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What happens when I get discharged from the hospital following surgery?

Diet

May resume your regular diet as tolerated.

It is normal to experience nausea and/or vomiting after surgery.  We do give medication to reduce its incidence.  This may also be a side effect of the pain medication or the anesthesia.  As nausea resolves, start to replenish fluids (drink water) and eat food that are easy to digest (toast, saltines, etc.).  If you experience continued nausea/vomiting, then contact us immediately.

Constipation may also occur from the pain medication and/or iron pills, if this occurs try to increase fluid, fiber, and fruit intake.  You may also buy Colace at the drug store.

Medication

Pain medication will be prescribed for you.  Take this as directed.  It is important that you are able to participate in Physical Therapy and perform directed exercises.

A blood thinner will be prescribed for you in order to minimize the problems related to blood clots. When you return to home, if you are on Coumadin, your blood will be drawn 1-2 times a week.  This will allow your medical doctor or medical consultant to regulate your Coumadin dosage appropriately.  You will receive a call from your primary physician or consultant physician regarding Coumadin dose changes based on the labs that are drawn.  This is not necessary if you have been placed on Aspirin only.  If you do not receive a call please contact the medical doctor whom you saw for clearance prior to the surgery. You will be on a blood thinner for up to six weeks.

Alcohol is permitted, but only in moderation, ONE DRINK PER DAY.

Activity

While in bed, keep operative leg elevated to decrease swelling and pain.  Do not keep a pillow under your knee as the pillow will create a contracture  The idea is to get full extension of your leg.

Walk with crutches or walker initially but progress to a cane as soon as a Physical Therapists says that it is safe to do so. You may be able to start with a cane within a couple of weeks of the surgery. You are allowed weight bearing as tolerated. Range of motion is as tolerated.

There are exceptions to weight bearing status and range of motion may be restricted. Your surgeon will specifically identify this to you if needed.

Post-op Exercises:  walk, isometrics, and ROM exercises.  You are allowed to go outside prior to first post-op visit.  Bend knee as tolerated, continue exercises as instructed by Physical Therapy to achieve increased range of motion.

You may not drive for a month if you are taking narcotic medication or if your right knee has been operated on.  You may be a passenger in a car at any time.  If you are not taking narcotic medication or if your left knee was operated on, then you may start driving as comfort dictates. 

You may travel by plane after two weeks, but you may want to reserve an aisle seat for comfort.

When able, may participate in water aerobics (after the first post-operative visit), low impact aerobics, golf, bowling, Nordic track. Higher impact sports or activities may be possible, but check with your physician before undertaking these activities

Kneeling after knee replacement is allowed. It will not damage your knee replacement.  A knee pad may make it more comfortable.

Incision Care

Do not submerse incision under water (i.e. bathing, swimming) until cleared by your physician.  Showering is permitted.

Call for any drainage from incision, redness, swelling, increased pain, or temperature greater than 101 degrees F.

It is normal to have some numbness around the incisional area, this may resolve in 6 months to a year, but may be permanent.

Bruising and warmth of the incision is normal for 4 to 6 weeks after surgery.

Swelling of knee, leg, and foot is normal and may persist up to 6 months to a year.

If you experience increased pain, swelling, drainage from the incision, numbness/tingling, redness, or temperature greater than 101 degrees F, please call us immediately.

Results of Study: 

What happens when I get discharged from the hospital following surgery?

In the cost-conscious managed care environment, patient's postoperative disposition must be justified. These studies accurately identified and predicted a patient's disposition, thereby expediting their discharge plan and containing cost.

METHODS: The initial prospective study involved 66 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) who were interviewed 2 weeks preoperatively via telephone by 2 orthopaedic nurse specialists. The questionnaire was designed to elicit the patient's functional level, motivational level, mental status, environment support factors, and social support system (SSS). The nurse and patient agreed to a post-hospital discharge plan: home, a skilled care center, or rehab center. Data was then correlated with the actual post-hospital placement. A subsequent study involving 127 patients undergoing THA and TKA, used the predictive factors identified in the first study to preoperatively assign a disposition. This was then correlated with the actual post hospital disposition.

RESULTS: The initial prospective study identified the availability of a SSS as the critical factor determining discharge disposition. 95% with available SSS did go home. The 2 who did not became confused postoperatively and required a rehab center. 100% with no SSS went to a predetermined rehab center. In the second study, 127 patients were interviewed preoperatively. 100% with no SSS available proceeded to the predicted skilled care or rehab center. 66% with available SSS did go home. 34% with an available SSS went to either a skilled care or rehab center. Reasons for a skilled care or rehab center disposition included 9 patients undergoing bilateral THA or TKA, 10 requested these facilities for various personal reasons, and 10 were unable to return home with their available SSS because of the lack of progression with their physical therapy program (i.e. safety issues). The remaining 2 patients had postoperative complications of urinary incontinence and poor wound healing.

DISCUSSION & CONCLUSION: The primary predictive factor in planning a patient's disposition is the presence of a SSS consisting of available relatives or friends. When present, 66% of patients go home. When absent, 100% of patients go to a rehab facility. Exceptions were in hospital complications, personal preference, and unanticipated lack of progression in physical therapy. A secondary predictive factor is whether the patient is having unilateral or bilateral THA and TKA. 100% of patients undergoing bilateral THA and TKA proceeded to a skilled care facility or rehab center.