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. 

Common Back & Neck Surgery Precautions

Common Back & Neck Surgery Precautions

The video protocols offered by KB Fitness, LLC, include some of the more common and standard exercises that you can expect to be taught while receiving Physical Therapy during specific time frames following an injury or surgery.  However, each surgery/injury and each individual undergoing surgery or recovering from an injury are different.  We all heal at different rates, and some surgeries are more extensive than others.  There is an expected time frame for the patient to be able to perform certain activities, and that is what the protocols provide…a base or foundation to work off of.  The benefit of seeing a Physical Therapist is having the frequent one-on-one guidance as you progress through your protocol.  Your therapist will decide when to “hold you back” and when to “push you harder,” again using the protocol as a guideline. 

Unfortunately, not everyone has the time, insurance or the finances to allow them to attend Physical Therapy.  So the videos offered here were produced to help those who do not have the convenience of going to a Physical Therapy Clinic.  It is advised, however, that you take the Home Exercise Handouts that accompany each video protocol to your Physician during your follow-ups for him/her to check off which exercises you should and should not be doing at any particular time.  I have found that two different surgeons performing the same surgery may expect their patient to be functioning at different levels in their rehab, as some surgeons are more aggressive or conservative than others.  For example, some surgeons may send you home wearing a back brace, while others may not.  This is why it is very important to keep your doctor, surgeon, and/or therapists informed of what activities you are doing or intend to do following your surgery or injury, by showing them the Protocol Handouts.   

Although two different surgeons may have different expectations at certain times following surgery/injury, there are some common precautions that patients should be made aware of following surgeries, especially Cervical or Lumbar Spinal Fusion.  Here are some precautions to keep in mind that many surgeons do agree on….

• Remember B-L-T!!!  This stands for absolutely No Bending, Lifting, or Twisting
• Learn how to Log Roll and use it to get in and out of bed. Click HERE to see a video describing the Log Roll Technique.  This video was taken from the HomeBound and Deconditioning Video Series

• If you are recovering from a Neck Fusion, wear the collar you received at all times.  You should also receive a shower collar after surgery
• If you are recovering from Low Back Fusion, you must wear your back brace if walking more than 5 minutes.  You do not have to wear it if sitting or in bed (unless your surgeon says otherwise).  Wear a T-shirt under the brace to avoid direct skin contact with the brace
• Do not lift objects greater than 10 pounds.  The time frame for this varies by surgeon so make sure you ask during your follow up visit, which occurs within 2 weeks following surgery
• Limit your sitting to 30-60 minutes.  Follow this by walking or lying down.  You may sit in a recliner with your feet up
• Walk, Walk, Walk as much as possible, but take frequent rests.
• Ask your doctor about when you can return to aerobics or strenuous exercises, but it usually takes 3 months
• If you have to climb stairs, do so carefully
• Ask your doctor when you can shower as you may be advised not to get the surgical bandages wet.  They occasionally use waterproof bandages but this varies.
• Do not pull off the steri-strips.  They will come off on their own. 
• Go to the ER if you experience chest pain, difficulty breathing, prolonged nausea/vomiting, severe and uncontrollable pain, or are in a car accident.
• Make sure to call the surgeon’s office if you incision opens, if you have a fever greater than 101, or there is drainage at the incision site 5 days after surgery.
• No driving until you visit your surgeon at the post-op visit and get approval.  Remember, if you do drive prior to receiving permission and are in an accident, this may pose an issue in regards to your auto insurance coverage.  If you are still taking the narcotic pain medicine, your doctor may either tell you not to drive until you are off the meds, or he/she may advise you to wait 4 hours after you take the meds before driving.
• Following Fusion of the neck or spine, Do Not perform ANY neck or back exercises until your doctor allows.  This may take over a month following surgery.  Just Walk, Walk, Walk!!!  The exercises on the Fusion DVD Protocols are to be performed to strengthen your neck or back only after enough healing has occurred and you receive permission from your surgeon.  You may receive Physical Therapy immediately following surgery.  However, this usually is to make sure you are navigating your home safely and following all post-surgery precautions.