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.

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.

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Before 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. 

*Knee replacement patients: If you had a knee replacement, in between therapy sessions you may have a continuous passive motion machine (CPM), but this is not mandatory. You will not be sent home with a CPM machine. You will also still have your nerve catheter in and will need to wear your immobilizer when you are out of bed to prevent falls.

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 following anesthesia options with you and your family:

  • Spinal anesthetic: This option is preferable in most patients because it is easier to wake up from, lowers your risk for blood clots in your leg, may lower your chance of infection, and will leave you feeling less groggy or sick.
  • Femoral nerve catheter: This is used for pain management (if you are having a total knee replacement).

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

Our surgeons' prefer that you receive a spinal anesthetic. This recommendation is based on the available literature and outcomes typical of patients undergoing joint replacement.

Spinal Anesthesia

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 so you won’t feel pain there during the surgery. You may receive other medicines that make you relaxed and sleepy, but you may not be in a deep sleep.

An anesthesia provider monitors your heart rate and rhythm, blood pressure, breathing and oxygen levels.

Advantages of spinal anesthesia:

  • Does not require a breathing tube, so you are able to breathe on your own
  • Less confusion or drowsiness
  • Lower chance of infection, bleeding, and blood clots
  • Lower risk of blood transfusions
  • Better pain relief to bridge recovery time between surgery and the next few hours

Disadvantages of spinal anesthesia:

  • If the injection does not work, you will need general anesthesia
  • Small chance of headache
  • Very small chance of nerve injury from the spinal needle
  • Extremely small chance of bleeding near the spine that needs surgery
  • Small chance of urinary incontinency or retention (fewer than 10 percent of patients)

General Anesthesia

While we prefer spinal anesthetic, we can also provide general anesthesia, which may be the best choice for people who are not good candidates for spinal anesthesia (or for those who prefer general anesthesia). Both types are common and safe.

On surgery day, discuss your choice with your anesthesiologist, who will review your medical history and answer any questions you may have. Whichever you choose, we will do everything possible to keep you comfortable during surgery and safely control your pain afterward.

Some patients undergoing spinal anesthesia choose to bring a music player and headphones to listen to something calming during surgery. Your anesthesia team will be more than happy to accommodate this, if you choose!

Day After Surgery

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 second day after surgery. Case managers will have made arrangements with the home health and skilled nursing facility you chose prior to surgery. Ask your case manager what time your transportation should arrive on your day of discharge.

Additional Information & Resources