April 6, 2016 - TCO

Discharge

• Will I go home or to a skilled nursing facility after surgery?

  Depending on whether you go home or to another facility to recuperate will play a role in when discharge occurs. In general, a patient may be transferred to the rehabilitation facility or home on the 2nd or 3rd post-operative day.

  Whether you are sent directly home or to a facility for rehabilitation will depend on your progression in physical therapy as well as your comfort level with going home. In general, if you live with someone who will be assisting you, discharge home is the usual procedure. Most patients can go directly home if it is deemed safe by their doctors and physical therapists. While not required, it is highly recommended to have someone to assist you the first 48-72 hours after discharge on a full-time basis and perhaps part-time the first week or two after this.

  When you leave the hospital, your family should bring an extra pillow(s) for you to sit on in the car. It will be most comfortable for you to sit in the front seat. Your physical therapist will show you how to best get in and out of the car.

  If you live alone or are in an environment at home where your safety is a question because you have not achieved your discharge goals, you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient from a few days to a few weeks, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. The hospital social worker will help arrange your stay at a skilled nursing facility.

• What can I expect the first few days after discharge?

  Expect a time of transition. You may feel overwhelmed the first day or two after discharge and may even feel you’ve made a mistake coming home so soon. This may occur even after discharge from a rehab facility. Be patient, and give yourself some time to adjust. Many patients report that after the first day or two of practical problem solving and establishing a routine, they experience a change in their progress and notice a definite upward trend in their recuperation.

• Do I need someone to stay full-time with me when I go home?

  It is our recommendation that someone be with you the first 24-72 hours after discharge. Many patients do live alone and we realize this is not always possible. But if you have a relative or a friend who offers to stay with you, take this offer for your own ease of mind. Many times patients have family members or friends who stay with them all day in the hospital. While this is certainly welcomed, it is often more helpful that this person be available after you leave the hospital. If you do live alone and either are discharged from rehab or from the orthopaedic floor with no help available at home, perhaps a friend or neighbor can call you daily to check on your progress.

• What should I watch for and when should I call the office?

  Call Dr. O’Neill’s office if you notice any of the following:

  • Fever over 102°
  • Drainage from incision
  • Increasing redness around incision (remember some redness around the incision is normal)
  • Incision hot to touch (some warmth of the knee is normal)
  • Chest pain
  • Chest congestion
  • Problems with breathing
  • Calf pain or increasing swelling in your legs

• When do I see the outpatient physical therapist?

  Hip replacement patients will not see a physical therapist once they leave the hospital. Knee replacement patients should make their first therapy appointment should be made for the week after surgery. Appointments will be scheduled 2-3 times a week at first and then get less frequent as your knee progresses.

  Physical Therapy will last anywhere from 6 to 12 weeks depending on the individual. Rehabilitation is very individualized and is tailored to how you feel and progress during your therapy session. Your therapist will document the progress of your knee flexibility, pain control, and swelling. It is your responsibility to do your exercises daily and make your therapy appointments. Your commitment to your exercise program is the key to a full recovery. The goal is to get 0-120 degrees of motion in your knee following surgery. You will not get your motion back overnight, this takes time, patience, and commitment to your therapy exercises. Leg and knee strengthening will begin at your first therapy appointment and continue throughout therapy.

  You will be using an assistive device such as crutches or a walker to help with your weight bearing as you heal. Your therapist will help you progress your walking as you get stronger. Gradually increase how far and how long you walk. You should start with 3-4 short walks every day. After your walk, lie down, elevate and ice your knee to reduce swelling.

• When can I go up and down stairs?

  Stair climbing will be practiced in the physical therapy program before you leave the hospital. Most patients can climb stairs before leaving the hospital. If you live in a 2-story home and have practiced stair climbing, stairs can be done one to two times a day after discharge, depending upon your comfort level and provided that your physician has approved this activity. Patients sometimes find it beneficial to set up a bedroom on the first floor prior to surgery so they don’t have to go up and down the stairs as often.

• Will I need pain medicine after I’m discharged from the hospital?

  Most patients do require a short-term course of pain medicine. Expect to be on some type of pain medication for several weeks after discharge. Most patients take these medications the longest to sleep at night and/or before therapy sessions. Renewals on these prescriptions can be obtained by calling Rebecca, Dr. O’Neill’s secretary. Please allow for 24 hours for all refills. Rebecca is not in the office on Friday afternoons so if you need a refill prior to the weekend, this would need to be submitted by Thursday. Remember to allow time to come to the office to pick up the prescription because most narcotic pain medications cannot be called into the pharmacy instead you need a handwritten prescription.

• What other medications will I be discharged with?

  1. Pain medication
  2. Aspirin – you will take a full aspirin (325mg) every day for 4 weeks.
  3. Lovenox – after hip replacement surgery you will continue the Lovenox injections in your stomach for 5 days. After these are done you will start the aspirin.
  4. Stool softener – surgery, being sedentary, and narcotic pain medication can make you constipated so you will have a stool softener to use as needed.

• How long will I need to use my walker or crutches?

  Walkers, crutches, and/or canes are usually used the first 2-3 weeks after joint replacement surgery. After that time, most patients do not need any support for walking if they did not use any support prior to surgery.

• When do I follow-up with Dr. O’Neill?

   

   

  You will be seen for your first post operative appointment 2 weeks after your surgery. Further follow-ups are typically made 6 weeks and 12 weeks from surgery, more frequent if necessary. Routine total joint follow-ups are 1 year and 5 years after surgery and then every 5 years after that. Dr. O’Neill is happy to see you at any time if you have questions or concerns.

• When can I go outside?

  Comfort and safety should be the primary guidelines for doing going outside and on short trips. It is suggested to start with short trips at first, perhaps to therapy or your local supermarket or church, for example. Gradually increase the number and length of outside activities as you feel more comfortable.

• When can I drive?

  Driving routinely is not permitted before 2 weeks from the time of your surgery. However, you may drive earlier if you feel you can do so safely. The type of surgery, side of surgery (left vs. right leg), and your overall general condition plays a part in this decision. You should no longer be taking narcotic pain medication during the day when you start driving again.

• When will I be able to return to work?

  This varies with each patient. In general, patients usually do not return to work until after their first check-up at 2 weeks from surgery. Patients who have a desk job are able to return to work on the average within 3-6 weeks. If you have a more physically demanding job it may be 10-12 weeks before you are back at work. This should be discussed with Dr. O’Neill so that the best decision for your individual situation is made. If you need paperwork filled out for your employer bring this to the office prior to your surgery, try to avoid bring any paperwork to the hospital. You can also mail or fax (952-456-7804) paperwork to the office to the attention of Rebecca.

• When will I be able to participate in sports activities?

  Depending upon what activity you want to participate in will determine when you can safely start these activities again. Swimming, walking distances (hiking), bicycle riding, golfing, and other low impact sports activities can likely be tried after a few weeks. Returning to more aggressive activities such as tennis, downhill skiing, or aerobics exercises will probably not be recommended for quite some time. Your return to any of these activities should be discussed with Dr. O’Neill.

• When will I be able to have sexual intercourse after my surgery?

  In most cases, sexual activities can be resumed when the patient feels comfortable enough to do so. If the patient has been cautioned to maintain certain position restrictions, these restrictions should be followed in this instance also. In general, most patients resume their normal sexual activities between 4-6 weeks following surgery.