Are you getting ready to have a total knee replacement or total hip replacement? These procedures are fairly common these days and over the last two decades medical advances in materials and surgical techniques have improved to the point where success rates are 90-95%. But just because joint replacement surgeries are common and success rates are high does not mean that getting a joint replacement is a breeze. It’s still a major surgery that will require recovery time and hard work after the procedure. Below we’ll discuss ways to get the most out of your recovery and what to expect after a joint replacement.
The first way to maximize recovery after a joint replacement is to prepare ahead of time.
Pre-hab!! – We put this at the top of the list because we think it’s that important. The better you are going into surgery, the better you are going to be coming out of surgery. If your knee is stiff and you can’t bend it or straighten it fully, start trying to improve those motions. If your hip muscles have gotten weak, start trying to strengthen them up. Get your upper body stronger, because for a period of time you’re going to need some upper body strength to use a walker/cane, move around in bed, and push up from chairs. If possible, losing some weight is a good idea because it helps ease the stress on hips and knees. Don’t save the rehab and exercises for after surgery, start now with pre-hab! Our physical therapists can help show you what things you need to start working on.
Practice – This is second on the list because it goes hand in hand with pre-hab. Learn and practice the exercises you will be doing after surgery. After surgery you’re going to be sore and tired and sometimes movements can be hard to grasp under these circumstances. If you learn and practice before surgery, you’ll know how to do it and what the exercises are supposed to feel like. It will make the recovery less daunting and easier to do without wondering “am I even doing this right?” On top of that, practicing using a walker and cane before surgery is helpful as well. It is definitely worth setting up a pre-surgery physical therapy appointment to learn these skills.
Quit Smoking – This is an important one. We know it can be a challenge, but stopping, or at the very least decreasing, smoking before a surgery can go a long way. Smoking slows recovery, makes the surgery heal slower. It also increases chances of complications and infection during and after surgery.
Timing of the surgery – Think about what you have going on in your life and how your surgery may affect it. What’s your work schedule, do you have any vacations coming up, are there any weddings or graduations you’ll need to attend?
Get the details – How long will the surgery take? Will you stay at the hospital or will it be an “outpatient” procedure where you go home that day? It’s becoming more common for people to have joint replacements without a hospital stay so make sure you know that the plan is. Will you need a walker or a cane afterwards (yes, you will. Do you have one?). How long until you can drive? How long will you be off work? If you have a total hip replacement, there are certain motions that you need to avoid for the first two months after surgery so it would be good to know these precautions before you have the surgery. The answers to a lot of these questions will vary by the individual and where you are having your surgery done.
Get your home ready – You won’t be as mobile when you first get home. Situate things in the house so it’s easier to move around. You may need to set up a temporary bedroom and recovery area on the first floor. Clear walkways of clutter so you can maneuver without risk of tripping. Try to get things like your phone within easy reach. Arrange to have some help at the house like a friend or relative. Freeze some meals and stock up the pantry.
You did all your preparation and you’ve had your joint replacement. Now it’s time for the recovery! Here is what this process generally looks like.
Day 1, the journey begins
You’ll start moving around and at least get out of bed and transfer to a chair. You will learn how to put weight through your leg and you may even start walking. You’ll do muscle squeezes and ankle pumps to help blood flow (you’ll already know these if you did your pre-hab!). If you had a hip replacement, there will be certain motions that you need to avoid. These precautions will be explained to you and you’ll be taught how to move around without endangering your hip replacement. If you’re having surgery without a hospital stay, someone will take you home and you’ll start your recovery from there.
You’ll move around more, getting used to moving around with a walker, or sometimes crutches. If you’re in the hospital, you’ll work with a physical therapist to practice walking the hallways.
Day 3 and 4
You should be able to get in and out of bed on your own, get in and out of chair without help, and use the bathroom by yourself. You may even learn how to do a couple of stairs safely with your walker or cane (this is sometimes a requirement before you are discharged home). Some people may need to head for a short stay in a rehab center, but most folks will go home.
You’ll be using all the things you learned at the hospital to manage at home. You’ll change your dressing if necessary, keep the incision clean and dry, and watch for signs of infection. You’ll want to keep ice on the joint as well, it helps keep the pain and swelling down! Get up and move around every hour or so. A physical therapist will come to your house if you have home health set up. If you aren’t having home health physical therapy, you’ll have someone take you to physical therapy.
You’ll continue going to physical therapy, usually 2-3 times each week. Keep on moving at home, going on short walks, doing the exercises, and icing. Around 2 weeks after surgery you’ll follow up with your surgeon’s office and get the staples removed from your incision. Once the staples are out, you can take a shower, but check with your surgeon because each surgeon has different preferences on how they want you to take care of the incision. Between 4-6 weeks after your joint replacement surgery you should be close to getting rid of the walker or cane, at least for shorter distances.
Generally this is when people start driving again. If you have an automatic transmission and your joint replacement was on your left leg, you may be able to drive a little earlier, around the 3 week mark. 6 weeks after surgery is generally when people return to work as well. Some people can go back earlier if they have a pretty sedentary job, as long as they are able to get up and move around and do some exercises while at work. If you have a more physically challenging job, returning to work can take longer depending on what you have to do at work. By 6-8 weeks after surgery, you shouldn’t need to use a cane or walker anymore.
Week 6 – 12
During this time you’ll continue to improve the strength of the muscles around the joint replacement and work toward getting full motion back. You’ll do activities that help you get back to normal, and you’ll probably be doing things that you weren’t able to do before your joint replacement. Over this period your rehab will shift to more challenging exercises that prepare you for what your long term goals are, like gardening, traveling, golf, and other more strenuous activities.
12 Weeks and Beyond
Usually 12 weeks after surgery is when people get cleared to return to higher level activities. You’ll likely be finished up with formal physical therapy, but you should continue to do many of the exercises you learned. Just because your formal physical therapy is finished, doesn’t mean your recovery is over. Your hip or knee replacement still might not feel quite all the way better, but you’ll be better than you were before surgery and you’ll feel better and better every month. A general rule of thumb is that a true full recovery takes close to 1 year. And if you are feeling like you need some more guidance on how to progress to higher level activity after your joint replacement, you can always schedule a refresher appointment with your physical therapist to make sure you’re still on track.