Information provided in this document is for general use because individual patient characteristics greatly influence the recovery and final outcome.

This information is a compilation of published material in the public domain and from personal experience.

         

This document was prepared by Jayanthi Subbarao MD, MS, Clinical Professor, Department of Orthopeadic surgery & Rehabilitation.  Loyola University Chicago  Stritch School of medicine. Maywood Illinois. USA. Maywood.IL. U.S.A.                

Frequently Asked Questions following Hip and Knee joint replacement

Publications ( Health care - Self Help Resources )

  • How long do I need to use the walking Aids?

    • Most patients will begin with a walker or two crutches for about 4 to 6 weeks.

    • They will progress to one crutch or cane and then gradually walking without support but your doctor and or the therapist recommend duration and type of ambulatory aid that you need to use.

    • It is safe to use a cane (for 3-4 months) when you are walking in unfamiliar, crowded on uneven areas so you can avoid injury to the joint.

Some of the significant factors are:    

  • Pre surgical activity level

  • Pain in other joints especially the other knee or shoulders

  • Tolerance to pain

  • General Medical status

  • Body weight

  • Type of prosthesis utilized

  • Uneventful recovery from surgery

 

It is important that you should follow the patient instructions given to you at the time of discharge from the hospital. Make sure you ask questions and make a note of the answer for future follow up. EG: Medications for pain management and starting of therapy at home, use of CPM (continuous passive motion machine etc).

 

For some patients inpatient rehabilitation management may be required.

 

According to Center for Medicare and Medicaid Services (CMS) guide lines:

 

  • Knee or hip joint replacement, or both, during an acute hospitalization  immediately preceding the inpatient rehabilitation stay and also meet one or more of the following specific criteria:

  • The patient underwent bilateral knee or bilateral hip joint replacement surgery during the acute hospital admission immediately preceding the IRF admission.

  • The patient is extremely obese with a Body Mass Index of at least 50 at the time of admission to rehabilitation.

  • The patient is age 85 or older at the time of admission to the Inpatient Rehabilitation facility.

 

You should notify your primary care physician that you are discharged from the hospital and that you will contact him/her for general medical management.

Make sure that you obtain pain medications from only one physician and take them regularly as recommended.  Withholding pain medications for fear of being dependent on them can slow your ability to tolerate therapy and your recovery. You should not take over the counter pain medications and other medications without discussing with your physicians.

 

  • When are the staples removed?

The staples are generally removed within 14 days depending on the wound healing. This is generally done at the time of follow up with your surgeon.

 

  • Can I shower with my staples in?

Yes. You should cover the clear plastic wrap and tape to prevent moisture on the incision.

 

  • How long do I need to wear the compression stockings (to prevent blood clot)?

Compression stockings should be worn till the swelling subsides or at least two weeks and you are able to walk about 200 feet several times. You can take the stocking off at night unless you are advised to wear continuously. You should elevate the leg when you are not wearing the stockings.

 

  • What type of Rehabilitation will be done at home?

In most cases home physical therapist management is recommended but in some patients with hip replacement surgery occupational therapy may be recommended to retrain advanced self care skills. The duration and frequency of therapies is generally depends on your progress and ability to manage by yourself and with assistance from family members.  In some cases therapy may be continued as outpatient to further advance your activity level and strengthening.

 

  • How long before I can drive?

This restriction is longer for patients who undergo hip joint replacement. Generally most patients are cleared for driving in 3 to 6 weeks.

 

  • Are there precautions for driving?

Patients with knee joint replacement should avoid firmly planting the foot with the knee flexed. Patient with hip joint replacement should follow “Hip Precautions”.

Avoid crossing the legs while sitting.

Move the seat as far away from dash board as possible.
Monitor your hip flexion while sitting in a Low seat.
Watch your foot when getting in and out of the car.

 

  • When can I resume Sexual activity?

Knee replacement Patients: You may resume sexual inter course when your pain subsided and you are comfortable with positioning of the knee without strain.

Hip replacement patients:It is safe to resume sexual inter course in 3-6 weeks if your post surgical recovery was uneventful, incision is healed and muscle strength in hip group is improved. You should remind yourself about the “hip precautions” (you should particularly avoid excessive hip flexion, adduction and internal rotation during all activities including sexual activity.

 

  • How long before I am completely “back to normal”?

Most patients are back to 90% to 95% of normal function within 3-6 months after joint replacement surgery.

 

  • How long will my newly replaced joint last?

  1. It depends on your life style and your intensity of activities.

  2. Direct trauma to the joint due to fall or accident.

  3. >90% of patients will have a fully functional joint for about 10 years after surgery but many factors contribute to the wear and tear of the joint.

  4. The most important factor is the amount of stress placed on the artificial joint. Such stress is naturally higher in younger patients because of their involvement in sports and other high intense activities.

  5. Complication free (especially infection and dislocation of the prosthesis) post operative recovery.

  6. Increased body weight also seems to be related to earlier failure.

  7. The normal failure of a replaced joint is due to the slow progressive wear of the plastic component.

Please remember to talk to your physician and therapist if you have questions about your situation and also if what you read is applicable to you.

 

RELEVANT REFERENCES:

  • Reference: http://orthoinfo.aaos.org. This is a link to American Academy of orthopedic surgeons. Activities After Hip Replacement-OrthoInfo - AAOS

  • International Journal of Rehabilitation Research: September 2001 - Volume 24 - Issue 3 - pp 191-198: Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants: MULHOLLAND, SUSAN J.1 *; WYSS, URS P.2.

    Abstract

    The purpose of this review of the literature was to investigate the functional range of motion requirements of non-Western populations in respect to artificial hip and knee joint implants. It was discovered that in Asia and the Middle East many activities are performed while squatting, kneeling, or sitting cross-legged. These positions demand a greater range of motion than that typically required in Western populations. For example, authors report that to squat one requires 130°–full hip flexion and 111°–165° (or full) knee flexion. To sit cross-legged one requires 90°–100° hip flexion and 111°–165° (or full) knee flexion. This study identified a lack of documented research in this area, and the research that has been done provided inconsistent data. Potential reasons for discrepancies in the data are discussed, including the use of different methods to collect range of motion measurements, unclear use of terminology, and variations in normal passive and active range. In conclusion, this study stresses the importance of culture and function in the design and use of any new joint or product.

  • Rehabilitation After Hip- and Knee-Joint Replacement: An Experience- and Evidence-Based Approach to Care: Brander, Victoria MD; Stulberg, S David MD: American Journal of Physical Medicine & Rehabilitation: November 2006 - Volume 85 - Issue 11 - pp S98-S118.

  • Hip Precautions: http://www.upmc.com/patients-visitors/education/rehab/Pages/total-hip-replacement-precautions.aspx

  • Exercises following Hip replacement: http://orthoinfo.aaos.org/topic.cfm?topic=a00303

  • Joint replacement Overview from Medscape: http://emedicine.medscape.com/article/320061-overview.

  • Taking care of your new hip joint: Medline Plus Medical

  • www.nlm.nih.gov, patient in: United States National Library of Medicine

    Loading, After you have hip replacement surgery, you will need to be careful how you move your hip, You will need to learn exercises make your new hip stronger: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000171.htm

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