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Interviewer: What should you expect after your total joint replacement, whether you had a knee or hip replaced? The surgery is done and now we're going to talk about the recovery process. We'll also discuss some other things you need to know after your surgery.

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When Can I Go Home After Joint Replacement Surgery?

Interviewer: We're with Dr. Chris Pelt. He's a joint replacement expert at Ï㽶ÊÓƵ of Utah Health Care in the orthopedic center. So let's talk about after the surgery. I'm out of the operating room, how long am I going to be in the hospital now before I get to go home?

How Long Is Surgery?

Dr. Pelt: One of the things we'll start with is how long is the surgery. Its two hours or so. You're going to be gone from your family member for about three to four hours total. Then you're going to be going to the inpatient floor. 

How Long Will I Stay in the Hospital?

On average most of our patients will be in the hospital for one to two days. The average length of stay is about two days. Some patients are able to go home the day of or the day after surgery. And it's rare that patients need to stay longer than two days. So, expect an average length of stay about two days. And most patients afterwards will be able to go home.

What Will I Do During My Hospital Stay?

What we want to inform patients about is what is it going to be like while I'm in the hospital? What am I going to be doing? For the most part, what we're trying to do is make sure your pain is well controlled, that you're able to get up and walk around. You'll be able to do that on your own, transfer in and out of your hospital bed. In fact, we're going to get you up and walking on your joint the day of the surgery. You're going to able to put as much weight as you feel comfortable putting on it. You'll have a therapist working with you. They're going to guide you through the processes to make this safe for you and prevent you from having a fall or something else.

But you'll be able to do all these things primarily under your own power. You're not going to have somebody that's going to be lifting you. So our goals are to make sure your pain's well controlled, that your medically stable, that your blood pressure, your pulse, your breathing is all well controlled. And that you're able to sort of do the things you're going to need to be able to do when you leave the hospital on your own. Eat, drink, go to the bathroom, all the routine things we need to do in life.

Interviewer: So, when somebody leaves the hospital, then what are they going to expect when they're at home? You got a lot of support at the hospital. Will you still continue to have that at home?

Returning Home After Joint Replacement Surgery

Dr. Pelt: We find that the best outcomes are when our patients are able to return home. There are very few patients that will require a need to stay in the rehabilitative center, a skilled nursing center for example. When we have our patients able to go home, they're able to have access to resources still.

We're going to send a home-health care company, potentially, to your home if you need that. That will have a physical therapist that will visit you in your own home. Some patients may be able to visit an outpatient physical therapy center with their family driving them, perhaps in the first few days where they're going to receive physical therapy.

Early on, once you're out of the hospital you're going to be able to still get physical therapy. They're going to be working on strengthening gently without major resistance and not lifting weights on the day that you leave the hospital. But just starting to use gravity, using the weight of your leg to get a little bit of strengthening of the muscles and getting those moving again. And a little bit on gentle range of motion, especially in the knee. We're working and making sure that our knee gets all the way out straight, and that we start gently working on flexion.

Strength Training

We're not going to ask you to leave the hospital and jump on an exercise bike all on the same day. We're going to ask you to take it slowly, but we're sort of working on gentle strengthening, gentle range of motion, and walking and moving around the house and doing the activities of daily living. And then it's going to be a slow progression after that.

Interviewer: And the joint itself is strong, the process of what you're doing at this point is re-strengthening the muscles?

Dr. Pelt: That's right.

Interviewer: Am I correct on that?

Dr. Pelt: In hip replacement it takes about six to eight weeks for our body to incorporate the implant. Our body grows bone into the implant. That's how it's going to be stable for the rest of our lives. So, we don't want to do too much too early. But the activities of daily living and average weight bearing activities are not going to impact that at all we've found.

Similarly with the knee, most knee replacements may have some bone cement. Some of them may also have some bone ingrowth as well. Activities of daily living are not going to impede the bone healing process. So, you're able to do things gently, but maybe not running a marathon in the first six or eight weeks.

Interviewer: Sure. Put that off for a couple of years afterwards. Maybe not even that long.

Dr. Pelt: Yeah, maybe not. Most patients may be able to get back to many activities that they want to do within three to four months of the joint replacement actually.

Importance of Having a Support System

Interviewer: After I get home, how long do you require that I have a family member there?

Dr. Pelt: We really think it's important again, we've mentioned this before, that family is really important to this. Bringing family, friends, somebody that cares about you that will be able to potentially be around again. This is not a person that's going to need to pick you up and physically move you around your home. You're going to be able to do all those things yourself. You're going to be able to get yourself to and from the bathroom, to and from the kitchen if you need to.

But what we'd like to have is somebody that's going to be around that can do some light housework, help prepare some meals, and take some of that burden of being at home off of yourself. They may not even need to be present 24 hours a day. Somebody that can check in on you throughout the day might be just adequate enough. But for at least three days it's really great to have somebody around, and many patients will feel comfortable having someone that can take about a week or so and spend time with them.

Interviewer: Yeah, even if its for mental or emotional support I suppose, that's important as well.

Dr. Pelt: Absolutely, absolutely.

When Do I Start Physical Therapy?

Interviewer: So when does the physical therapy start? You mentioned after the surgery you're going to do some body weight type stuff. Just getting up, standing down helps start that process. When does the physical therapy kick in?

Dr. Pelt: Yeah, so you're going to start physical therapy the day of your surgery. You're going to have a physical therapist getting you up and helping you walk around and start moving. They're going to start showing you exercises that you're going to be performing. When you're in the hospital, the same exercises are going to be the ones you're going to do when you get back home. Therapy's going to continue. Again, it's going to start slowly, but you're going to continue to increase that with the activities that you're doing over the course of the next six weeks or so.

In the first couple of weeks, like I said, we may have some patients that will need some resources to have therapy come to their house. Others will be able to go to outpatient physical therapy. Ultimately most patients will transition at some point to the outpatient physical therapy setting where we have more resources. There's more exercise equipment and gym stuff that's available to them. More resources for them to have an optimal outcome.

Importance of Stretching & Exercise

Interviewer: How crucial are those stretches and those exercises to the recovery process? If you have two equal patients and one is really good about it and the other one is kind of okay, does it make a huge difference?

Dr. Pelt: It makes a huge difference. Therapy is vital to the outcome. We know that the patients that do the best are those that have had a physical therapy program and rehabilitative things. Patients that suffer the most are those that don't move it. They lay around. They aren't getting up and active, and they have more pain, they have less motion. Their outcome suffers as a result.

At the same time, we mentioned, we don't want to over do it. Doesn't mean I want you to run out of the hospital and start doing Arnold Schwarzenegger lifts and things. We're not talking about that. We're wanting you to just sort of follow the guidelines and your experts with their therapy department and your surgical team will lay out some exercises that are approved with the therapists that we work with. So that we're undergoing this in a very protocolized way to optimize your chances for a great outcome.

Pain Management

Interviewer: Some people are worried about taking pain medication, so what can they do to make sure they manage their pain effectively?

Dr. Pelt: Well first it's important for patients to know that these surgeries are painful. There invasive surgeries and pain is part of this. We're going to be working our very best to minimize pain. We may not be able to eliminate it, but we're going to try to make it as minimal as possible and hopefully allow it to be tolerable. It's going to improve each day after the surgery gets better.

And that's one of the most important things. The first day or two might be the toughest. And the first two weeks after a knee or hip replacement might be harder than the later four weeks for example. But, as you'll see as time progresses your body will be healing and your pain will be lessened.

After the first two maybe four weeks we're hoping most patients will are able to get off their narcotic pain medications, and moving toward Tylenol and anti-inflammatories. And eventually after the first 6, maybe 12 weeks, they might be able to get off of everything all together and really controlling it with other methods like, ice.

Ice & Elevation

Elevation is incredibly important, especially in knee replacement. Getting the toes up so that blood is running out of the leg and really getting a lot of the swelling down is very important. It's one of the ways to help minimize pain without having to take any medications.

So, we're going to show you the things that we feel are important to help you decrease your pain. We're going to provide you with medications. And we're going to be there as a support for you as we help you taper off of those over the course of the next couple of weeks after your surgery. We're available to answer phone calls and really going to be there throughout the process with you, through this whole experience.

When Can I Go Back to Work?

Interviewer: Some people probably don't mind the extra few days off work, but some people just really want to get back to their life. How long after the surgery can you kind of get back to work, walk, drive, those sorts of normal things?

Dr. Pelt: That's a great question. So, the average what we tell patients is that you'll be walking the day of the surgery, you're going to be around at two weeks, the skin is healing but still kind of swollen phase. At six weeks most patients are doing things they need to do in life. So that means most people are getting back to work. It might depend what on what kind of work you do to figure out if you're going to be able to go back then or maybe before.

Some patients with desk jobs that aren't going to have to be on their feet or lifting things all day long, might be able to get back to work in the two to four week range. People that are on their feet or carrying things more might be in the four to eight week range for when they can return to work. Really heavy laborers, people that are up on high ladders or climbing up and down things all the time, it might be a 6 to even 12 week range for those patients.

It's going to be different for different patients and it's also going to be different depending on what your job description and duties are. But those are the average time points. I tell most people they're able to do the things they need to do, including most job duties by about six weeks.

When Can I Resume Driving?

Driving fits into that time frame fairly similarly. Some of the research that's been done suggests that in the four to six weeks range it's probably safe to drive. It depends on a couple of factors. You cannot be on narcotic pain medications, because that's driving under the influence so we want to avoid that. So getting off the pain mediation is important to be able to drive. And it almost might depend on which side of the body, if you have a right sided knee replacement compared to a left sided. Most of us drive automatic transmission vehicles today, and it might take you a few extra weeks on the right side. You have to be safe driving.

And so, to think about that, imagine a little kid running out and front of you to grab their little tennis ball or something, and you need to be able to slam on the breaks and control your car with absolute certainty. We often recommend patients go a parking lot of the local church or grocery store where there's no other vehicles or people around, before they start going out on the road just to make sure they feel comfortable.

Interviewer: Yeah. You really got a learn how to drive, just like you have to learn how to do everything else.

Dr. Pelt: You do, you do.

How Will Joint Replacement Change My Life?

Interviewer: How is this hip or knee replacement going to change my life?

Dr. Pelt: Going back to what are the goals of hip and knee replacement. We're trying to decrease pain and improve function. Hip replacement has outcomes that are 90-95% good to excellent results, meaning patients have significantly decreased pain and they're very satisfied with their outcomes.

Knee replacement, as we mentioned, is a slightly different surgery. About 90% of patients will have good to excellent results, have decreased pain. That means there might be a 10% or so group of patients that might still have some residual pain. Some of that, again, is setting expectations. Making sure patients realize that our goal is to decrease pain and improve function, but perhaps cannot make it a perfectly pain free joint. We hope it will be, but some patients may have residual symptoms. So it's important for them to realize that.

Ultimately we want to get them back to the things they enjoy doing, and the things they need to do in life. We think that on average, of about three months after joint replacement, most patients are getting back to some of the activities they enjoy doing. Golfers, are starting to chip and putt at this point.

People that like to ski might be thinking about groomer skiing again, on the easy greens may be to start, but you'll be able to do more and more perhaps as time progresses. Getting to and from the grocery store. Doing more of the things you wanted to do happen in that three month range. You're going to be healing for about a full year afterwards.

Whether its a hip or knee replacement, our body does take time for those soft tissues to get used to the implant, and for the trauma and the swelling in the things, to improve from this surgery. Also, to rehabilitate the muscles that may have been weak or deficient coming into the surgery, because of the pain and arthritis and the lack of function they had coming in as well.

So we're working on all of those things for even up to a year, and some patients maybe even takes a little bit longer than that. But there's going to be a healing process that will continue to go on throughout the course of that time frame. But ultimately we're looking to get people back to doing the things they need to and want to do in life.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. Ï㽶ÊÓƵ of Utah Health Sciences Radio.