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- My name is Paul Toogood.
I'm an orthopedic surgeon here
at Zuckerberg San Francisco General Hospital.
I treat trauma patients, injured patients,
and I also perform elective hip and knee replacements.
On this video, we're going to talk
a little bit about the recovery process
that is typical after one of those procedures.
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So, after surgery, patients wake up in the recovery room,
what we call the post-anesthesia care unit.
And I'm happy to report that most of the time
most patients' pain is pretty well controlled.
Patients are groggy after surgery
and it takes them a couple hours
to wake up and feel more normal.
Some patients will have some nausea
that will require medication.
And yes, some patients will also have pain
that we can usually keep well-controlled
with pain medications.
After you're done being in the recover room for a few hours,
most patients will then go up to their normal hospital floor
where they'll be staying for the duration of their stay.
And everyday during your hospitalization,
you really only have two goals.
One is to keep your pain controlled.
And we do that with a combination
of intravenous and oral medications.
And the other one is to slowly get more mobile,
to slowly get up and out of bed.
The first day after surgery,
that may just mean swinging your legs
over the side of the bed.
And then by days two and three,
we're hoping that you're walking down the hall
with the assistance of a nurse or a physical therapist.
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As long as everything goes well,
most people are in the hospital
for two to three days after a hip or knee replacement.
So, most patients will have their surgery on a Tuesday,
and that means some patients will be leaving on Thursday
and some patients will be leaving on Friday.
There's no written rule about when patients leave.
It's really when they're ready to go.
So, whenever we think they're gonna be safe to discharge,
that is when patients go home.
And that's generally, as I said,
two to three days after surgery.
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So, it's important to understand
after hip and knee replacement
that most patients don't have zero pain.
However, it's also equally important
to understand that most patients
have their pain well-controlled.
And by well-controlled,
I mean that their pain is good enough
that they're able to get up and out of bed
and work with therapy on getting mobilized.
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Recovery after hip and knee replacements
is not a single point in time.
Rather, it's a process.
So, patients are acutely recovering
for the first two to six weeks after surgery,
meaning that it's very clear to them
that they've had recent surgery.
They have some discomfort.
They're not able to do all of their normal activities.
Usually by the six to 12 week mark,
patients are feeling substantially better.
Life may not be totally normal for them,
but they're certainly feeling better
than they were acutely after surgery.
And then between three months
and really up to a year after surgery,
patients continue to improve.
The trajectory of that improvement is not as acute.
They're improving smaller and smaller amounts everyday.
But people will continue to notice easily up for a year
that their motion, that their discomfort,
that their ability to walk is improving
for that long a period of time.
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After surgery, while patients are in the hospital,
everyone sees a physical and an occupational therapist.
And these are the individuals that help you
start the process of getting up and out of bed
and returning to your normal activities.
So, simple things like putting on your socks and shoes,
walking down the hall, going up and down stairs.
These are all things that you're gonna work on
with a therapist while in the hospital.
After the acute hospitalization,
most people will continue
to see a therapist in some fashion.
And it depends on where you discharge to
after the hospital stay.
For those patients that go to a rehab facility,
there will be physical and occupational therapists
at that facility that will work with you
on a daily basis to improve your mobility.
For patients that are doing well enough
to go directly home after surgery,
they will either have a therapist come to their home
and work on things at their home
or they may go to the physical therapist's office
to work on therapy as an outpatient.
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So, people are always curious about
what their function's gonna be like
after a hip or knee replacement,
and it's a complicated answer.
Certainly, the main reason we do these operations
is to get people's pain better
and therefore their function better.
And I do expect patients to notice that postoperatively.
So, some patients may notice,
before surgery they have difficulties walking long distances
and going up and down stairs.
And I expect symptoms like that to improve after surgery.
That's again, the reason we do these sort of operations.
However, we don't change the entire patient.
We just change their hip or knee pain.
And so while I expect people to walk
down the street more comfortably,
go up and down stairs more comfortably,
we don't routinely take people
from walking down the street
and turn them into marathon runners.
But their basic functions we do expect them
to perform with less pain and at a higher level.
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After hip and knee replacement,
we know that patients are at a risk
for developing blood clots in their legs.
And these can be dangerous.
They can go to the lungs and cause significant problems,
including death.
Because of that, all patients after surgery
go home on some form of blood clot prophylaxis
to prevent this problem.
For many patients, for the first two weeks
that involves giving themselves an injection
of a medication called Enoxaparin.
This is a medication that's very effective
for preventing blood clots
and that's why we like to use it.
However, it is an injection,
so patients need to be mentally prepared
for that postoperatively.
The nurses will teach patients how to do that
on the hospital floors before they discharge.
Fortunately, it's just a two week period
where patients have to give themself an injection.
And after that, we usually transition to an oral medication,
aspirin, for another month to continue to reduce that risk.
But without the need for a needle stick on a daily basis.
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After patients are discharged from the hospital,
they of course have an incision
over their knee or over their hip.
Fortunately, very little needs
to be done with that incision.
After a discharge from the hospital,
we usually just recommend that people
maintain a dressing on it.
They don't need to change it
on a daily basis or anything like that.
We usually just recommend that the same dressing
that was put on in the hospital
is maintained there until they follow up.
Redness and swelling is often normal
around the hip or knee replacement,
but what is not normal is drainage.
So, the only time we typically
worry about redness and swelling
is if it's associated with that drainage,
with the leakage of fluid onto the bandage.
So, if you just have redness and swelling,
that's usually normal.
Not something you necessarily need
to contact your hip or knee surgeon for.
But if you have the new onset of fluid leakage,
of drainage from the incision after you leave the hospital,
that is something that we wanna know about
'cause that could be a sign of an infection.
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