Total Joint Surgery Information

Hip or knee replacement surgery has the power to transform your life. We’ve provided this content and downloadable information to make preparing for—and recovering from—your hip or knee surgery as safe and trouble-free as possible.

It’s our goal to provide you with the best outcome and shortest recovery time so you can return to the activities you love. If you have questions or need to get in touch, please contact 503-418-8889.

Preparing for hip replacement surgery

Hip replacement involves the removal of the damaged and worn cartilage and bone and replacement of your joint with metal and plastic. Restoring proper leg lengths and removal of bone spurs (osteophytes) is also performed.

Preparing for your knee replacement surgery

Knee replacement involves the removal of the damaged and worn cartilage and bone, which is then replaced with metal and plastic. You may be a good candidate for a knee replacement if you’ve had severe arthritis, but have still been able to maintain your activity level.

About your surgery team

Your care will be provided by a multidisciplinary team. That means a group of health care professionals with expertise in many different medical specialties will be caring for you. This includes:

  • Surgeons
  • Anesthesiologists
  • Nurses
  • Physical and occupational therapists
  • Physician assistants
  • Resident physicians

Our entire team is located on our state-of-the-art orthopaedic specialty ward. This ward was specifically designed to maximize your comfort and recovery. It is equipped with a physical therapy gym as well as a car simulator to facilitate your transition from the hospital to home.

Pre-operation information

Preparing for your surgery

You can prepare for your surgery well in advance of the actual procedure. To make your recovery easier, some simple things you can do include:

  • Maintaining a healthy weight or losing excess weight
  • Eating healthy food
  • Managing any existing medical problems, such as hypertension and diabetes
  • Staying as active as possible

What will I need to have after my surgery?

You will need to get items for care after your surgery, including:

  • A front-wheel, adjustable walker
  • Cane
  • Raised toilet seat
  • Ice pack

The Basics

What is hip replacement?

Hip replacement involves the removal of the damaged and worn cartilage and bone and replacement of the joint with metal and plastic. Restoring proper leg lengths and removal of bone spurs (osteophytes) is also performed.

What can I do pre-op to get ready and make recovery easier?

  •  Stay active and strong
  • Minimize pain medicine
  • Weight optimization: Maintain a healthy weight or lose excess weight
  • Eat healthy food
  • Manage all medical problems:
    • Blood sugar
    • Blood pressure
    • Take medications regularly and as prescribed

What should I avoid?

Stress and anxiety

What do I need to prepare for my recovery?

  • Walker (front wheel adjustable walker)
  • Cane (adjustable or correct height for you)
  • Solid railing on stairs
  • Ice pack (frozen peas, ice, gel pack)
  • Consider bathroom shower chair, pull bar installation

Who will be taking care of me?

Before surgery the care team is comprised of your surgeon, physician’s assistants, nurse practitioners and resident physicians. Our schedulers will assist with arranging surgery and all necessary pre-operative visits.

After surgery the resident physicians and surgeon coordinate your care. We are fortunate to have a dedicated and experienced orthopaedic nurse practitioner on the inpatient ward to assist with your care and discharge planning. A nurse will be assigned     to you every shift, along with a nurse’s aide. A team of dedicated orthopaedic physical therapists will evaluate and work

with you daily. An occupational therapist may evaluate you as well. A nurse case manager will be available to assist with any discharge planning needs, such as arranging additional rehab as needed. Our team is a consistent and dedicated team on our orthopaedic specialty ward. This ward was specifically designed to optimize your comfort and recovery and is equipped with a physical therapy gym, complete with a car simulator to facilitate your transition home

Who are resident physicians? Why should I let them be involved in my care?

Resident physician who work with our team are college and medical school graduates who have succeeded at gaining entrance into our orthopaedic surgery training program. Orthopaedics is frequently one of the most competitive medical subspecialties to get into, and thus orthopaedic surgery residents were at the top of their medical school classes. They are physicians with several years of experience. They assist with your care to your benefit and theirs, and our team is in control of all protocols, decisions and the entire surgical procedure. If you have specific questions or concerns about this, please let us know.

How do I know if I need to go to a skilled nursing rehab facility after surgery?

If you live alone and have no one available to come and care for you, then a rehab stay is recommended. Details of this all depend on your recovery and insurance benefits. Caseworkers at the hospital will be available to arrange this after surgery. Having several facilities in mind and visiting them before surgery is very helpful for this process, though availability and insurance coverage will determine the final plan.

How much help will I need when I get home?

You will need to be home with a family member, friend or caregiver who is going to be available and helpful most of the days and nights. For the first few nights home, having someone around 24 hours a day is best.

Will I be able to climb stairs?

Yes, you will be taught how in the hospital.

When will I be able to drive?

Most patients resume driving about one month from surgery. Right hips are slower than left hips to heal. Before you drive you should be:

  • Walking well with cane
  • Weaned off pain medication
  • Have good control of the leg

Wound care

When can I remove my bandages?

Leave PICO dressing intact until battery begins to alarm or you reach post operative day seven, then remove. You can leave wound open to air or cover as you desire. You may shower immediately. Do not expose battery pack to direct water stream.

Should I put Neosporin or vitamin E on my wound?

Please do not put any ointments on your wound until given the all-clear in clinic. Ointments such as Neosporin can be irritating to healing skin if used regularly. Skin will naturally heal and touching it repeatedly exposes the wound to infection.

Pain

How painful is hip replacement?

There is significant pain involved in hip replacement. You may feel worse before you feel better. The best candidates for hip replacements are patients who have severe arthritis but who have coped well and maintained their activity levels in spite of discomfort.

Much of the early pre- and postoperative care is directed toward controlling postoperative pain. Regional anesthesia procedures such as spinal anesthesia are encouraged to minimize early pain. Oral narcotic (opioid) and non-narcotic pain medications are used. Intravenous (IV) pain medication is also available. In addition to pain medications, ice and elevation are used for comfort.

Medications

What if I hate taking pain medications?

Typically some amount of pain medication is necessary to get people moving around after hip replacement. Pain medications have several common adverse reactions, such as nausea, itching, confusion and even delirium. Also, constipation and sleep disruption can occur. Some side effects can be treated; others are more difficult to control. Several different oral and IV pain medications exist, and patients respond differently to pain medications. Please inform us if you have had a previous reaction to a pain medication. While adverse reactions to pain medications are problematic, they rarely represent true allergies.

How long will I need pain medications?

Every patient is unique. A typical patient who did not take pain medications before surgery is able to wean off of all narcotic medication in the first month after surgery.

Patients who were taking oral narcotic pain medications prior to surgery may take longer to wean off of pain medications. Patients who take narcotics for some other reason may not wean off at all. The goal is to get you back to at-or-below pain medication doses by six weeks post-operatively. At that point you will be transitioned back to the prescriber who was providing your chronic pain medication prior to surgery.

How do I wean off pain medications?

Weaning off of medications is a natural process. Pain medications are “as-needed” or “PRN” medications. They are to be taken when needed, not on a rigid schedule. If you are sleeping, you should not set an alarm to awaken you to take more pain medications. They should only be taken when you are awake and feeling discomfort. Sleeping is a sign of appropriate pain control. You will notice in the early days after surgery that if you rest, ice and elevate your hip that you will take less pain medication. If you stand or walk for long periods, you will need more. As time passes, pain from surgery naturally goes away. As this happens, you decrease the dose and frequency with which you take medications. For example, if you are taking three pain pills about every four hours when you are discharged from the hospital, you will likely be able to decrease to pain pills every five or six hours within the first week after surgery. Keep track of how many pain pills you take every day, and slowly decrease the number of pills per day over time.

We may be able to switch you to a more mild pain medication than the one you left the hospital with. We will discuss this with you at your follow up appointments.

How do I get refills on pain medications?

Please plan ahead. We provide you a reasonable estimate of the quantity of pills you will need until your first follow up appointment. If you are running low and do not have an appointment, please call our office and request a refill when you still have at least two or three days of medications left. Narcotics are controlled substances and all but the mildest narcotics require a physical paper prescription to have them filled. We cannot phone in most pain medication prescriptions or refills. You will need to arrange to have the prescription picked up or it will be mailed to you. Every pain medication refill request will be answered with weaning encouragement and instruction.

Extremely large quantities of pain medications are not safe to prescribe, and each prescriber must use his or her judgment as to an appropriate quantity of pain medication that can be prescribed at one time.

Anticoagulation

Why am I on a blood thinner?

Thinning blood, or anticoagulation, after hip or knee surgeries is routine and recommended by several national guidelines. It is done to prevent blood clots from forming. Blood clots, or deep venous thromboses, form in the legs and can cause pain and swelling. If the clot mobilizes, it travels through the heart and into the lungs. This is called a pulmonary embolism, or PE, and can be life threatening.

Blood clots are common after hip and knee replacement surgeries if we do nothing to prevent them. Our team follow national guidelines and do several things to prevent blood clots:

  1. Early mobilization after surgery
  2. Sequential compression devices (SCDs) on legs in the hospital
  3. Anticoagulation

Xarelto, or rivaroxaban, is one of several choices of anticoagulating medicine. It has the advantage that it is a pill that does not require blood monitoring. Other anticoagulants are low molecular weight heparins (Lovenox, Fragmin), Coumadin (Warfarin), or aspirin.

In addition to the three preventive measures above, we ask if you have a personal or familial history of blood clots or clotting disorders. We may ask that you temporarily stop taking hormone replacement therapy. Blood clot prevention is one of many reasons we require patients to quit smoking before surgery, as nicotine increases the risk of blood clots.

Like many aspects of medicine and surgery, anticoagulation has benefits and risks. We carefully monitor for signs of hematoma or other bleeding while patients are on an anticoagulant.

Physical Therapy

When will I start physical therapy?

Some people start physical therapy before surgery. All patients start physical therapy the day of or morning after surgery while in the hospital.

Once you are home, you should do your exercises from the hospital and work on walking, but no formal outpatient therapy is initiated until six weeks post-op. This delay in therapy is so your hip capsule can heal and to allow bony ingrowth into your prostheses.

What are therapy goals?

Walking with a cane in two weeks and without any assistance at six weeks. It is important that you can walk with no limp. The criteria for changing from a walker or crutches to a cane, then nothing is that you do not limp.

Will my leg be longer?

Yes, very slightly. Your hip is strongest and most stable if the hip is restored to its original position. As your cartilage wears out, the hip loses height. We restore that height. Restoring your natural leg length during hip replacement helps prevent hip dislocations, a major complication. We use pre-operative digital (computerized) templates to create a road-map for your surgery and measure your leg length several ways in surgery to assure appropriate leg length. The differences we are talking about are less than a centimeter, approximately 1/4 inch.

After surgery, your spine and pelvis have to adjust to a new leg length. It is common for people to feel excessively long at first. We verify leg length with X-ray and can reassure you that it is not “inches too long.” We encourage you to walk and use your leg and over time, as most people adjust and by 12 weeks after surgery the leg length feels appropriate.

Why is my motion limited after surgery?

“Hip precautions” are recommended after all hip replacements. The specific details of your precautions depend on the surgical approach you have. Regardless of surgical approach, your hip capsule is incised to perform the hip replacement, and the restricted motion early after surgery promotes healing of the capsule and promotes hip stability.

The Basics

What is a knee replacement (arthroplasty)?

Knee replacement involves the removal of your damaged and worn cartilage and bone and replacement of your joint with metal and plastic. Joint realignment and ligament balancing are also performed.

What can I do pre-op to get ready and make recovery easier?

  • Stay active and strong
  • Minimize pain medicine
  • Eat healthy food
  • Maintain a healthy weight or lose excess weight
  • Manage any existing medical issues:
    • Blood sugar
    • Blood pressure
    • Take medications regularly and as prescribed

What should I avoid?

Stress and anxiety

What do I need to prepare for my recovery?

  • Walker (front wheel adjustable walker)
  • Cane (adjustable or correct height for you)
  • Solid railing on stairs
  • Ice pack (frozen peas, ice, gel pack)
  • Consider a bathroom shower chair, and/or pull bar installation

How much help will I need?

You will need to be home with a family member, friend or caregiver who is going to be available and helpful most of the days and nights. For the first few nights home, having someone around 24 hours a day is best.

When will I be able to drive?

Most patients resume driving about one month after surgery, providing you are:

  • Walking well with cane
  • Weaned off pain medication
  • In good control of your leg

Will I be able to climb stairs?

Yes, you will be taught how in the hospital. “Up with good, down with bad.” Lead with your good, non-operative leg going up the stairs, and lead with your sore operative leg going down. Work toward using both legs symmetrically.

How do I know if I need to go to a skilled nursing rehab facility after surgery?

If you live alone and have no one available to come and care for you, then a rehab stay may be recommended. Details of this all depend on your early recovery and insurance benefits. Case workers at the hospital will be available to arrange this after surgery. Having several facilities in mind and visiting them before surgery is very helpful for this process, though availability and insurance coverage will determine the final plan.

Who will be taking care of me?

Before surgery, the care team is comprised of your surgeon, physician’s assistants, nurses and resident physicians. Our schedulers will assist with arranging your surgery and all pre- and post-operative visits.

After surgery, the surgeon and resident physicians will coordinate your care. Also, we are fortunate to have a dedicated and experienced orthopaedic nurse practitioner on the inpatient ward to assist with your care and discharge planning. A nurse will be assigned to you every shift, along with a nurse’s aide. A team of dedicated orthopaedic physical therapists will evaluate and work with you daily, typically twice a day. An occupational therapist may evaluate you as well. A nurse case manager will be available to assist with any discharge planning needs, such as arranging additional rehab as needed. Our team is a consistent and dedicated team on our orthopaedic specialty ward. This ward was specifically designed to optimize your comfort and recovery and is equipped with a physical therapy gym, complete with a car simulator to facilitate your transition home

Who are resident physicians? Why should I let them be involved in my care?

Resident physicians who work with our team are college and medical school graduates and are part of our orthopaedic surgery training program. Orthopaedics is frequently one of the most competitive medical subspecialties to get into, and thus orthopaedic surgery residents were at the top of their medical school classes. They are all physicians with several years of experience. They assist with your care to your benefit and theirs, and our team in control of all protocols, decisions and the entire surgical procedure. If you have specific questions or concerns about this, please let us know.

Pain

How painful is knee replacement?

There is significant pain involved in knee replacement. You may feel worse before you feel better. The best candidates for knee replacements are patients who have severe arthritis but who have coped well and maintained their activity levels in spite of discomfort.

Much of the early pre- and post- operative care is directed toward controlling post-operative pain. Regional anesthesia procedures such as femoral and sciatic nerve blocks, nerve catheters, and spinal anesthesia are encouraged to minimize early pain. Oral narcotic (opioid) and non-narcotic pain medications are used. Intravenous (IV) pain medication is also available. In addition to pain medications, ice and elevation are used for comfort.

What if I hate taking pain medications?

Typically some degree of pain medication is necessary to get people mobilized after knee replacement. Without adequate pain control and mobility, you cannot participate fully in physical therapy exercises that are crucial for successful results. Pain medications have several common adverse reactions, such as nausea, itching, confusion and even delirium. Also, constipation and sleep disruption can occur. Some side effects can be treated; others are more difficult to control. Several different oral and IV pain medications exist, and patients respond differently to pain medications. Please inform us if you have had a previous reaction to a pain medication. While adverse reactions to pain medications are problematic, they rarely represent true allergies.

How long will I need pain medications?

Every patient is unique. A typical patient who did not take pain medications before surgery is able to wean off of all narcotic medication in the first month after surgery.

Patients who were taking oral narcotic pain medications prior to surgery may take longer to wean off of pain medications. Patients who take narcotics for some other reason may not wean off at all. The goal is to get you back to at-or-below pain medication doses by six weeks post-operatively. At that point you will be transitioned back to the prescriber who was providing your chronic pain medication prior to surgery.

How do I wean off pain medications?

Weaning off of medications is a natural process. Pain medications are “as needed” or “prn” medications. They are to be taken when needed, not on a rigid schedule. If you are sleeping, you should not set an alarm to awaken you to take more pain medications. They should only be taken when you are awake and feeling discomfort. Sleeping is a sign of appropriate pain control. You will notice in the early days after surgery that if you rest, ice and elevate your knee, you will take less pain medication. If you stand or walk for long periods, you will need more. As time passes, pain from surgery naturally abates. As this happens, you decrease the dose and frequency with which you take medications. For example, if you are taking three pain pills about every four hours when you are discharged from the hospital, you will likely be able to decrease to pain pills every five to six hours within the first week after surgery. Keep track of how many pain pills you take every day, and slowly decrease the number of pills per day over time.

We may be able to switch you to a more mild pain medication than the one you left the hospital with. We will discuss this with you at your follow-up appointments.

How do I get refills on pain medications?

Please plan ahead. We provide you a reasonable estimate of the quantity of pills you will need until your first follow-up appointment. If you are running low and do not have an appointment, please call our office and request a refill when you still have at least two or three days of medications left. Narcotics are controlled substances and all but the mildest narcotics require a physical paper prescription to have them filled. We cannot phone in most pain medication prescriptions or refills. You will need to arrange to have the prescription picked up or it will be mailed to you. Every pain medication refill request will be answered with weaning encouragement and instruction.

Extremely large quantities of pain medications are not safe to prescribe, and each prescriber must use his or her judgment as to an appropriate quantity of pain medication that can be prescribed at one time.

Physical therapy

When will I start physical therapy?

Some people start physical therapy before surgery. All patients start physical therapy the day of, or morning after surgery. A continuous passive motion machine, or CPM, is used to control swelling and initiate motion. Therapists will teach in-bed stretching and strengthening exercises. Therapists will also assist you with standing and walking. You will be taught to walk with a walker and how to maneuver stairs.

Why is therapy so important?

The success of knee replacement is dependent on correct surgical implantation (our job) and early achievement of motion and strengthening (your job). Both are absolutely necessary for a successful outcome. Pain control, swelling control and dedication to achieving early motion with daily exercises are the keys to success.

What are therapy goals?

By two weeks:

  • Full active knee extension, straightening, against gravity
  • Knee flexion, bending, to at least 90 degrees

By four weeks:

  • Minimal swelling
  • Heel-toe gait with cane only or no device
  • Wean pain medication to low dose, occasional use

What are the best exercises to achieve these goals?

  • Ice and elevation to control swelling and pain
  • Successful pain medication regimen that enables you to move and perform therapy, but does not make you goofy, sleepy or feel over-sedated
  • Keeping knee straight while in bed or in a chair by resting your heel on a rolled towel, armrest, footstool or coffee table
  • Actively straightening knee in this position by tightening quadriceps muscle and pushing the back of the knee to the floor
  • Sitting in a hard chair and bending knee, using non-operative leg to assist with bending
  • Meeting with your therapist for active and passive stretching, strengthening and gait training exercises

How do I elevate my knee?

Helpful post-operative elevation requires that the knee is above the level of the heart. This requires that you are lying down completely and elevating your leg on multiple pillows or cushions

Wound Care

When can I remove my bandages?

Leave PICO dressing intact until battery begins to alarm or you reach post operative day seven, then remove. You can leave wound open to air or cover as you desire. You may shower immediately. Do not expose battery pack to direct water stream.

Anticoagulation

Why am I on a blood thinner?

Thinning blood, or anticoagulation, after hip or knee surgeries is routine and recommended by several national guidelines. It is done to prevent blood clots from forming. Blood clots, or deep venous thromboses, form in the legs and can cause pain and swelling. If the clot mobilizes, it travels through the heart and into the lungs. This is called a pulmonary embolism, or PE, and can be life-threatening.

Blood clots are common after hip and knee replacement surgeries if we do nothing to prevent them. Our team follows national guidelines and does several things to prevent blood clots:

  • Early mobilization after surgery
  • Anticoagulation
  • Sequential compression devices (SCDs) on legs in the hospital

Xarelto, or rivaroxaban, is one of several choices of anticoagulating medicine. It has the advantage that it is a pill that does not require blood monitoring. Other anticoagulants are low molecular weight heparins (Lovenox, Fragmin), Coumadin (Warfarin) or aspirin.

In addition to the three preventive measures above, we ask if you have a personal or familial history of blood clots or clotting disorders. We may ask that you temporarily stop taking hormone replacement therapy. Blood clot prevention is one of many reasons our team requires patients to quit smoking before surgery, as nicotine increases the risk of blood clots.

Like many aspects of medicine and surgery, anticoagulation has benefits and risks. We carefully monitor for signs of hematoma or other bleeding while patients are on an anticoagulant.

Post-operation information

Will I have pain after surgery?

After your surgery, your pain will be controlled in a variety of ways, such as:

  • Regional nerve blocks – these block pain by placing medication near the nerves which affect a certain part of your body
  • Oral medications
  • IV pain medication

When you are home, take pain medications only when needed, not on a rigid schedule. If you are sleeping, you should not set an alarm to wake you up so you can take more. Pain medication should only be taken when you are awake and feeling discomfort.

When can I remove my bandages?

Leave PICO dressing intact until battery begins to alarm or you reach post operative day #7, then remove. You can leave wound open to air or cover as you desire. You may shower immediately. Do not expose battery pack to direct water stream.

Why am I on a blood thinner?

Thinning your blood after a hip or knee surgery is normal and recommended by several national health guidelines. It is done to prevent blood clots from forming in the legs. Blood clots can travel from the legs to the heart and lungs: This is a life-threatening condition called a pulmonary embolism.

Support

You will need to have a friend, family member or caregiver who will be available and able to help you after your surgery. It is best to have someone who can be there for 24 hours a day the first few days after your surgery.

Activities

After surgery, you may find everyday activities, such as getting dressed and using the bathroom, a lot more difficult. Safety devices, such as a shower chair or raised toilet seat can help. Also, if you will need to take the stairs at home, make sure your stairs have a solid arm railing.

When will I start physical therapy? [KNEE]

Pain management, swelling control and dedication to achieving a range of motion with daily exercises is the key to success in knee replacement surgery. You will either start physical therapy before your surgery or right after. A continuous passive motion machine (CPM) is used to control swelling and initiate motion.

Your physical therapist will teach you how to do in-bed stretching and strengthening exercises. Therapists will also assist you with standing and walking. You will be taught to walk with a walker and how to maneuver stairs.

When will I start physical therapy? [Hip]

Pain management, swelling control and dedication to achieving a range of motion with daily exercises is the key to success in hip replacement surgery. Most hip replacement patients do not need formal physical therapy, but it is available if needed.

Once you are home from the hospital, you should still continue to do the exercises you did in the hospital and work on walking. This is so your hip capsule can continue to heal.

Recovery

Moving around is one of the most important things you can do after surgery.

Walking helps increase blood flow, flexibility, muscle strength, balance and endurance. Your team will work with you to set up a walking schedule that can help. You will also need to do exercises at home that will increase joint mobility and promote complete healing.

It is good to challenge yourself, but please progress safely and with input from your health care team.

When will I be able to drive? [KNEE]

You will likely be able to drive about a month after surgery, providing you:

  • Walk well with a cane
  • Have stopped pain medication
  • Have good control of your leg

When will I be able to drive? [HIP and KNEE]

Depending on the type of vehicle and which leg (right or left) some patients can return to driving in one to two weeks, while others need up to six weeks before driving.

The goal of rehabilitation is to increase your strength and endurance so you can achieve your activity goals. These are general guidelines and may not completely apply to your situation. When in doubt, please clarify any questions with your therapist and/or physician.

Timeline

Surgery

  • 1-3 days in the hospital

First 2 weeks

  • Home exercise program
  • Walking program

At 2 weeks

  • Start 2nd part of exercise program
  • Continue walking program

At 6 weeks

  • If you are not meeting your activity goals, outpatient physical therapy may begin

Before surgery

Think about:

  • The family/friends who will be available to help you once you leave the hospital
  • How far you need to walk to get to your house and around your house
  • How many stairs you need to climb
  • Any obstacles you are worried about navigating at home

*Your responses will help us with working with you to prepare for your return home

In the hospital –beginning the day of surgery

To regain your strength and energy, it is important to get up to the chair for your meals and to take 1-2 walks in the hall every day you are in the hospital.

A physical therapist will work with you to gain independence with getting out of bed and chairs, walking, and climbing stairs.

An occupational therapist will work with you to gain independence in dressing, showering and toileting. They will help you determine what additional equipment you may need at home. See next page.

Initially you will need an assistive device (walker, crutches) to walk. If you have one already, bring it to the hospital to use, otherwise you will be provided one.

Activities of Daily Living

Devices to assist with daily living after hip arthroscopy

Following surgery, you may find everyday things such as dressing, toileting, and bathing, are a lot more difficult. There are several devices that may help you with independence in these areas (see images).

You may consider borrowing these items from a friend or family member.

However, if you need to purchase the equipment, you may choose to wait until after surgery to decide what you specifically will need.

Therapy Program and Education

Primary focus after surgery

  • Learning the precautions
  • Control swelling
    • Ice
      • Important for reducing swelling and can also assist with pain management
      • 15-20 minutes, 3-5 times a day
    • » Elevation
      • Ankle above knee and knee above hip, make sure the knee is straight

Progressive Walking Program

It is important to walk! Walking helps to increase blood flow, flexibility, muscle strength, balance and endurance. Below is a general walking program progression, which may be adapted based on your specific needs.

Week Time Pace
1 5 minutes, 3 times a day Easy
2 5-10 minutes, 3 times a day Easy
3 10-15 minutes, 3 times a day Easy

Initially, make sure your walking path is safe and manageable. It is important as your recover to challenge yourself, but please progress safely and with input from your outpatient physical therapist.

Home Exercise Program Part 1: First 2 weeks

Ankle Pumps: As often as you can

Ankle pumps exercise

In a seated or lying position, move your ankles up and down.

This exercise is safe to do as often as you can.

Glute sets: 5 - 6 times a day; 10 - 20 repetitions each

Glute sets exercise

In a seated or lying position, tighten your buttock muscles and hold for 2-5 seconds.

Quad Sets: 5 - 6 time a day, 10 - 20 repetitions each

Quad sets exercise

In a lying position, tighten your thigh muscles to straighten the knees to press the back of the knee down into the bed/ couch and hold for 2-5 seconds.

Heel Slides: 5 - 6 time a day, 10 - 20 repetitions each

Heal slides exercise

In a lying position, slide the heel towards your buttock while keeping the kneecap and toes pointed straight up.

Hip abduction: 5 - 6 time a day, 10 - 20 repetitions each

Hip abduction exercise

In a lying position, keep the knee straight and the leg “dragging,” slide the leg outwards ~10 inches. Make sure the knee cap and toes are pointed towards the ceiling.

Long Arc Quads: 5 - 6 time a day, 10 - 20 repetitions each

Long arc quads exercise

In a seated position with thighs supported as much as possible on a hard chair, kick the leg out and up with the goal of fully extending the knee.

Home Exercise Program Part 2: progress as able

Standing hip abduction: 5 - 6 time a day, 10 - 20 repetitions; both legs

Standing hip abduction exercise

While holding onto a stable surface. Raise the leg out to the side ~12 inches while keeping the knee straight and the toes pointed straight forward.

Mini-Squats: 5 - 6 time a day, 10 - 20 repetitions; both legs

Mini squats exercise

While holding onto a stable surface. Slowly drop hips down ~10 inches like you are sitting into a chair. Look forward and stick your buttocks out behind you keeping your back straight.

Standing hip extension: 5 - 6 time a day, 10 - 20 repetitions; both legs

Standing hip extension

While holding onto a stable surface. Raise the leg backwards ~6 inches while keeping the knee straight and the toes pointing forward.

While holding onto a stable surface. Raise the leg backwards ~6 inches while keeping the knee straight and the toes pointing for

Standing marching exercise

While holding onto a stable surface. Raise the leg into the air to mimic marching. Do 1 leg at a time, do not alternate.

The goal of rehabilitation is to increase your strength and endurance so you can achieve your activity goals. These are general guidelines and may not completely apply to your situation. When in doubt, please clarify any questions with your therapist and/or physician.

Timeline

  • Surgery
    • 2-3 days in the hospital
  • — First 7-10 days after hospital stay
    • Home exercise program
    • Walking program
    • Initiate outpatient physical therapy
  • After 7-10 days – 12 weeks
    • Continue outpatient physical therapy
    • New home exercise program from outpatient physical therapist—see attached protocol

Before surgery

Think about:

  • The family/friends who will be available to help you once you leave the hospital
  • How far you need to walk to get to your house and around your house
  • How many stairs you need to climb
  • Any obstacles you are worried about navigating at home

*Your responses will help us with working with you to prepare for your return home

In the hospital – beginning the day of surgery

To regain your strength and energy, it is important to get up to the chair for your meals and to take 1-2 walks in the hall every day you are in the hospital.

A physical therapist will work with you to gain independence with getting out of bed and chairs, walking, and climbing stairs.

An occupational therapist will work with you to gain independence in dressing, showering and toileting. They will help you determine what additional equipment you may need at home. See next page.

Initially you will need an assistive device (walker, crutches) to walk. If you have one already, bring it to the hospital to use, otherwise you will be provided one.

Activities of daily living

Devices to assist with daily living after hip arthroscopy

Following surgery, you may find everyday things such as dressing, toileting, and bathing, are a lot more difficult. There are several devices that may help you with independence in these areas. You may consider borrowing these items from a friend or family member. However, if you need to purchase the equipment, you may choose to wait until after surgery to decide what you specifically will need.

Therapy Program and Education

Primary focus after surgery

  • Get the knee straight—the most important within the 1st 2 weeks
    • No pillow under knee in bed
    • Heel prop—see home exercise program
  • Control swelling
    • Ice
    • Important for reducing swelling and can also assist with pain management
    • 15-20 minutes, 3-5 times a day
  • Elevation
    • Ankle above knee and knee above hip, make sure the knee is straight
  • Bend the knee
  • Quad muscle activation

Progressive Walking Program

It is important to walk! Walking helps to increase blood flow, flexibility, muscle strength, balance and endurance. Below is a general walking program progression, which may be adapted based on your specific needs.

Week Time Pace
1 5 minutes, 3 times a day Easy
2 5 - 10 minutes, 3 times a day Easy
3 10 - 15 minutes, 3 times a day Easy

Initially, make sure your walking path is safe and manageable. It is important as your recover to challenge yourself, but please progress safely and with input from your outpatient physical therapist.

Home exercise program

Ankle pumps: as often as you can

Ankle pumps exercise

In a seated or lying position, move your ankles up and down

Glute Sets: 5 - 6 time a day, 10 - 20 repetitions each

Glute sets exercise

In a seated or lying position, tighten your buttock muscles and hold for 2-5 seconds.

Quad Sets: 5 - 6 time a day, 10 - 20 repetitions each

Quad sets exercise

In a lying position, tighten your thigh muscles to straighten the knees to press the back of the knee down into the bed/ couch and hold for 2-5 seconds.

Short Arc Quad: 5 - 6 time a day, 10 - 20 repetitions each

Short arc quad exercise

In a lying position, place a bolster/folded pillow/large ball/ rolled large towel under the knee. Once this is placed, kick the leg and lift the heel from the bed/couch with the goal of fully straightening the leg.

Heel Prop: 5 - 6 time a day, with a goal for 10 minutes each

Heal prop exercise

In a lying position, place a bolster/folded pillow/large ball/ rolled large towel/end of the couch under the heel. This will “ oat” your knee and allow gravity to pull the knee straight. Relax into the stretch and allow gravity to do the work, you do not need to assist. THIS IS EXPECTED TO BE UNCOMFORTABLE. This is to stretch the knee into extension, a motion that many patients have not been able to achieve for some time.

Heel Slides: 5 - 6 time a day, 10 - 20 repetitions each

Heal slides exercise

In a lying position, slide the heel towards your buttock while keeping the kneecap and toes pointed straight up.

Hip abduction: 5 - 6 time a day, 10 - 20 repetitions each

Hip abduction exercise

In a lying position, keep the knee straight and the leg “dragging,” slide the leg outwards ~10 inches. Make sure the knee cap and toes are pointed towards the ceiling.

Long Arc Quads: 5 - 6 time a day, 10 - 20 repetitions each

Long arc quads exercise

In a seated position with thighs supported as much as possible on a hard chair, kick the leg out and up with the goal of fully extending the knee.

Seated Knee Flexion: 5 - 6 time a day, 10 - 20 repetitions each

Seated knee flexion exercise

In seated position, place the foot on the  oor in front of you. Slowly pull the heel towards the chair (a paper plate on carpet or a towel on tile helps the foot slide easier). Once the foot can no longer slide, scoot hips toward the front of the chair to get a deeper knee bend if able.

Medicare CJR program

The Medicare CJR program is a new Medicare program in which your health care providers work together to give you the best care and control costs. With CJR, you benefit when your surgeon, hospital, care center, home health nurse or physical therapist, and main doctor all work together. To learn more read our CJR Fact Sheet.

The first year of the 5-year CJR pilot program concluded in April, 2017. In May, the Center for Medicare and Medicaid Services reported that OHSU met its year 1 goals. One of the outstanding metrics in this report is OHSU's quality score, which was 19.65, ranking OHSU as excellent in the "performance category." This means that OHSU exceeded the threshold for being rated "excellent", which is a score of 13.2, by a significant margin.

Contact us

503-418-8889

Locations

Center for Health & Healing
Building 1, 12th floor
3303 S.W. Bond Avenue
Portland, OR 97239

OHSU Beaverton
15700 S.W. Greystone Ct.
Beaverton, OR 97006

Refer a patient

Joint Surgery Guide

OHSU Total Joint Surgery Guide

Information for patients having total hip replacement, hip resurfacing, total knee replacement or joint revision surgery, our guide will help you plan for your surgery, post-surgery rehabilitation and recovery.

Download your Joint Surgery Guide

Insurance information

OHSU Accepts most insurance plans. View OHSU's Insurance and Billing page