Your Pathway to Recovery
Planning for Discharge
It is anticipated that you will be discharged from the hospital 3 days after your surgery. In all cases, it is dependent on your physical and clinical status. Our goal is for you to go home, and the majority of people do. People are happier in their own home. But there are occasions when a patient is not safe enough or mobile enough to go directly home.
The total joint team will meet each morning to discuss your progress and assess your readiness for discharge. Usually it can be determined by the second post-op day whether you will be going home or to another facility. The Case Manager and/or Social Worker will speak with you and your family to finalize your discharge plan.
The equipment you need at home will be ordered. It is recommended that someone be there to receive it one day prior to discharge or on the day of discharge.
Physical and Occupational Therapy
You will be seen in the morning and afternoon by the physical therapist. You will receive a complete evaluation, and be instructed on your exercises and activity precautions, if any. Your therapist will discuss your rehab plan, set goals with you, and keep a log to track your progress through each session.
The occupational therapist will evaluate you and instruct you on activities of daily living, such as getting dressed and bathing.
To summarize, your discharge plans may include the following:
- Discharge home with physical therapy visits.
- Discharge home with immediate outpatient facility physical therapy.
- Sub-acute rehabilitation in a skilled nursing facility (Nursing Home)
IMPORTANT NOTE: Your clinical condition and insurance play a major role in your discharge options. It is very important that you know your discharge options prior to your surgery. Please contact your insurance company and clarify what posthospitalization services are available to you. You may also contact the Case Manager prior to your surgery to help you clarify your insurance questions.
Community Resources and Rehabilitation
The Social Work and Case Management Department staff is available to assist you and your family with any questions or concerns about discharge planning or community resources.
Discharge Instructions
Recovery at Home
During your first few weeks at home, you will adapt what you've learned at the hospital to your own setting. Follow these simple instructions to make your home environment safe:
- Be sure all walking areas are free of clutter—remove throw rugs
- Store items within easy reach.
- Prepare meals ahead of time and store in the freezer.
- Have your favorite home delivery numbers handy.
- Put away throw rugs, or use non-skid ones.
- Tack down loose carpeting.
- Keep walking areas clear of objects, including telephone wires, electrical and extension cords.
- Watch out for small pets that tend to get underfoot.
- Avoid open-toed slippers, which can catch on rugs, etc. Wear only slippers or shoes that have backs.
- Raised door thresholds should be clearly marked.
On stairs:
- Install stable carpeting to provide cushioning if a fall does occur.
- Take your time and concentrate.
- Install/use the handrail on one or both sides of the stairs.
- Look at your feet.
- Keep a clear field of vision when carrying things.
- Hallways and stairs should be free from clutter.
To decrease the risk of slipping:
- Wear sensible shoes with good traction.
- Avoid walking in only socks on linoleum, wood and tile surfaces.
- Clean up all spills immediately.
- Keep magazines and newspapers off the floor. They are slippery if stepped on.
In the bathroom:
- Avoid throw rugs. If necessary, use non-skid styles.
- On tub and shower floors, use a non-slip bath mat (such as Rubbermaid).
- Enter and exit a tub cautiously. A non-slip bath mat should be on the floor in
- front of the shower/tub as well.
- You may need to install secure grab bars in the tub/shower and by the toilet
Follow Up Appointments
You will be instructed when to follow up with your surgeon. Call the office when you get home and make your appointment so you do not forget.
Your surgeon will instruct you on your physical therapy plan. In some cases you will have home physical therapy for a period of time. This will be determined by your ability to get in and out of the car and your physical condition. As soon as you are able, you will be going to outpatient therapy. You will be given exercises to do at home by your physical therapist.
Medications
You will receive prescriptions for pain medication and other medication you may need. Have someone fill the prescriptions as soon as you are discharged. If your pain medication is not effective enough, or you experience unpleasant side effects, do not hesitate to call your orthopedic surgeon.
Ice Packs
Ice packs are very effective for pain and swelling. They can be applied to the surgical site for 20 minutes a few times a day, especially after therapy and walking or activity that may cause some swelling.
Managing Constipation
You may experience constipation because of decreased activity and use of pain medication. The following will help control this problem:
- Take a daily laxative and stool softener as needed.
- Increase your water intake (as long as your doctor approves).
- Eat a diet high in fiber—including fruits, vegetables and foods rich in whole grains.
- Prunes or prune juice may be effective.
- If you do experience ongoing constipation, consult with your doctor.
Anticoagulation Therapy
You will be prescribed a blood thinner to prevent blood clots after your joint replacement surgery. Your surgeon may order either Lovenox or Coumadin. It is extremely important to take the medication as prescribed by your surgeon.
Lovenox is a blood thinner given in the form of an injection once or twice a day, depending on whether you have a hip or knee replacement. You or your family will be instructed while in the hospital on how to give the injections and be given prescriptions for the medication and supplies. You will be taking the Lovenox for approximately 2-3 weeks after your surgery and will be given follow-up instructions and precautions.
Coumadin (Warfarin) is a blood thinner medication that you will take by mouth once a day after your surgery. Blood levels must be drawn as prescribed by your physician tomonitor the correct dose.
Your Nutrition
While your body is in the process of healing, it needs proper nutrition. It is important that you eat a well-balanced diet. Take a daily multivitamin with an iron supplement if ordered by your surgeon. (Please note: Iron supplements can be constipating as well.)
Wound Care
Check your surgical site daily for signs of wound infection. Call your surgeon's office if any of the following symptoms appear:
- Increased rednessIncreased swelling — some swelling after exercise or therapy is normal;
- Increase in pain;
- Any drainage;
- Oral temperature greater than 101˚F.
If you have been discharged with a dressing still on your incision, you may change it as needed. Sterile gauze and tape can be picked up at your local pharmacy. Ask your surgeon when it is okay to leave it uncovered and open to air.
If your sutures or staples are still in place, you may not shower unless otherwise advised by your surgeon. Keep your surgical incision dry at all times. Wear loosefitting clothing to avoid friction to the surgical area. You may tape a Telfa® gauze pad over the incision site when wearing clothes that may rub. Leave open to the air at night.
If your sutures or staples have been removed, you may shower. Be sure to dry the surgical site gently and completely. Do not peel off steri-strips from your incision.They will fall off by themselves within 3-6 days.
Long-Range Protection Against Infection
While incidence is rare, patients who have an artificial joint are at higher risk for infection. Antibiotics will provide protection against infection and should be used in the following situations:
- Medical or surgical procedures by your physician or dentist including routine dental checkups.
- Certain diagnostic procedures such as catheterization or endoscopy involvingintestines, lungs, bladder and kidney.
- Serious infections elsewhere in your body.
It is important that your physician and dentist know that you have an artificial joint so that they may prescribe and remind you to take antibiotics as appropriate. If you have any questions about types of procedures requiring antibiotics, call your orthopedic surgeon.
For more information or to make an appointment please call
1-877-233-WELL (9355).