Getting back on your feet again
Modern surgery is often successful, especially surgeries that address bone and joint pain and dysfunctions. With a new knee or hip, your pain can be reduced greatly. Previous problems such as walking, climbing stairs, squatting, bending, rotating your body – all become so much easier once you have a new hip or knee joint. But to make this possible, it is important you prepare for the surgery accordingly and follow rehabilitation as prescribed.
Visiting nurse service
A visiting nurse can come to your home several times during the first week or two of your recovery and rehabilitation. The visiting nurse will:
- Assess your physical condition and recovery
- Check your vital signs (temperature, blood pressure, blood oxygen, heart functioning, etc.)
- Review your medications
- Answer any questions you might have
Physical therapy is to get you moving as quickly as possible. Your commitment and complete cooperation with your assigned physical therapy program is essential. A physical therapist will:
Review the physical therapy program that you started while in the hospital
- Measure and record the progress you make towards improving range of motion
- Check how you are performing your exercises, using a walker or crutches, navigating steps and much more
- Watch how you are using therapy equipment sent home with you
- Adapt your program to your specific situation now that you are home
- Help you adapt your surroundings at home to ensure your safety while moving around and doing your exercises
Occupational therapy helps you with the activities of daily living. In some cases, an occupational therapist will be part of your care team. An occupational therapist will:
- Assess your home and suggest how to make improvements or adapt your home
- Teach you how to get in and out of your bed, navigate steps, bathe and take care of other personal needs
- Help you re-learn how to do activities of daily living such as cooking, light housekeeping and more
- Work with you to develop strategies to carry out daily activities
Preparing for surgery
Once you have scheduled a hip or knee replacement surgery, you should make preparations to ensure that your surgery and recovery goes as smoothly as possible. Here is a checklist to help you prepare.
Learn about your procedure
If your hospital offers a class on joint replacements, take advantage of this. Also, there are many resources on the Internet that provide invaluable information about hip and knee replacement surgery. Some resources are listed at the bottom of this page.
Get into shape
You will want to be in as good a shape as you can be so that you speed up your recovery.
If you smoke, either stop smoking or cut way down. Smoking affects blood circulation, delays healing and slows recovery.
If you’re overweight, try to lose a few pounds.
Ask your surgeon about exercises you can do before surgery. Ask about the exercises you will be prescribed after surgery. If you become familiar with then now, you will be better able to do them following surgery.
Building up strength is important too. A strong upper body will make it much easier to get around on crutches or a walker.
If you drink alcoholic beverages, do not consume any alcohol for several days before your surgery.
If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.
Two months before your surgery:
Visit your primary care physician to get medical clearance for this surgery.
If there is a possibility that you might go to a rehabilitation facility after your surgery, it might be wise to visit possible sites in advance. Make sure that the facility will take your health insurance.
Two to Four weeks before your surgery:
Review and adhere to all directions from your surgeon’s office regarding the filling out of forms, getting medical clearance, changes to your prescription drugs, etc.
Your surgeon will let you know the specific medications to stop taking in advance of your surgery.
Go for routine pre-surgical tests such as a chest X-ray, blood work and others
Significant dental conditions and problems should be treated prior to surgery. Although uncommon, an infection can occur as a result of these dental procedures if bacteria enters your bloodstream. If necessary, be sure to schedule an appointment with your dentist before your joint replacement surgery to treat any problems you may have.
Once your surgery has been scheduled, call your insurance company to inform your health provider of your upcoming procedure. You’ll need to provide the date of your surgery, procedure type and the phone number for our office. You should discuss the type of post-surgery services your insurance plan covers, such as rehabilitation hospital care and home physical therapy, as well as equipment, such as a commode and walker.
Be sure to think about your return home in advance of your surgery because you will need help caring for yourself for twenty-four hours a day for at least the first week at home. Figure out ahead of time who will assist you and talk with them about your concerns. If no one is available to care for you, a discharge-planning nurse can help make arrangements for skilled nursing or caregivers to help you at home.
- Have a friend or family member pick you up from the hospital on the day of your discharge.
- You will need help 24-hours a day for at least the first week. Organize friends, family or neighbors to check in on you after that time for additional help if needed.
- In addition, make sure you have rides planned to all follow-up visits, which will be at three, six and 12 weeks after surgery.
- If you have crutches or a walker, bring them to the hospital. If you don’t already have walking aids and need them, the hospital staff will help you to either rent or purchase these and other recommended devices, such as a raised toilet seat, bedside commode, tub chair and other aids.
- A hospital bed, if needed, can be rented on a weekly basis. The hospital staff can help you arrange this.
In addition, arranging meals that can be stored and frozen and stocking up on prepared meals will eliminate extra work for your caregiver. It also is highly recommended that you organize your home with safety features to prevent accidents. These include making pathways in crowded areas, eliminating all throw rugs, securing extension cords and telephone cords strung across the floor, securing handrails in your bathtub and stairways, and placing all needed items at a level so that you can easily reach them. You also should be sure that your house is equipped with the following:
- Raised toilet seat
- Stable shower bench or chair for bathing
- Long-handled sponge or shower hose
- Reaching device that will allow you to grab objects
Pack a small suitcase for your hospital stay that includes: a list of all medications you are taking, personal hygiene items, comfortable and loose clothing, a knee-length robe and slip-on shoes. Leave all valuables at home, including jewelry, wallet and watches. It is not necessary to bring your actual medications, however, do bring a list of your medications and their dosages. The hospital will provide you with your prescriptions.
You will probably be in the hospital for several days following your joint replacement surgery. If you have any complications, other disabilities or illnesses, or have no one to help you at home, you may need to spend several weeks in a rehabilitation facility before going home. You and your healthcare team will determine this together.
Literally, the first time you stand or take your first steps following surgery will begin on the day of your surgery. Using a walker or crutches, you will walk a short distance with the assistance of nurses. Because you are healing, there will be some discomfort, but this will be helped with medicines prescribed by your surgeon.
Physical therapy begins as soon as possible–usually the day after surgery—to strengthen your muscles and help you regain motion in your joint. The physical therapist will help you with a gentle program in the hospital and then work with your at-home therapist to see that your recovery is as speedy as possible.
Become an active participant in your own healing
Most patients achieve their success goals with joint replacement surgery. But, this success depends a lot on what you do when you go home. Follow your doctor’s advice about what to do at home, medications, and how to exercise.
Watch out for complications
If problems do occur, most are treatable. You should be watching for:
- Infections which can occur in the wound, or around the new joint. Minor infections in the wound are usually treated with drugs. Deep infections may require a second operation to treat the infection or replace the joint.
- Warning signs are:
- Persistent fever (higher than 100 degrees)
- Shaking chills
- Increasing redness, tenderness or swelling of your wound
- Drainage of your wound
- Increasing pain with both activity or at rest
- Blood clots which are clumps of blood that can form if the blood moves too slowly. Your surgeon may suggest blood thinning drugs or special stocking’s, exercises or boots to help your blood move faster. Warning signs are:
- Pain in your leg unrelated to your wound
- Increasing redness, tenderness
- Increasing swelling of your leg, ankle or foot
If pain, redness or swelling occurs in or around your new joint or leg after you leave the hospital, contact your surgeon right away.
Getting back to your normal activities
As soon as you are up to it, get active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:
You can resume driving when you are no longer taking narcotic pain medication, and when your strength and reflexes have returned to a more normal state. Ask your surgeon when it is safe to resume driving.
Depending on your condition, you may be able to resume sexual activity within several weeks after surgery. Consult your doctor about this.
You can safely sleep on your back, on either side, or on your stomach.
Return to work
It may be several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.
Sports and exercise
Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement.
Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
Swimming is an excellent low-impact activity after a total knee replacement; you can begin as soon as the sutures have been removed and the wound is healed.
In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.
Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector. You may also wish to carry a medical alert card to show to the airport screener.