Postoperative Care: What to Expect after Hip and Knee Replacement Surgery

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.

8 replies
    • holycrossleonecenter
      holycrossleonecenter says:

      Hi Stan,

      Dr. Leone has opted out of Medicare since October of 2009’. If you would like to come in to see Dr. Leone, his fee is $250 and includes X-rays. If it’s determined that they need a hip or knee replacement, Dr. Leone’s fee would be $5,500. The initial consultation fee would be deducted from the surgery fee, and all office visits for 90 days after the surgery is included in the surgery fee. Then, every year or two you would come back in for a follow up visit, which is then charged at a reduced rate of $150.00 including the X-rays. Everything else that may be associated with your surgery; “hospitalization, anesthesia, rehab and any medical equipment that may be necessary”, would all be covered by their Humana Gold plan. Just Dr. Leone’s fee is an out of pocket expense.

      Thank You,
      The Leone Center for Orthopedic Care Staff

  1. Michael
    Michael says:

    Very informative post, and great timing to find this as my mother is having a hip replacement surgery next week. Thanks for sharing!

    • Jim
      Jim says:

      I require narcotic pain meds for severe pain caused by my other medical conditions and hip pain. Will I be given the narcotics after hip replacement while in the hospital and while in a rehab facility and for use later in my home?

      • holycrossleonecenter
        holycrossleonecenter says:

        Hi Jim,

        If you already require narcotics and use them on a regular basis, then your body has built up a tolerance. What this means is that post-operatively you will need your baseline medications as well as additional pain medications to be comfortable. Weaning off all narcotics may be an ultimate goal, but decreasing or eliminating narcotics in the post-operative course simply is not appropriate. Because of other medications and modalities I use to combat post-operative pain, I do find that people who are addicted to narcotics still require far less medications than I’ve had to use in the past due to the multimodal regime I use now.

        Thank you,
        Dr Leone

  2. Denise
    Denise says:

    This blog is incredible. Very informative and gives me hope that, as a single mother, I won’t be left on my own during recovery. Looking forward to meeting with Dr. Leone.

  3. rrenamichelle
    rrenamichelle says:

    I would like to have advice for me ,to help a dear close friends that the husband is having hip and knee surgery done at the same time.he has ,ms.he will later on have the opposite done.what can I do to help the wife ,to help her husband have an easier recovery time.he has been in so much pain for so many years ,I just want to help him to rest ,eat ,sect.I want to really help in someway.thank you,have a good day.

    • holycrossleonecenter
      holycrossleonecenter says:

      Dear Rrena,

      The family or primary caretaker often does feel a tremendous amount of anxiety and pressure when a loved one is about to undergo surgery. It’s been my experience that when the family or caretaker, as well as the patient, are directly involved in the preoperative education process, then everyone has a better experience. Knowledge is power. When one knows what to expect and what the plan is, it results in much less anxiety.

      Your friend needs to feel enabled and that she’s not being put in a vulnerable position that she’s not comfortable with. I would encourage her to write down all her questions and concerns and then address each with the surgeon or his/her “team.” In the hospital, there also will be team to address concerns and help plan for hospital discharge and post- hospital-stay patient care and therapy. She needs to feel assured that her husband will not be discharged until a safe and acceptable plan has been agreed upon. She needs to know that both of them will have the help needed once he is home.

      You can help your friend be encouraging her to be involved in the preoperative process to understand the plan. If he will require going to another facility after his surgery, she can find out from his insurance company which facilities will be available to him and then visit those facilities ahead of time so that they can make a more informed decision. You then can help your friend by standing by her and supporting her.

      I wish you, your friend and her husband all the best.
      Dr. William Leone

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