If you or a loved one is having a major joint replacement surgery (knee, hip, or shoulder), there is a good chance that a few days after surgery you will be sent home rather than to a rehabilitation facility. This is because a mounting body of evidence in the medical literature suggests that a patient’s home is just as safe as a rehabilitation facility, and patients much prefer to recover at home. Homes are not designed as medical facilities, but there are several things you can do to adapt your current living arrangement into a comfortable and safe recovery space.
The pre-op appointment
The planning process begins in the surgeon’s office, at the time that you and your physicians decide to move forward with joint replacement. During this visit, a lot of time is taken up describing the procedure, the location of scars, and the anticipated recovery time. The surgeon is also likely to tell you whether you are expected to go home or to a rehabilitation facility. This decision depends on a number of factors, including your past medical history and your particular health risks following surgery. However, if you are like most joint replacement patients, the surgeon will recommend that you go home. If such a discussion does not take place at the pre-op appointment, you or a loved one should ask!
Role of the discharge planner
Most patients are admitted to the hospital on the day they are to have joint replacement surgery. This means you are likely to go directly to the pre-op waiting area to be prepared for your procedure. Following the surgery, one of the first people you are likely to meet will be a nurse from the discharge planning department. The discharge coordinator is responsible for helping you and/or family members get your living space ready for your return in a few days.
Even if you or your loved one lives alone, there is a good chance that the living space can be adapted for a patient coming home from joint replacement surgery. Much depends on the navigation around the living space: access to a place to sleep, to the bathroom, kitchen, etc. Many patients, especially those undergoing hip or knee replacement, will require a commode, at least in the early stages of recovery. Any kind of durable medical equipment you may need will be noted and ordered for you so that it may be delivered when you go home. Safety is a major priority. If, on the basis of discussions with the discharge coordinator, it becomes clear that you cannot return safely to your own home, arrangements may be made for transfer to a rehab facility.
Role of skilled home nursing and physical therapy
Nurses and physical therapists (PT) are always present on the orthopedics floor in any hospital. But there are also teams of skilled nurses and physical therapists specially trained to help you recover at home. Nursing and PT visits will be arranged with you prior to your going home from the hospital. The nurses will likely check your surgical sites and change dressings. Physical therapists will help design exercises for you, often immediately upon return home. The faster you get a new joint moving, the quicker you will recover.
Role of technology
Until recently, your physical therapist would write down exercises on a piece of paper, or at best would hand you a worksheet with diagrams describing how to exercise your new joint. Today, there are a number of smart phone applications that provide video instruction regarding exercises, as well as logs for recording improvements in mobility and for monitoring pain. Importantly, these apps cue patients as to when they may need to contact their physician. Early warnings such as these can help prevent post-surgical problems before they become serious.
Reducing the risk of readmission
The goal of any joint replacement surgery is to return the patient to the fullest possible degree of physical functioning. Nevertheless, post-surgical complications occur, requiring readmission to either an acute care hospital or to a rehabilitation facility. Most common among complications are infections and blood clots. Careful monitoring by visiting nurses can help catch infections early and can check for early signs of blood clots. The physical therapist can help ensure that the new joint is functioning properly and can help the patient avoid dislocating or loosening the new hardware.
By the book
Many hospitals have developed specially tailored books for the patient to take home. These valuable resources detail ways to prepare your living space, how to minimize the risk of falls, and what to do quickly in the event of a problem. Together, all these innovations and technologies can help speed recovery from a joint replacement and get you back on the road to recovery, literally and figuratively.