Total hip replacement - College of Occupational Therapists

Introduction
other members of the multidisciplinary team. This will commonly include information
on any hip precaution protocols in place to reduce the risk of dislocation. With the
advance of technology there is also the opportunity to consider other options, which
could increase service user choice about how they access information, such as websites/
mobile apps or digital television.
Empowering the service user to take responsibility for their own health management is
important, as it is believed that ‘expert service users’ will be more involved in their care
and outcomes, leading to increased reablement following surgery.
The service user story:
“I was very impressed with the support I received from the occupational therapists
when I was in hospital in January 2011. From the outset, their approach was pro- active
and very soon after arriving at the hospital there was a group meeting with a member
of the department. The purpose of this was to prepare us (pre- operation) for the
pitfalls (post- operation) and how to avoid these. The do’s and don’ts were explained
to us, we were shown how to dress, what aids we would have and how these could be
used. This meeting helped to relieve anxiety and allowed us to prepare both mentally
and physically for how we could cope post- operation. After hip surgery there were
further individual meetings with occupational therapists, where I had to demonstrate
my ability to dress as taught. I was also taken to the ‘home area’, to be shown how
best I should move around the kitchen once home. After this demonstration, I was
then observed putting this into practice. Before my discharge from hospital I had also
to demonstrate that I could manage stairs using sticks/crutches as I had been taught.
All the aids to support me at home had been supplied prior to my stay in hospital.
However, the commodes had not been adjusted/fitted. In the hospital, my partner was
given a very helpful demonstration by the occupational therapist so that he was able
to adjust the equipment to suit me for my return home. All in all, I had an excellent
experience as a patient at the Golden Jubilee and I am very grateful for the part the
occupational therapists played in that experience. What impressed me most was the
team- work displayed not only with the occupational therapy dept., but across all the
departments/groups involved in my care. Nurses, surgical team, doctors, occupational
therapists, physiotherapists, auxiliaries, cleaning staff – everyone seemed to know what
part he/she had to play, when it was to be played and how in terms of patient care. This
close working together made for efficiency and a high standard of care – all of which
reduced anxiety for me and made me feel confident about my outcomes postoperation.
. . .Forgot to say how useful the brochure ‘Patient Guide to Hips’ was in
preparing me pre and post- surgery. Practised exercises pre- op, which made it easier
post- op.”
Golden Jubilee National Hospital service user feedback
Hip precautions, which are restrictions on range of movement and activities undertaken
by the service user, were traditionally implemented as a preventative measure. The aim
was to reduce the likelihood of dislocation by facilitating the healing of soft tissues
surrounding the replaced hip (Restrepo et al 2011).
Variations exist in practice; some services now have no routine hip precautions, but
where they exist, these generally advise not to flex the hip beyond 90 degrees, and to
avoid adduction and rotation of the hip. Risk of dislocation can be influenced by factors
such as surgical approach, and whether surgery is completed electively or post- trauma.
College of Occupational Therapists
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