difficulty, such as
steep stairs or difficult access can be identified by the service user and discussed with
the occupational therapist in order to jointly plan agreed intervention. Where an
individual has an established condition and is awaiting elective surgery, they may have
already been provided with equipment to assist them in daily activities. The most
common item prescribed by occupational therapists for service users receiving a primary
total hip replacement is a raised toilet seat, with the other most frequently prescribed
items being chair and bed raisers, perching stools, long- handled reachers and dressing
aids (Drummond et al 2012).
The service user also has an opportunity to discuss issues relating to support which may
be needed on discharge. This can identify if a care package could be beneficial, or
whether they have arranged support from family and friends or private providers.
Equally, some service users may be carers or parents and thus have responsibility for
others. This stage of the intervention may take the form of a discussion with the service
user, completion of a form by the service user/family, or a visit to the service user’s
home.
Education to build on a service user’s current knowledge, address concerns, and provide
an opportunity to discuss what their surgery will involve and how recovery will impact
on their daily lives, is an important element of pre- operative occupational therapy.
Education may be delivered individually or as a group teaching session. Group sessions
may be delivered in a ‘joint school’ incorporating information from the consultant
(regarding the procedure) and anaesthetist, in addition to teaching and facilitation by
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Occupational therapy for adults undergoing total hip replacement