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. 

Hip Replacement: What You Need To Know Part 4

Hip Replacement: What You Need To Know Part 4

So you have just had your Total Hip Replacement and will be returning home soon, if you do not transfer to an Inpatient Rehabilitation Center first.  The benefits of returning home are that you can sleep in your own bed without the daily distractions that you would have to deal with in a Rehab Center.  But you better be sure that you can safely navigate your home environment before you opt out of going to Rehab, because if not, you may end up falling at home and returning to the hospital needing a hip revision surgery or a hip surgery on the other side due to a fracture.  

Inpatient Rehab is beneficial because you will usually receive at least 5 hours of therapy each week.  On the other hand, if you return home, you may only receive Home Therapy 2-3 hours a week.  When your return home approaches, you will want to be proactive in preparing your environment.   You may also want to enlist the help of friends or family members for cooking, shopping, housekeeping, laundry and bathing assistance.  

You may have to make modifications in your home in order to maximize your safety.  Grab bars positioned in your shower will assist you in entering and exiting.  I do not advise the suction cup grab bars as they may loosen from time to time.  

If you live in a multi-story home, you will want to consider railings along the staircases.  

Following your hip surgery, you will most likely have difficulty transferring out of a chair, so an elevated seat (multiple pillows) with armrests and a firm cushion is preferred.  

You will also want to consider an elevated toilet seat so that your knees will remain lower than your hips (Total Hip Precaution). The Total Hip Precautions should be followed for at least 6 weeks after surgery, depending on your surgeon's orders.

You may purchase a shower chair so that you are at less risk of slipping in the tub.  

A removeable showerhead will also be beneficial.  

For dressing, consider buying a long handle shoe horn and sock aid so that you will not have to overly flex at your hips.  

A reacher will help you pick objects off the floor if you drop something.  

Don't forget to remove all throw rugs and loose electrical cords that may be in the walk ways, as these are trip hazards.  

Some people set up a single area in their home where they will spend most of their time.  This area will have the telephone, television remote, medications, bottled water, books/magazines, etc..

If you are unsteady when walking, a 3-in-1 commode can be placed by your bed so that it can be used throughout the night if you need to use the bathroom.  It can also be placed over the toilet (after removing the basin) to elevate the seat or in the shower as a shower chair.

As insurance companies are covering less equipment nowadays, you may have to purchase most of the above mentioned equipment online or at a local medical supply store, Walgreens, CVS, Home Depot or Walmart.  

Hip Replacement: What You Need To Know Part 3

Hip Replacement: What You Need To Know Part 3

More Information About The Surgery

The Total Hip Replacement prosthesis is made up of a ball component and socket component.  These may be made of metal or ceramic.  Depending on your bone density, the components may be cemented into place or press-fit to allow the bone to grow into the components.  
  


You will either be put to sleep using general anesthesia, or may be given a spinal/epidural or nerve block which allows you to remain awake, but numbs you from the waist down.  


During the surgery, which lasts a few hours, the damaged cartilage is removed and replaced by the prosthetic components to allow proper function and alignment of your hip.  Plan to stay in the hospital for a few days.  


Initially, a foam wedge may be placed between your legs in order to maintain the hip precautions (prevent ankle crossing). 
 


A Physical Therapist will evaluate your strength, balance and ability to transfer, walk and navigate stairs (if you have stairs at home) the day of the surgery or a day after, depending on the surgeon's orders.  If it seems that you will not be safe to return home, inpatient rehab will be recommended.  

Pneumonia is potential risk following surgery due to pain medication, bedrest and anesthesia.  To help prevent pneumonia, a spirometer will be provided in order to minimize shallow breathing.  This measures the amount of air you inhale and exhale.  You must use this frequently throughout the day as an exercise.

Your incision may be closed using stitches or staples which will be removed within two weeks.  A water proof bandage may be applied by the surgeon, which will allow you to shower without having to change the bandage.  

 

Exercise is critical in your recovery.  Following inpatient rehab, you may want to consider home care Physical Therapy.  On average, the return to light daily activities takes 3-6 weeks.  Your Physical Therapist may provide you with a Home Exercise Program which you should perform daily.  These exercises can be purchased in video format HERE.  You can also find videos on bed mobility, transfers, stair navigation, fall recovery, and embolisms with the Tips for Knee Rehab: $16.95 DVD and Home Bound and Deconditioned DVD: $26.95

One common life threatening complication following surgery is the formation of blood clots in your leg veins.  


TEDs support stockings and blood thinners are usually prescribed by your surgeon as a preventative measure.  

Ankle pumps and daily walking will also be beneficial.  Warning signs of a blood clot are 
1)pain in your calf unrelated to the surgery site
2)redness, warmth and/or swelling of your leg.  

If you suddenly experience shortness of breath or chest pain, call 911 as this may mean that a clot has reached your lungs and you may be experiencing a pulmonary embolism.  

Following surgery, there is always a risk of infection.   If you suffer from a fever, chills, redness or swelling at the incision site, drainage from the wound or severe pain in the hip, you will need to call your surgeon immediately and follow all directions received. Also keep in mind that you will no longer be able to have dental work without taking antibiotics prior.  

If you plan on travelling after your surgery, consult with your surgeon to discuss how long you need to wait following the surgery.  You may also want to request a card that will tell all travel security agents that you have a prosthetic hip, as you may activate metal detectors following the replacement.

For the Total Hip Replacement DVD, which explains common Physical Therapy exercises and appropriate time frames following the surgery, click HERE.