Guide to Total Joint Replacement
After Surgery
After your joint replacement, you will be taken to the Recovery Room,also known as the Post Anesthesia Care Unit (PACU) where you will be cared for by a group of dedicated nurses. After two to four hours in the PACU, provided that certain criteria are met and that you remain in stable condition, you will be transported to your regular hospital room. Family and friends will be allowed to visit once you are settled in.
Your care team will monitor your progress throughout your hospital stay to ensure your safe and efficient recovery. Among other things, they will periodically check your vital signs including your temperature, blood pressure, etc., and will inspect the dressings that cover your incision, if needed. You may also have blood tests or blood transfusions as necessary. You will need to resume normal bladder and bowel function. High fiber foods and water help prevent constipation.
Prevention of Blood Clots
At the direction of your surgeon, you may be given a blood thinner drug. An intermittent pneumatic compressive device will be applied to each leg that compresses your extremities intermittently and feels like a blood pressure cuff. This promotes circulation and decreases the possibility of blood clots.
Exercise Your Lungs
Prolonged bed rest, as well as anesthesia, may cause you to develop a cough or to not breathe normally. After surgery, your nurse will give you an “incentive spirometer” which is a small machine that you will blow into throughout the day. We recommend using this device at least 10 times per hour while awake to help your lungs function better and decrease your chance of developing pneumonia or a fever.
How to Use the Incentive Spirometer
1. Sit up.
2. Hold the incentive spirometer in an upright position.
3. Breathe out normally.
4. Place the mouthpiece in your mouth and seal your lips tightly around it.
5. Breathe in slowly and as deeply as possible (notice the blue object rising toward the top of the column).
6. Hold your breath for at least five seconds.
7. Exhale slowly and allow the piston to fall to the bottom of the column.
8. Rest for a few seconds.
9. Repeat these steps at least 10 times every hour.
10. After each set of 10 deep breaths, cough if you can.
Rounds
The orthopedic team will meet daily with your care team to discuss your progress . This multidisciplinary approach includes the attending orthopedic surgeon, physician assistant, physical therapist, case managers/social workers and nursing. You are strongly encouraged to ask questions or voice any concerns that you may have at any time. Surgery can be painful and we are most interested in making you more comfortable.
Fall Prevention
After surgery, it is important to ask for help before trying to get in and out of bed or going to the bathroom. You will walk to the bathroom with assistance from the staff. Wearing the non-skid socks provided by the hospital may also enhance your safety.
EXERCISE AND REHABILITATION
After your operation, the rehabilitation interdisciplinary team will start you on a course of treatment that will assist you with your new knee or hip The rehabilitation team consists of your doctor, nurses, therapists, physician assistants and case managers.
The day following your surgery, a physical therapist will assist you out of bed and help you to a standing position. You will begin to walk on your new knee or hip using a walker. In most cases, you will be allowed to put all your weight on your new knee or hip – this is called “weight bearing as tolerated .”
Sometimes, because of the nature of your surgery, your doctor may decide that at first you should place only part of your weight on your operated leg – this is called “partial weight bearing .” As time passes, you will be able to increase the amount of weight that you place on the operated side to weight bearing as tolerated. Your doctor will leave specific instructions with your rehabilitation team.
Around the second or third day after your surgery, you will be walking with greater confidence, negotiating stairs and be ready for discharge.
For the first month or two following surgery, most patients should perform some form of therapy – either home therapy, outpatient therapy, or in some cases therapy as part of care in a rehabilitation facility . You are primarily the one responsible for doing your therapy.
Your participation in therapy is critical to a successful surgical outcome following total joint replacement. The knee and/or hip joint require movement after surgery to prevent the formation of scar tissue that would make the joints stiff so it’s important to move as soon as possible . Your physical therapist will instruct you on exercises that will help your joint regain its flexibility and strength. It may be recommended that you exercise three times a day – morning, afternoon and night . While it is important to exercise, it is important not to over do your exercises .