Your joint replacement surgery is just one step to a healthy joint. Optimizing your recovery after your hip or knee replacement ensures you’ll be able to take full advantage of your new joint.
Ice
Ice helps significantly with postoperative recovery for hips and knees, particularly for knees. Ice helps with swelling and some large-scale studies have shown it is a better pain reliever than narcotics.
People often ask about specific ice machines, and I tell them ice in whatever way they can get it to the wound is the best way to do it. Machines are fine, but frozen bags of peas work just as well. Make sure you put some sort of protective barrier between the wound itself and the ice, such as a pillowcase or a piece of clothing.
Don’t wait too long to start using ice. For joint replacement patients, ice can be applied as soon as they are out of surgery to control pain from the beginning.
Motion
Pre-operative range of motion is the best predictor of post-operative motion. If you want a great outcome after your knee replacement surgery, working on your motion before surgery is one of the most important things you can do. Before surgery, work on bending your knee as much as you can and work on getting it fully straight.
Right after surgery bending may not be possible due to swelling, but the more you can move it before the more it’s going to help you after as well.
For hip replacement patients, movement is also key.
Muscle mass
Getting a joint replacement is like getting a brand-new set of wheels. If the engine is not good enough to drive those wheels, that car is not going to go anywhere. Your muscles are the biggest drivers of your outcome. For your knee, the important muscles are your quad and hamstrings and for your hip, your hip flexors and your abductors. Having strong muscles is going to be very helpful for your postoperative recovery.
Pain management
Hip and knee replacements are big surgeries, so we want to be on top of the pain. Ice should be your first line to get the swelling under control, but patients often don’t realize that some other medications may be combined as directed. For example, Tylenol and anti-inflammaories of your choice, like meloxicam or ibuprofen, may be combined. They work together much, much better than either one works by itself and they can help get the pain and inflammation under control.
Tylenol is an analgesic: it helps to modulate the brain receptors to decrease the pain signal. The NSAIDs like ibuprofen and meloxicam work by decreasing the inflammation at the source. You’re attacking the pain from multiple fronts: you have the ice for local swelling; the NSAIDs to help with the inflammation; and the Tylenol to decrease the signals in the brain to say to get the pain under control.
Supportive health
Supportive health plays a big role. Make sure your room is comfortable, especially in the middle of the night. If you get too cold for example, and suddenly jerk, you may cause pain.
Distractions are key. Have some sort of distractions already planned for after surgery, like reading a book or watching some of your favorite TV shows.
Take a break from your activity every 30 minutes and move to help with circulation, swelling, and motion, as well as helping prevent blood clots from forming.
Your GI health is important as well. Many of the things that happen before, during and after surgery can cause difficulties with the GI system, such as constipation from medications. You don’t want to strain after a joint replacement, so take a gentle stool softener if needed.
Hydration helps with preventing constipation caused by medications and it gives your body the resources it needs to rebuild after losing blood during surgery.
Being aware that nausea may be a symptom after surgery is important. Some patients may have anti-nausea medications prescribed, while others may find that food and drink with ginger in them works well enough.
A healthy diet is important, including plenty of protein to help with recovery after surgery.
Be careful
It’s a marathon, not a sprint. Use your walking aids like a cane or a walker for the first week after surgery, if you feel you need to. You’re not relying on them to support you: the implants can support you, but the walking aids are a good safety net and help prevent falls.
Incision care
Waterproof skin glue usually closes up the wound, with a waterproof dressing on top that allows you to take showers from the day after surgery. It’s important that overall hygiene is well-maintained.
After about a week or 10 days, you’ll remove the waterproof dressing like you would remove any Band-Aid and leave the wound open to air. The skin glue underneath provides a secondary defense and you can continue to take showers as normal. However, just let the water and soap run over the wound. Don’t scrub the wound. When you’re finished, pat it dry gently. Don’t cover it up all the time after you take the initial dressing off because it can trap moisture and cause new problems. Don’t use products such as Voltaren gel or Neosporin on the wound.
Don’t take a bath until several weeks after surgery. You want to avoid submerging the wound because there could be tiny openings in it through which bacteria could enter your body and cause an infection.
Frequently Asked Questions
How does physical therapy fit into joint replacement recovery?
Physical therapy plays a big role, especially for knee replacements. The name of the game after a knee replacement is motion, motion, motion. We’re trying to get the knee to bend back as much as we can. Right after surgery, your knee is going to be painful and not want to move. While you won’t want to move it because of the pain, the initial days and weeks after surgery are some of the important and pivotal time to get the motion back.
Take the pain medication and work on bending the knee as much as you can and getting the muscle strong.
Hip replacements don’t require physical therapy anymore, as the activities of daily living serve as physical therapy. However, not requiring it does not mean being opposed to it. If you think you would benefit from physical therapy sessions after your hip replacement, please schedule them.
Prehab, or doing physical therapy exercises before surgery, plays an important role. Activities such as building the muscle up can be done before surgery to optimize your recovery and make sure you have a good outcome.
How soon can patients go up steps after surgery?
One of the requirements of leaving a hospital or surgery center after your hip or knee replacement is being able to go up and down stairs. However, it will take you longer – what used to take you a minute may now take you five minutes.
Limit the number of times you go up and down. If your bedroom and main bathroom are on the second floor and your living room and half bath are on the first floor, sleep in your bed where you’re comfortable, shower in your bathroom, then go downstairs and stay on the first floor for the majority of the day. If you go up and down the steps multiple times a day, your muscles will get fatigued which will lead to increased pain and poor pain control and a potentially more difficult time with therapy and recovery.
Do you have suggestions of specific exercises for patients to do before their surgery?
I recommend exercises from the American Academy of Orthopedic Surgeons (AAOS), the national organization for orthopedics in general, and the American Academy of Hip and Knee Surgeons (AAHKS), which is focused on hips and knees.
AAOS has great beginner exercises for every body part with pictures and information about reps and sets. AAHKS has specific exercises for hip and knee replacements with videos for before and after the surgery. They have a wide variety of exercises for specific hip and knee ailments as well.
Would swimming or water aerobics be a good exercise after a hip or knee replacement?
Yes, these are my go-to exercises. However, you first need your surgeon’s approval that you’re allowed to submerge your wound before you do water activities. Swimming is terrific: it takes the effect of gravity away so your weight isn’t as much on the joint, but it is still a very comprehensive workout of all of the muscle groups. It loosens things and prevents your joints from becoming stiff, as well as being good aerobic exercise.
Are there restrictions on dental procedures around the time of your replacement?
Except for emergencies, I ask patients not to schedule dental procedures for about two to three weeks before and three months after a hip or knee replacement. Any time you do a joint replacement the joint becomes very vascular, which means there is a lot of blood flow going through the area. The blood flow causes the swelling.
When dental work is done, there’s a small chance that bacteria could potentially go into your bloodstream, get to the joint and cause an infection. It’s not common but it can happen and we want to prevent it. By waiting, the joint recovers and the extra blood flow goes away.
How long does it take to recover from a hip or a knee replacement?
It depends on how you define recovery. You’re up and walking and going up and down stairs the same day as surgery. Around week six or week eight after surgery, most patients are about 70% recovered. At about three or four months, most patients are about 95% recovered. However, if you see a patient around week six or week eight and you didn’t know they had had a joint replacement, you couldn’t tell by looking.