Going Home

9. Going Home From The Hospital

Prior to release from the hospital the Home Care Coordinator will see you. Prescriptions will be written for pain medicine and a blood thinner to prevent blood clots (usually Coumadin, also called warfarin). You will be issued either a walker or crutches (whichever you use better).  We recommend a bedside commode, which you will need to purchase.  The bedside commode is usually placed over your own toilet.  The bedside commode can be used a shower seat.  Additional items that may be useful are a "reacher", "sock-cone" and a long handled shoe horn. These can be ordered from the Home Care Coordinator, but insurance usually doesn’t pay for them.  You can order these through the home care coordinator before discharge. It may be less expensive, however, if you purchase the bedside commode and the additional items (if needed) prior to your hospitalization.

Although you will be independent with most activities of daily living when you leave the hospital, it is important that you not be alone for the first one to two weeks. During this period of time, it is extremely helpful to have someone help prepare meals, clean the house and give you some of the things that you will need. It is not necessary that this person be medically trained. Physical therapy will be arranged and a therapist will visit your house, usually 3 times a week for 5 weeks. Also, visiting nurses will be arranged to perform wound checks, remove the staples and draw blood for checking the level of activity of the blood thinner (Coumadin).

For the first two to three weeks, you will be somewhat limited in your activities. You are usually allowed to put as much weight as tolerated on the operated leg, but you will find that it will be uncomfortable to put full weight for 1-2 weeks.  So, plan to use a walker or crutches for 1-2 weeks. As soon as you can comfortably bear full weight, switch to a cane in the opposite hand. We recommend using the cane until you can walk without a significant limp.  This usually takes another 1-2 weeks.  You will most likely find during these first weeks that you easily get fatigued. You can go out for short walks and short rides in the car, but you should not plan any major outings or long walks. 

Occasionally it may be necessary to spend a short time in a rehabilitation hospital if progress with physical therapy is slow or other medical problems require more nursing care, or if you live alone and friends or family are not available. Special orthopaedic rehabilitation units at several facilities are available. Private insurance, Medicare or Medi-Cal usually pay for such services.

10. Post Operative Office Visits

The decision of when to drive after surgery is yours. You must decide when you can safely drive the vehicle while still following the bending restrictions and not posing a danger to yourself or others. We generally recommend waiting 4-6 weeks before driving.

The first "official" postoperative visit will be at approximately six weeks from your surgery, at which time you will have x-rays taken. Your surgeon, or his physician’s assistant, will inform you at the six week visit what restrictions can be changed.

By three months after surgery, you will usually be strong enough to resume most normal and recreational activities. Normally, 75% of the strength is gained by three months, 90% by six months and 100% by one year after surgery. You will be required to come for postoperative visits and x-rays at six weeks, three months, six months, one year and then every other year. Routine every other year follow-up is important as it allows your doctor to evaluate x-rays and look for any changes.

Plans to return to work should be made with your surgeon pre-operatively. Your job type will affect this. If you have a desk job with moderate amounts of walking, you can usually return to work 2 – 3 weeks following your surgery, but you may need to use a cane and it may be wise to go back part-time for a week or two. If your job requires more physical activity, you may need to be off work 6-8 weeks.

11. Living With Your New Knee

Exercises such as swimming, bicycle riding, walking (treadmill or elliptical okay; use shoes with a cushioned heel) are encouraged.  “Low impact sports” like golf, bowling, or doubles tennis are fine. Sports such as racquetball, jogging, and skiing are not recommended.  Activities involving jumping at any time or lifting heavy objects (on a routine basis) are to be avoided.

12. Prophylactic Antibiotics

Without appropriate precautions it is possible for bacteria from the blood stream to settle in the hip joint causing an infection after a total hip replacement. Patients with dental infections have been known to have the infection spread to their hip joints. Similarly, infections elsewhere in the body can also spread to the hip. In addition, manipulation of areas that are known to have bacteria can also cause bacteria in the blood stream. Any dental procedure that causes some bleeding of the gum can result in bacteria in the blood stream. The chance of this resulting in an infection is extremely low, but precautions should still be taken. Therefore, it is wise to take prophylactic antibiotics before and after these procedures. Similarly, any procedures on the GI tract or genital-urinary tract also require prophylactic antibiotics. Simply mentioning the fact that you have had a total hip replacement will usually alert your dentist or doctor to these possibilities and they will take the appropriate action. If not, call our office and we will prescribe them.

13. Summary

In summary, lots of things are going to happen both before and after your surgery. By reading this, we hope that you will be prepared for some of these things. Hopefully, this will generate some questions. Please ask your surgeon or any of the staff. Please remember that the goal of the surgery is to relieve pain and to restore function so that you should be able to perform the routine activities of daily living. Your knee will never be completely "normal" again, but it should give you a significantly improved level of function and pain relief as compared to your pre-operative status.