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Following the surgery, the most important thing is to improve your mobility. I want you getting up, walking around multiple times a day, even setting a timer for every hour to get up out of your seat and to walk. Typically with the use of the walker. This allows for your joint to move and actually improves the pain relief. It also allows for decreased risk of blood clots as well as any pulmonary issues or complications.
Following the surgery, the most important thing is to improve your mobility. I want you getting up, walking around multiple times a day, even setting a timer for every hour to get up out of your seat and to walk. Typically with the use of the walker. This allows for your joint to move and actually improves the pain relief. It also allows for decreased risk of blood clots as well as any pulmonary issues or complications.
The procedure itself takes about an hour and a half to complete. We use a spinal anesthesia for anesthesia purposes, which is a needle in the back. It numbs you from the waist down. This allows us to not utilize as much anesthesia medicines during the surgery, which allows you to feel much more rejuvenated and fresh following the surgery rather than the nauseous feelings that anesthesia can sometimes create. Typically, you wake up with a bandage on your thigh and all the sutures underneath are absorbable. With the anterior approach to hip replacement surgery, many patients can be discharged from the hospital the same day. In fact, many of these patients are being performed at outpatient surgery centers, the patients that choose to stay overnight, typically released the following morning following a physical therapy session. Some patients do require a longer stay, particularly if they have been on a walker or a cane or even a wheelchair leading up to surgery as they will require a longer recovery process.
Getting back into the swimming pool, I do require at least four to six weeks following their surgery before submerging your incision underwater. Infection is a very high risk following joint replacement surgery, and we don't want any water to get underneath your wound. Allowing the wound to be sealed at around four to six weeks prior to submerging underwater will decrease your risk of infection.
Another common question is "when are avid golfers can return back to the game?" I typically tell patients to abstain for at least six weeks following their joint replacement surgery. The idea is that the fact of going through a full swing with a golf swing places a lot of torque through the implant, either the hip or the knee replacement. We want to allow at least six weeks for the hips for that implant to grow into the bone. Typically, we start with just light pitches and even putting and abstaining from a full swing up until two to three months following the surgery.
Many patients will ask when they can go back to driving. Typically with right-sided replacement surgery, it's typically around three weeks. My requirements are you have to be off of a walker or any of the narcotic medicines, and the last requirement is more subjective in that patients have to feel that they can suddenly slam on the brakes if a small child were to run in front of their car. Typically, all of these things occur within around three weeks following the joint replacement, but many patients it can be sooner.
Following the surgery for knee replacement, physical therapy is an important part of the recovery process. Our therapists work with the patient to improve their mobility as range of motion following knee replacement is very critical, especially in the early periods as it can become harder and harder to increase that range of motion due to the stiffness that can occur as the joint heals and the soft tissue itself starts to contract around the knee. During this time, it's important to keep the motion alive.
Following anterior approach hip replacement surgery, I typically do not prescribe formal physical therapy. Instead, we have an app on the phone or your mobile device that demonstrates videos of physical therapists doing exercises at home. This is utilized instead of formal therapy, especially in the early period as unlike the knee replacements, hip replacements, we really want to focus more on just getting up and walking either with the walker or on their own without assisted devices. Many patients then choose never to attend formal physical therapy and will instead continue their home exercise program.
Postoperatively patients are typically prescribed different types of pain medicines. Having a little bit of a background in pain management following surgery, there are multiple different modalities we can use to attack the pain following surgery. The term used for this is multimodal pain management strategies where we use different medications to attack the pain pathway in different modalities. Typically, this initiates even before the surgery itself in the form of preoperative analgesia with anti-inflammatory medicines as well as nerve blocks. The surgery itself utilizes an injection around the joint to deaden the nerves and improve the analgesic effect, as well as the anti-inflammatory properties of the injection itself. Following the surgery, it is very critical to stay ahead of the pain and not allow the pain to catch up to the patient. We utilize a number of different medicines which all act in different ways, including scheduled Tylenol, some type of anti-inflammatory, such as Celebrex or Meloxicam. We also do typically prescribe a low dose opioid or opioid alternative such as tramadol or hydrocodone.
Postoperatively patients have the ability to participate in a mobile app platform, which allows for patients to engage with either myself or my physician assistant following the surgery. There may be simple questions that often don't require a phone call to the clinic, but can be responded through a text message. Occasionally these questions are after hours or on the weekends, and therefore the patients find a benefit with direct communication with their surgeon. The app itself also engages with the patient with vignettes, daily stories of what to expect, and tips or tricks to improve swelling, pain, as well as provide the physical therapy videos. This patient interaction mobile platform is a significant step up in allowing our patients to recover more uneventfully and quicker.
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