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April 6, 2016 - TCO

After Surgery

Dr. O’Neill

Dr. O’Neill will try to meet with your family members immediately after surgery. If for any reason you family is not available he will try to call a family member if a contact phone number is left.

Dr. O’Neill will make rounds daily on his patients whenever possible. In addition, his physician assistant, Jessie, or one of his partners will make rounds daily to monitor your progress and make any changes required for your care. If they are unavailable one of Dr. O’Neill’s partners will see you in the hospital.

Recovery Room

After surgery you will spend at least an hour in the recovery room. While there, your blood pressure and heart rate will be monitored closely until you are stabilized. You will have a mask over your face for oxygen. Your family will not be able to see you in the recovery room.

You will find a large dressing has been applied to the surgical area to maintain cleanliness and absorb any fluid. If you had a standard hip replacement, you may also notice a V-shaped wedge pillow (abduction pillow) between your legs. This keeps your new hip in the best position while you are in bed. If you had the direct anterior or minimally invasive total hip, you will not need an abduction pillow.

Knee replacement patients will use a continuous passive motion (CPM) machine to continuously bend and straighten the knee. This machine, propped under your leg in bed, helps keep your knee from becoming stiff after surgery.

Back in Your Room

Once your condition is stabilized post-surgery, you will be transported to your own hospital room on the surgery and orthopedic floor of the hospital. You will continue to have your vital signs and surgical dressing monitored. Once you’ve settled in, several members of your care team may drop in to orient you to your hospital routine.

A hospitalist/medical doctor will meet with you to determine which of your home medications will be restarted. The doctor of physician assistant will monitor your condition and check in with you daily while you are in the hospital.

The first night of your stay, you will most likely be somewhat “groggy” from the medications you receive in surgery.

Activity

Starting on day one post-operatively, you will be getting out of bed and attending physical and occupational therapy sessions. These sessions are vital to your progress and are arranged for 2-3 sessions per day. You will spend a great deal of time exercising your new joint. The more quickly you start moving again, the sooner you will be able to regain independence. Mild exercises of ankle pumping and gluteal sets are usually recommended by your physical therapist as soon as you are awake from surgery and able to perform them.

The physical therapists will teach you the exercises needed for your optimal recuperation and instruct you on your weight bearing technique using a walker or crutches.

Physical therapy for knee replacement patients will address range of motion. Gentle movement, such as the CPM machine, will be used to help you bend and straighten the knee. Your leg may be elevated to help drain extra fluid.

Your physical therapist will also go over exercises to help improve knee mobility and to start exercising the thigh and hip muscles. When you are stabilized, your physical therapist will help you up for a short outing using your crutches or walker.

Hip replacement patients begin physical therapy soon after waking up from surgery, with your physical therapist helping you move from your hospital bed to a chair. By the second day, you’ll begin walking longer distances using your crutches or walker. You are safe to put comfortable weight down when standing or walking. Hip patients will also do exercises to tone and strengthen the thigh and hip muscles, as well as ankle and knee movements to pump swelling out of the leg.

The occupational therapist is trained to assist you in adapting your activities of daily living to your post-operative limitations. Activities such as bathing, dressing, using the bathroom, transfers from bed to chair, ambulation, and stair climbing will all be addressed during these sessions. Instructions for traveling by various modes of transportation will also be discussed.

Before you leave the hospital, you will learn how to:

  • Get in and out of bed by yourself
  • Walk down the hall with your walker or crutches
  • Get in and out of the shower by yourself
  • Get in and out of a chair
  • Manage steps at home
  • Get in and out of your car

A nurse or nursing assistant will help you turn and change position in bed. Try to avoid twisting your leg when turning in bed. When turning in bed it is most comfortable to have a pillow between your legs. Avoid resting with a pillow under your knee, this can cause a loss of full extension of the knee after knee replacement surgery. If you want to elevate your leg rest your leg with a pillow under your ankle or calf. Elevating your leg will help keep swelling in the knee and lower leg down.

Pain Management

You will be able to have medicine for pain so you can move around without much discomfort. Immediately after surgery you will control when you get your IV pain medication by pressing a button. The day after surgery you will be transitioned to oral pain medication. Dr. O’Neill typically uses a pain medication called Oxycodone.

Some patients experience back discomfort after surgery. This is caused by general soreness of the surgical area and the prolonged lack of movement before, during and after surgery. Periodic change of position helps relieve discomfort and prevents skin breakdown.

Breathing

Right after surgery, your nurse will remind you often to take deep breaths and coughs. It is very important to do this at least every 2 hours. Deep breathing can help prevent pneumonia or other problems that can slow down your recovery and lengthen your hospital stay. You will use a device called an incentive spirometer, which helps you breathe in and out correctly. Using it regularly can help keep your lungs clear.

Your Diet

Immediately after surgery, you can have a diet of clear liquids or soft foods as tolerated. Your diet will be advanced to a regular diet depending how you tolerate the liquids. If constipation becomes a problem later on, try:

  • Eating 5-7 servings of fresh fruit and vegetables daily
  • Eating a hot breakfast with a hot beverage daily
  • Increasing fiber in your diet with whole grain cereals and breads
  • Drinking at least 6-8 8oz. glasses of water daily
  • Increasing physical activity as much as you can tolerate