Hip Fracture Instruction Sheet

Dr. Solberg’s Office Number is 213-455-8448. This information should be useful after your hip surgery. Please read this information carefully. You will receive further instructions at your next visit.

Expect to stay in the hospital about 4-7 days. For the first 2 days, you will receive pain medication through your intravenous tubing. The side effects of narcotics are numerous, and most of them are fairly mild. They include itching, nausea and sleepiness. These are common and are not allergic reactions which produce hives and tongue swelling.

You may have a small drain in your leg to evacuate the blood that collects around the implant. The bandage will be changed and the drain removed on the second day after surgery. You will be switched to oral pain medication on the second day after surgery as well. If this does not control your pain adequately, you may ask for stronger pain medication. About two-thirds of patients will go to a short term rehabilitation facility after leaving the hospital. Most of the time a determination is made after 2 or 3 days as to whether you will be able to go home or to a rehab facility. This decision is made based on a number of factors including amount of support at home and progress while in the hospital. Most people stay at rehab between 1-2 weeks.

You should expect some swelling in the foot on the affected side, you will also have some bruising which may track down to your foot. This is normal. Expect this swelling to persist for several months and it resolves slowly, so don’t be impatient in waiting for the swelling in your foot to subside. This is normal and is not due to some additional injury. For most people, I recommend using a compressive stocking such as T.E.D. hose to help control the swelling. You should put the stocking on first thing in the morning and take it off at the end of the day. This can make noticable difference in swelling and I encourage my patients to start using compressive stockings as soon as they are out of the cast and have their stitches out. I’ve included a link to the TED hose web site below www.tedhose.com.

The muscles which pull your leg out to the side will be the weakest after surgery. They will also take the longest to gain their strength back. You should do side leg raises as instructed by your therapist at least twice a day and more if you can tolerate.

After discharge from the hospital, you should sleep with at least 1 pillow between you legs. It is OK to sleep on your side or you stomach, but you should avoid bending your hips up. Avoid sleeping in the fetal position.

You will start physical therapy while you are still in the hospital and continue after your discharge from the hospital. Although each patient’s therapy program is individually tailored to their ability, the basic goals are the same and most therapists recommend a set of exercises that rehabilitate the muscles and tissues around the hip to allow you to walk normally. This is a slow process that takes months to accomplish, so don’t be in too much of a hurry. I have included a link below from the University of Utah which reviews the basic exercises and protocol for hip replacement rehab. I think it is useful and I would encourage my patients to do many of the exercises on their own in between visits from the physical therapist Physical Therapy Exercises Link any patients have restrictions on weight bearing (the amount of weight the leg can support) after their surgery. In many instances I only allow patients to put 10-20 lbs of pressure on the involved leg for a period of about 6 weeks after surgery. The reason in doing this is to protect the fixation and prevent falling and loosening the repair. For many older patients it is very difficult for them to judge how much pressure they are putting on the leg. When this happens I recommend bed to chair transfers only to prevent the patients for accidentally stepping with their full weight on the involved leg. Pool therapy is really useful in this circumstance because it allows the individual to put some weight on their leg and begin the coordinated movement of walking without putting a lot of stress on their repair. I recommend patients stand in chest deep water and walk around the edge of the pool to hold on to the side rail. I think doing this 3-4 times a week really helps to rehabilitate the muscles in the hip and leg in preparation for full weight bearing. I recommend patients begin pool exercises after about 2 weeks (once the incision is completely sealed). Although having a individual therapist is definitely beneficial, its not necessary every time you go to the pool.

Pool-Therapy

Take your pain medication as directed by your prescription. Do not wait until the pain is intolerable to take the medication. It will take between 30-60 minutes to begin working, so take it accordingly. When you begin doing more therapy and exercises, your pain level may increase, this is perfectly normal. Rather than increasing your dose of narcotic, I recommend you can combine it with Advil or Aleve. Over the counter Advil or Aleve work as well as prescription medication and can be taken safely in conjunction with your prescription. If you want to combine you prescription with Advil or Motrin, take 3 tablets (600 mg) three times a day, if you are using Aleve (naproxen) take two tablets (440 mg) twice a day. Make sure you take these medications with food to avoid stomach upset. Make sure you check with me before doing this because many patients are on blood thinners for the first two weeks after surgery and the Aleve or Advil can interact with the blood thinner and cause problems.. Keep your incision dry, you can wrap your leg with saran wrap to keep it dry during showers. Once the oozing has stopped, leave the bandages off.

You will be on a medication called Lovenox after the surgery. This medicine keeps you from getting blood clots in the leg which is the single most common complication after surgery. Unfortunately, blood clots are difficult to detect and if not treated can lead to serious complications and even death. Because of this, it’s very important that you take your blood thinner every day. The medication is injected once a day and the nursing staff will instruct you or your family members on how to adminster the medication prior to leaving the hospital.

Try to be patient with your progress. Most patients have a fairly slow recovery taking 6-8 months just to return to their baseline level of function. Most patients are afraid of falling again and many continue to use a walker permanently after surgery. Walking is the best exercise you can do.

Call Dr. Solberg’s Office if you notice any of the following symptoms.

You may be connected with an associate if you are calling in the evening hours. Have your discharge orders and description of your procedure available.

  • Temperature over 101° Fahrenheit
  • Numbness in the foot
  • Increasing, severe pain in the hip
  • Increasing redness around the incisions
  • Markedly increased swelling in the leg

You have been prescribed pain medication which has a number of side effects. Most common are drowsiness, nausea and or vomiting, itching, constipation and irritability. If these are prolonged or severe, your pain medication may need to be changed. You must contact our office during business hours to have a new prescription written or a prescription refilled. After hours (after 5:00 pm or weekends), the on call doctor will not give you a refill or a new pain medication prescription.