Having Joint Surgery? A Veteran Orthopedic Nurse Shares Her Best Advice for Patients
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f you’re one of the more than one million people who get a total joint replacement each year, or you're electing to have another type of joint surgery, knowing how best to prep for the procedure can not only alleviate anxiety but also help set you up for a successful recovery.
We asked Shandy Welch (shown at right)—a certified Family Nurse Practitioner who works with the Johnson & Johnson Medical Devices Companies to help implement their hip fracture care program in hospitals around the United States—for her insider advice on what to do if you’re considering, preparing for or recovering from orthopedic surgery.
Tips for How to Prep for Your Procedure ...
Interview several surgeons.
“You are the quarterback in this game,” stresses Welch, who has 20 years of experience working with orthopedic surgeons. So choose a surgeon who makes you feel comfortable, doesn’t rush you out of the office, and thoroughly answers all your questions and concerns, big or small. “I had a patient who wanted to bring a stuffed bear into surgery,” Welch says, adding that the surgeon managed to make it work.
Ask questions about life after surgery.
Now is the time to prepare for what comes next, which could mean a lengthy recovery in the hospital or time spent in a rehabilitation facility before heading home. Some questions Welch suggests asking:
- Is there any activity I absolutely shouldn’t do post-operation, and for how long?
- Will I need any medical help to deal with bandages, swelling or drainage?
- Should I buy any equipment to use while recovering, like a commode, shower chair, walker or cane?
- Will I be able to walk up and down stairs? If not immediately, when?
- How long until I can drive a car?
- When will I be able to go back to work?
- What kind of pain management will be available to me?
Start a smoking cessation program.
Quitting smoking one to two months before surgery can help lower your risk of complications. If you're struggling with how to do it on your own, Welch suggests “partnering with your primary health provider, acupuncturist, hypnotherapist or another professional to help you kick the habit.”
Assemble a caregiving team.
Make sure to line up someone to drive you home after the procedure, as well as someone who can pick up any post-surgery prescriptions and help you with cooking and other chores. Welch also advises stocking your freezer with healthy meals in advance, and looking into meal- and laundry-delivery services while you are recovering.
Retrofit your home for recovery.
If you're having hip or knee surgery, you may not be able to immediately navigate stairs, so consider setting up a sleeping area on the main floor. Other considerations: Remove possible tripping hazards, like cords and loose rugs, and store things you’ll need frequently somewhere you can easily reach them.
Put a physical therapy plan in place.
Ask your physician, friends and family for recommendations in advance, and make sure your chosen provider accepts your insurance. If you can start on your own beforehand, even better. Welch had a patient who focused on building quad strength before a total knee replacement. “He rode a stationary bike and swam for two months before surgery, which had an amazing effect on his recovery,” she says.
Practice relaxation techniques, like yoga or meditation.
Welch had a patient who was so anxious about her hip replacement surgery that she actually walked out of the waiting room before her procedure. So Welch suggested she listen to a guided meditation soundtrack called Guided Meditations to Promote Successful Surgery for a few weeks before her new surgery date. “The morning of the rescheduled procedure, the time kept getting pushed back,” Welch recalls. “When we hit the three-hour mark, I thought, That’s it, we lost her. But sure enough, I found her in the waiting room listening to her tapes, doing great!”
Welch says she can almost tell immediately who will and won’t do well after surgery just from their points of view. Approaching the journey as an active participant rather than a victim makes a huge difference.Share
Tips for the Day of and Right After Your Procedure ...
Take any required medications with the smallest sip of water that gets the pill down.
Anesthesia can lower your ability to eat or drink without aspirating—that is, having it go down through the lungs and windpipe instead of the esophagus. "Using less water can help with that," Welch says.
You should also bring a list of any meds you take with exact names and dosages, a list of any allergies or sensitivities you have, your insurance card and any legal documents the hospital has asked you to fill out, such as a healthcare proxy or power of attorney. There's no need to bring your own pills or prescriptions—the hospital will provide you with everything you need. Prior to giving you any medication, the nurse should check your wristband and ask for your name and date of birth to confirm who you are so she can administer the proper dosage.
Leave personal valuables, including jewelry, at home since you can't bring them into surgery.
If you wear contacts, leave them at home for the same reason, and wear glasses instead.
Wear loose-fitting clothing and comfortable, slip-on shoes.
Layers and socks are good, since many hospitals keep temps low. If you’re staying overnight, pack something easy to put on to wear home, like sweatpants.
Don't be embarrassed to ask for help going to the bathroom after surgery.
You are not inconveniencing anyone—nurses are there to help you. If you’re on IV fluids, you’ll likely have to go more often; plus, you may be on medication that can make you unsteady.
Ask for detailed instructions at discharge.
These might include:
- When to follow up with your doctor
- When you may shower
- How mobile you should be at home—orthopedic surgical patients are typically asked to start walking, even if supervised and for just a little bit, on the day of their surgeries to prevent blood clots and other complications
- How to care for your wound
- What signs or symptoms might warrant a call to your doctor or 911
“Having all the tools you need available to you sets you up for the most comprehensive recovery possible,” Welch says.
Tips for Your Recovery ...
Choose the right foods.
Your body is working hard to heal and rebuild, so a protein-rich diet is key. Some snacks to consider keeping on hand: almonds, hard-boiled eggs, cheese and protein shakes.
Keep in mind that some level of pain is normal.
That said, don’t push yourself too hard. “Working through the pain” isn’t wise. "If you’re grimacing, stop what you’re doing," Welch advises, adding that a little discomfort is probably okay, but you should confirm with your doctor to be sure.
Research shows that pain is best managed with multimodal pain management—that's science speak for using several different medications and methods, such as acetaminophen, ibuprofen or aspirin, along with a topical pain reliever, ice, elevation of the affected limb and rest.
Go to physical therapy as directed.
All patients usually work on strength training, expanding range of motion and stretching. For lower-body procedures, PT usually involves activities like walking, maintaining balance and climbing stairs.
“It may hurt a little, but not moving will become even more painful and could even create the need for another surgery,” Welch says. Translation: Do not sit around all day binge-watching TV. Take a walk to the mailbox every morning, and make plenty of trips to the kitchen to get food or water (unless, of course, your care team instructs you otherwise).
Try to keep a positive attitude.
Welch says she can almost tell immediately who will and won’t do well after surgery just from their points of view. Compare I can’t believe this is happening to me! to This knee replacement is really going to help me. “Approaching the journey as an active participant rather than a victim makes a huge difference,” Welch says.