oint orne - peacehealth · now that you and your orthopedic surgeon have decided joint replacement...

bone & join

t center

Joint Journey

Bone & Joint Center Bone & Joint Center

Bone & Joint Center

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Tab 2For placement only

The Journey Begins: Diagnosis

Making the decision to have a joint replacement is indeed a journey. You’ve probably been living with pain that has decreased your ability to enjoy even some of the simplest things in life.

This colorful journal shows some of the hobbies, travels, and other activities our patients would like to get back to after recovery. Whether enjoying nature or tending the garden, our sincere hope is that you’ll appreciate less pain and a more active lifestyle because of your knee replacement!

As you prepare for your surgery, rest assured that you have selected one of the nation’s leading orthopedic care teams. Having done

Throughout the journal, you will see boxes that give you important notes and “to-do” lists. Be sure to read it carefully. It has information you must be aware of before, during, and after your surgery. Check off each item as it is completed.

thousands of successful knee replacements, the orthopedic surgeons at Rebound and the skilled staff at PeaceHealth Southwest Medical Center make sure you’ll receive the best of care in our Bone and Joint Center.

This journal is part of your care. The information is a general guide to help you prepare for your surgery. The doctors and staff who will provide your care put it together, but you always should follow the instruction provided by your medical team, even when they are different from the instructions in this journal.

2 PeaceHealth Southwest Medical Center

Joint Journey Appointments ChecklistPOST-OP

Post-Op Physical Exam with Surgeon (page 34)

Day____________ Date___________ Time ____________

Location _________________________________________

Outpatient Physical Therapy (page 34)

Day____________ Date___________ Time ____________

Location _________________________________________

Therapist ________________________________________

PRE-OP

Dental Exam (page 13)

Day____________ Date___________ Time ____________

Location _________________________________________

Joint Journey Class (page 13)

Day____________ Date___________ Time ____________

Location Total Joint Center

Labwork/EKG (page 14)

Day____________ Date___________ Time ____________

Location _________________________________________

Medical Consult (page 14)

Day____________ Date___________ Time ____________

Location _________________________________________

Nurse Pre-assessment/PAS (page 14)

Day____________ Date___________ Time ____________

Location Total Joint Center

Blood Donations (page 15)

Day____________ Date___________ Time ____________

Location _________________________________________

Pre-Op Physical Exam with Surgeon (page 15)

Day____________ Date___________ Time ____________

Location _________________________________________

SURGERYDay____________ Date___________ Time ____________

Location PeaceHealth Southwest’s Firstenburg Tower

LocationsTotal Joint Center Physicians’ Pavilion

by PeaceHealth Southwest (3rd Floor)200 NE Mother Joseph Place, Ste 305 Vancouver WA 98664

Rebound Orthopedics Physicians’ Pavilion

by PeaceHealth Southwest (1st Floor)200 NE Mother Joseph Place, Ste 110 Vancouver, WA 98664

Salmon Creek Medical Office Building2121 NE 139th Street, Ste 300 (Bldg. A), Vancouver, WA 98686

Rose Quarter One Center Court, Ste 110 Portland, OR 97227

Southwest Washington Blood Program (Puget Sound Blood Center)

9320 NE Vancouver Mall Drive, Ste 100 Vancouver, WA 98662

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MEDICALCENTER

PHYSICIANS’BUILDING

AND GARAGE

Physicians’Pavilion

E.W. AND MARY FIRSTENBURG

TOWER

MO

THE

R J

OSE

PH

PL.

87th

AV

E

92nd

AV

E

5th STREET

MILL PLAIN BLVD.

MOTHER JOSEPH BUILDING

505 BUILDING

PARKINGGARAGE

SpecialtyClinic

Mill PlainUSBank

EMERGENCY

Health Education

Center

CancerCenter

Family Birth Center

Admin.Building

ENTRANCE

ENTRANCE

ENTRANCE

ENTRANCE

ENTRANCE

ENTRANCE

ENTRANCE

ANGELO LOBBYENTRANCE

5TH STREET

ENTRANCE

92ND AVEENTRANCE

1

2

5

6

3

4

P L

$

$

Entrance to Firstenburg Tower

Main Hallway

92nd Ave Cafe Gift Shop 92nd Ave

Pavilion Cafe Gift Shop 5th Street

Josephine’s Cafe Pharmacy

Fireside Cafe ATM

1

2

34

56

P

$Laboratory ServicesL

Guest Services

Campus Directory

Parking Lot Codes

Building A

Building B

Park in Parking Garage for:n Joint Journey class – 3rd floor Physicians’ Pavilionn Nurse Pre-op/PAS unit – 3rd floor Physicians’ Pavilionn Orthopedic appointments – 1st or 3rd floor

Park in Parking Lot B for:n Access to Tower 8 or the 2nd floor Surgery

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Important Phone Numbers Name Phone Number

Your Surgeon:

Your Primary Care Physician:

Your Pharmacy:

Your Physical Therapist:

PRE-OP CONTACTSCogentHMG Hospitalists/Medical Consult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-3009Joint Journey Care Coordinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-6787PeaceHealth Southwest Insurance Authorization/Verification . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-2122PeaceHealth Southwest Nurse/Pre-assessment (PAS) Services . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-4821PeaceHealth Southwest Patient Access/Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-2124Rebound Billing Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-449-1129Rebound Surgery Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-449-1063Southwest Washington Blood Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-567-4800Total Joint Center Rebound Main Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-254-6161

SURGERY CONTACTSPeaceHealth Southwest Main Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-2000PeaceHealth Southwest Ortho Nursing Unit-Tower 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-4800Surgery Check-in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-4966

POST-OP CONTACTSAnticoagulation Clinics PeaceHealth Southwest Specialties Anticoagulation Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-2500 Vancouver Clinic Anticoagulation Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-397-3269 Kaiser Anticoagulation Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . 1-877-452-2525 (toll free) or 503-249-6777PeaceHealth Southwest Patient Financial Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-7002PeaceHealth Southwest Physical Rehabilitation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360-514-2048

WEBSITESn www.swmedicalcenter .org

n www.swjointjourney .org

n www.swmedicalcenter .org/rehab

n www.reboundmd .com

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THE WARM UP: PRE-OPWhat is a knee replacement? . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

I am scheduled for surgery, what’s next? . . . . . . . . . . . . . . . . . . 12

What are the pre-surgery appointments? . . . . . . . . . . . . . . . . . 13

How do I prepare for my stay in the hospital? . . . . . . . . . . . . . . . 16

How can I prepare my home and myself for surgery? . . . . . . . . . 17

What do I do the day before my surgery? . . . . . . . . . . . . . . . . . . . 19

Instructions for a Betadine or Hibiclens Shower . . . . . . . . . . . . 19

THE BIG DAY: SURGERYWhat happens the day of surgery? . . . . . . . . . . . . . . . . . . . . . . 23

What happens in pre-surgery and during recovery? . . . . . . . . . 24

How is pain managed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

THE HOSPITAL COURSE: START MOVINGWhat can I expect in the hospital? . . . . . . . . . . . . . . . . . . . . . . . . . 29

What are the post-op appointments . . . . . . . . . . . . . . . . . . . . . 34

THE ROAD HOME: BEING READY AFTER YOUR HOSPITAL STAYWhat about discharge from the hospital? . . . . . . . . . . . . . . . . . 39

Activites of daily living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

What physical therapy and exercise do I do after my joint replacement? . . . . . . . . . . . . . . . . . . . . . . . . . 45

THE BRIDGE TO RECOVERY: SUPPORT MATERIALS & THERAPYDo I need an advance directive? . . . . . . . . . . . . . . . . . . . . . . . . 49

What are blood thinners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Walker safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Prevention of infection after joint replacement . . . . . . . . . . . . . 55 Exercises after your knee replacement . . . . . . . . . . . . . . . . . . . 56

Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Post-op pain medication record for home . . . . . . . . . . . . . . . . . 62

Exercise flow sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Table of Contents

9


Warm Up

The Warm Up: Pre-op

11Joint Journey Journal

WHAT IS NORMAL KNEE ANATOMY?The knee is a hinge joint and has three bones. The end of the thigh bone (femur) meets the top of the shin bone (tibia). The knee cap (patella) rests in front of the end of the thigh bone. The joint is surrounded, stabilized and cushioned by soft tissue such as joint capsule, ligaments, muscles and cartilage. Normal alignment is when the knee is angled slightly inward from the hip down toward the knee.

The Warm Up: Pre-op

KNEE REPLACEMENT JOURNAL

Bone & Joint Center

WHAT IS AN ARTHRITIC KNEE?Arthritis is the erosion of the knee lining and cartilage. As the joint continues to wear, bone spurs may develop and cause joint noise and pain. Sometimes knee alignment changes to become more “bow legged” or “knock kneed”. As pain worsens, it becomes increasingly difficult to do every day activities.

If you have any questions about your treatment or this journal, be sure to ask. Use the space provided to jot down questions you have.

Normal Knee Anatomy

Arthritic Knee Anatomy

X-ray of Normal (L) and Arthritic (R) Knee Anatomy


WHAT IS TOTAL KNEE REPLACEMENT OR PARTIAL KNEE REPLACEMENT?

I AM SCHEDULED FOR SURGERY. WHAT’S NEXT?Now that you and your orthopedic surgeon have decided joint replacement surgery is the right choice for you, you will need to begin preparing for surgery. You will have several appointments, tests and procedures that provide vital information to your medical team and help guide you through your “Joint Journey”. Information regarding these appointments is on the following pages. You will find an appointment checklist on page 2 of this journal.

If you have any questions or if you must cancel or change any of the appointments, please call us so we can make every effort to accommodate your needs without having to reschedule your date of surgery. We are always happy to talk with you.

Please bring your Joint Journey Journal to all of your appointments .

3 to 4 weeks ahead: � I have selected a coach to help me through my joint journey.

� I have the paperwork and appointments from my surgeon’s office.

� I am registered for my Joint Journey class.

� I know when and where to do my labwork.

� I have my medical consult appointment scheduled.

� I have my blood donation appointment scheduled, if required.

1 to 2 weeks ahead: � I have my Nurse/PAS appointment scheduled.

� I am scheduled for my Pre-op with surgeon.

� My coach is prepared to take me home from the hospital.

The Warm Up: Pre-op (continued)

Total Knee Replacement or Partial Knee Replacement are two ways for treating an arthritic knee. These operations replace the damaged joint surfaces with sophisticated artificial parts made of metal and plastic. The worn surfaces of your old joint are smoothed and the new parts inserted and joined to your bone. Your surgeon considers many factors when determining the best procedure for you including your age, health, joint damage, activity and the prosthetics. Your surgeon is an expert and aims for the best possible outcome for your knee problem.

The surgery requires about two hours and a brief hospital stay. A four to eight inch incision is made down the middle of the knee to access the joint. The incision may be closed with staples that are removed at the post-op appointment with the surgeon.

Total Knee Replacement

Partial Knee Replacement


WHAT ARE THE PRE-SURGERY APPOINTMENTS?Three to four weeks before your surgery, you will need to begin preparing for surgery. You will have several appointments designed to help guide you through the knee replacement process and answer your questions.

PRE-OP APPOINTMENTS

Dental Care

For your safety, we recommend you see your dentist within the six months leading up to your surgery to ensure you do not have any infections or problems that could delay your surgery. However, do not schedule closer than four weeks prior to surgery. This will allow sufficient healing time in the event any dental work, including routine cleaning, is required. You schedule this appointment yourself, if necessary.

Joint Journey Class

You will be scheduled to attend this session that will provide you with important information you need in order to make your surgery and recovery a success. During this class, you will:n Discuss the surgical process and prevention of

complications

n Discuss pain management and medications

n Review exercises and any preparation you will need to do at home

n Discuss how to bridge your recovery from hospital to home

n Answer any questions you may have

Please bring the Joint Journey Journal and your coach to the class. Your scheduler will tell you the date and time of your class. Please refer to the class card found in the cover pocket of this journal should you need to reschedule. We recommend you schedule this class four to five weeks prior to surgery.

We strongly encourage you to bring a “coach” to your Joint Journey class as well as to your doctor appointments. Your “coach” is someone who can help you after your surgery. The class will provide you and your coach with the important information you need in order to make your surgery and recovery a success. Please do tell us if you are alone and need extra help.

I have seen my dentist at least a month before my pre-op appointment with my surgeon.

Date __________________

Your surgeons office will provide a list of the dates and times of your class and initial appointments.

Pre-surgery tests provide vital information to your medical team. To prevent a delay or cancellation of your knee surgery, you should complete the tests, blood work, and appointments by your pre-op appointment with your surgeon. If you must cancel or change an appointment please refer to the phone numbers on page 4.


Lab work / EKG

You may be asked to complete your pre-operative lab work (blood and urine tests) and EKG separate from your nurse pre-assessment or medical consult appointment. Your scheduler will direct you where and when your lab work is to be completed. Be sure to bring the Lab Requisition form to your appointment. This appointment occurs approximately three to four weeks prior to surgery.

Medical Consult

An internal medicine or primary care provider will be consulted to assess your risk for surgery. Your fitness for surgery, your medications, lab results and heart tests will be evaluated. Where you obtain your medical consult is based on your primary care doctor and insurance. You may be asked to see a CogentHMG provider at PeaceHealth Southwest, your primary care physician or a Vancouver Clinic provider for medical consultation. CogentHMG providers are internal medicine specialists who see patients in the hospital. Known as hospitalists, they specialize in taking care of hospitalized patients’ medical issues to supplement the surgical care.

If you see a hospitalist, he or she (or a partner) will see you while you are in the hospital. The hospitalist will work with your surgeon during your recovery. Your surgeon and your hospitalist together will coordinate your discharge plan. Your surgery scheduler will let you know about this appointment and it should occur approximately three to four weeks prior to surgery.

Nurse Pre-assessment / PAS and Patient Access / Registration

A hospital nurse will review your health history, document all your medications and may complete some of the pre-op tests of your blood, heart and urine. Please bring the Lab Requisition form, all of your medicine bottles and supplements (including over-the-counter medicine bottles, herbs, vitamins or other supplements you take), your Joint Journey Journal, identification and insurance card.

A patient registrar may verify your personal and insurance information at this time or will contact you by phone. The Nurse / PAS office will contact you to schedule this appointment within the two weeks prior to surgery.

Our staff will refer to this journal during your appointments. It’s important for you to bring this booklet with you to each visit.

I have the following for my nurse pre-assessment appointment:

� Bottles of all medications and supplements I take

� A list of my surgeries

� I am prepared to tell the doctor about any of the following:

a. Heart trouble

b. Kidney trouble

c. Anesthesia reactions

d. Cancer

e. History of blood clots or bleeding problems


You may eat a light meal before your lab work or medical consult visit when your blood work is drawn.


Blood Donations

Not everyone who has surgery will need to give blood ahead of time. If your surgeon decides you need to donate blood before your surgery, you will be asked to take donation supplements. If you are scheduled to donate blood, you will begin taking iron and vitamin tablets 30 days prior to your first blood donation. We recommend that you take ferrous sulfate, 325 mg one tablet per day and one adult multivitamin per day. The Southwest Washington Blood Program will be notified and they will call you to provide instructions and to schedule your donations. Expect their call three to four weeks before surgery.

Pre-op Physical Exam with Surgeon

About a week before your surgery you will meet with your orthopedic surgeon. The surgeon will do a final review of the information from your medical consultation, your blood work and check the surgical site to make sure you are in good shape for surgery.

You and your doctor will talk about medicines and supplements you are taking. Stop taking all herbal supplements two weeks before your surgery. If you take a blood thinner, anti-inflammatories or certain antidepressants, ask your surgeon when to stop taking them. They can cause bleeding or may interact with medicine you will receive in the hospital. Check with your surgeon to see what is right for you.

At this appointment expect to sign your surgical consent. Your signature on this consent gives the surgeon permission to do your surgery, and indicates that you have talked about the benefits, risks and alternatives. If you haven’t yet been scheduled for your pre-op physical exam with your surgeon, contact the Rebound office.

After your Pre-op exam and up until your surgery date, notify your surgeon if you develop a sore throat or fever, or a change in your skin by your knee such as cuts or scrapes.

A blood transfusion may be needed after your surgery. Your doctor may recommend that you donate blood for your surgery. Giving blood for your own use is called an“autologous” blood donation.

Things to do at your Pre-op physical exam with surgeon.

� Validate medicines to take the morning of the surgery

� Get a prescription for a walker

� Complete the physician section of a disabled parking permit if appropriate. (permits are provided at the Joint Journey class)

For some patients the labwork, medical consult and nurse pre-assessment visits may be combined.


HOW DO I PREPARE FOR MY STAY IN THE HOSPITAL?

How am I pre-registered for the hospitalization?

The PeaceHealth Southwest patient registrar will call you to verify your contact information, insurance and necessary forms to complete prior to surgery.

How long will I be in the hospital?

To go home from the hospital, you need to be able to get in and out of bed by yourself and walk well with a walker or crutches. If you have stairs at home, you will need to know how to go up and down stairs. Your physical therapist will show you how to do these activities.

Patients with a single knee replacement surgery may leave the hospital one to two days after surgery. If you are having both knees replaced, you may be in the hospital for an additional day after surgery.

What do I need to know about financial arrangements?

Before you are scheduled for surgery, the Rebound surgery authorization coordinator and the hospital will contact your insurance carrier to get authorization for surgery and the details on your medical benefit coverage. If you have any financial concerns or questions, call PeaceHealth Southwest’s insurance authorization or Rebound’s surgery authorization (see page 4 for phone numbers). They can discuss a payment plan if needed.

What if I am from out of town?

If you live out of the area, the patient registrar will contact you as noted above. The Rebound surgery scheduling coordinator will talk to you about where and when to have your blood work and other tests completed. If you have any questions about these, please ask the surgery scheduler.

If you or a family member needs a place to stay before your surgery or while you are in the hospital, you can check the PeaceHealth Southwest website at www.swmedicalcenter.org/lodging for suggestions.

Need a hotel in the Vancouver area?swmedicalcenter .org/lodging

You may want to validate your insurance benefits including potential co-pays and out of pocket expenses for:

� Durable medical equipment (walker, commode, etc.)

� Anticoagulation medicines (blood thinners)

� Skilled nursing facilities (for potential post hospital rehab/care)

� Physical therapy (clinics, visit numbers or co-pays)

Be prepared for some out of pocket expenses for some DME, medications, surgeon, physician assistant and anesthesiologist.



HOW CAN I PREPARE MY HOME AND MYSELF FOR SURGERY?As you prepare for your total joint replacement surgery, here are some important things to start right away.

Exercise for healing.n It is good to exercise as much as you can before

surgery to prepare your body for the stress of the surgery. You should do simple exercises designed to strengthen the muscles around your joint. You can also exercise your arms and uninvolved leg. For some of these exercises, see the back of this journal.

Eat well.n Eat a Nutritious Diet.

n Good nutrition helps to preserve and build muscle and is essential for you to heal. Between now and your surgery, eat a healthy diet. A healthy diet includes protein, fruits, vegetables, breads and is low in fat.

n Sometimes after surgery you may experience a decrease in your appetite. It may be helpful to drink a nutritional supplement.

Drink fluids.n Be sure to drink at least six 8-ounce glasses

of fluid each day. To avoid extra weight gain, be careful you are not drinking high calorie beverages.

STOP SMOKING.n Smoking raises your risk of a complication after

surgery. It also makes your incision heal more slowly. Smoking is not allowed in the hospital.

Durable medical equipment (DME).n You will need a walker or crutches to use after

the surgery. Most patients prefer a front wheeled walker. Your surgeon will provide a prescription for the device and you may pick it up ahead of time at one of the DME stores listed on the sheet in the back pocket of this journal.

n Sometimes special equipment makes daily activities easier at home. You may wish to consider an elevated toilet or shower seat, a cordless telephone, remote control for the television, or a rolling cart for moving items in the house.

n Other equipment may be needed. The therapists will make recommendations after your surgery for adaptive equipment or devices such as commodes, risers, etc. The care manager will help make arrangements to get other necessary items.

I have done the following to prepare my home:

� Arranged for my companion to help me at home after my surgery for shopping, cleaning, transportation, etc.

� I know who will provide transportation for me to and from the hospital and to my post-op appointments.

� Removed throw rugs from every room.

� Removed other items I might fall over (children’s toys, step stools, pet toys) from every room.

� Put clean sheets on my bed.

� Stored items at waist level.

� Moved the furniture to clear a traffic path so my home is safe when I use a walker or cane.

� Raised my bed so the mattress is level with or above my knees.

� Arranged a place for my pet so I don’t trip when I am walking around.

� Installed grab bars in my bathroom.

� Have a safe way to get on and off the toilet.

� Prepared meals for my use while I recover from surgery.

� Have a dressing kit to help me to get dressed on my own after surgery (may be purchased during your hospital stay).

� Have a large ice pack to use on my knee (gel, peas, ziplock).


Prepare your home.n As strange as it seems, planning your

discharge from the hospital starts now. Taking steps to prepare now can prevent hazards that could lead to a fall, loss of balance, or make it difficult to move while you recover.

We encourage your coach to participate in your activities during your surgical recovery. This person will need to be present when we review the teaching and written directions for home. If you are alone and need extra help, please let us know.

While we want everyone to go home right after surgery, in some cases patients need extra care and may need to go to a rehab facility for a period of time until they are able to return home.

I have stopped taking herbal supplements two weeks prior to surgery.

Date _________________

I have asked my surgeon when to stop taking my blood thinner. I am to stop taking blood thinners on

Date _________________

I am/am not to take Coumadin on

Date _________________

I am to stop taking my anti-inflammatories on

Date _________________

Between your pre-op physical exam with your surgeon and your surgery, be sure to call the surgeon’s office if you have:

� Any unusual change in your skin, cuts, scrapes of the surgical leg

� A cough, cold, fever, or the flu

If you walk, cycle, or swim, keep doing these things between now and your surgery.

Exercise as you are able, within the limits of pain.


Dressing Kit:

A Dressing Kit contains several adaptive devices to make dressing and daily living skills easier. You may purchase a kit when you are in the hospital. While hospitalized, if you would like to meet with an Occupational Therapist to instruct you in how to use the kit, let your medical team know.


WHAT DO I DO THE DAY BEFORE MY SURGERY?You will receive a call from the hospital the night before surgery to confirm the time you need to arrive. Your surgery will be at PeaceHealth Southwest Medical Center’s Firstenburg Tower.

For your safety, do not eat or drink anything after midnight the day before your surgery. The one exception is that you may take your medicines (with small sips of water) as recommended by your surgeon. Your surgeon may recommend that you start taking a blood thinner the night before your surgery.

It is important that we can call you the night before your surgery to let you know if changes come up. Be sure you give us a phone number where we can reach you during the 24 hours before your surgery.

� I have not had anything to eat or drink after midnight.

� I have given PeaceHealth Southwest my 24 hour contact number.

� If recommended, I have taken a blood thinner the night before surgery.

See page 4 for surgery check-in phone number

INSTRUCTIONS FOR A BETADINE OR HIBICLENS SHOWERFollow instructions below for taking an antibacterial shower the day of surgery, unless instructed differently.

1. Shower normally. Rinse. Turn water down to a dribble from shower head.

2. Add a small amount of soap in your hand and start washing from shoulder to toes.

3. Do not use washcloth or nylon scrubber, use your hands only.

4. Using your hands rub your body with the soap, adding water from the dribbling shower head as needed. Use all the soap provided.

5. Keep soap out of eyes, ears and mouth.

6. Using your hands to rub and scrub your body, keep adding water as needed to keep the soap wet on your body for a total of ten minutes if using Betadine or five minutes if using Hibiclens.

7. Concentrate most of your effort scrubbing the surgical area of your body.

8. After ten minutes if using Betadine or five minutes if using Hibiclens, turn the water in the shower on fully and rinse well. This soap is very drying and must be rinsed well.

9. After your shower towel dry with a freshly laundered towel and dress with freshly laundered clothes.


SURGICAL SITE INFECTIONS

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in one to three out of every 100 patients who have surgery.

Some of the common symptoms of a SSI are:n Redness and pain around the area where you had

surgery

n Drainage of cloudy fluid from your surgical wound

n Fever

SSI can be treated with antibiotics. The antibiotic given to you depends on the bacteria (germs) causing the infection. Sometimes patients with SSI also need another surgery to treat the infection.

WHAT I CAN DO BEFORE SURGERY TO PREVENT SURGICAL SITE INFECTIONS:n Tell your doctor about other medical problems

you may have. Health problems such as allergies, diabetes, and obesity could affect your surgery and your treatment.

n Quit smoking. Patients who smoke get more infections.

n Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop infection.

21

Big Day


The Big Day: Surgery


WHAT HAPPENS THE DAY OF SURGERY?

What about taking medicine before surgery?

The morning of your surgery, take only those medicines as directed by your surgeon at your pre-op physical exam with a small sip of water. At the hospital, you may also be given preventive pain medicine before surgery.

If you take diabetes medicine, make the following changes:

n Insulin—On the day of surgery, take only half your usual morning dose of insulin.

n Oral diabetes medicines or diabetes pills—Do not take diabetes pills the morning of surgery. If you have a history of low blood sugar readings in the mornings, do not take your oral diabetes medicines the evening before surgery.

Clarify which medicines to take before surgery with your surgeon at your pre-op physical exam appointment.

When you are in the hospital, your blood sugar might be checked more often than you usually do. Because surgery and procedures can make it more difficult to control your blood sugar, you may be given insulin, even if you do not use it at home.

When should I arrive for my surgery?

On the day of your surgery, most patients arrive two hours before surgery. Go to PeaceHealth Southwest’s Firstenburg Tower entrance (refer to map on page 3). Proceed to Surgery on the second floor and tell them you are there to check in.

Where does my coach wait?

Bring your coach with you on the day of your surgery. While you prepare for surgery, your coach can wait in the surgical lounge on the second floor. During your surgery, your coach can take a pager and go anywhere in the hospital. Most patients are in surgery about two hours and in the recovery room for one to two hours.

I am bringing to the hospital: � Glasses, contact lenses, hearing aid, dentures,

cleaning solution and the cases for each

� Toiletries and personal items

� Loose fitting shorts to wear in the gym

� Comfortable change of clothes, such as a sweat suit, or tee shirt and loose fitting pants or shorts, and comfortable, soft-soled shoes to wear home

� Walker labeled with your name, if you have one

� Pharmacy card to facilitate getting your discharge medications.

Your surgery time is an estimate. We make every attempt to keep the surgery on schedule. Your actual time will depend on whether other surgeries cancel, take longer than expected or we have emergencies.

PeaceHealth Southwest is located at: 400 NE Mother Joseph Pl. Vancouver, Washington

Visiting later, park in west parking area Lot B off of 87th Avenue or Pavilion Garage. From the garage, access to the Tower is on Pavilion level 2.

The Big Day: Surgery


Bone & Joint Center


What personal items may I bring to the hospital?

Leave valuables at home. Personal items cannot be taken into surgery but your coach or a family member or friend may bring you any belongings you need after your operation. Items to bring include eye, ear and mouth ware along with cases, toiletries, clothing and wireless devices. If you use a CPAP machine for breathing at night, you may bring your mask and tubing. A machine will be provided. PeaceHealth Southwest does have wireless internet access and cell phones may be used on most hospital units.

WHAT HAPPENS IN PRE-SURGERY AND DURING RECOVERY?

What happens before surgery?

Once you arrive in Surgery, you will:n Change into a hospital gown.

n Have your temperature and blood pressure checked.

n Have an IV started for fluid and medicine.

n Confirm your surgery with your surgeon.

n Indicate which leg is having surgery and you and your surgeon will mark it.

n Have your surgical site prepared.

n Talk to the anesthesiologist about your surgery.

n Take your first pain medicine.

Once the preparations are completed, your coach will be called in to wait with you, prior to your surgery.

What happens in recovery?

After your surgery, we will take you to a special recovery room for care until you wake up from your anesthesia. In the recovery room we will: n Check your vital signs, and your heart, lungs and

stomach.

n Monitor the oxygen placed in surgery.

n Monitor the dressing and wound drain placed in surgery.

n X-ray your knee.

n Continue your IV.

n Prevent blood clots with pressurized leg wraps that will intermittently squeeze your legs to promote circulation. You will wear them any time you are not up walking. Expect to have elastic stockings on your legs too.

n Monitor the urinary catheter placed in surgery.

n Treat any nausea. Tell your nurse if you have it.

n Treat your pain. Tell your nurse your pain level.

The Big Day: Surgery (continued)

You will be provided special instructions and special soap to shower at home on the morning of surgery (see page 19).

To prevent surgical site infections: � At the time of your surgery, speak up if someone tries to shave you with a razor. Ask why you need to be shaved and talk with your surgeon if you have any concerns.

� Ask if you will get antibiotics before surgery.


HOW IS PAIN MANAGED?In the long term, surgery will reduce the amount of arthritic pain you have. However, you will still have some short-term pain as you heal. By the time you go home, you will be taking a few pain pills each day.

It is important to tell us if you have pain. In order for us to help you, we need to know what your pain is like. You can use the following scale, with 0 being no pain and 10 is the worst you can imagine. Our goal is to keep your pain at your acceptable level. This pain may be troubling, but can be coped with most of the time.

You will determine the acceptable level that also allows you to mobilize as needed for therapy and daily activities. Let your caregivers know how you feel and how well pain relieving measures are working for you. There are several things we use to lessen your pain such as ice packs, repositioning, walking and medications.

Using ice packs

You may have numbness around your surgical site so use care when applying ice packs. Always use a barrier such as a towel between the pack and your skin and only leave it on for 15 minutes per hour.

Why do I need to cough and deep breathe?

As soon as you are able, you will want to cough and take deep breaths to clear your lungs and prevent complications. Your nurse will reinforce how to use your incentive spirometer. Remember to use it frequently– you don’t need to wait for us to remind you. We suggest you do up to 10 breaths with your incentive spirometer every hour when you are awake. Continue to use the device during the first week after you leave the hospital.

0 2 4 6 8 10


Long Term Pain Management

You will go home with a prescription for pain medicine. Most patients use it consistently for one to two weeks and then gradually taper frequency and dosage over one to two months. You will work with your orthopedic surgeon on how best to manage pain as you progress through your Joint Journey.

The Big Day: Surgery (continued)

27

Hospital Course


The Hospital Course: Start Moving


WHAT CAN I EXPECT IN THE HOSPITAL?

On the day of surgery

1. Tests and assessmentsn Initially, your vital signs will be checked

several times an hour.n Every four hours for the first day, we will

check your surgical site and ask about your pain level.

2. Medical treatmentn Your IV will remain in place until you drink

liquids adequately. n Ice placed on the surgery site will make it cool,

more comfortable, and minimize swelling. n Throughout the day, you will feel your leg

being squeezed by the leg wraps to prevent blood clots. You may also haven Elastic stockingsn A wound drainn Urine cathetern Leg exercisier (CPM)

3. Activityn Today you will sit by the side of the bed,

stand, and even take a few steps.n If you are in your hospital room by mid-

afternoon, the physical therapist will meet with you to begin your exercises. Otherwise, your first physical therapist visit will be the day after surgery.

n Your nurse will place a blanket roll under your ankle for ten minutes each hour to help you straighten your knee.

n You will do frequent ankle pumping exercises for circulation.

4. Medication

You will have pain medicine and antibiotics either as a pill or in your IV. We may give you a blood thinner. Your doctors will determine which regulator medicines to resume taking in the hospital.

5. Nutrition and diet

You will be able to drink clear liquids and begin a regular diet, usually within a few hours of surgery.

6. Education on preparing to go home

Your nurse will begin to discuss your plans for leaving the hospital. Be sure you tell the nurse about the help you have arranged. If you have any questions about going home, please ask.


The Hospital Course: Start Moving

Bone & Joint Center


The Hospital Course: Start Moving (continued)

Questions to ask:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

What is Occupational Therapy? � Therapeutic use of activities and/or

devices to increase independent function.

� May include adaptation of task or environment to achieve maximum independence and to enhance quality of life.

� Most patients who have knee replacement do not have OT while in the hospital.

� While hospitalized, if you would like to meet with an OT, let your medical team know.

Equipment Purchase � Limited equipment reimbursed by

insurance.

� OT may teach you how to use the Dressing Kit items for dressing and daily living skills (see page 19 for Dressing KIt description)

� OT may make specific self care equipment recommendations based on your needs.

To prevent surgical site infections after surgery:

� Make sure that your healthcare providers clean their hands before examining you.

� Family and friends who visit you should not touch the surgical wound or dressings. Also, they should clean their hands with soap and water or an alcohol based hand rub before and after visiting you.


Day 1 — The day after your surgery

1. Tests and assessments

We will draw your blood and check your hemoglobin.

2. Medical treatmentsn Although you probably won’t have an IV

running, an IV access will remain in your arm so that we can give you medicine easily if you need it.

n If you need blood, you will have a transfusion. n You will need to continue to do your deep

breathing exercises several times a day. n If you have a drain in your wound, we may

remove it today.n The catheter in your bladder, we will remove

this morningn We will change your wound dressingn Your leg exerciser may be used as you like for

comfort

3. Activity

We invite your coach to be involved in your activities. n We will add more strengthening exercises and

begin working on your home program. n You will continue to do frequent ankle

pumping exercises for circulation.n You will be up walking and in the chair five to

six times during the day. This includes sitting in a chair for all your meals, bathroom trips, and walks with your nurses and therapists. The aim is to walk as much as tolerated. Some patients will walk 30 to 50 feet and some will walk 100 feet or more.

n If you have had a partial knee replacement, you may be ready to go home this afternoon.

� I should only put weight on my operated leg in the amount of ____________.

4. Medication

In most cases, your antibiotics will finish today. You may start a stool softener today and will continue a blood thinner. You will continue to receive your pain medicine to help you stay active. You will continue to take your regular medication as directed by your surgeon.

5. Nutrition and diet

If you need help with your diet, let us know. A dietitian is available to help you. Drink plenty of fluids.

6. Education and preparing to go homen Your physical therapist (PT) will review your

recommended exercises and knee precautions.n The pharmacist or nurse will visit to discuss

your anticoagulation plan.n If you need special equipment for home, such

as an elevated toilet seat or commode, the therapist and the care manager will arrange for it today.


Day 2 — The second day after your surgery Day of discharge

1. Tests and assessments

You will have another blood test today.

2. Medical treatments

These will be similar to day one.

3. Activityn This is ususally the day you go home. You

should be able to walk 100 to 150 feet, get in and out of bed with a bit of help and go up two or three stairs with help..

n Your coach will be shown how to help you with exercises and getting around. You may need help lifting your leg onto the bed and for certain exercises.

n Continue to place the towel roll under your ankle to straighten your knee for 10 minutes every hour when awake.

n Occupational TherapyIf your medical team feels it is necessary, you may see an occupational therapist. The occupational therapist may recommend a dressing kit (see page 18).


4. Medications

You will receive pain medicine to keep you comfortable – narcotic pain medication is constipating. You will continue to receive a stool softener today. If you have not gone to the bathroom (bowel movement) since your surgery, you may have a laxative if needed. You will continue your blood thinner.

5. Nutrition

If you have not felt hungry since your surgery, you may find your appetite picks up today.

6. Education and preparing to go homen You will have the chance to talk to your nurse

and review your medicine for home as well as other home instructions.

n If you need special equipment for home, such as an elevated toilet seat, commode or hip kit, the therapists and the care manager will arrange for it today.

n Remember to do your breathing exercises every hour for the next week at home.

n Remember to exercise your legs and tell your nurse if you have any numbness or tingling.

n If you have any concerns about your care at home, tell us now. We want to make sure your needs are met by the time you leave.

n If you have any questions about what we have talked about already, be sure to ask. If you don’t understand something, ask questions.


Day 3 — The third day after your surgery Day of discharge if still in hospital

1. Tests and Assessments

You will have another blood test today.

2. Medical treatments

These will be similar to the previous days, as needed.

3. Activityn You should walk over 150 feet, and get in and

out of bed with little help.n You will practice climbing stairs with the

therapists today.

4. Medications

These will be the same as day two.

5. Nutrition

Your appetite should continue to improve over the next few days.

6. Education and preparing to go homen You will have the chance to talk to your nurse

and review your medicine for home as well as other instructions.

n If you have any questions about what we have talked about already, be sure to ask.

I have talked to my nurse about my home plan to:

� prevent infections

� manage my pain

� protect my joint

� perform my exercises

� maintain my nutrition.

My ride home is arranged for this time: _________________

I am ready to go home (discharge) when: � I know how to move myself in and out of bed/chairs, walk, and climb stairs.

� I can complete my home exercises for range of motion and strength.

� My coach knows how to help me with exercises and getting around.


WHAT ARE THE POST-OP APPOINTMENTS?

Post-op Physical Exam with Surgeon

Your surgeon will examine the surgical incision, remove staples or stitches if appropriate, and assess your pain management. This first post-op appointment with your surgeon will be seven to 10 days following discharge from the hospital or sooner if problems arise. Please wear or bring shorts to this appointment. This likely has been scheduled by your surgery scheduler - please refer to your appointment checklist.

If you do not have this appointment scheduled yet please be sure to call Rebound to arrange it and note it on your appointment check list.

Outpatient Physical Therapy

Knee replacement patients start outpatient therapy soon after discharge. When you attend the Joint Journey class, the instructor will collect information to schedule your first Outpatient Physical Therapy appointment to soon occur after your discharge from the hospital.

Anticoagulation Labwork

Your surgeon will prescribe medication to thin your blood for several weeks after surgery to minimize your risk of developing blood clots. Some medications require careful monitoring to ensure you are on the proper dose. After surgery and before you are discharged from the hospital, you will be advised when and where to go for these appointments, if applicable.

Your follow-up appointment with your Rebound surgeon should have been scheduled before your surgery. If you don’t have an appointment, please let your nurse know.

Get in the habit of writing down your questions to bring to your doctor appointments. Use this Journal for that!


Common questions to ask your surgeon at your post-op appointments:

� If needed, ask for a pain medicine prescription refill.

� Validate how long to wear the TED stockings

� Validate how long to use the walker

� Whether to continue physical therapy at home or do I need to go to a clinic?

Long Term Follow-up

Because you have a prosthetic (artificial) joint replacement, it needs to be examined and x-rayed by an orthopedist on a regular basis. An orthopedist’s evaluation of your joint replacement and x-ray provides the best opportunity to note the integrity of the prosthesis and level of wear. Though rare, problems could develop without you experiencing symptoms. Our surgeons recommend follow-up at one year, two years and every other year thereafter.


PHYSICAL THERAPY HELPS THIS PT JOURNEY BACK FROM KNEE SURGERY

Physical therapist John Wisti ended up on the other side of the elliptical this year. John “wore our” his knees playing sports – football, wrestling and rugby. In February, John opted for bilateral total knee replacements at PeaceHealth Southwest with Mark Colville, MD, an orthopedic surgeon at Rebound. “Rebound has many great surgeons for knee replacement, but I selected Dr. Colville because I’ve known him for years. I respect his work and his professional manner,” said John.

Having worked as a physical therapist at PeaceHealth Southwest for nearly three decades, John relished engaging with respected co-workers in a new way. He did six weeks of outpatient therapy and pushed himself to get back on his feet fast. “My knees were painful, swollen and stiff but you just have to move them to get better,” he said. John’s Joint Journey had him back to work, on his side of the elliptical, in just a few months.

Testimonial

37

Road Home


The Road Home: Being Ready


WHAT ABOUT DISCHARGE FROM THE HOSPITAL?

Will I need help at home?

You will likely do better after surgery than you think possible. We want people to go directly home from the hospital and we know that most people do best with 24 hour help at home for the first week or two following total joint surgery. We suggest you identify someone to call your “coach” who can help you at home once you are discharged. Your coach usually doesn’t have to provide physical assistance but provides support, encouragement and close supervision to meet your daily needs.

What if I need to go to a care facility?

There are times when extra care is needed or you may not have anyone to help you at home and you may need to go to a care facility for a few days or weeks until you are able to safely return home. PeaceHealth Southwest has care managers to assist you in making arrangements for alternative care placement if that becomes necessary. Generally, Medicare provides for short term skilled nursing and rehab care following joint replacement surgery if certain criteria are met. For example, if you require assistance to walk or transfer or to remember your new joint safety precautions. Insurance provider benefits vary. Look on your insurance card for the Customer Service number to call and ask what your plan’s preferred & contracted Skilled Nursing Facility (SNF) choices are and to validate your specific coverage. Usually they can tell you what is covered by the plan in terms of number of days or percent of charges or other expenses you may incur.


The Road Home: Being ReadyWhere can I find a care facility?

Refer to the list of our local SNF options on the yellow sheet in the back of your journal. If you do not qualify for SNF care but do not have help at home, there are local retirement facilities that provide respite care. This is not usually covered by insurance and rates vary depending on the level of services utilized.

Can I get home in a car?

You will need someone else to drive you home or to your care facility once you are discharged from the hospital. Most patients are able to get in and out of a car with help. If this is not possible, the care manager will help arrange transportation by wheelchair. Most insurance companies do not cover wheelchair transportation and wheelchair transport costs vary from $30 to $60 or more, one way.

Will I need any special equipment?

Your physician and therapists may prescribe and recommend walkers, crutches, commodes or other equipment. Medicare and private insurances usually cover partial costs of these items. They do not usually pay for adaptive equipment for dressing and bathing. Not all patients require dressing equipment but if you have limited mobility these tools will improve your independence with self care. PeaceHealth Southwest has an onsite vendor available to provide some equipment that is covered by most insurers. If necessary, the care manager will help you make arrangements to get equipment you may still need for home. A list of local durable medical equipment (DME) providers is included in the cover of this journal.

Bone & Joint Center


ACTIVITIES OF DAILY LIVING

What special care should I take after my surgery for daily activities?

Special care is required for some of your daily activities.

You will need to use a walker, crutches or cane around home for the first four to six weeks. You may need it longer when you are out of your home. Ask your surgeon when it is safe for you to stop using it.

The Road Home: Being Ready (continued)

LOWER BODY DRESSING (Pants and Underwear)Equipment: Reachers and/or Dressing Stick

Process:n To dress you will either want to be sitting on a bed or in an armchair. You

may find it more difficult on a soft bed.

n Make sure that your equipment and clothes are next to you before you begin.

n Use the reacher and hold the top waistband of either the underwear/pants on the side of the leg you had your surgery on. Always dress the operated leg first. Once the surgery leg is in the clothing leg hole use the reacher again grabbing the waistband of the good leg and pull into place.

n Pull the underwear/pants up to your thighs prior to standing to pull both of them on completely.

n Keeping your surgery leg in front of you stand with your walker to pull your underwear/pant to your waist.

n To remove your pants reverse this process.

Helpful hints:n Straighten the pants out to ensure there are no folds in the pants as you

put them on.

n Once you can reach the pants with your hands put the reacher aside.

n Your socks or compression socks are slippery and may increase your chances of falling. Use care when standing on bare floors.

n It is easiest to put your compression socks on prior to pulling up your pants.


SOCKS DRESSING (Socks and compression hose)Equipment: Sock aid

Process: n Put the sock aid on your lap. Pull the sock onto the sock aid

remembering to pull the sock tight against the end and keep the heel side down.

n Hold the handles on the cord and lower the sock aid to the floor in front of your foot. Gently pull the handles with your foot inside the sock aid until the sock is in place.

n You may want to use the reacher or dressing stick to adjust the sock as needed.

n To remove your sock use the plastic covered end of the dressing stick or reacher, push the sock off over your heel and then over your toes.

Helpful hints:

The sock aid will also work for the compression socks.

SHOESEquipment: Long handled shoe horn and elastic shoe laces

Process:n Position the shoes in front you prior to putting them on using a reacher

or shoe horn

n Stand with your walker to slip your shoes onto your feet.

n If you have restricted weight bearing on your surgery leg or balance issues you may need to sit for this activity.

Helpful hints:n It is recommended to wear slip-on shoes that are supportive.

n Elastic shoe laces are made to prevent bending over to tie shoes.


BATHING AND TOILETINGEquipment: Bath bench, raised toilet seat or bedside commode, long

handle sponge

Process for Bathing:n Your surgeon prefers you take a sponge bath until your post-operative

appointment and staples are removed. Your incision needs to be well sealed and waterproof prior to showering. Avoid baths, hot tubs or swimming for several weeks and until your incision is completely healed.

n Avoid climbing into or over the edge of a bathtub. It is safer to use a walk-in shower or use a bath bench. Do not get into the shower until your balance and agility allow you to do so safely. Do not get down into the tub. Always have someone to help you the first few times you shower.

n If you have a tub/shower combo always use a bath bench for safety with the transfer. To transfer onto a bath bench in a tub, back up to the edge of the tub, sit down over the edge of the tub onto the bench keeping your surgery leg in front of you. Once safely seated, carefully bring your legs into the bathtub.

n To dry off your feet, use a towel wrapped around a reacher device or long-handled shoehorn. Another idea is to hold onto the ends of a long towel and form a loop that will reach down to your toes.

Helpful hints:n Have someone with you for your first several showers.

n A non-skid mat, a grab bar, tall stool, and walker are all useful for safety.

Process for Toiletingn To transfer onto a raised toilet seat or commode, back up until you feel

the toilet behind you.

n Reach back for the commode armrest or counter, keeping your surgery leg in front of you and slowly sit down.

Helpful hints:n If you have a bedside commode, set the commode next to the bed

during the night to avoid walking to the bathroom in the dark. Put the bucket in place and face the commode toward the head or foot of the bed to make safe transfers. During the day the commode can be returned to the toilet in the bathroom.

n To set the height of the commode or any chair, measure from the floor to the back of the knee and add three inches.



CAR TRANSFERS

Process:n Have your driver push the front seat passenger side seat all the way back

and recline it to a comfortable recline.

n Use your walker to back up to the car. Keeping your surgery leg in front of you, reach back and slowly sit down on the side of the seat.

n Once seated, lean back into the seat using your arms to scoot your bottom back. You may need assistance lifting your surgery leg into the car.

Helpful hints:n If you have cloth seats, a plastic bag over the seat will help you slide

easier.

n You may want a firm cushion to elevate the seat height.

DRIVINGn You have a legal responsibility to be a safe driver and your safety while

driving will be compromised after surgery.

n You need to have good leg strength and coordination to operate the pedals safely.

n If you have had a knee replacement on your left knee, you may start to drive an automatic transmission when you are not taking narcotic pain medicine and you can easily get in and out of the car. If you have had a knee replacement on your right knee, research has shown that you should wait six weeks before you return to driving.


HOME ENVIRONMENT

What do I sit on?

You will find it easiest to sit in a chair that has arm rests and a solid seat such as a wing back chair, some office chairs, high stools such as in the kitchen or some patio furniture may also work well. You will want to avoid chairs that rock, have wheels, swivel or move as they increase your risk of falling.

Recliners can be comfortable but because they are soft and sit low, they make transfers difficult.n Avoid sitting on chairs, stools, or toilet seats that

are lower than your knees. Use a firm cushion to raise the height of the chair seat to knee level.

n To sit in a recliner, back up until you feel the chair behind you. Keeping your surgery leg in front of you, reach back for the arm rest. Sit slowly on the front edge of the recliner. Lean back and use your hands to help scoot your bottom back.

n When you get up from a chair, move to the edge, and use the chair arms to help you stand. Place your leg that had surgery in front. Then push up from behind with the good leg while keeping the leg that had surgery in front of you as you stand.

n Also refer to page 53 about getting up from a chair using a walker.

Helpful hints:n It may be difficult to bend down and pick up

objects from the floor. Keep a reacher close by to pick up items off of the floor

n Keep frequently used items in the bathroom and kitchen at counter height to avoid bending and reaching.

n Remove all throw rugs from the floor to prevent slips or falls.

n You may find it useful to use a walker bag or tray on your walker to place items in to carry around your home.

n Keep animals out of the way to prevent falls.


PLAYING SPORTSOnce your doctor tells you it is OK to do so, you may participate in sports activities, such as cycling and golf. Do not do any activity that involves abrupt starting-stopping, twisting, or impact stress. Also, do not do any activity that involves excessive bending, lifting or pushing heavy objects, until advised by your surgeon.

SEXUAL ACTIVITYn Sexual activity can be resumed as soon as

tolerated.

n Alternative positioning may be necessary to minimize pain in your new knee.

n Please speak with your surgeon if you have specific questions related to resuming sexual activity after joint replacement.

To prevent surgical site infections when I go home from the hospital:

� Before you go home, your doctor or nurse should explain everything you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital.

� Always clean your hands before and after caring for your wound.

� Before you go home, make sure you know who to contact if you have questions or problems after you get home.

� If you have any symptoms of an infection (see page 20 for symptoms), call your doctor immediately.


WHAT PHYSICAL THERAPY AND

EXERCISES DO I DO

AFTER MY JOINT REPLACEMENT?If you follow your exercise and therapy routines, you should see continued improvement over time.n Even if it is uncomfortable, work on your knee

motion from the beginning, before healing scar tissue restricts your motion. Work on straightening and bending your knee as advised by the therapist.

n Although most patients use a walker or crutches for only a couple of weeks and are walking well by four to six weeks, it takes most patiens three to six months to regain moste of their strength and enery after a total knee replacement. It may take longer to regain optimal strength and motion in the replaced joint.

n Look at the exercise sheets in the journal and do the exercises as often as the therapist advises.

WEIGHT GAINTo protect your new joint, eat sensibly to avoid weight gain.

WHAT DO I EAT AFTER MY SURGERY?Your appetite comes back gradually after surgery. If you don’t feel like eating, it may be a side effect of the medicine you take. Here are some ideas to help:n If you don’t feel like eating hot foods such as

meat, chicken, or fish, try cold foods such as milk, cheese, yogurt or eggs. You might also find sandwiches, ice cream or sherbert appealing.

n If it is easier to take liquids or you just aren’t eating well, try a nutrition drink like Ensure®, Instant Breakfast® or Glucerna®.

n If your food intake continues to be a problem, ask to speak to a dietitian.

HOW DO I AVOID CONSTIPATION?Pain medicines, reduced activity, decreased appetite and dehydration may cause constipation. Effective ways to minimize constipation are:n use an over-the-counter stool softener such as

Docusate® or a laxative.

n eat more foods with fiber such as brown rice, high-fiber cereal, whole-grain bread, fruits and vegetables.

n drink at least six 8-ounce glasses of water a day.

n get up and walk around the house every hour or two during the day.

If you continue to have problems with constipation, contact your surgeon.

PeaceHealth Southwest Medical Center and Rebound Orthopedics are proud to be the team you selected to meet your surgical needs. We want to congratulate you as you progress to a more mobile, active lifestyle.

We hope you’ve found your patient journal helpful as you prepared and recovered from your surgery. Let us know how else we can serve you!

Remember to do your physical therapy exercises.

Get up and around as much as you are able. Walking and other activities after surgery also build strength.

47

Bridge to Recovery


The Bridge to Recovery:Support Materials and Therapy


The Five Wishes form is available online:

www .swmedicalcenter .org/5wishes

DO I NEED ADVANCE DIRECTIVES?Advance directives are a way to make sure your wishes are followed. If you have an Advance Directive, Physician Order for Life Sustaining Treatment (POLST), Durable Power of Attorney, or a Five Wishes Plan, bring a copy with you and show it to your nurse. If you do not have any of these forms, we would be glad to provide you with a copy of Five Wishes to complete. Just ask or request it online!

Privacy Practices

Your health information is confidential. The Notice of Privacy Practices explains how your records are protected. If you have not received a copy, ask for one.

You should be aware that the educational class as well as portions of the therapy sessions after your surgery are held in a group setting. If at any time you are not comfortable with discussing your surgery in a group setting and would like to meet privately, just let us know. Any information discussed will be kept confidential.

The Bridge to Recovery: Support


Bone & Joint Center


A Patient’s Guide to Medications Following Joint Replacement

WHAT ARE “BLOOD THINNERS”To prevent blood clots following your surgery you will likely be put on a blood thinner, also called an anticoagulant. Anti means against and coagulant refers to blood clotting. Therefore, an anticoagulant helps prevent clots from forming in the blood. Blood clots can cause serious medical problems such as deep vein thrombosis, pulmonary embolus, and stroke.

There are many types of anticoagulant medications that are used after joint surgery, which are also sometimes called “blood thinners”. The type and duration of your blood thinner medication varies depending on your surgeon. Ask your surgeon what type of blood thinner they will put you on after surgery. Some common blood thinner medications include:

n Coumadin® (Warfarin) – Tabletn Arixtra® (Fondaparinux) – Injectionn Fragmin® (Dalteparin) – Injectionn Lovenox® (Enoxaparin) – Injectionn Xarelto® (Rivaroxaban) – Tabletn Aspirin

What are some potential drug interactions?

Any medication that can alter blood clotting is a concern while taking blood thinners, including both over-the-counter (OTC) and prescription medications. Examples include anti-inflammatory medications like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin (although some patients take both aspirin and blood thinners per physician orders). Coumadin® (Warfarin) is especially known to cause drug-drug interactions and may require dose adjustments of your medications. While you are on blood thinners,

it is very important that you always check with the surgeon or pharmacist before taking any new medications to avoid drug interactions.

What are possible side effects of blood thinners?

The most common side effect is bleeding. Bruising is common while taking anticoagulants. You should contact your surgeon, the clinic, or pharmacist if you experience any signs or symptoms of bleeding that do not stop after a few minutes, including: n Persistent headache

n Nosebleeds

n Bleeding of the gums

n Red or black colored bowel movements

n Red or dark brown colored urine

n Vomiting blood

n Heavy bleeding when shaving

n Unusually heavy vaginal bleeding

n Skin rash, itching or hives, swelling of the face, lips, or tongue (with injectable medications)

n Pain or irritation at the injection site (with injectable medications)

Special Instructions with oral or injectable blood thinners:n Monitor your skin closely for bruising or red spots,

which could be a sign of bleeding. Call your surgeon immediately if you have any bleeding or bruising.

n Do not take any prescription or over-the-counter medication, including vitamins and herbal preparations, unless ordered by your doctor or discussed with the pharmacist.

n If you forget to take a pill or injection, don’t take another dose to “catch up”. Call the clinic or your pharmacist for directions.

The Bridge to Recovery: Support (continued)


n Tell your doctors, dentist, and pharmacist that you take a blood thinner, especially before starting a new medication after having a medical, dental or surgical procedure.

n If you take Coumadin® (Warfarin): Try to maintain a consistent diet. Do not dramatically vary your dietary intake of foods high in vitamin K, as these foods can interfere with how your body processes this medication.

n If you take an injectable blood thinner: It is important that you put your used needles and syringes in a special sharps container. A sharps container will be provided to you when you get your injection education materials after surgery.

Getting Your Medications:Before you leave the hospital after your surgery, your surgeon will write you a prescription for your blood thinner medication. You can fill you prescription at the hospital pharmacy or at your own pharmacy. Check that your pharmacy carries that particular medicine before you leave the hospital. It is very important that you take your blood thinning medication once you leave the hospital in order to prevent clots that can cause serious medical problems such as deep vein thrombosis, pulmonary embolus, and stroke.

What might it cost?Blood thinner medication is extremely important, but can also be expensive. Most insurance providers will cover the cost of blood thinner medications you will need following surgery, but benefits vary. To help you better prepare for planned expenses following your surgery, you should talk with your surgeon about what blood thinner they plan to prescribe for you. Then look on your prescription insurance card for the Customer Service number to call and ask if the medication is covered, or what anticoagulant or blood thinner is preferred by your plan. Usually they can tell you specifically what medication is covered by the insurance plan and the percent of charges or copays you may incur.

ORAL BLOOD THINNERS There are several types of oral blood thinners that you may be prescribed after joint surgery to prevent blood clots, including Coumadin® (Warfarin) and Xarelto® (Rivaroxaban). These medications are tablet form and usually taken once a day.

XARELTO® Xarelto® (Rivaroxaban) is a newer oral anticoagulants that your surgeon may prescribe. You will be educated by a pharmacist or nurse on its use.

How does Xarelto® work?

Xarelto® blocks the activity of a specific clotting factor which helps prevent harmful clots from forming.

What is the dose of Xarelto®?

Xarelto® is a oral blood thinner taken once daily. The duration of therapy will be dependent on the type of joint replacement surgery done (usually two to four weeks). No routine monitoring is required while taking this drug so no blood test is needed.

What are some potential drug interactions?Some medicines can interact with Xarelto® and can increase your risk of bleeding. Before starting any new medications please check with your doctor or pharmacist.

COUMADIN® Coumadin® (Warfarin) is the most common oral blood thinner and is taken once daily to help prevent blood clots.

How does Coumadin® work?

Coumadin® blocks the formation of vitamin K-dependant clotting factors in the liver. Vitamin K is needed to make clotting factors that help the blood clot and prevent bleeding. By blocking the formation of these clotting factors, Coumadin® stops harmful clots from forming and keeps clots from getting bigger.


What is the dose of Coumadin®?

The dose of Coumadin® is very patient specific. The pharmacist at the anticoagulation clinic will monitor and adjust your dose periodically.

What are some potential drug interactions of Coumadin®?

Several factors, including diet, medications, alcohol consumption and general health, can affect your response to Coumadin®. Many antibiotics and other medications can interact with Coumadin®. Always check with your anticoagulation clinic pharmacist before taking any new medications or supplements.

Are there foods I should be concerned with while taking Coumadin®?

Foods high in vitamin K will change the way Coumadin® affects your body. You do not need to avoid these foods, but it is important to keep your vitamin K intake consistent. Foods high in vitamin K include:

INJECTABLE BLOOD THINNERSThere are several types of injectable blood thinners that you may be prescribed after joint surgery to prevent blood clots, including: Arixtra® (Fondaparinux), Fragmin® (Dalteparin), and Lovenox® (Enoxaparin). These medications are for injection under the skin on the stomach/abdomen, usually once or twice a day.

How do injectable blood thinners work?

Injectable blood thinners block the activity of certain clotting factors, which can stop harmful clots from forming.

What is the dose of the injectable blood thinners?

The dose of injectable blood thinners depends on the type of medication you may be prescribed. Each one can be adjusted by your pharmacist based on your weight, kidney function, and other factors. All of the injectable blood thinners are either dosed once or twice a day and come in pre-filled syringes.

How do I give my self the injections?

You or your coach will be trained on how to give injections. Before you leave the hospital, you will be educated on how to give the injection, safety, and dosing times. The injection site should be rotated daily to avoid any irritation or bruising under the skin.

Do I need to get labwork blood tests after I start the medications?

Your surgeon may decide to monitor routine laboratory tests while you are on the injectable blood thinner, generally around the time of your post-operative appointment.


n Turnip greensn Broccolin Cabbagen Kale

n Brussel sproutsn Seaweedn Mustard and collard greensn Spinach

What is the blood test that I need and how often is it checked?

The risk of bleeding is significantly reduced by routine monitoring of a blood test, called the Prothrombin Time/International Normalized Ratio (PT/INR). This blood test measures how long it takes for your blood to clot. The test will require a small sample of blood from a fingerstick usually one to three times per week.

Before you leave the hospital, you will be advised by the pharmacist when and where to go for your anticoagulation labwork after surgery. Your lab results and dose adjustments will be communicated to you by the anticoagulation pharmacist at the clinic or over the phone. Follow-up anticoagulation visits will be arranged to maintain close monitoring of your INR result.


WALKER SAFETY

First Things First

It is important that you follow your doctor’s orders and only put the amount of weight on your operated leg as advised. After surgery, your physical therapist and nurse will review this with you. Follow these instructions until you are reevaluated by your physician and told to follow new instructions.

Precautionsn Be aware of the surface you are walking on. When

outside, be cautious of uneven and icy or wet surfaces (dirt, grass, gravel, cement, etc.).

n Remove all loose/throw rugs, especially in the bathroom, kitchen and entry ways.

n Clean dirt and stones from the walker rubber tips and if they wear out, replace them. Also, make sure all hardware is tight.

n Have someone nearby to help you until you get used to walking with the walker, especially when walking on stairs.

n Do not try to hop one-legged without the walker (if you have limitations in weight bearing on one side) even for short distances as this could lead to further injury.

n Try to walk slowly, especially at first; going fast can be fatiguing and dangerous as the walker could tip easily.

To Get Up From A Chairn Avoid sitting in chairs that are low or do not have

arm rests as it is difficult to get out of these.

n The walker is too unstable to hang onto when getting up or down - use the chair armrests or seat surface instead.

n Scoot forward to the edge of the chair

n Place affected leg slightly forward and other foot back underneath you.

n Keep your head up and lean shoulders forward over your unaffected leg (or both).

n Push up from chair with both hands on the chair arm rests or seat edge.

n Check your balance with the walker once up.

To Sit Down In A Chairn Use the walker to back up to the chair until you

feel the chair on the back of your legs.

n Place affected leg slightly forward.

n Let go of the walker and reach back for the chair arm rest with first one hand and then the other.

n Lower yourself slowly into the chair.

What is my weight bearing status: � Weight bearing at toleration

� Partial Weight Bearing (PWB) __________%

� Touch Weight Bearing (TWB) (10 lbs. or less)

� Non Weight Bearing (NWB)

Follow these weight bearing instructions until you are seen by your doctor.


To Walk With A Walkern Proper walker height allows a slight amount of

elbow bend when standing erect with hands on the walker.

n To walk, move the walker ahead so the back walker legs are at least to your toe level

n Step forward to the middle of the walker with your affected leg first and push down on the handgrips as you step forward with your other leg.

n Check your balance before you pick up and advance the walker again.

n You never need to get closer than the middle of the walker. Stay back from the front walker bar. If you get too close and your legs get ahead of your hands, you may lose your balance backward.

n When using a walker with wheels and you don’t have to limit weight bearing on one side, you can roll the walker along the floor continuously as you stay between or slightly ahead of the back legs.

n Wheeled walkers make less noise if you are not pushing down hard on the back legs while moving it forward.

n You may put tennis balls, ski or glider tips on the back legs to lessen the noise on hard floors.

Stair Climbing

If you have only one step and you have weight bearing limitations, it is easiest to turn around and back up to the step using the walker, then step up backwards with your good leg first. Bring your operated leg up, step backward and then bring up the walker. Be careful as you turn around.

If you have several steps, you will need a railing or an assistant on one side. n Going up: Step close to the bottom step; turn

walker sideways with opening away from you; place two walker legs (or a cane) on the step you are going to and the other two on the step you are on. Grasp the upper corner of the walker (or cane) with one hand and hold the railing (or helper) on the other side; push down on the walker (or cane) to check stability and then step up with your “good” leg first; then bring operated leg up, check your balance and advance the walker up again.

n Going down: Position the walker sideways as noted above; grasp the upper corner of the walker (or cane on lower step) and the railing (or helper) as above; push down on the walker (or cane) to check stability and then step down with the “bad” (operated) leg first; bring the good leg down, check your balance and move the walker.

Remember down with the bad!

Remember up with the good!



THE PREVENTION OF INFECTION AFTER A TOTAL JOINT REPLACEMENTYou have undergone a total joint replacement procedure. There are instances where infection in one part of your body may cause bacteria to circulate in your blood, possibly resulting in infection at the site of your implant. Therefore, it is essential that you seek prompt treatment of infections anywhere in your body. The signs of an infection in your total joint implant might include pain, swelling, fever, warmth over the joint, or other unusual symptoms. You should contact your surgeon’s office if you have any concerns that you might have and infection in your total joint implant. You should contact your physician or your dentist if you have any concerns that you might have an infection in other areas of your body.

Dental Care

Good dental hygiene is important and you should see your dentist for regular dental care whether or not you are having a dental problem. Before you have any dental procedure we recommend that you take two grams of cephalexin (Keflex) one hour prior to the procedure. If you are allergic to cephalexin or penicillin or are unable to take cephalexin (Keflex) for any other reason we recommend that you take clindamycin 600 mg one hour before the procedure. Your dentist can order that for you, or you can contact your doctor’s office for a prescription prior to your dental appointment. These guidelines should be followed for the rest of your lifetime.

Other Invasive Procedures

When having any type of surgery or invasive procedure, it is important to inform your doctor who will be preforming the procedure that you have had a total joint replacement. Your doctor can then make the determination of whether or not preventative antibiotics are needed. Please contact your surgeon’s office for the prescribing guidelines for your doctor. Your surgeon will tell you whether these guidelines should be followed for several years or for the rest of your life.

The above recommendations follow the February 2009 guidelines of the American Academy of Orthopaedic Surgeons which can be viewed at:

www.aaos.org/about/papers/advisetmt/1033.asp


EXERCISES AFTER YOUR KNEE REPLACEMENT

A Ankle Motions


1. Bending ankle, lift the foot up toward your leg.2. Then push the foot away from your leg, pointing your toes.3. Repeat 10 times every hour.

B Front Thigh Tightening: Quad Sets

1. With your leg straight out, tighten the front thigh muscle to extend fully your knee. 2. Make sure your kneecap moves up and your knee fully extends.3. Hold for 5 seconds, then relax. 4. Repeat 10 times, 5 times a day.

C Back Thigh Tightening: Ham Sets

1. Lie as shown on a bed with the knee slightly bent.2. Push your heel down firmly, tightening the muscles on the back of the thigh. 3. Hold for 5 seconds, then relax.4. Repeat 10 times, 2 times a day.


D Knee Bending: Lying Down

1. Lie flat on your back.2. Bend your knee and slide your heel toward your bottom. Bend as far as you can.3. Slowly straighten and lower your leg.4. Repeat 10 times, 2 times a day.

E Knee Straightening (Over Roll)

1. Lie flat on your back with a small roll under your knee. 2. Raise the heel of the leg over the roll until the knee is straight.3. Slowly lower the foot.4. Repeat 10 times, 2 times a day.

F Straight Leg Lifts

1. Lie on your back with your knee straight and the other knee bent as shown.

2. Do one quad set (see B), then raise your leg straight off the bed about 12-18 inches.3. Lower your leg slowly, keeping the knee tight and straight.4. Repeat 10 times, 2 times a day.


G Leg Slide

1. Lie flat on your back.2. Slide your leg straight out to one side as far as you can. Keep your knee and toes pointing up.3. Slowly bring your leg back to the center.4. Do 10 times, 2 times a day.

H Knee Bending: Sitting Stretch

1. Sit on a chair. Place the foot of one leg back under the knee. Bend the knee as much as you can.2. Without moving your foot, scoot your hips forward toward the edge of the chair. 3. Hold for 1-3 minutes. Feel a stretch.4. Repeat 5 times, 5 times a day.

I Knee Straightening Stretch

1. Sit with one leg propped up on a chair OR lie on your back with a roll under your heel as shown.2. Relax, and let the knee straighten.3. Maintain for 5 minutes.4. Repeat 10 times a day.



J Sitting Leg Lifts

1. Stand supported by a walker or steady chair.2. Place your feet shoulder width apart.3. Squat slowly, bending at your knees.4. Keep your feet flat on the floor.5. Repeat 10 times, 2 times a day.

1. Sit on the edge of your bed or on a chair.2. Lift your foot until your knee is straight. Maintain your thigh firmly down on the chair.3. Slowly lower your leg.4. Repeat 10 times, 2 times a day.

K Mini Squats


Frequently Asked QuestionsWe are glad you have chosen PeaceHealth Southwest Medical Center for your Joint Journey. Patients have asked many questions about joint replacement. Below is a list of the most frequently asked questions along with the answers. If there are any other questions that you need answered, please ask your medical team. We want you to be completely informed about this procedure.

What is arthritis and why does my joint hurt?See page 11

What is total joint knee replacement?See page 12

When should I have this type of surgery?Your surgeon will help you decide if you are a candidate for the surgery. The decision will be based on your history, exam, x-rays and response to conservative treatment.

Am I too old for this surgery?Age is generally not an issue if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.

Will I need a second opinion prior to the surgery?The surgeon’s office secretary will contact your insurance company to preauthorize your surgery. If a second opinion is required, you will be notified.

What are the possible complications associated with joint replacement?While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, dislocation and premature wear, any of which may necessitate implant removal/replacement surgery. While these devices are generally successful in attaining reduced pain and restored function, they cannot be expected to withstand activity levels and loads of normal healthy bone and joint tissue. Although implant surgery is extremely successful in most cases, some patients still experience pain and stiffness. No implant will last forever, and factors such as a patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Will I need blood?See page 15

Should I exercise before the surgery?See page 17

Do I need to be put to sleep for this surgery?You will likely receive medications which cause amnesia or loss of memory for the time of surgery. What most people call “being put to sleep” does not always mean you receive a general anesthetic. Many of our patients have a spinal anesthetic which numbs only the legs. Frequently patients are then given medications which allow them to “sleep” during the surgery. The choice is between you, your surgeon and the anesthesiologist.

How long does the surgery take?See page 23

Will the surgery be painful?See page 25

Who will be performing the surgery?Your orthopedic surgeon will perform the surgery. An assistant often helps the surgeon during the surgery. The assistant may be a Physician Assistant or a specially trained Registered Nurse.

How long will I be in the hospitalSee pages 29-33

Are there any permanent restrictions following the surgery?The high impact activities such as running, singles tennis and basketball are not recommended. Injury prone sports such as downhill skiing are also restricted. Depending on the surgical approach of your surgery, the surgeon will determine the type of joint precautions you are to follow.

How often will I need to be seen by my doctor following the surgery?See page 34

Where will I go after discharge from the hospital? Will I need help at home?See page 39

What if I live alone?Three options are usually available to you:n Return home with help from a relative or friend.n Return home with help from a home health nurse and therapists

for one or two weeks. Home health visits are brief and occur one to three times weekly to teach you and your family how to care for you. You need to be “homebound” according to the definition that your insurance company uses (usually not the same as just not having a ride).

n Discharge to a subacute facility following your hospital stay, depending on your insurance policy and what your needs are. (See page 39)

Will I need a walker, crutches or cane? Will I need any other equipment?See pages 17 and pages 39-44

How long will I need to take pain medication?See pages 25,


My knee is swollen after surgery. Is that normal?Some swelling in your knee can be normal. Your body is still recovering from surgery and it may take a while for your tissue and blood vessels to return to normal functioning. Treat the swelling by elevating your feet above your heart and applying an ice pack to your knee. A balance of activity is key; walk a little, sit a while, and lie down with your feet up for a while. If you have unusual redness, warmth or pain in your calves, notify your physician immediately because these may be signs of a blood clot.

How will this affect my sleep?It is very important you get your rest. You will be busy doing therapy exercises, walking and healing. Sometimes it is difficult to find a comfortable position to sleep. When your knee is not moving it will get stiff, so while sleeping you will probably need to change positions. While sleeping on your back, you could put a pillow under your lower leg to elevate it, which will also decrease swelling.

Will I need physical therapy?You will be seen in the hospital by physical therapy staff that will teach you exercises and proper walking techniques. The success of your joint replacement depends on your compliance with your therapy program at home. You will have goals for strength and range of motion that will improve your daily activities. See page 45

What physical/recreational activities may I participate in after my surgery?You are encouraged to participate in low impact activities such as walking, dancing, golfing, hiking, swimming, bowling, and gardening at your surgeon’s recommendation. See page 44

When can I take a shower?See page 42

Is it possible to exercise too much?Follow the recommendations of your surgeon and physical therapists. See pages 56-59

How long until I can drive and get back to normal?See page 43

When can I resume sexual activity?See page 44

When will I be able to get back to work?We recommend that most people take at least one month off from work unless their jobs are quite sedentary and they can return to work on crutches or a walker.

I feel a little depressed. Is that normal?Yes, you have been through a lot and the side affects of the narcotic medications will also have an effect.

Do I have to worry about infections after the incision is healed? See page 55

Can I do anything to hurt my new knee?Do not be afraid to use your new knee. The components are solidly in place when you leave the operating room. Your therapists will teach you the exercised to continue to make progress. Your knee can tolerate any normal positioning and the more you move your knee the less it will feel stiff and painful.

Can I kneel on my new knee?Yes, once the incision is completely healed and the swelling is gone. It will not harm your knee to kneel but it can be quite uncomfortable for 6 to 12 months or longer. Kneeling on grass while working in the yard, is usually OK. You must have the range of motion needed; if your knee does not bend far enough, it will not be comfortable.

How long will my new joint last?All implants have a limited life expectancy depending on an individual’s age, weight, activity level and medical condition(s). A total joint implant’s longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time. See page 34

Why might I require a revision?Just as your original joint wears out, a joint replacement will wear over time as well. The most common reason for revision is gradual wearing of the plastic liner.

How long, and where, will my scar be?Surgical scars will vary in length but most surgeons attempt to keep the incision as short as possible. For a knee, this is between two and eight inches.

Will I notice anything different about my joint replacement?In many cases, patients with joint replacements think that the new joint feels completely natural. However, we always recommend avoiding extreme position or high impact physical activity. The incision can remain tender and sensitive for quite some time. It will gradually improve.


Date g 8/21

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Post-op Pain Medication Record for Home

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Date gDay g12:00 AM MIDNIGHT i12:301:00 AM 1:302:002:303:003:304:004:305:005:306:00 AM6:307:007:30 M8:00 O8:30 R9:00 N9:30 I10:00 N10:30 G11:00 AM11:3012:00 PM NOON i12:301:00 PM 1:30 A2:00 F2:30 T3:00 E3:30 R4:00 N4:30 O5:00 O5:30 N6:00 PM6:307:007:308:008:309:009:3010:0010:3011:00 PM11:30

Post-op Pain Medication Record for Home

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oint orne - peacehealth · now that you and your orthopedic surgeon have decided joint replacement...

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