Rapid Recovery: Timeline After Minimally Invasive Joint Replacement Surgery

Aug 22, 2019

Richard A. Sweet, M.D.

Kate S. Hamilton, PA-C

Introduction: The advances of minimally invasive surgical techniques along with those in pain management techniques have provided a recovery timeline after total joint replacement surgery that is dramatically improved over the past experience.

Pain Management: With new pain management techniques, patients are now much more comfortable in the immediate postoperative period. Past routine use of “nerve blocks” of the femoral and sciatic nerves at the hip by the anesthesia team pre op has been discontinued. Though effective for 12-18 hours at numbing the knee, these shots also “paralyzed” the leg muscles such that a patient could not walk or pursue therapy till the blocks wore off (at which time the knee was no longer numb). Current techniques utilize direct infiltration of a new long acting slow release 36-hour local anesthetic directly into the knee joint itself at the end of surgery. This technique has the advantages of lasting much longer (36 vs 18 hours), of not “paralyzing the muscles of the leg, and for allowing for the immediate start of PT. This, combined with a muscle preserving surgical approach, allows the patient to get ahead of the rehab curve early and get out of the hospital much sooner.

KNEE

Surgical Technique: With minimally invasive surgery there is less dissection and cutting of the muscles and ligaments of the knee. What the patient observes is that the skin incision is shorter, the quadriceps muscle function returns more quickly, range of motion is regained more rapidly, that the hospital stay is shorter, and that ambulatory aids (cane, walker, or crutches) can be discarded sooner. The operation itself usually takes less than 90 minutes to complete.

In Hospital Physical Therapy: Mobilization begins the day of surgery. Aided by the improved pain management techniques described above, the patient is up in a chair, walking and starting actual physical therapy the afternoon and evening of surgery.

Hospital Stay: With modern minimally invasive surgical techniques and improved pain management methods, the hospital stay is usually brief. For fit healthy patients, a one-night hospital stay is now common. Older patients, those let fit, or those planning a discharge to a rehabilitation facility will typically stay two or three nights.

Showering Postoperatively: It is safe to get the wound wet on the 5th day postop if all drainage has ceased. If any drainage persists, the wound should be kept clean and dry with a sterile gauze dressing applied and changed as necessary till it completely stops.

Physical Therapy after Hospital Discharge: Three options are available for post hospital therapy.

  1. Home Therapy – This is the most commonly employed option. The quality of home therapy is quite excellent. Duration varies, but is generally employed for 2 to 4 weeks.
  2. Outpatient Therapy – Outpatient therapy in a physical therapy department has the advantage of better equipment vs. what is available in home. More mobile patients may opt for outpatient care. Patients often transition from home to outpatient therapy as they become more mobile.
  3. Rehab Facility Transfer – A point of emphasis: in general, patients do better at home, recover more quickly, and become independent more rapidly at home vs. in a rehab center. The forced necessity of caring for oneself at home actually speeds up the recovery process. And one’s home is the safest envi- ronment to avoid illness, etc. However, the direct transfer from the hospital to a rehab facility for patients who have no help at home or have very moor mobili- zation ability is still occasionally necessary. Insurance coverage for rehab stay varies and needs to be inves- tigated in advance. Duration of rehab stay can be as short as a few days or as long as several weeks and depends on the speed of recovery and the amount of support each patient will have when returning home.

Time on Walker or Crutches: Full weight bearing is generally allowed immediately after surgery. Patients can wean off the walker or crutches as their muscle function, swelling and soreness allows. Many patients have moved to the use of a cane by 7 to14 days postop.

Time on a Cane: Once off the walker or crutches, the use of a cane in the opposite hand is helpful (to prevent an excessive limp) for another week or two. Most physical- ly fit patients are off all ambulatory aids including a cane by 3 weeks postop.

Time Until Return to Driving: It is generally safe to re- turn to driving 2 weeks after left knee surgery and 4 weeks after right knee surgery. Before returning to driving though, a patient should be off all narcotic pain medica- tions and have sufficient mobility and strength so as to be able to safely handle a car.

Returning to Work: Predicting a return to work date is difficult. Motivational issues play an important role. Great variability exists. In general, patients returning to a sedentary job tend to return to work 6 weeks postop and those with more physically demanding jobs tend to return at three to four months postop.

Returning to Recreational Athletics: Patients can return to light recreational sports such as golf by 4 to 6 weeks postop. More strenuous sports such as tennis may require 12 to 16 weeks before return is possible.

HIP

Surgical Technique: With minimally invasive surgery there is less dissection and cutting of the muscles and ligaments of the hip. The patient observes that the skin incision is shorter, muscle function returns more quickly, the hospital stay is shorter, and ambulatory aids (cane, walker, or crutches) can be discarded sooner. The operation itself takes less than 90 minutes to complete.

In Hospital Physical Therapy: Mobilization begins the day of surgery. Aided by the improved pain management techniques described above, the patient is up in a chair, walking and starting actual physical therapy the afternoon and evening of surgery.

Hospital Stay: With modern minimally invasive surgical techniques and improved pain management methods, the hospital stay is usually brief. For fit healthy patients, a one-night hospital stay is now common. Older patients, those let fit, or those planning a discharge to a rehabilitation facility will typically stay two or three nights.

Showering Postoperatively: It is safe to get the wound wet on the 5th day postop if all drainage has ceased. If any drainage persists, the wound should be kept clean and dry with a sterile gauze dressing applied and changed as necessary till it completely stops.

Physical Therapy after Hospital Discharge: Three options are available for post hospital therapy.

  1. Home Therapy – This is the most commonly employed option. The quality of home therapy is quite excellent. Duration varies, but is generally employed for 2 to 4 weeks.
  2. Outpatient Therapy – Outpatient therapy in a physical therapy department has the advantage of better equipment vs. what is available in home. More mobile patients may opt for outpatient care. Patients often transition from home to outpatient therapy as they become more mobile.
  3. Rehab Facility Transfer – A point of emphasis: in general, patients do better at home, recover more quickly, and become independent more rapidly at home vs. in a rehab center. The forced necessity of caring for oneself at home actually speeds up the recovery process. And one’s home is the safest environment to avoid illness, etc. However, the direct transfer from the hospital to a rehab facility for patients who have no help at home or have very moor mobilization ability is still occasionally necessary. Insurance coverage for rehab stay varies and needs to be investigated in advance. Duration of rehab stay can be as short as a few days or as long as several weeks and depends on the speed of recovery and the amount of support each patient will have when returning home.

Time on Walker or Crutches: Full weight bearing is generally allowed immediately after surgery. Patients can wean off the walker or crutches as their muscle function, swelling and soreness allows. Many patients have moved to the use of a cane by 7 to14 days postop.

Time on a Cane: Once off the walker or crutches, the use of a cane in the opposite hand is helpful (to prevent an excessive limp) for another week or two. Most physically fit patients are off all ambulatory aids including a cane by 3 weeks postop.

Time Until Return to Driving: Patients should not return to driving until cleared to do so postop. In part this is due to liability issues if an accident should occur. It is generally safe to return to driving 2 to 4 weeks after left hip surgery and 4 to 6 weeks after right hip surgery.

Returning to Work: Predicting a return to work date is difficult. Motivational issues play an important role. Great variability exists. In general, patients returning to a sedentary job tend to return to work 4 to 6 weeks postop and those with more physically demanding jobs tend to return at 3 months postop.

Returning to Recreational Athletics: Patients can begin to return to light recreational sports such as golf by 4 to 6 weeks postop. More strenuous sports such as tennis may require 12 to 16 weeks before a return is possible.

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