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Important points to remember:

  • Every patient is different and everyone recovers at different speeds.
  • Be patient and stick with the plan.

Prior to surgery:

  • Be sure to have made arrangements for a ride to the hospital.
  • If you are having an outpatient joint replacement, you will also need to have arranged a ride home the same day.
  • Prepare your home for the recovery period as previously explained in the “Preparing For Surgery” tab.
  • Talk with a physical therapist prior to surgery and schedule an appointment with them so that you can have a smooth transition into the recovery phase once you are at home.
  • Be sure not to eat anything the night before surgery.

Day 0:

  • You arrive at the hospital either in the morning or afternoon.
    • The hospital will contact you about your appropriate arrival time.
  • Prior to surgery, you will go to the preoperative holding area where your nurse will have you changed into a gown.
  • After this, you will meet with your anesthesiologist and CRNA.
  • You will have your blood pressure and other vital signs checked to ensure you’re stable enough for surgery.
  • I will be there before surgery to talk with you, answer any last minute questions that might not have been addressed in the office and to mark your leg with my initials indicating the correct operative site.
  • You will then go back to the operating room where you will receive spinal anesthesia unless otherwise indicated.
  • The operating room nurse will call your spouse or contact listed once the case has started.
  • Generally, the operative portion of primary hip replacements take between 60-90 minutes and primary knee replacements take around 90 minutes.
  • Once the surgery has completed, you will go to the recovery room (PACU) where you will “wake up’ from anesthesia.
  • I will call your spouse or contact listed once the operative portion is completed and give an update.
  • We will get an XRay of either the hip or knee in the PACU.
  • Generally, most patient will remain there for around an hour prior to being transferred to your hospital room.
  • If you’re having surgery at the Hospital for Special Surgery (HSS), you will be transferred straight to your hospital room after the surgery where you will recover.
  • For the most part, immediately after surgery you have minimal pain because of the spinal or adductor canal block (knee replacements).
  • You will be up walking almost immediately the day of surgery once your nerves wake up.
  • Some patients get light headed or dizzy standing up after surgery.
    • This is called “orthostatic hypotension”.
    • It can be due to fluid shifts from the surgery and anesthesia and will improve with IV fluid.

DAY 1:

  • The day after surgery is generally not too painful.
  • It’s imperative at this point to not try and do too much because you have minimal pain.
    • This results in significant swelling and pain in the following days.
  • It’s common to have swelling and a heavy feeling in the operative leg.
  • You will start to take Aspirin 81mg twice a day to prevent a blood clot.
  • It’s also important to continue your scheduled medications to keep your pain controlled.
    • Refer to the “Pain Control” tab for specific instructions for taking pain medication.
    • The goal is to minimize narcotic pain medication while having improved pain control.
  • Most patient’s will be discharged home the morning after surgery once they have worked with physical therapy.

Day 2:

  • You will start to see swelling all throughout the leg.
  • Some patient’s describe their legs as stiff, heavy and swollen; almost like a telephone pole.
  • It’s crucial at this point to keep icing your leg and keeping it elevated.
  • Also, remember to take your scheduled pain medication to maintain active pain control.

Day 3-5:

  • These are the days which can become difficult for patients because of swelling and difficulty with sleeping.
  • Getting a good night’s sleep is difficult early in the postoperative period.
  • Your leg will remain swollen during these days and it’s not uncommon to experience bruising down to your toes.
  • Continue to keep your leg elevated above the level of your heart and keep icing it.
  • You might have to take some of the supplemental narcotic medication during these days along with the scheduled non narcotics to achieve pain control.
  • It’s very common to have a good morning and a rough night or a good day followed by a rough next day.

Day 6-10:

  • Your pain is starting to slowly improve.
  • Night time is still the most difficult at this point.
  • You continue to have good days followed by bad days.
  • Your leg will continue to have swelling so its important to have it elevated and use ice or the ice machine often.
  • Avoid aggressive exercises.
  • It’s not uncommon for patients who underwent an anterior hip replacement to have numbness over the outside of their thigh and those who underwent a knee replacement to have numbness over the outside of their knee.
    • This will get better with time.

Day 11-13:

  • Pain should continue to improve.
  • Swelling will still be present but should be slowly improving.
  • Night time is still the most difficult.
  • If you had a knee replacement, you should be able to reach 90 degrees range of motion as your swelling improves.
  • If you experienced bruising, this should be getting better.
  • Your ankle will still sometimes be black or purple if you had significant bruising after the surgery.

Week 2-3:

  • I will see you back for a wound check during this timeframe.
  • Most of the time, your stitches are under the skin so they don’t have to be removed unless otherwise noted.
  • Your pain continues to improve.
  • You should be off narcotic medication at this point.
  • Patient’s generally start to get out of the house a little bit more.
  • Swelling can still be an issue as you walk more.
    • Continue to ice and elevate
  • This is the earliest point you can start to drive.
    • You will need to be off narcotic medication and able to put full weight on the operative extremity.
  • You continue to work with physical therapy.

Week 3-6:

  • Pain continues to improve daily.
  • You are able to walk longer distances each day.
  • Range of motion after a knee replacement should be 120 degrees.
  • You will be off narcotic pain medication at this point
  • You can stop taking Aspirin 81mg twice a day after 30 days.
  • Most patients will return to work during this time period.
  • Sleep is improving.

Week 6-12:

  • You start to return to normal activities.
  • During this time period, you can resume low impact exercises such as swimming, biking, stairs, elliptical, yoga.
  • Golfers can work on light chipping and putting.
  • Most patients will be back at work.

Week >12:

  • You can return to full impact activities such as tennis, snowboarding, surfing.
  • Golfers can start hitting driver and full swing irons.
  • You should be back at work already.
  • Sleeping should be back to normal at this point.

Activities Postoperatively

Overall

0-6 weeks:

*Outpatient PT starting immediately

*Rarely home therapy

6-12 weeks:

*Low impact exercises: swimming, biking, stairs, elliptical, yoga

>12 weeks:

*Full impact activities: tennis, snowboarding, surfing

Golf

0-6 weeks: no golf

6-12 weeks: putting, light chipping

>12 weeks: driver, full swing irons

Driving

Left Hip and Knee Replacement: 2 weeks

Right Hip and Knee Replacement: 3 weeks

*Criteria: Must be off narcotic pain medication and able to place full weight on the operative leg.

Return to work: 3 weeks

  • The Ortho Answer
  • American Academy of Orthopaedic Surgeons
  • American Association of Hip and Knee Surgeons
  • International Congress for Joint Reconstruction
  • Auburn University
  • The University of Texas Health Science Center at Houston
  • Emory University - Leading Research University in Atlanta GA
  • New York University
  • Insall Scott Kelly Institute for Orthopaedics & Sports Medicine