Coumadin (warfarin) is a blood thinner used to prevent the formation of blood clots in the legs following hip and knee replacement surgery. Coumadin therapy begins the night of your surgery and continues for one month. It is very important that the proper Coumadin dosing is followed and this will require testing your blood to see how much Coumadin in fact is present or how "thin" is your blood. The blood test will be checked daily while you are in the hospital and typically will be checked once a week following release from the hospital. The test is generally done at the hospital laboratory, who then calls and/or faxes the results to our office. One of our nursing staff will call you to confirm the proper Coumadin dose.

The average length of stay after both knee replacement and hip replacement is just over 3 days. Most of our patients spend between 3 and 5 days in the hospital, following which they are discharged to home. Some patients do stay in the hospital in a "swing bed" which allows some additional days of rehabilitation time and some patients go from the hospital to a nursing home for additional rehabilitation. Our joint replacement patients are typically scheduled on Monday and go home on Thursday.

All knee and hip replacement patients receive physical therapy twice a day while they are in the hospital. All knee replacement patients receive physical therapy after discharge from the hospital. The length of physical therapy varies between 2 and 6 weeks, depending on each individual patient's progress and need. Hip replacement patients generally do not require formal physical therapy following hospital discharge.

We ask that patients keep the incision dry by covering it until the staples are removed, which is generally 10 to 14 days following surgery. Showers may be taken, however, once a patient is able to stand safely and independently.

The amount of weight on the leg is determined by the technique of fixation to bone of the knee or hip prosthesis. For most of our patients we encourage full weight bearing immediately following surgery. This includes all of our knee replacement patients. Some of our hip replacement patients who have an uncemented prosthesis, will be asked to put partial weight on the leg for 6 weeks following surgery.

A prescription for pain medicine will be given to you, prior to the date of your surgery so you can get it filled and have it available at home. It is likely that you will need additional pain medicine once that prescription is finished, and we will refill that on a case by case basis.

Driving a car after knee or hip replacement depends on a lot of factors. The side of your surgery certainly makes a difference, as well as whether you are driving an automatic or manual transmission. Patients with left knee or hip surgery, and who are driving an automatic transmission, need to be able to get safely in and out of a vehicle. Patients who have right knee or hip surgery take a bit longer to recover well enough to be safe operating the brake and accelerator foot pedals. I would estimate that it takes approximately 6 weeks for most patients to return to where they function well enough to be safe driving a vehicle.

We recommend that for 2 to 3 weeks following the surgery you do not lie on your surgical incision, to allow the wound to heal completely. Thereafter it is primarily an issue of pain and discomfort when lying, but the wound should be healed well enough to allow you to lie in whichever position you wish.

The knee immobilizer is used in order to keep you out of a position where the hip might dislocate. It is intended to be worn at night or when sleeping, but does not need to be worn when you are awake and certainly should not be worn while attempting to walk. We ask that the immobilizer be used for 6 weeks following the surgery to allow time for the wound and soft tissue to heal fully.

The white support stockings or TED hose are worn to provide compression on the leg to help keep down the swelling and help to prevent blood clots. We wish for you to wear these stockings on both legs for 2 weeks and on the operative leg for 4 weeks following surgery. The stockings may be removed twice a day for approximately one hour each time.

You are certainly welcome to call at any time if you have a question or feel that a problem is developing following your knee or hip replacement. Our nursing staff is quite capable of handling most questions during the work day and we would encourage you to use them as a resource. Any questions with which they are not comfortable, they immediately seek consultation with the physicians and/or physicians assistant.

All patients will initially begin walking with physical therapy, during the hospitalization, using either crutches or a walker. How long you need to use each of those varies with each patient and the specifics of their hip or knee replacement.

The length of time off of work following hip and knee replacement varies depending on the type of work to which you will have to return. Return to sedentary work is usually possible after one month. More physical work may require 6 to 12 weeks of time away from work.