ck st. joseph mercy oakland patient...

TELEGRA

PH

WO

ODW

ARD

FRA

NK

LIN

WID

E T

RA

CK

CRO

OK

S

From Detroit

Exit 75

SQUARE LAKE

From Flint

From Utica

75

59

ST. JOSEPHMERCY OAKLAND

St. Joseph Mercy Oakland

44405 Woodward Avenue

Pontiac, MI 48341-5023

stjoesoakland.org

OUR MISSION

We serve together in Trinity Health in the spirit of the Gospel,

to heal body, mind and spirit, to improve the health of our

communities and to steward the resources entrusted to us.

patient guide

TOTAL KNEE REPLACEMENT

44405 Woodward Avenue

Pontiac, MI 48341-5023

stjoesoakland.org

SJM-251_KNEE_2009booklet_FINALLL.indd Spread 1 of 22 - Pages(43, Sec2:C)SJM-251_KNEE_2009booklet_FINALLL.indd Spread 1 of 22 - Pages(43, Sec2:C) 6/26/09 12:58:25 PM6/26/09 12:58:25 PM

WELCOME TO ST. JOSEPH MERCY OAKLAND

The Joint Care CenterFor more than 75 years, the medical team at St. Joseph Mercy Oakland (SJMO) has been dedicated to improving

the health and well being of the southeastern Michigan community. In support of this effort, SJMO orthopedic

physicians have developed the nationally renowned Joint Care Center (JCC).

St. Joseph Mercy Oakland’s JCC provides a comprehensive and personalized program for patients undergoing

elective surgery for total knee or hip replacement. With highly skilled orthopedic surgeons, nurses, therapists, and

technicians using state-of-the-art technology, the JCC is proud to serve as a model for other joint care programs

across the country.

We Are With You Every Step of the WayFrom the day you and your doctor decide you should have a new joint, through the surgery, to your fi nal rehabilitative

therapy session, you will receive exceptional service and support from the dedicated staff at St. Joseph Mercy

Oakland’s JCC.

This book, along with the video and class, were created to help you prepare for your orthopedic patient experience.

Take time to review the materials before coming to the hospital. Feeling nervous or scared is normal; we hope this

information about what to expect during your hospital stay and your recovery process will alleviate your fears.

1 • TOTAL KNEE REPL ACEMENT TOTAL KNEE REPL ACEMENT • 42

QUESTIONS AND NOTES

SJM-251_KNEE_2009booklet_FINALLL.indd Spread 2 of 22 - Pages(1, 42)SJM-251_KNEE_2009booklet_FINALLL.indd Spread 2 of 22 - Pages(1, 42) 6/26/09 12:58:26 PM6/26/09 12:58:26 PM

41 • TOTAL KNEE REPL ACEMENT

QUESTIONS AND NOTES

ANATOMY OF THE KNEE

The Knee Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Total Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

SURGERY

Before Your Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 – 6

Post-Op Day #1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Post-Op Day #2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Post-Op Day #3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

MANAGING PAIN

Managing Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 – 11

Anticoagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 – 14

PHYSICAL THERAPY

Ten Reasons to Keep Moving After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Ways to Manage Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Exercise Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 – 26

RECOVERY AT HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 – 28

DISCHARGE INSTRUCTIONS

Narcotic Pain Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 – 30

Bowel Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 – 32

Pain Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

STEPS FOR...

Bathing at Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 – 37

Getting Into and Out of a Car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

DISCHARGE PAIN MEDICATION LOG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

QUESTIONS AND NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

TABLE OF CONTENTS

TOTAL KNEE REPL ACEMENT • 2


ANATOMY OF THE KNEE

The Knee JointThe knee joint is a major weight bearing joint

in your body. This joint is formed where the

upper leg bone, called the femur, and the

bones of the lower leg, called the tibia and

fi bula, meet. Over the center and in the front

where the femur and tibia meet is the knee

cap or patella. The knee is surrounded and

held together by muscles, ligaments and other

soft tissues. Beneath the bones of the knee,

cartilage cushions the knee and allows the joint

to move in a smooth and free manner.

Total Knee ReplacementDisease and/or injury can damage the knee

joint. You and your doctor have decided that

a total knee replacement is likely to decrease

your pain and make walking easier. During

this operation, the diseased portions of the

joint are resurfaced and covered with an

artifi cial joint called a metal prosthesis which

is cemented in place. This type of operation

usually takes about 1 to 1-1/2 hours.

3 • TOTAL KNEE REPL ACEMENT TOTAL KNEE REPL ACEMENT • 4 0

QUESTIONS AND NOTES


DISCHARGE PAIN MEDICATION LOG

TIME MEDICATION TAKENDAY

Pain Medication

Other

DAY

Pain Medication

Other

DAY

Pain Medication

Other

DAY

Pain Medication

Other

DAY

Pain Medication

Other

DAY

Pain Medication

Other

DAY

Pain Medication

Other


BEFORE YOUR SURGERY

• Do your pre-op

exercises

• Get medical/cardiac

clearance for your

surgery

• Make a list of all the

medications you are

currently taking and the

times you take them;

bring this list with you

anytime you go to the

doctor or hospital

SURGERY – BEFORE YOUR SURGERY

Pre-Operative VisitsYou will have a pre-operative visit with a nurse and

anesthesiologist in our pre-admission testing department. The

appointment is usually scheduled 1 to 2 weeks before your

surgery date. During this appointment you will have a physical.

The nurse will confi rm that we have your lab work, EKG and

chest x-ray, if needed. You should complete these tests the same

day if we don’t already have them on fi le.

You will participate in an educational joint replacement class that is

1-1/2 hours long. Your coach will accompany you to class, will come

to at least two of the therapy sessions and will assist you once you

go home. Your coach can be anyone: a friend, relative or neighbor.

Planning for DischargeIt is very important to plan for your discharge needs before

surgery. You should discuss with your family the care that you

will need and make plans for this care ahead of time. You will

receive education in this book and in the joint replacement class

to help you understand what your needs will be.

In order to return home when you are discharged from the

hospital you should:

• Have someone available for at least 3 to 4 days; sometimes

you may need this care for a longer period

• Be able to walk far enough to get into and around your home

• Be able to climb steps to enter your home and get to your bed

The JCC staff will assist you during your hospitalization by

obtaining any needed equipment for home use and by making

arrangements for home care therapy.



SURGERY – DAY OF SURGERY

DAY OF SURGERY

Please leave your

additional clothes or

belongings in the car and

have your family/friends

bring them in later in the

day when you are assigned

a room in the JCC.

Male patients having knee

replacements can bring

swim trunks in addition

to shorts. Swim trunks

with inside netting are

easily washable.

Pre-Op ChecklistRemember to bring the following items with you to the hospital.

• Pre-Op Education Manual

• Walker – if you have one

• Toiletries – toothbrush, toothpaste, comb or brush, electric

razor and non-powder deodorant

• CPAP machine – if you use one

• All of your home medications in their bottles:

– Do not bring pain pills, Coumadin® or vitamins

– If you are on insulin, know the type, dose and times administered

– Note: Nursing staff will verify all of your medications on the day of

surgery and then your family can take them home

• Your insurance card(s)

– You may fi ll any new prescriptions at our outpatient pharmacy

• A check or credit card to pay for home medical equipment

• Durable Power of Attorney papers and/or living will papers

ClothingAs part of the JCC program, we require you to dress in regular

clothing. Doing this helps to speed up your recovery process and

gives you the opportunity to practice dressing yourself before you

go home. Please remember to bring clothing that is loose fi tting

and comfortable. All clothing stands the chance of being soiled by

incisional drainage or an IV. We recommend that you bring the

following clothes:

At least four changes of clothing including:

• Shorts with elastic waists; male patients may bring swim trunks

• Short sleeve shirts; women may wear dresses

• Cardigan or sweater that buttons in front for extra warmth

• Loose fi tting undergarments – at least fi ve changes; no support girdles

• Bathrobe and pajamas are optional


STEPS FOR...

Getting Into and Out of a Car You must follow total hip precautions while getting in and out of

the car until your hip precautions are lifted. A midsize or large car

with reclining seats is the most comfortable and the safest. Before

entering the car, place a plastic garbage bag on the seat, slide the

front passenger seat back as far as possible, and recline the seat to

45° or more.

AUTOMOBILE OBSTACLES & SOLUTIONS

• BUCKET SEATS

Add a pillow on the seat

to level and raise its

height

• SEATS DON’T

RECLINE

Place a pillow behind

your hips and slouch in

the seat

• BUCKET SEATS

WITH 4”

CONSOLE

Recline the seat fully, sit

on upper half of the seat

before swinging legs into

the car

• OWN A VAN OR

SPORTS UTILITY

VEHICLE

Build a platform

4” x 4” x 6” or purchase

a sturdy step stool to

use as a step-up into

the vehicle

STEP 1

Back up to seat until you feel the

seat touch the back of your leg.

STEP 2

Place your right hand on seat or

the outside of the door frame,

waist high. Place your left hand

inside car on dashboard.

STEP 3

Extend your operated leg forward

and lower yourself slowly onto the

seat. Tuck your head inside the

door frame.

STEP 4

Lean back on your arms and push

yourself back towards the driver’s

side using unoperated leg.

STEP 5

Swing your legs into the car, one at a

time, keeping your toes pointed out

and knees apart. Slightly bend your

knee to clear the door.

STEP 6

Once legs are inside the car, reposition yourself into the seat,

maintaining hip precautions. To get out of a car, reverse the process.


Bathing with a Tub Bench or Shower StoolAfter your knee surgery it is important that you do not fall. Getting in and out of a bath tub or

shower can be frighten ing. With proper instructions you can succeed. If you are not permitted

to place all your weight on your new knee you will need a tub bench or shower stool.

STEPS FOR...

STEP 1

Back up to your tub bench.

STEP 2

Place your operated leg forward and sit down.

STEP 3

Sit on front edge of bench with your

operated leg extended.

STEP 4

While leaning back, swing your legs into

the tub.


HINTS FOR

BREATHING

Breathe deeply and

use your incentive

spirometer (if provided)

ten times every hour

while you are awake.

HINTS FOR

ACTIVITY

Do ankle pumps and circles

every hour while awake.

GOALS

• Get out of bed or dangle

• Manage pain

SURGERY – DAY OF SURGERY

Activity• The nursing staff will help you turn in bed every two hours or

sooner if you are uncomfortable.

• You will be helped by the nurse to sit on the side of the bed

during the evening of surgery. You should not get up by yourself,

unless your nerve block has completely resolved.

• You will have special pump stockings on both of your legs to help

with blood circulation and to prevent blood clots.

• You should begin your ankle pump exercises immediately after

surgery.

• The nursing staff will wake you occasionally during the night to

observe your condition and monitor your vital signs.

• If your physician orders it, you may be placed in a continuous

passive motion (CPM) machine. This will be used anywhere

between four hours to the entire night.

Breathing Exercises• Breathe deeply and cough ten times every hour while you are

awake. It is very important to exercise your lungs and this will

help minimize your risk of developing pneumonia.

Diet

• You will have a clear liquid diet for lunch/dinner. If you tolerate

this, you will be advanced to a regular diet.

• Room service is available between 6:30 a.m. - 7:00 p.m. by

calling 248.858.FOOD (3663).

Tubes and Drains• An intravenous fl exible catheter will be placed in your vein to give

you fl uids and medications.

• A catheter to drain your urine will be placed in your bladder during

your operation.

• During your operation a drain may also be inserted near your

incision to remove excess fl uid from around your new joint.



SURGERY − POST-OP DAY #1

DISCHARGE

PLANNING

You will be discharged

on the third day after

surgery if you are ready.

Your physical therapists

will identify the

equipment you will

need at home. The

JCC staff will assist

you in obtaining your

equipment.

GOALS

• Manage pain

• Excercise

• Rest in between

therapy sessions

HINTS FOR

ACTIVITY

Do ankle pumps and

circles every hour while

awake.

GROUP THERAPY

Group therapy occurs

twice today. Check

with your nurse for

specifi c times. We invite

coaches to attend as

many group therapy

sessions as possible.

Activity• Staff will assist you with bathing and dressing yourself between

4 a.m. and 5 a.m.

• Your blood will be drawn today to check your blood counts.

• Physical therapy begins today. It is important to work with the

physical therapists; they understand you are not feeling your best.

• Your therapist will instruct and assist you with your exercises and

walking. Exercise is by far the most important thing that you can

do for yourself both before and after surgery.

• You will have physical therapy four times today: two individual

sessions in your room and two group sessions in the therapy room.

• Work on straightening your knee when in bed. No pillows under

your knee unless okayed for short periods by your nurse or doctor.

• You will sit in the recliner chair for most of the day. Ask your

nurse for help to change your position. You should not get up by

yourself, unless your nerve block has completely worn off.

• Continue to do ankle pump and circle exercises while in bed or

in the chair.

• Your CPM will be continued this evening, if ordered.


observe your condition and monitor your vital signs.

• Ice packs to the knee reduce swelling and decrease pain. You will

be given an ice pack right after surgery. Your knee will be iced

several times daily.

Breathing Exercises• Breathe deeply and cough ten times every hour while you are

awake. Doing this exercises your lungs, helps minimize your risk

for pneumonia and helps decrease your body temperature.

• If ordered, you may use an incentive spirometer.

Tubes and Drains• You will have a catheter to drain your urine. It will be removed

today or tomorrow morning.

• If you have a drain it will be removed either today or tomorrow.

• Your IV will be capped off as long as you are well hydrated.


HINTS FOR BATHING

• Use a fl exible shower

hose with an on/off

switch

• A long handled sponge

will let you wash all

parts without bending

• Place a rubber mat in

the bottom of the tub

• A grab bar inside your

tub is helpful to prevent

slipping

Bathing at HomeIf you can place your full weight on your operated leg, you do

not need a tub chair.

STEP 1

Step over the

bathtub wall with your

operated leg by turning

sideways, bending your

knee back.

STEP 2

While holding onto

the grab bar, bring the

other leg into tub.

STEPS FOR...



STEPS FOR...

Bathing at Home .............36

Bathing with a Tub Bench

or Shower Stool .............37

Getting Into and Out

of a Car ............................38


SURGERY – POST-OP DAY #2

COACH

Please be present for

either morning or

afternoon group therapy

sessions to observe the

patient’s progress and

receive instructions from

nursing and physical

therapy staff.

GOALS

• Manage pain

• Walk in the halls with

minimal assistance

• Plan for discharge

Activity• Most patients can take showers this morning. You will get

dressed in your own clothes.

• Your blood will be drawn today to check your blood count.

• You will be out of bed most of today. The staff will help you to

walk in the hallway. Again, you will work with physical therapy

four times today.

• Instructions on how to go up and down stairs will begin today.

• You will sit in the recliner chair for most of the day. Ask your

nurse for help to change your position.

• Continue to do ankle pump and circle exercises while in bed or

in the chair.

• Your CPM will be continued this evening if ordered.


observe your condition and monitor the equipment.

• Continue to ice your knee frequently.

Breathing Exercises• Continue to breathe deeply and cough ten times every hour

while you are awake. Doing this exercises your lungs, helps

minimize your risk for pneumonia and helps decrease your

body temperature.

• If ordered, you may use an incentive spirometer.

Planning Your Discharge• You will be discharged tomorrow around 10:30 a.m.

• Remind your coach, family member or friend to be here in the

morning to take you home.




SURGERY − POST-OP DAY #3

COACH

Please arrive in the

morning to review

the patient’s discharge

instructions. You may use

valet parking and they will

reimburse you when you

show the discharge papers.

GOALS

• Manage pain

• Go home

PHYSICAL THERAPY

AT HOME

Your home care

therapist will contact you

within 24 hours of your

arrival at home.

Activity• You will be able to get out of bed to the chair with minimal

assistance from the staff

• Continue to ice your knee frequently

• The physicial therapist will see you today before you leave

• You will have one last group therapy session

• The therapist will assist with the car transfer

Diet• Continue with your prescribed diet and drink several glasses of

water daily to help prevent constipation

• Make sure to eat plenty of fi ber-containing foods

Planning Your Discharge• The nurse will review directions for your care at home including

caring for your incision, taking your anticoagulant medication and

scheduling when to return to the doctor

• Suggestion – To help remember when you have last taken

pain medication, record the times on your “Discharge Pain

Medication Log” (page 39)


InfectionThe possibility of infection in your artifi cial joint may exist after the

following situations:

• Any dental procedure

• Liver biopsy

• Sigmoidoscopy

• Kidney surgery

• Any infection

• Genitourinary instrumentation

• Tonsillectomy

• Bronchoscopy

• Barium enema

• Prostate and bladder surgery

• Colonoscopy

Notify your physician or dentist for antibiotic treatment before

these and other medical procedures. You must do this for your

lifetime. Please discuss this with your orthopedic surgeon.

INFECTION PREVENTION

Wash your hands

frequently.

Take a shower and let

water run over your

incision. Pat it dry.

Notify your doctor or

dentist prior to any

dental or invasive medical

procedures as you may

need to take preventative

antibiotics.




WHEN TO CALL YOUR DOCTORCall your doctor if

you experience any of

the following signs and

symptoms for:

BLOOD CLOTS

• Pain in your calf

• Redness, swelling, or

warmth in your leg or calf

• Chest pain

• Shortness of breath

INFECTION

• Increased temperature

– 100 degree temperature

for three days

– 101 degree temperature

for one day

• Increased drainage

from your wound

• Foul odor from your

wound

• Redness, swelling, and/

or warmth of your wound

• Increased pain in your

wound

Pain Control

• You will get a prescription for pain medication before your

discharge

• Use the pain medication as directed – especially before doing

your exercises

• Elevate your legs to help reduce swelling and/or pain

• Do not drink alcohol when taking pain medication

• Do not drive while taking pain medication

• Call your doctor if increased pain is not relieved by pain

medication

Temperature• Take your temperature once a day between 3 p.m. and 7 p.m.

• You can purchase a thermometer at any pharmacy or larger

grocery store

Activity• Use a walker or crutches as directed until your doctor indicates

otherwise.

• Gradually increase your activity each day.

• While sitting, elevate your leg to reduce swelling.

• Perform your ankle exercises, as instructed by your health care

team, to promote circulation.

• Do your exercise program 3 to 4 times a day.

• As your knee improves, try to use it more. For example, bend

your knee and use that leg when getting up and down from

sitting.

• If possible, obtain and use a recliner chair during your immediate

recovery at home.

NOTE: Your new knee prosthesis is metal, and you may

activate metal detection devices, at the airport.



MANAGING PAIN

Managing pain is a major concern for many facing surgery. People

used to think that severe pain after surgery was something they

“just had to put up with,” but with current treatments, that is no

longer true. Today, you can work with your nurses and doctors

after surgery to help keep your pain at a mild to moderate level.

Facts about Pain ManagementTake action as soon as the pain starts. It is important to ask for

pain medication before the pain becomes severe, since it is

harder to get pain under control once it has become severe.


MANAGING PAIN

Pain Management Can Help You• Get well faster – With less pain, you can start walking, doing

your exercises and participating in physical therapy

• Improve your recovery phase – People whose pain is well

managed seem to do better after surgery and discharge

Pain Management Ideas• We will help manage your post-op pain using a combination of

IV and oral pain medications

• Ice therapy is a good complement to pain medications

• Elevating your legs is also helpful in reducing swelling and thus

decreasing pain

• Some pain is to be expected. Total joint replacement is a big

surgery; however, your goal is to be at a pain level of four or less.

• Remember, it is okay to ask for pain medication

Your nurse will ask you to describe your pain on a range from 0 to 10 as

shown on the scale above. We want you to be as comfortable as possible.

Ask for pain medication before your pain increases, or when you are getting

ready to exercise.

0 1 2 3 5 6 7 8 9 10

WORST PAINPOSSIBLE

MODERATE PAIN

NO PAIN

4

PAIN SCALE



Stimulants and Stimulant/Stool Softener

These products directly stimulate the bowel. You should not use

these products until you have fi rst tried other laxatives or stool

softeners, or unless ordered by your doctor. They include:

• Pericolace (docusate/casanthrol)

• Correctol (docusate/phenolphthalein)

• Doxidan (docusate/phenolphthalein)

• Senokot (senna)

• Dulcolax (bisacodyl)

For direction in use, read the label carefully. Long-term use of

these stimulants may cause dependence. Therefore, you should

discontinue their use when your bowel habits return to normal.

NOTE:

• Senna and cascara can discolor your urine yellow-brown, pink-

red, red-violet or red-brown

• Swallow bisacodyl tablets whole and avoid milk products or

antacids within one-hour of a dose




Possible factors causing slow return of bowel function after

surgery include use of narcotic pain relievers, decreased daily

activity/exercise and changes in eating habits.

Laxatives and Stool SoftenersLaxatives and stool softeners help prevent constipation and are

recommended for short-term use after surgery or a hospital stay.

It is important to maintain a high fi ber diet and to drink plenty of

fl uids. Take plenty of walks daily.

Stool softeners help fat and water to mix and cause stool to

soften. They include Colace, docusate sodium, and Surfak,

docusate calcium. The normal dose is one or two capsules, one

or two times a day. All products listed may be purchased at your

local drug store.

Bulk-producing products create stool to hold more water causing

the urge to have a bowel movement. They include Metamucil and

Fiberall, psyllium and Fibercon, polycarbophil. The normal dose is

found on each product package and they are usually mixed with

water or juice. Start with the smallest recommended dose unless

you have taken the laxative on a regular basis before surgery.

BOWEL MANAGEMENT

RECIPE FOR

SEVERE ONGOING

CONSTIPATION

Mix together:

• I cup applesauce

• I cup coarse

unprocessed bran

• 3/4 cup prune juice

This mixture will be like

a thick paste. Keep it

refrigerated in a covered

container. Take 1 to 2

tablespoons of the mixture

every day with a glass

of water. Take it in the

evening for a morning bowel

movement. Increase the bran

mixture by two tablespoons

each week until your bowel

habits are regular. Always

drink one large glass of water

with the mixture.

Eating a diet high in fi ber and

drinking at least 6 to 8 cups

of water daily can also help

with bowel management

during your recovery period.


After your total joint replacement your doctor will prescribe

an anticoagulant. An anticoagulant is a medication that helps

to reduce the risk of blood clots. There are several options for

anticoagulation and your doctor will decide which is the best for

you. The following three are medications we commonly use.

Lovenox® (enoxaparin sodium)This is an injectable anticoagulant. It is dispensed in a pre-fi lled

syringe. You will be shown in the hospital how to give the injection

to yourself or your coach may give you the injection. The nurse

will give you a Lovenox® kit. The kit, however, does not contain

the medication; you will need to get your prescription from the

nurse before you leave. We suggest that you have it fi lled at our

outpatient pharmacy. Please read your instructional booklet and

view the video before leaving, and ask the nurse any questions that

you may have. If you do not have prescription coverage, please notify

your surgeon’s offi ce before surgery.

Coumadin® (warfarin)

This is a pill that is taken at the same time each day. You will be

given this medication in the afternoon. It is important that the

level of Coumadin® in your body is monitored. INR is a blood

test that measures this level. Dosing for Coumadin® may change

depending on your INR, so pay attention to your instructions

when you are discharged. When you go home after leaving

the hospital, your doctor will tell you how much Coumadin®

to take each evening. If you are going home after leaving the

hospital, you will have your blood checked two times a week by

home care personnel. A staff member from our Anticoagulation

Pharmacy Department will contact you about changes in your

Coumadin® dose. The testing of your blood is important, so do

not miss a blood draw. Please read your Coumadin® instructions

before leaving the hospital and ask the nurse and pharmacist any

questions you have.

MEDICATIONS

ANTICOAGULATION



ANTICOAGULATION

DO NOT TAKE ANY OF THESE MEDICATIONS WHILE TAKING ANTICOAGULANTS UNLESS DIRECTED BY YOUR DOCTOR:

• Aspirin or aspirin-

containing products,

including ointments or

skin creams

• Other platelet inhibitors

such as clopidogrel

(plavix)

• Salicylates (aspirin-like

products)

• Nonsteroidal anti-

infl ammatory drugs

(NSAIDS)

• Cold or allergy products

or pain relievers

containing any of

these drugs

AspirinAspirin is a pill that should be taken at the same time each day. No

special testing occurs with Aspirin.

While Taking AnticoagulantsTaking these medications can increase the time it takes for your

blood to clot and can increase your risk for bleeding.

If you have or develop any of the following, notify your doctor

immediately.

• A serious fall or if you hit your head

• Bleeding from a cut or your nose that you cannot stop

• More bleeding than usual when brushing your teeth

• Heavier than normal menstrual period or other vaginal bleeding

• Blood in your urine or stool

• New and signifi cant bruising

• Fever, sickness, severe diarrhea or nausea

• Dizziness or confusion

• Call 911 if you have chest pain, shortness of breath, rapid or

unusual heartbeat

CALL 911, IF YOU HAVE CHEST PAIN, SHORTNESS OF BREATH, RAPID OR UNUSUAL HEARTBEAT.


What precautions should I take?

If you are pregnant; breast feeding; or have serious heart, liver,

lung, or kidney disease; or any seizure disorders; tell your doctor

before taking a narcotic medication. If you have had problems

with drug addiction, report this to your doctor.

Are there any drug interactions I should be aware of?Serious adverse effects may occur if narcotic medication is taken

with alcohol, other narcotics, sedatives, barbiturates and/or

antipsychotic medications such as Thorazine, Trilafon, Mellaril,

Vesprin, Haldol, etc.




The information that follows is for use as an educational aid and

does not cover all possible uses, precautions, side effects or drug

interactions. For more complete information about the prescribed

medication you are taking, ask your pharmacist or doctor.

Some of these preparations are combination products and may

contain other medications such as Tylenol or Aspirin. Do not

take extra Tylenol in combination with your pain medication. You

should never take more than 4000mg of Tylenol (Acetaminophen)

in a 24-hour period.

Narcotics/Pain MedicationsNorco, Vicodin, Tylenol #3, Percocet, Oxycontin, Norco and

Darvocet

What do they do?They depress pain signals from your brain.

What are they used for?Most products are used to control moderate to severe pain.

What are the side effects?Gastrointestinal symptoms including nausea, vomiting, decreased

appetite, constipation and cramps are the most common side

effects. Other common side effects include lightheadedness,

dizziness and sleepiness.

Are there any serious side effects?Serious adverse reactions such as slowed breathing, respiratory

arrest, changes in blood pressure and slowed heart rate may

result, but are less common and usually occur with over dosage.

NARCOTIC PAIN MEDICATION

HINTS WHILE

TAKING

MEDICATION

• Report any of the

following signs to your

physician: allergic reaction

such as rash, itching,

dizziness, confusion,

hallucinations, shortness

of breath

• Addiction to narcotics can

occur when they are used

for extended periods of time

• Use only as directed,

NEVER take more than

your prescribed dose

• Do NOT drink alcohol

• Do NOT drive or

operate heavy machinery



Blood ClotsIf you have any of these signs or symptoms of a blood clot,

notify your doctor immediately.

• New and sudden pain or swelling in your leg; this could include

your non-operated leg

• Discoloration or redness around your incision

• Warmth of the calf or the leg

If you experience a fall, or you are involved in a motor vehicle

accident, or you hit your head, go directly to the emergency

department. It is very important that you notify the ER that you

are currently taking anticoagulants. These medications may put

you at an increased risk for bleeding and, without immediate

medical treatment, serious side effects may occur.

ANTICOAGULATION



PHYSICAL THERAPY

On the day of surgery, or the fi rst day after surgery you will begin

your physical therapy. Your physical therapist will work closely with

you and design an exercise program specifi cally for you. During your

hospital stay, a therapist will assist you with your walking, work on

exercises and knee range-of-motion, and help you practice stairs as

indicated. Your doctor will determine the amount of weight you will

be able to place on your operated leg.

Exercises Exercises are an essential part of your recovery from a joint

replacement surgery. Starting to exercise early helps ensure a faster

recovery and a better outcome. The knee or hip tends to become

very stiff after surgery, and the exercises will help you regain your

range-of-motion. Exercises will also focus on strengthening the

quadriceps muscle in your thigh. This muscle assists you in sitting,

standing up and climbing stairs. Your therapist will match your

exercises to your tolerance, and will design a home exercise program

specifi cally for you. It is important to take your pain medication

regularly so that pain is not an issue when you exercise. With lower

levels of pain, you will make faster progress in physical therapy.

Before leaving the hospital you should be able to: • Walk using a walker or crutches

• Get in and out of a chair or bed with minimal or no assistance

• Do your exercises

• Climb stairs with assistance if needed

TEN REASONS TO KEEP MOVING AFTER SURGERY

• Reduce your risk for

developing pneumonia

• Reduce your risk for

developing blood clots in

your legs

• Improve fl exibility

• Help with the return

of bowel function so you

can eat a regular diet

• Reduce your risk of

developing constipation

• Reduce stiffness and pain

• Increase your muscle

strength and endurance

• Improve your mental

outlook

• Reduce your risk of

developing bed sores

• Help your wound to heal

PHYSICAL THERAPY


RECOVERY AT HOME

SittingUse a recliner to help keep your legs elevated.

Household ChoresLimit housework to light chores, like dusting, that can be done

while on a walker.

Return to WorkCheck with your doctor.

Automobile TripsOnce you are home, limit your car rides to short trips. Do not

drive until your doctor authorizes it.

Rest PeriodsPlan to lie down and rest several times during the day. Ice your

knee during this time.

GardeningYou may garden after recovery.

KneelingAvoid kneeling for three months. In the future, you will be

permitted to kneel for short periods of time with the consent of

your doctor.



RECOVERY AT HOME

GENERAL INFORMATION

DietContinue your prescribed diet. Remember to drink plenty of water.

Bowel FunctionYou may use a mild laxative such as Milk of Magnesia or stool

softeners (page 32).

BathingYou may shower after discharge. You may be able to use your

free standing commode, with the bucket removed, to sit on in the

shower. Do not sit in a tub, pool or jacuzzi.

Wound CareKeep your incision clean and dry. Let the shower water run over your

incision, then pat it dry. Wash your hands before touching your incision.

WalkingGradually increase the amount of walking you do at home. Get up

and walk every half hour within your comfort level. If you progress

to using only one crutch or a cane, use it on the opposite side of

your surgery.

ExerciseIt is very important to continue your knee exercises at least three

times a day to get your motion and strength back. After checking

with your doctor, playing golf, swimming, upper body exercise and

other moderate activities are usually permitted. More active sports

such as tennis and skiing should be limited.

HINTS FOR WALKING • Bend your knee as you

bring your foot forward.

• Wear footwear that will

stay on your feet and

will not allow you to

slip or trip.


WELCOME TO SAINT JOSEPH MERCY OAKLANDWELCOME TO SAINT JOSEPH MERCY OAKLANDPHYSICAL THERAPY

USING STAIRS AFTER SURGERY

When going up the stairs,

always step up with your

non-surgical (good) leg

fi rst. When going down

the stairs, your surgical

(bad) leg goes fi rst.

Remember, “Good goes

up, bad goes down.”

Ways to Manage Steps• Using one crutch or a cane, and one sturdy rail is probably the

best way to manage steps. You have good leverage for bearing

weight on your arms and the rail helps provide balance.

• If you have room to set a walker on each step, landing or

threshold, then using the walker to get up or down steps usually

works quite well.

• Having two rails can be the best option; however, on many steps

the two rails are too far apart to be helpful.

Other Options for Stairs• If your stairs have no handrails, you can use two crutches. This

option takes more balance and you will need assistance.

• You may want to consider having a rail put in anywhere you have

two or more steps in a row.

• Your physical therapist will help assess the best option for managing

your steps at home. You will practice prior to going home.




BEFORE SURGERY

SITTING EXERCISES TO BE DONE IN A STURDY CHAIR WITH A FIRM BACK AND ARMS.

Armchair Push-UpsSitting, grip the arm rests of your chair.

Straighten arms, raising your bottom up.

Hold for a count of 6. Repeat 10 times,

3 – 4 times daily.

Scapular AbductionPinch your shoulder blades together,

but do not shrug your shoulders.

Hold for a count of 6. Repeat 10

times, 3 – 4 times daily.

Seated Bicep Curls and Tricep PressBring your arms down beside your

body. Bend from your elbows bringing

the palms of your hands up toward your

shoulders, squeezing and tightening

the bicep muscle. Hold 6 counts. Then

straighten your elbows turning your

palms so your hands face toward the

back of your body – squeeze and tighten

the tricep muscle. Hold for a count of

6. Repeat the sequence 10 times, 3 – 4

times daily.

Wall PressesStand with your feet hip distance

apart, facing a wall. Place your hands

on the wall at shoulder height. Your

elbows should be straight, but NOT

locked. Bend your elbows, bring your

nose toward the wall and hold a few

seconds. Return to starting position.

Repeat 10 times, 3 – 4 times daily.

Keep stomach muscles tucked in for ALL exercises.


WELCOME TO SAINT JOSEPH MERCY OAKLANDHOME CARE ONLY

One Foot BalanceBalance on your surgical leg. Begin with

your eyes open and then try to perform

the exercise with your eyes closed. Hold

for 6 counts. Repeat 10 times, 3 – 4

times daily.

Backwards Step-UpUsing a stool or the fi rst step on a set of

stairs, step backward until you feel the

step on the back of your legs. Step up on

to the step backward. Repeat 10 times,




HOME CARE ONLY

Prone Flexion/ExtensionLying on your stomach, bring the

heel of your surgical leg toward your

buttocks as far as you can. Hold for 6

counts. Relax. Repeat 10 times, 3 – 4

times daily.

Note: You can place a sheet around your

ankle to help you to pull the heel toward

your buttocks for a good stretch.

Quarter SquatStand with your back to a wall and with

your feet shoulder-width apart. Slide

down the wall until your knees are at 30

to 45 degrees of bend. Hold for 6 counts.

Return to a standing position. Repeat 10



BEFORE SURGERY AND IN-HOSPITAL

DO YOUR

EXERCISES AT

LEAST 3 – 4

TIMES A DAY.

REPEAT EACH

EXERCISE 10

TIMES.

The purpose of these

exercises is to increase

motion and strength in

your operated knee. We

recommend you take

your pain medication 30

to 45 minutes prior to

doing these exercises.

Quad SetLying on your back, push the back of

your knee down into the bed. Hold

for a count of 6. Relax. Bend the non-

surgical leg to protect your back. Repeat

10 times, 3 – 4 times daily.

Prolonged Extension StretchIf you’re having trouble straightening

your knee, you may be asked to place a

large towel roll under your heel. Relax

your leg to allow gravity to stretch the

back of your knee. Work up to a 15 to

30 minute hold.

Straight Leg RaiseLying on your back with the knee of

your non-operated side bent and foot

fl at on the bed, lock the knee of the

operated side and raise straight leg to

be equal to other knee. You may need

assistance. Hold for a count of 6. Repeat


Heel SlidesLying on your back, start with both legs

straight. Slide the heel of your operated

leg toward your body, bending your hip

and knee as much as possible, but not

past 90 degrees. Hold for a count of 6.

Slowly slide heel back to starting position.




Ankle PumpsLying on your back, push your heel.

Relax your foot, then point your toes.

Alternate pushing your heel and then

pointing your toes in a pumping action.

Complete 10 times, 3 – 4 times daily.

Hip Abduction/Adduction with Straight KneeLying on back, slide your operated leg

out to the side. Keep your toes pointed

up and knee straight. Bring your leg

back to the starting point. Repeat 10


Buttocks Squeeze Tighten your buttocks muscles. Hold for

6 seconds. Do 10 sets, 3 – 4 times daily.


HOME CARE ONLY

Forward Step UpUsing a stair or stool, step up with

your surgical leg fi rst, then down with

your non-surgical leg fi rst. Repeat 10


Knee Flexion StretchUsing a stair or stool, step up with your

non-surgical leg and lean forward increasing

the bend in your knee. Hold for 5 seconds.




WELCOME TO SAINT JOSEPH MERCY OAKLANDWELCOME TO SAINT JOSEPH MERCY OAKLANDHOME CARE ONLY

Prolonged Passive Knee ExtensionSit with your back supported, your

surgical leg extended and your knee

unsupported. Your ankle and foot

should be resting on a stool. Let gravity

stretch the hamstrings (back of thigh).

Hold for 15 to 30 seconds. Repeat 3 –

4 times daily.

Gravity Assisted Knee ExtensionPlace a pillow under your abdomen to

protect your lower back. Lay on your

stomach. Let your lower legs, beneath

the knees, hang off the end of the bed

allowing for your knee/hamstrings to

stretch. Hold 15 to 30 seconds. Repeat



You may apply ice to

your knee after you are

done exercising. Ice can

help with the pain and

swelling. Always have a

layer of clothing or a towel

between your skin and the

ice pack. Apply it for about

20 minutes.


Short Arc QuadLying on your back, place a large towel

roll under your operated knee. Straighten

the knee completely; hold for a count

of 6. Relax. You may need assistance to

bend your knee a little further. Repeat 10


Long Arc QuadSit in a chair with your thigh supported.

Straighten your surgical knee

completely. Hold for a count of 6.


Prolonged Flexion StretchThis exercise works best if your foot

does not slide too well: do it either

barefoot or in a good-fi tting slipper. Slide

your surgical foot backward as far as you

can, then slowly scoot forward a little

more to get your knee bending a little

further. Hold 15 to 30 seconds. Repeat

this sequence 3 more times.



For all standing exercises, hold onto a table or countertop, not your walker.

WELCOME TO SAINT JOSEPH MERCY OAKLANDWELCOME TO SAINT JOSEPH MERCY OAKLANDTAUGHT IN HOSPITAL FOR HOME CARE

Heel-Toe RaisesStanding, hold onto a table or counter

top. Raise up on your toes. Hold for 6

counts. Repeat 10 times, 3 – 4 times daily.

Short SquatsStanding, hold onto a fi rm surface.

Bend your knees halfway, straight to a

full stand. Hold 6 counts. Repeat 10


Standing Hip Extension Stand with your feet shoulder-width

apart. Tighten your buttocks. Keeping

your knee straight, lift your surgical

leg back. Hold for 6 counts. Return to

starting position. Repeat 10 times,


WELCOME TO SAINT JOSEPH MERCY OAKLANDTAUGHT IN HOSPITAL FOR HOME CARE

Hip Abduction Standing, hold onto fi rm surface. Raise

your surgical leg out to side. Keep your

toes pointed straight ahead. Hold for 6

counts. Repeat 10 times, 3 – 4 times daily.

Hip Flexion Standing, hold onto a fi rm surface.

Lift your surgical leg up toward you, but

not past 90 degrees. Hold for 6 counts.


Knee Flexion Standing, hold onto a fi rm surface.

Bend your surgical leg up behind you

with your knee pointing toward the

fl oor. Hold 6 counts. Repeat 10 times,


Straight Leg RaiseStanding, hold onto a fi rm surface.

Move your surgical leg forward at the

hip and hold for 6 seconds. Repeat 10



ck st. joseph mercy oakland patient...

Documents