Dr Bose Post-Op Protocol

Birmingham Hip Resurfacing (India) — A guide to patients

The anesthetist will be seeing you the day prior to the surgery, or earlier if required. Usually a general anesthetic is preferred for BHR due a variety of technical reasons. After the surgery, the patient will be in the recovery room for about 3 hours after which he will be shifted to the wards.

Strict adherence of instructions regarding visitors is mandatory. Only one person who will be known as the primary attendant is allowed inside the patient’s room. Should the patient have any other visitor, the primary attendant will come outside the room to speak to them. The patient’s family must actively discourage visitors for the first 3 post –op days. Only the patient is permitted to eat inside the room.

It is preferable to take only liquids on the day of surgery and progress to a normal diet the following morning. The medical team will give instructions on ‘ankle pump’ exercises. A sterile towel is kept between the dressing and the bed sheet.

1st post – op day

The intravenous fluids are discontinued if patient is taking orally .For the first 48 hours following any surgery; pain is common due to the cutting of tissues. For this pain powerful (narcotic analgesics eg. Tramadol is given). The patient can request the nurse for these injections. These medicines also cause slight dizziness. If the patient feels comfortable, he can start walking with a walker on the first post-op day. If dizzy due to medications, the walking is postponed to the next day. The patient has to do deep breathing exercises, Static quadriceps and gluteal contraction exercises. The last dose of narcotics are given for this night.

2nd post-op day

Usually non-narcotic pain medication like inj. Diclofenac is given on the morning and blood sample taken for hemoglobin estimation. Drains are removed and the wound inspected. Last dose of antibiotic is given and the I/V cannula removed. All medications are changed to the oral formulations.

Typically the following are given: Iron & vit preparation, chymerol forte, oral painkillers like proxyvon and gastro protective agents like pantaprazole. Patient is also fitted with a pair of below knee Ted Stockings. Some patients will receive blood-thinning injections if indicated.

Patient walks with the help of a walker with the assistance of a physiotherapist for short distances. Patient goes to the x-ray dept for check x-rays. One can start lying on the un-operated side with a pillow in-between the thighs (not knees or legs).

Day 3

Patient can walk for longer distances as comfortable. He can also start sitting in a chair with a pillow height. It is important to keep in mind that the capacity of recovery following surgery is very different among individuals. Therefore these milestones are only guidelines and variability is common. Patient continues the exercise programme in bed as per the instruction booklet.

Day 4

Dressing are done again and sticker type dressing ( Curapor or Surgiwear) is done if there is no wound ooze. Patient can start to use the western type toilet and wear normal clothes that are comfortable like pyjamas, lungi, dhoti or baggy shorts. If the surgeon permits a shower is possible with a special (surgiwear swimproof) dressing applied for this purpose From this point on the mobilization programme is variable for each individual patient.  In principle they progress to elbow crutches when the phsyio deems fit.

Day 5

Once they can climb stairs with the help of elbow crutches, they are ready for discharge.

Usually the patient is fit to travel by car taking the front seat. The sitting is accomplished by first sitting on the car seat with the feet on the road and then lifting each leg individually into the car.

Patient from abroad or those who need to take a flight back must keep the following points in mind during the flight.

• To carry a bottle of water to ensure adequate intake of fluids.
• Compulsory wearing of TED stockings during the flight.
• Requesting an aisle seat and taking a few steps in the corridor every half hour.
• To do the ankle pump exercises when seated.

At home

At home they walk with a pair of crutches usually for about 10-15 days and when completely comfortable discard the crutch on the side of the operation first. Then when the other crutch is also felt unnecessary, this is also discarded. Walking, climbing stairs or cycling can be done for long periods of time. Patient reports back to the hospital at about 12 days for removal of skin clips. Outstation patients can get this removed by a doctor locally. A letter to this regard will be given at the time of discharge. The next follow –up visit is at 6 weeks when a check x-ray is repeated. Outstation patient can do this locally and post the x-ray to the doctor. A request for this is also given at the time of discharge. The subsequent compulsory visit to the doctor is at 6 months post-op.

There is no post –op restrictions after a Birmingham Hip Resurfacing operation and the patient can use it as a ‘normal hip’. However the soft tissues around the hip joint, which were contracted at the time of the hip disease, will take time to relax following the excellent movement that has been restored in the hip. Hence if there is pain while attempting a certain activity like sitting on the floor, it implies the patient is not yet ready for that particular activity. One can give a gap of about a week and then try it again. Like wise the activity level improves in a stepwise manner till the soft tissues also become normal. Patient is ready for sports (inclusive of contact sport) at about 3 months post-op.