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o r t h o pa e d i c c a r e

Preparing for

Joint Replacement Surgery

Table of Contents

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1 General Information HealthEast Joint Replacement Program..........................2 Your Orthopaedic Team....................................................3 Joint Replacement Time Line....................................... 4-5

Millions of people are treated for arthritis pain each year. It is hard to do your everyday work and tasks when your joints hurt. Total joint surgery is one way to alleviate some of the pain of an arthritic joint. What you do before and after surgery can help get you back on your feet sooner. There are things you can do to keep from having problems related to the surgery. This book helps you prepare for surgery and heal faster.

2 Preparing for Surgery Getting Your Body Ready..............................................6-7 Developing a Plan for Going Home..................................8 Getting Your House In Order........................................ 8-9 Home Safety................................................................. 9-11 Getting Ready for Your Hospital Stay............................ 12 Showering Instructions.............................................. 12 My Checklist.....................................................................13

3 While Your are in the Hospital Surgery Admit Unit......................................................... 14 Recovery Room.......................................................... 14-15 Activity after Surgery................................................. 15-16 Pain Management....................................................... 17-18 Preventing Complications.......................................... 18-19 My Checklist.....................................................................19

4 Home Instructions Incision Care....................................................................20 When to Call your Surgeon............................................21 Managing Pain....……………………………………………..21 Commonly Asked Questions.....................................22-24 My Checklist.....................................................................24

5 Additional Resources HealthEast Home Care....................................................25 Outpatient Therapy.........................................................25 Therapeutic Equipment..............................................26-28 Web Sites.........................................................................29 Food Guide Pyramid.......................................................30 Exercises Hip................................................................................31 Knee.............................................................................32 Glossary...........................................................................33

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General Information

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Congratulations! Your decision to have joint replacement surgery is the first step to regaining a more active and independent lifestyle. You will have the best results if you plan ahead and actively participate in the whole process. This book contains information about: • What you can expect before, during and after surgery • Getting you body ready for surgery • How to be organized and equipped for you home recovery • How to manage your pain • How you can help prevent complications • Services and resources that my help you after your hospital stay We’ve included a checklist at the end of sections 2-4 to help you prepare for your surgery. Be sure to bring this book with you to the hospital. We will be adding to it. Remember this is just a guide. Your doctor, nurse or therapist may add to it or change some of the recommendations. Keep this book as a handy reference for at least the first year after your surgery. If you have questions, call the nurse educator at: 651-326-7650. HealthEast Joint Replacement Program

Your Responsibilities as a Joint Replacement Patient

• R  efer to this book to help you learn about your care. • A  sk questions about anything you do not understand. • L et the team members know about any concerns. • D  o as much for yourself as permitted, before, during and after your hospital stay. This will help you stay as independent as possible.

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Here at HealthEast we have a unique and exciting recovery program designed specifically for patients in need of a hip or knee replacement. This program, called Joint Camp or Joint Journey, focuses on a wellness approach to joint replacement. Some of the key features of this program include: • Education for your family and friends on how they can participate and guide you during your recovery. • Individualized care from nurses and therapists who specialize in caring for joint replacement patients. • A wellness philosophy We introduce normal activities as soon as possible. This includes getting you out of your hospital gown and into your own clothes. So be sure to bring sweat pants or other loose fitting items such as shorts or skirts and tops. You should also bring comfortable shoes such as tennis shoes or sneakers.

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Your Orthopaedic Team

There will be many health professionals to help you before, during and after your joint replacement surgery. It is important for you to be an active partner in that team. The following members of the Orthopaedic Team will be caring for you: Orthopaedic Surgeon

• Assesses your need for surgery • Performs your surgery and directs your care • Visits you in the hospital (this will be done by your surgeon or his/her partner) • Evaluates you at follow-up appointments Primary Care Physician/Internist

• A ssesses your medical condition in preparation for your surgery • Performs pre-admission testing for your surgery • A ssesses your medical condition during your hospital stay Social Worker

• Identifies discharge needs • Coordinates your discharge plans with your nurse and physical therapist • Makes arrangements for continued care after discharge • Assists with questions you may have about insurance and financial concerns. Nurse

• The registered nurse (RN) delivers direct nursing care and provides supervision for Patient Care Assistants (PCA’s) Physical Therapist

• Evaluates your physical abilities and home needs • Assists you with an exercise and walking program • Provides instructions for home activity Occupational Therapist

• Teaches you how to handle day-to-day activities following surgery • Demonstrates temporary life-style changes that are needed

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Joint Replacement Timeline Getting My House in Order

Start

u

u

I’ve decided to have joint replacement surgery! I need to go to class!

Who will stay with me?

Consider rehabilitation options

Safety-proof home

In the Hospital

u u

Walking, stairs, transfers, home equipment and instruction

Increase sitting and walking

Pain control and devices to prevent complications

At Home

u

u Discharge home (or extended care if needed)

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Physical therapy Follow home exercises and precautions

Appointment with surgeon at 10-14 days; staples out

Improvement continues for up to a year

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Getting My Body Ready

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u Dental work up to date

Physical exam, review of medications

Hibiclens showers at home

u

In the Hospital

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u Therapy starts Sit up Stand Exercise

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Surgery

Anesthesia: general or regional

Finish I can be more active than I have been in years! 5 3

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Preparing for Surgery

Getting Your Body Ready

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Health Exam

Before surgery you will need a physical exam to be sure you are in good health. • See your family doctor 3-30 days before surgery. IMPORTANT!

• Your doctor will do some blood tests.

About 2 weeks before your surgery you need to call your doctor. Ask him if you are taking any medicines that “thin your blood”

• Your doctor may do a heart test (EKG) at this time. • A sk your doctor about your medications. Bring a list of all medications you are taking. Include any vitamins, herbal remedies or over-the-counter medicine that you take regularly. You can use the My Medicine list included in the back of this book. Some medicines need to be taken the day of surgery. Some medicines should NOT be taken the day of surgery. Some medicines should be stopped for a period of time before surgery (see box at left). Your doctor will tell you what medicine to take and what to stop taking.

• m  ost times it will be important to STOP any medicine that thins your blood for a period of time before having surgery. • t hese medicines can cause extra bleeding during and after surgery. • a ny changes or adjustments to these medicines should be done only with a doctor’s direction Items that thin the blood are:

• Aspirin • Ibuprofen (Advil, Motrin) • A  nti-inflammatories (Aleve, Naprosyn) • Fish oil • Vitamin E • H  erbal Medicines (Gingko, Glucosamine, etc) • Blood thinners (Coumadin) • Anti-platelets (Plavix)

• A nurse will call you 1-2 business days before you surgery. She will ask you questions about your health (surgeries, illnesses, etc.) and if you have any allergies. She will also ask you to tell her all the medicines you take. It is very important to talk with you doctor about all of your medicines before surgery. Controlling your arthritis pain is very important. Tylenol may be used to help manage your pain. If Tylenol is not effective, call your surgeon or family doctor for a prescription. Dental/Medical Procedures

Make sure your dental work is up to date before surgery. From now on, you should tell your dentist and other doctors about your joint replacement if you need dental or medical procedures. Any procedure causing bleeding or trauma may allow bacteria into the bloodstream. These bacteria may travel in the bloodstream to the new joint causing serious infection. This is rare but you should inform doctors and dentists before any procedures. The doctor may recommend you take antibiotics before and after the procedure. Nutrition

Good nutrition is important for healing and helps prevent infection. The following are tips to keep in mind before and after surgery:

Before surgery:

• Eat nutritious foods. • Choose foods from all food groups.

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• Eat fruits, vegetables, and whole grains. Foods high in protein are important. Try lean meat, chicken or fish. Protein is also found in beans, peas, and nuts. Include dairy products, such as low fat milk, cheese and yogurt. Avoid processed snack products and soft drinks.

Getting Your Body Ready (cont)

IMPORTANT!

• Calcium is very important.

I f you are overweight, meeting with a registered dietitian or attending the Woodwinds Ways to Wellness program is suggested to help you lose weight. Excess weight will put an undue burden on your new joint. Losing weight will improve the outcome of your surgery. For more information about Ways to Wellness call 651-232-1926 .

• If you do not tolerate dairy products try soy milk or rice milk. • Ask you doctor if you should be taking a calcium supplement. • If you need to lose weight now is not the time to restrict calories. Choose healthier foods. • Do not restrict calories for a quick weight loss before surgery. • If you are missing nutrients in your diet talk to your doctor. He may suggest taking a multivitamin.

After surgery:

• You will start with a clear liquid diet. Solid foods will be added as you return to your usual diet. – Tell  your nurse if you have special food requests. • Eat slowly after surgery.  – You  may not be able to eat as much as you normally do at one meal. – S nacks are available. • Eat nutritious foods. – C  hoose foods from all food groups. – Eat  fruits, vegetables, and whole grains. Foods high in protein are important. Try lean meat, chicken or fish. Protein is also found in beans, peas, and nuts. Include dairy products, such as low fat milk, cheese and yogurt. Avoid processed snack products and soft drinks. • Do not restrict calories after surgery. – Y  our body needs adequate nutrition to promote healing. • To avoid constipation, increase fiber in your diet. – H  igh fiber foods include fruit, vegetables and grains. – D  rink plenty of fluids. – T  alk to your doctor if you become constipated.

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Developing a Plan for Going Home

A HealthEast social worker will meet with you during your stay in the hospital. In consultation with your doctor, she or he will help you create a plan for when you leave the hospital. Your health care team will help decide what (if any) skilled help is needed. Call your insurance company before surgery. Ask what services are covered during your recovery. Home

Many people return to their home after 2-3 days in the hospital with the support of family, friends or neighbors. To help you continue with your rehabilitation efforts, your doctor may order the following resources: • Home  Physical Therapy: A physical therapist comes to your home and helps you continue the therapy initiated in the hospital. • Outpatient  Physical Therapy: You continue your physical therapy at a rehabilitation center in your area until you are recovered. A social worker can help verify insurance coverage and arrange for these and other home services to help you. Rehabilitation/Extended Care Facilities

At times, it is necessary to go to a rehabilitation facility for a short time before you return home. Choosing which one depends on your preference and your insurance coverage. A social worker will help with these arrangements.

Getting your House in Order

Arrange for help at home.

Start looking for someone to help you when you go home. Most people can go back to their own home 2-3 days after surgery. But for the first couple weeks you will need someone to: • drive for you. • take care of your pets. • help with housework. • help with cooking. • help do your shopping. Plan to stay primarily on one level of your home when you first get home.

If you have many stairs in your home, consider ways you can rearrange things to make them more manageable at first. For instance, if a bathroom is not accessible on the first floor, a commode may be ordered.

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Getting your House in Order (cont)

Plan ahead for your meals.

Talk to family and friends about helping with meals or make sure you have easy-to-prepare items on hand. Meals on Wheels can be ordered if needed. Identify equipment you already have available.

You may need items such as a cane, crutches, a walker, raised toilet seat, shower bench, or reacher. If you already have them you will not need to obtain them at the hospital. Obtain supplies for changing your dressings.

You will need 4 inch square bandages and paper tape, available at drugstores. Handicapped Parking Permit

You may want to apply now for a temporary handicapped permit to use after surgery. An application is included in the pocket of this book. Your doctor’s signature is required. Home Safety

It is a good idea to have your house ready for your return before you have surgery. Some simple changes will help prevent falls. These tips can make your home safer and make it easier for you to do your daily activities: Emergency

• P ut working smoke detectors in each bedroom and kitchen area. • K now what to do in case of a fall or medical emergency. Floors To prevent tripping:

• Repair or replace torn carpeting. • Make the transition between types of flooring (such as carpet to wood floor) as even as possible. • Keep floors and stairs free of clutter. • Remove throw rugs. • P ut nonskid pads under area rugs, or secure edges with double-backed tape.

To prevent slipping:

• Avoid waxing wood or linoleum floor.

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Home Safety (cont)

Stairs

• Install handrails by stairs, and replace handrails that are not sturdy. • Place nonskid treads on wooden stairs to prevent slipping. • Secure carpeting on stairs by tacking carpet firmly to each step. Living Areas

• Arrange furniture so pathways are not cluttered. • Place sturdy pieces of furniture along the pathway for support. • Chairs and tables need to be sturdy and stable enough to support a person leaning on them. • Remove glass tables and furniture with sharp edges or corners. • Chairs with armrests and high backs provide more support when sitting and more leverage when getting in and out of a chair. • P ut a sturdy table next to your chair to hold things you use often. • Tables with four legs are more stable than pedestal type tables. Sleeping Area

• If possible adjust the height of the bed so your feet touch the floor when you’re sitting on the edge of the mattress (about 24 inches). • Put a sturdy table or nightstand within reach. • Keep a phone and list of emergency numbers on the table. • Never smoke in bed. Lighting

• Have emergency lighting (flashlights) readily available. • Light switches should be located by each door of the room. • Be sure the house has enough lighting to see all walking areas, especially hallways, stairs, and bathroom. • Put a night light along the passage to the bathroom.

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Home Safety (cont)

Medications

• Keep medications out of the reach of children. • Do not keep medications in the bathroom. • Be sure to have adequate lighting when reading medication labels and instructions. • Dispose of medications that have expired or you are no longer using. Entrance Doors

• Put bright lights over front and back doors. • Oil or replace locks and handles if difficult to open. Bathroom Safety

• Toilet – U  se an elevated toilet seat or commode if you need support getting on and off the toilet. – I nstall grab bars around the toilet if you need more leverage to get off the toilet. • Bathtub – Set  water heater temperature at 120 degrees or on the low setting. – I nstall skid-resistant strips or a rubber mat. – U  se a bath seat if it is difficult to stand during a shower or too difficult to get up out of the tub. – Install  grab bars on the side of the tub or shower for balance. – D  O NOT use the soap dish or towel bar for balance. These can easily pull out of the wall. Kitchen Safety

• Store frequently used items at waist level. Use a reacher or grabber for items not in reach. Never stand on a chair or footstool for reaching. • Use the front burners of the stove to avoid reaching over burners. If there are small children at home, use the back burners. • Keep baking soda near the stove to extinguish small cooking fires and keep a fire extinguisher in the kitchen.

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Getting Ready for your Hospital Stay Pre-Operative Shower

Twice before your surgery (the night before and the morning of surgery), bathe or shower using a chlorhexidine gluconate product (such as Hibiclens). This is an antiseptic/ antimicrobial skin cleanser. The purpose of these showers is to remove as many germs as possible before surgery. You can obtain the Hibiclens at your class or from the nurse educator. Showering Instructions:

• C  ut the Hibiclens package open at the top and pour half of it onto a clean wash cloth. • G  et your body wet, and wash all body parts from the neck down. • Rinse

Pre-Registration

The admitting department will call you three to five days before surgery for registration and insurance information before you come into the hospital. If we haven’t reached you before your admission, this will be done the morning of surgery. An admitting nurse will call you regarding health information and instructions a day or two before surgery. If you haven’t been contacted by the last business day before your surgery, you may call the admitting nurse:

St. Joseph’s Hospital 651/232-3171



St. John’s Hospital



Woodwinds Campus 651/232-0839

Insurance Pre-Authorization

Some insurance companies require pre-authorization before surgery. Contact them directly if you have any questions. The Night before Surgery

Your stomach must be completely empty before surgery. Do not eat or drink anything – not even water after midnight. (This includes smoking and gum chewing.) If surgery is late in the day, you will be given special instructions. Your surgeon or family doctor may want you to take some of your regular medication with a small amount of water. Contact your doctor with any questions. Going to the Hospital

Check in to the hospital 1 1/2 to 2 hours before your scheduled surgery time. On the next page you will find directions for where to go on the day of surgery and a checklist of what to bring.

• P  our the remaining Hibiclens onto the wash cloth. Again, wash all body parts from the neck down.

Health Care Directive

• R  inse thoroughly after the second washing.

Your Family

• D  ry with a clean towel that has not been used since it was laundered.

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651/232-7171

A health care directive (living will) makes your medical wishes known. If you already have one, please bring a copy to the hospital. If you do not have a health care directive but wish to fill one out before admission, call 651-326-2273. Family members and friends are an important part of your recovery. We encourage them to take an active role in helping guide you through each day, both in the hospital and at home. One family member or friend should plan on attending at least one of your physical therapy sessions during your hospital stay. They are welcome to attend all sessions if they are able.

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Driving Directions

St. Joseph’s – Park in the 10th Street ramp. Take the elevator to the first floor and enter the DePaul tower through the double doors. Proceed to the main lobby. St. John’s – Enter through the main entrance. Go past the information desk to the admitting department. Woodwinds - Enter through the main entrance. Go to the Welcome Desk.

Condition Report

In order to give out any information regarding your condition we must have your permission. We ask that you select ONE family member to act as a spokesperson when talking with the nurses and doctors. This person can then share the information with the rest of the family. This helps to ensure your privacy and allows the nursing staff more time to care for you. Visiting

We believe that time with loved ones is essential to healing. Your day time hours will be filled with many activities so we ask that family members and friends visit during the early evening hours. Getting an adequate amount of rest is also important so we ask that you balance visiting time with quiet, restful time. Leave valuables such as watches, jewelry, cash, credit cards and cell phones at home.

My Checklist Preparing myself for surgery:

My caregiver/support person should plan to:

n P  hysical exam with family doctor 3-30 days before surgery

n A  ccompany me to therapy in the hospital to learn what to expect and how to help

n Review medications with doctor

n Help with meals, shopping, driving

n Update dental work n Perform the exercises I learned at class

n S tand by in case I need help to move from bed to chair, into a car or walking up stairs

n Hibiclens  shower the day before and morning of surgery

n S upport and encourage me through all the hard work!

Is my house in order?

What to bring to the hospital:

n Who will help me at home?

n M  y list of medications, dosages and how often I take them

n R  emove throw rugs, electrical cords, clutter, etc.

n This book

n Install handrails by stairs

n Shoes and stockings I normally walk in

n Plan ahead for meals

n Toiletries

n Identify  any equipment I already have available (cane, walker, raised toilet seat, shower bench, etc)

n C  omfortable clothing such as sweat pants, walking shorts or skirts

n G  et a supply of 4 inch square bandages and paper tape

n I f you will be purchasing home equipment from the hospital please bring cash or a check to pay for these items.

n Apply  for a temporary handicapped driving permit, if needed.

n My Health Care Directive

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While You Are in the Hospital

Surgery Admit Unit (SAU)

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You will get ready for surgery here. You will receive a gown, bathrobe, allergy band (if you have an allergy) and identification band.

IMPORTANT!

Anesthesia

(Knee replacement only)

The anesthesiologist or anesthetist administers any regional or general anesthesia during surgery. They also monitor your breathing, blood pressure, heart rate, and the amount of oxygen in your blood. You will meet with your anesthesia specialist before surgery to talk about the different kinds of anesthesia, risks and benefits, and any problems you may have had from anesthesia with previous surgeries.

If you have a femoral nerve block: • Y our leg will feel heavy and numb • I t is much like the numbness you feel when a dentist gives you Novocaine • Y ou will have muscle weakness in your leg until the block wears off. • T he block lasts 4-8 hours (sometimes longer) • Do not get out of bed by yourself. • Always call your nurse for help to get out of bed.

The types of anesthesia most often used for this surgery are:

• General anesthesia in which you go to sleep. • Regional or local anesthesia, in which you are awake but you are numb from the waist down. You may also be given medication to make you drowsy or help you sleep through the surgery. You may feel no sensation in the surgical area for a few hours after the procedure, then regular sensations will gradually return. • Femoral nerve block (knee replacement only–see box at left), in which numbing medication is injected near the nerve so that the area around your knee will be numb. This helps decrease pain after surgery. Surgery Holding Area

Your hair is covered with a cap. An anesthesiologist discusses past surgery experiences with you and will answer any questions you have. An intravenous catheter (IV) for fluids and medication will be started. A small rubber tube called a catheter may be placed into your bladder to drain urine. Your surgeon checks on you and answers any questions. By this time it may seem like many people are repeating the same questions, but it’s important for us to check and recheck even the smallest detail. It also gives you many opportunities to ask questions or clarify anything you may not fully understand. When ready, you are moved into your surgery room. Recovery Room Post Anesthesia Care Unit (PACU)

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When surgery is finished, you are taken to the PACU. You feel sleepy after surgery; it is normal to feel this way. Specially trained nurses monitor your heart rate, blood pressure, breathing, your level of pain, and incision site often.

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Recovery Room Post Anesthesia Care Unit (PACU)

As you wake up you may be connected to pieces of equipment. This varies from one patient to another, depending on the kind of surgery you had. When you are awake, you will be transferred to the orthopaedic nursing unit. Your family will be kept informed of your progress. It is important for you to take deep breaths and cough while you are waking up from anesthesia to clear your lungs. The nurses will remind you to do this frequently. They may also ask you to do some easy exercises, which will help the blood flow in your legs. Waiting

Surgery usually takes about two hours. After surgery you will be in a recovery room another hour or two. There may be a longer wait if the surgery scheduled before yours takes longer than expected. There is a waiting room for your family just outside surgery. Spiritual Care

Chaplains are available at all times to support you and your family, including visits, prayer and sacraments. You and your family may request a chaplain by asking your nurse or your own pastor or minister may visit at any time during your stay. Activity after Surgery

Recovery and Resuming Activity

You will recover on the orthopaedic unit of the hospital. You may not feel like having visitors for at least a day after surgery. IMPORTANT!

Always ask for assistance when getting up.

After surgery you will have a large dressing over your incision. You will also have a drain that removes extra fluids and helps prevent swelling around the incision. The drain is removed the day after surgery. Rehabilitation starts the day of surgery. Your first priority in the hospital is to work hard in therapy. You will have physical therapy (PT) two times a day. For Hip replacement only:

A big foam wedge or pillow is placed between your legs while you are in bed. This is to keep your hip in proper alignment, promote healing of muscles and tissues around the new joint and prevent dislocation of your new hip. There will be limits on how far you can bend your hip, which you will learn in the hospital. For Knee replacement only:

Your surgical knee may be placed in a continuous passive motion machine (CPM) starting the day of surgery. The machine moves the knee to prevent stiffening and improve blood circulation. Movement of the knee increases gradually on the machine.

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Activity after Surgery (cont)

Usual progression of activity is as follows: Day of Surgery

• Exercise in bed • Sit at the edge of the bed • Walk short distances in room if tolerated .

• Practice transfer from bed to chair 1st Day After Surgery

• Go to PT for exercises and walking • Increase sitting and walking time 2nd-3rd Day After Surgery

• Increase sitting and walking activity • Review of precautions • Assessment of activities of daily living • Receive assistive devices and home instruction • Discharge to home or extended care The occupational therapist will help you determine which assistive devices you may need at home such as a raised toilet seat, reachers, and stocking aides. You will need a walker, crutches or cane to take home with you as well. Cell Phones

Cell phone use in the hospital is often limited to lobby areas only. Please check with your nurse or other hospital staff member to find out where you can safely use your cell phone. Can I Smoke?

Smoking is not allowed in the hospital by patients, visitors or employees. This is a Minnesota State Law. If you smoke, we encourage you to quit or cut down before surgery. Discuss methods of controlling withdrawal symptoms with your doctor. Smoking decreases your body’s ability to fight off infection. It decreases clearance of lung secretions, and increases your chance of pneumonia and blood clots. Smoking interferes with blood circulation and healing and impairs your body’s ability to bond to your new joint.

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Pain Management

Pain is not uncommon following surgery. You are the key to getting the best pain control. The doctors and nurses will help you to be as pain-free as possible, but they need your help. The amount and type of pain differs from patient to patient—even those who have had the same operation. There are different medications and methods for delivering pain relief for you after surgery. These methods include: • Intramuscular (IM): Injections of pain medication are administered by the nurse at your request.

IMPORTANT!

PCA is only to be used by YOU! Family members or friends are not allowed to use your PCA button under any circumstance.

• Intravenous Patient Controlled Analgesia (PCA): Pain medication you administer through the IV by activating the pump. • Oral: Taken by mouth. Your surgeon selects the medication and method of pain control. He or she will discuss the benefits and risks of the methods and medications before you receive them. As you recover after surgery, your doctor will give you different pain control methods to provide you with the best pain relief. Help prevent or relieve pain by:

• Asking your surgeon:

– What method of pain control will I have?



– What should I expect?



– Will there be much pain?



– How long is it likely to last?



– Will there be medication side effects? • Designing your pain control plan:



– W  hat choices do I have concerning pain medicine?



– Learn deep breathing and relaxation exercises.



– R  eview pain control methods that have previously worked for you.

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Pain Management (cont)

• A sk for pain relief medicine when pain begins. It is easier to prevent or relieve pain before it has taken hold. Your pain may increase when you begin activities; take pain medicine before your therapy sessions.

Pain Scale Help the doctors and nurses “measure” your pain. Reporting pain as a number helps them to know how well your plan is working and if any changes need to be made. You will be asked to rate your pain on a scale of 0 to 10.

PAIN SCALE

After surgery:

• Tell the doctor or nurse if you continue to have pain after receiving medicine. Don’t worry about being a “bother.” The medicine or method may need to be changed. • Don’t worry about getting “hooked” on pain medicine. Studies show that this is very rare—unless you already have a problem with drug abuse. • Other methods may also help in preventing or relieving your pain, such as: – R  elaxation

– Massage

– Hot or cold packs

– M  usic

– Positive thinking

0

2

4

6

8

10

No hurt

Hurts little

Hurts more

Hurts even more

Hurts whole lot

Hurts worst

Preventing complications

You will play a key role in helping to prevent complications. Blood Clots

• Wear support stockings (TEDs) • Use foot pump machine in the hospital • Do “ankle pumps” and other leg exercises • Take medicine as prescribed Infection

• You will be given antibiotics while in the hospital • You will be given instructions about dressing changes and future antibiotic use before you go home. Pneumonia

• Use the spirometer as directed • Breathing deeply helps ensure your lungs are working properly after surgery. Do breathing exercises as follows: – B  reathe in slowly and deeply through your nose. – H  old your breath for a count of three. – B  reathe out slowly.

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Preventing complications (cont)

• Coughing helps clear secretions from your air passages. Do coughing exercises as follows: – Take two to three deep breaths. – Cough two times.

IMPORTANT!

Pressure ulcers

Tell your nurse if you have pain on your heels or buttocks. This may mean you have too much pressure on your skin.

Pressure ulcers (“bed sores”) can develop over bony body parts. This includes your elbows, heels or buttocks. Your nurse will work with you to prevent pressure ulcers by: • Helping you change positions frequently • Turning and rubbing your skin with lotion • Encouraging you to eat and drink • Encouraging you to be out of bed and walking • Elevating your heels off the bed with pillows Dislocation (hip only)

With your new hip, bending greater than 90 degrees is usually prohibited for several weeks. You will be taught specific precautions while you are in the hospital. It is important that you follow these precautions to avoid dislocating your new joint. Poor Motion (knee only)

Use the CPM machine as directed by your nurse. You will need to have the machine on many times throughout the day and evening, when you are not in therapy or other activities. You can help remind the nurse to put it on when you are in bed.

My Checklist n My first priority is to work hard in therapy!

For hip replacement only:

n A lways ask for assistance when getting up.

n T  o prevent dislocation, follow precautions as given.

n Tell  my nurse or doctor before pain becomes too severe. Take pain medicine before therapy. n To  prevent pneumonia, do deep breathing, coughing exercises and use the spirometer.

For knee replacement only: n W  ear CPM machine several times during day and evening, when not in therapy.

n T  o prevent blood clots, wear support hose, do ankle pump exercises, and use foot pumps as directed by staff.

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Home Instructions

Incision Care

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Incision Care

• For the first 7 days after your surgery you may shower with your incision covered. Use plastic wrap (Saran wrap) and paper tape. After 7 days you may shower without covering your incision if there is no drainage coming from your incision. Do not scrub over the incision line. No tub baths, swimming pools, hot tubs or lakes until you doctor tells you it is safe to do so. • Your incision staples will be removed about the 10th–14th day. • Keep your dressing clean and dry. Change as needed. • To change the dressing: – W  ash your hands. – C  arefully remove old dressing. – C  heck for signs of infection: Redness, swelling or hardness, warmth, odor, pus – D  o not touch the incision. – A  pply 4”x 4” dressing with tape. – W  ash your hands again. Diet

• Eat well-balanced meals. • To avoid constipation, increase fiber by eating fruits, vegetables, grains, and drink plenty of fluids. Support Stockings

• Wear support stockings all day and evening until your surgeon advises you to stop. • It is okay to take them off at bedtime and put them back on in the morning. • Wash stockings in mild detergent and hang to drip-dry. Icing Your Incision

If it makes you more comfortable, you may ice your incision. This will also help reduce swelling. Limit icing to 20 minutes at a time, so that your skin doesn’t freeze. It works well to use ice cubes in zip-loc bags; you may crush them in a blender if you prefer. (For knee replacement only)

If you were given an ice device in the hospital, use it at home according to the directions printed on the side of the device, and/ or given by your nurse.

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When to call your surgeon IMPORTANT!

For any episode of shortness of breath or chest pain or tightness, call 911.

Managing Pain

Call your surgeon if you have: • Pain in your calf, tenderness or increased swelling in calf. • A n increase in drainage or pain from your incision, or other signs of infection. • Change in feeling in your affected leg. • A temperature over 100° F or the chills. • Problems urinating; burning or itching on urination. • Any other concerns It is normal to have pain after your surgery. Pain medication will help reduce your pain, but will not take away all of your discomfort. Your pain will decrease gradually over time and you will not need to take as much medication. To “taper” the amount of pain medication you are taking, try 1 pill instead of 2. If this controls your pain slowly increase the amount of time between each dose. • For example, if you are taking 2 pain pills every 4 hours and are having very little pain, try taking 1 pill every 4 hours. If this works, after one or two days try taking 1 pill every 6 hours and then 1 pill every 8 hours. Medication Instructions

• Take all medications as prescribed. • If your medication seems to be causing nausea or itching, call your surgeon. • If you need a refill on your pain medication call at least one or two days before you run out. Narcotic pain medication will not be refilled on the weekend so please call and make your request by Thursday afternoon at the latest. • Preventive antibiotics may be needed before dental and surgical procedures. • Tell all your doctors and dentist you have had your joint replaced. • Do not drink alcohol while taking pain medication. Other Instructions

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Common Questions After Joint Replacement Surgery

Can I drive?

Your physician will tell you when you may drive—usually several weeks after surgery. Safely operating a motor vehicle especially in emergency situations is a complex skill requiring a return to normal functioning. You may be eligible for a temporary disability handicapped parking permit from the Department of Transportation’s Motor Vehicle Division. Call them with any questions at 651-297-3377. An application is available in the front pocket of this book. This needs to be filled out by both you and your physician/surgeon. How do I get into the car?

Have the car parked several feet away from the curb. Push the front passenger seat all the way back. Place a plastic trash bag on the seat of the car to help you slide and turn frontward. 1. Turn your back to the car and back up until you feel the car touch the back of your legs. 2. Place your right hand on the back rest of the seat and lower yourself down. Keep your operated leg extended out in front of you and duck your head so that you don’t hit it on the doorframe. 3. Turn frontward, leaning back as you lift the operated leg into the car. Will I set off metal detectors?

Your prosthesis is a strong piece of metal that may set off the metal detectors at the airport. It will not harm you. How long will I have to exercise?

It may depend upon your goals and expectations regarding your surgery. If you want as normal a joint restoration as possible, you must realize that the first phase depends upon the surgeon, the second upon the therapist, and the third and equally important phase rests squarely upon your shoulders. For many, a regular program of exercise increases the function and stamina of the new joint, which improves progressively each month. Your doctor looks to your physical therapist to outline a continuing program of exercises, which you should do at regular intervals after discharge from the hospital. The doctor may want to add or modify these, or may arrange for return outpatient visits to therapy in the months following your surgery.

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Common Questions After Joint Replacement Surgery (cont)

My hip and knee are quite painful after I exercise. Why is this?

Severe pain and cramps or muscle spasms should be brought to the attention of your surgeon. If in doubt you should discontinue the exercise until she or he has assured you that no problem exists. Most patients experience aching in the operative leg after exercises. This may occur immediately or after several hours and may be due to accumulation of energy releasing fuels, breakdown products in muscle, or unaccustomed strenuous exercises to sedentary joints. Such aching is not dangerous, but there are many safe and nonhabit forming drugs available for your relief. Talk to your doctor. Heat often is ordered if such cramps persist. Occasionally, ice is more effective. Usually such aches disappear spontaneously as the condition of your muscles and joints improve with exercise. My hip/knee is swollen. Is this normal?

Swelling (also called edema) is common after surgery. You may have swelling around the hip/knee and down the leg. This is normal. It can continue up to 6 months or longer. To help decrease swelling, place a cold pack on the affected area for 20 minutes. Do this 3-4 times a day. When can I sleep on my operated side?

You may not find this comfortable for several weeks or even months. It should be safe, if not comfortable, after six weeks. How do I put on socks?

You may need to use a sock aid or have someone to assist you. How do I put on shoes?

Use slip-on shoes and a long-handled shoe horn if necessary. If you desire, you can convert shoes with laces into slip-on shoes by replacing the shoelaces with a piece of elastic. How should I bathe and do my toileting?

• Use a bath bench in the tub or take a stall shower. (A shower is preferred instead of a tub bath, on a permanent basis.) • A long-handled sponge may be useful to reach your legs and feet when bathing. • Continue to use the raised toilet seat, as most toilet seats are lower than desirable. Also use a pillow when sitting in a lower chair to avoid bending too much.

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Common Questions After Joint Replacement Surgery (cont)

How can I carry items while I’m recovering?

A walker bag or crutch bag will allow you to carry items while walking. Small items may be carried in your pockets. In general, how should I do my household chores?

Remember not to break the “DO NOT” rules when performing household chores. Example: Cleaning the floor, taking out the garbage, dusting low tables, making beds, etc. If you cannot use assistive devices (long-handled mop, long-handled dust pan, etc.), have someone else do these tasks for you. Why is it important to save my energy after surgery?

You will heal faster and better; you can continue your independence and do more for yourself and it is safer – when energy goes down, accidents can happen. Are there precautions about sex?

In general, the same precautions you have been taught about the position of your new joint also apply during sexual intercourse. Discuss with your surgeon when you may resume sexual intercourse. In the back of this book you will find a booklet with specific positions and guidelines. If you have questions regarding the content of the book, feel free to ask your Occupational Therapist at the hospital.

My Checklist Questions for my surgeon at the clinic visit after surgery: n H  ow much longer do I need to use my walker or cane?

n (Hip replacement only) Will I be able to bend my hip more than 90°? If so, when?

n When can I begin driving?

n A  re there any guidelines / precautions about sexual intercourse?

n Do I need to continue to wear the TED socks? n C  an I resume my walking, biking or exercise program that I had prior to my joint replacement? n W  hen can I return to work? Are there any modifications that I should make, such as reduction in hours, lifting restrictions, position restrictions?

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n W  ill I need preventive antibiotics if I have dental work or surgical procedures? Additional questions I have:

Additional Resources

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HealthEast Home Care

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Phone: 651-232-2800 If you need assistance at home after surgery, you may want to consider HealthEast Home Care. It is a complete resource for trained home health care professionals and specialized services. Available 24 hours a day, 7 days a week, our network of professionals and our track record of quality care has made us a leading provider of home health care services in the Twin Cities metro area and beyond. HealthEast Home Care is a state licensed and Medicare/Medicaid certified home health care agency.

Outpatient Therapy

HealthEast Optimum Rehabilitation Clinics

HealthEast Optimum Rehabilitation can help the recovery process by providing professional orthopaedic therapy programs. Individual treatment plans are designed to suit your specific needs. Therapeutic and rehabilitative processes emphasize active patient participation. Treatment plans include specific activities or exercises that will hasten your return to normal, pain-free activity. There are six conveniently located Optimum Rehabilitation Clinics: Maplewood

Markham Pond Professional Center 1570 Beam Ave., Suite 120 Maplewood, MN 55109 Phone: (651) 232-7820 Midway

University Park Medical Building 1690 University Avenue #B40 St. Paul, MN 55104 Phone: (651) 232-5412 Oakdale

Tessar Professional Building 1099 Helmo Avenue, Suite 110 Oakdale, MN 55128 Phone: (651) 232-5075 Woodbury

Woodwinds Oak Center 1825 Woodwinds Drive Woodbury, MN 55125 Phone: (651) 232-6767

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Therapeutic Equipment

Many of the following vendors will special order items by request. Midwest Medical Services

8400 Coral Sea St. NE, Suite 200 Blaine, MN Phone: 763-780-0100 or 1-800-780-8553 Open Mon.-Fri. 8-4 Rents and sells new and used equipment. Carries mobility, bathroom, dressing, self-care, medical, and therapeutic exercise products. Accepts phone orders and offers delivery services. Will submit insurance claims. Apria Home HealthCare

1645 Energy Park Drive St. Paul, MN Phone: 1-800-247-1658 131 Cheshire Lane, Suite 300 Minnetonka, MN Phone: 952-404-1600 Rents and sells new and used equipment. Carries mobility, bathroom, dressing, medical and therapeutic exercise products. Accepts phone orders and deliver. Will submit insurance claims. Goodwill-Easter Seals

553 Fairview Ave. St. Paul, MN Phone: 651-379-5922 Open Mon., Tues., Thurs., Fri. 9-4; Wed. 9-1 Offers free rental of mobility, bathroom, dressing and self-care products for up to 3 months. Inventory varies. Please call ahead to request what you need. Northern Medical Supply Co.

180 West 7th Street St. Paul, MN Phone: 651-227-3707 or 1-888-400-3707 Open Mon.-Fri. 9-5 and Sat. 9-12 Rents and sells new and used equipment. Carries mobility, bathroom, dressing, self-care, medical, and therapeutic exercise products. Accepts phone orders and offers delivery and installation services. Will submit insurance claims.

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Therapeutic Equipment (cont)

Jackson Medical Equipment

982 Thomas Avenue St. Paul, MN Phone: 651-645-6221 Open Mon.-Fri. 9-5 and Sat. 9-1 Rents and sells new and used equipment. Carries mobility, bathroom, dressing, self-care, and therapeutic exercise products. Offers equipment repair services. Accepts phone orders, and delivery and installation services are also available. Will submit insurance claims. CW Health Care

4301 Quebec Ave. N. Suite 3 New Hope, MN Phone: 651-645-0010 Open Mon.-Fri. 8-5 Rents and sells new and used equipment. Carries mobility, bathroom, dressing, self-care, and therapeutic exercise products. Accepts phone orders. Delivery and installation services available. Will submit insurance claims. American Cancer Society

2520 Pilot Knob Road, Suite 150 Mendota Heights, MN 55120 Phone: 651-255-8100 Open Mon.-Fri. 8:30-4:30 Offers various services to cancer patients. May loan items to individuals who qualify based on financial and insurance status. Carries mobility, bathroom, dressing, self-care, and therapeutic exercise products. Also has wigs and breast prostheses. Will take orders by phone and will deliver. Will submit insurance claims. Additional Resources

For other therapeutic/medical equipment vendors, look in the Yellow Pages under “hospital equipment/supplies” and/or “medical supplies.” Hardware stores and department stores such as Menard’s and Target also carry some of these products. For installation of home equipment, look in the Yellow Pages under “contractors-general” and/or “plumbers”.

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Therapeutic Equipment (cont)

Equipment available for purchase at the hospital

• Reacher • Dressing Stick • Flexible Sock Aid • Rigid Sock Aid • Long-Handled Shoe Horn

– Plastic



– Metal • Long-Handled Bath Sponge • Leg Lifter • Raised Toilet Seat

Please note that if you choose to purchase equipment through HealthEast, you will be asked to pay for the equipment by check or cash prior to discharge from the hospital. Home Modification Resources Merchants Maintenance & Construction

P.O. Box 49963 Blaine, MN Phone: 612-781-8083 Provides commercial and residential inspection and consultation services regarding alterations for handicap accessibility. For additional referrals contact: Metro Center for Independent Living, Inc.

1600 University Ave., Suite 16 St. Paul, MN Phone: 651-646-8342 A nonprofit organization that provides information and referrals regarding equipment, repairs, contractors, funding, support groups, housing and transportation.

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Web Sites

www.aaos.org

Web site for American Academy of Orthopaedic Surgeons. Check out the Patient Education Section about Total Joint Replacement and Arthritis. www.arthritis.org

Web site for the Arthritis Foundation. Especially helpful sections: • Take Action Against Arthritis • Arthritis Today’s Drug Guide • Resource Room www.healtheast.org

A complete guide to services available in the HealthEast Care System.

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Food Guide Pyramid This food guide will help you plan meals and maintain a healthy diet.

MyPyramid.gov

Grains

Vegetables

Fruits Grains

Milk

Food Guide

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Meat & Beans

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Hip Surgery Patients Only The following exercises should be done before your surgery: At least 2 times per day, 10 repetitions each leg

1. Ankle pumps • Bend ankles up and down

2. Quad sets • P ush knees down and hold five seconds to tighten muscles on top of thigh

3. Straight leg raises • Bend one leg • Lock other knee straight, then lift it 6-7 inches • Hold five seconds • Lower leg slowly

4. Side leg lifts • Lift one leg out to one side • Bring leg back to center • Do not lean forward (Repeat using other leg)

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Knee Surgery Patients Only The following exercises should be done before your surgery: At least 2 times per day, 10 repetitions each leg

1. Ankle pumps • Bend ankles up and down

2. Quad sets • P ush knees down and hold five seconds to tighten muscles on top of thigh

3. Short arc quads • Place a large can or rolled towel under leg • Straighten knee and leg • Hold five seconds

4. Straight leg raises • Bend one leg • Lock other knee straight, then lift it 6-7 inches • Hold five seconds • Lower leg slowly

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Glossary Anesthesiologist Anesthetist

A doctor specializing in care of patients receiving anesthesia. An advance practice nurse specializing in care of patients receiving anesthesia.

Foot Pump

A pneumatic device which puts intermittent pressure on the foot. It keeps blood moving to help prevent blood clots.

CPM

Continuous Passive Motion machine; moves the knee to prevent stiffening and improve circulation.

Dislocation

Hibiclens

IV-intravenous Intramuscular (IM) OT PCA

Prosthesis PT Spirometer TEDs

Occasionally, after hip replacement surgery, the ball can be dislodged from the socket. In most cases the hip can be relocated without surgery. An antiseptic cleanser to use the day before and morning of surgery to remove germs from the skin. A tube is placed into a vein to deliver medication. Injections of pain medication into muscle. Occupational Therapy Patient Controlled Analgesia: a method of pain control in which the patient controls the amount of medicine administered through the IV. Your new joint. Physical Therapy A special device used in the hospital to help you breathe deeply. Support stockings to help prevent blood clots.

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NOTES

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HealthEast® Orthopaedic Care Preparing for

Total Joint Replacement Surgery

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