The average hospital stay after hip or knee surgery is about three to five days. Once you can perform certain tasks such as getting out of the bed unassisted, using the toilet, showering yourself and climbing stairs, you are ready to be discharged.
Whether you will be discharged straight home or first to a rehabilitation centre is a decision which will be made after a discussion between you, your family, the hospital discharge planner and A/Prof Munjed Al Muderis. The decision will depend on a variety of factors such as the surgery you have had, your current condition and your home set-up and situation.
If you go straight home you will need some assistance and help at home for several weeks. If this is not possible, you may need to spend some time at a rehabilitation centre first.
Tips To Make Your Homecoming Easier:
- Give a copy of your home key to a trusted family member
- Pay all your bills (such as telephone, gas, electricity etc.) prior to your hospital stay so that you don’t have to worry about them after discharge
- Keep some money at home so you won’t need to go to the bank
- Make an arrangement to get fresh groceries delivered to you at home after surgery
- At home place items you use frequently within easy reach so you do not have to reach up or bend down
- Rearrange furniture so you can get about easily on a walker or crutches. If your bedroom is upstairs you may want to change rooms so you sleep on the ground floor rather than having to climb the stairs
- Remove any items that may cause you to slip or fall such as rugs, floor mats and electrical cords
- Install mobility and disability assistance items in your bathroom such as a shower chair, a grab bar and raised toilet. These can all be either hired or bought from a mobility aid store
- If you live alone ask a member of your family or a close friend to stay with you for the first few weeks after surgery. If this is not possible ask them if they could check on you regularly
- Keep important phone numbers handy such us our phone number, your local general practitioner and the emergency service numbers
If your condition requires you to go to a rehabilitation hospital then the discharge planner and the nursing staff will arrange your transfer where you will be under the care of one of our trusted rehabilitation physicians. The choice of the hospital will be determined based on your preference and the availability of beds.
Wound Care, Sutures and the First Post Operative Visit
It is important to keep the skin clean and dry. You can have a daily shower as usual and wet the surgical site with warm water and soap. However, make sure you dry the area well with a clean towel using a padding technique; do not wipe the region. Wiping can increase the risk and spread of infection.
The dressing applied in the hospital is usually waterproof and it should last a few days. However, it may need to be changed if it gets dirty or becomes loose. A community nurse can help you with the change of dressing if you are not able to do it yourself. If the wound is required to not get wet, you will be advised to first bag the area before showering.
Swelling is normal for the first three to six months after surgery. Elevate your leg above the level of your hip when lying down and always put a stool under your heel when sitting on a chair.
Apply an ice pack for 15 to 20 minutes at a time, a few times a day for the fist few weeks after surgery to help reduce swelling.
In most cases we use a cosmetic technique and sutures which do not need to be removed. However in certain conditions where this technique is not advisable (such as contaminated trauma or surgery in certain parts of the body) then the sutures may need to be removed. This is usually done on your first postoperative visit to the clinic where a wound check and examination of the region will also be preformed. Depending on your condition an X-ray may also be taken.
The First Post Operative Visit:
We will arrange for your first postoperative visit to occur between one to two weeks after your surgery. If you are still in the rehabilitation hospital at this stage we will communicate with your rehabilitation physician regarding your well being and visit you there if needed.
Medications and Diet
It is important that all medications are taken as directed. In many cases you will be given a blood thinner to prevent life-threatening clots from forming in the veins of your calf and thigh. This will be given either in the form of tablets or subcutaneous injections, which the nursing staff will teach you how to self-administer.
By the time you leave the hospital you will have returned to eating your normal diet. Continue to drink plenty of fluids and avoid excessive intake of vitamin K while you are taking the blood-thinner medication. It is also advised that you consult with your doctor regarding taking any other vitamins. Try to limit your intake of coffee and alcohol. It is also a good idea to keep an eye on your weight since your body metabolism and activity level is different during the recovery stage.
Activity (Walking, Stairs, Sitting, Sleeping)
It is important to try and stay active and mobile when you get home but avoid overdoing your exercises. There will be good days where you feel well and bad days where there may be some pain; this is normal. You will gradually get better over time.
We recommend mobilisation with a small level of weight bearing by using walking aids such as crutches or a walker. The amount of weight bearing you will be allowed to do will vary depending on the type of your surgery.
Stairs should be limited if possible until healing has progressed. When ready, the following information may be useful:
To climb the stairs: Use the unaffected leg to step up first, bring the affected leg up to the same step and bring your crutches or walking stick up with you.
To go down stairs: Put your crutches or walking stick on the lower step, bring the affected leg down to that step and finally step down with the unaffected leg.
- Try to organise a comfortable chair with arms and a stool to put under your heels while sitting. The chair should be high enough, especially in the case of hip replacement surgery. It is important not sit on low chairs.
- If you have had hip or knee replacement surgery it is very important not to sit with your legs crossed at the knees.
- When trying to stand up from a chair always use the unaffected leg to push up and keep your affected leg out in front of you. Do not drive through this leg.
- While you may not always feel like it, it is important for your recovery to ensure you get up move around on a regular basis, at least once every hour or two. You do not need to do much, a walk around the house or even the room is sufficient.
- While seated try to keep moving your toes and ankles up and down, this will help pump fluids up your leg and reduce the chance of deep venous thrombosis.
Sleep on your back with your legs slightly apart or on your side with an abduction pillow (these can be purchased from a mobility aid shop) in the case of hip arthroplasty. With regards to all other surgeries you should avoid sleeping on the side of the wound for the first six weeks after surgery. It is common to get sudden sharp onsets of pain while you are sleeping but the pain shouldn’t last long, typically disappearing after a few minutes.
Return To Work and Driving
You can return to driving an automatic car about six weeks post surgery provided you are no longer taking narcotic pain medication. If you have a manual car, you may need to wait another few weeks until your leg is strong enough to push the clutch down.
Getting in and Out of Car:
If you have a normal sedan car you may need to put a pillow on the seat and use the front seat of the car. This is generally not required with a higher car such as a four-wheel drive. We do not recommend getting into a sports car for at least a few months especially if you just had hip replacement surgery, as the angle is too low.
The return to work timeframe will vary depending on the type of surgery you have had performed as well as the nature of your work. If you have had minor surgery or you work in an office, then you could most likely return to work two to three weeks after surgery. However, if you have had major surgery, or your work requires heavy physical activities, then you may need a few months before returning to work.
Sports and Sex
Depending on the type of surgery you have had, a return to sport and other physical activities may be appropriate six weeks after surgery. However, in the case of of joint replacement certain sports are not allowed post surgery or a longer recovery time by be needed. Before resuming sports you will need to have a discussion with your doctor.
However, in the case of swimming you can begin swimming as soon as the wound has healed. This should occur approximately six weeks after surgery.
You can resume your normal sexual relations four to six weeks after surgery. If you have had hip replacement arthroplasty certain precautions will need to be taken in as certain positions are not advisable. For further details you will need to speak to your doctor.