When is a hip or knee joint replacement required?
Joints are responsible for absorbing the shock from walking, running and many other activities. As one ages, joints tend to deteriorate which can cause severe joint pain or dysfunction. Similar symptoms can be observed in traumatic injuries resulting from falls and motor vehicle accidents.
Where possible, joint issues are treated conservatively with pain medication and other non-invasive treatments, however more severe cases may require an orthopedic surgery to correct a joint surface or replace a joint with an orthopedic prosthesis implant.
Preparation for joint replacement surgery
With a planned elective surgery, one may need to prepare for the upcoming joint replacement as directed by their surgeon.
In some cases, the team of doctors involved in your care may adjust your medications in order to ensure that the surgical procedure has the highest chance of success with minimal complications. This sometimes includes temporarily discontinuing blood thinners to reduce the risk of bleeding during surgery and the use of supplements to reduce the risk of anemia.
Moreover, it is sometimes recommended by the surgeon that you participate in pre-operative physiotherapy to increase one’s strength and endurance to improve the chances of having a successful recovery after surgery.
An occupational therapist may also be involved to evaluate one’s home for any safety hazards and bathroom equipment recommendations to boost safety upon returning home from the hospital.
When a home visit prior to surgery is not possible, the hospital may provide you with an informational package suggesting certain safety equipment to help you return to your activities of daily living and walking with greater ease.
Ideally, these pieces of equipment should be obtained prior to the surgery date so they are available upon the return home. Of course, the required equipment depends on whether someone will be placed on any activity restrictions following their operation.
Activity Restrictions Following Joint Replacement
Depending on the surgical procedure and surgeon, you may be asked to maintain certain activity restrictions ranging from several weeks to a couple of months or until follow up with the surgeon.
If instructed by the surgeon, one must follow their hip precautions to ensure the joint heals well following surgery. Typical precautions following total hip replacement surgery include:
- No crossing of the legs or ankles when standing up, sitting down or lying down.
- No twisting at the waist to reach for items to one’s side.
- No bending forward from the waist or lift one’s knee above the height of the waist (ie. ensure that less than 90 degrees of flexion is always maintained during the period of activity restrictions)
Tip: An easy way to remember one’s hip precautions is to ensure that one’s knee on the surgical side does not bend or flex. While the knee may have no restrictions, preventing it bending helps to maintain the precautions at the hip. The leg on the surgical side must remain as straight as possible even during transfers into the bathtub, onto the toilet or bed.
Similarly, one’s knee may have precautions following total knee replacement. These commonly include restrictions that suggest to not:
- Pivot on or twist the operated knee
- Kneel or squat low to the ground
These restrictions are meant to prevent someone from dislocating their artificial joint from its position and promote good recovery of the surgical site. To help with any pain that one may have after surgery, a prescription of pain medication may be used to help achieve reasonable control of symptoms.
While many people avoid pain medication, physical therapists suggest to take their prescribed pain medication at least 1 hour before any rehab or exercises as this can minimize pain and promote greater endurance and range of motion during physical activity. Being able to participate fully in one’s home exercise program and other rehab regimes can minimize the recovery period for some and help someone return to their former functional level more quickly.
How long do hip precautions last after surgery?
Typically, total hip precautions last approximately 6 to 12 weeks post surgery. However, the surgeon should be consulted as this is dependent on the procedure method and surgical approach. Some may require lower duration of precautions, whereas others are able to return to activity as tolerated following their procedure. Prior to leaving the hospital, ensure that you have been educated on the length of precautions and what steps one must take to ensure that transfers are safe.
How long do knee precautions last after surgery?
Usually, one must utilize a cane or aluminum frame walker for mobility support for approximately 4 to 6 weeks after their knee replacement. Depending on how one progresses through rehab, it may be longer, so it is important to consult one’s surgeon or physical therapist for further guidance.
In some cases, you may be asked to only apply feather or touch weight bearing through the operated side. This may last for a few weeks in which case a physical therapist would suggest bedside exercises that can be done from sitting or lying down to strengthen the joint. It is anticipated that you would return to normal weight bearing status, however this may take several weeks if not longer depending on the operation.
Preparing for hospital discharge following joint surgery
Following surgery, people recover in the hospital for a short period of time. Depending on the complexity of the surgery, this may range from a one to three day hospital stay or longer if there are any complications.
Staying in hospital following surgery is meant to ensure that any anesthesia remaining in one’s system has been expelled and that there has been no adverse issues with the joint replacement or hardware that would require further intervention.
It is customary for physical therapy to be initiated one day post op as studies have found that access to rapid rehabilitation is linked to more successful health outcomes. Within a hospital setting, this may involve brief walks with support from an aluminum frame walker under the watchful eye of a physical therapist and their assistant or an occupational therapist.
Also, physiotherapists help people practice climbing and descending stairs as this is a common challenge faced by people as they attempt to enter their homes following hospital discharge.
When the physician has deemed someone safe to be sent home, transportation home is arranged with friends or relatives. Hospital staff may assist with the car transfer to ensure that any joint precautions are exercised correctly. Car transfers can be made more safe with the use of a swivel seat cushion placed on the car seat to help rotate someone’s body while sitting in the vehicle.
Moreover, a discharge summary is provided to the patient with a brief discussion of the hospital course, any medication changes and what symptoms are a cause of concern that would require a visit to the emergency department.
Also, a follow up plan is usually established to have any remaining staples or sutures removed after surgery. Usually their removal occurs a week or more post surgery to allow for optimal closure of one’s surgical wound. In some cases, surgeons defer this to one’s family doctor, however it is dependent on the surgeon and one’s proximity to the surgical facility.
If one has an unusual amount of bleeding from the surgical site, community based nursing care may be arranged for management of the wound.
Finally, it is important to liaise with your medical team to understand how soon after surgery you are required to have a follow up appointment with the surgeon. Usually this can be anywhere from a few weeks to a month, however a contact number for the surgeon’s office is usually provided so that any joint dysfunction or unforeseen issues following surgery can be addressed quickly.
What happens if I am not ready to go home after joint surgery?
In situations where one is not able to ambulate or navigate the stairs following surgery, a more extended hospital stay on an inpatient rehabilitation unit may be required. In these cases, the team and rehab therapists place an application to the rehab unit asking to accept the patient for a short stay to work on goals of returning someone to their former functional abilities and boost their strength.
These types of rehab programs can be run out of the hospital, however in more recent times, hospitals have been delegating this work to community based physiotherapy clinics to free up hospital beds for patients awaiting their own joint replacement procedures.
Depending on how one progresses through rehab, the program can be more lengthy with less intensity of activity or have a shorter duration with more rehab intensity. For most high functioning individuals, inpatient rehab is usually limited to one hour sessions per day of occupational therapy and one hour of physical therapy.
Within these settings, it is also commonplace for recreational therapists to be involved. These providers utilize recreation and sport related activities depending on one’s tolerance to help work towards the goal of returning someone to their baseline mobility and strength.
Of course the therapists would establish a treatment plan that takes into consideration one’s endurance and pain levels which may affect the ability to participate in lengthy therapy sessions. As a result, therapy may be shorter depending on an individual’s ability to tolerate rehab.
Assistive device and safety equipment recommended following joint surgery
As a result of activity restrictions, an individual may have a difficult time completing activities of daily living such as bathing and dressing. With the use of dressing aids and a reacher, it is possible to remain independent with these activities despite having activity restrictions.
Similarly, transfers may be a challenge if someone has hip precautions where they are not allowed to flex at the hip beyond 90 degrees. To more easily get into the bathtub for a shower, a tub transfer bench can be utilized.
Transfer challenges are also experienced at the toilet following a joint replacement surgery. For this area, a raised toilet seat can be used to raise someone a little higher and decrease the hip flexion. Also, a toilet safety frame or nearby grab bars can be used to help someone into standing as bearing weight through the surgical side may not be allowed.
Summary of common equipment recommendations following joint replacement surgery:
Dressing aids
Reacher
Help pick items off the floor without reaching down and bending from the waist.
Sock aid
Helps to put on socks without bending forward or crossing one’s legs.
Dressing stick
Can help with dressing and pulling one’s pants or underwear up, prevents the need to bend down.
Elastic shoe laces
These laces tighten on their own and prevent the need to bend down or cross one’s legs to tie shoes.
Long handled shoe horn
Can be used to easily slip the heel of one’s foot inside a shoe without bending forward.
Bathing aids
Tub transfer bench
Helps with getting in and out of the bathtub to have a shower from a seated position.
Shower chair
Can sit and rest during a shower if one is on partial weight bearing or feather touch weight bearing status.
Long handled sponge
Can help to wash and scrub one’s feet or back, minimizes need to twist and bend at the waist.
Hand held shower head
The flexible hose can be used to wash the various parts of one’s body while sitting.
Grab bars
Can be held for support or balance and used for help with standing up.
Toileting aids
Toilet safety frame
Can be used for support with lowering oneself down on the toilet or with standing up.
Grab bars
Used to pull oneself into standing from the toilet.
Raised toilet seat
Increases the height of the toilet overall to reduce flexion at the hip to maintain precautions.
