Recovering from orthopaedic surgery

Catheters, dressings and drains

Foley catheters are rarely used, but if you have one it will be removed as soon as possible after surgery.

You will have a dressing over your incision, which is typically waterproof. You will be given specific instructions regarding your dressing when you go home.

You may have a drain that was inserted during surgery. It is secured with tape and fastened to your dressing. It's normal to see some bloody drainage. The drain will be removed before you go home if you're leaving the day of surgery or first thing the morning after surgery if you stayed in the hospital overnight.

Getting up and moving

You will be encouraged to be up and moving the day of your surgery. Early walking helps with pain and helps decrease the risk of blood clots and pneumonia. An occupational therapist will help you get dressed in your own clothes.

With some help, you'll be able to walk to the restroom and sit up in a chair.

If you had a hip or knee replacement, a therapist will show you how to use a walker, and you'll be able to start taking short, assisted walks in the halls. You will also practice stairs for when you go home. Over the next few days, you'll increase the distance you walk and work on bending your new joint. But you shouldn't walk alone. During your stay, always call for help before getting out of a bed or chair.

If you had a shoulder replacement, your arm will be immobilized. This may affect your balance. So during your stay, always call for help before getting out of a bed or chair.

Checking on your progress

Your surgeon or the surgeon’s assistant will stop by to check on your condition.

A case manager will contact you to start planning your return home.

Most patients can go home the day after surgery. If you aren’t able to go home on this day, you will stay another night in the hospital. You'll also continue physical therapy and occupational therapy to make progress toward going home.

Managing pain and preventing clots

You will be given oral pain medications and muscle relaxers. IV pain medication is used for severe pain. Ice is also helpful for pain and swelling. You will be able to take your ice machine with you to at home. Remember to always cover your skin before using ice.

You will be given a medication to help prevent blood clots after surgery. The surgeon will give this based on your medical history. Continue to do your ankle pumps throughout the day.

Going home

Before leaving the hospital, you'll be given written instructions covering things like medications, physical therapy, activity, home equipment, home health services, contact numbers and when to follow up with your surgeon.

Have a question about your hospital stay?

Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 or the Joint Replacement Patient Navigator at 308.660.1191 to speak with one of our experienced staff members.

Hip replacement, knee replacement or shoulder replacement surgery at Great Plains Health can change your life for the better. Surgery can help you get back to the activities you love—without pain. But before you can leap into old routines, you'll need to stretch and strengthen the muscles and tendons that surround your new joint.

Exercise and your new joint

After joint replacement surgery, you're likely to feel stiffness. Some movements might even cause you discomfort.

Exercise can help restore flexibility and normal function to your joint. And exercise can also help protect you from blood clot formation.

After surgery, your orthopedist will give you a series of exercises to perform every day. It's important to follow the instructions for how to do the exercises and how often to do them. It's also important to keep doing the exercises until your doctor tells you to stop.

Physical therapy

Most patients do physical therapy after they leave the hospital. The joint care team will make arrangements for you with our physical therapy department or the facility of your choice. If you can't attend physical therapy, an in-home therapist can be arranged.

The number of physical therapy sessions you need will be based on your progress. In many cases, the more effort you put into your exercise routines, the quicker your recovery.

Understanding your exercise program

The orthopedists at Great Plains Health will make sure you understand what's expected of you and what you need to do before you leave the hospital. If you have questions as you heal, we're here to help. Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with your surgeon or a member of our staff.

You made great strides while you were in the hospital. But there is still some work to be done. This is the time to rely on your coach and other friends and family for support.

Here are a few tips to help you stay safe, healthy and comfortable as you heal.

Protecting your joint

Follow these tips to help protect your joint and feel comfortable at home:

If you had a hip replacement (posterior or lateral approach):

• Don't lie on the surgical hip.
• Don't cross your legs at the knees.
• Don't bend at the hip or waist more than 90 degrees. Use a reacher to pick things up.
• Don't turn your feet excessively inward or outward when you bend down. Don't stand pigeon-toed.
• Don't sit on a low toilet or chair that would cause your hip joint to bend more than 90 degrees.
• Don't bend forward when getting out of a chair. Move to the edge of the chair and lift yourself up with your arms.
• When lying down, don't cross your legs or roll your surgical leg toward the other leg.
• When lying down, don't bend forward to reach for something.
• Wear shoes and slippers that provide good support.
• Sit in chairs that have arms.
• If your muscles begin to ache, cut back on your exercises, but don't stop them altogether.

If you had a knee replacement (anterior or anterior-lateral approach):

• Don’t cross your legs at the knees.
• When lying down, don’t cross your legs or roll your surgical leg toward the other leg.
• Avoid large movements of your leg forward and backward.
• Wear shoes and slippers that provide good support.
• Sit in chairs that have arms.
• If your muscles begin to ache, cut back on your exercises, but don’t stop them altogether.

If you had a knee replacement:

• Don't keep the knee flexed or bent. That may shorten the knee muscles and make it difficult to fully extend the leg.
• When lying down, position a pillow under your ankles for support. Avoid putting a pillow under the knee, causing it to flex or bend.
• Continue using shoes with good support. Avoid wearing open-toe slippers or shoes without a back.
• Sit in chairs that have arms to help you get up.

If you had a shoulder replacement:

• Don't roll the shoulder backward.
• Don't extend the elbow behind the body.
• Don't lift, push, pull or stretch with the arm.
• Don't support your body weight with your hand or arm.
• Support your elbow and upper arm with a pillow when lying down. A recliner may be the best choice for the first few days at home.
• Wear an immobilizer or sling until you follow up with the surgeon. You may remove it two to three times daily to move your fingers, wrist and elbow.

Are there any activities that I should avoid after surgery?

Keeping your new joint moving will help your recovery. But you should return to normal activities gradually. You may have to work your way up to a particular activity.

If you've had a hip or knee replacement, talk with your surgeon before participating in high-impact or injury-prone sports, such as:

• Jogging.
• Tennis.
• Basketball.
• Downhill skiing.
• Football.

If you've had a shoulder replacement, you should not jar your joint or push it to its most extreme range of motion. Talk with your surgeon before:

• Lifting or pushing heavy objects.
• Making hammering or forceful movements.
• Boxing or doing any other arm/shoulder impact sports.

Coping with swelling

If you had a hip or knee replacement, you may experience swelling in your leg. Lie on your back and prop your feet up on pillows so your feet are elevated above your heart. Gravity will help drain the excess fluid. This is a good time to apply ice as well.

The white compression stockings you were given in the hospital will help keep the swelling down by compressing the veins in your leg and preventing fluids from pooling. They will also help prevent blood clots from forming. Most people wear them for four to six weeks after surgery. Your surgeon will tell you when you can stop. When using compression stockings, keep these things in mind:

• They should be worn during the day and taken off at night.
• Clean the stockings by handwashing them in a mild detergent and letting them air-dry overnight.
• Notify your surgeon right away if you notice any increased pain or swelling in either leg.

If you had a shoulder replacement, you may experience swelling in your arm and hand. It's usually less pronounced in the morning and increases throughout the day. To help reduce the swelling, you can elevate your hand and forearm on pillows for 30 to 60 minutes at a time during the day.

To help prevent swelling, avoid activities that leave your arm in a hanging position. If swelling is severe and accompanied by arm pain first thing in the morning, contact your surgeon.

Coping with pain

If you're in pain, you're less likely to move or do your exercises. Inactivity can cause the joint to stiffen and slow your recovery, undoing all your excellent work during your hospital stay.

Try these tips to help you protect your joint and feel comfortable at home:

• Take your pain medication 20 to 30 minutes before you exercise. This will make moving the joint much easier.
• Control discomfort by applying an ice pack or using your ice cooler on the joint. Don't ice the joint more than 15 minutes per hour. Nonstop ice can cause tissue damage and slow the healing process. Always use protection, such as a towel, between the ice and your skin.
• Change your position every 45 minutes.
• Avoid napping during the day so that you will be able to sleep better at night.
• Short, frequent walks can help.

When you think you're ready to wean yourself off of your pain medications, try substituting extra-strength (acetaminophen (such as Tylenol) or scheduled Tylenol extended release for one dose of narcotic pain medication. Gradually increase the number of substitutions until you are no longer taking any narcotics. Be careful not to go over the maximum amount of acetaminophen per day: 3,000 to 4,000mg. Ask your nurse what your maximum dose should be.

If you're taking a blood thinner, check with your doctor before taking any other types of pain reliever. Many common over-the-counter pain relievers may interact with your blood thinner and cause problems.

Preventing infection

Taking care of your incision is the first step to preventing infection. Remember:

• Keep your incision clean and dry.
• Don't immerse your joint in water until your staples or sutures have been removed and your incision is completely healed, which is usually around 4 to 6 weeks.
• Don't use any lotions, rubs or ointments on your wound unless directed to do so by your surgeon.
• Examine your wound daily and report any signs of infection.

Your dressing will typically be waterproof. You will be given specific instructions on the dressing you have and if you will need to change it or if you will be coming back to the orthopaedic clinic to have it changed.

While your incision is healing, some redness, heat, swelling and bruising around it is normal. But call your surgeon if:

• The redness increases and pain does not subside.
• You develop a fever or night sweats.
• You notice any increase in drainage or if the discharge changes color or has an odor.
• You notice an increase in pain (not associated with normal exercise).

During the first two years after joint replacement, you're more susceptible to infection. However, infections are possible throughout your life. So always follow these steps:

• Notify your doctor before any procedure that may break the skin.
• When scheduling dental work, inform your dentist that you've had a joint replacement. Your dentist may give you antibiotics to take.
• If you see a new doctor, be sure to include the joint replacement in your medical history.

Preventing constipation

Changes in your daily routine, as well as taking narcotic pain medicines, can result in constipation. These steps can help keep your system moving:

• Eat fiber-rich foods, like grains, fresh fruits and vegetables.
• Drink plenty of water.
• Avoid liquids that contain caffeine, such as coffee and cola drinks.
• Avoid alcohol.
• Incorporate a daily walk or two into your exercise routine.
• Wean yourself off of narcotic medications as soon as possible.

If you do become constipated, use stool softeners or laxatives as needed.

Have a question about your at-home care routine?

Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with your surgeon or a member of our staff.

Returning to work

Returning to work depends on the physical demands of your job, as well as your progress. Most people plan on taking a one-month leave of absence. Your surgeon will tell you when you can return to work.

Driving after surgery

It can be as little as four weeks or as long as six weeks or more before you can begin driving again. The timeline depends on the progress you make during your recovery.

The type of car you drive also matters. For instance, if you had a left hip or knee replaced, you may be able to drive a vehicle with an automatic transmission in as little as four weeks. If your surgery was on your right hip or knee or you drive a vehicle with a manual transmission, then you may not be able to drive for six or more weeks.

You should not drive if you are still taking prescription pain medication or muscle relaxers. Your surgeon will let you know when it's OK to drive.

Sex after surgery

After surgery it will take time to regain your strength. Most people feel able to have sex about four to six weeks after surgery. Although healing times can vary, by that point the incisions, muscles and ligaments are usually sufficiently healed. Talk to your surgeon if you have any questions.

Blood clots after surgery can cause serious problems. Chances are your doctor will prescribe a blood thinner (or anticoagulant) to help prevent them. You can also take these steps:

• Wear compression stockings during the day. Take them off at night.
• Do your daily joint exercises.
• Go for daily walks.

Types of blood thinners

There are several kinds of blood thinners your doctor may prescribe. You will be given information on the specific medication you will be taking at home. The hospital pharmacist will call you at home after discharge to review your medications.

Taking blood thinners safely

Blood thinners are usually safe and effective if taken according to your doctor's directions. These tips can also help you use them safely:

• Check with your doctor before taking nonsteroidal anti-inflammatory medications, vitamins or over-the-counter drugs that contain aspirin.
• Avoid drinking alcohol.
• Postpone any procedures that could cause bleeding, such as dental work or minor surgical procedures. If it's not possible to postpone the procedure, be sure the dentist or doctor knows you are taking blood thinners and that you've had a recent joint replacement.
• Avoid any activities that may result in injury, including hobbies that use power tools or sharp instruments that could break the skin.

Signs and symptoms to watch for

Call your surgeon right away if you fall, have a traumatic injury or experience any of the following symptoms while taking a blood thinner:

• Bleeding or oozing from your surgical wound.
• Nosebleed.
• Blood in your urine or stool.
• Coughing up or vomiting blood.
• Excessive bleeding when brushing your teeth.

• Spontaneous bruising (not caused by an injury).

Also call your doctor right away if you accidentally take more than your prescribed dose, even if you don't have any symptoms.

See a doctor right away if you have any symptoms of a blood clot in your legs, including:

• Swelling in your thigh, calf or ankle that does not go away if you lie down with your feet elevated above your heart.
• Pain and tenderness in the calf of either leg.
• Dizziness, numbness or tingling.
• Rapid or unusual heartbeat.
• Vomiting, nausea or fever.

If a blood clot travels to your lungs, it can be life-threatening. Call 911 right away if you experience:

• Sudden chest pain.
• Difficult or rapid breathing.
• Shortness of breath.
• Confusion.

Have a question about your medication?

Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with your surgeon or a member of our staff.

Will my joint feel any different?

After a hip replacement, the new joint usually feels natural. Some people may notice that the leg with the new hip seems slightly longer than it was before. That's usually because years of slow degeneration of the hip joint caused a shortening effect the body compensated for. Once the joint is replaced, the leg feels longer.

In other instances, the surgeon intentionally lengthens the leg at the joint during the surgery. This is done to prevent the joint from dislocating or popping out of the socket. Over time, the new leg length becomes less noticeable. Sometimes a small lift placed inside the opposite shoe can help correct the length difference. Talk with your surgeon if you encounter this problem.

A few patients report aching in the thigh when standing or bearing weight. This pain normally goes away after a few months.

After a knee replacement, kneeling may be uncomfortable during the first year. But it should become less noticeable over time. Some people also notice a minor clicking sound when they bend their knees. This is normal. It's the result of the artificial parts of the knee coming in contact with each other.

How long will my new joint last?

Various factors—such as your weight, activity types and activity level—can affect the life of your new joint. Current studies suggest that the average hip or knee prosthesis lasts 15 to 20 years. As new materials and procedures come along, this expectation may change.

Will I need to have my joint replaced again in the future?

Some people have hip or knee replacements that last their entire lives. Other people may need to have the procedure repeated. For example, if the bone doesn't bond properly to the first replacement, the prosthesis may become unstable and need to be replaced. Or if the plastic spacer that cushions the joint becomes extremely worn, it may also need to be replaced.