Things to Remember When Recovering From a Total Knee Or Total Hip Replacement

Things to Remember When Recovering From a Total Knee Or Total Hip Replacement

 Total Hip Replacement

When undergoing a Total Hip Replacement, there are two common approaches, Anterior or Posterior.  



Briefly, with both approaches, you will be able to weight bear on the surgical leg after surgey as much as you can tolerate when walking (unless the surgeon specifies otherwise).  You may be placed on blood thinning medication following surgery to prevent blood clots, and will have your blood checked by a Home Health Nurse or at a clinic throughout the weeks following surgery using PT/INR testing to see how quickly your blood clots.  The quicker it clots, the higher the chance of blood clots.  However, the longer it takes to clot, the more blood loss you may have upon simple cuts, such as when shaving (it is advised to use an electric razor during this time).  

Your incision site will be bandaged and daily dressing changes are usually ordered.  After 10-14 days, the bandage and staples will be removed and replaced by steristrips. Do not pull the steri-strips off.  They will fall off on their own.  As the edges begin to curl up, you may trim them.



Once the wound is closed and there is no drainage, you will be able to shower.  In addition to the Home Health Nurse, you should take the responsibility of assessing for signs of infection, such as fever, redness, inflammation and/or pus discharge at the incision.  If your temperature is above 101 degrees, contact your surgeon.  

Use the incentive spirometer ten times per hour, at least twice a day.



Wear your TED Hose as directed by your doctor.  You may be allowed to remove them overnight and for sixty minutes twice a day (ask your surgeon). 

 

While lying in bed, keep your legs elevated by rolling up towels or pillows, and placing them under your ankles.  This will protect your heels from the pressure of the mattress.  Do Not place anything under your knees

For the Posterior Approach, restriction of movement and positioning include:

• No crossing your ankles
• Do not combine hip flexion, adduction and internal rotation

      

• If you sleep on your side, place a pillow between your knees

• No sidelying hip abduction exercise until 4 weeks post-op

• No resistive exercises for 4 weeks (no weights on the surgical leg)
• Walk, Walk, Walk!!!

For the Anterior Approach, restrictions include:

• No crossing ankles

• Initially, no Straight Leg Raises, no Hip Extension, no groin or hip flexor stretches, no Squats or Lunges.  Ask your surgeon upon follow up when you can begin these exercises, then see Total Hip Replacement DVD.
• Walk, Walk, Walk!!!

In regards to walking following both Approaches, you may progress from a walker to a cane to no device if it does not cause an increase in pain and if you can fully weight bear on the affected leg without a limp.

Total Knee Replacement

Following most Total Knee Replacements, there are usually less movement precautions than the Total Hip Replacement.  Your staples will be removed within 10-14 days, steri-strips will be applied, and you will be allowed to shower following staple removal as long as the incision is not open or draining.  You may also be placed on blood thinners.  You will receive an Incentive Spirometer, and will be required to wear TED Stockings.  You will be able to Weight Bear on the affected leg as much as you can tolerate and may progress from a walker to a cane to no device as long as the quality of your gait pattern is not antalgic (no limp).  The initial focus is on gaining full knee extension range of motion. 


 You must be able to fully straighten your leg as soon as possible.  Flexion of the knee will be a challenge too.  However, it will come in time.  Extension is the priority.  Remember, you may not place anything under your knee when sitting or lying.  No pillows, no rolled towels, nothing under your knee!!! In fact, it is advised to place a pillow or towel roll under your ankle in order to assist gravity in fully straightening your knee.  


Following surgery, you may be sent home with a CPM unit which is a Continuous Passive Motion Unit.  This will move your knee from a bent position to a straight position for you, and you can expect to use it three times a day for two hours each time. 



You also will be given exercises to do (See Total Knee Replacement DVD), but should not perform Resistive Exercises for 4 weeks.  Remember, most importantly, Walk, Walk, Walk!!

If you are considering a Total Hip or Total Knee Replacement, there have been many advancements in the technology which claim to be less invasive, causing minimal muscle and tissue damage, thereby speeding up your recovery time.  Unfortunately, with newer techniques, there is less information regarding long term results.  There are pros and cons to the newer as well as the traditional surgical techniques.  It is good for you to do your homework on what is available, before making a decision.  Some doctors perform these newer techniques more frequently than other doctors, so take your time finding the right surgeon.   Research how many replacements and what types of replacements they do each year.  This will help guide you in your decision.

An example of a newer technique for a less invasive hip replacement can be seen HERE.  And for a more customized, patient-specific knee replacement, click HERE.  These are not the traditional replacement surgeries, and may offer faster recovery times. 

Many Benefits To This Knee Exercise

Many Benefits To This Knee Exercise

 

Following an injury or surgery to your knee, regaining strength and mobility is a very important goal to establish.  In addition, your standing balance and hip stability may also be impaired during this time.  These goals are all very important if you have stairs at home, because you will need to safely navigate them so that you do not fall and become a "frequent flyer" at your local hospital. 

Most patients who have stairs in their home and are recovering from a knee or hip injury have been told "Up with the good, down with the bad."  This means that initially you must rely on the uninjured or "good" leg to control your body weight when ascending and descending stairs.  The "good" leg goes up first in order to lift your body to the next step.  On the way down, your "bad" leg goes to the lower step first as you must control the descent of your body using the stronger leg.  This is the safest way to navigate the stairs.  However, your ultimate goal is to regain symmetry in leg strength.  So a few weeks into recovery, as long as there are no weight bearing precautions on the injured leg, I will have my patient stand at the bottom of their staircase to practice placing the weaker leg on the first step.  Once they gain the appropriate range of motion in the hip or knee to allow placement of the foot on the step without compensation, I will progress them to lifting their body to the next step using the "weaker" leg.  Remaining at the lowest section of the staircase ensures client safety, as being at the bottom of the staircase, if the weaker leg does buckle, they will not fall down a flight of steps.  As confidence and strength improves, I will have my client perform multiple repetitions of this activity and eventually navigate the staircase alternating legs.

 

Now, going back to the "up with the good, down with the bad" technique.  Besides safety, there are many other benefits to using this technique.  In order to lift and place the "good" leg onto the first step, you must shift your weight onto the weaker leg.  This weight shift onto the weaker leg helps improve stance time on that leg during gait, which will minimize limping.  It also helps to improve the "weaker" side's hip, knee and ankle stability , as well as single leg balance, and client confidence level.  Many times, my clients will shift their weight onto the weaker leg and very quickly 'throw' the stronger leg up to the step, either because the injured leg is not strong enough to hold the body up, or their confidence in single leg stance on the weaker side is poor.  I provide verbal cues and sometimes manual cues to assist proper technique while letting them know that I will not allow them to fall.  They must perform this step-up slowly and with control.  The slower they lift the "good" leg to the next step, the longer they must stand on the weaker side, thereby improving hip strength, stability and single leg balance.  

As their confidence, balance and strength improve, I ask them to lift the "good" leg up two steps.  I do not require them to lift their body to the second step, but use this technique to challenge their stability and single leg balance on the weaker leg even more.  They must stand on the affected side for a longer time in order to place the "good" leg on the second step with control and coordination.  

If knee mobility is an issue, I will have them perform foot placement of the affected, weaker side on the first step with a progression to the second step, incorporating a lunge stretch in order to maximize knee flexion range of motion.  This technique will be easier  for them as they are standing on the stronger leg in order to place the weaker leg on the first or second step in order to perform the stretch.

 

So, you are not just performing stair training here.  You are also working on balance, stability, confidence, flexibility, and strength.  

 

Stair Training Tips:

1) Lifting the stronger leg first ensures safety and also forces you to balance on the weaker leg.  This improves standing tolerance on the affected side, single leg balance and hip/ankle/knee stability

2)Lifting the weaker leg first will help strengthen that leg as it must then lift your entire body to the next step.  Once the weaker leg is positioned on the next step, lunging into it will improve knee flexibility on that side.