Recovery / Rehabilitation Process

Physical therapy and occupational therapy after your joint replacement surgery are critical parts of your recovery, as well as to help you regain range of motion and strength. Although you may feel significant pain during and after your therapy sessions, it is necessary for your recovery. Your physical therapist will teach you how to:
  • Lay in your bed in comfortable positions.
  • Move from sitting to standing
  • Walk with an assistive device (a walker, crutches, a cane).
  • Comply with hip and knee precautions.
  • Perform a home exercise program on your own.
  • Walk up and down stairs with an appropriate assistive device.
  • Comply with hip or knee precautions while performing functional activities
  • Perform transfer techniques, such as getting on and off toilet seat with and without assistance or getting into and out of a car.
  • Perform self-care activities, such as dressing with adaptive equipment and assistance if needed.

Total Joint Precautions

While recovering from surgery, you will follow specific precautions provided to you by your therapists. These precautions allow you to heal properly and help prevent potential complications. Make sure to ask your surgeon when it is safe to stop following these precautions.

Knee

  • Do not pivot or twist your operated leg.
  • Do not kneel or squat.

Hip

Note: Precautions may vary, depending on the surgical approach. Your surgeon and therapist will discuss your specific precautions. General precautions are as follows:
  • Do not bend your operated leg beyond a 90-degree angle.
  • Do not pivot or twist your operated leg.
  • Do not cross your operated leg or ankle.

The Days Following Surgery

Your goal is to keep moving. We encourage you to get up for meals, go to the bathroom, and get out of bed –all with assistance. You will continue to have therapy, and your activity level will be increased. Your IVs will be discontinued and removed once you are drinking enough fluids. Pain is an expected part of recovery. Pain levels vary per person. We will give you cold packs or wraps to manage your pain and reduce swelling. Oral pain medication will be prescribed for you and available at discharge. While in the hospital, we will ask you to rate your level of pain several times a day. It’s important to tell us if you’ve had any problems with any pain medications in the past. Knowing this will help us better manage your pain.

Your Hospital Discharge

Discharge planning starts the moment you decide to have surgery. Most patients are ready to be discharged from the hospital three to five days after surgery; however, specific criteria must be met. You will be discharged from the hospital when:
  • Your medical condition is stable.
  • You are able to eat and urinate.
  • Your pain is controlled with oral pain medication.

At Home Instructions

After surgery, you can expect gradual improvement over the coming months. You should expect less pain, stiffness and swelling, and a more independent lifestyle. Returning to work depends on how quickly you heal and how demanding your job may be on a new joint. After you are discharged from the hospital, there will be a few days before you return for a follow-up visit with your surgeon. This period of time is critical in your rehabilitation and for positive long-term results from your surgery. In general, patients do very well after discharge. However, it’s important that you contact the surgeon’s office if any of the following occur:
  • You have increasing pain in the operative site.
  • There is new or increased redness or warmth since discharge
  • There is new or increased drainage from your incision.
  • The operative site is increasingly swollen.
  • Your calf becomes swollen, tender, warm, or reddened.
  • You have a temperature above 101 for more than 24 hours.
  • For total knee replacement, your ability to flex (bend your knee) has decreased or remains the same as when you were discharged from the hospital.

Managing Pain and Discomfort

We encourage you to take your pain medication as soon as you begin to feel pain. Do not wait until the pain becomes severe. Follow the instructions on the prescription label. Remember to take your pain medication before activity and bedtime. If you need to have stitches or staples removed and you are still taking pain medications, be sure to have a friend or family member drive you to your surgeon’s appointment. Pain medication may cause nausea. If this happens, decrease the amount you are taking or stop and contact your surgeon’s office. If you need additional pain medication, please contact your surgeon’s office. If you need more pain medication, you must give a three-day advance notice before you run out medication. Please plan ahead, especially for holiday weekends.

Also remember:

  • You are not permitted to drive a car while taking narcotic pain medication.
  • It may take several days to have a bowel movement. Anesthesia and pain medication often cause constipation. Drink plenty of fluids and eat whole grains, fruits, and vegetables. A stool softener or laxative can help bowel function return to normal.
  • Please do not hesitate to call your surgeon’s office with any questions or concerns.

Incision Care

Your incision will be covered with a dressing. Before you go home, your surgeon or nurse will explain how to take care of your wound and when to remove your dressing. Make sure you understand these instructions before you leave the hospital and who to contact if you need assistance. Call your surgeon immediately if you notice any increase in drainage, redness, warmth, or have a fever above 101 degrees Fahrenheit for more than 24 hours. These may be signs that your incision may be infected.

Walker, Crutches, Cane

Use your assistive devices for balance as instructed by your surgeon or therapist. By your first post-op visit with your surgeon, you may have already improved and changed from using a walker or crutches to a cane (as recommended by your surgeon or therapist).

The First 48 hours at Home

No matter how much you prepared for your homecoming, it will be an adjustment. You will likely experience anxiety and question whether you were discharged too early. This is a normal feeling, so relax and focus on your recovery. Expect a call from the Specialty Care Coordinator. This is your opportunity to report any problems and ask any questions. Also expect a visit from the physical therapist or occupational therapist within 48 hours of discharge.

Activity

  • Continue your exercise program and increase activity gradually; your goal is to regain strength and function.
  • Follow all therapy instructions.
  • Resume activity as you gain strength and confidence.
  • For total knee replacement, swelling of the knee or leg is common with an abrupt increase in activity. If this occurs, elevate the leg above the level of your heart (place pillows under the calf, not behind the knee joint), and apply ice directly to the knee. You may continue with elevation and icing as needed to help decrease swelling and discomfort.
  • Continued exercise at this early stage is important to achieve the best outcome with your new joint replacement. Based on your needs, your therapy may be continued at home or in an outpatient setting of your choice. You will be given an exercise program to continue exercising at home.
Do not sit for longer than 30 to 45 minutes at a time. Use chairs with arms. You may nap if you are tired, but do not stay in bed all day. Frequent, short walks—either indoors or outdoors—are the key to a successful recovery. You may experience discomfort in your operated hip or knee, and you may have difficulty sleeping at night. This is part of the recovery process. Getting up and moving around relieves some of the discomfort. You should climb stairs with support. Climb one step at a time –“good”leg up - “bad”leg down. Hold on to a railing, if available. You may be a passenger in a car, but you should sit on a firm cushion or folded blanket to avoid sitting too low. See the instructions at the end of this guide for specific information for getting in and out of the car. You may not drive before your first post-op visit. The decision to resume driving your vehicle is made by your surgeon.

Lifting

Do not lift anything heavy after surgery. Avoid lifting objects in a position where you need to squat or bend. Avoid climbing ladders. Your surgeon will let you know when it is OK to lift heavy objects. Weeks 1 to 6 at Home Our health team members are available to assist you 24 hours a day, 7 days a week. You or a family member can call and receive answers to general questions as well as instructions in the event of an emergency. Do not hesitate to call your surgeon’s office regardless of the issue. During the first six weeks after discharge, you should be making progress week by week. Most patients are eager to report their progress at follow-up visits and are ready to move to the next level in their recovery. Most patients can accomplish the following during the first six weeks after total joint replacement:
  • Walk without help on a level surface with the use of walker, crutches, or cane as appropriate.
  • Climb stairs as tolerated.
  • Get in and out of bed without help.
  • Get in and out of a chair or car without help.
  • Shower using a tub bench once staples are removed –as long as there are no issues with the incision.
  • Resume your activities of daily living including cooking, light chores, walking, and going outside the home. You should certainly be awake and moving around most of the day.
  • Some patients return to work before the first follow-up visit. This is approved on an individual basis and should be discussed with your surgeon.

Icing and Elevation

After a joint replacement, swelling is expected. Swelling can cause increased pain and limit your range of motion, so taking steps to reduce the swelling is important. Continue using ice packs or some form of cold therapy to help reduce swelling. For knee replacement, you may use pillows to elevate; however, it’s important to elevate the entire leg, down to the ankle. Never put a pillow only behind your knee so your knee is in a bent position. Your knee should be straight when elevated.

Diet

Resume your diet as tolerated and include vegetables, fruits, and proteins (such as meats, pulses, fish, chicken, nuts, and eggs) to promote healing. Also, remember to have an adequate fluid intake (at least 8 glasses a day). It is common after surgery to lack an appetite. This may be the result of anesthesia and the medications. Proper nutrition is needed for healing. During the healing process, the body needs increased amounts of calories, protein, vitamins A and C, and sometimes, the mineral zinc. Eat a variety of foods to get all the calories, proteins, vitamins, and minerals you need. If you have been told to follow a specific diet, please follow it. What you eat can help heal your wounds and prevent infection and potential complications. If you’re not eating well after surgery, contact your healthcare provider about nutritional supplements. Weeks 6 to 12 at Home This period after joint replacement is a time of continued improvement. You will probably notice an in- crease in energy, a desire to do more activities, and a noticeable improvement in your new joint. Please keep in mind that every patient is different and will improve at a different pace. If you are not happy with the pace of your recovery, please contact your surgeon’s office to discuss your concerns.

Walking

After your six-week follow-up visit, you will likely start using a cane to walk and move about. Use the cane until you return for your 12-week follow-up visit. Walk with the cane as much as you want as long as you are comfortable.

Back to Work

Many patients return to work after the six-week follow-up visit. Tips to remember for returning to work include:
  • Avoid heavy lifting after you return to work.
  • Avoid standing or sitting for long periods of time.
  • Avoid activities such as frequently climbing stairs or climbing ladders.
  • Avoid kneeling, stooping, bending forward or any position that puts the new joint under extreme strain.
  • Expect a period of adjustment. Most people return to work with few problems. However, you may find the first several days very tiring. Give yourself time to adjust to work again and gradually this should improve.

Continue Exercise Program

Continue to exercise. Many patients stop working with physical therapy during this time. However, exercising is the most important activity to increase strength and leads to the best outcome. Work or home activities should not replace your exercise program.

Comply with all Restrictions

Although you are feeling back to normal, it is important to understand and follow the restrictions your surgeon discussed with you. Any restrictions are to protect your operative hip or knee as you continue to heal. If you want to achieve a successful outcome, be patient and follow your surgeon’s instructions.

Three-Month Follow-Up

You will see your surgeon for another follow-up visit about 3 months after surgery. We encourage you to resume normal activities both inside and outside the home. Helpful tips:
  • Be realistic and pace yourself and gradually resume activities.
  • Increase your walking distance and activities, but not all at once.
  • Keep a cane in the trunk of your car to aid with discomfort, or uneven or icy ground.
  • Enjoy the benefits of your total joint.
  • Continue to call with any questions or concerns. Our staff is always available to assist you.

Six Months and Future Follow-Up Visits

Your next appointment is six months after surgery, then once a year unless told otherwise. These appointments give you a chance to discuss any concerns about your total joint replacement or other joints in which symptoms may develop.

Lifelong Fitness

The goal of your surgery is to give you a new joint that allows you to perform everyday activities without pain. However, this joint is not indestructible. Avoid sports or other activities that may put stress on the joint until discussed with your surgeon. Stay as active as you can after recovering from your surgery. Ask your surgeon or therapist about activities and exercises that are right for you. It may or may not be appropriate to return to the exercise routine that you used before surgery. An increase in body weight puts stress on the hip, so try to maintain a healthy weight.

Potential Complications

Blood Clots

Blood clots are potential complications following hip or knee joint replacement surgery. A blood clot from your leg can travel to your lungs and cause serious health complications. Preventing a blood clot from forming is the best treatment method. You can lower your risk of developing a blood clot by:
  • Exercising and staying active (moving about).
  • Taking blood thinners, such as aspirin, warfarin (Coumadin®), or other drugs.
  • Wearing support stockings.
Some foods and supplements may alter the effectiveness of blood-thinning medications, such as foods with high amounts of vitamin K. Talk to your surgeon about certain foods to avoid while on this medication. The symptoms of a blood clot include:
  • Pain and / or redness in your calf and leg unrelated to your incision. •Increased swelling of your thigh, calf, ankle, or foot.
  • Increased skin temperature at the site of the incision.
  • Shortness of breath and chest pain or pain when breathing.
If you develop any of these symptoms, go to the nearest emergency department or call 911.

Surgical Site Infection

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. Some common symptoms of surgical site infection are:
  • Increased redness and pain around the area where you had surgery •Any drainage, in particular, cloudy fluid from your surgical wound •Fever
If any of these symptoms occur contact your surgeon’s office immediately.

Preventing Infection

Preventing infection is extremely important for the rest of your life. Your new joint is artificial and does not have your body’s natural protection against infection. It is possible to develop an infection in your artificial joint if antibiotics are not taken before certain procedures. These procedures include:
  • Dental procedures
  • Colonoscopy/Sigmoidoscopy
  • Cystoscopy/Genitourinary instrumentation •Prostate and/or bladder surgery
  • Kidney surgery
  • Cardiac catheterization
  • Barium enema
  • Endoscopy
Before having any procedures, let the physician or dentist doing the procedure know you have an implant. He or she should provide antibiotics. You may also contact the surgeon who performed your joint replacement to obtain the appropriate prescription antibiotics, if needed.