Hip And Knee Replacement Recovery Planning Guide
ContentsOsteoarthritis And Joint Damage Other Reasons For Joint Damage Deciding To Have Surgery Signs Replacement Surgery Is Right For Your Loved One Knee And Hip Replacement Surgery Complications Preparing For Surgery Choosing The Right Surgeon Time At The Hospital Options During Recovery Deciding What Type Of Recovery Care Your Family Member Will Need Home Health Care Skilled Nursing Facilities After Recovery
Surgery to you or your loved one’s hip or knee can be a disruptive affair, with a long recovery period. Hip and knee replacement surgery recovery, particularly in your senior years, requires careful planning. By the end of this article, you’ll understand all the considerations you need to factor in when developing your recovery plan following hip or knee replacement surgery.
Hip and knee replacement surgeries are among the most commonly-performed types of non-emergency surgeries. Approximately one million of these procedures are performed each year in the United States, and the American Academy of Orthopedic Surgeons estimates that among Americans between 80% and 89.6% have had a total hip replacement surgery and 10% have had a total knee replacement.
While these procedures, which replace arthritic or damaged joints with an artificial joint, typically made of metal or plastic, are designed to alleviate pain and restore joint function, the recovery time needed after them can be significant. The average time for complete recovery from a total knee joint replacement is 3-6 months, and the average time for complete recovery from a total hip joint replacement is 6-12 months. Throughout this time, patients may need wound care, pain management, physical therapy and occupational therapy and may need to make use of assistive devices or other durable medical equipment.
Planning for these recovery months will allow your loved one to have the safest and most successful recovery possibly and will enable them to get the most out of their new joint.
Osteoarthritis And Joint Damage
Arthritis is an umbrella term for a range of diseases and conditions that cause pain and stiffness in the joints. Although it is commonly thought of as a single condition, there are actually more than 100 types of arthritis and, according to the Arthritis Foundation, arthritis is so prevalent that it affects 1 in 4 adults and 1 in 250 children. The disease is the number one cause of disability in the United States, and these numbers are predicted to continue growing as the American population ages.
Osteoarthritis, or degenerative arthritis, is the most common type of arthritis. Osteoarthritis occurs when the cartilage that provides the cushioning between joints wears away. This causes bones to rub against each other and results in pain, swelling, and increased damage to the joints. Eventually, the damage to the joints may be severe enough that replacement is the best option for pain relief.
Risk factors for developing osteoarthritis include:
- Obesity: Carrying excess weight for a number of years can put a strain on the joints and cause cartilage to degenerate faster.
- Genetics: A number of potential inherited factors, such as the production of collagen, alignment of bones, and pain sensitivity can make a person more likely to have osteoarthritis.
- Repeated Injury: Repeated damage to muscles, ligaments, and tendons, as well as repeated fractures, can lead osteoarthritis. This sort of damage is sometimes seen in athletes.
- Serious Injury: A previous significant injury can also lead to osteoarthritis in some cases. This is known as post-traumatic arthritis.
- Overuse: Repetitive motions over a long period of time can weaken the joints and lead to osteoarthritis. This is often seen in people who did a lot of heavy lifting or standing in their careers.
- Other Diseases: People who already have a disease that weakens their bones or muscles may develop osteoarthritis.
Other Reasons For Joint Damage
While osteoarthritis is the most common reason for hip joint or knee replacement, there are other conditions that cause the kind of severe joint damage that requires replacement surgery. Rheumatoid arthritis, a common type of arthritis which generally affects people between 20 and 50, is an autoimmune disease that causes the joints to swell. This swelling can, over time, lead to the destruction of the joints and their cartilage. Other autoimmune diseases that cause chronic swelling, such as lupus, gout, and psoriasis, can also weaken and damage the joints.
Deciding To Have Surgery
Hip and knee replacement surgeries are generally considered when no other course of pain relief has helped a person. People who undergo hip or knee joint replacement have significant pain in the affected joint, typically from osteoarthritis, and have trouble with the motions of everyday life such as walking, climbing steps, sitting, or standing. If your loved one is on pain medication, follow exercises, has received therapy, or has assistive devices and is still having trouble doing these types of activities without pain, their doctor may recommend surgery.
Signs Replacement Surgery Is Right For Your Loved One
If a doctor has recommended joint replacement surgery, you and your family member should have a conversation about their lifestyle and pain level to decide if the procedure is the right choice. Some factors to consider might be:
- Has your family member’s pain stopped them from doing the things they love?
If your family member is no longer able to enjoy life and activities like golfing, hiking, or simply walking in the outdoors due to pain, surgery may help them return to these activities and improve their quality of life.
- Is their pain getting worse?
Worsening hip or knee pain with time can be a sign that degeneration in the joint is progressing. If moderate or severe pain has become a regular part of life for your family member, a prosthetic joint might be a good option.
- Is pain keeping them up at night?
Many people, including those in the very early stages of arthritis, have hip or knee pain when they are engaging in physical activity. As joint pain worsens, however, this can extend to pain during rest. It can make it difficult to fall asleep and stay asleep. Lack of sleep can have an extremely negative effect on overall health, and can worsen daytime pain, further limiting what your loved one is able to do.
- Have they tried other pain relief methods with no success?
There are many proven methods for reducing the joint pain of arthritis that you will want to consider before surgery. A doctor may put your family member on a weight loss plan, for example, or prescribe a brace to be worn overnight or during certain activities. If these methods are not making a difference, or are only offering temporary relief, surgery might be the next step.
- Are they prepared for the recovery process?
Joint replacement has a lengthy recovery. The initial pain might be worse than what they were experiencing before the procedure. They will need to work with physical therapists to learn to move their new joint. Additionally, a doctor might advise lifestyle changes, such diet changes, exercises, or smoking cessation, as part of their recovery.
- Do you know what their insurance will cover?
Knowing how much hospital, therapy, short-term, or long-term care coverage is available through your family member’s insurance, Medicare, or Medicaid services will help you in planning for the procedure. Since hip and knee replacement surgeries are not generally emergency procedures, you might have the flexibility to determine a time that works best for your family and situation.
- Are they willing to have help during their recovery?
Your family member might be very independent, but in their recovery from hip or knee replacement surgery, they are going to need help, at least for the first several weeks. Most patients are homebound for a few weeks after surgery and require help getting dressed, bathing, cooking, and with other daily activities. There are several options for how to get your loved one this care, and you can decide together with them if it should be done in their home or in a facility.
Knee And Hip Replacement Surgery Complications
Hip and knee replacement surgeries have a very high success rate of over 90 percent and are generally very safe. However, all invasive medical procedures carry some risk. Some rare, but possible, risks to be aware of with joint replacements include:
- Blood clots
- Allergic reactions
- Misaligned joints
- Nerve damage
- Heart attack
Your family member’s doctors will discuss these risks with you and let you know if any existing health conditions they might have may increase any of these risks.
In addition to surgical risks, it is important to be aware that artificial joints can wear out with time. Generally, an artificial hip or knee can last around 20 years. Factors like overuse or injury can shorten this time. Sometimes it may be necessary to do additional surgery on the artificial joint or to replace it with a new artificial joint. This is known as revision surgery.
Preparing For Surgery
A doctor will examine your family member and assess their joint. They will take x-rays and perform other tests to determine the best type of artificial joint for your loved one’s situation. They will consider the general health, weight, age, mobility, and goals of your family member when deciding on a prosthetic. If your family member is at a high risk for infection, muscle degeneration, or is in poor health, their doctor may decide the surgery is too risky.
Choosing The Right Surgeon
Make sure you and your family are comfortable with the surgeon who will be performing the procedure. Don’t be afraid to ask questions and get to know the surgeon and their record. Find out how many times the surgeon has successfully performed the procedure. You can ask around to find out their reputation and what previous patients thought of their work and care practices. Additionally, make sure you know exactly what procedure the surgeon will be using. Different surgical techniques have different levels of invasiveness which can affect recovery time and overall success.
Time At The Hospital
A total hip or knee replacement surgery will take a few hours. The length of the actual procedure will depend on your family member’s individual joint, how damaged it is, and what method their surgeon has chosen. After surgery, most patients spend 3 to 4 days in the hospital. During post-operative care, hospital staff will begin their physical therapy. They will be given a walker and helped to move around their hospital room. They will receive help to bend and straighten the replaced joint. They may be asked to climb a few stairs. A nurse will provide care for their surgical wound, and they will be prescribed pain management medication.
A discharge planner, nurse, or doctor will talk to you and your family member about what they will need after their hospital stay. While they can provide suggestions, already having a plan will make the process much smoother and easier for your loved one.
Options During Recovery
According to 2010 data from California hospital discharge reports, around 77 percent of patients who have had a total knee or hip replacement surgery procedure are discharged to either home health care or an extended care facility of some sort. All patients recovering from these surgeries will need to follow a physical therapy plan, monitor their incision, monitor their hip or knee for swelling.
While someone in good health who is living with a spouse, adult child, or other companions may be able to manage these things with a degree of independence, most people, especially older adults, receive assistance either at home, at a nursing facility, or at a rehabilitation facility during their recovery.
Patients who go home without home health care will still need to attend outpatient physical therapy sessions, and because of their limited mobility in the first weeks after surgery, will need someone with them to help with bathing, dressing, and other activities. Starting physical therapy within the first four days after surgery is extremely important to the success of the operation.
Deciding What Type Of Recovery Care Your Family Member Will Need
There are a number of factors that go into a successful recovery. Deciding what level of care your loved one will need during their recovery is something that needs to be done well before the surgery takes place. These questions can help you think about the situation and make an informed choice.
- How safe is your family member’s home?
Take a walkthrough of their home and assess how difficult it would be for them to navigate it during their recovery. Consider:
- Are there stairs? If so, how many? Are they indoors, outdoors, or both?
- How far apart are the bedroom and bathroom?
- Will crutches work in the home?
- Is there a shower or a tub? Can a bench or chair fit inside it?
- How high are shelves and drawers?
- Are there uneven floor surfaces like rugs or loose floorboards?
- Can the phone be reached from the bed?
- Is there good lighting throughout their home?
- Could adaptive equipment fit in their bedroom/living room?
You may want to observe your family member at home for a few hours, making note of how they manage these things. This will give you a good idea of how practical it would be for them to be in their home when they are recovering. If you are considering home health for your family member, consider asking someone from the agencies you are evaluating to give you an assessment as well. That way, if they cannot safely work with your loved one at home, they can let you know upfront.
- Will your family member be staying alone?
Home health care is not a 24/7 option in most cases. While you may be able to privately pay an agency or caregiver for round-the-clock care, Medicare and other insurances will only pay for a set number of hours a week. If your family member has you or someone else living or staying with them, this might be all the time they need, especially if the person staying with them is able to help with basic tasks like meal preparation or assisting them in walking to the bathroom.
- Does your family member have transportation?
While home health care brings many services to people’s homes, a patient who is recovering from total knee or hip surgery will still need to get out of their home for appointments with their doctor, as well as for groceries and other daily errand needs. If your family member drives, it may be several weeks before they are able to get behind the wheel again. There are services that provide transportation for seniors, but these often need to be setup in advance.
- Is your family member at higher risk for any complications?
Patients with certain conditions may need additional monitoring. For example, a diabetic patient will need blood sugar testing, patients with heart conditions may need blood clot work done to make sure they are clotting appropriately, and patients with frequent urinary tract infections may need to have a urinary catheter placed and cared for. A home health nurse or extended care facility nurse can manage these things and report them back to the rest of the care team.
Home Health Care
For many people, being in their own home can aid their long-term recovery. Being around familiar people, objects and places can often have a comforting and therapeutic benefit. Patients who recover from home are likely to feel more independent and more in control of their long-term recovery. Home health care can help people reap these benefits while still providing the skilled care needed after joint replacement surgery.
Since knee or hip surgery is designed to increase mobility and independence after the recovery period, patients who have had them are often excellent candidates for home care. Studies have found that, when appropriately implemented, physical therapy as part of home health care is just as effective for people recovering from joint replacement.
After a hip or partial knee surgery, a home health care team will visit your family member’s home several days a week. A physical therapist will visit and work with them, helping them increase their ability to bend, walk, sit, and stand. An occupational therapist will also visit and help them begin to care for themselves and perform activities of daily living safely.
A nurse will visit and monitor your family member, checking their vital signs, incision site, and pain level and perform any needed bloodwork or skilled care. The nurse will examine the incision site for signs of swelling or infection and report them back to the doctor immediately. A home health aide or nursing assistant may also visit to assist with bathing, dressing, and bathroom use.
The home health team will teach your family member how to care for themselves after the service ends, making sure they are safe and that their new joint is healing properly. They can also teach any family members or caregivers how to help with daily tasks. They will report the progress being made, and any setbacks, to your family member’s doctor, allowing for a smooth and successful recovery.
Additionally, the home health team will make sure all the needed equipment arrives at your family member’s home and that it is in good working condition. A social worker from the team will work with you and your family member to make sure you have all the appropriate equipment. As your family progresses, the physical or occupational therapist may recommend changing equipment, such as going from a walker to a cane. The home health agency will help you make this change.
When planning for your family member’s operation, you can take the time to meet with and interview several home care agencies to find one that is the right fit.
Home Health Care And Assisted Living
Even if your family member already lives in an assisted living facility, they may need home health care in the weeks right after their surgery. The staff at the assisted living facility can help with bathing, dressing, and other personal care needs, but may not be qualified to assist with incision care, physical therapy, or other recovery needs. Since an assisted living facility is considered living in the community, a home health care agency’s visits will likely be covered by Medicare or insurance.
Talk to your family member’s assisted living facility before the surgery to see what the standard procedure is. They may have home health care agencies they work with regularly or have partnerships with, or they may be able to make recommendations based on the experiences of other residents. They can also let you know exactly what their staff is able to assist with and what they may need to get additional care for.
Paying For Home Health Care
Medicare pays for 100% of home health care as long as certain criteria are met. In the case of a person leaving the hospital following surgery, Medicare will cover the costs of home care as long as the agency is Medicare-certified and as long as a doctor certifies that the need is both part-time (less than eight hours a day) and temporary (less than 21 days). Medicare will also pay for any durable medical equipment your family member needs, such as raised toilet seats, shower chairs, or walker or crutches.
Other insurance plans will pay for this short-term home health care on a similar basis. Call your family member’s plan to find out exactly what services are covered, and for exactly how long.
If after the initial recovery period your family member still needs the skilled level of services to be safe at home, you may need to look into additional payment options, such as Medicaid, PACE programs, long-term care insurance, or private pay.
It is important to know that if your family member no longer needs physical therapy or skilled nursing services, Medicare and other insurances will no longer cover the home health care, even if your family member still needs occupational therapy or personal care services.
Skilled Nursing Facilities
A skilled nursing facility can be a great choice for people who live alone and do not have anyone who is able to stay with them during their recovery. Skilled nursing facilities provide around-the-clock care. They are staffed with nurses, nursing assistants, physical therapists, occupational therapists, speech therapists, dietitians and social workers. Often, additional professionals, such as respiratory therapists or audiologists, are also employed.
In a skilled nursing facility, your family member will get the services they need that will allow them to return home safely. This will include daily or frequent physical and occupational therapy, pain medication and pain management, and any nursing services they may need. Nursing staff can take care of any infection risks, monitor them for any complications, and ensure any needed blood work or other testing is complete. Nursing assistant staff, typically certified nursing assistants or patient care technicians, will take your family member’s vital signs, assist them with showering, eating, and dressing, and transport them to their appointments.
A social worker will be on staff to assist you in getting your family member back home with any needed services, such as home health or equipment. A dietitian will make sure the meals your family member receives follow both their doctor’s orders and the customs of any religious or cultural practices your family member adheres to. Together, the skilled nursing team will assist your family member in recovery and make sure they are prepared to go home safely after their therapy.
You can visit and tour several skilled nursing facilities before the operation to find the right one for your family member. You can take this time to see resident rooms and therapy suites and ask questions of staff. You might want to select a favorite skilled nursing facility, as well as one or more backup facilities they would also feel comfortable in, in case there is not a bed available at your number one choice when your family member discharges from the hospital.
Continuing Care Facilities And Skilled Nursing Care
If your family member lives in a continuing care community, they can receive skilled nursing care in the skilled wing section or building of their community, as long as there is a bed available. This option can greatly help in recovery since the surroundings will be familiar to your loved one, and the staff will be familiar with them. In these facilities, your family member will receive the skilled care they need, and when they are ready, they will be discharged back to the assisted living or independent section of the community.
Paying For A Skilled Nursing Facility
Medicare will cover a stay in a skilled nursing facility as long as there has been a qualifying hospital stay. A qualifying hospital stay is an inpatient stay that lasts at least three days. In the case of a knee or hip replacement surgery, these criteria should easily be met. The facility must be Medicare-certified, and the doctor must certify that your family member needs daily skilled nursing care. Once these conditions are met, Medicare will cover 100% of the stay for the first 20 days.
Medicare Considerations In A Skilled Nursing Facility
If you are planning to use Medicare to pay for your family member’s recovery stay in a skilled nursing facility, it is important to keep a few things in mind:
- Medicare will only pay for a semi-private room. If you want a private room for your family member, you will need to pay the difference in cost.
- Medicare will only pay 100% of the cost for the first 20 days. On days 21-100, Medicare only covers a portion of the cost, and you or your family member will be responsible for $167.50 a day. After day 100, Medicare will no longer cover the stay.
After 100 days, if your family member still needs the level of care provided by the skilled nursing facility, you will need to look into other ways to pay for their care, such as Medicaid, long-term care insurance, Social Security, or private pay.
Most people who have had a hip or knee replacement are able to care for themselves after about three to six weeks. After this initial period, it can take up to a year for full recovery. After full recovery, the full benefits of the new joint will be felt. Your family member will be in significantly less pain, and will be able to move around more freely than before surgery. Their quality of life will likely be greatly improved and they will be more independent.
Their new joint will be monitored by the doctor to make sure it is not wearing down or causing other complications in their body. If additional therapies or surgeries are needed, they can be discussed down the road with the entire care team. The doctor will let you and your family member know what activities can be resumed, and if any are still not recommended--for example, jogging is often not recommended for patients who have a total or partial knee replacement because it can wear out the joint faster. However, new research has lead many doctors to reconsider this and to recommend as much physical activity as the patient can safely handle. Be sure to talk with your family member’s doctor and therapists about what activities are safe for them.
Overall, the reduction in pain and increased mobility after a hip or knee replacement are marked for patients. These procedures are likely to get even more common in the coming years, especially as the American population ages. Preparing for these operations in advance can assure your family member’s procedure will be a success and that they will get many full years of life and use out of their new joint.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.