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| HELPFUL HINTS POST-DISCHARGE |

 

After you are discharged from the hospital or rehab facility you will have a period of 4-6 weeks until you are seen again by your surgeon. This time is important in your rehabilitation and in the long term results from your surgery. Listed below are specific as well as general tips to help you accomplish the maximum benefits from this portion of your surgical experience. We hope that this information provides useful and timely information to you regarding this phase of your joint replacement surgery.

  1. The First 48 Hours - No matter how much you have prepared for your homecoming, this time is always one of adjustment. You may experience a slight period of anxiety and even wonder if you have come home too early. Relax and remember, this is a normal feeling. Give yourself a little time to become accustomed to your routine at home and you'll be well on your way.
  • Visitors - Be aware that many times well-meaning friends and relatives stop by to visit on the day you come home. Remember, this is your first day home and you have had a major operation - don't overdo! Get the rest you need to continue your recuperation period.
  • Exercises - Continue your exercise program - Once home, the major focus for you will be to regain strength and function. Don't skip exercise sessions - the only one to suffer will be you when you don't reach your maximum potential. Keep in mind that once your surgeon has completed your surgery the rest is up to you.
  • Case Manager Follow-up Call - Expect a call from the case manager or physicians assistant in your surgeons office. This post discharge phone call is made to maintain contact between the surgeon and you. Report any problems, and ask any questions, no matter how minor you may believe them to be. It is much more beneficial to ask questions and report problems rather than to worry about them. Remember, it is "always better to be safe than sorry."
  • Home Care - Expect a call from the physical therapist or home care nurse within 48 hours of discharge to arrange for continued home care if necessary.
  1. Week 1-6 After Discharge
  • Help Is A Phone Call Away - Remember that the health team members in the office are available to assist you. The secretaries, clinic staff, physicians assistants and residents are available 5 days a week during normal business hours. In addition, resident coverage is available 24 hours a day 7 days a week in the event of a problem. This availability allows for you or a family member to call and receive answers to general questions as well as instructions in the event of an emergency.
  • Use The Common Sense Approach - As you continue to recuperate at home you may encounter a problem or may have questions that you would like to ask. Do not hesitate to call the office if this is the case. Keep in mind also that even if your home care provider says that everything is allright, but you still feel you need to speak with someone in the office, you should do so rather than worrying about your progress.
  • Things To Report - In general, patients do very well after discharge. However, you should contact the office if any of the following occur:
    • You have increasing pain in the operative site
    • There is redness or warmth which is new or increased since discharge
    • There is drainage from your incision which is new or increased
    • The operative site is increasingly swollen
    • Your calf becomes swollen, tender, warm, or reddened
    • You have a temperature above 100.4 for more than 24 hours
    • In the case of total knee replacement, your knee feels as if it is decreasing in flexion (bending) rather than increasing or at least staying the same as when discharged.
  • Increasing Your Activity - During the first 6 weeks after discharge you should find yourself making progress week by week. Most patients returning at 6 weeks for their follow-up appointments are eager to report their progress and ready to move on to the next level in their recuperation. Listed here are activities that most patients can expect to accomplish during their first 6 weeks after total joint replacement.
    • Walk independently on a level surface with the use of your walker or crutches
    • Climb stairs at least once a day
    • Get into and out of bed independently
    • Get into and out of a chair or care independently
    • Shower using a tub bench once your staples are removed provided there is no problem with the incision
    • Gradually resume your activities of daily living including cooking, light house cleaning, walking more, and going outside the home. You should certainly be up and about all or most of the day.
    • Drive 4-6 weeks after your surgery
    • In some cases return to work prior to your 6 week check-up. This is allowed on an individual basis and should be discussed with your surgeon.
    • Resume sexual activity when you are comfortable in doing so. In total hip patients this can be done by following the Sexual Precautions Do's and Don'ts After Total Hip Replacement.

As stated above, your first post-operative visit is approximately 6 weeks after your surgery. We hope that the information which is presented here acts as a helpful guide to make these first few weeks at home as comfortable as possible. Please remember that you are encouraged to call your physician's office if you have any questions or problems during this time.

  1. Week 6-12 After Discharge
  • Progressing Every Day - The 6-12 week period after your joint replacement is a time of continued progression. You will probably notice an increase in your energy, a desire to do more activities the better you feel, and a noticeable improvement in the strength of your operated leg. Please keep in mind that every patient is different and will progress at different levels. If you feel that you are not progressing satisfactorily, please contact your physician's office to discuss your concerns.
  • Ambulation - Once you are seen for your 6 week check-up you will most likely advance to using a cane for ambulation. Remember to use the cane until you return for your 12 week follow-up. You may walk with the cane as much as you want as long as you are comfortable.
  • Back To Work - Most patients return to their work after being seen for their 6 week visit. Tips to remember for returning to work are:
    • Avoid heavy lifting (over 25 pounds)
    • Avoid prolonged standing or sitting
    • Avoid activities such as climbing stairs frequently or climbing ladders
    • Avoid any positions which would call for extremes in terms of range of motion, i.e. kneeling, stooping, bending forward
    • Expect a period of adjustment - Most people return to work with minimal problems. However, you may find the first several days very tiring. Remember to give yourself time to adjust to work again and gradually this should improve.
  • Continue Your Exercise Program - Keep up with your exercises to keep up your progress! Many patients do not need to work with a physical therapist during this time, but remember that your exercises are the one most important activity to help increase your strength and give you an optimal surgical result.
  • Maintain Any Restrictions - While you may feel like you can do anything, if your surgeon has restricted your activities or body positions in any way, you need to realize this is done to protect your operative hip or knee while it continues to heal. If you want to achieve the best possible surgical result, be patient and follow your physician's instructions
  1. From 3 months to Forever After - Once you have reached the 3 month period after surgery, you will see your physician for another follow-up visit. This visit usually marks the time when you may go without any assistive device for walking and without any restrictions on your weight bearing.

    • Continuing to Progress - You are encouraged at this point to resume your normal activities both inside and outside of the home. Keep in mind as you continue to return to your activities to use the common sense approach. Some tips for doing this are:

      • Be Realistic - Pace yourself and resume activities gradually. Increase your walking distance or activities such as bowling, tennis, biking, or dancing over a period of time, not all at once.
      • Keep a cane in the trunk of your car. If you are travelling for any distance, sight seeing on an extended trip, or out during winter conditions, this may come in handy if you start to tire, experience discomfort, or face uneven or icy ground.
      • Enjoy the benefits of your total joint. Keep in mind that your joint replacement was done to relieve pain and help you resume your normal activities. By the time you have reached the first year after your surgery, you should be doing all that you would like to do.
      • Continue to call with any questions or concerns. Our staff is always available to assist you and will be happy to find answers to any questions you may have.

    • Following the Total Joint Patient Forever - Your schedule for further follow-up appointments from this time on is 6 months after your surgery and then annually unless directed otherwise. These appointments are important to keep for several reasons. The most important reason for these appointments is you. By following your condition both you and your surgeon will have an accurate picture of your status at any given time. You also will have a chance to discuss any concerns regarding your total joint replacement or other joints which may develop symptoms. In addition, the x-rays and physical exams done at each visit may alert you and your surgeon to any problems with your total joint which sometimes can be seen on x-ray or physical exam before any symptoms are felt by the patient. This in particular is the primary reason we encourage patients to return for appointments even when they may feel they are doing well and don't need to see their surgeon. Remember, your total joint replacement is a permanent part of you and your follow-up appointments should be considered a part of this also.

In conclusion, we hope the information presented here has been helpful. While each patient is certainly viewed as an individual, we have offered this information as a result of following our patients for over 20 years. If after reviewing this information you have any questions or concerns, please feel free to contact our office.