After Surgery
After your surgery, you will be cared for in the recovery room until you are admitted to a hospital room. Your stay in the hospital will depend on your general health status prior and post joint replacement surgery, and may vary from 2 to 4 days.
Blood Thinners
In most cases, patients are kept on a blood thinner for 2 weeks after surgery. Some patients that are considered at higher risk for blood clots may be kept on blood thinners for a longer period (4-6 weeks). If you were taking a daily aspirin prior to surgery, it can be restarted once you are out of the hospital
Things to look out for when you return home after surgery
Do not hesitate to call our office or your primary care physician if you have any health concerns. These are a few particular things to look out for:
Showering and Bathing
Specific instructions will be given at the time of discharge. In most cases, patients go home with a special waterproof dressing that allows for showering right away. This dressing is designed to be left in place for one week and then it can be removed. If a traditional gauze dressing was used, then showing must be delayed until the wound is completely dry. All patients should avoid taking baths or swimming until given the okay - usually 3 weeks after surgery.
TED Hose
The compression stockings (TED hose) help decrease swelling in the leg and reduce the risk of blood clots. They should be worn for 2-4 weeks following surgery. Feel free to remove them while showering or when in bed at night, and then replace them in the morning.
Sleeping
There are no sleeping precautions after hip and knee replacement surgeries. Unfortunately, many patients do seem to have some trouble getting a good night sleep after surgery, but this seems to resolve after a few months.
Physical Therapy (PT)
All patients get PT in the hospital twice a day. Patient care is always individualized based on patient needs. Please remember that the exercises you do independently matter more than the formal Physical Therapy! In almost all cases full weight bearing is permitted right away. You should walk as much as you can tolerate with gradually increasing your activities. Trial and error will tell you how much activity is too much. If you have “overdone it,” then you may experience increased pain and swelling. Just take it easy for a day or two and then try again at a less intense level. Remember that the healing process takes months, not weeks!
Sports and Exercise
Regular exercise is encouraged. However, people with joint replacements should avoid high-impact types of exercise and sports (i.e., jogging or basketball are NOT recommended). Golf and doubles tennis can be resumed 3 – 6 months after surgery. The goal of hip and knee replacements is to eliminate or decrease pain so that you can remain active, but too much activity will certainly cause your joint replacement to wear out more quickly. There is no way to say exactly how much activity is too much. It is best not lift or carry more than 50 pounds after a joint replacement.
Walkers and Crutches
At first, a walker or crutches provide needed support, but as your strength improves and pain decreases you can switch to using a cane and eventually wean off support completely. Most people start weaning off of the walker or crutches after a couple of weeks, some even sooner. Remember that it’s better to walk smoothly with a cane than to limp around without one - walking with a limp can cause pain in your back or other joints. Usually your Physical Therapist can help advise you when to transition away from the support.
Driving and Traveling
There is no fixed amount of time that driving is prohibited. In general, when your driving leg has good strength and control and you are no longer taking pain medicine such as hydrocodone (Norco), or oxycodone (Percocet), then it should be okay to drive. It is best not to take any long trips for three months after surgery. While not an absolute requirement, this advice is given because the risk of blood clots remains higher than normal for about 3 months after knee or hip replacement, and prolonged sitting in a car or plane can add to this risk.
Most people with hip and knee replacements do set off the metal detector. Simply tell the TSA agent that you have had a joint replacement. If/when you set off the metal detector, the agent is required to pull you aside and check you using a “wand.” Unfortunately, it does not help to have an identification card that states that you have had a joint replaced, as anyone could easily produce a counterfeit card.
Getting Back to Work
Long-term Follow-up
X-rays can pick up signs of wear or loosening long before you feel any discomfort and therefore should be checked regularly. The frequency of follow-up will be based on your activity level and it can vary from visits once a year to once every five years.
Blood Thinners
In most cases, patients are kept on a blood thinner for 2 weeks after surgery. Some patients that are considered at higher risk for blood clots may be kept on blood thinners for a longer period (4-6 weeks). If you were taking a daily aspirin prior to surgery, it can be restarted once you are out of the hospital
Things to look out for when you return home after surgery
Do not hesitate to call our office or your primary care physician if you have any health concerns. These are a few particular things to look out for:
- Signs of Infection: You or a family member should check the surgical incision every day for signs of infection. While it is normal for the area around the incision and staples to be a little pink and a little warm, the skin should not be red or hot. If there is ever redness that seems to be spreading you need to contact our office immediately or go to the Emergency Department. A sudden increase in pain may also be an indicator of infection.
- Blood clot (DVT) in a leg vein can cause the leg to swell and become more painful. Everyone’s leg has some swelling after surgery, but if the amount of swelling suddenly increases and especially if the swelling doesn’t improve after elevating the leg, then you should call our office or go to the Emergency Department. A pulmonary embolism can cause chest pain, shortness of breath, and rapid heart rate and requires immediate attention.
- Constipation: Pain medicines (narcotics) often cause constipation. It helps to eat a high fiber diet and it is recommended that patients take an over-the-counter stool softener like Colace daily. If needed, consider also using a laxative such as Milk of Magnesia or Dulcolax and contact your primary care physician for further treatment as needed.
Showering and Bathing
Specific instructions will be given at the time of discharge. In most cases, patients go home with a special waterproof dressing that allows for showering right away. This dressing is designed to be left in place for one week and then it can be removed. If a traditional gauze dressing was used, then showing must be delayed until the wound is completely dry. All patients should avoid taking baths or swimming until given the okay - usually 3 weeks after surgery.
TED Hose
The compression stockings (TED hose) help decrease swelling in the leg and reduce the risk of blood clots. They should be worn for 2-4 weeks following surgery. Feel free to remove them while showering or when in bed at night, and then replace them in the morning.
Sleeping
There are no sleeping precautions after hip and knee replacement surgeries. Unfortunately, many patients do seem to have some trouble getting a good night sleep after surgery, but this seems to resolve after a few months.
- Hip Replacement: You can sleep on either your operative or non-operative hip whenever you feel comfortable doing so. It may be difficult to sleep on your stomach because it can be challenging to get into and out of that position.
- Knee Replacement: You should feel free to sleep in any position that you are comfortable. When you are asleep, you have no control over the position of your knee, so it is futile to try to keep the knee straight when you are sleeping. If you have worked hard during the day to exercise your knee, you should be able to rest guilt-free without worrying about your knee position.
Physical Therapy (PT)
All patients get PT in the hospital twice a day. Patient care is always individualized based on patient needs. Please remember that the exercises you do independently matter more than the formal Physical Therapy! In almost all cases full weight bearing is permitted right away. You should walk as much as you can tolerate with gradually increasing your activities. Trial and error will tell you how much activity is too much. If you have “overdone it,” then you may experience increased pain and swelling. Just take it easy for a day or two and then try again at a less intense level. Remember that the healing process takes months, not weeks!
- Hip Replacement: After discharge from the hospital, most patients do very well exercising on their own and don’t need formal PT.
- Knee Replacement: Upon discharge, we arrange for most patients to have a physical therapist to come to their home 3-5 times per week for the first 2-3 weeks after surgery. After the home therapy, most patients will then be switched over to outpatient Physical Therapy. The total duration of physical therapy is usually 6 to 12 weeks, depending on when all goals are met. Your goal in the first 2-3 months after knee replacement is to maximize how far your knee can bend (flexion) and straighten (extension). Our goal is a range-of-motion (ROM) at least as good as your preoperative level and preferably 0-120 degrees. After 3 months, it’s almost impossible to gain significant flexion or extension. Your initial goal after knee replacement is to maximize your ROM rather than walking distance, strength, balance and stamina.
Sports and Exercise
Regular exercise is encouraged. However, people with joint replacements should avoid high-impact types of exercise and sports (i.e., jogging or basketball are NOT recommended). Golf and doubles tennis can be resumed 3 – 6 months after surgery. The goal of hip and knee replacements is to eliminate or decrease pain so that you can remain active, but too much activity will certainly cause your joint replacement to wear out more quickly. There is no way to say exactly how much activity is too much. It is best not lift or carry more than 50 pounds after a joint replacement.
Walkers and Crutches
At first, a walker or crutches provide needed support, but as your strength improves and pain decreases you can switch to using a cane and eventually wean off support completely. Most people start weaning off of the walker or crutches after a couple of weeks, some even sooner. Remember that it’s better to walk smoothly with a cane than to limp around without one - walking with a limp can cause pain in your back or other joints. Usually your Physical Therapist can help advise you when to transition away from the support.
Driving and Traveling
There is no fixed amount of time that driving is prohibited. In general, when your driving leg has good strength and control and you are no longer taking pain medicine such as hydrocodone (Norco), or oxycodone (Percocet), then it should be okay to drive. It is best not to take any long trips for three months after surgery. While not an absolute requirement, this advice is given because the risk of blood clots remains higher than normal for about 3 months after knee or hip replacement, and prolonged sitting in a car or plane can add to this risk.
Most people with hip and knee replacements do set off the metal detector. Simply tell the TSA agent that you have had a joint replacement. If/when you set off the metal detector, the agent is required to pull you aside and check you using a “wand.” Unfortunately, it does not help to have an identification card that states that you have had a joint replaced, as anyone could easily produce a counterfeit card.
Getting Back to Work
- Hip Replacement: People with desk jobs and flexible schedules can try to go back to work after a few weeks. People with jobs requiring prolonged standing and full eight-hour days, however, may need to wait for 2-3 months before returning to work.
- Knee Replacement: People with desk jobs and flexible schedules can try to go back to work in a little as a few weeks, though it is usually best to wait for 4-6 weeks. People with jobs that require prolonged standing and full eight-hour days may need to wait for 3 or even 4 months before returning to work.
Long-term Follow-up
X-rays can pick up signs of wear or loosening long before you feel any discomfort and therefore should be checked regularly. The frequency of follow-up will be based on your activity level and it can vary from visits once a year to once every five years.