Your Hospital Stay

Most of our patients will spend one night in the hospital following their joint replacement surgery. During your stay, your care team will do everything possible to ensure you are comfortable and able to participate productively in physical therapy, and in preparations for your return home. Below, you'll find a general outline of what to expect during your stay at the hospital.

Your Care Team

Your care team includes residents, fellows, a physician's assistant, nurse, medical assistants, and discharge planners. Many of these team members visit you frequently during your hospital stay. Residents will see you every morning, typically between 5 and 7 am, and a nurse will be checking in on you regularly throughout your time in the hospital.

Be aware that your surgeon may not be able to visit you during your stay; however, he or she is in contact with your care team in case you need any special assistance.

Resource

When Same Day Surgery Is Right for You (AAHKS—American Association of Hip and Knee Surgeries)

Day Before Surgery

Call between 2–5 pm for your surgery time.

University of Utah Hospital: 801-585-1449

University Orthopaedic Center: 801-587-5373

  • Bath with anti-bacterial soap. (Bathing can also be done the morning of surgery.)
  • Use clean clothes, sheets, and pajamas. 
  • Get a good night's sleep.

If you have an questions, please call our office before 4 pm on the business day before your surgery.

Before Coming to the Hospital

  • Do not eat or drink after midnight.
  • If our pre-op team asks you to take specific medications on the morning of surgery, you can do so with small sips of water.
  • You may brush your teeth and rinse your mouth, but do not swallow.

Day of Surgery

Where to Come on the Day of Surgery

University of Utah Hospital: At University of Utah Hospital we recommend that you use the complimentary valet service at the front entrance of the hospital. From the main entrance, turn right and sign in at the check-in desk in the lobby. Do not bring your medications. The hospital will provide the medications.

University Orthopaedic Center: At University Orthopaedic Center, sign in at surgery check-in located on the first floor. Bring all your medications in their original bottles.

Leave your walker or crutches in your car until you reach your hospital room after surgery. Make sure these items are labeled with your name, and your family can bring them to your room.

checklist-patient-guide.png

 

When You Arrive at the Hospital

  • Leave walker or crutches in the car until you reach your hospital room after surgery.
  • Label these items with your name, and your family can bring them to your room.

Pre-Op

Once in the pre-op area, you will change into a hospital gown. We may check vital signs and additional blood work. Your nurse will confirm your name and information, place an ID band on your wrist, and check your paperwork. BE FLEXIBLE. Bring a book to read in case the previous surgery is longer than expected.

Next, you will meet your anesthesia staff, consisting of an anesthesiologist and resident or nurse anesthetist. They will discuss the anesthesia type you will have: a spinal anesthetic. 

The anesthesia staff will also start your IV, and your surgical site will be shaved and cleansed with anti-bacterial cloths. If you have dentures, hearing aids, socks or any jewelry, please remove them unless arrangements have been made to keep them with you. You will be given a hat to cover your hair.

The anesthesia team will escort you to the operating room, and your family can go to the waiting room at this time. Once your anesthetic is given, you will receive a foley catheter (tube to drain your bladder). Your leg is then positioned for surgery, and the surgical prep is performed. Many blue drapes are placed over your joint to ensure sterility, and you will not be able to see anything beyond this stage.

Anesthesia Choices

ANESTHESIA CHOICES

 

There are essentially two ways of receiving anesthesia during joint replacement surgery: general anesthesia and spinal anesthesia. Your anesthesiologist will meet with you before your surgery to discuss your medical history, perform a brief physical exam and based off of this assessment, along with other surgical factors, will offer a mode of anesthesia that is safest for you.

 

For spinal anesthesia, a doctor injects numbing medicine into your lower back (into the spinal fluid). The medicine makes you numb from the waist down for a few hours so you won’t feel pain during the surgery. You may receive other medications that make you relaxed and breathing on your own, but not unconscious. Some patients undergoing spinal anesthesia choose to bring a music player and headphones so they can listen to something calming during surgery. Your anesthesia team will be more than happy to accommodate this!

 

General anesthesia involves total unconsciousness during surgery. Most other surgeries, such as an appendectomy or a hernia repair surgery are performed under general anesthesia. Because of the level of deep unconsciousness, a breathing tube is placed in the trachea to help the patient breathe during surgery. Nausea and pain medications are given through the IV.

 

There are advantages and disadvantages to both modes of anesthesia.

 

Advantages of spinal anesthesia:

  • Does not require a breathing tube, so you are able to breathe on your own
  • Less ‘stressful’ on the heart and lungs. Less risk of postoperative pulmonary problems in patients who already have respiratory problems.
  • Less confusion or drowsiness after surgery
  • Lower chance of infection, bleeding, and blood clots

 

Disadvantages of spinal anesthesia:

  • May be contraindicated in patients with spine problems or history of spine surgery
  • Contraindicated in patients who have bleeding disorders or who have not stopped anticoagulation medications at an appropriate time before surgery
  • Small chance of a positional headache
  • Very small chance of nerve injury from the spinal needle
  • Extremely small chance of bleeding or infection near the spine that requires surgery
  • Small chance of urinary incontinency or retention

 

For patients going home on the day of surgery, we generally recommend a spinal anesthetic for total knee replacement surgery and general anesthesia for those having a total hip replacement. This recommendation is based off of your need to adequately recover from surgery and perform your first rehabilitation exercises before being ready to go home on the day of surgery.

 

For patients staying in the hospital after surgery, we generally recommend spinal anesthesia unless the surgery is a revision of a prior joint replacement operation or is otherwise surgically complicated, then a general anesthetic is often indicated.

 

Your anesthesiologist will factor all of the information regarding your health and the type of surgery to determine the safest mode of anesthesia for you. Rest assured, you and the anesthesiologist will determine what mode of anesthesia is best for you. Either way, you will be watched carefully in the operating room by a skilled anesthesia team.

After Surgery

Your nurse will instruct you on how to use the breathing machine at your bedside. Be sure to use it regularly in order to help keep your lungs clear and active throughout the recovery process, including after your return home.

Practice ankle pumps as frequently as you feel comfortable. Most patients will be up and walking with physical therapy the same day that they have surgery. For your first time standing on your new joint, you may simply get out of bed and take a few steps in your room. No matter what, a physical therapist will assist you the first time you get out of bed.

We do not use catheters, so you will be able to use the bathroom. However, please ask for assistance from the care team at the hospital.

A physical therapist will return in the afternoon to work with you. If you can walk a little bit farther each time you get up, you are making progress.

Case management will come to your room to review your discharge plan, and will be happy to help resolve any questions that might arise about your discharge. Case management will communicate directly with the home health agency you have selected, and with your insurance company, to ensure that your discharge will run smoothly. 

 

Before you leave the hospital, you should feel comfortable on oral pain medications and be able to maneuver yourself with your new joint replacement. You should be able to eat, urinate, and possibly have a bowel movement on your own.

If you do not have a bowel movement within four to five days after surgery, call the office. 

Your appetite will start to improve. It is important to drink water, eat fruits and consume foods high in fiber to promote a bowel movement, as pain pills slow down this process.

Your foot pumps will still be connected to your feet. Have your foot pumps removed before getting out of bed.

You will have an occlusive dressing over your incision. You should leave this in place until your follow up appointment.

Physical therapy (PT) will be similar to day one, as you will get out of bed at least two times throughout the day. An occupational therapist will visit you to discuss different aids for recovery at home.

You are ready to go home when:

  • You are medically healthy.
  • Your pain is controlled.
  • You are able to move around safely.
  • You are able to eat and urinate
After your joint replacement, it is normal for your joint to feel warm, red, or slightly swollen—but if you feel sick, or have a temperature more than 101.5 degrees, please contact your doctor immediately. And of course, if you have any questions or concerns about your surgery, medications, or treatment plan, please do not hesitate to contact our office.

Pain Management & Expectations

Prescription Refills

Allow one to two business days for any refills or prescription requests. Hours of operation are 8 am–4 pm, Monday–Friday.

Send us a MyChart message or call us at 801-587-7109 before you run out.

On-call providers will not refill medications.

Understanding Your Pain

Pain is real. So is addiction. The CDC reports that overdose death from prescription opioids has more than quadrupled since 1999. While we use these medications to manage pain after an operation, they must always to be taken as prescribed. We will wean you off as soon as possible.

It is important for you to understand your pain and that the goal is not to be pain-free in the weeks after surgery, but to have pain that is manageable and tolerable.

Pain Management

While in the hospital, we encourage you to talk with your nurse to manage your pain after surgery. Your nurse will communicate your needs to your doctor. It is your responsibility to communicate with the staff about how you feel so they can best help your recovery.

Our goal is to have you off narcotic pain medication before week six after your operation. We will work with you to help you ease off these medications. You should reduce your use of narcotics as soon as your pain allows.

Ice, rest, and elevation can help manage the pain and reduce the need for strong pain medication. When your pain is not severe, take non-narcotic pain medication, like Tylenol (acetaminophen). If you find that your pain not controlled by Tylenol, take your prescribed medication as directed.

If you have been prescribed warfarin do not take any anti-inflammatory medications (other than Celebrex) until you have stopped taking warfarin. The combination of blood thinners and anti-inflammatories can cause your blood to be too thin, and could lead to bleeding in your joint or stomach.

Before Discharge (Leaving the Hospital)

Before you are able to leave the hospital we need to make sure you are prepared. We will:

  • Review your discharge plan.
  • Make sure you have all the equipment you will need at home (a walker or crutches, toilet seat riser, reach-and-grab tool).
  • Make sure your support team will be available to assist you for the first few days at home.
  • Review all your medications with you and mak sure you understand how to use them
  • Provide all medication prescriptions you will need.
  • Make sure you understand how to care for the dressing and incision.
  • Understand the proper way to ice and elevate for a hip surgery or a knee surgery.
  • Confirm all your follow up appointments: Two-week wound care check, physical therapy appointment, and a six-week follow up with your surgeon.
You may shower as long as your dressing is well-sealed (cover it with medical tape, plastic wrap, or something similar).

Ice & Elevation for Knee Replacement

Remember, if you have had a knee replacement, ice and elevation are essential to help you control pain and move your operated joint above your heart—"TOES ABOVE NOSE".

When You Should Call Us

You should contact your doctor immediately if you experience:

  • Drainage from your incision outside of dressings,
  • Calf pain or swelling that does not improve with elevation, or
  • New redness or severe pain in your lower leg.

Call 911 immediately if you experience any of the following:

  • A pop and strange twist to your leg with or without bearing weight. This may be a sign you have dislocated your hip.
  • Inability to lift your foot and straighten your knee.
  • Sudden difficulty breathing, chest pain, or chest pain when you cough.
  • Shaking chills or a temperature more than 101.5 degrees.
  • A severe fall and the inability to bear any weight on your leg.
  • Numb, cold, or blue/pale looking toes.

Discharge Planning

Your discharge is planned for the same day or first day after surgery. If you need it, case managers will help you make arrangements with the home health and skilled nursing facility you chose prior to surgery.