II. The Day of Surgery

What to Expect Throughout

Your hospital stay will progress something like this:

Pre-Op

  1. Arrive at the hospital at the appointed time.
  2. Complete the admission process.
  3. Have final pre-surgery assessment of vital signs and general health.
  4. Remove all personal belongings – dentures, hearing aids, hairpins, wigs, jewelry, glasses, contact lenses, nail polish, all underwear – and leave them with your family or friends during surgery. You will be dressed in a hospital gown and nothing else.
  5. There will be several checks to make sure the correct joint is being replaced: your surgeon will review your X-ray and mark the area to be operated on; nursing staff will check the consent form you signed to make sure it agrees with the procedure on the operating room list.
  6. Final meeting with anesthesiologist and operating room nurse.
  7. Start IV (intravenous) catheter for administration of fluids and antibiotics.
  8. Transportation to the operating room.

In Surgery

Many people will be with you in the operating room during your one to three-hour surgery, including:

  • Orthopaedic surgeon(s) – your doctor(s) who will perform surgery.
  • Anesthesiologist or nurse anesthetist – the doctor or nurse who gives you anesthesia.
  • Scrub nurse – the nurse who hands the doctors the tools they need during surgery.
  • Circulating nurse – a nurse who brings things to the surgical team.

Your surgeon and the anesthesiologist or nurse anesthetist will help you choose the best anesthesia for your situation. No matter what type of anesthesia you have, be assured you will not feel the surgery. Options include:

  • General Anesthesia – You are put to sleep. Minor complications such as nausea and vomiting are common, but can usually be controlled and settled within 1-2 days.
  • Epidural – You are numbed from the waist down with medicine injected into your back. (This is also used for women giving birth.)
  • Spinal – Much like the epidural, you are numbed from the waist down with medicine injected into your back.

You may have any of the following inserted:

  • An Intravenous Tube (IV) – This is placed in your arm and used to replace fluids lost during surgery, administer pain medicine, or deliver antibiotics and other medications.
  • A Catheter Tube – This may be placed in your bladder to help your healthcare delivery team keep up with your fluid intake and output. It is most often removed the day after surgery.
  • A Drain Tube – This may be inserted in your bandage site to help reduce blood and fluid buildup at the incision.

Elastic stockings will be put on your legs to help the blood flow. You may also have compression foot pumps wrapped around your feet and connected to a machine that blows them up with air to promote blood flow and decrease the possibility of blood clots.

Immediately After

After surgery you will spend at least an hour in the recovery room. While there, your blood pressure and heart rate will be monitored closely until you are stabilized. You will have a mask over your face for oxygen.

You will find a large dressing has been applied to the surgical area to maintain cleanliness and absorb any fluid. If you had a hip replacement, you may also notice a V-shaped wedge pillow (abduction pillow) between your legs. This keeps your new hip in the best position while you are in bed.

Knee replacement recipients may use a continuous passive motion (CPM) machine to continuously bend and straighten the knee quadriceps (thigh muscles). This machine, propped under your leg in bed, helps keep your knee from becoming stiff after surgery.

Back in Your Room

Once your condition is stabilized post-surgery, you will be transported to your own hospital room where you will continue to have your vital signs and surgical dressing monitored. Once you’ve settled in, several members of your care team may drop in to orient you to your hospital routine.

Pain Management

Some patients experience back discomfort after surgery. This is caused by general soreness of the surgical area and the prolonged lack of movement before, during and after surgery. Periodic change of position helps relieve discomfort and prevents skin breakdown.

You will be able to have medicine for pain so you can move around without much discomfort.Make sure to talk with your doctor before surgery about your pain management options. You may receive pain medicine through your IV, through the epidural or in shots or pills.

Breathing

Right after surgery, the health team will remind you often to take deep breaths and coughs. It is very important to do this at least every 2 hours. Deep breathing can help prevent pneumonia or other problems that can slow down your recovery and lengthen your hospital stay.

Your doctor may want you to use a device called an incentive spirometer, which helps you breathe in and out correctly. Using it regularly can help keep your lungs clear.

Your Diet

Immediately after surgery, you can have a diet of clear liquids or soft foods as tolerated. If constipation becomes a problem later on, try:

  • Eating 5-7 servings of fresh fruit and vegetables daily
  • Eating a hot breakfast with a hot beverage daily
  • Increasing fiber in your diet with whole grain cereals and breads
  • Drinking at least 6-8 8oz. glasses of water daily
  • Increasing physical activity as much as you can tolerate

 

Positioning

If you are a hip patient, the head of your hospital bed should not be elevated more than 70 degrees during the first few days after surgery. Sitting up too high might allow the artificial ball to dislocate from the hip socket.

If you are a knee patient, your physician may order a leg splint called an immobilizer to keep you from bending your knee. It should be worn when you are out of bed or at night when you are sleeping.

A staff member will help you turn and change your position in bed. Make sure you avoid twisting your leg when turning in bed.When turning in bed you should have a pillow between your legs. Avoid resting with a pillow under your knee.

Exercising

You will be evaluated by a physical therapist, who will go over exercises and precautions for avoiding dangerous movements. You may be surprised at how soon after surgery joint replacement patients are encouraged to get up and start moving—often as early as the day of surgery. The more quickly you start moving again, the sooner you will be able to regain independence. Mild exercises of ankle pumping and gluteal sets are usually recommended by your physical therapist as soon as you are awake from surgery and able to perform them.

As You Recover

In the days following surgery, your orthopaedic surgeon, nurses and physical therapists will closely monitor your condition and progress.

You’ll spend a great deal of time exercising your new joint and continuing deep breathing exercises to prevent lung congestion. Gradually, your pain medication will be reduced, the IV will be removed, your diet will progress to solids and you will become increasingly mobile.

Physical therapy for knee patients will address range of motion. Gentle movement, such as the CPM machine, will be used to help you bend and straighten the knee. Your leg may be elevated to help drain extra fluid.

Your physical therapist will also go over exercises to help improve knee mobility and to start exercising the thigh and hip muscles. Ankle movements help pump swelling out of the leg and prevent the possibility of a blood clot. When you are stabilized, your physical therapist will help you up for a short outing using your crutches or walker.

Hip patients begin physical therapy soon after waking up from surgery, with your physical therapist helping you move from your hospital bed to a chair. By the second day, you’ll begin walking longer distances using your crutches or walker.Most patients are safe to put comfortable weight down when standing or walking. However, if your surgeon used a non-cemented prosthesis, you may be instructed to limit the weight you bear on your foot when you are up and walking.

Hip patients will also do exercises to tone and strengthen the thigh and hip muscles, as well as ankle and knee movements to pump swelling out of the leg.

Whether you are sent directly home or to a facility for rehabilitation will depend on your physician’s assessment of your abilities. In general, if you live with someone who will be assisting you, discharge home is the usual procedure. The case manager will make your arrangements for further home or outpatient physical therapy. Most patients can go directly home if it is deemed safe by their surgeon and physical therapists.

If you live alone or are in an environment at home where your safety is a question because you have not achieved your discharge goals, you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient for a 3-5 day stay, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. If you live alone or are not progressing rapidly enough in therapy sessions and it is unlikely you will be able to do so in a rehab setting, a sub-acute facility may be recommended for a longer period of recuperation. Insurance coverage for these post hospital stays vary according to condition and plan and will need to be discussed by the patient, the case manager and the insurance company as warranted.

Before you are discharged home, you should be able to safely get in and out of bed, walk up to 100 feet with crutches or walker, go up and down stairs safely, access the bathroom and consistently remember to use hip precautions to prevent dislocation before going home. These tasks should be able to be completed independently or with minimal assistance.

Before you Leave the Hospital

Before you leave the hospital, you will learn how to:

  • Get in and out of bed by yourself
  • Walk down the hall with your walker or crutches
  • Get in and out of the shower by yourself
  • Get in and out of a chair
  • Manage steps at home
  • Get in and out of your car