Things everyone should know before their surgery
- Dr. Kurtz gives everyone his personal email address and his nurse's email address. Email communications are appropriate for non-urgent questions either before or after their surgery like "can I have a refill on my prescription." Please be respectful this privilege and send only appropriate clinic questions or concerns through email. Emails are typically answered by the end of each day. If for some reason you do not get an answer within a day or two, please email us again or just call us. After surgery, patients can share pictures of their incisions or videos or their progress through email on their smart phones. These pictures can often save a patient from having to come in for a clinic visit. Urgent issues should be handled with a phone call to Dr. Kurtz's office or call 911, not email.
- Dr. Kurtz believes in shared decision making. There are many choices during surgery that are more about patient comfort than patient health and outcomes. One patients maybe more comfortable with choice A and another patient may prefer choice B. For instance, some patients may want a spinal anesthetic with or without heavy sedation; other patients may want a general anesthestic and breathing tube in their throat. Some patients may want a foley catheter during surgery so they don't have to get up to pee after surgery; other patients may want to avoid a foley catheter. Some patients may not want to do physical therapy after their hip replacement; others may want to do a lot of physical therapy. Some patients may want to go home quickly after surgery; other patients may need a longer stay and possibly a few weeks in inpatient rehab. Dr. Kurtz will try to accommodate all reasonable and medically safe requests.
- Most younger and healthier patients can usually go home within a day. Sicker patients may require 3 days and an inpatient rehab or skilled nursing stay. I try to get patients back into a normal routine and normal activities of daily living as soon as possible, but all patients are different.
- Every patient is expected to shower the day after surgery unless they are not medically stable enough to do so. All incisions are closed with dissolvable suture and a waterproof dressing. There are no staples or suture to remove. Most patients will remove their surgical dressing a week after their surgery. After that time, the incision will be healed enough to allow the patient to shower and allow the water to wash over the incision. Patients should not soak in a bath tub for three weeks.
- For routine joint replacements, Dr. Kurtz typically allows unrestricted activity immediately after surgery. However, patients should gradually increase their activity and avoid any rapid increases in their total cumulative amount of time standing and walking during a day. The bone around the joint replacement must get used to the stress of the implant pushing on the bone. This stress adjustment typically takes between 6 to 12 weeks. For the first week or two, many patient may want to limit their standing to 30 minutes to 1 hour total throughout the day. By four weeks, many patients can stand for 2-3 hours total throughout the day. By eight weeks, many patients can stand for 8 hours a day. When a patient does too much activity too fast, they may sometimes start limping and have increased pain for a few days. If you think back to when you might have worked out really hard at the gym, you typically felt fine the day you worked out, but two days later you could hardly even get out of bed. The same thing happens with joint replacements. When a patient with a new joint replacement does too much activity, they typically don't feel sore for a day or two. It is best to just avoid over doing it by gradually increasing your total cumulative time standing and walking.
- Most patients after a joint replacement will have poor balance and some weakness for a few days to weeks so they need to be careful walking to prevent falls. Walking aids like a rolling walker or cane are recommended as long as a patient is at risk of falling. When a patient is stable on their feet and not at risk of falling, the patient can walk without any aids. If your balance is altered, be safe and use the walker. The easiest way to mess up a prefect joint replacement is to fall down and hurt something.
- Patients are often tired and nap more after surgery. Building up your energy level takes a few weeks, but your energy level should return to normal by two to three months. Some patients experience a loss of appetite, which is typically a result of taking pain medications. Some patients will lose a few pounds.
- Patients can return to work whenever they feel they are ready. Often, starting back to work part time is preferable. The first week back to work is typically very tiring. Most patients can get back to desk work in six weeks and heavier lifting work by three months. Some patients go back to work in a week or two.
- Dr. Kurtz prescribes pain medicine after surgery, but not before surgery. He will continue the pain medicine for up to 3 months, but he expects patients to be off pain medicine by then unless there are some extraordinary circumstances. Most patients have switched off narcotic pain medication and onto just tylenol and possible an NSAID by 6 weeks. Patients must be off narcotics before they can drive. Their balance and coordination must be reasonably normal as well. This is usually about 4 weeks after surgery, but differs between patients.
- Every patient is expected to participate in their recovery. The surgery is only part of a successful joint replacement. Good communication with your therapist, Dr. Kurtz, and his nurse is critical to achieving your goals. Working hard at muscle strengthening and stretching is important before and after surgery.