Coming Home After Joint Replacement Surgery

Senior with walker entering home with help from in-home caregiver

For many of us, joint pain is the first signal that we're growing older. Historically, a deteriorating hip or knee could have meant the end of a senior's independence and active life. Not anymore! Joint replacement surgery is postponing the onset of disability and prolonging active life for more and more seniors each year. Go to the clubhouse of any golf course and you're likely to hear an older golfer happily announcing a return to the links with a new "bionic" hip or knee.

The Centers for Disease Control and Prevention (CDC) reports that the rate of joint replacement among older adults more than doubled in the decade between 2000 and 2010, and continues to increase. Each year, more than 300,000 older adults receive a total hip replacement. Almost 700,000 get knee replacements, making it the most common inpatient surgery in the age category. Our aging population, plus improvements in the surgery, are behind the increase, and many people are opting to have the surgery sooner rather than later.

What happens when these patients leave the hospital?

Today, with the rising cost of hospital care, there's a trend toward shorter hospital stays. The CDC reports that the average hospital stay after joint replacement now averages four days for hip replacement and a bit less for knee replacement. A shorter stay is not a bad thing, experts remind us. Seniors in the hospital are at higher risk of delirium, infections, disturbed sleep and blood clots from inactivity.

What's the next step? There was once the expectation that when joint replacement patients were discharged from the hospital, they would spend some time in an inpatient rehabilitation setting, such as a nursing home or sub-acute care facility. For some, this is still the best choice. But the CDC reports that an increasing number of joint replacement patients are being discharged directly home.

Is this merely a money-saving decision? A study presented at the 2017 annual meeting of the American Academy of Orthopaedic Surgeons confirmed that the cost savings for patients who recovered at home averaged $10,776. But beyond that, reported the study authors, recovery at home can be the healthiest choice for many patients, even those who live alone. "In the past, most surgeons have been reticent to discharge patients directly home after joint replacement surgery if they live by themselves, instead opting for such patients to enter a rehab facility," said Dr. William J. Hozack, an orthopedic surgeon at The Rothman Institute. "However, we found that patients living alone were able to safely recover without any increase in the rate of complications. Even more strikingly, patients were generally happy and content being in the comfort of their own home during recovery."

The study, titled "Even if You Live Alone, There Is No Place Like Home After Total Joint Arthroplasty," concluded, "Given the cost savings of in-home recovery, the emotional benefits of patients recovering in familiar surroundings, and no measurable difference in pain, complications or functional outcomes, we believe home discharge is appropriate for the vast majority of patients undergoing joint replacement."

Is home recovery right for me?

Home care worker helps client load the dishwasher

If you're considering joint replacement, talk to your doctor and rehabilitation team about whether recovering at home with outpatient or home physical therapy is the right choice for you. They'll want to know about the suitability of your home — a fourth-floor walkup apartment might not be workable, for example. Home medical equipment is available. Skilled nursing services can be provided in the home. But most of the help you’ll need will be assistance with your everyday activities — the things you do that you take for granted. Nonmedical in-home care — less costly than skilled home health services — can help bridge the gap between your hospital stay and full recovery. You might hire a caregiver to help with some of the things that will be temporarily difficult, such as:

Transportation. You shouldn't drive until your doctor says you've regained a safe level of strength, range of motion and reaction time. And you should never drive while under the influence of narcotic pain medications. Until you're cleared for driving, you might rely on friends and family for a ride to your follow-up appointments, rehab sessions and so forth … but that can get old! The cost of taxicabs and rideshare services adds up fast, and you might find yourself anxiously checking your watch, wondering whether the driver will show up on time. So remember that in-home care doesn't just happen at home. A trained, professional caregiver can provide transportation to your medical appointments and wherever else you want to go, and will know how to help you safely enter and exit the passenger seat.

Sticking to your home exercise routine. Rehab specialists tell us the success of in-home rehabilitation depends on how well the patient faithfully follows their prescribed home exercises. Yet fear and anxiety can keep a patient from using the new joint as recommended. In-home caregivers can provide the needed encouragement and supervision. Reports one patient, "The caregiver was right there in case I fell down. I never did fall, but I probably would have stuck to the couch just in case, if the caregiver hadn't been there."

Medication management. A patient might be prescribed pain medications, anticoagulants, antibiotics and other post-surgical drugs — added to medications for other health conditions. While nonmedical in-home caregivers aren't allowed to administer medications, they can remind you to take them, and be sure you can get your prescriptions at the pharmacy. You're in charge of your own medication regimen, but it helps to have someone reminding you.

Bathing, dressing, grooming and getting about. Most patients are up and on their feet by the time they get home from the hospital, but may need assistance with getting into the shower, getting to the toilet, and putting on shoes and clothing. Certain movements, such as lifting, bending or moving the joint at certain angles, are also off-limits until the patient gets the OK from the surgeon. The caregiver can help with tasks that require those movements, and can assist with a cane, walker, crutches, bathroom modifications and other adaptive devices and durable medical equipment.

Grocery shopping and preparing meals. Proper nutrition is important for healing, and keeping your bones strong, your energy level up and your digestive system regular. The caregiver can take you to the grocery store and prepare meals — or help you do so, if you like. "I wanted to bake a birthday cake for my granddaughter," recalls one former patient. "The caregiver and I did it together. She got out the pans I couldn't reach, and loaded and unloaded the dishwasher afterwards … oh, and she also shared the great idea to add some cardamom to the frosting!"

Housekeeping. It's a real mood boost to have your house clean and in good order. Occupational therapists recommend moving furniture around if necessary to create an unobstructed path to the bathroom and kitchen. The last thing a person who's just had a knee or hip replacement needs is to trip over a basket of magazines on the way to the bathroom! The caregiver can remove fall hazards, clean, vacuum, dust, do laundry, and assist with pet care.

The information in this article is not intended to replace the advice of your healthcare provider. If you have questions about recovery after joint replacement surgery, talk to your doctor.

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Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.