Joint Replacement Surgery - Fequently Asked Questions
Q: When do the sutures or staples come out? A: Typically 12-14 days after the surgery.
Q: When can I return to work? A: The answer to this question is very individualized. It depends on the type of work you do and the complexity of the surgery. Typically for uncomplicated hip replacement, as soon as you are comfortable you can return to sedentary types of work (desk jobs, etc.). If your work requires significant walking, carrying or lifting, it will often take 4-6 weeks for many people to return to work.
Q: When can I shower? A: It is usually best to wait until the staples or sutures are removed to begin showering. Sponge baths can be used for the first two weeks. If care is made to protect the wound and avoid getting it wet, then some can shower earlier.
Q: When can I drive? A: The laws of the state that you live in will govern when it is legal to drive after surgery on your limbs. Everybody is different and I would encourage you to wait until you are fully recovered and your response time has returned to normal. You may feel that you can drive earlier, but you may be placing yourself and others at risk.
Q: After Hip Replacement how long must I sleep on my back with the abduction pillow between my legs? A: Six weeks. I know it is tough, but it is a good idea to let the tissues heal completely to allow for maximum stability of your hip.
Q: What sort of activities may I participate in after my hip/ knee replacement? A: Once your hip has healed and your recovery is complete, you may return to a wide variety of recreational activities. I would recommend that you choose low impact sports and activities, as these place a risk on your artificial hip. Walking, swimming, bicycling, and golfing are all recommended activities. Higher impact activities such as running, tennis and skiing are discouraged. High impact activities may damage the prosthesis and lead to wear and loosening. Activities which cause a lot of twisting of the leg (skiing and tennis) increase the risk of a dislocation.
Q: When can I return to sexual activity? A:Typically, patients can return to sexual activity 6 weeks after surgery. It is important to respect the hip precautions during any activity to minimize risk of dislocation. It is rare for there to be any problem in this regard.
Q: How long do I need a raised toilet seat? A: Usually six weeks. Some people find it more comfortable to use it longer.
Q: When can I travel? A: Depending on the rate of your recovery, most people who live out of state can return home after the sutures or staples are removed (12-14 days after surgery). Occaisionaly people can travel sooner depending on the circumstances. If an airplane flight is required, I would recommend a first-class or business-class seat to allow for leg elevation. It is also a good idea to make sure that the Coumadin level is optimal prior to flying, to reduce the risks of thrombosis.
Q: Which is better home therapy or outpatient therapy? A: Whenever possible we prefer that patients go to a recommended outpatient center for their physical therapy. This usually results in a more rapid recovery then in-home physical therapy.
Q: How many sessions of physical therapy do I need? A: Everyone is different. Most people are on at least 6 weeks of outpatient physical therapy. Several HMOs will not cover all the therapy which you need. Patients need to contact their provider to find out what their benefits are.
Q: Will I need to go to an inpatient rehabilitation center? A: After their hospital stay, patients can either go home with assistance or can go to stay in an inpatient rehab unit. This decision is determined by the level of support at home, your progress, the complexity of the surgery and the benefits allowed by your insurance.
Q: Which inpatient rehabilitation center will I go to? A: This completely depends on what your insurance company will allow. My preference is for my patients to go to Mount Sinai Medical Centerís inpatient rehabilitation unit. Most insurances, including Medicare, will allow for inpatient rehab at Mount Sinai. It is very important for you to verify your allowed benefits with your individual insurance company to determine where they will let you go. In the case of HMO and PPO plans, my staff is usually unable to make this determination. It is up to the individual patient to discuss this with their own insurance.
Q: Who will follow me when I am in the rehab unit? A: For patients who go to Mount Sinai Medical Centerís inpatient rehabilitation unit, a rehabilitation medicine specialist will see you daily and monitor your rehab course. This is usually Dr. Lipkin, Dr. Toledo or Dr. Tolchin. I typically do not go to the rehab on a regular basis unless there is a problem. If I am needed I will go there immediately and resolve any Orthopaedic issues. Your medical doctor, if on staff at Mount Sinai, may also see you while in the rehab. For patients who go to an outside facility, most of these facilities have a medical staff. If a problem arises there, you can either be transported to the Emergency Room or my office via ambulance or patient transport.
Q: Will I be on a Walker?, Crutches?, a Cane? If so, for how long? A: Every patient and each operation is different. Typically most patients begin on a Walker and progress to Crutches or a Cane and then to nothing. The rate of this progression is highly individualized. In most cases, we let the patient progress as rapidly as they feel able.
Q: Why is it important to stop smoking before the surgery? A: One of the major risks of hip replacement is thromboembolism (blood clots). Smoking increases the risk of this complication significantly and therefore must be stopped prior to surgery. Smoking also increases the risks from the anesthesia and often complicates the post-operative care.
Q: Do I need to take antibiotics for dental work and medical procedures after my hip/knee replacement? A: This point is somewhat controversial. I recommend that my patients take antibiotics prior to any dental work or medical procedure after a joint replacement has been performed. My office staff will be happy to provide you with our recommended guidelines for this.
Q: If I have not been to a dentist for some time, is it a good idea to go prior to my hip replacement? A: Absolutely. One of the risk factors for post-operative infections is dental disease. I recommend that all my patients have their teeth checked and have any contemplated dental work performed before their hip replacement.
Q: What kind of floors and rooms are available for me at Mount Sinai Medical Center? A: Both private and semi-private (shared) rooms are available. Private rooms are available on both the orthopaedic floor (4-main) and 8-main, a special luxury floor with a separate foodservice and accommodations. Private rooms on 4-main and 8-main cost extra and my staff will be happy to direct you to the appropriate hospital official to make these arrangements.
Q: What type of Anesthesia should I get? A: Total hip/knee replacement can either be done with a general anesthetic, a spinal anesthetic or an epidural anesthetic. From my perspective, it usually doesnít matter. The anesthesiologist will meet with each patient during their pre-op visit and discuss the risks and benefits of each option. Sometimes, a patientís medical condition will eliminate some of the options. You can decide on the type of anesthesia during your meeting with the anesthesiologist.
Q: Will I need a blood transfusion? A: All patients will lose blood during the course of a hip replacement procedure. Most patients will then need a blood transfusion. Transfusions come in three types: Autologous, Directed-Donor, and Blood Bank (anonymous donor). Most hip replacement patients will donate some blood to be set aside prior to surgery. This is autologous blood. It will be given back after the surgery. Usually, this is all the blood that a patient will need. Sometimes, additional blood is necessary. This blood will have to come from another person, either known (directed-donor) or anonymous (blood bank). If blood can be donated by a relative in advance of surgery, then this can be used. Usually, however, additional blood is obtained from the blood bank. Blood transfusions are only performed if it is medically necessary. This means that the risks of not obtaining the blood can be life threatening. All blood bank units are tested as much as possible and the risks of transfusion are kept as low as medically possible.