Pre-Surgical Therapy
Pre-surgical therapy is vital to the successful outcome of your surgery. Your orthopaedic surgeon has prescribed therapy through a smartphone application called “My Mobility.” This application provides education, exercises, communication with your care team, and prepares you for your upcoming hip or knee replacement. Numerous reminders and exercises will be provided up to one month before the surgery. Going through all of the educational content and completing these exercises will decrease return to function time following your operation. If you do not have a smartphone, however, a formal physical therapy prescription will be provided.
Medical Evaluation
If you elect to proceed with joint replacement surgery, you will need to schedule a complete history and physical examination with your primary care physician several weeks before your operation. This is needed to ensure that you are healthy enough to have the surgery and complete the recovery process. Your primary care physician should be aware of your upcoming surgery and prepared to help post-operatively. If you have a history of heart disease, your cardiologist is an integral member of the team as we plan your joint replacement. Your cardiologist will provide surgical clearance as well as assist in managing your cardiac medications before, during, and after your procedure.
Tests
Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help your doctor plan your surgery.
Medications
Tell your doctor about the medications and supplements you are taking. Your primary care physician and the pre-surgery department from the hospital or surgery center will tell you which medications to stop taking.
Dental Evaluation
Although the incidence of infection after joint replacement is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your joint replacement surgery.
Urinary Evaluation
People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking joint replacement surgery.
Home Planning
Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:
- Safety bars or a secure handrail in your shower or bath
- Secure handrails along your stairways
- A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation
- A toilet seat riser with arms, if you have a low toilet
- A stable shower bench or chair for showering
- Removing all loose carpets and cords
- A temporary living space on the same floor because walking up or down stairs may be more difficult during your early recovery
- You may need assistance at home with cooking, showering, or laundry for several weeks
Anesthesia
After arriving to the surgery center or hospital, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia, spinal, or regional nerve block anesthesia. The anesthesia team, with your input, will determine which type of anesthesia will be best for you.
Risks of Surgery
All surgical procedures have some inherent risks. Despite utilizing specialized pre-operative testing, less invasive techniques, and novel pain and rehabilitation management, every joint replacement is still a major surgery. Although advances in technology and medical care have made the procedures very safe and effective, these risks really do exist. These risks should be considered carefully before deciding to have surgery. We encourage you to discuss the potential risks with your orthopaedic surgeon, primary care doctor, and your family.
Every measure will be taken by our team of experts to minimize the risks and avoid complications. Although complications are rare, they do sometimes occur. We will do our very best to avoid the most common risks, which include:
- Blood Clots
- Hematoma
- Infection
- Nerve, Blood Vessel, and Ligament Injuries
- Delayed Wound Healing
- Limited Range of Motion
Pain Management
After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Medications are often prescribed for short-term pain relief after surgery. Many types of medications are available to help manage pain, including opioids, no-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the United States. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
Preventing Blood Clots
Your doctor may prescribe one or more measures to prevent blood clots and decrease leg swelling. These may include special support hose, inflatable pumps on your calves, and blood thinners. Foot and ankle exercises are also encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.
Physical Therapy
Most patients begin exercising their joint on the actual day of surgery. The MyMobility smartphone application coaches you through specific home exercises before and after surgery. If you do not have a smartphone, or you prefer to work with an actual physical therapist, outpatient physical therapy is recommended instead of home physical therapy. Outpatient physical therapy is more beneficial because there is more exercise equipment available at the outpatient therapy location than at your home. Physical therapy teaches you specific exercises to strengthen your leg and restore joint movement to allow walking and other normal daily activities soon after your surgery.
Preventing Pneumonia
It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (atelectasis) which can cause fever and make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called an incentive spirometer to encourage you to take deep breaths. Continue to use this daily until you are up and around as often as you were prior to your surgery.
Post-Operation Instructions
Wound Care and Dressing
- 99% of primary joint replacements use absorbable sutures and Dermabond skin glue. Only complicated wounds and more involved revisions use a removable surface closure like staples or a ZipLine device.
- If your clear bandage following your hip replacement hasn’t fallen off in 5 days, remove it.
- If you have a Zipline closure device, it will be removed in the office after 10 days.
- If you have staples/sutures, they will be removed in the office or at home by a home health aide approximately 3 weeks after your surgery.
- TED Hose can help with leg swelling but is not mandatory. You may use as needed.
Bathing and Showering
- You may shower starting post-operative day 2.
- Do not take a bath, swim in a pool, or scrub the incision for 6 weeks after surgery or until your wound is checked by your surgeon and determined to be completely healed.
After Surgery
- If you had a hip or knee replacement, you can expect to have compression pumps on your calves to help prevent potential blood clots. They should be worn 20 out of 24 hours per day for 2 weeks.
- You may have a special wrap for ice therapy.
- Most primary hip and knee replacements (1st time replacements) allow patients to walk immediately, and a therapist or nurse will help you stand soon after surgery. If weightbearing is limited for some reason, the surgeon or nurse will communicate this with you.
- Once your vital signs are stable and you have regained movement and sensation in your lower extremities, someone will assist you to sit at the edge of the bed, stand, and walk.
The procedure itself takes approximately 1-1.5 hours. Your doctor will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your leg. Different types of implants are used to meet each patient’s individual needs.
After surgery, you will be moved to the recovery room, where you will remain for several hours while you recover from anesthesia. After recovery, you will be transferred to your private room for an overnight stay or to a different room where you will be prepared for discharge to home. If you are going home the same day as surgery, you will be evaluated for safe ambulation before being discharged.
Controlling your Pain
- The amount of pain and discomfort you experience depends on many factors. You will receive pain medication orally and if needed through your IV after surgery. Your physicians and nurses will do everything possible to relieve your pain and discomfort using medications and other techniques.
- Communication is an important part of helping us manage your pain. It is important to share information with your nurses about any pain you experience. Be as specific as possible. For example: Where is the pain? How often do you feel pain? What does the pain feel like: is it sharp, dull, aching, spread out? On a scale of 1 to 10, where 10 is the worst pain imaginable, how would you rate your pain?
Recovery Goals
Day of Surgery
- Up in chair as tolerated
- Diet as tolerated. Start slow and advance as you feel better
- Ankle pumps as instructed
- Incentive spirometry 10 times every hour while awake
- Ice therapy in place
- Physical therapy begins
- Manage pain
- Transition home (for outpatient surgeries)
- Walk with a walker to help with balance for first few days
- Inflatable calf pump: will be worn at least 20 hours/day for 14 days (hip and knee replacements only)
At Home: First Postoperative Day
- For hip replacement, leave clear bandage in place for 5 days unless soiled
- Continue use of ice compression every 2 hours
- Take pain medication as needed
- For hip and knee replacements, elevate ankle above the knee and the knee above the hip to reduce swelling when you are not doing exercises or walking
- Perform exercises at least 3 times per day
At Home: Second Postoperative Day
- May remove stocking and white dressings from knee
- May shower
- After shower, pat the wound area dry
- Increase your activity as pain and swelling allow
- Continue use of ice compression every 2 hours
- Take pain medication as needed
- Elevate ankle above the knee and above the hip to reduce swelling when not walking or doing your exercises
- Outpatient or home physical therapy may begin to further help improve function, walking, and reduce swelling
Managing Swelling
With a hip/knee replacement, it is normal to have bruising around your thigh or knee and down to your foot as well as up the inner thigh in to the groin area. You may also experience swelling of the upper and lower leg down to the foot and ankle. Swelling usually peaks around 7 days after surgery.
Be sure to use your ice machine or ice pack 3-4 times a day for no longer than one hour at a time with your leg elevated. This will help reduce pain and swelling. Keep extra frozen plastic bottles filled with water on hand to keep your ice machine functioning. Be sure to place a towel or ace wrap on your knee under the ice.
When to call your Surgeon
- A fall with injury
- Numbness, tingling, or burning that persists
- Pain not relieved by medication or pain that is getting worse
- Thick yellow drainage or bleeding from the incision site
- Fever greater than 101.0°F
- Inability to do your exercises
- Excessive swelling that persists
- Toes that are very cold and do not get warm when you cover them
- Any unexpected problems, concerns, or questions
Return to the Office
- You will need to return to the office to remove your ZipLine closure device in 10-14 days or your staples at 3 weeks if you had a revision hip or knee replacement.
- For primary hip and knee replacements, the first post-op follow-up appointment is 6 weeks after surgery.
Dental/Infection Prophylaxis
We recommend antibiotic prophylaxis for life for all patients who have had a joint replacement and are undergoing a dental cleaning, extraction, root canal, or filling. We recommend a dose of Amoxicillin before and after the dental procedure. In situations of procedures involving skin penetration or testing involving the gastrointestinal and genitourinary tract, we also recommend preventative antibiotic administration. Prescriptions for prophylactic antibiotics for these procedures can be obtained by your dentist, your physician performing this procedure, or our office before your procedure is performed. It is recommended that you report your joint replacement to any physician you may see. A card that lists the appropriate antibiotics for specific procedures is available from the office and will be provided to you after your surgery.
