Positioning
If you are a hip patient, the head of your hospital bed should not be elevated more than 70 degrees during the first few days after surgery. Sitting up too high might allow the artificial ball to dislocate from the hip socket.
If you are a knee patient, your physician may order a leg splint called an immobilizer to keep you from bending your knee. It should be worn when you are out of bed or at night when you are sleeping.
A staff member will help you turn and change your position in bed. Make sure you avoid twisting your leg when turning in bed.When turning in bed you should have a pillow between your legs. Avoid resting with a pillow under your knee.
Exercising
You will be evaluated by a physical therapist, who will go over exercises and precautions for avoiding dangerous movements. You may be surprised at how soon after surgery joint replacement patients are encouraged to get up and start moving—often as early as the day of surgery. The more quickly you start moving again, the sooner you will be able to regain independence. Mild exercises of ankle pumping and gluteal sets are usually recommended by your physical therapist as soon as you are awake from surgery and able to perform them.
As You Recover
In the days following surgery, your orthopaedic surgeon, nurses and physical therapists will closely monitor your condition and progress.
You’ll spend a great deal of time exercising your new joint and continuing deep breathing exercises to prevent lung congestion. Gradually, your pain medication will be reduced, the IV will be removed, your diet will progress to solids and you will become increasingly mobile.
Physical therapy for knee patients will address range of motion. Gentle movement, such as the CPM machine, will be used to help you bend and straighten the knee. Your leg may be elevated to help drain extra fluid.
Your physical therapist will also go over exercises to help improve knee mobility and to start exercising the thigh and hip muscles. Ankle movements help pump swelling out of the leg and prevent the possibility of a blood clot. When you are stabilized, your physical therapist will help you up for a short outing using your crutches or walker.
Hip patients begin physical therapy soon after waking up from surgery, with your physical therapist helping you move from your hospital bed to a chair. By the second day, you’ll begin walking longer distances using your crutches or walker.Most patients are safe to put comfortable weight down when standing or walking. However, if your surgeon used a non-cemented prosthesis, you may be instructed to limit the weight you bear on your foot when you are up and walking.
Hip patients will also do exercises to tone and strengthen the thigh and hip muscles, as well as ankle and knee movements to pump swelling out of the leg.
Whether you are sent directly home or to a facility for rehabilitation will depend on your physician’s assessment of your abilities. In general, if you live with someone who will be assisting you, discharge home is the usual procedure. The case manager will make your arrangements for further home or outpatient physical therapy. Most patients can go directly home if it is deemed safe by their surgeon and physical therapists.
If you live alone or are in an environment at home where your safety is a question because you have not achieved your discharge goals, you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient for a 3-5 day stay, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. If you live alone or are not progressing rapidly enough in therapy sessions and it is unlikely you will be able to do so in a rehab setting, a sub-acute facility may be recommended for a longer period of recuperation. Insurance coverage for these post hospital stays vary according to condition and plan and will need to be discussed by the patient, the case manager and the insurance company as warranted.
Before you are discharged home, you should be able to safely get in and out of bed, walk up to 100 feet with crutches or walker, go up and down stairs safely, access the bathroom and consistently remember to use hip precautions to prevent dislocation before going home. These tasks should be able to be completed independently or with minimal assistance.
Before you Leave the Hospital
Before you leave the hospital, you will learn how to:
- Get in and out of bed by yourself
- Walk down the hall with your walker or crutches
- Get in and out of the shower by yourself
- Get in and out of a chair
- Manage steps at home
- Get in and out of your car