The hip and knee sections each discuss the specifics of the weeks after surgery, and there are some differences between each. In general, knee replacements are somewhat more challenging in rehabilitation than hips because there is a greater range of mechanical problems and primarily because the knee will become quite stiff if it is not aggressively moved.
However, there are some generalities for the first three weeks after surgery that are common for all joint replacements (both knees and hips) and bear mentioning.
Incision Care
Most surgeons will allow showering (but not submersion!) when the wound is dry. Some surgeons advise waiting until the staples or sutures are removed, although in our practice we generally let patients begin showering two days after leaving the hospital if the wound is dry. Check with your surgeon about when it is acceptable to begin showering (it is usually included in the discharge instructions).
Incisions usually have some redness along the scar for many months. Most knee or hip incisions gradually become a thin white line over the first year after surgery. Some patients are prone to keloid formation, which is harmless but can result in a less cosmetic scar.
Absorbable sutures can sometimes "spit," poking through the skin with a tiny bit of string visible and sometimes some associated fluid. This is not uncommon and is not typically any cause for concern.
Some physicians advocate rubbing vitamin E oil over incisions to decrease scarring. There are also a number of commercial ointments and salves that purport to decrease scarring. There is not significant evidence that these treatments really improve wound healing, although the massaging of the surgical site itself probably is helpful. I often recommend breaking open vitamin E capsules and rubbing the incisions to my patients because the massaging action helps to decrease fibrous scar adhesions.
New incisions are definitely prone to sunburn, however, and if you go to the beach or are out in the sun in the first 12 months after surgery, you should take care to protect the scar from the sun. It should be covered with clothing ideally, or at least very high SPF sunblock.
Swelling
Some degree of leg swelling is normal after hip and knee surgery, and it is not unusual for some patients to even notice a slight difference between the size of the legs for months after surgery. However, it should steadily be improving, and any swelling that suddenly becomes markedly worse should be reported right away as it can be a sign of a blood clot.
Bruising is also normal for a few weeks. This gradually resolves.
Noises
It is common for most joints (hips and knees) to make some noise after surgery, often in the form of clicking or popping. As long as there is no specific pain associated with the noise, it is usually harmless. There are numerous reasons for the noises, which are often from tight ligaments or scar tissue or from the contact of the artificial components themselves. Rarely, some materials (e.g., ceramic total hip replacements) can have some "squeaking" noises. Any noises that are associated with specific pain should be reported.
Fever
It is common for most surgery patients to have mildly elevated temperatures in the week or two after surgery. However, persistent fevers for more than a week or two, or particularly high fevers beyond 101º F, can be indicative of infection and should be called in. It is a good idea to keep a thermometer at home and simply check if you feel any chills or as if you may have a fever.
Drainage from the Wound
Most hip and knee incisions are dry by the time patients leave the hospital, although it is not unusual for some to have drainage for a week or possibly more. It is more common in larger, obese patients or patients who are undernourished (and have slower healing). It is probably also more common in smokers.
A particularly common source of drainage is the site of a drainage tube if one was used. This is usually the last spot to close up.
As long as the drainage is clear, yellow, or just bloody (sanguinous), there is usually not much need for concern although it should be reported to the visiting nurse or surgeon if it persists more than a few days. Drainage that changes character and becomes thick, green, white, or foul-smelling can be indicative of infection and should be reported right away.
Pain
Some soreness after surgery is expected. The analogy that I often tell my patients is that if I kicked them in the shin, I would expect it to be sore for a couple of weeks, and surgery is usually a little more than a kick in the shin.
However, soreness should gradually be getting better week by week. Any sudden changes, particularly severe ones, should be called in. These are often simply the result of muscles resuming normal activity, and most patients have been relatively inactive with the affected hip or knee because of the need for surgery in the first place.
Patients usually are prescribed various medications for pain. Most patients use narcotic medications for the first week or two, and sometimes beyond that as there is a great deal of variation from person to person in pain tolerance. It is preferable to discontinue narcotics as soon as possible, however, as these do have some undesirable effects such as constipation, nausea, occasional confusion, drowsiness, and a tendency to build up a tolerance to the opioid medication over a few weeks. In general, we prefer for our own patients to transition to Tylenol within a couple of weeks if possible.
Numbness or Tingling
Some numbness around the incisional area is normal and is usually the result of tiny cutaneous nerves that are necessarily transected with the skin incision. This usually resolves over a period of weeks to months and is not typically bothersome for most patients, although if it affects a large area, care will be needed with using ice or heating pads to make sure that the skin does not burn.
Numbness that is worsening, on the other hand, needs to be reported. Weakness in bringing the foot upwards at the ankle that is new or worsening should be reported.
General Considerations In The Home
Although most patients are ambulatory by the time they get home, many are surprised by the little things that they may need assistance with during the day. Suddenly preparing meals and taking out the trash are major events for a while. Fortunately, these things soon get easier within days to weeks.
Before surgery, it is a good idea to look through the house and try to anticipate ways to make post-operative life less challenging. Loose area rugs or extension cords that run across the floor should be taken up. A shower stool is helpful, and grab bars in the bathroom are even better. If possible, it is often helpful to stock up on frozen food so that preparing meals is easier.
It is usually helpful to have a cordless phone that you can clip onto your belt, particularly since getting to the phone is likely to take a little longer in the first few weeks. Some patients have found fanny packs or clothes with big pockets to be helpful so that they can keep small items handy.
Most patients after joint surgery can sleep in a normal bed. However, some patients find that it is helpful to order a hospital bed to have it on a downstairs level if they normally sleep upstairs. Many insurance plans will cover a hospital bed for a short period of time if necessary.
Managing Post-operative Visits and Medications
Most surgeons have patients return in 3 to 6 weeks after surgery for a quick wound check. Be sure that you have your appointment arranged after you get home. Like most practices, we recommend that patients call and schedule their post-operative visit as soon as they get home from the hospital.
The hospital sends a list of discharge medications and dosages home with the discharge instructions. The visiting nurse usually has this information also. Most patients do not go home on an antibiotic unless there is a specific reason to do so, but if you have been prescribed one, be sure to take it as directed. Any blood thinners are also very important to take (e.g., aspirin, warfarin, or heparin injections). Most other medications, such as for constipation, nausea, and pain medications, are taken as needed.
In general, most aspects of daily life and function in the hip or knee should steadily improve each week after surgery. Any change in this direction of progress, where something becomes more difficult or uncomfortable rather than steadily improving, is often a sign that you should check with you surgeon's office.
If you have any questions or problems, call your surgeon. Many patients have a visiting nurse that sees them regularly who can also answer questions. Most practices have a medical assistant or physician assistant available to return calls if the surgeon is unavailable or operating that day.
Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.
