Recovery at Home

I strongly believe that in most cases, the best place for patients to recover safely is their own home. Rarely, patients may require a short stay at a skilled nursing facility, but our intention is to avoid this if possible and minimize the length of the stay if necessary. Patients who are discharged to skilled nursing facilities have higher readmission rates, infection rates, and overall complication rates than patients discharged to their home.

Total Knee Replacement Discharge Instructions

Pain control at home

  • Initially, you will be on a strong oral pain medication. You will receive one prescription for 42 tablets to use for the 2 weeks after surgery. You may need 1 tablets every 4 hours for the first day or two but you are expected to quickly transition to Tylenol and an anti-inflammatory medication. It is okay to take a regular strength (325 mg) Tylenol with you pain medications.
  • Please understand that it is normal to have pain after an operation. It is important to remember to use ice, rest, elevation, and deep breathing to help you manage the pain.
  • Ice should be used for the first few weeks, particularly if you have a lot of swelling or discomfort. Apply for 30-45 minutes at least 4-6 times daily.
  • It is very common to have constipation post-operatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. Be sure to take in adequate amounts of water during the day. In rare instances, you may require a suppository or enema.
  • Opioid dependency is a growing problem in the United States. We will limit the amount of medication we give you after surgery. It is illegal to attempt to obtain pain medications from more than one physician.

Caring for your incision

  • In most cases you will leave the hospital with the dressing that was applied in the operating room. We would like for that dressing to remain intact for one week. It may be removed by your home therapist and if necessary, a new dressing will be applied. If, for some reason, the dressing becomes loose, wet, or otherwise damaged, you may remove it and reapply a dry gauze covering. Do not apply any antibiotic ointments or other treatments to the incision.
  • The dressing is waterproof and you may shower normally without affecting the dressing. If the dressing does become damaged and requires removal, you may still shower normally as long as the incision is not actively draining. Simply wash the area with soap and water and pat dry with a towel. Apply clean dry gauze to the incision.
  • You should not swim or get in a hot tub until the incision is healed, usually around 4-6 weeks. Be sure to discuss this with your doctor at your 6 week follow-up.
  • In most cases your stitches are absorbable and do not need to be removed. If you have skin staples, then they will need to be removed at your first appointment following surgery.

Physical Therapy

  • The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. When you go home, you may have a therapist come to visit you for up to 2 weeks. Depending upon your progress at home, you may have outpatient physical therapy. Your therapist will help you walk, regain motion, build strength, and help you reach your post-operative goals. Your therapist will keep your surgeon informed of your progress.
  • It is most important that you work on getting your knee straight in the first few weeks after surgery to avoid developing a flexion contracture. A flexion contracture is a permanent bend in the knee due to tight hamstring tendons.
  • You should spend some time each day working on straightening your knee (extension) as well as bending your knee (flexion). A good way to work on extension is to place a towel roll underneath your ankle when you are lying down. A good way to work on flexion is to sit on a chair or stationary bicycle and bend your knee. Avoid using a pillow or towel rolled behind the knee for any length of time.
  • Initially, you will climb stairs leading with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. As your leg gets stronger, you will be able to perform stairs in a more regular pattern (about 1 month).
  • In most cases, you will be discharged home with a walker that you may need for up to 1 month after your operation. You will then be allowed to advance to a cane outdoors and no support around the house for several weeks. You will gradually return to normal function without any assistive devices. You will use an assistive device until you can walk without a limp. This may take up to 6 weeks.

Also, view the Physical Therapy Exercises after Knee Replacement video.

Blood clot prevention

  • Without proper prevention, blood clots can be very common after joint replacement surgery. Therefore, we recommend using a blood thinner beginning shortly after your surgery and continuing for several weeks until your activity has increased and your risk of developing blood clots has decreased. There are several types of blood thinner and your specific situation will determine which type of blood thinner you will receive.
  • Compression stockings (TEDS) should be used for the first 2 weeks in order to help reduce swelling and improve circulation. You may wear them longer, especially if you find that your ankles swell without them. You may remove them at night.
  • You may be given a mobile leg compression device (Compression Solutions) at your pre-operative appointment. These are similar to the leg compression device used in the hospital to prevent blood clots. They should be worn as much as possible while at home for the first 3 weeks after surgery. Since they are portable, you should attempt to wear them for 12 out of 24 hours daily. Additionally, there is a cold compression wrap that goes over the knee. It should be used for 30-45 minutes 4-6 times daily.

Also, view the video about Triple Play compression therapy to help prevent life-threatening DVT (Deep Vein Thrombosis)

Resuming Activity

  • Driving: If you had surgery on your right knee, you should not drive for at least 4 weeks. After 4 weeks, you may return to driving as you feel comfortable. If you had surgery on your left knee, you may return to driving as you feel comfortable as long as you have an automatic transmission. DO NOT DRIVE IF TAKING NARCOTICS!
  • Work: Typically, if your work is primarily sedentary, you may return after approximately 1 month. If your work is more rigorous, you may require up to 3 months before you can return to full duty. In rare cases, more time may be necessary. You may find that you need to get up and move around to keep your knee from becoming stiff.
  • Travel: You may travel as soon as you feel comfortable. It is recommended you get up to stretch or walk at least once per hour when taking long trips. This is important to help prevent blood clots. You should use the portable leg compression device while traveling. Please avoid air travel for the first 2 weeks after surgery.
  • You may set off the machines at airport security depending on the type of implant you have and the sensitivity of the security checkpoint equipment. The TSA has issued a policy that can be found here. Basically, they will conduct a pat-down and/or wand evaluation of anyone who has metal hardware that sets off the detector. No card or note is necessary. Be sure to plan accordingly; wear loose fitting clothes and permit extra time for security screening.

Follow-Up Appointment

You will need to follow up in the office within 2 weeks of your surgery.

Other common issues

  • Many patients have difficulty sleeping at home following knee replacement surgery. Non-prescription remedies such as Benadryl or Melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.
  • It is not uncommon to have feelings of depression after your knee replacement. This may be due to a variety of factors such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist.
Normal things about your new kneeAbnormal things about your new knee
  • Clicking noise with knee motion
  • Skin numbness on the outer (lateral) part of your knee
  • Swelling around knee and/or lower leg
  • Warmth around the knee
  • “Pins and needles” feeling at or near incision
  • Dark or red incision line
  • Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.
  • Increased bruising that may extend down to or past your ankle
  • Increasing redness, particularly spreading from the incision
  • Increasing pain and swelling
  • Fevers (>101 F)
  • Persistent drainage from your wound
  • Ankle swelling that does not decrease or resolve overnight with elevation
  • Bleeding gums or blood in urine/stool.

Total Hip Replacement Discharge Instructions

Caring for your incision

  • In most cases you will leave the hospital with the dressing that was applied in the operating room. We would like for that dressing to remain intact for one week. It should be removed by the home therapist 7-10 days after your surgery.  If, for some reason, the dressing becomes loose, wet, or otherwise damaged, you may remove it and reapply a dry gauze covering.  Do not attempt to apply any antibiotic ointments or other treatments to the incision.
  • The dressing is waterproof and you may shower normally without affecting the dressing. If the dressing does become damaged and requires removal, you may still shower normally as long as the incision is not actively draining.  Simply wash the area with soap and water and pat dry with a towel.  Apply clean dry gauze to the incision.
  • You should not swim or get in a hot tub for 6 weeks. Be sure to discuss this with your doctor at your 6 week follow-up.
  • Your stitches are absorbable and do not need to be removed.

Pain control at home

  • Initially, you will be on a strong oral pain medication. You will receive one prescription for 42 tablets to use for the 2 weeks after surgery.  You may need 1 tablets every 4 hours for the first day or two but you are expected to quickly transition to Tylenol and an anti-inflammatory medication. It is okay to take a regular strength (325 mg) Tylenol with you pain medications.
  • Please understand that it is normal to have pain after an operation. It is important to remember to use ice, rest, elevation, and deep breathing to help you manage the pain.
  • Ice should be used for the first few weeks, particularly if you have a lot of swelling or discomfort. Apply for 30-45 minutes at least 4-6 times daily.
  • It is very common to have constipation post-operatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. Be sure to take in adequate amounts of water during the day. In rare instances, you may require a suppository or enema.
  • Opioid dependency is a growing problem in the United States. We will limit the amount of medication we give you after surgery.  It is illegal to attempt to obtain pain medications from more than one physician.

Follow-Up Appointment

You will need to follow up in the office within 2 weeks of your surgery.

Hip Precautions

  • Initially, you will climb stairs leading with your non-operated leg when going up stairs and lead with your operated leg when going down stairs. You can use the phrase, “Up with the good, down with the bad” to help you remember. After 6 weeks, you can perform stairs in a more regular pattern.
  • If you underwent a direct anterior hip replacement, you do not have formal dislocation precautions. You should always be careful to avoid any position that feels uncomfortable but the following restrictions do not apply to you.
  • If you underwent a posterior hip replacement, you should avoid bending at the hip more than 90 degrees, crossing your legs, and turning your toes inward. Avoid low chairs and furniture because they require too much bending at the hip in order to get up. If you must reach to the floor when seated, always reach between your legs, not to the outside.  Use an elevated toilet seat to avoid excessive bending of the hip. If possible, use a chair that has arms. The arms provide leverage to push you up to the standing position. When sitting, position your legs so that you can see your inner thigh, calf and foot (not the outside). If your physician orders different precautions, you will be instructed on them by your physical therapist.
    • Follow these precautions very carefully for the first 12 weeks. You should always avoid extreme positions of the hip.
    • You may sleep on your operative side whenever you feel comfortable. You may sleep on your non-operative side at 4 weeks with a pillow between your knees unless otherwise instructed by your surgeon.

Physical Therapy

  • The physical therapist plays a very important role in your recovery. You will see a physical therapist soon after your operation and throughout your stay at the hospital. When you go home, you may have a therapist come to visit you. Your therapist will help you walk, regain motion, build strength, and help you reach your post-operative goals. Your therapist will help keep your surgeon informed of your progress. The most important exercise you can do is walking.
  • You will be instructed by your physical therapist on appropriate exercises and given a list to follow.
  • Most people will not require outpatient physical therapy after the home therapy is completed. You will continue home exercises.
  • Everyone heals from surgery at a different pace. In most cases, you will leave the hospital using a walker. You will then be allowed to advance to a cane outdoors and no support around the house. You will gradually return to normal function without any assistive devices. You should use an assistive device until you can walk without a limp.
  • You may begin using a stationary bicycle without resistance after 2 weeks starting with 5-10 minutes and gradually build up your endurance.

Also, view the Physical Therapy Exercises after Hip Replacement video.

Blood clot prevention

  • Without proper prevention, blood clots can be very common after joint replacement surgery. Therefore, we recommend using a blood thinner beginning shortly after your surgery and continuing for several weeks until your activity has increased and your risk of developing blood clots has decreased.  There are several types of blood thinner and your specific situation will determine which type of blood thinner you will receive.
  • Compression stockings (TEDS) should be used for the first 2 weeks to help reduce swelling and improve circulation. You may wear them longer, especially if you find that your ankles swell without them. You may remove them at night.
  • You may be given a mobile leg compression device (Compression Solutions) at your pre-operative appointment. These are similar to the leg compression device used in the hospital to prevent blood clots.  They should be worn as much as possible while at home for the first 3 weeks after surgery.  Since they are portable, you should attempt to wear them for 12 out of 24 hours daily.

Also, view the video about Triple Play compression therapy to help prevent life-threatening DVT (Deep Vein Thrombosis)

Resuming Activity

  • Driving: If you had surgery on your right hip, you should not drive for at least 4 weeks. After 4 weeks, you may return to driving as you feel comfortable. If you had surgery on your left hip, you may return to driving if you feel comfortable, as long as you have an automatic transmission. Be careful getting in and out of a car, and avoid crossing your operated leg over the other. DO NOT DRIVE IF TAKING NARCOTICS!
  • Work: Typically, if your work is primarily sedentary, you may return after approximately 1 month. If your work is more rigorous, you may require up to 3 months before you can return to full duty. In rare cases, more time may be necessary
  • Travel: You may travel as soon as you feel comfortable. It is recommended you get up to stretch or walk at least once per hour when taking long trips. This is important to help prevent blood clots. Use your portable leg compression device while traveling.  Please avoid air travel for the first 2 weeks after surgery.
  • You may set off the machines at airport security depending on the type of implant you have and the sensitivity of the security checkpoint equipment. The TSA has issued a policy that can be found here. Basically, they will conduct a pat-down and/or wand evaluation of anyone who has metal hardware that sets off the detector.  No card or note is necessary.  Be sure to plan accordingly; wear loose fitting clothes and permit extra time for security screening

Other common issues

  • Many patients have difficulty sleeping at home following hip replacement surgery. Non-prescription remedies such as Benadryl or Melatonin may be effective. If this continues to be a problem, medication may be prescribed for you.
Normal things about your new hipAbnormal things about your new hip
  • Clicking noise with hip motion
  • Skin numbness near or around your incision.
  • Swelling around hip, knee and/or lower leg
  • Warmth around hip
  • “Pins and needles” feeling at or near incision
  • Dark or red incision line
  • Increased bruising
(Call the office immediately if you experience any of these)

  • Increasing redness, particularly spreading from the incision
  • Increasing pain and swelling
  • Fevers (>101 F)
  • Persistent drainage from your wound
  • A sudden “giving way” of your hip with inability to bear weight
  • Ankle swelling that does not decrease or resolve overnight with elevation
  • Bleeding gums or blood in urine/stool
  • It is not uncommon to have feelings of depression after your hip replacement. This may be due to a variety of factors such as limited mobility, discomfort, increased dependency on others, and/or medication side effects. Feelings of depression will typically fade as you begin to return to your regular activities. If your feelings of depression persist, consult your internist
  • It is not uncommon to feel as though your leg lengths are different. At surgery, leg lengths are assessed very carefully and an attempt is made to make them as equal as possible. Sometimes, the new hip has to be lengthened in order to obtain proper muscle tension (to help avoid hip dislocation). Wait 6 months before making any final judgments about your leg lengths. Your muscles and body take time to adjust to a new hip. In rare cases, a shoe lift may be prescribed for a true difference in leg lengths. In most cases, however, no treatment is necessary.

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