Post-operative questions
Will I need blood after the surgery?
In most cases, the answer is no. Donating your own blood before surgery may be wise in some circumstances, but increasingly we use a blood salvage system during surgery. This allows us to capture the lost blood and re-infuse it into your body. Rarely, you may need blood after surgery, and we will use blood from the blood bank for this purpose. Nothing is entirely risk-free and blood transfusions carry a small but finite risk of complications, including disease transmission. With increased scrutiny and testing, for all practical purposes, blood transfusions are safe. If you have strong feelings about this or have religious beliefs that prohibit blood transfusions, please let us know early on, so that we can prepare accordingly.
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How long will I stay in the hospital?
People vary widely in their recovery times. In-hospital stay is typically two days after an uncomplicated joint replacement of the knee or hip. In general, you will be assisted to a chair on the day after surgery and you may be able to walk limited distances. Then, each day gets better. Recovery time varies highly from one patient to another. Much depends on other existing medical conditions. For example, arthritic disease in other major joints, heart disease, diabetes, obesity, depression and other related conditions can affect how quickly you recover.
If the patient is elderly, lives alone, or has specific needs, then we will transfer them to the inpatient rehabilitation unit. Most people go home and have a home health nurse attend to their needs for a few weeks. In rare cases, very elderly or debilitated patients might need to go to a nursing home to recuperate. This typically happens with complex surgeries, such as a multiple-time failed surgery referred to us or someone who has worn out an artificial joint placed a long time ago.
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How long will it take for me to recuperate from having my total joint replacement?
As a rule of thumb, the younger you are and the more muscular you are, the longer and more difficult your recovery. For example, a 39 year old healthy male will progress much slower than a 76 year old woman, with the identical operation. This may sound paradoxical, but I have seen it over and over again. I encourage younger patients to keep their own joints as long as possible because as a rule, their recovery is slower.
Knees: Most patients bend the knee easily and walk without assistance by four weeks. With the MIS-2-incision procedure, the time to independent walking is even faster. We encourage patients to take it easy and not push the limit until about six weeks after surgery. By that time, bone has had a chance to grow into the metal pores of the implants and the implants become a part of your skeleton. Then, most people can do what they want.
Keep in mind that the process of adjusting to a new prosthetic joint and the process of remodeling of bone around the implant can take much longer. Many patients will feel like the joint is truly part of their body by around two years after surgery.
The bottom line: Plan to take your time. Slow down and recover properly. No one can understand or feel your pain or emotions as you recover. Give yourself the time and space that it takes to heal. Even the modern minimally-invasive procedures that we routinely perform take their toll on the body and mind. Let your body and mind be the guide and let yourself recover at your own pace.
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I had constipation and nausea after my last surgery. How to avoid this problem in the future?
Constipation is a common problem a day or two after surgery. The narcotic medications typically result in constipation, along with other factors. Based on patient suggestions, we now give a stool softener before the surgery. This seems to work; allowing resumption of normal bowel routine quickly after surgery.
Nausea is usually a reaction to one of the narcotic pain killers. With modern surgical and anesthetic methods, we are moving away from heavy narcotics to localized pain blocks and pain-medication infusing pumps. Also, an anti-nausea agent is given before the operation to reduce the chances of nausea after surgery. If you do feel nausea, we have many medications that can treat it effectively.
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When can I drive?
For a replacement operation on the right leg, hip or
knee, it is wise to wait a month. By that time, you have
control of your reflexes, making driving safe. For the left
side, with an automatic transmission, usually 10-14 days is fine
before you start driving.
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How soon can I fly on an airplane after hip or
knee replacement surgery?
As soon as you are comfortable with sitting down, you can fly. Usually,
3-4 weeks is the minimum realistic time. During flying or driving long
trips, exercise your calf muscles and ankles frequently. Also, get out
of the car, or walk the aisle of the airplane to avoid the possibility of blood
clots. Take the blood-thinners that are prescribed after surgery to reduce
the risk of blood clots.
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Do I need an ID card to carry to get past airport
security with an artificial hip or knee?
Yes, we have these cards for you to carry. With heightened
security measures however, be prepared to have the security personnel
at airports screen you more thoroughly. In some cases, patients
have been asked to show security personnel their surgical scar. Usually,
the ID card will suffice though.
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Can I place full weight on the operated leg after surgery?
Knee: Knee replacement patients can place full weight right after surgery, without restrictions. They will likely need a cane or walker to balance themselves for a while. The length of time that the walker, crutches or cane is used after surgery is very variable from one person to another. If you feel secure and can maintain your balance, you can start walking without an assistive device. Practically, this can take anywhere from 2-4 weeks, depending on the person. Use your common sense, and try small steps at home first. If you feel comfortable, increase your pace accordingly.
Hip: As for hip replacements, it is essential to use some form of assistive device for at least 6 weeks after surgery. Hip implants are loaded in torsion (i.e., a rotational stress is placed on the implant each time you get up, turn in bed, or go up or down stairs), in addition to being loaded in compression, which is your weight pressing down on the implants. Knee implants are loaded mainly in compression. As a result of this difference, it is essential to let the hip implants bond to your bone first, before increasing your activity level. That is why it is important to be careful and protect the new hip joint, no matter how good or impatient you feel, and no matter what the implants were made of or who did the surgery, or how small the surgical incisions were. At six weeks after uncomplicated first time hip replacement surgery, you can discard the cane entirely, and walk unlimited distances as limited by your tolerance. You can ride a lawn mower or tractor at this time. At twelve weeks after such surgery, you can do whatever you please. In specific cases, and in all revision type surgeries, these instructions do not apply. Rather, individualized and customized recovery programs will be specified, unique to your case.
When should I stop using crutches, cane or walker?
Total knee replacement: You can discontinue these as soon as you are comfortable. Practically, it is wise to use a cane for at least 2-4 weeks after the surgery, at the least, to make sure that you are stable. Surgery upsets your metabolic system and many people don't feel "quite right" for some time after surgery. Alterations in appetite, sleep, taste, mood, balance and strength are common after any surgical procedure. There are no weight-bearing restrictions with total knees either. We strongly encourage you to move the knee as much as possible, since most of your mobility is gained in the first four to six weeks after an artificial knee replacement.
Total hip replacement: The use of a cane is recommended for at least 6 weeks after surgery consisting of a total hip replacement, regardless of what surgical approach was utilized.Use a cane, crutches or walker for six weeks after surgery. Occasional standing and taking a few steps without such support may be okay, but it is better to have something in your hand. Twisting movements place a lot of torque on the hip joint. While these forces may be relatively benign in the knee, the hip is a different story. Before six weeks, the parts are simply impacted into bone, they are not fused to it. Treat the hip just like a broken bone that one would protect with a cast. The purpose of the cane is to slow you down and make you cautious so that nothing is wrenched loose while the components are healing. Once x-rays confirm healing, you can do what you want.It is possible to cause the hip implants to move by being overly aggressive with your activities after surgery.
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When can I ride a lawn mower?
You can ride a lawn mower whenever you are comfortable but this should
not be done earlier than two weeks after surgery. Riding a horse
should be deferred until six weeks after surgery.
When can I shower and take a tub bath? When can I swim or get into a lake?
You can shower anytime after the surgery, as long as you can stand safely, either alone or with some help. Usually this will take a day or two after surgery. The incision can be covered with a piece of plastic, such as Saran Wrap®. If the dressing gets wet, a new dry dressing should be used to cover the incision. A tub bath, swim or immersion in a lake should wait about ten to 12 days.
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Why do I have to take a blood thinner (Coumadin or Warfarin)? When can I stop?
We place every patient on a blood thinner daily for one month after surgery. If you can tolerate it, you will take a "baby" aspirin (81 mg strength, enteric-coated) for another two months after the blood thinner is stopped, particularly if you plan a long trip in an airplane or a car.
Bone surgery, particularly hip and knee replacement surgery is associated with a significant risk of blood clots developing in the calf, thigh or pelvic veins. These clots often do not have any obvious symptoms or signs. Clots can cause chronic swelling of the legs, pain, and circulation and skin problems. In rare instances, a clot can break off and go the lungs producing a fatal pulmonary embolism. The risk of clots greatly decreases when the blood is thinned right after surgery..
possibility of a bleed in tissues that are susceptible to this after surgery represents a drawback. We monitor Coumadin levels closely. If the blood is too thin, we may elect to hold therapy and start bed rest until the drug levels return to safe limits.
Coumadin reduces but does not eliminate the risk of blood clots. If you have a high risk factor or develop a blood clot, Coumadin therapy might be continued for a longer period of time.
If you have used Coumadin before and have had any unusual reaction to this drug, please let us know. You are likely to have the same reaction when you are exposed to this drug again. If we know about it, we can prepare accordingly.
How long can I have pain medications refilled?
Most, if not all, patients will taper off the use of narcotic drugs by about three months. These medications have addictive potential. Some of them cannot be called into pharmacies. Please call for refills during the weekdays, when our staff is fully available to address this problem. We will ensure that you have a sufficient supply of medications before you leave the hospital. Sometimes, adding an anti-inflammatory drug can reduce pain dramatically.
In some instances, it may be necessary to continue pain medications for longer than three months. We individualize treatment for every person.
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Why do I have "popping and & clicking" in my artificial knee?
This is normal and it represents the artificial materials contacting each other. The knee is designed to do this.
By six to nine months after surgery, the popping and knocking sensation may disappear, but in some cases, you can feel it even after that time. It is entirely harmless.
After total hip replacement, an occasional pop may signal a muscle or tendon moving across the artificial joint. As long as this is not painful, this is an expected and benign process. Very rarely, the artificial hip may dislocate, i.e., the ball may jump out of the socket. This is definitely not a benign process, and you will know it. Fortunately it is rare, and with modern surgical techniques, it almost never happens after a first time hip replacement. Re-do surgery is more complex, and the risk of dislocation is higher.
How long will I have swelling and warmth in my surgical site?
Swelling,some redness and warmth often occurs after a joint replacement procedure. The ankle may also swell on the operated leg. It represents the normal process of healing. Expect this to continue for six to nine months after surgery; associated medical conditions such as obesity, diabetes, heart disease, varicose veins or previous swelling may cause swelling to occur even longer.
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When can I go back to work after surgery?
It depends on the type of work. If you are in hard labor, it is best to wait for three months before swinging into full action. Prior to that time, you can return to some light duty work if this is possible. For other jobs that require some standing, sitting, and walking, it is possible to return earlier. It really depends a lot on the individual and their job. Typically, most people will give themselves at least three to four weeks after joint replacement before returning to work in some capacity. Whatever works for you, we can accommodate it.
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How soon can I resume sex after a hip or knee replacement
operation, and what positions are safe?
You can resume sexual activity as soon as you are comfortable, in
any position that does not cause discomfort. With the older hip replacement
methods, certain restrictions and precautions were recommended, but those do
not apply with our newest surgical methods.
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Can I ride a horse, ATV, jet-ski, or other recreational vehicle
after an artificial hip or knee?
Yes, any type of recreation or riding is fine, just as soon as healing
is complete. To be safe, please wait a minimum of six week before you take
up such activities. In selected cases, we may advise you to wait a bit
longer. |
