GENERAL FAQ’S

For some people, yes. It’s especially true for patients with arthritic joints who have not had a joint replacement, but also the case even after you have a new prosthetic in place. Weather changes are predicted by changes in barometric pressure, which is the weight of the air pressing against the earth’s surface.  These changes can trigger pain and stiffness in the area of the prosthesis. The activity of bone adapting and growing around the metal leads to the sensitivity felt during weather and pressure changes. These sensations normally disappear within one to two years following surgery.

While everyone and every joint is different, there are some general guidelines for using walking aids:

  1. Discuss a plan with your surgeon or therapist, as they will help you evaluate what is needed at each stage of recovery
  2. Use whatever aid you need during your recovery that enables you to walk with no limp and
  3. Work up to taking good, strong strides so that your gait is a normal heel – roll to toe – then push off from the ball of your foot movement.

You will probably come home from the hospital on a walker that you should use for at least several weeks before making any changes. The walker provides a high level of stability while you relearn to walk with a normal gait again. It’s especially helpful when you get up at night so you don’t lose your balance and fall. Once you are steady and strong on your walker, try switching to a crutch, cane, or even walk unaided. If you forget your walking aid when you get up, that’s a good sign you can start walking short distances without an aid. Whatever aids you choose to use or not use, be sure you are walking without a limp.Trying to hurry this process and limping around is not good for your new joint and it can cause other parts of your body to hurt or even be damaged. Once you stop using aids around your house, use at least a cane outside your home until you are steady enough to withstand a bump from another person or regain your balance on uneven areas. Having a cane in public alerts people they should be careful around you. When you feel strong and safe enough to put the aids away, then it’s usually time to do so.

Icing for up to twenty minutes several times a day is what most of us have been advised to do following an injury. Some therapists may even recommend this after joint replacement surgery, but with this type of surgery, ice is a critical part of pain management and should be used in different ways than when recovering from an injury. Ice not only on the joint, but any surrounding areas of discomfort. Always place a towel between your skin and the ice source to prevent freezer burn and ice as much as you like. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it’s free. While some care providers may put a maximum time on icing, others suggest you ice as often as you see fit. Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or may keep pain at bay. You can find relief through icing for weeks to months post op.

 

KNEE FAQ’S

Unexpected spasms of the leg muscles can occur after hip or knee surgery and are normal. They may last a few seconds or as long as several minutes. The spasms are caused by a sudden, intense involuntary contractions of muscle or muscle groups. The muscle suddenly shortens and becomes tight. Good hydration will help you avoid these painful episodes. Gentle stretching exercises may help reduce the chance of getting muscle cramps and massaging the area can ease pain and help the muscle relax once the spasm occurs. After a cramp, the muscle may feel tender for up to 24 hours. Supplementing with Magnesium has proved beneficial for many. If all else fails, for recurrent or severe cramps that disturb sleep, you surgeon or GP can temporarily prescribe medication that will help relax your muscles.
Small sensory nerve fibers are cut with the incision. These nerve fibers run from the inside to the outside of the joint and cutting them causes some areas to feel numb after surgery. It is a temporary sensation that normally resolves over a period of six months to one year post op. While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process. This process is not to be confused with the initial post op numbness resulting from anesthesia or a regional block which can produce numbness lasting for up to 72 hours post op.
The first stage of healing is the inflammatory phase. During this time it is very common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time. Following joint replacement, you may benefit from the use of a Leg Lifter. The Leg Lifter is a mobility aid that can assist in getting in and out of cars, wheelchairs, beds, recliners and much more. The Leg Lifter is an inexpensive option that helps provide safe movement in the early days, to weeks, of recovery.
Many people who have joints replaced ask about noises that come from their new joint. They describe a clicking or popping sound or they may have a definite clunk in a knee or hip when walking. While these unexpected noises are irritating, they are usually not a problem. The soft tissues around your new implant must settle in with each other and adjust themselves to work smoothly together with the hard metal, ceramic, or plastic parts of your prosthesis. If the noises or sensations are accompanied by pain or swelling, or if a new noise develops all of a sudden, let your surgeon know. Over time the clicking and clunking should subside.

 

HIP FAQ’S

It is not uncommon to feel as though there is a difference in leg lengths after hip replacement. Most of the time this is a perceived difference that will settle out over a few months. Because of cartilage loss in the hip joint, your pelvis gradually tilts as an accommodation. During surgery, your leg is immediately restored to its normal position and length. Because your pelvis is tilted, it then feels like one leg is longer than the other. As you begin walking with your new hip, your pelvis will gradually reposition itself. Wait at least three months post op before making a final judgement on leg length. During this time, don't use any lifts in your shoes, as that will just keep your body from readjusting itself normally. In addition to pelvic tilt, the feeling of leg discrepancy can be attributed to tight muscles or arthritis in the spine. Most cases resolve with stretches, exercise, and time. In the rare situation of a true difference, a shoe lift may be prescribed after 6 months or more. But for most people, no treatment is necessary and your legs will eventually feel normal again.
Unexpected spasms of the leg muscles can occur after hip or knee surgery and are normal. They may last a few seconds or as long as several minutes. The spasms are caused by a sudden, intense involuntary contractions of muscle or muscle groups. The muscle suddenly shortens and becomes tight. Good hydration will help you avoid these painful episodes. Gentle stretching exercises may help reduce the chance of getting muscle cramps and massaging the area can ease pain and help the muscle relax once the spasm occurs. After a cramp, the muscle may feel tender for up to 24 hours. Supplementing with Magnesium has proved beneficial for many. If all else fails, for recurrent or severe cramps that disturb sleep, you surgeon or GP can temporarily prescribe medication that will help relax your muscles.
Small sensory nerve fibers are cut with the incision. These nerve fibers run from the inside to the outside of the joint and cutting them causes some areas to feel numb after surgery. It is a temporary sensation that normally resolves over a period of six months to one year post op. While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process. This process is not to be confused with the initial post op numbness resulting from anesthesia or a regional block which can produce numbness lasting for up to 72 hours post op.
Trendelenburg Gait is an abnormal gait resulting from weak or defective hip abductor muscles. This muscle group includes both the gluteus medius and gluteus minimus muscles. This walking pattern is characterized by the dropping of one side of the pelvis during the stance phase of walking. The result is a noticeable limp that can be painful. You may also feel the weakness in the affected leg. The nerve damage or muscle weakness may be caused by developmental disorders of the hip, osteoarthritis, muscular dystrophy, neurological conditions or stroke, but can also occur as a result of trauma to the hip from surgery. Trendelenburg Gait can be disruptive, but is often treatable with orthotics or PT exercises designed to strengthen hip abductor muscles. Trendelenburg Gait may not always be fully correctable, but with treatment your gait may become smoother and steady, reducing risk of complications. Possible complications of chronic untreated Trendelenburg Gait include pinched nerves, hip grinding, the need for assistive devices, or death to bone tissue. If you experience weakness in your leg following a hip replacement, it's important to seek help from a physical therapist as soon as possible to help prevent the condition from becoming permanent.
Many people who have joints replaced ask about noises that come from their new joint. They describe a clicking or popping sound or they may have a definite clunk in a knee or hip when walking. While these unexpected noises are irritating, they are usually not a problem. The soft tissues around your new implant must settle in with each other and adjust themselves to work smoothly together with the hard metal, ceramic, or plastic parts of your prosthesis. If the noises or sensations are accompanied by pain or swelling, or if a new noise develops all of a sudden, let your surgeon know. Over time the clicking and clunking should subside.

 

SHOULDER FAQ’S

Other than the obvious technical aspects of the surgery, recovery from either a standard or reverse shoulder replacement usually is a bit easier than either knees or hips. Unlike knees or hips, it is likely your shoulder will be immobilized for up to 6 weeks to allow things to completely heal before beginning any serious physical therapy. You will have some passive motion exercises to keep the joint loose and mobile, but likely will be restricted from using the joint in any meaningful way. It is critical to adhere to your surgeon’s guidelines, as it is possible to damage unhealed soft tissue and lack any movement at all can result in a “frozen” joint. Pain is usually managed early in the recovery with Tylenol and sleep disruptions can be much less than with other joints.
Many people who have joints replaced ask about noises that come from their new joint. They describe a clicking or popping sound or they may have a definite clunk in a knee or hip when walking. While these unexpected noises are irritating, they are usually not a problem. The soft tissues around your new implant must settle in with each other and adjust themselves to work smoothly together with the hard metal, ceramic, or plastic parts of your prosthesis. If the noises or sensations are accompanied by pain or swelling, or if a new noise develops all of a sudden, let your surgeon know. Over time the clicking and clunking should subside.
Both standard and reverse shoulder replacements can significantly relieve pain from the loss of cartilage in the joint. Most patients are able to resume normal activities after recovery, although there may be some weight lifting limitations given by your surgeon, especially for a reverse replacement. Some patients have returned to sports gradually with no problems. It is possible that you may have some limits to movements behind your back, but many times that can be improved with targeted therapy once you are completely healed from the surgery.

 

PRE-OP FAQ’S

Either a machine or ice packs will work to help with pain and swelling following surgery or even pre-op if you have a lot of pain. No matter what you use to ice, be sure to place a towel between the ice source and your skin to prevent skin damage. And be sure to ice both the front and back of the joint. With ice packs, you’ll have fluctuating cold temperatures as they go from frozen and icy cold to mushy and warmer in a fairly short period of time. You’ll need several of them to rotate to get the best result. Ice machines maintain a more constant temperature. Instead of ice, freeze water bottles to place in the water and replace them every 4-6 hours. This can let you use the machine overnight without having to get up. When you fill the machine, put frozen bottles in along with some loose ice, then fill with water. This will ensure the circulating water is cold from the start. Be sure to remove the labels from the bottles, as the material can disintegrate and clog your machine.

 

RECOVERY FAQ’S

While a recliner isn’t a necessary recovery item, many are unable to imagine their recovery without one. Not only are they loved for comfort and convenience, but for the assistance they offer at a time when getting out of a chair can feel like a challenge. While your mobility is limited, a lift recliner makes it easier to sit or stand without straining or pain. Recliners provide a wide range of positions for you to relax, keeping you comfortable while you’re healing. You may need to make the recliner sit a bit higher if it doesn’t have lift capability, but that can easily be done with a simple wood platform or blocks. Reclining with your feet above heart level (“toes above the nose”) allows gravity to naturally reduce swelling and inflammation, boosting circulation and aiding your recovery. Be sure to ice anywhere that hurts when you’re elevating.

Sometimes the skin around your incision becomes dry and itchy while healing. Although it’s okay to put lotion or cream on the surrounding skin if it is uncomfortable, you should not apply anything close to or on the incision without the approval of your surgeon. It normally takes four to six weeks for the wound to fully heal and close. You don’t want to risk infection by applying a product near an open area before that time. Some of the more common creams and lotions used on a healed incision are Bio-Oil, Vitamin E Oil, E45 Cream, Palmer’s Cocoa Butter Lotion with Vitamin E, and Coconut Oil. The one exception to this guidance is a product called ACTIVE Skin Repair Hydrogel. This gel contains hypochlorous (HOCL), a compound made naturally by your body to promote healing. It can be applied to your incision at any point during recovery – it’s a germ fighter as well as a healing and moisturizing agent. But you still should discuss its use with your surgeon before using it.

A low grade fever (less than 101.5F) during the first week after surgery is a normal response by the body to the stress of surgery. It is most often caused by an inflammatory response to the tissue injury sustained during surgery. After the first week if you have a fever that lingers for more than a few days, or if a fever over 101.5 F begins several days after surgery, it’s recommended that you contact your physician to rule out the possibility of anything serious.

These pains are commonly called “zingers” or “stingers.” They’re very normal and many people get them. It feels like an electric shock, and can sometimes cause your leg to jerk suddenly. The pain may disappear as suddenly as it hit or it can linger. The pain occurs when nerve endings that were cut during surgery begin to reconnect or find new pathways. Generally “zingers” are a temporary problem and they will soon subside. They aren’t at all fun, but when you get that “zing,” you know your joint is healing and getting back to normal. Let your doctor know if this type of nerve pain hangs around for an extended period of time, as there are medications that can ease the discomfort.

Many people who have joints replaced ask about noises that come from their new joint. They describe a clicking or popping sound or they may have a definite clunk in a knee or hip when walking. While these unexpected noises are irritating, they are usually not a problem. The soft tissues around your new implant must settle in with each other and adjust themselves to work smoothly together with the hard metal, ceramic, or plastic parts of your prosthesis. If the noises or sensations are accompanied by pain or swelling, or if a new noise develops all of a sudden, let your surgeon know. Over time the clicking and clunking should subside.

 

Training exercises are what athletes do. They raise the heart rate, cause one to breathe heavily, and are often painful. Heart rate, breathing, and pain can reach extreme levels. Healing exercises should be done by anyone in recovery from surgery. The barely raise the heart rate or breathing levels and most importantly do not cause pain beyond a mild discomfort.

Following joint surgery, healing exercises such as stretching should be an integral part of recovery from Day 1, but it’s important not to undertake training exercises until healing is well underway or complete. Training exercises work by causing minor damage to muscle tissue (hence the pain), which heal back stronger. It doesn’t work that way with ligaments and tendons. Pain is indeed an indication of damage which usually will set back your healing process.

Severe episodes of excessive sweating called “night sweats” can drench your pajamas and sheets. It is often a normal part of the recovery process. Surgery can be hard on your body in many ways and and because inflammation is common during healing, this may contribute to the sweating you are experiencing. Night sweats can be a side effect of the anesthetic or drugs you’re taking in recovery. The drugs raise your body temperature and your body will try to cool through sweating. This is normally short lived. Staying adequately hydrated may help your body cleanse more quickly and provide relief. Since medication can be a possible cause, let your physician know this is happening and perhaps an adjustment to your medication will help. Keep in mind that while rare, an additional cause of night sweats can be infection. This is a possible risk with any surgery. If you suspect you may have an infection or have a fever of 101F (38.3C) or higher with increased pain, consult with your physician right away.

Small sensory nerve fibers are cut with the incision. These nerve fibers run from the inside to the outside of the joint and cutting them causes some areas to feel numb after surgery. It is a temporary sensation that normally resolves over a period of six months to one year post op. While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process. This process is not to be confused with the initial post op numbness resulting from anesthesia or a regional block which can produce numbness lasting for up to 72 hours post op.

Itching normally occurs during the second phase of healing referred to as the Rebuilding or Granulation and Proliferation stage. While itching is an uncomfortable distraction, it is considered normal. During this phase new skin tissue is formed to replace the damaged tissue. Histamine, a chemical released by the body as a protective barrier for the newly enclosed wound site, is what causes the itching sensation beneath the skin around the wound. The itching can last for as long as the chemical is released for wound healing, which can amount to several weeks. Follow your surgeon’s protocol for wound care. If the itching becomes severe, you may obtain relief through the use of a frozen gel pack (cold compress) which helps by numbing the area, reducing the itching sensation. Do not use topical agents close to, or on the incision without the approval of your surgeon. Infection is a real risk when the wound is not fully healed, which normally occurs between 4-6 weeks post op.

Follow your surgeon’s direction in regard to treating the wound area with care, changing any dressings as recommended. A product called ACTIVE Hydrogel containing hypochlorous (HOCL), a compound made naturally by your body to promote healing, can be applied to your incision at any point during recovery – it’s a germ fighter as well as a healing and moisturizing agent. We advise you consult with your surgeon before using it.

Sleep is important. Lack of sleep can lead to higher levels of pro-inflammatory cytokines delaying healing time. Aim to boost your immune response with adequate restorative rest.

Diet can make a difference. Fuel your body with healthy foods to speed wound healing. Fruits, vegetables, healthy fats and protein assist in the reduction of inflammation while improving wound function, which promotes healing. Some examples: berries, leafy greens, cruciferous vegetables, salmon, nuts and seeds. Protein sources such as meat, poultry, eggs and dairy help with muscle repair, tissue mending and collagen formation. Limit refined sugars which cause inflammation and avoid alcohol and smoking.

Hydration is also important for healing in recovery. Drinking at least 64 ounces (8 cups) of water daily lessens the chance of complication from a blood clot, but it also helps your body get rid of toxins from the anesthesia. Drinking water post surgery can be beneficial in all aspects of recovery.