My team and I take tremendous pride in providing not only the best surgical outcome for our patients but also providing the best experience. We emphasize preoperative education and planning. Repeatedly, we see that when patients go into surgery with more knowledge, more confidence, and a clear plan what will happen to them after surgery, they get well faster, have a better experience and return to their full life sooner. This is our goal.
I decided to write this short blog on four common questions, topics I’m routinely asked about after someone has a hip or knee surgery. When is it ok to shower and get the incision wet, when it’s safe to drive, when should they plan on returning to work and the what factors drive that timing, and finally when it’s safe to resume sexual activities?
When can I shower after knee or hip replacement surgery?
I encourage my patients to shower very soon after their surgery. Taking a shower not only makes everyone feel better, especially after surgery, but I’m a firm believer in “soap and water”.
Both total hip and total knee patients typically are home the day after their surgery. Patients who had a partial knee replacement are home the day of their surgery. The surgical incision for both hip and knee replacement patients is closed using a single subcuticular stitch. In my experience this creates a tighter initial seal of the incision so I’m more confident encouraging my patients to shower sooner. Some studies also support that there may be a lesser infection rate with this type of closure.
Total hip patients are sent home with a special “aquacel dressing” which has antimicrobial properties and allows the incision to “breath”. This dressing will stay in place until the suture is removed two weeks after surgery. Occasionally the “aquacel dressing” is changed once at home. Because the dressing so nicely covers the incision, I encourage my patients to shower as soon as they get home. It’s ok that the dressing gets wet, simple blot dry after the shower.
Total and partial knee patients’ incisions are also dressed with an antimicrobial dressing but not one that will stay on until the suture is removed like with the hip patients. Their incision is lightly covered with a gauze wrap for four days until the wound is sealed, then it is removed and patients are encouraged to shower.
Occasionally the gauge wrap is changed at home. Steri-strips cover the actual incision and tend to fall off by themselves as time for suture removal arrives. It’s perfectly ok to get the incision wet. Many patients prefer not to cover their incision after showering but rather allow it to be “open to air”, while some still feel more comfortable keeping it covered with a light gauze wrap.
If there is any wound drainage, then I ask my patient to delay showering until it stops and the incision fully sealed. Once the suture is removed, I encourage both my hip and knee replacement patients to begin exercising in a pool. Exercising in the pool is a wonderful way to regain motion, strength and balance and resolve any residual limp quickly. It feels great and gives people confidence.
How soon can I have sex after my hip or knee replacement?
Returning to sex after a hip or knee replacement is fine, as long as it’s comfortable and feels goods for both parties. That said, there may be some positions which simply aren’t comfortable or safe very soon after surgery. Most people wait about a 3-6 weeks before having sex but some tell me they enjoy sexual relations with their partner much sooner. I teach them not to push the flexion for either the hip or knee replacement until healing is well underway. In general, if it feels good, it’s fine. If it hurts or you get scared, stop. If an activity or position just doesn’t seem reasonable, then hold off and consider trying that position at a later date when the tissues have had more to heal. Remember, this is for fun.
In my career, I do not ever remember anyone telling me that they hurt themselves having sex too soon after their hip or knee replacement surgery. Many patients are initially embarrassed to discuss when they can resume sex but invariably all seem very pleased after we did.
On a positive note, a prospective study presented at the American Academy of Orthopedic Surgeons annual meeting in 2013, found that in 90% of patients, sexual function significantly improved after both primary hip and knee replacements and 84% reported improvement in general well-being. I think this is because both hip and knee replacement is such a powerful and predictable way to get rid of pain.
How soon after hip or knee replacement surgery can I drive?
Everyone heals and regains their confidence and reflexes to resume driving safely at a different pace. In generally, older patients >70 resume driving later than younger patients. Patients who had their right hip or knee replaced typically start driving later than those who had their left hip or knee replaced. This may be opposite in the United Kingdom and not applicable with a standard transmission. Recent reports suggest that, at least following a hip replacement, reaction times improve to a least pre-operative levels 4 weeks after surgery and improve more quickly in individuals under 70 years old. This may take longer following knee surgery.
In my practice, many younger patient resume driving just 2 weeks after surgery, especially if they need to go to work. Some even sooner if they had a left hip or knee replacement. Many older individuals will wait 6 weeks or longer before they feel “comfortable”. When patient first resumes driving, I ask that they practice in their own neighborhood and then if they feel comfortable, begin venturing farther.
If they don’t feel comfortable, wait a week or 2 and try again. But not to push, not to drive it they feel uncomfortable and ABSOLUTELY not to drive if they’re still taking any narcotics.
Clinically what I see is that when younger patients return to my office 2 weeks post-surgery for suture removal, most have given up their cane or in the process of doing that and have or are starting to drive.
How quickly can I get back to work following a hip or knee replacement?
The timing of when a specific patient returns to work depends on their motivation to return and their particular job. In general, patients that want to go back to work, return very quickly. Those that don’t, delay as long as they can.
Physicians, attorneys, accountants, business owners or restaurant owners routinely return to work very quickly. So often when I see them the next morning after their surgery, they’re already on their phones or laptops “doing business”. They later tell me that they stayed home one week, it “drove them crazy” so they went into work. They start with several hours each day the first week back and then return to full time. I could see myself falling into this category as well.
I care for other patients who do want to return to work but their position either prevent this or is more physically demanding. Some may request “light duty” if their situation allows. I support this. I think it’s therapeutic to get out of the house and back interacting with co-workers and worrying about “work stuff” rather than yourself. For others it’s either full duties and responsibilities or nothing so they stay out longer. Again, appropriate. It has been the rare exception in my practice that I’ve advised someone not to return to their previous job because it would have a detrimental effect on their health. Caring for a person who makes their living doing hard physical labor, for instance.
So if you’re out a week, or 2-3 weeks or even a couple of months, almost everyone returns to their workplace after surgery if they’re motivated to return.
Dr. William A. Leone is head of the Leone Center for Orthopedic Care at Holy Cross Hospital in Fort Lauderdale, Florida and has earned a reputation as one of the nation’s top orthopedic surgeons. An orthopedic surgeon for the past 28 years, his specialty is solving complex hip and knee problems. Call 954-489-4575 or visit HolyCrossLeoneCenter.com to schedule a consultation.