Total Joint Replacement: What You Should Know (Part 2)
In Part 1 of our 3 part series, we talked about how to get yourself prepared for an upcoming total joint replacement surgery. In this post, we’re going to discuss what to expect during your hospital stay and immediately afterwards.
Your Hospital Stay
For the typical total joint replacement, it’s pretty common to check in to the hospital anywhere from the early morning to early afternoon, depending on the time that your surgery is scheduled to start.
In many hospitals, it is now typical to be seen by physical therapy later in the same day as surgery. It may seem counterintuitive, but research shows better outcomes for patients that are able to get up the same day, as opposed to waiting a day or two. This, of course, is done in whatever way is safe and appropriate for you as the patient. If you can only make it to sitting on the edge of the bed – great! If you can get up and walk 200 feet with a walker – great!
Anything and everything counts. Protocol is different at every hospital, so find out what to expect at the location that you’ve chosen. I’ve worked in a couple of hospitals, and patients after a total joint replacement are seen once on the day of surgery, and then twice per day while in the hospital until you are discharged. In addition, you will likely be seen by an occupational therapist, who will make sure that you can get yourself dressed, manage in the bathroom, do your grooming tasks safely, and may recommend some of the pieces of equipment listed above.
Physical Therapy Options after the Hospital
One big discussion that always comes up while in the hospital is “discharge planning” – in other words, where do you go and what do you need once you leave the hospital? When it comes to discharge planning, you have several options. Your therapists will work with you to determine what is your best and safest option, depending on how you are doing during your hospital stay. If your therapist thinks that you need some extra time before you head home, they will recommend transferring to another facility for additional physical and/or occupational therapy. It may be because you can’t yet walk safe, functional distances without help, like to get to the bathroom. It may be because you’re having difficulty getting out of bed, and you don’t have a situation where you have someone at home that can help you in that way. There are many factors and scenarios that are considered when making these recommendations, because we realized that it’s always nice to go home – but we also need to make sure that it’s safe for both you and for anyone who is helping you at home.
Acute Rehab: After your stay at the hospital, you transfer to another facility that exclusively specializes in “acute rehab”. There are not as many options for this kind of place, typically, and you need to “qualify” to get in. During acute rehab, the goal is to have a total of 3 hours of therapy per day, and can include physical, occupational, and/or speech therapy. You have a schedule for the day, including rest breaks, and you often have therapy every day of the week.
Sub-acute Rehab: Again, you go to another facility immediately after the hospital. You still have frequent therapy throughout the week, but it would not be at the same 3 hours a day as in acute rehab. If the idea of 3 hours of therapy a day seems too intense to you, sub-acute rehab may be a good option.
If your therapist sees that you’re doing well with walking and can manage sufficiently and safely, they will recommend that you go home. But your therapy doesn’t stop there! They will recommend one of the following options.
Home Health PT: Your therapists come to you at your home. The great thing about this option is that they get to see you in your “natural habitat” – your layout, the equipment you have, etc. They work with what you already have, and give you recommendations of what to do as your routine. They typically come about twice a week. In some cases, they may only come to your home for 1-2 weeks; in other cases, it may be over a month. It all depends on what they’re seeing and how you’re doing.
Out-Patient PT: Eventually, no matter what option you choose from all those listed above, you will almost always end up in out-patient PT. You will now travel to a clinic of your choosing, and will often go 2-3 times per week, unless your therapist recommends otherwise.
According to a study published in Australia in 2017, patients who underwent uncomplicated total knee replacements did just as well with home health physical therapy as those who went to 10 days of in-patient rehab, even looking at information 26 weeks out from surgery and considering that someone may be alone at home. Now, this study lets us know that the appropriate people can benefit equally from the two options, but it’s still up to your therapist and the rest of the medical team to help you determine what is the best option for you and your situation. Regardless of the choice you make for what to do once you leave the hospital, the goals of physical therapy are the same. In physical therapy terms, it’s increasing your range of motion and strength, and decreasing pain and swelling. More importantly for you as the patient, it is to get you back to moving the way that you want to, so that you can return to activities that you enjoy and so that you can return to interacting with your friends and family in the ways that important to you!
Read our last installment of the three part series to find out more about the rehabilitation process itself.
Have more questions about a total joint surgery? Contact us at Back in Step Physical Therapy!
Check out Part 1 and Part 3 of this blog topic too!
Article author, Alyssa Arms, PT, DPT, OCS holds a Doctor of Physical Therapy (DPT) degree from the University of Colorado Anschutz Medical Campus, and later obtained a Board Certification as an Orthopedic Clinical Specialist (OCS). She is also the President and Owner of Back in Step Physical Therapy in Centennial, Colorado, and is an instructor at her PT alma mater.
