Post Operative Period

The white stockings are designed to be worn on both legs after your surgery. They are used to reduce the risk of blood clots, and a part of the risk reduction strategy, which includes the post operative blood thinners (ie Aspirin twice a day), and the foot pumps that are on your feet when you wake up from surgery. Having said that, sometimes, they can be overly uncomfortable, or too difficult to put back on after a shower. If this is the case, then you can remove them. They are designed to ideally be worn on both lower legs for a period of 2 weeks. Ensure that the top of them are not cutting in to your skin, especially after a knee replacement. When you get to 2 weeks post op, you may remove the white stockings.  

Driving is allowed once you are walking with at the most, a walking stick, and when you are not taking any of the sedating pain medications (ie Palexia or Endone). Usually we allow this after your first post operative appointment, but if you really need to drive, then please send me an SMS and let me know how you’re feeling, and if you fulfil the criteria above, then in general, I will let you drive – 0448 898 898

You may still take the Palexia/Endone or similar at nights before bed, as long as you don’t drive until the next day. The reason for this is for insurance purposes, as any accidents whilst you are under the “influence” of sedation analgesia will render your insurance void if an accident were to occur. 

Within your surgery paperwork, our team would have given you a date for your post operative appointment. This normally is scheduled for 2-3 weeks after your surgery. In some cases, it might be longer than this, in which case, an individual plan will be given to you – especially around Christmas time and during office closures. 

During your first appointment with us you will attend with our Nurse who will check your wound, and redress the area with a material called Hypafix. This is a breathable dressing that you may get wet. You would just pat it dry, rather than rubbing it dry, and it will fall off on its own thereafter after at least a few days. It is just there to help protect the area after the surgical dressing is removed but usually the wound has mostly sealed by then. I will also come to review you to ensure that you are doing well, and answer any questions you may have, and just check in on anything you need. 

If you need more analgesia, we can do this without you need to drive to see us. Just complete this form, and we will send the script to the pharmacy you select where you can then collect the medication from. Our team will advise you by SMS/Email when the script has been sent. Please note that we can only give scripts for the first 4 weeks post op this way. 

REGULAR

As a starting rule, we normally start with Panadol regularly. This would then be:

• Panadol (Paracetamol) 1g (which is 2 tablets of 500mg), 4 times per day. Or if you would prefer Panadol Osteo, you should only take this 3 times per day as each tablet is 625mg, rather than 500mg. 

NIGHT

I would then recommend taking something a bit stronger at night. This could be: 

• Endone 5mg (1 tablet), half an hour before bed; OR
• Palexia 50mg (1 tablet), half an hour before bed. 

WHEN REQUIRED

Then throughout the day, if required, you can take:

• Endone 5mg (1 tablet) at most 4 times per day, AND/OR
• Palexia 50mg (1 tablet), 4 times per day
• Or an alternative which you may have used if the above was not useful for you, or if you had allergies to those medications in hospital. Alternatives include: Tramadol, Panadeine Forte. 

You should aim to reduce the WHEN REQUIRED medications as soon as you can. If you were prescribed any LONG ACTING pain medications, this will stop once you have completed your script from hospital, as we cannot prescribe this any longer. 

A good strategy is the reduce the daytime opiate analgesia first (ie reducing the Endone and Palexia) and then continuing the regular Panadol and night time medications as you see fit. Once you are comfortable at night, you can then reduce that until you are off everything. Each person will have a different journey here, so don’t try to follow anyone else’s regimen. 

After your surgery, we normally increase your anticoagulation to prevent blood clots. In normal situations, Aspirin (usually 100mg) is given twice a day. This is to continue for 4 weeks post op. Aspirin can cause some irritation of your stomach so we will normally start you on a medication that reduces the side effects of Aspirin on your stomach. This is called Pantoprazole (Somac) or similar. 

For those people who are at high risks of clotting (ie have had a blood clot before, elevated BMI, current cancer, strong family history of clots, or otherwise being advised by our physician team), you may be placed on a stronger blood thinner (ie Xarelto, Eloquis, Apixaban) which we will tailor for your specific requirements. Our physician team (Dr Woo or Dr Khow) will handle this and advise how long you need to take it for.

In general, the first 2 weeks should just be walking, and getting comfortable. There are no real restrictions. In particular:

For HIP REPLACEMENTS: You can move as you wish. Traditional restrictions such as no bending down, no lying on your side, and no normal toilet seats or chairs DO NOT apply. You can move as you wish. Anything that is comfortable is allowed. If it hurts, then you should not repeat the movement. If it’s just a bit stiff, then you can keep going. Remember, the first few steps is always a little stiff when you get up. Work through that, and walking improves as you walk further. 

For KNEE REPLACEMENTS: Try to regulate your walking and exercises with the swelling. The main aim is to reduce the swelling around the knee as quickly as possible. If you do too many exercises, the knee will swell and impede the range of movement recovery. Focus one short walk, regularly, and then icing the knee down, and practicing the knee bending whilst sitting in a chair, and knee flattening when lying in bed like we showed you in hospital. You DO NOT need to do any muscular strengthening exercises or similar during the first few weeks. 

We do not prescribe defined exercise regimens because everyone is different. I believe in a more tailored approach which our physios will help you with whilst in hospital. The hospital sheet of exercises is a guide only.

Lifting your leg in and out of bed for both THR and TKR post op can be difficult to start with due to the muscle swelling, and deactivation. It will come back! Just ice down the leg to reduce the swelling and that function recovers on its own. The main goal for the first few weeks is safe walking, and swelling control. Specifically:

For Total HIP replacements – you can be quite lazy with your exercise movements. The main focus is walking, and trying to ensure you’re not walking with a limp. This means shortening your stride length, using the stick (IN THE OPPOSITE SIDE TO YOUR SURGICAL SIDE – unless you are a bilateral patient), and slowing your walking pace down. You DO NOT need to be doing a great deal of the knee lifts, and abduction exercises. Many short walks are preferable.

For Total KNEE replacements – the main focus for the first 6-8 weeks is range of movement and swelling control. Focus on getting the knee straight whilst lying in your bed or on the floor, and then focus on on bending your knee whilst sitting in a chair (whilst using your other leg to help pull your operated ankle back). It is difficult for the first 2 weeks to bend your knee whilst lying in the bed. Do not worry – this is normal.

As much as you like! A couple of bags of frozen peas cycling through the freezer is normally quite effective. You should be at most, using the ice on and off throughout the day. The regimen is not strict, but a good starting point is to ice the most swollen areas down every 2 hours for approximately 30 minutes each time, or until the ice has melted. Whilst you do not have to use ice, it can be very useful in reducing the swelling, which is where a lot of the discomfort comes from. You will feel that the quadriceps area (front of the thigh) is often the most swollen area for both hip and knee replacements, so icing this area can help a lot with the discomfort. 

During the first few weeks, you would already have been given gentle exercises to perform whilst you were in hospital. These are the same exercises that you would continue for a period of 2-3 weeks post op. There is no need to perform additional exercises during this time, as your focus is on swelling control and walking safely. 

Specifically:

For Hip Replacements: 

Ensure that you are walking safely with a walking frame/stick. There is no need to see a physio after you leave hospital for the first few weeks, as we are just allowing your body to reduce the swelling naturally. If you did want to see a physio, it is important not to perform too many muscular strengthening exercises during this time period. The focus should be on establishing your walking pattern, to enable you to walk without a limp. A limp to begin with is very common, but you should focus on decreasing your stride length, and walking pace, to give you the best chance to walk without a limp. Once the swelling decrease, your walking pace will increase naturally. 

For Knee Replacements:

Focus only on range of movement and swelling control. We do not need any dedicated physiotherapy after you leave hospital for the first 2-3 weeks. This is to allow time for your body to reduce the swelling first, and for you to make progressive improvements in range of motion. Our goal is to reach a situation where you are able to get your knee fully flat, and your knee bent to at least 90 degrees by 2 weeks. A few degrees extra each day will normally get you there. Feel free to organise to see a physio a few times after your first post operative appointment with us, as they are useful in guiding your progress and giving you harder exercises along the way. 

YES, you can sleep however you like. There are no restrictions after both hip and knee replacement surgery with our methods. Most people will prefer to have a pillow between their legs when lying on their side after both hip or knee replacements. This reduces the pressure on the soft tissues. 

When able, you are able to lie on your operated side as long as you feel it is comfortable. Anything that hurts you should not be continued. 

If you feel that something is wrong, or you’re worried about something, then let me know! Please SMS me at ANY time on 0448 898 898. It’s my personal mobile number, and the one I use to SMS you after the surgery. Send me photos or concerns as you need. Otherwise, we will see you at the post operative appointment!