What to Expect After a Hip Replacement

What to Expect After a Hip Replacement

Article Featured on Home Care Assistance

Have You Decided it is Time for Hip Replacement Surgery?

That aching, painful and stiff hip has reduced your quality of life. You can’t enjoy the activities you used to love, like a good golf game, a walk around the block or even playing with the grandkids, without constant pain.

Over 300,000 people have hip replacement surgery each year in the United States. Before you decide to join this group, it is important to know what to expect following surgery. What will you experience after your hip replacement? When will you feel back to normal? What can you do to speed your recovery?

Pain After a Hip Replacement

First things first, hip replacement surgery will hurt. All surgery does! Be prepared that you will experience a significant amount of discomfort in the first three days following surgery. Your mobility will be limited, and you will need to depend on others to help you with your regular activities of daily living. Even simple things like going to the bathroom will require assistance.

On the first day, a significant amount of surgical pain medication will be in your system. You may feel groggy but not as uncomfortable. On the second day, you will likely be able to get out of bed and start moving with assistance. Although you had surgery on the largest joint in your body, you will be walking on it in only one or two days.

Be ready for the third day after surgery. You will probably feel like you got hit by a truck. After surgery, your body sends a large number of inflammatory cells to the injured area in order to help with the healing process. These levels will be at the highest on day three. Inflammation means swelling and swelling means pain. Talk to your doctor their recommendations for using ice and taking an anti-inflammatory medication starting on the day of surgery. But remember, typically, once you get through day three the swelling and pain will get better.

Walking After Hip Replacement Surgery

Most likely, you will be up and walking the day after your surgery. Take it slow and don’t push yourself beyond what you can handle. Getting up and active following surgery is vital to speeding up your recovery after a hip replacement. Try to exercise for 20-30 minutes at a time. The first day that might just mean getting out of bed and to the hallway. Don’t feel discouraged by this!

Moving around will not only speed up your recovery but will also increase the circulation to your legs and feet which will reduce your chance of getting a blood clot. Blood clots are a serious risk following all types of surgery but can be prevented by early movement and exercise.

Getting out of bed will also help to maintain and increase your muscle strength while preventing your new hip from getting stiff. You’ll want to take full advantage of that new level of hip movement. Don’t forget that getting out of bed and being able to walk with a walker or cane is one of the goals you need to accomplish before going home from the hospital.

Your Hip Replacement Recovery Checklist

Typically, after two to four days you will be discharged from the hospital to either your home or to a rehabilitation facility. Here are some goals to use as a checklist when transitioning back to your home. Make sure that:

  • You can get out of bed by yourself.
  • Your pain is adequately under control. This doesn’t mean you’re pain-free but it should be manageable.
  • You can eat, drink, sleep and go to the bathroom.
  • You can walk with a cane, walker or crutches.
  • You’re ready to do home exercises on your own.
  • You know what you need to do to protect your new hip from an injury.

Before you go home, you will need to have someone available to help you at home. This can be a friend, family member or a caregiver. At home, you will want to make sure that your furniture is set up so that you can get around your house easily.

What Will Hip Replacement Recovery be Like?

It’s normal to have questions about what the healing process will look like after surgery. So we’ve gathered the answer to common questions.

When Can I Shower?

You will not be showering until you get the go-ahead from your surgeon because you need to keep the incision dry. But a sponge bath will feel heavenly when you get home! The first two weeks you will be at your highest risk of infection, so report any signs of redness, drainage or fever. Your surgical staples will usually come out on day 10-14 and then you can bathe or shower again.

When Can I Start Walking?

After your surgical staples are removed, you’ll be able to start to work on walking without a walker or cane. Don’t forget to move around as much as you can while at home. Make sure you do the physical therapy exercises you have set up, go for light walks and remember to rotate your ankles, bend your knees and practice leg raises while sitting up or lying down.

When Can I Drive?

You can usually start driving within three to six weeks following hip replacement surgery. However, you will need to make sure that you are no longer taking any pain medication that affects your response time or makes you groggy. Initially, you will likely find that an automatic transmission is easier to drive. Also, make sure you can tip your foot up and down without pain prior to driving. This can depend on which hip is operated on. If you had surgery on the side you use to drive, it may take longer to get behind the wheel.

When Can I Have Sex?

Yes, it is a question every patient has but often hesitates to ask. This can be especially awkward if it is your parent that has had a hip replacement and you are accompanying them to a doctor’s appointment. Check with your doctor to be sure, but it is usually safe to resume sexual activity six weeks to two months following a hip replacement. Remember, as with all activities, to listen to your body! Do not attempt to do more than you feel capable of and to stop or slow down if you notice increased pain.

Dr. Mehran, an orthopedic surgeon, shares this rule of thumb, “If you are still needing to use a walker, you are probably not ready for sex yet.” Still using a walker usually means that you have not yet regained enough strength and balance.

What Should I Eat After Hip Replacement Surgery?

The healthier you eat, the better you heal! The food that you put into your body will provide you with the energy and nutrition needed to fight off infections, accelerate healing, increase your strength and energy and build up your nutrition stores. Speed up the recovery process by eating healing foods like berries and dark leafy greens.

6 Tips for a Successful Hip Replacement Recovery

Along with following your surgeon’s discharge plan for exercise and physical therapy, it’s important to make a few changes to your home.

“Preparing your home with the same care shown to your physical recovery will set you up for success,” says Barbara Bergin, M.D. of Texas Orthopedics, Sports and Rehabilitation Associates. She suggests starting with the following six steps.

1. Remove Tripping Hazards

Slips and falls are common reasons for hip replacement surgeries in the first place. To avoid hospital re-admission with an injury to your other hip, or damaging the replacement, Bergin suggests removing all throw rugs, floor mats, etc. from your home.

“You’ll be shuffling your feet for a while,” says Bergin. As a result, you can trip on throw rugs, including those you use in the bathroom or kitchen. If you prefer to keep the rug where it is, Bergen suggests “fastening them using carpet tape to keep the edges down.” However, she says that the best bet is removing the tripping hazard to eliminate any concerns about a fall.

2. Upgrade the Bathroom

Installing a handicap or comfort height toilet is a better option than a temporary elevated toilets apparatus, says Bergen. “Not only do the temporary appliances get dirty easily, but it’s also recommended to use a comfort height toilet permanently after a total joint replacement.” Doing so, she says, will improve the quality of your life, along with that new joint.

You should also use a shower chair. Make sure that you have a sturdy chair that is higher than average and firm. You will find this easier to get up from. To get in and out of the shower easily, you also might want to consider having a grab bar installed in the bathroom.

3. Raise ‘em up

“Elevating the legs helps get that swelling down,” Bergin says. Swelling can limit your ability to get your life back to normal. She suggests, “Using big pillows or wedges to elevate your legs if recommended.” This includes having a pillow to place in between your legs while sleeping. “A nice, fat body pillow provides comfort and helps promote restful sleep.”

4. Gather the Right Tools

Bergin says over time, you may easily perform many daily activities once again. But in the first days and weeks at home, some of life’s little tasks like getting dressed or feeling steady while retrieving something from a cabinet might be challenging. She encourages people to have a few handy gadgets to make these tasks as stress-free—and safe—as possible.

“Sock donners and handy grabbers that extend your reach are absolute musts,” she says. Other helping hands include leg lifters, bendable bath sponges and a long-handled shoe horn. Many companies sell these items together as a “hip kit” package.

5. Raise Your Seat

If you can afford it, Bergen suggests asking your doctor for a prescription for a lift chair. She says, “Your knees, hips and arms will appreciate it, and that your other bad hip will really appreciate it!” Although insurance doesn’t cover the cost of the chair, having a prescription can avoid the need to pay sales tax in some areas.

6. Borrow, Don’t Buy

Many of the items you’ll need to speed down the road to recovery post hip replacement will only be required for a few weeks or so. Instead of paying the full price out-of-pocket (medical equipment is frequently not covered by many insurance plans) or even your deductible’s portion of these items, check in your area for free or low-cost community resources. These can alleviate the sting of having to outfit your home with several new tools and medical equipment.

“Family members and/or patients may borrow this equipment for little or no cost from community medical equipment lending programs, also known as medical equipment reuse programs or loan closets,” says Janice Selden, Director of Great Lakes Loan Closets.

These organizations accept medical equipment from community members who no longer need it. “They clean the equipment, check to make sure it is safe, and lend it back out to members of the community who need it. Typical equipment includes wheelchairs, walkers, shower aids, and dressing aids,” explains Selden.

Organizations like these usually provide an online directory of locations that provide these services throughout the country and can be very helpful for patients.

Do’s and Don’ts After a Hip Replacement

The dos and don’ts might be different depending on what type of surgical technique your doctor used. Your doctor and physical therapist can give you a specific list to remember. These precautions are pretty standard to prevent your new hip from dislocating and to help with a quick and thorough recovery.

Do

  • Keep your operated leg facing forward.
  • Make sure your operated leg is in front of you as you sit or stand.
  • Use chairs that are high enough that your knee is lower than your hip when bent.
  • Use ice to reduce swelling.
  • Use heat before exercising to warm up the muscles for 15-20 minutes. This will help you to have better movement.
  • Reduce the amount of exercise you do if you are in pain but continue to stay active and resume your exercises as soon as possible.
  • Ask your doctor about safe sleep positions.
  • Limit the amount of weight you carry.

Don’t

  • Cross your legs for six to eight weeks.
  • Allow your knees to sit higher than your hips.
  • Lean forward while sitting, especially to pick something up off the floor.
  • Turn your foot in or out when you bend down.
  • Bend at the waist beyond 90 degrees.
  • Twist your hips.

How Long Until You Feel Good Again After a Hip Replacement

It will take time before you are out dancing again! Hip replacement is an excellent option to increase your health and quality of life. The American Academy of Orthopedic Surgeons report that 95% of patients who undergo a hip replacement stated the procedure was successful. They reported relief from hip pain and were able to be more active and connected with their loved ones following the surgery.

These results are encouraging but it is not an overnight cure. You can expect it to take 10-12 weeks before you are able to return to all your favorite activities. At some point, you are going to feel like your recovery is taking too long. It’s important to remind yourself that feeling frustrated and limitations to physical ability are a normal part of the healing process.

Take a break and relax from pushing yourself. Do something you can enjoy. Get help if you need it, think about how far you have already come, then get back up, keep on moving and eating healthy. 10-12 weeks will feel like a long time, but once you are enjoying a pain-free stroll or game of golf, that time will be just a memory.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip or knee replacement - after - what to ask your doctor

What to ask your doctor after hip or knee replacement

Article Featured on Medicineplus.gov

You had surgery to get a new hip or knee joint while you were in the hospital. Below are some questions you may want to ask your health care provider to help you take care of your new joint.
Read more

How to Use Crutches, Canes, and Walkers

How to Use Crutches, Canes, and Walkers

Article Featured on AAOS

If you break a bone in your leg or foot, have a procedure on your knee or lower leg, or suffer a stroke, your doctor may recommend that you use a walking aid while you are healing or recovering. Using crutches, a cane, or a walker can help keep your weight off your injured or weak leg, assist with balance, and enable you to perform your daily activities more safely. When you are first learning to use your walking aid, you may wish to have a friend or family member nearby to help steady you and give you support. In the beginning, everything you do may seem more difficult. With just a few tips and a little practice, though, most people are able to quickly gain confidence and learn how to use a walking aid safely.

Make Your Home Safer

Making some simple safety modifications to your home can help prevent slips and falls when using your walking aid:

  • Remove throw rugs, electrical cords, food spills, and anything else that may cause you to fall.
  • Arrange furniture so that you have a clear pathway between rooms.
  • Keep stairs clear of packages, boxes, or clutter.
  • Walk only in well-lit rooms and install a nightlight along the route between your bedroom and the bathroom.
  • In the bathroom, use nonslip bath mats, grab bars, a raised toilet seat, and a shower tub seat.
  • Simplify your household to keep the items you need within easy reach and everything else out of the way.
  • Carry things hands-free by using a backpack, fanny pack, or an apron with pockets.

Crutches

If your injury or surgery requires you to get around without putting any weight on your leg or foot, you may have to use crutches.

Proper Positioning

  • When standing up straight, the top of your crutches should be about 1-2 inches below your armpits.
  • The handgrips of the crutches should be even with the top of your hip line.
  • Your elbows should be slightly bent when you hold the handgrips.
  • To avoid damage to the nerves and blood vessels in your armpit, your weight should rest on your hands, not on the underarm supports.

Walking

Lean forward slightly and put your crutches about one foot in front of you. Begin your step as if you were going to use the injured foot or leg but, instead, shift your weight to the crutches. Bring your body forward slowly between the crutches. Finish the step normally with your good leg. When your good leg is on the ground, move your crutches ahead in preparation for your next step. Always look forward, not down at your feet.

Sitting

To sit, back up to a sturdy chair. Put your injured foot in front of you and hold both crutches in one hand. Use the other hand to feel behind you for the seat of your chair. Slowly lower yourself into the chair. When you are seated, lean your crutches in a nearby spot. Be sure to lean them upside down—crutches tend to fall over when they are leaned on their tips.

To stand up, inch yourself to the front of the chair. Hold both crutches in the hand on your injured side. Push yourself up and stand on your good leg.

Stairs

To walk up and down stairs with crutches, you need to be both strong and flexible. Facing the stairway, hold the handrail with one hand and tuck both crutches under your armpit on the other side. When you are going up, lead with your good foot, keeping your injured foot raised behind you. When you are going down, hold your injured foot up in front, and hop down each step on your good foot. Take it one step at a time. You may want someone to help you, at least at first. If you encounter a stairway with no handrails, use the crutches under both arms and hop up or down each step on your good leg, using more strength.

If you feel unsteady, it may be easier to sit on each step and move up or down on your bottom. Start by sitting on the lowest step with your injured leg out in front. Hold both crutches flat against the stairs in your opposite hand. Scoot your bottom up to the next step, using your free hand and good leg for support. Face the same direction when you go down the steps in this manner.

Canes

A cane can be helpful if you have minor problems with balance or stability, some weakness in your leg or trunk, an injury, or a pain. If you are elderly, using a single point cane may help you to walk more comfortably and safely and, in some cases, may make it easier for you to continue living independently.

Proper Positioning

  • When standing up straight, the top of your cane should reach to the crease in your wrist.
  • Your elbow should be slightly bent when you hold your cane.
  • Hold the cane in the hand opposite the side that needs support. For example, if your right leg is injured, hold the cane in your left hand.

Walking

To start, set your cane about one small stride ahead of you and step off on your injured leg. Finish the step with your good leg.

Stairs

To climb stairs, place your cane in the hand opposite your injured leg. With your free hand, grasp the handrail. Step up on your good leg first, then step up on the injured leg. To come down stairs, put your cane on the step first, then your injured leg and then, finally, your good leg, which carries your body weight.

Walkers

If you have had total knee or total hip replacement surgery, or you have another significant problem, you may need more help with balance and walking than you can get with crutches or a cane. A pickup walker with four legs will give you the most stability. A walker lets you keep all or some of your weight off of your lower body as you take steps. With a walker, you use your arms to support some of your body weight. As your strength and endurance get better, you may gradually be able to carry more weight in your legs.

Positioning

  • When standing up straight, the top of your walker should reach to the crease in your wrist.
  • Your elbows should be slightly bent when you hold the handgrips of the walker.
  • Keep your back straight. Don’t hunch over the walker.
  • Check to be sure the rubber tips on your walker’s legs are in good shape. If they become uneven or worn, you can purchase new tips at a drug store or medical supply store.

Walking

First, position your walker about one step ahead of you, making sure that all four legs of the walker are on even ground. With both hands, grip the top of the walker for support and move your injured leg into the middle area of the walker. Do not step all the way to the front. Push straight down on the handgrips of the walker as you bring your good leg up so it is even with your injured leg. Always take small steps when you turn and move slowly.

Sitting

To sit, back up until your legs touch the chair. Use your hands to feel behind you for the seat of the chair. Slowly lower yourself into the chair.

To stand up, push yourself up using the strength of your arms and grasp the walker’s handgrips. Do not pull on or tilt the walker to help you stand up.

Stairs

Never climb stairs or use an escalator with your walker.

Rotator Cuff and Shoulder Conditioning Program

Rotator Cuff and Shoulder Conditioning Program

Article Featured on AAOS

After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following a well-structured conditioning program will also help you return to sports and other recreational activities.This is a general conditioning program that provides a wide range of exercises. To ensure that the program is safe and effective for you, it should be performed under your doctor’s supervision. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.Strength: Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.Target Muscles: The muscle groups targeted in this conditioning program include:

  • Deltoids (front, back and over the shoulder)
  • Trapezius muscles (upper back)
  • Rhomboid muscles (upper back)
  • Teres muscles (supporting the shoulder joint)
  • Supraspinatus (supporting the shoulder joint)
  • Infraspinatus (supporting the shoulder joint)
  • Subscapularis (front of shoulder)
  • Biceps (front of upper arm)
  • Triceps (back of upper arm)

Length of program: This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. Performing the exercises two to three days a week will maintain strength and range of motion in your shoulders.

Getting Started

Warmup:Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to the strengthening exercises. When you have completeds the strengthening exercises, repeat the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.

Ask questions: If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist.

1. Pendulum

Main muscles worked: Deltoids, supraspinatus, infraspinatus, subscapularis

Equipment needed: None

Repetitions: 2 sets of 10
Days Per Week: 5 to 6

Step-by-step directions

  • Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.
  • Gently swing your arm forward and back. Repeat the exercise moving your arm side-to-side, and repeat again in a circular motion.
  • Repeat the entire sequence with the other arm.

Tip: Do not round your back or lock your knees.

2. Crossover Arm Stretch

Main muscles worked: Posterior deltoid
You should feel this stretch at the back of your shoulderEquipment needed: NoneRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm.
  • Hold the stretch for 30 seconds and then relax for 30 seconds.
  • Repeat with the other arm.

Tip: Do not pull or put pressure on your elbow.

3. Passive Internal Rotation

Main muscles worked: Subscapularis
You should feel this stretch at the front of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Hold a stick behind your back with one hand, and lightly grasp the other end of the stick with your other hand.
  • Pull the stick horizontally as shown so that your shoulder is passively stretched to the point of feeling a pull without pain.
  • Hold for 30 seconds and then relax for 30 seconds.
  • Repeat on the other side.

Tip: Do not lean over or twist to side while pulling the stick.

4. Passive External Rotation

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in the back of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Grasp the stick with one hand and cup the other end of the stick with the other hand.
  • Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain.
  • Hold for 30 seconds and then relax for 30 seconds.
  • Repeat on the other side.

Tip: Keep your hips facing forward and do not twist.

5. Sleeper Stretch

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in your outer upper back, behind your shoulderEquipment needed: NoneRepetitions: 4 reps, 3x a day
Days Per Week: DailyStep-by-step directions

  • Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed.
  • Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder.
  • Hold this position for 30 seconds, then relax your arm for 30 seconds.

Tip: Do not bend your wrist or press down on your wrist.

6. Standing Row

Main muscles worked: Middle and lower trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keep your arm close to your side and slowly pull your elbow straight back.
  • Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together as you pull.

7. External Rotation With Arm Abducted 90°

Main muscles worked: Infraspinatus and teres minor
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent 90° and raised to shoulder-height, as shown in the start position.
  • Keeping your shoulder and elbow level, slowly raise your hand until it is in line with your head.
  • Slowly return to the start position and repeat.

Tip: Make sure your elbow stays in line with your shoulder.

8. Internal Rotation

Main muscles worked: Pectoralis, subscapularis
You should feel this exercise at your chest and shoulderEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keep your elbow close to your side and bring your arm across your body.
  • Slowly return to the start position and repeat.

Tip: Keep your elbow pressed into your side.

9. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together.
  • Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keeping your elbow close to your side, slowly rotate your arm outward.
  • Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together when you pull your elbow back.

10. Elbow Flexion

Main muscles worked: Biceps
You should feel this exercise at the front of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Stand tall with your weight evenly distributed over both feet.
  • Keep your elbow close to your side and slowly bring the weight up toward your shoulder as shown.
  • Hold for 2 seconds.
  • Slowly return to the starting position and repeat.

Tip: Do not do the exercise too quickly or swing your arm.

11. Elbow Extension

Main muscles worked: Triceps
You should feel this exercise at the back of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Stand tall with your weight evenly distributed over both feet.
  • Raise your arm and bend your elbow with the weight behind your head.
  • Support your arm by placing your opposite hand on your upper arm.
  • Slowly straighten your elbow and bring the weight overhead.
  • Hold for 2 seconds.
  • Slowly lower your arm back down behind your head and repeat.

Tip: Keep your abdominal muscles tight and do not arch your back.

12. Trapezius Strengthening

Main muscles worked: Middle and posterior deltoid, supraspinatus, middle trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 sets of 20
Days Per Week: 3 to 5Step-by-step directions

  • Place your knee on a bench or chair and lean forward so that your hand reaches the bench and helps support your weight. Your other hand is at your side, palm facing your body.
  • Slowly raise your arm, rotating your hand to the thumbs-up position and stopping when your hand is shoulder height, with your arm parallel to the floor.
  • Slowly lower your arm to the original position to a count of 5.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

13. Scapula Setting

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back, at your shoulder bladeEquipment needed: NoneRepetitions: 10
Days Per Week: 3Step-by-step directions

  • Lie on your stomach with your arms by your sides.
  • Place a pillow under your forehead for comfort, if required.
  • Gently draw your shoulder blades together and down your back as far as possible.
  • Ease about halfway off from this position and hold for 10 seconds.
  • Relax and repeat 10 times.

Tip: Do not tense up in your neck.

14. Scapular Retraction/Protraction

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back at your shoulder bladeEquipment needed: Begin with a weight that allows 2 sets of 8 to 10 repetitions and progress to 3 sets of 15 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on your stomach on a table or bed with your injured arm hanging over the side.
  • Keep your elbow straight and lift the weight slowly by squeezing your shoulder blade toward the opposite side as far as possible.
  • Return slowly to the starting position and repeat.

Tip: Do not shrug your shoulder toward your ear.

15. Bent-Over Horizontal Abduction

Main muscles worked: Middle and lower trapezius, Infraspinatus, teres minor, posterior deltoid
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Lie on your stomach on a table or bed with your injured arm hanging over the side.
  • Keep your arm straight and slowly raise it up to eye level.
  • Slowly lower it back to the starting position and repeat.

Tip: Control the movement as you lower the weight.

16. Internal and External Rotation

Main muscles worked: Internal rotation: anterior deltoid, pectoralis, subscapularis, latissimus.
External rotation: posterior deltoid, infraspinatus, teres minor
You should feel this exercise in the front and back of your shoulder, your chest, and upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 to 4 sets of 20
Days Per Week: 3 to 5Step-by-step directions

  • Lie on your back on a flat surface.
  • Extend your arm straight out from the shoulder and bend the elbow 90° so that your fingers are pointed up.
  • Keeping your elbow bent and on the floor, slowly move your arm in the arc shown. Bring your elbow down to a 45° angle if you experience pain at 90°.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

17. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on your side on a firm, flat surface with your unaffected arm under you, cradling your head.
  • Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow against your side and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
  • Slowly lower the weight to the starting position to a count of 5.

Tip: Do not let your body roll back as you raise the weight.

18. Internal Rotation

Main muscles worked: Subscapularis, teres major
You should feel this stretch in the front of your shoulderEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on a firm, flat surface on the side of your affected arm.
  • Place a pillow or folded cloth under your head to keep your spine straight.
  • Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow bent and against your body and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
  • Slowly lower the weight to the starting position.

Tip: Do not let your body roll back as you raise the weight.

Alternative Methods to Help Manage Pain After Orthopaedic Surgery

Alternative Methods to Help Manage Pain After Orthopaedic Surgery

Article Featured on AAOS

After orthopaedic surgery, your doctors and nurses will make every effort to control your pain. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain.

Surgeons and their patients are increasingly using alternative methods, such as relaxation techniques and acupuncture, to supplement conventional medicine. A combined approach to pain management is often the best option because it allows the surgeon to tailor pain control methods to each individual patient.

This article focuses on alternative approaches your doctor may recommend for pain management.

Transcutaneous Electrical Nerve Stimulation (TENS)

In transcutaneous electrical nerve stimulation (TENS) a special device transmits low-level electrical charges into the area of the body that is in pain.

A TENS system consists of a small, battery-powered machine connected by wires to a pair of electrodes. The two electrodes are connected to your skin near the source of pain or at a pressure point. A mild electrical current travels through your skin and along your nerve fibers which may cause a warm, tingling sensation. A typical TENS session lasts anywhere from 5 to 15 minutes.

Many studies have found that TENS is useful in easing pain after surgery, as well as pain related to injuries, such as fractures and sprains. TENS may also be helpful for some chronic pain conditions, particularly low back pain. TENS is generally considered safe. However, its routine use is not recommended.

There is also an acupuncture version of TENS in which the electrical impulses are sent through acupuncture needles instead of electrode pads. This form of TENS is called “electro-acupuncture” or percutaneous electrical nerve stimulation (PENS).

How TENS Works

There are several ways TENS is thought to relieve pain:

Gate Control Theory. In order for you to feel pain, the sensation must travel through a “gate” to get to the brain. Normally, the pain is allowed to flow freely through the gate because it (pain) is the only sensation trying to get through. However, if the gate becomes flooded with another type of sensation (in this case, an electric current), the gate will reach capacity and no longer have room for the underlying pain sensation to get through.

Release of Endogenous Opiates. Some scientists believe that TENS works by forcing certain nerve cells to release more of the body’s natural pain killers called “endorphins.” This causes you to feel less pain.

Central Inhibitory Effect. TENS may also work by changing the way your brain perceives pain.

When to Avoid TENS

TENS might not work as well if your pain is caused by mental or emotional problems. It also does not work as well if you suffer from drug addiction.

TENS should not be used if you have any of the following conditions:

  • Implanted medical device (defibrillator or pacemaker)
  • Pregnancy
  • Epilepsy
  • Mental retardation
  • Undiagnosed pain

Continuous Passive Motion

Continuous passive motion (CPM) is a technique in which your joint is moved constantly in a mechanical splint to prevent stiffness and increase range of motion. A CPM machine moves your joint for you without requiring you to exert any effort.

Medical evidence indicates that in many cases immobilization increases pain after surgery. As a result, early motion has been applied to many orthopaedic problems. CPM is thought to be most effective in the rehabilitation treatment of:

  • Cartilage damage
  • A bacterial infection inside a joint
  • A fracture around a joint after it has been fixed with internal devices

CPM is believed to enhance the nutrition of your joint, discourage the formation of scar tissue, and prevent the abnormal shortening of the muscles surrounding your joints.

CPM machine

This CPM machine cradles the lower leg and gently moves it.

If you can already move — either actively or passively — without CPM, then using the device will not be beneficial. CPM is not a substitute for working with an experienced physical therapist who is trained to provide both active and passive motion exercises. If your doctor recommends CPM, you will also be monitored by a physical therapist.

The most important time to use a CPM device seems to be in the first 2 to 7 days after surgery, for about 4 to 6 hours every day.

Initially, CPM was only used in hospitals or outpatient physical therapy clinics, but today, CPM units can be purchased for use at home.

Acupuncture

When acupuncture is combined with traditional pain relief methods, it may be helpful for some types of chronic pain:

  • Low back pain
  • Osteoarthritis
  • Fibromyalgia
  • Aching muscle pain (knots)
  • Tennis elbow
  • Carpal tunnel syndrome
  • Stroke rehabilitation

Acupuncture points tend to be areas of your skin that contain relatively large amounts of intersecting nerve endings that feed into your muscles or bones. Some scientists believe that these “acupoints” possess special electrical characteristics that can be manipulated using painless hair-thin needles.

A typical acupuncture procedure lasts for about 30 minutes. Treatments are used to relieve local pain and swelling, as well as to provide a more general feeling of relaxation due to the release of your body’s natural painkillers, called endorphins.

Because each acupoint is responsible for producing effects in different areas of the body, it is important to be clear with your provider about the specific area and intensity of your pain. The acupuncturist can then target the correct acupoint.

Psychological Methods

Psychological methods can be effective as an additional treatment for pain control. These methods can reduce or eliminate the need for medication. Some of oldest and best documented psychological methods include:

  • Relaxation techniques
  • Guided imagery
  • Medical hypnosis

In 18 medical research studies, medical hypnosis, guided imagery, or relaxation techniques were used to improve recovery after surgery. In 16 of the studies (4 were orthopaedic surgeries), researchers documented improvements in both the physical and emotional recoveries of the patients.

These results demonstrated that psychological methods are effective as an additional treatment for pain management, postsurgical recovery (physical and emotional), and orthopaedic rehabilitation.

These methods appear to have potential in orthopaedic surgery that could reduce pain, enhance treatment outcomes, and contain or even reduce medical costs.

Knee Replacement Surgery for Arthritis

What Can I Do After Knee Replacement Surgery? When to Return to Normal Activity

Article Featured on AAOS

After having a knee replacement, you may expect your lifestyle to be a lot like it was before surgery— but without the pain. In many ways, you are right, but returning to your everyday activities takes time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.

Even though you will be able to resume most activities, you may want to avoid doing things that place excessive stress on your “new” knee, such as participating in high-impact sports like jogging. The suggestions here will help you enjoy your new knee while you safely resume your daily activities.

Hospital Discharge

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. If your knee replacement is performed on an outpatient basis, you will go home on the same day as surgery.

Before you are discharged from the hospital, you will need to accomplish several goals, such as:

  • Getting in and out of bed by yourself.
  • Having acceptable pain control.
  • Being able to eat, drink, and use the bathroom.
  • Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs.
  • Being able to perform the prescribed home exercises.
  • Understanding any knee precautions you may have been given to prevent injury and ensure proper healing.

If you are not able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total knee replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Warning Signs of Infection

  • Persistent fever (higher than 100 degrees)
  • Shaking chills
  • Increasing redness, tenderness or swelling of your wound
  • Drainage of your wound
  • Increasing pain with both activity and rest

Warning Signs of a Blood Clot

  • Pain in your leg or calf unrelated to your incision
  • Tenderness or redness above or below your knee
  • Increasing swelling of your calf, ankle or foot

In very rare cases, a blood clot may travel to your lungs and become life-threatening. Signs that a blood clot has traveled to your lungs include:

  • Shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Notify your doctor if you develop any of the above signs.

Recovery at Home

You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.

Preparing Your Home

The following tips can make your homecoming more comfortable, and can be addressed before your surgery:

  • Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
Home recovery center

Prepare a “recovery center” by placing items that you use frequently within easy reach.

  • Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Get a good chair—one that is firm with a higher-than-average seat and has a footstool for intermittent leg elevation.
  • Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
  • Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.

Wound Care

During your recovery at home, follow these guidelines to take care of your wound and prevent infection:

  • Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as often as directed by your doctor. Ask for instructions on how to change the dressing before you leave the hospital.
  • Follow your doctor’s instructions on how long to wait before you shower or bathe.
  • Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.

Swelling

You may have moderate to severe swelling in the first few days or weeks after surgery. You may have mild to moderate swelling for about 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.

Medication

Take all medications as directed by your doctor. Home medications may include opioid and non-opioid pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.

Be sure to talk to your doctor about all your medications—even over-the-counter drugs, supplements and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.

It is especially important to prevent any bacterial infections from developing in your artificial joint. Some patients with special circumstances may be required to take antibiotics prior to dental work to help prevent infection. Ask your doctor if you should take antibiotics before dental work. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.

Diet

By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin supplements. You may also be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you taking the blood thinner medication warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Continue to drink plenty of fluids and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming Normal Activities

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Driving

In most cases, it is safe to resume driving when you are no longer taking opioid pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

You can safely sleep on your back, on either side, or on your stomach.

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may take from several days to several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your knee flexible. When riding, try to achieve the maximum degree of bending and straightening possible.

As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your knee replacement.

  • Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
  • Swimming is an excellent low-impact activity after a total knee replacement; you can begin swimming as soon as the wound is sufficiently healed. Your doctor will let you know when you can begin.
  • In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your operated leg to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.