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Your Surgery Guide and Resources Hip and Knee Replacement Surgery This section covers the instructions you'll receive for the night before surgery, what happens while you're in the hospital, and what to expect on your return, etc. We also give you some tips to make the transition from hospital to home easier for you and your family and keep you on the road to recovery. Preparing for Surgery: Just Prior to Admission Since hip replacement surgery is usually scheduled in advance, there is a lot you can do ahead of time to make your recovery in the hospital and at home go smoothly. In your surgeon's office you will fill out the forms to schedule your surgery, hospital admittance, pre-testing and pre-surgery education program. Cedars-Sinai will call to confirm your surgery date, financial information and attendance at the Multidisciplinary Preoperative Training and Education Program. If preoperative tests have not been completed by your doctor, you will be scheduled for testing by our Surgery Assessment and Testing Program. Carefully follow your healthcare team's advice about:
To avoid surprises later, learn about your insurance coverage. Talk with your benefits manager at work or call your insurance company and find out what the insurance plan will and what you'll be responsible for. Even before you have surgery, you can start to think about going home! You'll be able to leave the hospital when your condition is stable and you're able to walk safely, including up and down stairs, if needed at home. The average length of stay in the hospital is five days. Once you're home, understand that it's normal to have good and bad days. But as long as you continue exercising, there will be more good days and your general condition is likely to improve. Preparing for Surgery: The Arrangements When you come in for surgery, or even when you are going for pre-admission, it's a good idea to have someone with you. They can listen and take notes for you. Make a list of all medicines you are taking and any food or drug allergies you may have. Bring this list with you and give it to the admitting nurse. You will be told about your rights for advance directives, which are written directions for your care should you become unable to make decisions. If you have a living will and or healthcare power-of-attorney or an existing advance directive, bring a copy of these with you. If you have questions about advanced directives, call the Social Service Department at (310) 423-4446. Report any health changes since your pre-surgery physical exam to your surgeon. Tell your surgeon if you get any cuts, scrapes or sores on the affected leg. Tell your surgeon if you have any signs of infection, such as chills, fever, coughing or runny nose within a week of your scheduled surgery. You must stop eating and drinking by midnight the night before surgery. This keeps the stomach empty, which will reduce the likelihood of nausea and vomiting. On the morning of the day of your surgery, you can shower or take a bath, brush your teeth and shave. Do not eat or drink anything. However, do follow your instructions about taking your daily medicine or any pre-surgery medications ordered by your doctors. Arrive at the hospital on the day of your surgery at the time your surgeon's office gave you. Be sure to bring:
Your Hospital Stay Day 1 (Before Surgery) At the hospital, someone will take you to a room where a nurse will help you get ready for surgery and answer last minute questions. An anesthesiologist will talk to you and explain the type of anesthesia that will be used during surgery. An intravenous tube (IV) will be placed in your arm or on the back of the hand. This tube supplies your body with necessary medicines and fluids. You will be given medicine to make you drowsy and relax you just before you go into the operating room. When you go to surgery, your loved ones will be shown to a waiting area. Surgery usually lasts 1 to 3 hours. You will be in the recovery room for another 2-3 hours. Someone will update your family or significant others, as to your surgery and recovery progress. Day 1 (Recovery Room) You will gradually wake up during the immediate recovery period. You may feel groggy from the anesthesia. You will still have tubes and monitors attached. In addition, there will be:
The nurses will keep a close watch on your recovery and help make you comfortable. If you need pain medicine, don't wait too long to ask for it. It is easier to prevent pain than to stop pain or catch up with it. They will be asking you to "pedal" your feet up and down to make sure you have feeling in your legs and feet, especially the side that was operated on. It is important to tell your nurse if you feel numbness, tingling or pain in your feet and legs. When you are fully responsive and your blood pressure, pulse and respiration are stable, the recovery room nurses will transport you to the Orthopedic Unit for the next phase of your recovery. Your Recovery Everyone's recovery rate is different and how quickly you recover depends in part on your physical health and level of activity before surgery and how complex your hip surgery was. Your participation in the recovery program is very important. The hospital staff will monitor your medical condition and do the things you cannot do for yourself. As you become more active, you'll need to become more involved in your recovery. Post-operative care for joint replacement patients is similar to that for other surgical patients. Once you are fully awake and stabilized in the recovery room, you'll move to a private room in the Joint unit. Vital signs and neurological checks are recorded regularly during the first 24 hours following surgery. Once you are taken to your private room, you will continue to receive antibiotics and fluids through an IV tube. After a few days, the IV will be disconnected, with any remaining antibiotics administered orally. A Foley catheter, which may be inserted into the bladder during surgery to keep it empty, is usually removed one to two days after surgery. You may also have a suction device inserted (a HemoVac®), which has a container that measures the amount of drainage from the wound; it is usually removed two to three days after surgery. Generally, you can expect to have pain medication every three to four hours, as needed. Or the doctor may prescribe a patient-controlled analgesia (PCA) device, which allows you to administer the dosage you need when you need it. To prevent the formation of dangerous blood clots in the legs, special surgical stockings are placed on the legs and remain on through your hospitalization. In addition, you will perform special exercises (such as calf pumping) throughout the day to encourage circulation in the legs. In some cases, patients are given blood thinners. To prevent respiratory complications, you may have to breathe into "blow bottles" and cough several times a day, clearing the lungs of anesthesia and preventing the build-up of fluids. The wound dressing is changed on the third day, or as indicated by the physician. The metal clips are removed six to 12 days following surgery, depending on the rate of healing. Physical therapy begins either the day of or the morning after surgery. You will receive the postoperative instructions during the preoperative education and training class, and again each morning that you're hospitalized. Your physicians will discuss with you your continued physical and occupational therapy, home health care and rehabilitation program. Through a combination of rest, physical therapy and pain management, you should feel stronger and more comfortable each day. Physical therapy sessions, which may begin on the day of or the day after surgery, take place in groups at the Institute to encourage socialization with other patients and accelerate your return to productive life. Mutual support and shared achievements during recovery also help patients develop a positive outlook. Your surgeon will determine which type of rehabilitation is most appropriate - in-home or outpatient - based on the functional deficits identified during hospital evaluations. Patients typically progress from non-weight bearing to full weight-bearing exercises. Physical therapy includes gait training, therapeutic exercises that address balance, strength, flexibility and movement, plus joint and tissue mobilization. Patients are also given home exercises to do. Each day you'll receive a copy of your personal goals. You are encouraged to get out of hospital gowns and into comfortable sports clothes as soon as possible. Families or your caregivers also are asked to participate in therapy so they can keep you on track after discharge. Group therapy sessions or patient activities in the gym are great places for socializing with new friends, as well as progressing with your therapies. Planning Your Discharge You will be evaluated each day after surgery by your care team, which includes nurses, therapists, a social worker, a case manager, your doctors and yourself. The goal is to get you home quickly and safely. If you are medically stable, but not yet mobile enough to be discharged home safely, then a social worker will help make arrangements to have you admitted to a less "intense" level of care unit at Cedars-Sinai or at another facility or hospital in the community. If you need to be transferred to another facility for long term rehab, the social worker will help you in making that move as well, including determining insurance coverage. Your physical and occupational therapists will determine any special equipment and therapies you might need. They will work with you and the social worker or case manager to order the appropriate items and service. Note: If you live alone, or have a limited support system, you may need long term care or care in the home. If so, please inform the health care team during the pre-op program. Or you can call the social service department to start working on arrangements before you are admitted. Most insurance policies will not pay for 24-hour care, however, if you feel you need help with daily activities (bathing, shopping) the social worker can provide you with a list of agencies that offer such services. Preparing the Home: Helpful Hints Becoming aware of and removing hazards in your home can help make your recovery easier and safer. If necessary, get help rearranging furniture to make it easier to walk around safely. Tip: think about maneuvering with a walker or crutches. Remove throw rugs and objects on the floor. Keep items you use often within easy reach. Move items, so you are not reaching up high or bending down low. Move electrical cords out of the way. Make sure your house is well stocked with groceries and food.
Check out your usual sitting areas. Following your hip precautions will affect where and how you sit, and how you should get up from a sitting position. A good rule to remember when sitting is "always sit with your hips higher than your knees." Sit in your favorite chair: are your hips higher than your knees? If not, you can raise the level of your hips by placing a firm pillow in the seat. Once at Home: Helpful Hints Avoid uneven or wet floors in the bathroom and kitchen. Watch for pets that may jump on you or run in your path. Wear rubber soled shoes and low, closed heeled shoes to prevent slipping. Use your walker and crutches and hold onto handrails when using a cane. Keep rooms well lit at all times. Transportation Home The majority of patients go home as a passenger in a car. You will be taught how to get into and out of a car before you leave. There is wheelchair van service for a nominal fee that can be arranged for you. Ambulance service is used only in specific cases, as set up for you in advance by the social worker. The Role of Your Family and Friends Your loved ones are especially important while you recover and adjust. They can help you make your home safer so you can go about your activities without hurting yourself. They can also help you with grocery shopping and preparing food. Perhaps most important, they can cheer you on and celebrate your accomplishments.
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