Pre-operative Education for Total Hip Replacement
Your Role — Nurse
Orthopaedic Ward
Your 72-year-old patient is scheduled for a total hip replacement tomorrow morning. This is their first major surgery. The patient has been living with severe osteoarthritis for five years and has not responded to conservative management. You are admitting the patient and completing the pre-operative checklist.
- •Confirm patient's understanding of the surgery and why it is needed. Find out their main concerns about the procedure and recovery.
- •Explain the admission process and pre-operative preparation (nil by mouth from midnight, shower with antiseptic wash, compression stockings for DVT prophylaxis).
- •Describe what to expect on the day of surgery (anaesthetic review, marking of surgical site, transfer to theatre, recovery room). Outline post-operative care (pain management, wound care, drain removal, early mobilisation).
- •Discuss expected hospital stay (typically 3-5 days) and discharge criteria (safe mobilisation, adequate pain control, wound healing). Explain hip precautions (no hip flexion beyond 90 degrees, no crossing legs, no internal rotation — for 6-8 weeks).
- •Find out about social circumstances (support at home, home environment: stairs, bathroom access). Arrange occupational therapy and physiotherapy assessment. Establish patient's consent to proceed.
The Interlocutor
Played by the actor / assessor
You are 72 years old and have severe osteoarthritis in your right hip. You've had pain and stiffness for five years and now struggle to walk more than a few hundred metres. Surgery was recommended after nothing else helped. You are admitted to the ward the night before your total hip replacement.
- •When asked, say you understand you're having a hip replacement but you're very nervous — you've never had an operation before.
- •Say you're worried about the pain after surgery; your neighbour had a knee replacement and said it was very painful.
- •When asked, say you live alone in a two-storey house. The bathroom is upstairs and the kitchen is downstairs. You're not sure how you'll manage when you go home.
- •Say you've heard you need to be careful with your hip afterwards but you're not sure exactly what you can and can't do.
- •Say you feel more reassured now. You understand what will happen tomorrow and you're ready to go ahead.
Sample Role-play
Hello Mrs Patel. I am David one of the orthopaedic nurses. You are scheduled for your hip replacement tomorrow morning. I want to go through everything so you know what to expect. How are you feeling?
Very nervous to be honest. I have never had an operation before. I do not know what to expect.
That is completely natural. Most people feel nervous before their first surgery. Let me walk you through what will happen step by step. Tonight you need to shower with a special antiseptic wash called chlorhexidine. This reduces bacteria on your skin and lowers the risk of infection.
OK. What time is the surgery tomorrow?
You are the second case on the list so expect to go to theatre around mid-morning. From midnight tonight nothing to eat or drink — this is essential for the anaesthetic to be safe. Tomorrow morning the anaesthetist will visit to discuss your options and the surgeon will mark your hip. Then you will go to theatre.
What about the pain afterwards? My neighbour had a knee replacement and said it was terrible.
Pain management has improved significantly. You will receive regular paracetamol and anti-inflammatories plus stronger medication if needed. We also use ice packs to reduce swelling. The most important thing is to tell us if you are in pain. We will ask you regularly using a pain score from zero to ten. Do not try to be brave — good pain control helps you move better and recover faster.
I will tell you if I am in pain. How long will I be in hospital?
Typically three to five days. The goals we need to achieve before discharge are: your pain is controlled with oral medication you can walk safely with your walking aid your wound is healing well and you can manage at home after discharge you will need to follow hip precautions for about six to eight weeks.
What exactly are hip precautions?
Three simple rules to protect your new hip. One do not bend your hip past a right angle — no bending to pick things up from the floor. Two do not cross your legs or ankles. Three do not twist your body — when you turn move your feet first and turn your whole body. The physiotherapist will go through these with you after surgery.
Six to eight weeks is a long time. I live alone. I am worried about managing.
That is a very practical concern and it is excellent you raised it now. I will refer you to occupational therapy who will assess your home and arrange equipment like a raised toilet seat a shower chair and a grabber for picking things up. Some patients also benefit from a short rehabilitation stay before going home.
I would rather go home if I can manage with equipment.
That is reasonable. The therapists will work with you to make that possible. After surgery you will sit out of bed on the same day with help. The physiotherapist will see you the next day to start walking with a frame or crutches. Early mobilisation reduces your risk of blood clots and speeds up recovery.
Walking on the same day? That sounds soon.
Yes just sitting or standing with support initially not walking long distances. Let me summarise. Tonight antiseptic shower and nil by mouth from midnight. Tomorrow surgery then sitting out of bed. In hospital three to five days learning to walk safely. At home follow hip precautions for six to eight weeks. OT will arrange equipment. Any questions?
No you have covered everything. I feel much better prepared. Thank you David.
You are very welcome. The team will take excellent care of you tomorrow. Try to get a good night rest. Rest well tonight Mrs Patel. We will take excellent care of you tomorrow. The team will take excellent care of you. Try to get a good night rest. Get a good night rest and the team will take excellent care of you tomorrow. You are in very safe hands.
Useful Phrases
Clinical Background
Pre-operative education for total hip replacement significantly improves outcomes and reduces anxiety. Key nursing responsibilities: DVT prophylaxis (compression stockings, early mobilisation, anticoagulation), infection prevention (pre-op shower, antibiotic prophylaxis), hip precautions education, and discharge planning. Patients living alone need特别 assessment for home support needs.
Common Mistakes to Avoid
- ✕Minimising the patient's anxiety about surgery — acknowledge it rather than dismissing it.
- ✕Failing to assess social circumstances early — discharge planning should start at admission.
- ✕Overloading with information without checking understanding — use teach-back for hip precautions.