What the Occupational Therapist Said

On to the last section of the Joint Replacement Information Session I attended earlier this month. This is what Christie, the Occupational Therapist (OT), had to say :

The OT is there to help you learn how to manage daily tasks at home - bathing, toileting, sitting, driving, and so on. They can help with training, equipment, setting up your house, and so on.

Hip precautions are set by your surgeon (they vary depending on whether the incision is done from the front or the back of the thigh). At Canberra Hospital they are prescribed for strictly 3 months, no exceptions. And possibly longer (I know of women with hip dysplasia who were given hip restrictions for as long as a year). 3 months is the minimum time for the ligaments that support the hip joint (and were cut / disrupted during surgery), to restabilise and repair.

My surgeon (and most of the Canberra surgeons) use the posterior approach (closer to the back).

Hip Precautions (posterior THR) :

1. The operated leg must not cross the mid-line of the body - not when sleeping, standing, or sitting. No crossed legs!

2. No internal rotation. Do not let the leg turn in towards the mid-line (ie pigeon-toed) - and no twisting of the upper body towards the operated side.

3. Do not bend the operated hip less than 90º - so you can't bend forward for anything. This one has the biggest impact on daily functioning. I won't be able to sit on anything lower than my knees. There are some diagrams here.

Daily tasks

Showering

• Have your toiletries in easy reach, on a shower caddy or shelf. Don't leave shampoo on the floor, for example.
• Use soap on a rope, or liquid soap in a dispenser (tick)
  
• Use a long-handled brush &/or sponge (tick, tick)
  
• Use a shower stool if you're wobbly! (tick) They can be borrowed from the hospital - I got one from Aldi
  
• Not quite sure how to dry my legs yet ... my feet may get very good at grabbing towels for this!
  

Getting Dressed

• Use long-handled aids such as a reacher, grabber (tick x 2), long shoe horn (tick), sock putter-on-ers (tick) etc
• Have the items to put on in easy reach
• A long-handled shoe horn is extremely useful when away from home, as the curved end can be used to hook and grab things that slip out of reach (like undies when in the loo!)

Toileting

• Be very careful how far forward you bend
• Place the toilet paper forward, so you don't have to twist to reach it
• Use an over-loo chair at home for 3 months (will be lent to me from the hospital)
  

As for going to the loo when you're out ... this is a problem! Unfortunately all the disabled toilets I've checked so far have low seats - including the ones at the hospital!


After asking around on Hipwomen, several women mentioned using devices that allow women to wee standing up - I decided on the brilliant (Aussie invention!) Whiz Freedom. I know it only takes care of 'Number Ones' - but it's a great start (and great if you're into camping too!).

Cooking

• Have all equipment at waist height, easy to reach
• Temporarily store your crockery on the bench, or in some higher location

Cleaning and Gardening

Don't do it. Well, you can possibly do a little, with a great deal of caution. But there's to be no vacuuming, sweeping, mopping, digging, weeding, mowing, or raking. Any excuse to drop the housework, and get the kids and hubby to take over!

Work

Most people need 4-6 weeks off work - the main thing if you go back to work within the 3 months, you still need to do your hip precautions. I should be okay, since I work from home, and just so long as my brain is functioning (debatable at times!), I can work on my laptop in bed, or at my desk.

Driving

Driving after a joint replacement is illegal in Canberra for 6 weeks post-surgery. 3 months of no driving is recommended for THR.

As a car passenger : tilt the back of the seat backwards, so the angle is very wide when sitting down.

Setting up the house

• Check what steps & stairs you have to deal with.
• Grab rails in the bathroom can be very helpful. The suction cup sorts are not strong enough!
• Use a toilet seat raise for 3 months
• Low lounge chairs are out - look for more suitable seating around the house - they must be knee height or higher
• Foam wedge cushions are good (tick)
  
• Get in and out of bed on the same side as your operated hip
• Sleep on your back for 4-6 weeks
• Check the house for mats, cords, and ensure you have a clear pathway for your crutches - reduce the risk of tripping and falls!

Goals before admission

• Assess what might be difficult to do at home, so you can get help from the OT
• Organise your home environment
• Buy the small aids you need
• Finish any necessary tasks (pay bills, pre-cook meals, etc)

Walking Aids

After surgery you start out on a forearm support frame, then move to a pick-up frame or a wheelie frame. Finally, crutches and walking sticks, which you'll need for quite some time at home. I've got walking sticks and elbow crutches of my own.

NB : It's normal to get an increase in pain when you go home from hospital, as you're being much more active.

Hip Dislocation

You'll know if it dislocates! Go straight to Casualty (by ambulance if you can't sit up), and get them to call your surgeon - they can fix the joint, pulling it into place, but it will require anaesthetic. Possibly surgery. Urk.


Your Miss Petal photo reward. She's wearing a little jumper I designed for her.