The process of rehabilitation from surgery begins prior to your surgery. After first meeting Dr. Leone and scheduling your surgical date, you will be given specific exercises to do. These exercises condition your muscles and breathing. We have learned that if your body is used to doing these exercises before surgery, they are much easier to perform after surgery. We will not prescribe any exercise that hurts. Pain is your body “talking” to itself. We encourage gentle persistence and discourage pain.
Many of these same exercises will be continued during the postoperative period. Your medical team will make sure you have the equipment and resources you need, and understand how to perform the exercises and techniques that will maximize your recovery.
After Your Surgery
The day following your surgery, your rehabilitation will begin with two supervised physical and occupational therapy sessions. It will continue each day you remain in the hospital. Initially, you’ll be instructed on how to use a walker. You’ll be progressed from the walker to a cane or other ambulatory device as appropriate, with the goal of getting you walking on your own as soon as possible. Your therapist will teach you how to use devices like reachers and sock aids, as needed.
Your second day after surgery will be much like the first, but you’ll be more active and spend more time out of bed. Dr. Leone and his team will visit you again, as will the internist. You will dress in your own cloths and be out of bed for all meals. You will have two physical therapy sessions. We’ve created a special “gym” on our orthopedic floor where you will go for your therapy.
Your nurse will continue to assess your pain and provide medication as needed. Your Patient Liaison and case managers will meet with you and coordinate your discharge—either to your home or to another facility. They will help ensure that you have the supplies that you will need. All your instructions will be reviewed and written down. Any prescriptions will be given to you and an appointment for your suture removal will be made.
The Day of Your Surgery
Most patients get out of bed and start walking with supervision the day of your surgery. This is wonderfully therapeutic. Getting out of bed so quickly after surgery helps your circulation, protects your skin against pressure sores and results in an “I can do it” attitude and confidence that results in a faster recovery.
The Day Following Your Surgery
The morning after your surgery you are encouraged and assisted getting out of bed for breakfast, changing out of a hospital gown into your own cloths, and walking to the
bathroom to wash up for your day. You will receive physical therapy and occupational therapy. You will practice standing, sitting, walking, getting in and out of bed, going up and down steps and even getting into and out of a car. You will receive instructions on how to use a walker and then progress to a cane or other ambulatory device when appropriate, 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. Occasionally a patient is not ready to go home the first day after their surgery and will benefit from another day or two in the hospital. This decision is individualized for each patient with their unique and specific needs and desires.
Dr. Leone and his team will give you specific guidelines regarding body positions to avoid the morning after surgery depending on his assessment of the stability of your hip during surgery. These are not the same for everyone and tend to be much less restrictive than in years past. The goal is to encourage the new prosthetic ball to
remain fully seated within the new socket until the surrounding tissues heal and mature which provides stability.
Managing Post-Operative Pain
As part of The Leone Center surgical protocol, we work to stay ahead of the pain curve. We emphasize pre-empting pain rather than playing “catch up.” Pain is more effectively managed with a multi-modal approach that includes everything from the type of anesthesia used to the pain medications given before, during and after your surgery, and prior to physical therapy. Medications administered the morning prior to or during surgery include:
• Tylenol to lower your sensitivity to pain as well as decrease the amount of pain.
• Neurontin which also helps to decrease postoperative pain by affecting chemicals and nerves in your body that are involved in pain pathways.
• Medicines which decrease anxiety and make you drowsy.
• A long-acting narcotic to dull pain receptors before pain sets in, as well as medication to prevent nausea following surgery.
• An IV steroid just prior to the start of your surgery and postoperatively.
• After implanting the components, the tissues around the new joint are injected with a “cocktail” including a long-acting local anesthetic, morphine and an NSAID. This combination has greatly reduced post-operative pain and the need for narcotics. This has resulted in our patients routinely getting out of bed the day of surgery and walking.
• You will receive tranexamic acid just prior to surgery and postoperatively. This medication decreases intra- and post-operative blood loss.
• IV antibiotics before and after surgery to lower the risk of infection.
In the recovery room, you will receive an IV NSAID called Toradol. This is a super-version of aspirin that works to decrease pain via an alternate “pathway” in the body and has proven to be remarkably effective.
Narcotics are prescribed as a backup but are being used in smaller amounts and with less frequency. Narcotics are avoided whenever possible because they tend to cause nausea, constipation and occasionally confusion. Also Tylenol as well as a NSAID is continued on a regular schedule.
Our entire team is very sensitive to your post–operative pain. You will be encouraged to take pain medication initially on a schedule and prior to your therapy to help stay ahead of the pain curve.
Now That Your Home
• Continue your exercises faithfully to reduce pain and swelling and improve motion.
• Dr. Leone will discuss with you specific positions to avoid after surgery and for how long. Each patient is different. Most patients are given permission to sleep on either
side right after surgery with a regular pillow between their legs.
• My staff will call you a day or two after your surgery to confirm that you are doing well and answer any question that you have. You will also be encouraged to come
to my office if you would like for us to check you.
• You will have been given an appointment to come to our office two weeks after your surgery for suture removal.
• Pool exercises and swimming after surgery are encouraged. You will be instructed when to start these activities once your suture is removed.
• You will be discharged from the hospital with a special “Aquacel” dressing covering your hip. This dressing can remain in place for the full two weeks. You may shower
with this Aquacel dressing covering your hip once you are home.
• Elevate your legs three times each day for 45 minutes. You may stop when you no longer see any ankle or lower leg swelling.
HINT: Rest your feet on a soft pillow, placed on top of two couch pillows. Your ankle needs to be higher than your heart.