• Your Hospital Experience

  • Admission to the Hospital

    It’s normal to feel nervous when you arrive at the hospital. But rest assured, knee and hip replacements tend to have very good results. The hospital staff will do whatever they can to answer your questions and make the day easier on you. Here is what you can expect on the day of your surgery.

    • You will change into a hospital gown and your clothes will be put into a bag for storage until after your surgery.
    • A nurse will take your vital signs. You will be asked questions regarding your name, health history, and allergies many times prior to your surgery. These questions are very important for the physicians and nurses to be sure they have identified you and your procedure correctly.
    • You will be asked to sign a consent form for surgery.
    • An intravenous (IV) line will be placed in your arm.
    • You will meet your anesthesiologist, who will talk to you about the type of anesthesia you will receive. He or she will discuss your health history in order to determine what is best for you.
    • You may be given general anesthesia. This means you will be unconscious. You will have a breathing tube in your throat that will deliver the anesthesia. Your throat may feel a little sore after surgery from the tube.
    • You may be given another type of anesthesia called a spinal or epidural. This is delivered as a shot in the lower back, and it numbs you from the waist down. You will also receive IV sedation to help you relax throughout the procedure.
    • You may receive both general and spinal anesthesia.
    • Depending on your surgeon, first-time (primary) joint replacements take about two hours. Second-time (revision) joint replacements are more complex and tend to take between two and four hours.
    • After surgery, you will be taken to the Postanesthesia Care Unit, or the PACU, for recovery. Your surgeon will go to the main lobby to discuss the surgery and your condition with your family. In the PACU, your vital signs will be monitored closely and your dressing (bandages) will be checked. Your circulation and nerve function will also be monitored.
    • After your recovery in the PACU, you will be taken to the hospital’s Orthopedic Unit.
    • Please designate one person as the family spokesperson who may call nursing for condition updates throughout your stay. The hospital phone number is 909.985.2811.
    • Visiting hours are 6 a.m. to 8 p.m. Our nursing units observe quiet time between 2 to 4 p.m. each afternoon. During this time, visitors are encouraged to take a break in the Café and allow patients to rest.

    Pain Control After Surgery

    Joint replacement surgery is painful, but it is a different type of pain than what you have been feeling. The good news is that the discomfort should lessen greatly over the first several days.

    • Total knee patients: In most cases you will receive a continuous regional nerve block during surgery. This is called a femoral nerve block and it will be inserted by the anesthesiologist. You will have a thin tube inserted into the upper thigh that will constantly deliver the medication to your knee. The medication will be in a balloontype pump filled with a local anesthetic, which will be in a black bag-type carrying case. It will help control pain to the front part of your knee for a few days after surgery.
    • Total knee patients: Surgeons may request that the anesthesiologist give a sciatic nerve block to control pain in the back of the knee. It may cause you to feel as though your leg is “heavy.” This lasts for about 12 to 24 hours. Your physical therapist may have you stand while your leg feels this way, but he or she won’t ask you to walk until you can flex your ankle.
    • Pain medication will be given to keep you comfortable. At first you may receive medication through your IV, then you will take it by mouth.
    • It is important for you to work with your surgeon and nurses on controlling your pain. When you maintain a tolerable pain level you:
      • — Move better, which is important for your rehabilitation.
      • — Breathe deeper, which will help prevent any lung complications.
    • You will not become addicted to pain medications because as your pain decreases, your medication will be reduced as well. If you are in pain, let your nurse know!

    Your Incision

    • Your incision will be closed with staples, surgical glue, or sutures. These will be covered with a thick, bulky dressing.
    • Your incision will be vertical and about 4 to 6 inches long. If you had previous surgery, the surgeon may use the prior scar.
    • When healed, the scar will be red for 6 to 12 months, then it will fade to a thin white line.
    • Some numbness around the scar is normal.
    • Postoperative swelling and warmth around the incision will last for several months.

    Descriptions of Pain

    No pain or discomfort.
    1 or 2
    Minor pain or discomfort; does not interfere with participation in activities or interactions with others.
    3 or 4
    Somewhat limits or prevents participation in activities; limits ability to concentrate or interact with others; interferes with appetite or sleep; causes irritability.
    5 or 6
    Interferes with restful sleep; decreases appetite; increases heart and breathing rates, blood pressure, muscle tension, and irritability; causes nausea and depression over time; causes a desire to withdraw or severely limits interactions with others.
    7 or 8
    Continuous or frequent, even when still or at rest; causes increased breathing, heart rate, blood pressure, and muscle tension; prevents or seriously limits participation in meeting own basic needs; causes an inability to sleep or eat; prevents concentration and focus; causes depression and desire to isolate oneself from others.
    9 or 10
    Worst pain ever experienced or imagined; intolerable pain that interferes with all aspects of life; complete incapacitation that requires immediate medical evaluation and intervention.

    Using an Incentive Spirometer

    Working with an incentive spirometer helps keep your lungs clear. It also strengthens your breathing muscles and helps prevent health problems such as pneumonia. For best results when using an incentive spirometer, follow the steps below.

    1. Sit up and hold the spirometer upright. Make sure you do not tilt it.
    2. Relax as you breathe out. When you have exhaled fully:
      • Place your lips around the mouthpiece.
      • Be sure your lips create a tight seal around the mouthpiece.
    3. Inhale slowly and deeply. When your lungs feel full, note the volume level reached on the spirometer. Hold your breath until the ball or disk has been raised for at least three to five seconds.
      • Inhaling too quickly may set off an audible tone. If this happens, inhale more slowly.
    4. Remove the mouthpiece. Exhale slowly. Take a few breaths, then repeat the exercise.
      • Do 5 to 10 repetitions. Aim for the goal set by your healthcare provider. Try to reach a higher volume level on the spirometer with each breath.
      • Perform this exercise every hour while awake or as often as directed.

    Daily Post-Op Activities

    Day of Surgery
    You will be on bed rest the day of your surgery, but your physical therapist (PT) may work with you later in the day. He or she may have you sit up on the side of the bed, stand, and then walk a few steps. It is not unusual for you to feel lightheaded, weak, and sometimes nauseated the first time you get up after surgery.

    Post-Op Day 1
    The next day your PT will teach you how to get out of bed, transfer into a chair, and how to use a walker. Your PT will work with you twice a day, morning and afternoon. During this time:

    • You will continue to be repositioned while in bed.
    • You will have pain medication that is adjusted for physical therapy.
    • You will be encouraged to do your exercises as often as possible.
    • You will do your deep breathing frequently and use your incentive spirometer ten times an hour.

    Your nurse will assist you with a sponge bath. He or she will also provide you with the items you need for self-care.

    • We encourage and welcome your family to assist with your self-care.
    • Your surgeon will determine if it is okay for you to shower. In most cases, however, you may shower after you have been discharged from the hospital.

    Post-Op Day 2
    The goal of the second day after surgery is to prepare you for discharge. This may happen after your surgeon and PT determine you are physically fit to return home. During this day, you’ll also:

    • Walk with assistance from your nurse, as soon as the PT clears you.
    • Learn to transfer to the commode or raised toilet seat.
    • Be encouraged to participate in your own self-care.
    • Learn to walk up and down stairs.

    Post-Op Day 3
    Your surgeon may discharge you on the third day post-op depending on your progress and readiness to go home. The surgeon may also recommend that you go to a rehabilitation facility for a short time for more extensive physical therapy before you return home.