You will be given written discharge instrustions and prescriptions for any medications needed after discharge. A nurse will review these instructions with you and your family. If there is any information that you do not understand, please ask the staff before you leave.
Recovery: You will continue to heal and recover six to eight weeks after your surgery. You should balance periods of activity with periods of rest. Do not try to over-do or push yourself to the point of pain or exhaustion.
Medications: You will be instructed on your home medications before discharge.
Activity: Follow the activity guidelines and exercises as instructed by your doctor or physical therapist. Do not use exercise equipment or whirlpool baths/hot tubs until directed by your surgeon. It is important that patients receiving a total hip replacement abide by the following precautions:
Sitting: Do not sit longer than 30 minutes at a time. Walk or change position at least every 30 minutes. Even when traveling in a car, stop, get out, and walk every 30 minutes. Moving frequently decreases pain, stiffness, swelling, and your risk for blood clot development. Do not rest in recliners. The reclining position does not improve circulation or decrease swelling.
Walking: Always use your walker until instructed to do otherwise by your surgeon or physical therapist. Progress to a cane upon instruction of your surgeon or physical therapist. Walk daily at increasing distances.
Stairs: If you have stairs in your home, we recommend limiting your use of them to one trip up and down per day. Be careful and hold on to the railing or another person to prevent falling.
Driving: Do not drive until your surgeon instructs you to do so.
Sexual Activity: After your knee replacement you may resume sexual activity when you feel able. After your hip replacement you may resume sexual activity within six to eight weeks after your surgery as long as you are not experience pain or stiffness of the affected hip. Your hip precautions must be maintaind during intercourse. Please remember the following:
Incision Care: Your incision may be closed with stables or skin glue. If your wound was closed with staples, arrangements will be made to remove the staples that hold your incision together. Wash your incision gently with a liquid antibacterial soap and water and pat dry. You may shower when instructed do do so by your surgeon. Do not take a bath. Do notuse lotions, powders or oils on your incision. Watch your incision site for signs of infection. These include redness, excessive swelling, and drainage. Please notify our office immediately if signs of infection develop.
Antibiotics: An infection in another part of your body (sinuses, mouth, lungs, urinary tract, bowel, or skin) could possibly spread to your new joint. Contact your family doctor and orthopaedic surgeon if you develop any signs or symptoms of an infection after your surgery. To protect your new joint, you may need to take antibiotics before certain procedures, such as dental care or a surgical procedure. For a detailed list of our antibiotic recommendations please see below under Antibiotic Recommendations Following Joint Replacement.
Sleeping: Patients receiving a total hip replacement should not sleep on your side until instructed by your surgeon. When you are released by your surgeon to sleep on your side, sleep on the non-operative side and place a pillow between your knees to prevent your knees from crossing your midline.
Swelling: Swelling is common after surgery. Swelling may or may not occur in the hospital or once you are home and more active. The most common areas for swelling are the foot, ankle, knee, and at times the thigh. Swelling can be reduced by positioning, regular use of cold packs, performance of systematic muscle contraction, and wearing thigh-high compression stockings (we recommend wearing your compression stockings, or TED Hose, for the first two weeks following surgery; you may take these stockings off at night). To decrease swelling, lie with your operative leg elevated so that you foot is higher than your heart. This can be doe during periods of rest for at least 45 minutes, two to three times per day. Additionally, you may place a cold pack to the affected area for 20 to 30 minutes at a time. Muscle contractions decrease swelling mechanically through a pumping action. After surgery you may be walking less and geerally are not as active as normal, resulting in your leg muscles not contracting as often. Walk often during the day to activate these muscles. Also, perform the circulation exercises you learned in the hospital. These include ankle pumps, quad sets, and gluteal sets. It is recommended that you perform circulation exercises hourly, while awake, for several weeks following surgery. If swelling does not decrease during the night, call your doctor.
Amoxicillin 2 g 1 hour before the procedure and 1.5 g 6 hours after the procedure. IF ALLERGIC TO PENICILLIN, GIVE Clindamycin 600 mg 1 hour before the procedure and 300 mg 6 hours after the procedure. For extraction, we prefer ou to wait for 6 weeks after surgery. IF HIGH RISK PATIENT (prosthetic valve or surgical shunt) Ampicillin 2 g IV and Gentamicin 80 mg IV 30 minutes before the procedure. Repeat in 8 hours. IF ALLERGIC TO PENICILLIN, GIVE Vancomycin 1 g IVPB 1 hour with no repeat dosing.
Amoxicillin 2 g 1 hour before the procedure and 1.5 g 6 hours after the procedure. IF ALLERGIC TO PENICILLIN, GIVE Clindamycin 600 mg 1 hour before the procedure and 300 mg 6 hours after the procedure. IF HIGH RISK PATIENT (prosthetic valve or surgical shunt) Ampicillin 2 g IV and Gentamicin 80 mg IV 30 minutes before the procedure. Repeat in 8 hours. IF ALLERGIC TO PENICILLIN, GIVE Vancomycin 1 g IVPB 1 hour with no repeat dosing.
2 g of Ampicillin po or 2 g Amoxicillin po 30-60 minutes before starting the procedure in non-PCN allergic patients. IF UNABLE TO TAKE ORAL MEDICATION, GIVE: Ampicillin 2 g IV/IM with 30 minutes before the procedure. IF ALLERGIC TO PENICILLIN, GIVE: Clindamycin 600 mg po 1 hour before the procedure. IF ALLERGIC TO PENICILLIN AND UNABLE TO TAKE ORALLY, GIVE: Clindamycin 600 mg IV po within 30 minutes before the procedure. Urinary Tract Infection - Prophylactic antimicrobial coverage neede to be individualized according to microorganism.
Ancef 1 g IV 1 hour before the procedure. IF ALLERGIC TO PENICILLIN, GIVE: Cleocin 600 mg IV before the procedure. or Cleocin 300 mg ORALLY before and 150 mg 6 hours after the procedure.
We do not advise antibiotic prophylaxis for cataracts, pap smears or cervical biopsies.
Once you have had your surgery, you may begin to worry about going home with your new knee — how you will get around and get back to your daily life. Before you go home, your therapist will teach you the skills you will need such as how to get in and out of bed and how to use the stairs. Your therapist will also teach you how to walk with a walker, crutches, or a cane. The type of equipment depends on your doctor and your comfort with it.
Getting Out of Bed You will get out of bed as soon as possible. Do not try to get up by yourself. Your nurse or therapist will help you. Slide your surgical leg to the edge of the bed as you bend your stronger leg. Push with your hands and stronger leg as you lift your buttocks off the bed and move toward the edge of the bed. Begin to sit up. Using your arms and stronger leg, lift your buttocks and pivot toward the side until both your feet are on the ground. Stand up, pushing down on the bed with both hands. Reach for the walker. Getting Back into Bed You will also need help getting into bed at first. Slowly back up to the bed until you feel the back of your legs against it. Reach back for the bed and sit as far back as you can. Using your arms and stronger leg, scoot back until your surgical leg is supported. Lift your legs onto the bed as you slowly turn your body. You may need someone to help you lift your surgical leg at first. Scoot back as needed with your arms and stronger leg.
Follow these steps when you are using a walker, a wheeled walker, or crutches. Standing Up When you try to stand up from a sitting position, scoot your hips forward to the edge of the chair, bed, or toilet seat. Keep your surgical leg stretched out and your good leg bent with your foot flat on the floor. Use your arms to push down on the edge of the bed, chair, or toilet seat to push yourself up. As you stand up, shift your weight onto your good leg and grasp the handgrips of the walker, wheeled walker, or crutches. At the same time, move your surgical leg back in line with your good leg. Do not pull yourself up with the walker, wheeled walker, or crutches, as this could cause you to fall backward. Once you are standing, take a few seconds to get your balance before you take a step. Sitting Down When sitting down, slowly back up to a chair or bed until you feel the back of your legs against it. Slide or place your surgical leg forward. Then reach back for the armrests of the chair or the edge of the bed. While leaning slightly forward and keeping the surgical leg outstretched in front of you, lower yourself slowly into the chair. Use a firm chair with armrests. Do not hold on to the walker, wheeled walker, or crutches while lowering yourself. If you are using crutches, hold them in one hand, to one side, when you get up or sit down.
Your therapist will provide you with a walker that is the correct size for you and teach you how to use it. If you already have a walker, the therapist will check to make certain it is fitted for you.
Walking with a Standard Walker Lift the walker so that all four legs clear the floor. Move the walker forward about an arm’s length, placing all four legs of the walker on that floor at the same time. Step forward with your surgical leg first. Do not step too close to the front edge of the walker. With much of your weight on the handgrips of the walker, step forward with your stronger leg, bringing it slightly ahead of your surgical leg. Hold your head up and look straight ahead so you will be aware of any obstacles on the ground. When you need to rest while standing, make sure that all four legs of the walker are on the ground. Walking with a Wheeled Walker Push the walker as you walk, using as normal a walking pattern as possible. Do not step too close to the front edge of the walker. Keep your body in line with the back legs of the walker.
Going Up Stairs — Up with the "Good" Approach the stairs placing your feet about 6 inches from the first step. Fold your walker and hold it in one hand. It may be easier to put the front legs of the walker on the first step before folding it. Hold the rail with your other hand. Lift your walker and place it at the back of the step. Step up with your stronger leg and then bring up your surgical leg. Do this with each step, taking your time. At the top of the stairs, unfold the walker and set it on the landing. Make certain you hear the walker click into locked position. Place both hands on the walker. Step up first with your stronger leg and then bring up your surgical leg. Going Down Stairs — Down with the "Bad" Approach the stairs placing your walker close to the stairs. Fold your walker and hold it in one hand. Hold the rail with your other hand. Lower your walker to the front edge of the first step. Step down with your surgical leg and then step down with your stronger leg. Do this with each step, taking your time. At the bottom of the stairs, unfold the walker and make certain it clicks into the locked position. Place both hands on the walker. Step down with your surgical leg and then with your stronger leg.
Your therapist will adjust your crutches to the proper height and instruct you on how to use them. If you are using forearm crutches, your therapist will give you different instructions. Walking with Crutches Place both crutches ahead of you at a comfortable distance — usually about 1 foot. Step forward with your surgical leg. Step forward with your good leg, bringing it through the crutches and past your surgical leg. Move your crutches forward to balance. Continue these steps. Remember to:
Going Up Stairs — Up with the "Good" Allow about 2 inches between your feet and your first step. Push down on the crutches, and step up with your stronger leg first. Straighten your stronger leg and bring the crutches and your surgical leg up to the same step. Going Down Stairs — Down with the "Bad" Stand at the edge of the step, and lower the crutches to the step below. Place the crutches near the front edge of the step to help you keep your balance. Step down to the same step with your surgical leg. Push down on the crutches and slowly step down with your stronger leg.
You may need to use a bedside commode or an elevated toilet seat. Using a Raised Toilet with Armrests Back up to the toilet until you feel the back of your legs touching it. Reach back for the armrests and slowly lower yourself onto the toilet. Keep your surgical leg straight out in front of you. Bend your knee and hip on the stronger side as you lower yourself onto the seat. Reverse the steps when getting up. Use the armrests to push yourself up. Get your balance before reaching for the walker or crutches. Using a Raised Toilet Seat without Armrests Back up to the toilet until you feel the back of your knees touching it. Keep one hand on the handgrip of the walker or crutch while you reach back for the edge of the raised seat. Bend your knee and hip on the stronger side as you lower yourself onto the seat. Keep your surgical leg straight out in front of you as shown above. Reverse the steps for getting up. Place one hand on the handgrip of the walker or crutch and the other on the edge of the toilet seat. Get your balance before reaching for the walker or crutch.
The first week after your surgery, it is best to have someone with you to assist with taking a shower. Make certain you have your towel and supplies before you get in. To prevent falls, use a bath bench or chair. In a Walk-in Shower Walk to the edge of the shower and turn so that you are facing away from the shower stall. Reach back with one hand and grab the bath chair or bench. Leave your other hand on the walker. Sit down on the chair. Lift one leg at a time over the lip of the shower stall and turn to sit facing the faucet. To get out of the shower, turn your body while lifting one leg at a time over the lip of the shower stall. Stand up outside the shower stall by pushing off from the chair. In a Tub You may use your tub for a shower, but do not lower yourself in for a bath. Using the walker, walk to the side of the tub. Stop next to the bath chair and turn so that you are facing away from the tub. Reach back with one hand for the chair or bench. One hand should stay on the walker. Sit down on the chair. Keep the surgical leg straight out in front of you. Lift one leg at a time over the side of the tub and turn to sit facing the faucet. Use a long-handled sponge and shower hose to wash. To get out of the tub, turn your body while lifting one leg at a time over the side of the tub. Stand up outside the tub by pushing off from the chair.
Getting In A taller vehicle is easier to get in and out of than one that is lower to the ground. You are safest sitting in the front seat with your seat belt on and the seat upright.
Getting Out Have your helper place the walker close by. Pivot and lift your legs out of the car. You may need someone’s help with this. Scoot to the edge of the seat and with one hand on the back of the seat and the other on a secure spot, push to stand. If you are riding longer than 30 minutes, take a break from sitting. This will help prevent stiffness, swelling, and blood clots. Look for a safe place to park where you can walk — at least 25 feet to aid your circulation.