Post Surgery
Having joint replacement surgery is a major decision – one not be taken lightly. While you will undoubtedly welcome the pain relief you will ultimately experience after you have healed, it is natural to be anxious about the procedure itself and recovery period.
To ease any apprehension you might have about joint replacement surgery, we’ll walk you through what to expect after surgery, both in the hospital and at home.
In the Hospital
You will be taken to your hospital room a few hours after surgery. For most patients, the first night is uncomfortable but tolerable with anti-nausea and intravenous pain medications. Ice is applied to the surgical site. If you had surgery in the morning, you might be up and about in the afternoon or evening, while others may rest.
The day after surgery, patients usually switch to oral pain medications and start physical therapy. The most important thing after any joint replacement surgery is to get up and get moving as quickly as possible.
You will be discharged with detailed instructions about medications and dosages, weight-bearing status, activities to do and those to avoid, problems to call your doctor about, and when to follow up in the office (usually after 2-3 weeks and 8 weeks). You can also download discharge instructions here.
At Home
During the first few weeks after hip or knee joint replacement surgery, there are a number of things to look out for as you begin the healing process.
You will be allowed to shower (but not take a bath) two days after leaving the hospital if the wound is dry.
Incisions usually have some redness along the scar for many months. Most knee or hip incisions gradually become a thin white line over the first year after surgery.
Absorbable sutures can sometimes "spit," poking through the skin with a tiny bit of string visible and sometimes some associated fluid. This is not uncommon and is not typically any cause for concern.
New incisions are prone to sunburn, so you should take care to protect the scar from the sun in the first 12 months after surgery by keeping it covered or using a high SPF sunblock.
Patients often ask about how to minimize scarring. While you can apply vitamin E oil or a commercial ointment over incisions to reduce scarring, there is not significant evidence that these treatments really improve wound healing. However, massaging the surgical site typically helps to decrease fibrous scar adhesions.
Some degree of leg swelling is normal after hip and knee surgery, and it is not unusual for some patients to even notice a slight difference between the sizes of the legs for months after surgery. However, it should steadily be improving, and any swelling that suddenly becomes markedly worse should be reported right away as it can be a sign of a blood clot.
Bruising is also normal for a few weeks. This gradually resolves.
Some soreness after surgery is expected but should gradually get better week by week. Patients often comment that they no longer feel the grinding, deep joint pain with weight bearing that they had prior to surgery, and that most of the discomfort after surgery is muscular pain in the area of the incision. The more you are up and about moving your new hip or knee, the faster your pain will resolve.
We typically prescribe narcotic medications for the first week or two after surgery, with a transition to acetaminophen after that. While narcotics are helpful for pain relief, they often cause side effects such as constipation, nausea, occasional confusion, drowsiness, and a tendency to build up a tolerance to the opioid over a few weeks.
Depending on numerous factors, including the surgical approach, amount of surgical work needed, and particularly the state of the musculature around the hip before surgery, you can expect to limp for a while. In some cases, a limp may persist for a long time after surgery (most often for a patient who has had significant muscle atrophy, or wasting, from longstanding disuse of the hip prior to surgery).
It is common for most joints (hips and knees) to make some noise after surgery, often in the form of clicking or popping. As long as there is no specific pain associated with the noise, it is usually harmless.
There are numerous reasons for the noises, which are often from tight ligaments or scar tissue or from the contact of the artificial components themselves. Rarely, some materials (e.g., ceramic total hip replacements) can have some "squeaking" noises. Any noises that are associated with specific pain should be reported.
It is common for most surgery patients to have mildly elevated temperatures in the week or two after surgery. However, persistent fevers for more than a week or two, or particularly high fevers beyond 101º F, can be indicative of infection and should be called in. It is a good idea to keep a thermometer at home and simply check if you feel any chills or as if you may have a fever.
Most hip and knee incisions are dry by the time patients leave the hospital, although it is not unusual for some to have drainage for a week or possibly more. It is more common in larger, obese patients or patients who are undernourished (and have slower healing). It is probably also more common among smokers.
A particularly common source of drainage is the site of a drainage tube if one was used. This is usually the last spot to close up.
As long as the drainage is clear, yellow, or just bloody, there is usually not much need for concern, although it should be reported to the visiting nurse or surgeon if it persists more than a few days. Drainage that changes character and becomes thick, green, white, or foul-smelling can be indicative of infection and should be reported right away.
Post-Surgery Exercises
The exercise program after joint replacement is not temporary, but continuous. It is very important to continue with physical therapy and exercises after any joint replacement or resurfacing procedure. Rehabilitation will help your improve your mobility and strength with each passing day.
You should be walking at least 4 or 5 times per day, increasing your distance each time. Walking is your most important exercise after a joint replacement or resurfacing. It will increase your stamina and strength, decrease stiffness, help to prevent blood clots and constipation, and help improve how you feel in general.
It is better to walk for shorter periods with rests in between than to attempt a marathon session once or twice a day.
You should walk at a slow, steady pace on level ground. When you are not walking, you should rest in bed with your leg elevated above the level of your heart. These breaks are important to prevent swelling. Flex the ankles up and down whenever you think about it, which promotes circulation.
If your leg and calf suddenly become much more swollen, warm to the touch, and painful in the calf, it can be a sign of a blood clot and you should call the surgeon's office.
During the first week at home, you should not sit in a chair for more than 3 times a day for 30 minutes each time (usually at mealtime). After the first week, sitting periods can slowly be increased to a normal routine.
The following exercises are the ones we recommend in our practice. Your physical therapist, with orders from your surgeon, may also introduce additional exercises to work on specific muscle groups tailored to your needs.
Ten sets of the following exercises should be done each day, and at least 10 repetitions of each exercise should be done during each set. The standing exercises should be done while holding on to a table or using a crutch or cane for balance. If your balance is poor or you feel unsteady, then focus on the exercises that are performed lying down or sitting until you feel steadier on your feet.
Also note that while it is not unusual for exercises to generate some discomfort, significant pain is typically a reason for caution. If a particular exercise is too uncomfortable, then focus on other exercises. If you develop any problems that prevent you from continuing, such as lightheadedness, shortness of breath, or chest pain, then it is best to stop and contact your physical therapist or surgeon.
Discharge Instructions for Hip
Discharge Instructions for Knee
The following exercises are applicable for both hip and knee replacement:
Hip and Knee Bend
Bend the hip and knee in a standing position, lifting the leg up and down 10 times. Do not flex the hip beyond 90 degrees (should be level with the pelvis). Hold on to a table or walker for balance.
Ankle Motion
Lying flat, move the ankle in a circle. As you get stronger, try to lift the leg up while making the circle motion. Repeat 10 times.
Knee Isometric Strengthening
Lying flat, keep the legs straight and a little apart. Try to tighten the thigh muscles and push the knee downward against the floor or bed, holding the contraction for 5 seconds. Repeat 10 times.
Heel Slides
Lying flat, slide the foot (the one on the same side as the hip surgery) up as far as you can while keeping the heel in contact with the floor or bed, then allow it to slowly slide back. Repeat 10 times.
Knee Range of Motion/Straight Leg Raise
Lying flat, place a rolled towel or round pillow under the knee, then extend the knee so that the foot rises completely off the floor or bed. Hold it up for 5 seconds, then release. Repeat 10 times.
Add these two exercises to the list above for hip replacement:
Side Leg Lift
Stand with the knees straight. Lift the leg out to the side (known as hip abduction), hold for 5 seconds, and return to standing. Repeat 10 times. Use a table, rail, or walker for balance.
Gluteal Isometric Strengthening
Lying flat, keep the legs straight and a little apart. Squeeze the buttock muscles together for 5 seconds then release. Repeat 10 times.
