Much of the content on my blog explores the signs and causes of hip and knee degeneration as well as how to decide if and what type of hip or knee replacement surgery is right for you. In this blog, I will discuss what to expect after surgery, from the recovery room to postoperative home care and rehabilitation.
Both hip and knee replacement surgical techniques have greatly advanced, allowing surgeons to perform less-invasive and more precise procedures. These two factors alone facilitate a faster recovery process. Also, the sterile conditions under which I perform these surgeries, including laminar flow operating rooms and body exhaust suits worn by me and my team, the meticulous handling of tissues and a comprehensive regimen of antibiotics, all but eliminate the risk of postoperative infection.
In a previous blog, Managing Postoperative Pain, I outlined in detail the multimodal strategy I use to anticipate and manage my patients’ postoperative pain. Managing pain eases both the mental and physical effects of surgery and allows patients to get back on their feet more quickly. Our goal and strategy is to minimize and preempt pain by “staying ahead of the pain curve.” Although managing postoperative pain actually begins prior to surgery, medications also are administered in the operating and recovery rooms and continue postoperatively.
At the conclusion of surgery, a combination of a long-acting local anesthetic combined with a narcotic is injected into the surgical area to reduce early postoperative pain. Also, for partial or total knee replacement patients, a special local anesthetic is injected into the groin around the femoral nerve which further decreases pain. This is administered in the operating room while patients are asleep.
Once in the recovery room, I prescribe a combination of Intravenous (IV) NSAIDS and Tylenol. This combination will alternate every three hours over the next one to two days. A steroid is given just prior to the procedure and a second dose is administered the next day. I prefer that patients avoid using narcotics because they tend to cause nausea and occasionally confusion. I have been very pleased with this multimodal approach, which no longer is based on the use of narcotics, because patients feel so much more comfortable immediately after surgery and avoid so many of the narcotics-related complications that we routinely used to see. Narcotics still are available, but I find patients request or use them much less frequently.
From the recovery room, patients are transferred to their rooms on our designated orthopedic floor at Holy Cross Hospital. An orthopedic nurse then assesses patients to ensure that they are stable and comfortable. Patients receive daily visits by me and my team. This includes a general medical doctor who checks a patient’s condition during the entire hospital stay.
Although patients are taught to do some exercises the day of surgery, the real recovery work begins the day after. Physical therapy starts in the morning, with patients getting out of bed and practicing standing, sitting and taking steps around the room and to the bathroom, as well as two supervised physical and occupational therapy sessions. Beginning to move almost immediately after surgery is extremely therapeutic because it helps with blood circulation, prevents skin from breaking down, and is a real psychological boost. I also encourage my patients to put on their own clothes as it makes them feel better and more comfortable.
Patients are instructed how to use a walker and then progress to a cane or other ambulatory device as needed, with the goal of walking device-free as soon as possible. The physical therapist also will provide instructions in the use of reachers or “grabbers” and sock aids, as needed.
On day two, patients dress and get out of bed for all meals. Two physical therapy sessions take place in a specialized gym on the orthopedic floor. By day two, most patients are eager and ready to go home. Some patients, particularly those who have had a joint replacement before or those who just had a partial knee replacement, request discharge the day following surgery. However, some patients do prefer an extra day of therapy. If a decision is made for patients to go to another facility prior to going home, then some insurance companies require that they remain in the hospital for three days. We are sensitive to individual patient needs and customize our protocol accordingly.
Prior to leaving the hospital, my team and I will visit and finalize hospital discharge. A patient liaison will provide home-care instructions and have all prescriptions filled and ready to go for patients to take home with them. Patients who do stay for a third day have an additional morning physical therapy session prior to discharge.
Many patients participate in out-patient therapy after being discharged from the hospital. I encourage this, especially for patients who have had knee replacements. I strongly advise patients to have arrangements made with a facility prior to discharge. In fact, I hesitate to discharge a knee replacement patient until I know a rehab appointment has been set up. If patients prefer to have physical therapy at home, we make these arrangements; however for knee replacement patients, we counsel them to transition to out-patient therapy as soon as possible, because typically the quality of rehab is better at a specialized center.
Many of the same exercises will be continued during the postoperative period. Our medical team will make sure patients have the needed equipment and resources, and that they understand how to perform the exercises and techniques that will maximize recovery. Most patients return to our office two weeks after surgery to have the plastic surgery-like suture removed. Patients then begin exercising in a pool.
Our goal at The Leone Center for Orthopedic Care is to combine leading-edge technology with good old-fashioned care where the doctor-patient relationship is as important as the treatment. In my experience, patients who go into surgery prepared and knowing what to expect recover much more quickly. And that is our mission, to restore quality of life by making every step count.