When fully recovered, most patients can expect to return to work — unless your type of work is not advisable for people with artificial joints. Examples of these include construction work, certain types of carpentry, and occupations that involve repeated high climbing or lifting. You should discuss your situation with your doctor.

You may also be advised to avoid certain activities, including some athletics, as they may place excessive stress your new joint. Examples of these activities include:

Hip/Knee

• Skiing (snow or water)
• Basketball
• Baseball
• Contact sports
• Distance running
• Frequent jumping

Shoulder

• Any activity involving lifting or pushing heavy objects
• Any activity that places excessive stress on your shoulder joint
• Hammering and other forceful arm/shoulder movements
• Boxing and other arm/shoulder impact sports

After Joint Replacement, a Good Rule of Thumb is that Acceptable Physical Activities Should:

• Not cause pain, including pain felt later
• Not jar the joint
• Not place the joint in the extremes of its range of motion
• Be pleasurable

The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems.

It’s important to have realistic expectations. For example, artificial joints have limitations:

• Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
• The artificial joint will not restore function to the same level as normal, healthy bone.
• The life span of the artificial joint is not infinite. It cannot be expected to equal that of normal, healthy bone.
• Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.

It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery.

When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. The more quickly a joint replacement patient gets moving again, it is more likely that he or she will regain independence just as quickly. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge. Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery. If needed, the case manager can help arrange for you to have a home therapist.

The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems!

Regaining Mobility Safely, Slowly, Securely At first

Most people experience reduction in joint pain and improvement in their quality of life following joint replacement surgery. While joint replacement surgery may allow you to resume many daily activities, don’t push your implant to do more than you could before your problem developed.

Give yourself at least six weeks following surgery to heal and recover from muscle stiffness, swelling and other discomfort. Some people continue to experience discomfort for 6-12 weeks following their joint replacement.

During visits to the physical therapist’s office, your therapist may use heat, ice or electrical stimulation to reduce any remaining swelling or pain. You should continue to use your walker or crutches as instructed.

Your physical therapist may use hands-on stretches for improving range of motion. Strength exercises address key muscle groups, including the buttock, hip, thigh and calf muscles. You can work on endurance through stationary biking, lap swimming and using an upper body ergometer (upper cycle). Physical therapists sometimes treat their patients in a pool. Exercising in a swimming pool puts less stress on your joints and the buoyancy lets you move and exercise easier.

When you are safe putting full weight through the leg, several types of balance exercises can help you further stabilize and control the hip or knee. Finally, you will work with a group of exercises to simulate day-to-day activities, such as going up and down steps, squatting, rising up on your toes, bending down and walking on uneven terrain. You may be given specific exercises to simulate your particular work or hobby demands.

By six weeks, you may be able to return to many normal activities such as driving, bicycling and golf. When you see your surgeon for follow-up two to six weeks after surgery, he or she can advise you on both short and long-term goals.

As a rule, all joint replacement recipients should heed the following limitations during the first weeks after surgery:

• Expect to use a cane or walker for several weeks
• No kneeling, bending or jumping for the first month
• Don’t drive until ok with your doctor (usually 4-6 weeks)
• No alcohol with pain medication
• Don’t smoke – it slows healing
• You may hear some clicking in your knee as it heals; it’s normal
• Avoid sexual activity until after six-week check-up
• Continue wearing elastic stockings until your return appointment

In general, physical activities should:

• Not cause pain, either during activity or later
• Not jar the joint, such as when running or jumping
• Not place the joint in extreme ranges of motion
• Be pleasurable

Additional tips for living with your new joint:

• Ask for help – while your goal is to eventually do things for yourself, don’t take unnecessary risks by trying to do too much too soon.
• Recuperation takes approximately 6-12 weeks – you may feel weak during this time. Use ice for swelling and discomfort. Ice your knee for 15-20 minutes after each exercise period to reduce pain.
• Keep your appointments with your doctor – it’s important to monitor healing and function on a regular basis. You may need to check in with your doctor two to three times during the first two years, and at intervals of two to three years thereafter. During those visits, your surgeon will take X-rays and monitor wear.
• Under optimal conditions, your artificial joint may last for many active years. You should always consult your orthopaedic surgeon if you begin to have pain in your artificial joint or if you suspect something is not working correctly.
• Watch for infection – your new joint is a foreign substance to your body. Germs from other infections can move to your new joint and cause infection. Call your family doctor immediately if you have any signs of infection, e.g., skin infection, urinary tract infection, abscessed teeth, etc. Early treatment is crucial.
• Alert your dentist or family physician – tell them about your joint replacement before any dental work or procedure, such as a cardiac catheter, bladder exam, or surgery. You may always need to take antibiotics first to prevent infection.
• Your new joint may set off metal detectors in airports and other secured buildings. Your doctor can give you an identification card to carry in your wallet.

Long Term

Most patients have less pain and better mobility after joint replacement surgery. Your physical therapist will work with you to help keep your new joint healthy for as long as possible. This may mean adjusting your activity choices to avoid putting too much strain on your joint. You may need to consider alternate work activities to avoid the heavy demands of lifting, crawling and climbing.

More extreme sports that require running, jumping, quick stopping or starting and cutting are discouraged. More low impact exercises such as cycling, swimming, golfing, bowling and level walking are ideal.

Your doctor has provided this information to answer some of the questions you may have about the importance of preventing infection after your joint replacement. It will also help you better understand what to do if you develop an infection and require medical treatment.

Recovering From Joint Replacement

After your joint replacement, your orthopaedic physician will likely give you specific instructions on movement, exercising and wound care. Most people are encouraged to stand, even walk, the day after surgery. Your doctor may provide you with a walker, cane or crutch. Depending on the joint replaced, and your overall health, your doctor may also prescribe a course of physical therapy, so that a trained healthcare provider can guide you through specific therapeutic movements.

Joint replacement surgery has a 90% success rate across the board.¹ But, as with any surgery, there are possible complications associated with joint replacement. Among them, infection may occur in the wound, or even around the joint implant itself (prosthesis). Infection can set in while you’re in the hospital or after you go home. Minor infections of the wound are often treated successfully with antibiotics. A deeper infection may cause the implant to loosen, become painful and require additional surgery and, eventually, another joint replacement. The good news is that most infections are preventable.

Helping to Prevent Infection

Before and during your joint replacement surgery, your doctor will take measures to reduce the risk of bacterial infection. You may be given a preventative antibiotic right before, and for a short time after, your surgery. Your doctor will also recommend that you take antibiotics before you have any invasive procedure or test (like a colonoscopy or dental work).² Because you now have an implant, it may give bacteria a place to hide from your body’s natural immune response, increasing your risk of infection.² A preventative course of antibiotics will help to reduce that risk.

Treating a Joint Replacement Infection

People who develop infections within the first few months of joint replacement surgery are often treated successfully with intravenous antibiotics and a surgical technique that washes the infected implant. People who develop infections months or years after joint replacement appear to face more challenging treatment. Often these infections require surgical removal of the infected implant, use of a spacer impregnated with antibiotics to stabilize and treat the joint space, and longer-term intravenous antibiotics.² Careful blood monitoring helps to determine when the infection is thoroughly cleared. A new joint replacement may be considered at that time.

If you have any questions about caring for your wound site or preventing infection in your joint replacement, be sure to talk with your doctor.

References:

NIAMS: National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteonecrosis. National Institutes of Health, Department of Health and Human Services.

Total Joint Replacement AAOS Links

Total Hip Replacement
Total Hip Replacement Exercise Guide
Total Joint Replacement
Total Joint Replacement: Questions Patients Should Ask Their Surgeon
Total Knee Replacement

Total Joint Replacement AAHKS Links

Considering Joint Replacement Surgery