After Surgery

happy-elder-couple-blackYou may be wondering how long you’ll need to be in the hospital after joint replacement. Every individual is different, and insurance coverage will differ as well. Generally speaking, a total of 1-3 days (including the day of the surgery) is typical. It is important to note that each patient experience differs and you will be discharged when you have achieved the goals outlined by your orthopaedic surgeon. On the first day after your surgery, you may get out of bed and begin physical and occupational therapy, typically several brief sessions a day. These are first steps on your way to getting back into the routines of your life!

During your hospital stay, your orthopaedic surgeon works closely with nurses, physical therapists, and other healthcare professionals to ensure the success of your surgery and rehabilitation. Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, you should become more independent using two crutches or a walker.

If you need to work with a physical therapist after your joint replacement, the therapist may begin an exercise program to be performed in bed and in the therapy department. The physical therapist will work with you to help you:

  • Regain muscle strength
  • Increase range of motion

The physical therapist (or nurses) will also show you:

  • How to get out of bed
  • How to use the bathroom
  • How to get dressed

Discharge from the hospital will depend, to some extent, on your progress in physical therapy. The physical therapist will likely give you a list of activities, exercises, and “do’s and don’ts” when you leave the hospital, and you may also have the assistance of an occupational therapist or nurse to help with special needs.

When you’re ready for discharge, your surgeon will determine whether you can best continue to recover at home (the usual procedure) or in a facility where you can receive specialized rehabilitation help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within 1 to 3 days.

You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. However, you should soon get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with many surgeries, pain medication may be prescribed while you are healing.)

You may need a walker and/or crutches for a few weeks. You’ll be in touch with your doctor or orthopaedic surgeon as well as your case manager, so you’ll have plenty of opportunities to ask questions or discuss concerns as well as to report your progress.

Be aware that there are some things you should not do after joint surgery. It’s important to have realistic expectations. For example, artificial joints have limitations:

  • Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
  • The life span of the artificial joint is not infinite.
  • Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.

Your healthcare provider will instruct you about limiting your activities following the surgery. Remember: It is very important to follow these instructions!

The decision to resume a normal daily routine is one that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you:

  • You may practice stair-climbing in the hospital and should be able to do this by the time you leave.
  • You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don’t tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
  • When to resume driving a car, going to work and/or participate in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic surgeon’s advice and recommendations.
  • You may need to take antibiotics before dental work (including dental cleaning) and any surgical procedure that could allow bacteria to enter the bloodstream. Ask your healthcare provider whether you will need to take antibiotics at certain times to prevent infection.

Frequently Asked Questions: After Surgery

What will my hospital stay be like?

The first night of your stay, you will most likely be somewhat “groggy” from the medications you receive in surgery. You will be taken to your hospital room directly from the recovery room in your hospital bed to avoid transferring you from stretcher to bed. Once you are fully awake, you will be able to eat and drink as tolerated. Your vital signs, urinary output, and any drainage will be monitored closely by the nurses on the orthopaedic surgery floor. Appropriate pain medicine for the first 24 hours may be administered by intravenous method.

Starting on day one post-operatively, you will be getting out of bed and attending physical and occupational therapy sessions. These sessions are vital to your progress and are arranged for 2-3 sessions. The physical therapists attending you will teach you the exercises needed for your optimal recuperation and instruct you on your weight bearing technique using a walker or crutches. The occupational therapist is trained to assist you in adapting your activities of daily living to your post-operative limitations. Activities such as bathing, dressing, using the bathroom, transfers from bed to chair, ambulation, and stair climbing will all be addressed during these sessions. Instructions for traveling by various modes of transportation will also be discussed.

Will I see my doctor regularly while in the hospital?

The attending doctors make rounds daily on their patients whenever possible. In addition, the orthopaedic resident doctors or physician assistants make rounds twice daily to monitor your progress and make any changes required for your care. The case manager will also meet with you (and family members if necessary) in order to assure the proper discharge plan for your particular case. Arrangements for transfer to a rehabilitation floor or sub-acute floor either at the hospital or elsewhere will be evaluated by you and the case manager if this becomes an option.

How will I know whether to go home or to another facility for further rehab?

n general, if you live with someone who will be assisting you, discharge home is the usual procedure. Arrangements for further home or outpatient physical therapy will be made by the case manager. Most patients can go directly home if they are deemed safe by the physician and therapists. While not required, it is highly recommended to have someone to assist you the first 48-72 hours after discharge on a full-time basis and perhaps part-time the first week or two after this. If you live alone or are in an environment at home where your safety is in question (i.e., physical therapy/ occupational therapy goals not met), you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient for a 3-5 day stay, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. If you live alone or are not progressing rapidly enough in therapy sessions and it is unlikely you will be able to do so in a rehab setting, a sub-acute facility may be recommended for a longer period of recuperation. The choices available depend upon the patient’s insurance coverage and, therefore, will need to be discussed by the patient, the case manager, and the insurance company as warranted.

When will I be ready for discharge?

Depending on whether you go home or to another facility to recuperate will play a role in when discharge occurs. In general, a patient may be transferred to the rehabilitation floor on the 2nd post-operative day. Transfer to the sub-acute floor may also occur on the 2nd or 3rd post-operative day. If you are being transferred to another facility, transfers usually occur on the 2nd or 3rd post-operative day as well. Discharges to home usually occur on the 3rd to 4th post-operative day in general.

Discharge Day — Recovery

What can I expect the first few days after discharge?

Expect a time of transition. You may feel overwhelmed the first day or two after discharge and may even feel you’ve made a mistake coming home so soon.This may occur even after discharge from a rehab or sub-acute floor. Be patient, and give yourself some time to adjust. Many patients report that after the first day or two of practical problem solving and establishing a routine, they experience a change in their progress and notice a definite upward trend in their recuperation. If, on the other hand, you are experiencing pain or discomfort or have concerns about your condition, please consult your physician.

In addition, during this phase of discharge, usually within the first 24-72 hours, you will receive a telephone check-up from your case manager. You will be asked several questions to establish your progress and whether your post-discharge home or outpatient therapies have been started. This phone call also allows you to ask any questions or voice concerns regarding your home situation so they can be addressed.

Do I need someone to stay full-time with me when I go home?

It is our recommendation that someone be with you the first 24-72 hours after discharge. Many patients do live alone and we realize this is not always possible. But if you have a relative or a friend who offers to stay with you, take this offer for your own ease of mind. Many times patients have family members or friends who stay with them all day in the hospital. While this is certainly welcomed, it is often more helpful that this person be available after you leave the hospital. If you do live alone and either are discharged from rehab or from the orthopaedic floor with no help available at home, perhaps a friend or neighbor can call you daily to check on your progress. In addition, if home care has been arranged, these visits usually can be arranged so that someone is checking on you daily. The case manager will be discussing options available for your particular circumstances, and together you will develop a discharge plan, which will address your particular situation.

When can I go up and down stairs? Stair climbing will be practiced in the physical therapy program before you leave the hospital. Most patients can climb stairs before leaving the hospital. If you live in a 2-story home and have practiced stair climbing, stairs can be done one to two times a day after discharge, depending upon your comfort level and provided that your physician has approved this activity.

Will I need pain medicine after I’m discharged from the hospital?

Most patients do require a short-term course of pain medicine. Renewals on these prescriptions can be obtained by calling your surgeon’s office. Expect to be on some type of pain medication for several weeks after discharge. Most patients take these medications especially at night or before therapy sessions.

How long will I need to use my walker or crutches?

Walkers and/or crutches are usually used the first 6 weeks after surgery. You will then be allowed to use a cane, which again will be used for approximately 6 weeks. After that time, most patients do not need any support for walking.

When can I go outside?

Consult your physician for a recommended time to engage in outdoor activities. Comfort and safety should be the primary guidelines for doing this. It is suggested to start with short trips at first, perhaps to therapy (if nearby) or your local supermarket or church, for example. Gradually increase the number and length of outside activities as you feel more comfortable.

When can I drive?

Driving routinely is not recommended before 6 weeks from the time of your surgery. However, some physicians may allow the patient to drive earlier if they feel the patient can do so safely. The type of surgery, side of surgery (left vs. right leg), and the patient’s overall general condition plays a part in this decision.

If you feel you will need to drive earlier than the 6-week routine prescribed, you should discuss this with your surgeon and obtain his/her approval. Consult your physician for further details.

When will I be able to return to work?

This varies with each patient. In general, patients usually do not return to work until after their first check-up at 6 weeks from surgery. Some patients do return to work earlier if they can do so safely. This should be discussed with your physician so that the best decision for your individual situation is made.

When will I be able to participate in sports activities?

Depending upon what activity you want to participate in will determine when you can safely start these activities again. Swimming, walking distances (hiking), bicycle riding, golfing, and other low impact sports activities can likely be tried after a few weeks. Returning to high impact activities such as jogging, tennis, or aerobics exercises will probably not be recommended for quite some time. Your return to any of these activities should be discussed with your surgeon.

When will I be able to have sexual intercourse after my surgery?

In most cases, sexual activities can be resumed when the patient feels comfortable enough to do so. If the patient has been cautioned to maintain certain position restrictions, these restrictions should be followed in this instance also. In general, most patients resume their normal sexual activities between 4-6 weeks following surgery.

After Surgery: Getting Moving Again

It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery — as early as the day of surgery.

When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. The more quickly a joint replacement patient gets moving again, the more quickly he or she is likely to regain independence. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge. Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery. If needed, the case manager can help arrange a home therapist.

Life After Total Joint Replacement

The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. However, joint replacement surgery will not allow you to do more than you could before joint problems developed. Each patient’s physician will recommend the most appropriate level of activity following joint replacement surgery.

In the weeks following total joint replacement, certain limitations are placed on every patient’s activities. Using a cane or walker may be necessary for several weeks. Kneeling, bending, and jumping will likely be forbidden for the first month. It may be 6 weeks before driving is permitted. The orthopaedic surgeon and physical therapist will provide specific recommendations.

When fully recovered, most patients can return to work, although some types of work — such as construction work, certain types of carpentry, and occupations that involve repeated or high climbing — may not be advisable for individuals with a joint replacement. Also, athletic activities that place excessive stress on the joint replacement, such as skiing, basketball, baseball, contact sports, distance running, and frequent jumping, should be avoided.

After joint replacement, a good rule of thumb is that acceptable physical activities should:

  • Not cause pain, including pain felt later
  • Not jar the joint, as happens with running or jumping
  • Not place the joint in the extremes of its range of motion
  • Be pleasurable

It is also important for an individual with a joint replacement to keep his or her body weight as close to normal as possible. Joint wear and loosening increases with weight increase.

Talk to Your Doctor

You don’t have to live with severe joint pain and the functional limitations it causes! Even if you have not experienced adequate results with medication and other conservative treatments, total joint replacement may provide the pain relief you long for — and the resulting return to your favorite activities.

Write down a list of questions about your condition, your concerns, and the ways that total joint replacement might benefit you. Then make an appointment to talk to your doctor — and make note of his or her answers and recommendations.

Remember, even if your orthopaedic surgeon determines that joint replacement is a good medical option for you, it is still up to you to make the final decision. The ultimate goal is for you to be as comfortable as possible…and that always means making the best decision for you based on your own individual needs.

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