Rapid Recovery Total Joints

Introduction: with newer advancements in minimally invasive surgical techniques along with the development of multimodal pain control, the timeline after total joint replacement is dramatically improved.

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

In-hospital physical therapy: Early efforts at mobilizing the patient are made on the day of surgery. Either the patient will receive formal physical therapy, or at least get up with the nursing staff standing and ambulating. Therapy focuses on range of motion

Hospital stay: With modern minimally invasive surgical techniques and improved pain management, the hospital stay is usually very brief. For most fit and healthy patients, day of surgery discharge or one night in the hospital is the standard of care.

Showering Postoperatively: if a PICO wound VAC is used, it is safe to shower with this in place immediately after surgery, but do not get the battery pack wet. Otherwise, it is safe to shower on the fifth day post-op if all drainage has ceased. If wound drainage persists, the wound should be kept clean and dry with daily dressing change.

Physical therapy after hospital discharge:
3 options are available for post hospital therapy
1. Home therapy: a physical therapist comes to the home to perform therapy. Therapy equipment can be limited.

2. Skilled nursing rehabilitation facility transfer: This option is only best for extremely frail patients who cannot return home. Medical complications and hospital readmission rates are higher with discharge to SNF.

3. Outpatient therapy: as soon as patients can get to a physical therapy facility, they will recover more quickly. This is clearly the best option as soon as it is feasible.

Time on walker/crutches: Full weight-bearing is encouraged after surgery. Most patients can wean off the walker or crutches to a cane within 10-14 days post-op

Time on a cane: once off the walker/crutches, the use of a cane in the opposite hand is helpful for another week or 2. Most fit and healthy patients are off all ambulatory aids by 3 weeks.

Time until return to driving: in general most patients return to driving 4 weeks after left knee surgery and 4-6 weeks after right knee surgery. However, this is a decision that the patient must make as the surgeon, for legal reasons, cannot clear you for driving. Additionally, you must be off narcotic medication.

Returning to work: this can be incredibly variable depending on the type of work, the preoperative strength and vitality of the patient, and the motivation/desire to return to work. In general, almost all patients return to a sedentary job by 6 weeks and a more physically demanding job by 3-4 months.

Returning to recreational athletics: patients can return to light recreational sports such as golf by 4-6 weeks. More strenuous sports may require 12-16 weeks before returning is possible.

 

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TOTAL HIP
Surgical Technique: with minimally invasive surgery there is less dissection and cutting of the muscles and ligaments of the hip. This is true for both an anterior and posterior approach. The skin incision is shorter, muscle function returns more quickly, the hospital stay is shorter, pain is reduced, and ambulatory aids (cane, walker, or crutches) can be discharged sooner. The operation itself takes less than 90 minutes to complete.

In hospital physical therapy: early efforts at mobilizing the patient are made on the day of surgery. The patient will receive formal physical therapy or at least get up with nursing staff depending on what time of day the surgery was performed. Therapy focuses on weight-bearing and walking.

Hospital stay: With modern minimally invasive surgical techniques and improved pain management, the hospital stay is usually very brief. For most fit and healthy patients, day of surgery discharge or one night in the hospital is the standard of care.

Showering Postoperatively: if a PICO wound VAC is used, it is safe to shower with this in place immediately after surgery, but do not get the battery pack wet. Otherwise, it is safe to shower on the fifth day post-op if all drainage has ceased. If wound drainage persists, the wound should be kept clean and dry with daily dressing change.

Physical therapy after hospital discharge:
3 options are available for post hospital therapy
1. Home therapy: a physical therapist comes to the home to perform therapy. Therapy equipment can be limited.

2. Skilled nursing rehabilitation facility transfer: This option is only best for extremely frail patients who cannot return home. Medical complications and hospital readmission rates are higher with discharge to SNF.

3. Outpatient therapy: as soon as patients can get to a physical therapy facility, they will recover more quickly. This is clearly the best option as soon as it is feasible.

Time on walker/crutches: Full weight-bearing is encouraged after surgery. Most patients can wean off the walker or crutches to a cane within 10-14 days post-op.
Time on a cane: once off the walker/crutches, the use of a cane in the opposite hand is helpful for another week or 2. Most fit and healthy patients are off all ambulatory aids by 3 weeks.

Time until return to driving: in general most patients return to driving 4 weeks after left hip surgery and 4-6 weeks after right hip surgery. However, this is a decision that the patient must make as the surgeon, for legal reasons, cannot clear you for driving.

Returning to work: this can be incredibly variable depending on the type of work, the preoperative strength and vitality of the patient, and the motivation/desire to return to work. In general, almost all patients return to a sedentary job by 6 weeks and a more physically demanding job by 3-4 months.

Returning to recreational athletics: patients can return to light recreational sports such as golf by 4-6 weeks. More strenuous sports may require 12-16 weeks before returning is possible.