What to expect after joint replacement surgery

Making the decision to have hip or knee replacement surgery is a big deal. While you may be looking forward to the idea of being pain-free and moving around more easily, it’s important to have a realistic outlook of the process.

Knowing what steps to take before the procedure—and what to expect after—can help ease any fears you may have about surgery and can help set you up for a successful recovery.

From operating room to recovery room

A typical hip or knee replacement surgery usually takes one to two hours. Once the procedure is complete, you’ll be moved to a recovery room where you’ll be monitored for a period of time. If you had full anesthesia, you’ll need to take time to fully awaken. If you had spinal, epidural, or regional anesthesia, which means you’re awake but numb below the waist, then you’ll need time to let feeling come back to your lower body.

“You can expect to be in the recovery room for a couple of hours, until the hospital staff determines you’re stable enough to move to a regular hospital floor,” says Ugo Ihekweazu, MD, an orthopedic surgeon with Texas Orthopedic Hospital in Houston.

What to expect immediately after surgery

After the anesthesia wears off and you’re settled into your regular hospital room, you’ll likely feel tired. You may also start to feel pain, in which case the nurses will give you pain medication and ice for any swelling you’re experiencing at the surgery site.

Despite the discomfort you may experience, a big emphasis is often placed on moving around as soon as you’re able to tolerate it. “In some cases, that means getting up and walking even a few hours after surgery,” says Dr. Ihekweazu.

You’ll likely meet with a physical therapist who can show you how to properly use a walker, crutches, or other assistive devices you may use to help you get around.

“Physical therapy is probably the most important thing that patients are doing at the hospital after the procedure,” says Ihekweazu.

If you were admitted to the hospital, your post-surgery hospital stay could range from one night to a few days, depending on the procedure. Recovery from hip and knee replacement surgery has improved considerably in recent years, Ihekweazu points out.

Shorter hospital stays are due in large part to improvements in surgical and anesthetic techniques, explains Ihekweazu. “Surgeons are using more minimally-invasive techniques so there’s less muscle damage, and patients are able to get up and walk pretty quickly after hip or knee surgery.”

For some people, same-day or outpatient surgery may be appropriate, which means going home the same day as the surgery. Outpatient surgery has been made possible in part because of improved physical and occupational therapies, and more informed and detailed screening of patients’ needs and risk factors.

Surgeons can use robots to assist with procedures, which tends to provide greater precision and lead to more predictable outcomes. And 3D printing has made custom implants possible, so doctors can create a joint replacement that is personalized for your body

How does discharge work

If you’re admitted to the hospital, the day after surgery, depending on how you’re feeling, your healthcare provider (HCP) may start talking about whether you’re ready to go home. But everybody is different. Some people may feel eager to get home, while others may not feel up to it right away.

Patients with more complex surgeries, those with other serious health conditions, or those who may not have someone to help out at home might need to stay at the hospital or at a skilled nursing facility for inpatient rehabilitation. There, skilled nurses and physical therapists will be able to help you care for your wound and improve your strength and abilities.

Before you’re cleared for discharge from the hospital or an inpatient rehab, your HCP may want to confirm your ability to successfully do certain tasks on your own, including:

• Getting in and out of bed
• Walking with the use of a walker or crutches, and climbing a few stairs
• Eating, drinking, and using the bathroom
• Moving your joint, especially bending and straightening the knee after a knee replacement
• Performing any recommended home exercises
• Managing pain with the prescribed treatment plan

Once you’re ready, and you’ve been approved for discharge, you’ll likely meet with a member of the hospital or inpatient rehab staff (often called a discharge planner) to go over any instructions you need to follow while recovering at home, including:

• How to properly clean and care for your surgical wound
• How to spot the warning signs of possible complications
• How to care for your new knee or hip

Creating an optimal post-surgery home environment

Setting yourself up for success once you get home from the surgery requires putting in some legwork before your procedure. A specialist at the hospital can also help you prepare for a successful transition back home.

One of the main components is making modifications around your home to ensure safety. An occupational therapist may even come to do a home evaluation. The Arthritis Foundation recommends taking the following steps:

• Eliminate clutter to make getting around easier and to reduce the risk of falls
• Elevate low furniture—like seats, beds, and even toilets—to make getting up easier
• Install a seat in the shower as well as grab bars
• Move frequently-used items—like pots, pans, and plates—to places where you can easily access them
• Strategize ways to eliminate unnecessary trips up and down stairs. For example, if your bedroom is upstairs, this would involve creating a space for sleeping on the ground floor.

While assistive devices are also helpful after surgery, you may need to wait until after your procedure to see exactly what you’ll need. That said, having certain items on hand right away can be useful, such as:

• Ice packs, to help soothe pain and inflammation at the surgical site
• Comfortable, loose clothing that’s easy to get on and off and move around in
• Reachers and grabbers to help you get items stored up high and down low
• A walker basket, to help you move things around more easily
• A chair on wheels, to make it easier to get around when you’re not up for walking
• Compression stockings or TED hose to help reduce the risk for blood clots

You may also want to take time before surgery to enlist friends and family.

“Any time you have a big operation, there’s going to be a phase of uncertainty where you’ve got to rely on other people,” says Ihekweazu. “If you're fortunate to have a big network of family and friends, I would activate them. I would ask them to come visit you in the hospital and at home and to go on those long walks with you after surgery that help with your rehab.”

Ihekweazu adds that building that support system can play a big role in supporting your emotional health, as well.

Moving for a successful outpatient recovery

If you’ve had a hip replacement, the best thing you can do once you’re home is get up and walk, do stretching exercises and make sure you’re moving every day, says Ihekweazu. “For most hip patients, there’s not really any expectation to do outpatient physical therapy,” he notes. However, people can opt for the guidance offered by a physical or occupational therapist a few times each week, in addition to exercising at home.

The scenario is somewhat different if you’ve had a knee replacement. “Most surgeons would want their total knee replacement patients to be in some sort of outpatient physical therapy program as soon as they leave the hospital,” says Ihekweazu. He explains that surgeons may be concerned that certain patients don’t sufficiently move their knees after surgery, creating the potential for stiffness that could persist for several months. Taking part in physical therapy can help you regain range of motion, strength, and balance.

Take your time—and use help when you need it

Remember that it’s not uncommon to need help getting around at first.

“Most patients after hip and knee surgeries go home with a walker and use it for about two to four weeks after the procedure,” says Ihekweazu. That can vary depending on how active you were prior to the surgery. “The more active you were beforehand, the quicker you’ll be able to get around without the walker.” When you no longer need a walker, you may still benefit from using a cane for another few weeks to a month.

Just don’t push it. “The most important thing is to be safe,” adds Ihekweazu. “Don’t try to rush yourself off of a cane or walker.”

Pay attention to your pain and take steps to reduce it, like resting between activities and using ice or anti-inflammatory medicines (if approved by your HCP). If the pain lingers at six or higher on a 1–10 scale, let your HCP know.

Regaining a sense of normalcy

As the weeks go by during your recovery, you may start to wonder when you’ll get back to your old life. Ihekweazu notes that it typically takes six to eight weeks post-surgery for most patients to feel pain-free, while it’s not uncommon to take up to three to six months overall to start feeling normal again. Every patient is different, of course, and recovery times vary depending on your circumstances. Some patients may need a year to feel completely recovered.

Check in with your HCP about any questions you may have, such as:

• When can I resume normal activities?
• When can I drive again?
• When can I return to work?
• When can I travel again?

“Have a conversation with your doctor,” says Ihekweazu, “and go from there.”