The Cedars-Sinai Institute for Joint Replacement has developed a detailed, daily recovery guide to help you quickly achieve recovery. Your participation in the recovery program is very important. Your CSIJR team specialists will monitor your medical condition and do the things you cannot do for yourself. It is important to us to make your hospital stay and experience informative for a faster and easier recovery. Listed below are the daily guides for each day of your recovery at the hospital:

• Day 1: After Surgery
• Day 2: Postoperative Day #1
• Day 3: Postoperative Day #2
• Day 4: Postoperative Day #3

• After surgery you will start on clear liquids then advance to a regular diet

• Every two hours while awake you will need to exercise your lungs (deep breathing)

• The head of your bed may be elevated up to 60 degrees for comfort
• Blood is drawn to evaluate blood count
• The nurses will check your blood pressure and temperature, and circulation, movement and sensation of your leg

• Discomfort after this procedure is normal. The pain medication may not take away all the pain, but it will make you comfortable so you can carry out necessary activities and rest.
• You will have pain medication ordered (shots, PCA-patient controlled analgesia, or epidural)
• If the pain medication is not working or you are nauseated, let the nurse know
• You will have an intravenous needle placed in your hand or arm to give you fluids and medication. You may also receive a blood transfusion.
• You may be started on a stool softener
• Antibiotics: a few more doses to prevent infection

• You may have a catheter in your bladder draining urine for the first 24 hours after surgery.
• You will wear the leg sleeves (SCDs) to help blood circulation and help prevent blood clots.
• You will have a regular pillow or triangle (abduction) pillow between your legs to promote normal body alignment and for turning.
• There may be a drain in your hip that will remove excess blood from your hip wound. The doctor will remove the drain in 24 to 48 hours.

• Do your ankle pumps for improving circulation.
• You will be turned from side to back to side every few hours for comfort and to prevent skin problems.
• You may be ordered out of bed this afternoon, in which case a physical therapist or nurse will start your hip exercise program, sit you up on the side of the bed (legs dangling) and take some steps as tolerated.
• Do your thigh muscle squeezes. Hold for 6 seconds then release.
• Do your buttock squeezes. Hold for 6 seconds then release.

If you had minimally invasive surgery, you may be going home today or tomorrow.

• You will be eating a regular diet. Be sure to drink plenty of liquids.
• Eat = Energy = Healing. Everyday your appetite will improve.

• Every 2 hours while awake, do your deep breathing exercises.

• Bathing and grooming with the nurse's assistance.
• Nurses will check your blood pressure and temperature every 8 hours or more, if necessary. They also will check the circulation, feeling and movement of the leg on which you had surgery.
• You need to continue using the abduction pillow or regular pillow between your legs at all times. The nurses will continue to turn you for comfort.
• You should continue to wear the leg sleeves while you are in bed.
• Blood may be drawn to evaluate your blood count.
• The staff will review any hip precautions with you.
• If you are not able to return to your own home from the hospital, a hospital social worker will see you today and work with you on plans for your discharge from the hospital.

• If you are tolerating liquids well, your intravenous fluids will be discontinued.
• If you have a drain in your hip, your physician may remove it. The nurses will continue to monitor the wound or dressing.
• If you have a catheter in your bladder, it will be removed today and you will start to use the bathroom.

• You should continue to take your pain medication so that you will be comfortable enough to participate in your daily activities and physical therapy program.
• After your third dose of antibiotics, the IV will be removed. If you are on a PCA, the intravenous will be discontinued when your PCA is stopped.

• The nurse will teach you how inject yourself with medication to prevent blood clots (if ordered by your surgeon).
• You will be set up with home care for physical therapy and occupational therapy if needed.
• You will be seen by the equipment company representative to discuss any equipment needs that the therapist feels you need for home.
• The nurse will go over your instructions for home care.

• Do your ankle pump exercises.
• Do those buttock squeezes.
• Do those quad sets.
• Exercise those arms to get them strong.
• Time to sit up! The therapist and/or nursing staff will help you transfer to the chair at least twice today. We suggest that you sit up for 30 to 45 minutes at a time.
• If a physical therapist started working with you on Day 1, he or she will continue with your program. Otherwise you will start your therapy today. The exercises actually help to reduce swelling, which makes your hip feel better.

• Assess the strength in your arms and legs.
• Determine your ability to move in bed.
• Teach the following exercises: 1) ankle pumps, 2) heel slides, 3) quad sets, 4) short arc quads, 5) gluteal sets and 6) hip abduction
• Discuss proper positioning and movements you need to avoid.
• Assist you in moving to a sitting position at the edge of the bed. If able, you will stand and sit up for 30 minutes.
  
• Provide you with a sheet of written instructions with your exercises and movement precautions.
  
• Assist you in learning proper gait training.

• Review positioning and movement precautions.
• Perform exercises that you did in the first session
• Sit up in a chair for 30 minutes.
• Review gait training.

• Your nurse or care partner will assist you with your exercises.
• If able, stand and sit in a chair for 30 to 45 minutes as you have been directed by your therapist.
  

If you had minimally invasive surgery, you will be going home today.

• Remember, EAT = ENERGY = HEAL = HAPPY HIP!

• Continue to do your deep breathing exercises. Keep those lungs clear.

• Sit up in a chair for all meals
• Use the pillow between your legs when turning to help remind you of proper hip and leg position (away from the midline of your body)
• Your nurse will review your home instructions, including Fragmin (blood thinning medicine) injections if your doctor has ordered them, and dressing care. Family members are encouraged to get involved.
• An occupational therapist will see you about your equipment and device needs to help you in the activities of daily living
• Home care for physical therapy and occupation therapy will be set up for you by the home care liaison nurse
• The equipment you need will be ordered and delivered to the hospital

• Continue to take your pain medication so that you will be comfortable enough to participate in your daily activities and physical therapy program

• Each day try and get a little farther down the "street." The goal is to increase the distance you can walk while becoming more independent with your walker. You will see an improvement each day.
• You should be sitting in a chair for all meals. You are encouraged to sit for 45 to 60 minutes in the morning and afternoon to help you regain your strength.
• Do those buttock squeezes. Do those quad sets and heel slides.
• The physical therapist and nursing staff will continue your hip program

• Review positioning and movement precautions.
• Assist you with your exercises. You may be given additional exercises.
  
• Assist you in getting in and out of bed, the chair and walking. You may advance from a walker to crutches, and the distance will be farther.
  

• Review positioning and movement precautions.
• Assist you with your exercises
• Assist you with getting in and out of bed and the chair and walking

Today is the day you get to go home.

• Regular diet. Drink lots of fluid.

• Keep working those lungs and do your deep breathing.

• Sit up in the chair for all meals
• Use the bathroom
• If you have not had a bowel movement, you should ask for a laxative or enema.
• Keep a pillow between your legs while in bed.
• Your nurse will review your home instructions, including Fragmin injections (if your doctor has ordered them) and dressing care. Family members are encouraged to get involved.
• The physical therapist and nursing staff will continue with your hip program.
• Occupational therapy will instruct you on your daily activities using handy gadgets that will be a great help at home.
• Recite your "do's" and "dont's" of positioning.

• You are encouraged to sit up for 45 to 60 minutes at a time to help you get strong.
• You need to walk around and gain strength.
• You need to lie down and rest during the day.

It has been our pleasure to work with you during your stay at the Cedars-Sinai Institute for Joint Replacement.