Preparing for Hip and Knee Replacement

By: Cheryl Taylor RNFA • Posted on June 16, 2022

Women and Joint Replacement

As people age and want to maintain an active lifestyle many may face a joint replacement for themselves or for a loved one. Women account for at least 60% of all hip and joint replacements done in the US.

• Arthritis is the major cause for joint replacements, and women have more arthritis than men as well as more autoimmune conditions
• Pregnancy and delivery can affect the pelvic floor
• Any joint instability, injury, and/or muscle weakness of the hip girdle can affect the integrity of the joint
• Knee replacement increases in both men and women with age as well as prior injury, wear and tear and weight gain
• Up to 5% of women at age 80 will experience a hip replacement, while up to 10% of women by age 80 will experience a knee replacement
• A small percentage experience more than one joint replacement

How to know when you need a hip replacement

Some of the symptoms that might suggest you need a hip replacement include:

1. Pain in the anterior groin area when walking or at rest
2. Decreased range of motion of the hip
3. Feeling of joint instability
4. Limping (which can be from pain and/or muscle weakness)

Reduce stress on the joints

For every 5 pounds of extra body weight, that transmits to 25 pounds of extra pressure on the joints. Significantly reduce stress on the joints by:

• Losing 13 pounds of body weight
• Maintaining good nutrition, balanced muscle strength and bone health
• Wearing good footwear

Joint Replacement Surgery

Postmenopausal women on menopausal hormone therapy have better longevity of their joint replacement and a reduced risk for osteoporotic fractures (bone breakage). One’s age and anticipated life span previously factored more heavily in the decision to undergo a joint replacement; however improvements in technology and technique has brought joint replacement as an option for younger people. Some women who have had a hip replacement at a young age have gone on to have successful pregnancies and deliveries.

What to do before your surgery

1. Selecting your orthopedic surgeon and their team is very important to optimizing your health.
2. Get any screenings as well as any dental work and dental cleaning completed.
3. It's important to see your primary care physician and get up to date on all of your health care needs. Lower your blood sugar and blood pressure (if elevated), and optimize your weight which can be hard when you have a painful joint.
4. Working with a trusted physical therapist and/or trainer to optimize your strength and flexibility can also help.
5. Water therapy takes the pressure off the joints and may be something to pursue post operatively as well.
6. Be honest with your medical team regarding alcohol use, all medications, drug use and caffeine consumption. You may or may not have permission to have a sip of coffee for caffeine in the am if you think you may have a caffeine withdrawal headache. However, in general you are to have nothing by mouth after midnight on the day of your surgery.

What to discuss with your surgical team

When discussing the risks, benefits and alternatives of total joint replacement, your surgical team will discuss the different approaches, anticipated recovery time and the risks - which include but are not limited to infection, blood clot, and prosthesis malfunction.

• You will likely receive educational material on either hip replacement or knee replacement.
• Have your iron/ferritin level checked as many women run low in iron from menstruation, child-bearing and breast feeding. You want to optimize your iron levels pre-operatively (Vitamin C helps you absorb iron). Side note: Iron is also good for energy level and healthy hair! If your iron is low and un-explained, you may need a GI tract evaluation or if you are over age 45-50 colorectal cancer screening is recommended.
• If you need to lose weight and/or if your blood sugar is elevated, you may be advised to go on a low carb, Keto diet.

What you need for recovery

Prior to the surgery, you want to get your home ready for your recovery. Small children and pets can cause fall hazards and you do NOT want to trip or fall postoperatively.

Your surgical team will instruct you on what assistive devices you will need to purchase to help you recover. That likely will include:

• Walker (that a family member is to bring to the hospital upon discharge)
• Cane
• Pincher
• Bath seat
• Toilet seat elevation
• Shoe horns

Prepare your home in advance

1. Grocery shop in advance and make sure to have someone help with shopping post-surgery.
2. Prepare several meals in advance and have plans for someone to help you with meals post-surgery.
3. Find a laundry and yard work helper for when you are recovering.
4. You need to safety proof your home.
5. Practice getting up from a high back chair with arm rests and your bed with the appropriate use of a walker, reducing the weight bearing on the affected surgical limb.
6. Padded and seat cushions to prevent your hip from flexing past the 90 degree arch in chairs and in the passenger side of the car.
7. Having chairs with cushions and arm rests to help you use your upper body while you have reduced weight bearing is helpful along with elbow pads and padded workout gloves, especially if you have sensitive hands and tendons.
8. You will NOT be able to drive until you are off pain medicines and get medical clearance from your orthopedic surgeon.

It is best to plan to take the time and necessary help for your recovery and not compare your experience to your friends or what you might read on the internet. And NO you won’t be on the golf course in a few weeks or caring for your active grandchild in the several weeks that you are recovering post operatively.

Icing and physical measures

• There are a number of ice gel packs and contraptions that allow you to ice the hip or the knee to reduce swelling. You may need to use intermittently icing (20 mins on, 20 mins off) for several weeks.
• Wearing TED hose or Sigvaris support hose will help reduce swelling and blood clot risk.
• It is important to not lay in bed without moving legs and to not stand or sit too long.
• Keep a journal nearby to jot down your activities, medications and the time taken is very helpful. If you are not up to initially keeping it up, have a family member be your scribe.
• You will not be able to shower until you are given the go ahead based on wound healing. The extra stick saran wrap can be placed over your wound to avoid water on your incision. At your post-op visit, once the wound is fully healed, you can ask your team regarding silicone scar therapies if you are interested.
• Wearing compression stockings up to the waist if you have a lateral hip incision may help with the scar contouring.
• Do NOT get a pedicure or shave a week before the procedure and for at least a month after the surgery.

Packing a hospital bag

Packing your hospital bag for a surgery is similar to packing your bag for a delivery, only you will not be going home with a new baby but a new joint - which will require your attention!

• Pack lightly
• Do not bring valuables
• Bring your ID, a phone charger and loose comfortable clothes to change into

Bowel function

Opiates can significantly slow the bowels down, so you need adequate hydration, a stool softener and may even need some milk of magnesium or Miralax. The sooner you wean off opiates and use non-opiate pain medicine, the better the elimination pattern is. Ingesting high fiber, healthy food and adequate water will aid in your recovery. Bone broths and soups are nutritious, tasty and can be frozen in advance.

Post-Surgery

Physical therapy

Physical therapy may start in the postoperative area and it is very important to follow all precautions. You may be up and walking on the day of surgery and even possibly home that day or the next; however, pain level, ambulation, bowel function and the general medical condition are all taken into effect.

• Make a list of questions for your medical team and physical therapist regarding what activities you can and cannot do and what precautions you must follow like no bending past the 90 degree waist arch for hip replacement or external rotation of the hip. For the knee, active physical therapy to prevent knee contraction has to be done under supervision.
• Sexual activity may be resumed once you are feeling up to it. For women with hip replacement, it may take longer.
• If you have a knee replacement, you have to follow all instructions by your physical therapist to avoid any joint contracture and you will have to work on active flexion and extension exercises.
• If you have a hip replacement, you must follow all precautions to reduce risk of hip dislocation, particularly in the first 3 months.

Recovery

You need to realize it can take up to a full year for recovery and the first 2 years have increased blood flow to the joint area for healing and repair.

• Antibiotics are needed before dental work and certain procedures for the rest of your life because there is an increased risk for joint infections especially in the first 2 years post op.
• You can do low impact exercises such as biking, brisk walking, pilates, etc. However high impact activities like running are to be avoided as this will shorten the lifespan of the joint.
• You will have a new gait pattern and you need time and physical therapy to rehab your gait. You might notice some back pain or heel pain as you recover. Wear good and well fitting tennis shoes!
• You may perceive a leg length discrepancy after surgery, however this usually settles with physical therapy and time although occasionally a heel lift may be needed.

Progress and improvement is not always directly linear. Listen to your body and make a commitment to focusing on your recovery.

Be Strong, Be Healthy, Be in Charge!

-Cheryl Taylor RNFA

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• Arthritis Treatment Guide