Home Going Instructions After Total Hip/Total Knee Replacement

What should I expect after my total hip or total knee replacement?

NOTE: The following is a general guide to care following your procedure. Your healthcare provider may have somewhat different instructions for you. Please follow those.

After total knee or total hip replacement surgery you can expect gradual improvement over the coming months. You should gradually expect less pain, stiffness and swelling, and a more independent lifestyle. Returning to work depends on how quickly you heal and how demanding your job may be on a new joint.

After you are discharged from the hospital or rehabilitation facility, there will be a few weeks before you return for a follow-up visit with your surgeon. This period of time is critical in your rehabilitation and you may require outpatient therapy services for positive long-term results from your surgery.

In general, patients do very well after discharge. However, it’s important that you contact the surgeon’s office if any of these occur:

• You have increasing pain in the operative site.
• There is new or increased redness or warmth since discharge.
• There is new or increased drainage from your incision.
• The operative site is increasingly swollen.
• Your calf becomes swollen, tender, warm or reddened.
• You have a temperature above 101 degrees Fahrenheit for more than 24 hours.
• For total knee replacement, your ability to flex (bend your knee) has decreased or remains the same as when you were discharged from the hospital.

How do I manage pain and discomfort after joint replacement surgery?

Try to take your pain medication as soon as you begin to feel pain. Don't wait until the pain becomes severe. Follow the instructions on the prescription label. Remember to take your pain medication before activity and bedtime.

If you need to have stitches or staples removed and you're still taking pain medications, be sure to have a friend or family member drive you to your appointment.

Pain medication may cause nausea. If this happens, decrease the amount you are taking or stop and contact your surgeon’s office.

If you need additional pain medication, please contact your surgeon’s office. Give at least a few days advance notice before you run out of the medication. Please plan ahead, especially for holiday weekends.

Also remember:

• You aren't permitted to drive a car while taking narcotic pain medication.
• It may take several days to have a bowel movement. Anesthesia and pain medication often cause constipation. Drink plenty of fluids and eat whole grains, fruits, and vegetables. A stool softener or laxative can help bowel function return to normal.
• Don't hesitate to call your surgeon’s office with any questions or concerns.

Incision care

Your incision will be covered with a dressing. Before you go home, your surgeon or nurse will explain how to take care of your wound and when to remove your dressing. Make sure you understand these instructions before you leave the hospital and who to contact if you need assistance. Many providers will include this information in your hospital discharge instructions.

Call your surgeon immediately if you notice any increase in drainage, redness, warmth, or have a fever above 101 degrees Fahrenheit for more than 24 hours. These may be signs that your incision may be infected.

Walker, crutches, cane

Use your assistive devices for balance as instructed by your surgeon or therapist. By your first post-op visit with your surgeon, you may have already improved and changed from using a walker or crutches to a cane (as recommended by your surgeon or therapist).

How will I feel the first few days back from joint replacement surgery?

No matter how much you prepared for your homecoming, it will be an adjustment. You will likely experience anxiety and question whether you were discharged too early. This is a normal feeling, so relax and focus on your recovery.

Depending on your surgeon's policy, you may get a call from a care coordinator. This is your opportunity to report any problems and ask any questions. You may also get a visit from the physical therapist or occupational therapist within 48 hours of discharge. Your provider will let you know what to expect and the timelines involved.

What should I be doing in the early stages of my recovery?

• Continue your exercise program and increase activity gradually; your goal is to regain strength and function.
• Follow all therapy instructions.
• Resume activity as you gain strength and confidence.
• For total knee replacement, swelling of the knee or leg is common with an abrupt increase in activity. If this occurs, elevate the leg above the level of your heart (place pillows under the calf, not behind the knee joint), and apply ice directly to the knee. You may continue with elevation and icing as needed to help decrease swelling and discomfort.
• Continued exercise at this early stage is important to achieve the best outcome with your new joint replacement. Based on your needs, your therapy may be continued at home or in an outpatient setting of your choice. You will be given an exercise program to continue exercising at home.

Don't sit for longer than 30 to 45 minutes at a time. Use chairs with arms. You may nap if you are tired, but do not stay in bed all day. Frequent, short walks — either indoors or outdoors — are the key to a successful recovery.

You may experience discomfort in your operated hip or knee, and you may have difficulty sleeping at night. This is part of the recovery process. Getting up and moving around relieves some of the discomfort.

You should climb stairs with support. Climb one step at a time — “good” leg up — “bad” leg down. Hold on to a railing, if available.

When you're a passenger in a car, sit on a firm cushion or folded blanket to avoid sitting too low.

You may not drive before your first post-op visit. The decision to resume driving your vehicle is made by your surgeon.

Don't lift anything heavy after surgery. Avoid lifting objects in a position where you need to squat or bend. Avoid climbing ladders. Your surgeon will let you know when it is OK to lift heavy objects.

What should I expect during the first six weeks after discharge?

During the first six weeks after discharge, you should be making progress week by week. Most patients are eager to report their progress at follow-up visits and are ready to move to the next level in their recovery. Most patients can accomplish the following during the first six weeks after total joint replacement:

• Walk without help on a level surface with the use of walker, crutches or cane as appropriate.
• Climb stairs as tolerated.
• Get in and out of bed without help.
• Get in and out of a chair or car without help.
• Shower using a tub bench once staples are removed — as long as there are no issues with the incision.
• Resume your activities of daily living including cooking, light chores, walking and going outside the home. You should certainly be awake and moving around most of the day.
• Some patients return to work before the first follow-up visit. This is approved on an individual basis and should be discussed with your surgeon.

Icing and elevation

After a joint replacement, swelling is expected. Swelling can cause increased pain and limit your range of motion, so taking steps to reduce the swelling is important. Continue using ice packs or some form of cold therapy to help reduce swelling.

For knee replacement, you will need to elevate the leg to help reduce swelling. It is important to elevate the entire leg, down to the ankle. When elevating, your feet should be above the level of your heart. You may also use pillows to elevate, but never place a pillow behind your knee. Your knee should be as straight as possible when elevated.

Sexual activity after joint replacement

Many people worry about resuming sexual activity after a joint replacement.

Hip. Generally, it is safe to resume sexual activity six weeks after surgery as long as there is not significant pain. Initially, being on your back will be the safest and most comfortable positioning. As your hip heals, you will be able to take a more active role. Please discuss any specific concerns with your physical therapist or advance practice nurse.

Knee. Sexual activity may resume when you are comfortable. If interested, you may request a pamphlet demonstrating safe positions. Talk with your physical therapist or occupational therapist.

Resuming your diet

Resume your diet as tolerated and include vegetables, fruits and proteins (such as meats, fish, chicken, nuts and eggs) to promote healing. Also, remember to have adequate fluid intake (at least eight glasses a day). It is common after surgery to lack an appetite. This may be the result of anesthesia and the medications.

Proper nutrition is needed for healing. During the healing process, the body needs increased amounts of calories, protein, vitamins A and C and sometimes the mineral zinc. Eat a variety of foods to get all the calories, proteins, vitamins and minerals you need.

If you have been told to follow a specific diet, please follow it. What you eat can help heal your wounds and prevent infection and potential complications.

If you’re not eating well after surgery, contact your healthcare provider about nutritional supplements.

What should I expect during weeks 6 through 12?

This period after joint replacement is a time of continued improvement. You will probably notice an increase in energy, a desire to do more activities, and a noticeable improvement in your new joint. Please keep in mind that every patient is different and will improve at different pace. If you are not happy with the pace of your recovery, please contact your surgeon’s office to discuss your concerns.

Walking

After your six-week follow-up visit, you will likely start using a cane to walk and move about. Use the cane until you return for your 12-week follow-up visit. Walk with the cane as much as you want as long as you are comfortable.

Back to work

Many patients return to work after the six-week follow-up visit. Tips to remember for returning to work include:

• Avoid heavy lifting after you return to work.
• Avoid standing or sitting for long periods of time.
• Avoid activities such as frequently climbing stairs or climbing ladders.
• Avoid kneeling, stooping, bending forward or any position that puts the new joint under extreme strain.
• Expect a period of adjustment. Most people return to work with few problems. However, you may find the first several days very tiring. Give yourself time to adjust to work again and gradually this should improve.

Continue exercise program

Continue to exercise. Many patients stop working with physical therapy during this time. However, exercising is the most important activity to increase strength and leads to the best outcome. Work or home activities should not replace your exercise program.

Comply with all Restrictions

Although you are feeling back to normal, it is important to understand and follow the restrictions your surgeon discussed with you. Any restrictions are to protect your operative hip or knee as you continue to heal. If you want to achieve a successful outcome, be patient and follow your surgeon’s instructions.

When will be my next follow-up with my surgeon?

You will see your surgeon for another follow-up visit about three months after surgery. We encourage you to resume normal activities both inside and outside the home. Helpful tips:

• Be realistic and pace yourself and gradually resume activities.
• Increase your walking distance and activities, but not all at once.
• Keep a cane in the trunk of your car to aid with discomfort, or uneven or icy ground.
• Enjoy the benefits of your total joint.
• Continue to call with any questions or concerns. Our staff is always available to assist you.

Six months and future follow-up visits

Your next appointment is six months after surgery, then once a year unless told otherwise. These appointments give you a chance to discuss any concerns about your total joint replacement or other joints in which symptoms may develop.

A note from Cleveland Clinic

Wherever you have your total knee or total hip replacement done, the goal of your surgery is to give you a new joint that allows you to perform everyday activities without pain. However, this joint is not indestructible. Avoid sports or other activities that may put stress on the joint until discussed with your surgeon. Stay as active as you can after recovering from your surgery. Ask your surgeon or therapist about activities and exercises that are right for you. It may or may not be appropriate to return to the exercise routine that you used before surgery.

An increase in body weight puts stress on the hip, so try to maintain a healthy weight.