Day of Surgery
After your surgery, you will stay in the Post-Anesthesia Care Unit (PACU) until you are well enough to go to the orthopedic floor. If your surgery is in the morning, you will likely be able to walk the same day as your surgery. Once you have settled into your room a physical therapist will come and see you. They will instruct you how to use a walker or crutches and give you some exercises to do while in bed.
Post-Op Day 1
The morning after surgery a member of your doctor's team will come by and look at your dressing. We will remove any drains that you may have, including your catheter. Early removal of the catheter reduces your risk of developing a urinary tract infection during your stay.
Your nurse will pre-medicate you with pain medication in anticipation of your morning physical therapy session. She will make sure your thigh high compression stockings (TEDs) are on during the day, to minimize swelling and the risk of DVT. You will also begin receiving your blood thinner today to prevent DVT and pulmonary embolism.
Between 8am and 11am you should expect a physical therapist to come by and build on the exercises you received immediately after surgery. A good goal for today would be to walk to the nursing station and spend as much time as possible out of bed and in a chair.
If you require narcotic pain medication beyond the normal post-operative course you will be referred to the Pain Clinic or to your Primary Care Provider for further pain management.
Remember: Certain narcotic pain medications cannot be called into the pharmacy. Please plan ahead if your prescription is running low to allow for postal delivery.
Now that you have an artificial joint you will need to take antibiotics prior to all dental visits and invasive procedures. The current recommendation from the American Academy of Orthopedic Surgeons is to continue this practice for at least two years, if not for life. It is preferable to defer elective dental work and invasive procedures (i.e. colonoscopy/endoscopy) for three months following surgery to minimize risk of infection. Discuss your provider’s preferences at your first post-operative visit and at all follow-up visits as guidelines may change.
Post-Op Day 2:
A member of your doctor's team will come by early in the morning and change your dressing. The nurse will come and pre-medicate you for physical therapy. Physical therapy will see you twice today and continue to monitor your progress. You may even learn to walk up and down a set of stairs with your crutches! If you pass physical therapy you can go home.
Post-Op Day 3:
For patients who need to stay another day physical therapy will help you decide if you should be able to go home or to a rehab. Patient’s often comment on how much better they feel today than yesterday and decide they are ready to leave. Many of our patients prefer to go directly home from the hospital. If this is the case the MGH Case Manager will arrange for a visiting nurse and physical therapist to come see you at home. If a short term rehab stay is more appropriate that will also be arranged for you.
At the time of discharge you will be given a discharge summary that includes: your current medications, a summary of your hospital stay and instructions for follow-up. You should call Dr. Freiberg’s office at your convenience to schedule your post-op visit. Most patients’ will return to the office in 6 weeks and see Dr. Freiberg’s Nurse Practitioner, Kristin Wood, MSN, ANP-BC.
At your post-op visit, your nurse will assess your incision and functional status, review your x-rays and address all questions. You will return to the office in 3-6 months time for repeat imaging and exam. At that time you can see either your doctor or nurse. All cases are discussed with your doctor following clinic and he is available if needed for complications.
Physical Therapy (PT):
For the first 4-6 weeks after surgery you will likely need to use support, usually a walker, crutches or a cane. When you progress off support depends greatly on your health, strength and stability. Along with our office, your physical therapist will help you make the transition.
Most insurance companies permit a limited number of home visits for physical therapy. If your home PT expires before your first visit, please call the office and we will fax a prescription to the facility of your choice. If you continue with home PT until your first post-op visit, we will give you a prescription for outpatient physical therapy at that time. Many patients continue on with outpatient physical therapy for an additional 4-6 weeks.
During the first 4-6 weeks after surgery patients often need to take narcotic pain medication. MOST people are able to stop taking narcotics by 4 weeks post-op. Acetaminophen (Tylenol) or nonsteroidal anti-inflamatories (NSAIDs: Motrin, Aleve, Advil, Ibuprofen) are very effective managing post-operative pain. NSAID’s are very good at alleviating swelling and pain and are often more effective than narcotic. You should only take NSAIDs if you can tolerate them and it is OK with your doctor.