Getting Ready for Discharge

• After You Go Home
• Discharge Instructions

After You Go Home

The time to prepare for your arrival home is before surgery. You will want to consider having someone with you to be your caregiver for the first week or so. In choosing a caregiver, consider that this person should be physically able to do the following activities:

• Help you stand up from a chair, sofa, or bed
• Assist you while you are walking or using stairs
• Take you to appointments and shop for you
• Prepare meals

Physical Therapy at Home
You will receive home physical therapy after you have been discharged. The therapist will visit your home two to three times a week for the first two weeks. After you have completed your home physical therapy you will go to outpatient physical therapy as arranged by your surgeon.

If ordered by your surgeon, continue to wear your TED compression stockings at home for about four weeks. Remove them once or twice a day to check your skin for any breakdown.

Special Equipment at Home
You might need some special equipment for your home while you recover. This equipment will be delivered to you at the hospital or at your home prior to your discharge. The most common equipment for home includes:

• A walking aid, such as a front-wheel walker
• An elevated toilet seat
• A CPM (continuous passive motion) machine for total knee replacement, if ordered by your orthopedic surgeon

Discharge Instructions

Day of Discharge

• Arrange for all nonessential belongings to be taken home prior to day of discharge. These might include flowers, gifts, books, and magazines.
• Make sure you have your walker with you during discharge. You will need it to get in and out of the car.
• Be sure that the vehicle you go home in is comfortable for you to get into. It should be neither too low nor too high, and it should have plenty of leg room.

Activity at Home

• Your level of activity at home will vary according to your individual abilities and the type of surgery you had. Before you go home, your therapist will instruct you on your specific activities, exercises, and restrictions for the first weeks following surgery.
• The sooner you become active, the sooner you will get back to normal. You also need to protect your new joint so it can heal. So plan frequent rest periods throughout the day and do not overdo activities.

Medications

• You may take the oral pain medication your surgeon has prescribed as needed. If you have any unusual symptoms from the medication, such as nausea or stomach upset, call your physician's office. Taking pain medications with food or milk may help prevent stomach upset. Do not drink alcohol when taking pain medications.
• Pain medications and decreased physical activity contribute to constipation, so it is recommended that you use a stool softener and/or a bulk laxative.
• Your nurse will tell you what home medications you may resume taking.

Blood Thinners

• You will be sent home with a blood thinner, or anticoagulant, medication. Lovenox (enoxaparin) injection is the most common anticoagulant medication used in the hospital. You will be taught how to give yourself the injection while you are in the hospital. Give yourself the injection at the same time every day. If you miss a dose, let your doctor know. Do not double the doses.
• There is a small risk of bleeding with this medication. If you have minor bleeding from gums, nose, or skin, use firm pressure for five minutes to stop the bleeding.
• If you have major bleeding, coughing, are passing bright red, bloody or black stools, have pink or red-tinged urine, chest pain, shortness of breath, or you are vomiting blood, go to the nearest Emergency Department.

Diet
You may resume your normal diet. A well-balanced diet high in iron, protein, and vitamin C will promote healing.

Incision Care and Hygiene

• In most cases you can shower when you get home from the hospital unless your incision is draining or you have been instructed otherwise. After showering, pat the incision dry with a clean towel used only for your incision.
• Do not take a bath or go into pools or spas for three to six weeks after surgery or until advised by your surgeon.
• Keep your incision clean and dry; avoid using creams and ointments. Ask your caregiver or family member to check the incision every day. Call your surgeon if you have any signs of redness, increased swelling, drainage, increased tenderness, bleeding, calf swelling or tenderness, chest pain and/or shortness of breath, temperature of 101°F or above, and any other questions or concerns you may have. For any life-threatening emergencies, call 911.

Sexual Activity
Discuss with your surgeon any questions or concerns about when to resume sexual activities. Follow any and all precautions as instructed.

Driving
Your surgeon will decide when it is safe for you to drive, but generally you'll be able to drive in four to six weeks.

Exercise
You may be limited to walking, swimming, and using a high-seated stationary bike after your total joint replacement. Consult with your surgeon before doing any activity.

Returning to Work
This depends on what type of work you do, so discuss it with your surgeon.

Reminder About Dental Work and Minor Surgery
Before having any dental work or minor surgery, tell your dentist or physician that you have a total joint prosthesis. Antibiotics will usually be prescribed. The general rule is no dental work for one month before and six months after your surgery.

Follow-Up Appointment
It is very important that you return to your surgeon's office for your follow-up appointment. Your appointment is usually two weeks after your surgery. At this visit, you will have the staples removed from your incision. Do not hesitate to call your surgeon if you have any questions or concerns before your appointment.