Immediately following surgery, you will be taken to the recovery room where you will stay 1 to 2 hours. Your blood pressure, circulation, respiration, temperature, and wound drainage are carefully monitored. Patients may be transferred to an intensive care unit (ICU) for a day or two if close monitoring is needed. Most patients will be transferred directly to their own room. Private duty nurses are generally unnecessary. Once you are in a regular hospital room, family and friends may visit you. If you have a partner waiting on you during the operation, they will be informed when you arrive in your room. The room is modern and private with a private bathroom and configured to look more like a hotel than a hospital room; although all hospital functions are possible. TV and Internet access are available. Chairs and a fairly comfortable pull out bed for your partner are available.
When you arrive in your room the spinal anesthetic will still be in effect. You will not feel pain. Gradually over several hours the anesthetic will wear off; sensation and strength will return to your legs. You have been pre-loaded with pain medication to prevent severe pain. This medication will continue to be administered around the clock. However if you still start developing pain, you should alert your nurse, who can administer additional pain medication. You should stay ahead of the pain and request additional medication before it gets very painful. It is hard to catch up with the pain if you try to tough it out at first. We have you on oximeter and cardiac monitor for the first 24 hours. If you get too sedated from the pain medication, your nurse will not give you more. There are medications to reverse the effects of narcotic overdose if you get over sedated. Every person needs a different amount of medication. We start with a baseline regimen based on patient size, age and previous narcotic use. The protocol is then adjusted to your specific needs. Most patients require some additional oral medication over and above the routine scheduled protocol. Occasional a shot of morphine is required to get patients under control. It is very rare that pain is so bad that a PCA (Patient Controlled Analgesia) machine is required.
We use a multimodal pain management protocol to make you as comfortable as possible. The strategy is to use as many non-narcotic modalities as possible. But some narcotics are still required for 3-7 days after surgery. Narcotics cause most of the side effects. We give all patients routine anti-nausea medication, but if you are very prone to this problem several additional medications are on order and can be requested from your nurse as needed. The primary narcotic side effects are: nausea, itching, constipation, and mental changes including hallucinations. These are not symptoms of allergy. We maximize all non-narcotic methods of pain control. Other drugs are on order for you to request to minimize nausea, itching and constipation. But in the final analysis it is a balance between pain control and side effects. You have to determine how much narcotic you wish to take. When you go home you will get detailed written instructions in how to manage this protocol.
You will receive IV fluids until you are drinking enough. The IV catheter will be removed on postoperative day one immediately after your second dose of antibiotics if you are doing well. The catheter will also be removed from your bladder at this time. There are no surgical drains to remove or dressings to change. You will have a Sequential Compression Device (SCD) on your legs while you are bed for the first day to prevent blood clots. We will start administering a oral blood thinner 24 hours after surgery to prevent blood clots, after that you can stop using the SCD if you wish. In order to prevent respiratory complications you will be taught to perform simple exercises with an incentive spirometer and cough several times a day.
You will walk within 24 hours of surgery. As soon as your spinal is worn off the physical therapist will see you. Typically the first three patients operated on in a day will receive PT the first day. The later patients will rest overnight and begin PT first thing in the morning. I give the therapists detailed orders that allows them to teach you the correct protocol. Most patients are full weight bearing as tolerated with use of crutches for 1-2 weeks for support and a cane for 1-2 weeks thereafter. Patients with softer bone or complex deformities or revision surgery may have restricted weight bearing and require longer periods of crutch walking. Any type of crutches or a walker is equivalent in my view. It is a matter of patient preference. Walkers usually work better for older patients with weaker arms and heavy patients. The Physical therapist will teach you a few home exercises and a few precautions. All this will be written down in your discharge instructions. You will learn to climb stairs and get into a car. The hip resurfacings and large bearing total hips that I use are very stable and require minimal precautions dislocation is very rare with these implants. The hardest thing to do for the first week is just lifting your leg off the bed. Once you are in a sitting position you will easily be able to get up and walk. You will not really need assistance to do much on your own. After one week muscle strength already returns enough to move your leg well. As soon as you are walking well and are no longer dizzy you may shower. You should spend your day in a chair and walking around. Bed is for sleep only. Excessive Bedrest causes complications.
Patients who live within 4 hours drive of Columbia are usually discharged after 1-2 PT session on postoperative day one. Patients requiring longer travel are usually kept in the hospital for one additional day to be sure they are ready for travel. We are now offering this surgery as an outpatient procedure in our surgery center for selected healthy patients if their insurance plan allows it. Patients who live in the Columbia metro area can go directly home. We have a nurse check on you at your home in the evening and the following morning. If you don’t live in the Columbia area need to stay in a local hotel for 1-2 days if you elect to have outpatient surgery. Our protocols are now so good that outpatient surgery is feasible for many patients and is certainly cost effective. I never recommend a stay in a rehab facility unless a patient has serious co-morbidities and/or no one to help them at home. Insurance usually pays for rehab. A stay in a rehab facility increases your chance for a complication, particularly infection. It is my Philosophy that sick people congregate in hospitals and rehab facilities; healthy patients having elective joint replacement should minimize their stay in these. Some people who are medically able to go home from the hospital but have no help can hire a private duty nurses aide from an agency for $15-20 per hour. Insurance does not cover this. People who are flying from Columbia should plan one extra day in a hotel after discharge as an additional precaution (so travel plans don’t get cancelled if problems arise). Patients who are travelling by car can plan to begin their trip as soon as they are discharged from the hospital because they have more travel flexibility. You can’t drive yourself because you will be on narcotics.
At the time of discharge you will be given a detailed written instruction sheet that covers all aspects of your care. The nurse at the outpatient center or the hospital will review this set of instructions with you and your caregiver prior to discharge to make sure that you understand it. You will have an antibacterial sealed dressing in place that you can shower with. It will need to be removed after even days. All sutures are under the skin and dissolve.