Prepare ahead

The weeks leading up to your operation are as important as the operation day itself.  

After your surgery, you will either return home on the same day, or stay in hospital for just one night. Therefore, you should plan ahead before your surgery and think about how things might be for you when you return home. You must also attend all your appointments before your surgery date.

Arrange for transport

You should arrange for a family member or a friend to collect you after your surgery. The hospital does not routinely provide transport for your return home. 

Assistance for after your surgery

You have probably been living with joint pain for some time before your operation and will already have ways of adapting to certain situations at home. However, when you are recovering from your operation you may also need some extra help with general tasks initially, like cooking, shopping, and cleaning. You must organise this help before your operation date.

To ensure that your return home is successful and safe, you will need to have someone to stay with you overnight post discharge, and for a few days after returning home. This is essential if you are to go home on the day of surgery. 

Care agency support

Very few people require professional care support at home. If your personal choice is to have this help, you must arrange this privately.
The NHS can only provide professional care based on specifically assessed needs and cannot arrange convalescent care.

Prepare your home

Preparing your home environment in advance is really helpful for when you get discharged.

For example, you can:

• Freeze some simple to cook meals or have some ‘ready meals’ on hand.
• Move any regularly used items that are heavy, or out of reach, to more accessible places, such as move the saucepans you use frequently up from any low shelves or cupboards.
• Avoid potential trip hazards by removing any loose rugs or obstacles from the floor such as excess furniture or things that would be easy to trip over.
• Make arrangements for someone to care for any pets including walking dogs after your surgery.

Keep fit and healthy

The fitter you are before your operation, the less likely you are to have complications during and after your surgery.

You should seek to make some lifestyle improvements, such as:

• Reduce alcohol intake.
• Stopping smoking.
• Keeping as mobile as possible and exercising.
• Losing weight.

If you have any long term health conditions, you should aim to control these as well as possible before your operation to help prevent any complications and to avoid your operation being postponed. 

Check your own blood pressure if you are able to do so or get it checked at your GP.  If it is above 160/90 you are likely to require medication and the sooner this is started, the sooner we will be able to go ahead with your surgery. 

Similarly, if you suffer from diabetes and your HbA1c has not been checked for 6 months or was over 69mmol/mol the last time it was checked, please arrange to have this checked again, and work with your diabetic adviser to improve it. It is very unlikely that your surgery will be undertaken if your diabetes is not well controlled and your HbA1c is above this value.

Pre-operative assessment

The pre-operative assessment process is important as it helps the hospital plan your care.

You will be asked by the hospital to provide some information about your general health and current medications. You may be asked to provide this information via:

• A computer or mobile app.
• A telephone consultation.
• A video consultation.
• A face-to-face appointment.

This allows us to inform and advise you about your procedure, for example, we can provide you with instructions about medications and fasting times before your operation. 

What details will be checked?

At your pre-operative assessment appointments, we will check various medical details, such as:

• Your general health status.
• Your blood pressure.
• Your blood count to see if you are anaemic.
• Your kidney functions.
• How well you are controlling your diabetes.

Medicines

We will also review your medicines. It is fine to continue taking most medicines and to take them on the day of your surgery. However, there are certain medications we may need you to stop taking for a few days before your operation, such as:

• Blood thinning / anti-clotting medication.
• Some blood pressure medications.

We will give you clear instructions if this is needed and tell you when you should start these medications again after your surgery.

Ward staff will inform you of the pain relief that your surgical team have prescribed for you when you leave hospital. This discussion will also include advice about paracetamol and ibuprofen, where we advise patients to source their own supplies if they are able to do so, in line with North Bristol NHS Trust Policy.

Do your physiotherapy exercises

The exercises in the Physiotherapy section of this page should be completed both before and after your surgery.  Doing these exercises before your operation will strengthen your muscles and will help you to recover more quickly after surgery.

You will be given a specific time to arrive, depending on the time of your operation.

Eating and drinking before your operation

You must follow the instructions about fasting times. It is important that you follow the fasting instructions correctly or your operation may be cancelled on the day.  You must not have any food or very milky drinks for 6 hours before your surgery.

We encourage you to continue to drink plain water until you arrive at hospital and after your admission this will be provided according to your anaesthetist’s instructions. 

What to bring with you to the hospital

• All your current medication in original packaging.
• Wear loose, comfortable day clothes to get dressed back into after your operation. Your leg may be swollen after your surgery so make sure this is an appropriate size.
• Flat, sturdy footwear with a back in it. No mules or sliders.
• Overnight bag in case you are not ready to return home on the same day.
• Glasses, hearing aids, walking aids, or dressing aids that you might have.
• Phone, charger, headphones, music devices, if you would like to listen to music during your operation.
• It is also a good idea to bring something to read or to keep you occupied in case you have a wait.  Wi-Fi coverage can be variable.
• Contact details of the person who will be picking you up.
• Any letters you receive from the hospital giving you arrival instructions for the day of surgery.

Please try to avoid bringing in a large number of items with you and minimise items of high value or cash.

Arriving at the hospital

When you arrive, you will be greeted by a member of the reception team.  They will book you in and confirm some details with you. You will then be seen by one of the nursing team who will run through some additional questions.

Confirming your consent form

The surgical team will confirm with you the operation that they are planning to perform, and check your consent form. They will use a pen to draw an arrow on the leg that is going to be operated upon. 

They will be able to answer any last-minute questions you may have.

Meeting your anaesthetist

Before your operation, you will meet your anaesthetist. They will explain the type of anaesthetic that is going to be used, and answer any questions you may have about the anaesthetic.

Getting ready for your operation

When it is time for your operation, you will be asked to change into a theatre gown. You will then walk to the operating theatre with one of the team. There, you will be greeted by your anaesthetist, and you will also meet the operating department practitioner, who works with the anaesthetist, helping to look after you.

Routine checks

Some routine checks will be carried out to confirm your identity and to check if you have any allergies.  We will confirm again your operation, and what side you are having it on. 

Attaching monitoring equipment and a drip

One of the team will attach some standard equipment to monitor your heart, blood pressure, and oxygen levels while you are having your anaesthetic and operation.

Your anaesthetist will also be giving you various medicines through a drip in the back of one of your hands. These include antibiotics, anti-sickness medicines and fluids.

Spinal anaesthetic

In most cases, your anaesthetist will give you a spinal anaesthetic. This is very safe, and avoids the need for having a general anaesthetic, which may cause unpleasant side effects.

Spinal anaesthetic also helps you to recover quickly and receive the best post-operative pain relief.

Local anaesthetic is placed around some of the nerves in your lower back. This numbs your pain nerves so that you do not feel pain during the operation. 

The operation

Once you are in the operating theatre, your leg will be painted with some cleaning fluid and then covered with drapes. You will not be able to see the surgery and the spinal block will prevent you from feeling any of the operation.

Some people find listening to music through their headphones to be a good distraction. It helps them to relax, and this will be offered to you. You may wish to bring your own music on your phone or portable music device, and your own headphones. Some people prefer to have a small amount of sedation so that they have a light sleep through their surgery. Your anaesthetist will discuss and agree with you a plan depending on your medical history, and your wishes. 

The operation typically takes about 1.5 hours.  During this time, your observations will be continually monitored by your anaesthetist.

After the operation

At the end of your operation, you will be transferred to the recovery area where the nurses will monitor your observations. You will be encouraged to eat and drink.

When your spinal anaesthetic has sufficiently worn off, you will be assessed by the therapy team. Our nursing and therapy teams will help you get up, stand, and practice walking with suitable walking aids. The team will practice with you getting on and off the bed, chair, toilet and give advice on how to dress. You will be encouraged to get dressed in home “day clothes” with supportive footwear (no mules or sliders).  You will also be taught how to safely complete the stairs. 

In order for you to return home, the team needs to be happy that you can manage these activities at home with walking aids. If you require any equipment to assist you this will be assessed and provided prior to your discharge.  Please bear this in mind when organising your transport home.
 

Returning home

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or if you need to stay overnight with us at the hospital. 

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital. 

Arrange for support at home

If you live alone you will need to arrange for a friend or relative to stay with you overnight, post discharge and for a few days after returning home. You should arrange this before you come in to have your surgery. 

Wound dressing

Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound checked. Please leave any dressings in place and keep as dry as possible until this appointment. 

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle. 

Pain control

Joint replacement surgery is painful – just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild to moderate pain on movement. It is not going to be 100% pain free.

The pain relief package you receive has been specially designed to try and control your pain as well as possible.  It starts from the day of your surgery and continues after your discharge home.  We will give you the same pain relief tablets whether you stay in hospital overnight or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Additional medications

We will be asking you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses. 

What to expect when you get home:

Swelling is common to have some generalised swelling of the leg below your hip replacement. Swelling will often get worse if you sit for prolonged periods, so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and / or afternoon on the bed initially. If you experience increasing swelling and pain, please seek medical advice.

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain relief package. However, please ensure that you take these as prescribed, along with plenty of water to drink. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP. 

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. Please make sure that you follow the pain management programme you were discharged with to help control your pain. 

Sleepless nights: It is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side. 

What to look out for

Deep vein thrombosis (or DVT) Blood clots in the leg can occur after joint replacement surgery. If your leg becomes hard, swollen, hot and painful, especially in the calf area then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.

Infection is very rare. However, if your joint replacement or scar becomes hot, red and / or increasingly swollen or if you feel unwell, then please do seek medical assistance. 

Support after discharge

The Ward team will let you know what arrangements have been made for your follow-up appointments.

Following your discharge from hospital, there is always someone you can contact for advice. 

If you would like more information before your operation or have any questions after you have been discharged home or concerns about your wound, please ring 0117 414 1331 and one of the nursing staff will be able to advise you directly or be able to contact people from your surgical team for you.  

For therapy related queries, please contact Physiotherapy admin 0117 414 4412 or Occupational Therapy admin 0117 414 1272. 
 

Completing the exercises on the following pages will benefit your recovery, improve movement in the hip joint and develop the strength of muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery.

We recommend you continue these exercises for a minimum of 6 weeks post-surgery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Bed exercises 

To watch a video of exercises to do in bed visit: 

Hip replacement - bed Exercises (youtube.com)

Ankle pumps 

Lying on your back, point your toes up and down for the count of ten. Repeat every hour you are awake.
The aim of this exercise is to improve the circulation in the lower limbs, helping to prevent the formation of deep vein thrombosis (blood clots) and reduces swelling.

Knee bracing (static quadriceps)

Lying down on your back with your legs straight.
Pull your ankle up towards you and push the back of your knee down against the bed.
Hold for 5 seconds, then relax.
Repeat 10 times.
The aim of this exercise is to strengthen your thigh muscles ready for standing and walking.

Heel slides (on sliding sheet)

Lying down on your back with your legs straight.  
You will need assistance to place sliding sheet under your heel.  
Bend and straighten your hip and knee by sliding your foot towards your body and then away.
Repeat 5 – 10 times.
The aim of this exercise is to increase your hip movement.

Hip abduction (on sliding sheet)

Lying down on your back with your legs straight.
You will need assistance to place sliding sheet under your heel.
Slide your leg out to the side and back in.
Repeat 5 – 10 times.
Do not bring your leg back over your body’s midline.
The aim of this exercise is to increase your hip movement and strengthen the surrounding muscles to help with walking.

Bridging

Lying down on your back with your knees bent and feet flat on the bed.
Tense your tummy and bottom muscles and lift your bottom up off the bed.
Hold for 5 seconds. 
Repeat 5 – 10 times.
The aim of this exercise is to stabilise your pelvis during walking.

Standing exercises 

To watch a video of exercises to do while standing visit: 

Hip replacement - standing hip exercises (youtube.com)

Hip flexion in standing

Bend your hip and knee up in front of you and lower back down.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your muscles at the front of your hip.

Hip extension in standing

Keep your leg straight and take it behind you.
Try not to bend at the hips or knee.
Try to stand up tall.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom muscles to help with walking.  

Hamstring curl in standing

Lift your foot off the floor behind you, bending your knee.
Try not to bend at the hips.
Repeat 5 – 10 times.
The aim of this exercise is to stretch the muscles at the front of your hip and strengthen your muscle on the back of your leg.

Hip abduction in standing

Keep your leg straight and take it out to the side.
Try not to bend at the knee. 
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom and hip muscles to help with walking.   

Mini squats

Bend both your knees, pushing your bottom out behind you.
Keep your knees behind your feet.
Repeat 5 – 10 times.
Do not bend your hip more than 90 degrees.
The aim of this exercise is to strengthen your leg and hip muscles.

Calf raises

Raise up onto your toes on both feet.
Lower back down onto your flat feet.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your calf muscles.

Walking

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis and to steadily increase the distance as you recover. It is normal to be allowed to put full weight through your operated leg. 
As soon as possible, try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids. 

Stairs

The therapist will practice with you how to safely complete the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch.

Going down, put the crutch on the step below then step down with the operated leg, followed by the unoperated leg.

Activity

Walking is good for your new hip but remember your hip is an artificial joint. Pace your activity, walk and exercise regularly, little and often. The risk of dislocation is greatest in the first six weeks following surgery. To reduce the risk of dislocation whilst the tissues around your hip are healing, avoid forcing or overstretching movements. Avoid the combination of bending the hip and knee across the body towards the opposite shoulder as shown in the picture below.

Sleeping

You may sleep in any position including lying on either side. Initially when you lie on your non-operated side it may be more comfortable with a pillow between your legs to support the operated hip. When getting into bed, position your bottom back towards the centre of the bed and then slide yourself around into bed lifting your legs onto the bed. 

Sitting

Sit in a comfortable supportive chair after your operation (ideally with chair arms) to help you get up and down safely. Avoid low soft seating initially after your operation. 

Getting dressed

To put pants or trousers over your feet, hold the waistband and lower garment to your feet, inserting the operated leg first followed by the other leg before pulling them up. 

To undress, complete in reverse. When putting on shoes and socks, reach down on the inside of the operated leg to avoid uncomfortable twisting of your hip. A long handled reacher, shoehorn and sock aid can make dressing easier. These are readily available from mobility shops, pharmacies and online.  

Relationships

It is normal for your sex life to change initially following a joint replacement. Sexual intercourse may be resumed when you feel comfortable.

Driving

You can travel as a passenger in a car immediately following your operation. 

• It is best to sit in the front seat, have someone move it well back and reclined
• If possible, get into the car directly from the drive or road rather than the kerb or pavement
• Use your arms to lower yourself onto the edge of the car seat
• Keep your operated leg straight and out in front of you
• Slide back into the seat
• Lift both legs in as your body turns to sit upright in the seat.

You can usually resume driving around four to six weeks after your operation.  Stop regularly on longer journeys so you can get out of the car to change position and move around.  You must be safe to drive and be able to do an emergency stop.

We recommend that you inform your insurance company you have had a hip replacement before you start driving. 

Returning to full activities

Most people are ready to return to work at six to eight weeks after their operation. Air travel should be avoided whenever possible for the first six weeks. Depending on the sensitivity of the security scanner, your hip replacement may set off the alarm. 

You can resume most physical activities as soon as you feel comfortable and confident. You can swim once your wound has healed, swimming any stroke including breaststroke. Exercise bikes and treadmills can be used from six weeks, returning to outdoor cycling once comfortable. If you play golf, we suggest you can resume gradually after six weeks.

For activities such as tennis, badminton and cricket we suggest resuming from around 3 months. 

Contact sports are not advised following this surgery.

Equipment

The walking aids and any equipment prescribed to you after your surgery are provided by an equipment supplier. Please ring the number on the sticker on the equipment, to discuss its return.

Brennan V.M, Cochrane S, Fletcher C, Hendy D and Powell P (1995) Surveillance of adverse reactions in patients self infusing intravenous immunoglobulin at home. Journal of Clinical Immunology, 15, (2) 116-119.Campbell J (1997) Anaphylaxis. Professional Nurse, 12, (6) 429-432.

Hammarstrom L and Smith C.I.E (1986) Anaphylaxis after administration of gamma globulin for hypogammaglobulinaemia. The New England Journal of Medicine, 315, (8) 519. 

RCN Community Nursing Association (1995) Anaphylaxis. Guidance for Nurses, Midwives and Health Visitors. Revised edition. London: RCN.
Stangel M, Hartung H-P, Marx P and Gold R (1997) Side effects of high dose intravenous immunoglobulins. Clinical Neuropharmacology, 20, (5) 385-393.

Unsworth J.D and Wallington T.B. (2001) Practical Transfusion Medicine: Use of Intravenous Immunoglobulin. Blackwell Science. Ed. M.F. Murphy and Derwood H Pamphilon.

A.J Wills, D.J Unsworth (1998) A Practical Approach to the Use of Intravenous Immunoglobulin in Neurological Disease. Emergency Therapies in Neurology, 39, 3-8.

Subcutaneous Immunoglobulin 

Gardulf A, Hammerstrom L and Smith C.I.E. (1991) Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion. The Lancet, 338, 162-166

Gardulf A, Anderson V, Bjorkander J et al (1995a) Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs. The Lancet, 345,(8946), 36-369.

Gardulf A, Anderson V, Bjorkander J et al (1995b) Lifelong treatment with gammaglobulin for primary antibody deficiencies: the patients’ experiences of subcutaneous selfinfusions and home therapy. Journal of Advanced Nursing, 21, 917-927.

Gaspar J, Gerritsen B and Jones A (1998) Immunoglobulin replacement treatment by rapid subcutaneous infusion. Archives of Diseases in Childhood, 79, (48) 51.

Remvig L, Anderson V, Hansen N.E and Karle H (1991) Prophylactic effect of self-administered pump-driven subcutaneous IgG infusion in patients with antibody deficiency: a triple-blind cross-over study comparing P-IgG levels of 3 gl-1 versus 6 gl-1. Journal of Irrational Medicine, 229, 73-77.

NHS Constitution. Information on your rights and responsibilities. Available at:
www.gov.uk/government/publications/the-nhs-constitution-forenglan

Your sling can gradually be removed as your pain improves. There are various sling options and you may need to experiment to find what works best for you. Please contact the Plaster Room on 0117 414 8606 if you are struggling with your sling.  

Some options include:

A full arm sling or ‘Polysling’

This may be most comfortable in the early stages and if correctly applied and tightened regularly can provide good support for the broken bone. It can however be difficult to put this sling on and off by yourself.  And it can make it too difficult to use your arm and look after yourself. 

A collar and cuff 

This sling can be easily adjusted for comfort and is easier to put on and off yourself. 
Try to position it so it is supporting the weight of your arm well as pictured. 

Walking aids

If you use a walking aid such as a frame you may not need your sling on as the frame will provide the support your arms needs.

Pillows

You can support your arm on pillows instead of the sling when you are sitting down. This will give your neck a rest from the sling. 

• Your injured arm is likely to be very painful initially. It’s important that you keep the pain under control as much as possible. Please ensure you take regular painkillers as recommended by your doctor. Speak to your doctor if your pain remains poorly controlled.  
• Constipation is a common side effect of painkillers and reduced activity. Please try to stay well hydrated and take laxatives if required. It is important to seek advice from a health professional if you remain constipated. 
   

If the bone fragment (where it is broken) is sharp and prominent it can occasionally cause problems with your skin directly above the break. You are likely to have been advised if this is a concern for your break, but occasionally this only becomes apparent after your injury was assessed. 

If this is the case, you will need someone (a family member or carers) to closely monitor the skin. If you have any signs of the skin breaking down or infection you must contact the Fracture Clinic for review on 0117 414 1260. 

Signs of problems may include:

• Heat, redness, and increased swelling after the initial bruising and swelling goes down. 
• Small area of blistering or ulcer type appearance over the bone fragment.

There is an increased risk of developing a chest infection while you are recovering. You are likely to be less mobile than normal and you may also find it hurts when you breathe deeply. 

Taking deep breaths can reduce the risk of chest infections by keeping your lower airway working well, and by reducing the build- up of secretions. To help reduce this risk:

• Breath in slowly through your nose, imagine the base of your lungs expanding fully.
• Slowly exhale through your mouth.
• Do this 2 to 3 times in a row.

Try to do this every half hour if you can. You could set a timer, ask a family member or carer to remind you; or if you are watching television, use the adverts as a prompt. 

Please consider that it may be some weeks before you feel comfortable to use your arm effectively.  

You may need some help to eat and drink initially especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                      
• Please ask a health professional if you are struggling and unsure what to do. 

Gradually increase the use of your arm as your confidence increases and the pain settles. Trying to use your arm to eat, drink and care for yourself gives you the best chance of a successful recovery. 

• Practicing with an empty cup will build your confidence for meal times if you’re struggling to begin with. 
• Practice washing your face with your injured arm while sat at the sink. You can use the other hand to help if needed. 

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Remove your sling and gently extend your arm.
Now bend you elbow and try to bring your hand up towards your shoulder.

Getting your shoulder moving from about 3 weeks after your injury 

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 
You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises.

Place your hand under the elbow of the injured arm.  Lift gently until you feel a stretch at your shoulder.
Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders. 

Bones contain living tissue that is constantly being broken down and rebuilt. We call this process ‘bone turnover’.  
As we get older, the process of making new bone is slower than the process of breaking down of old bone, and so the amount of bone tissue we have reduces, and bones can start to lose some of their strength and structure and become weaker. This may lead to a condition called osteoporosis.   

A fracture that has happened easily after a minor injury such as a trip or fall is known as a fragility fracture. It is often the first sign that bones have lost some of their overall strength and structure. 

People who have had a fragility fracture have a higher chance of having another fracture compared to someone who hasn’t had a fracture.   

You may be contacted by the Fracture Liaison Service who will arrange to complete a ‘fracture risk assessment’ to see how likely you are to have further broken bones (fragility fractures). This may also be carried out by the team looking after you in hospital, or your own doctor at the GP surgery. 

The fracture risk assessment can help to guide whether you should have some further tests or investigations for osteoporosis. If it indicates that you have a high chance (risk) of having fractures, it may be recommended that you start taking some medication to help slow down the bone turnover process and improve your bone strength. This will help reduce the chances of having significant fractures like a hip fracture or a compression fracture of one of the spinal bones.   

A healthy lifestyle is important to reduce your risk of developing osteoporosis and having fractures, but if your risk for having fractures is high then it might not be enough on its own to reduce your chances of having further fractures.   

Exercise is good for bone strength - even if you have osteoporosis, a combination of good balance, coordination, and reflexes can help to reduce your risk of having a slip, trip, or fall.  

You may find it beneficial to do some strength and balance training to help reduce the chances of falls and further broken bones in the future. You may have this offered as part of your care support after your injury. If not there are classes and groups in the community you may wish to join, such as the Staying Steady classes  but if you have had one or more falls, or if you remain worried about falling, ask your GP to refer you to the specialist Falls Service. 

You can also help your bones by not smoking and by not drinking too much alcohol. Smoking, and/or regularly drinking more than the recommended weekly amount of alcohol has a harmful effect on bones, reducing the body’s ability to absorb calcium and changing how bone-building cells work, and can slow down the healing of fractures. 

Drinking more alcohol than the recommended safe amounts can also cause people to become unsteady on their feet and increase their chances of having falls and fractures. 

You should also make sure you have enough calcium and vitamin D, either from a healthy balanced diet and safe exposure of your skin to sunlight during the spring and summer, or by taking calcium and/or vitamin D supplements.   

For further information, you may wish to visit the website of the Royal Osteoporosis Society: Better Bone Health for Everybody (theros.org.uk) or contact their specialist nurse helpline on 0808 800 0035.

This is a good position to give your neck a rest from the sling. 

It’s important that you don’t allow sores to develop under your arm, so you or your carer need to:

• Wash your injured arm carefully every day and make sure your under arm is really dry. 
• Do not wear rings or jewellery for 6 weeks to reduce the risk of complications from swelling.  
• Massage your hand and arm regularly with any moisturiser. This may help a little with swelling and it can also reduce any fear you may have about touching your arm. 

There is an increased risk of developing a chest infection while you are recovering. You are likely to be less mobile than normal and you may also find your arm hurts when you breathe deeply. 

Taking deep breaths can reduce the risk of chest infections by keeping your lower airway working well and by reducing the build-up of secretions. To help reduce this risk:

• Breathe in slowly through your nose; imagine the base of your lungs expanding fully.
• Slowly exhale through your mouth.
• Do this 2 to 3 times in a row.
• Try to do this every half hour if you can. You could set a timer, ask a family member or carer to remind you, or if you are watching television, use the adverts as a prompt. 

• The injured arm is likely to be very painful at first. It’s important that you keep the pain under control as much as possible. Please ensure you take regular painkillers as recommended by your doctor.
• It can be difficult to manage your medication with one hand. Practice and tell someone as soon as possible if you cannot manage. Community teams (for example hospital discharge teams and district nurses) cannot usually help with medications so you might need a plan for this before you leave hospital. 
• It is quite common with this type of injury for the pain to increase in the first 1-2 weeks. This is due to swelling and inflammation as much as the injury itself. 
• It is possible your whole arm may swell and bruise including your hand and fingers.  It can help to know what is normal and that it will get better in time. But if you are worried or have new numbness please speak to a health professional. 
• Constipation is a common side effect of painkillers and reduced activity. Please try to stay well hydrated and take laxatives if required. It is important to seek advice from a health professional if you remain constipated.
• A simple collar and cuff (see picture on front page) will help to support your arm and reduce the pain when you are moving. If you are having any issues with your sling please contact the Plaster Room on 0117 414 8606.

To prevent the joints from becoming stiff you should:

Allow your injured arm to hang straight at the elbow at least twice a day – more often if possible. 
Standing with your arm hanging as pictured can be a good position to clean under your arm and to put your arm into clothing when dressing.  
If you are not safe to stand, try to hang your arm straight from a seated position if you can safely and carefully do so. You may need help from a family member or carer to do this. 

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Once your pain has settled a bit it’s time to get your elbow moving.  Remove your sling and gently extend your arm. Now bend your elbow and try to bring your hand up towards your shoulder.

It will be some weeks before you feel comfortable to use your arm effectively.  

Gradually increase the use of your arm as your confidence increases and the pain settles. Trying to use your arm to eat, drink, and care for yourself gives you the best chance of a successful recovery 

You may need some help to eat and drink at first especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up using a knife and fork.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                     
• Please ask a health professional if you are struggling and unsure what to do. 

If you normally use a walking aid with your injured arm it is likely to be too painful to use this initially. You may need support from a physiotherapist or occupational therapist to explore alternatives to keep you mobile. 

Once you are comfortable, you can use your arm normally to care for yourself– including putting weight through your arm to use walking aids if required. 

You may find your arm is still very swollen down to your hand. This is normal and usually improves once you are using your arm more. If you remain worried please see the advice at the end of the leaflet.

If you’re not already using your arm much, now is a good time to start trying a bit more. 

• Practicing with an empty cup will build your confidence for meal times if you struggle to begin with.  
• Practice washing your face with your injured arm while sat at the sink. You can use the other hand to help if needed. 

You can start to gradually use the sling less over a few days if you feel ready. You may find it useful to continue to wear it if you are out and about in a busy environment, or standing for a long period of time. 

Keep your hand supported when you are sitting and lying down to reduce swelling – try not to let it hang down by your side for extended periods of time. 

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 

You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises. 

Place your hand under the elbow of the injured arm. Lift gently until you feel a stretch at your shoulder. Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders.

If you find you need more practical support than anticipated when you get home then please contact Sirona who provide community based assessments through the Single Point of Access on 0300 125 6789 

• If you have worsening pain that doesn’t settle within 48 hours.
• If you notice any new change to the feeling in your hand or a new loss of movement in your hand or wrist at any stage after your injury.
• If you notice a new swelling.

If you are still significantly struggling with basic exercises or function after 6 weeks and have not been referred to outpatient physiotherapy, please contact the Frailty Trauma Practitioner to discuss referral. This is not an emergency service and calls may not be returned same day. 

If you feel you need urgent medical advice please contact a relevant health care professional such as 111 or your GP. 

Bones contain living tissue that is constantly being broken down and rebuilt. We call this process ‘bone turnover’.  

As we get older, the process of making new bone is slower than the process of breaking down of old bone, and so the amount of bone tissue we have reduces,and bones can start to lose some of their strength and structure and become weaker. This may lead to a condition called osteoporosis.   

A fracture that has happened easily after a minor injury such as a trip or fall is known as a fragility fracture. It is often the first sign that bones have lost some of their overall strength and structure. 

People who have had a fragility fracture have a higher chance of having another fracture compared to someone who hasn’t had a fracture.   

You may be contacted by the Fracture Liaison Service who will arrange to complete a ‘fracture risk assessment’ to see how likely you are to have further broken bones (fragility fractures). This may also be carried out by the team looking after you in hospital, or your own doctor at the GP surgery. 

The fracture risk assessment can help to guide whether you should have some further tests or investigations for osteoporosis. If it indicates that you have a high chance (risk) of having fractures, it may be recommended that you start taking some medication to help slow down the bone turnover process and improve your bone strength. This will help reduce the chances of having significant fractures like a hip fracture or a compression fracture of one of the spinal bones.   

A healthy lifestyle is important to reduce your risk of developing osteoporosis and having fractures, but if your risk for having fractures is high then it might not be enough on its own to reduce your chances of having further fractures.   

Exercise is good for bone strength - even if you have osteoporosis, a combination of good balance, coordination, and reflexes can help to reduce your risk of having a slip, trip, or fall.  

You may find it beneficial to do some strength and balance training to help reduce the chances of falls and further broken bones in the future.

You may have this offered as part of your care support after your injury. If not there are classes and groups in the community you may wish to join, such as the Staying Steady classes  but if you have had one or more falls, or if you remain worried about falling, ask your GP to refer you to the specialist Falls Service. 

You can also help your bones by not smoking and by not drinking too much alcohol. Smoking, and/or regularly drinking more than the recommended weekly amount of alcohol has a harmful effect on bones, reducing the body’s ability to absorb calcium and changing how bone-building cells work, and can slow down the healing of fractures. 

Drinking more alcohol than the recommended safe amounts can also cause people to become unsteady on their feet and increase their chances of having falls and fractures. 

You should also make sure you have enough calcium and vitamin D, either from a healthy balanced diet and safe exposure of your skin to sunlight during the spring and summer, or by taking calcium and/or vitamin D supplements.   

For further information, you may wish to visit the website of the Royal Osteoporosis Society at www.theros.org.uk or contact their specialist nurse helpline on 0808 800 0035.