PERI-OP: The day of your surgery
Prior to the day of your surgery, you will have a Bone Camp class at either the hospital or the Ambulatory Surgery Center. This class will go over the action steps that you will responsible for accomplishing and the activities you will participate in during the time before during and after your surgery. You will be familiarized with what to expect in the hospital from the orthopedic care team as well as what to expect at home from the home health team. The emphasis will be on those things that you and your coach can do to make your experience as positive as we can to again allow us as a team to achieve the best outcome.
You will meet the anesthesiologist after your bone camp class at the Ambulatory Surgery Center or at the Preadmission Testing appointment at the hospital.
For surgery at the hospital and ambulatory surgery center, you will present on the same day as your surgery. You will be asked to come to the facility several hours before your scheduled operation. During that time before your surgery, you will be checked in, have an IV started and you will meet the anesthesiologist. The anesthesiologist will review all the tests and clearances that have been done. They will then go over your risks of anesthesia. During this time the anesthesiologist will also perform any blocks that may be necessary for pain control. Once all the pre-op action items are completed you will be transported to the OR by the circulating nurse and anesthesia provider.
While you were in the pre-op area, the surgical team was busy preparing the room for your arrival to ensure that everything your surgeon would need for the surgery is available, in place and accounted for. Once in the OR, there are a number of action items that must be accomplished. Prior to the start of your surgery anesthesia administration, positioning, prepping, and draping as well as a time out process to ensure that the proper site is being operated on must all be accomplished, The OR team will keep your family informed of your progress during surgery.
Following surgery, you will spend some time in the recovery room. Once you are awake in the recovery room, the recovery room nurse and/or a physical therapist will evaluate you. You will receive an x-ray of your operative site and will then be walked for approximately 250 feet. This is for many reasons, the first is to alleviate your pain, your muscles may go into spasm from the surgery and walking breaks and stops the spasms from occurring. The second is to give you back the confidence that you can walk and the third is to help prevent blood clots from forming in the veins of your legs. You will notice support stockings on your legs, and you will also be started on medications, these two steps help to prevent the formation of blood clots.
Remember, even with these tools and medications, the number one way to prevent blood clots is MOBILIZATION and WALKING!!
There are many advantages to the Modified Hueter Direct Anterior Approach to the hip, the Kinematic Alignment Total Knee, and the Partial Knee techniques utilized by the surgeons at UNOVA Hip & Knee Center. One is the lack of ligament releases, tendon releases, and muscle splitting involved in the procedures this dramatically decreases our patients’ pain profiles allowing them to resume activities at an accelerated pace. Please keep in mind that your soft tissues will take at least six weeks to heal and as such you are advised to exercise restraint in the progression of your activities.
With the combination of Non-Opioid Anesthesia and the surgical techniques utilized by the surgeons at Unova Hip & Knee Center, you will be admitted to the hospital as an outpatient and be discharged home with Home Health for your recovery.
POST-OP: After your surgery
Your safety is our primary concern and as such we have developed a unique post-acute care triage program.
Arrangements will have been made for Home Nursing and Physical Therapy through our network of Home Health providers.
If you are discharged from the hospital your home nurse will arrive to assess and evaluate you the first day, she will then return on a schedule that is based on your particular needs. She will monitor your incision and evaluate your general health at these visits. Your staples will be removed by the home health nurse on post-op day #14 unless your surgeon has instructed her otherwise.
If you are discharged from the Ambulatory Surgery Center your Home Nurse will see you three times the first night to assess and evaluate you. She will also administer your post-operative antibiotics during the first 24hrs. She will then return on a schedule that is based on your particular needs. She will monitor your incision and evaluate your general health at these visits. Your staples will be removed by the home health nurse on post-op day #14 unless your surgeon has instructed her otherwise.
Your home therapist will meet with you on the day of your discharge. They will then return daily at the start and then decrease that to every other day as you meet certain milestones. You will be given a prescription for a cane and/or walker at your pre-op visit, you must make sure you have your walker and/or a cane at home prior to your surgery. THERE ARE NO EXCEPTIONS TO THIS. Since you cannot be discharged home without them, not having them will cause a delay in your discharge which Medicare will not pay for, thus making you responsible for the cost.
Your routine will consist of strengthening exercises and ambulation training to get you back to normal walking. Unless your surgeon has told you otherwise you can put your full weight on your operated leg. Most patients will be able to move from a walker to a cane in about 1-3 days. Once you are safe on a cane and have control of your operative leg you can resume driving a car, usually after your first post-op appointment at the Hip & Knee Center, usually around two weeks from the date of surgery.
All joint replacement patients will be started on Cymbalta 30mg before bed to start 1 week before surgery and continue for 30 days post-op.
As a Total Hip Replacement patient, you should purchase a bottle of Extra Strength Tylenol 500mg tablets and take 2 tabs every 6 hours. You can supplement this with Tramadol if necessary. All Total Hip patients are encouraged to walk if they develop any pain or discomfort. Since there was no muscle or tendon release during their surgery, spasms will be their only source of pain and these should easily resolve with walking.
As a Total or Partial Knee Replacement patient, your pain will be managed with a series of long-acting blocks around the knee as well as physical therapy, ice, elevation, and medications. Non-steroidal anti-inflammatory medications such as Ibuprophen, Celebrex, and Mobic will be the foundation. These will be supplemented with Celebrex, Tramadol, and rarely other pain meds as needed. With recent advances in pain management our current programs utilize little to no narcotic medication in the postoperative period.
Your Home Health team has direct contact with your surgeons’ team at all times and they have been trained in post-operative triage and management. Our patients have the unique benefit of being able to take advantage of the home health team, the office or our dedicated Urgent care to address their post-operative. needs. With this approach, we can address nearly all of our patients’ post-operative concerns without a visit to the ER.
You will be scheduled to see either the Physicians’ Assistant, Nurse practitioners, or your surgeon back in the office at two weeks post-op. You can expect 75 – 90% of your improvement after your hip replacement by three to six weeks. However, your hip will continue to improve for 12 – 18 months from the time of surgery.
Our goal is to get you back to your normal activities as quickly as possible but remember that your soft tissues do need some time to heal. Golf, Tennis, Pickleball, Softball, Bowling and most recreational activities are all safe to resume at your own pace, if there are activities not mentioned on the list please feel free to bring them up with your surgeon prior to your surgery.
There are some things that you can do to help your hip replacement to last as long as you do:
- You should exercise and eat well to control your weight.
- You should avoid high-impact activities that put undue stress across your operative extremity. Biking, Swimming, and Elliptical are good alternatives.
- Jogging or Running should be limited to 5k.
- For the remainder of your life, after your replacement, you should take antibiotics when you have any dental work that may cause bleeding in your mouth.
I hope this has answered a number of your questions and most of all relieved some of your anxiety over the processes around your surgery.