Institute for Movement and Orthopedics at Beaver Dam Community Hospitals, Inc.

Total Joint Experience

Goals

• Introduce you to the Joint Replacement Team

• Help you mentally and physically prepare for your joint replacement

• Reduce stress and uncertainty about your procedure and rehabilitation

• Answer your questions!

So you’ve decided to have your joint replaced…

Total Joint Care Team

• Our interdisciplinary team is here to serve you! – Orthopedic Surgeon and Physician’s Assistants – Nurse Navigator – Nursing Staff – Physical and Occupational Therapist – Respiratory Therapist – Pharmacist – Case Manager

Your Support System

• In addition to the trained medical professionals that will serve you, it’s important to have family or friends that can support you – Attend appointments with you – Provide transportation – Mow the lawn/shovel the driveway – Stay with you at home if necessary

Prepare your Home

• Remove tripping hazards – Throw rugs – Clutter – Cords

• Considerations for pet care

• Prepare and freeze meals in advance

• Reduce or eliminate your need to go up or down flights of stairs soon after surgery

• Make sure you have a comfortable chair that is easy to get up from

Prepare Yourself for Surgery

• Good nutrition is important – Adequate protein (i.e. eggs, nuts, chicken) – Limit alcohol intake, avoid smoking – Eat recommended servings of vegetables

• Flu Season (Sept. 1-March 31) – Get your flu shot 4 weeks before or 4 weeks after surgery,

unless directed otherwise by your surgeon • Dental work

– Avoid all dental procedures, including routine cleaning, for 6 weeks prior and 12 weeks after surgery

Prepare your Muscles

● Being as active as possible and exercising before your joint replacement can improve your mobility immediately following surgery and help speed up your recovery

Seated Chair Push Ups

• Sit in chair, hands on armrests

• Straighten arms to lift body

• Use sturdy chair, use legs to balance

• Don’t shrug your shoulders

• Perform 10-20 times daily

Bicep Curls

• Stand, palms facing forward

• Bring dumbbells toward shoulder

• Perform 10-20 times daily

Triceps Extension

• Raise your arm upward with your elbow bent, stabilized by your other hand.

• Straighten your arm up toward the ceiling, then lower it back down and repeat.

• Perform 10-20 times daily

Ankle Pumps

• Lay on back

• Pump ankles

• Perform 10 times, 3 times a day

• In the hospital, do 10x/hour when awake

Quad Sets

• Lay on back, knee straight

• Push back of knee down by squeezing thigh muscle

• Perform 10 times, 3 times/day

• In the hospital, do 10x/hour when awake

Heel Slides

• Lay on back, legs straight

• Slide heel towards buttocks

• Bend knee as far as comfortable

• Perform 10 times, 3 times/day

Supine Knee Extension

• Lay on back with knee propped on ball

• Straighten knee, keeping leg resting on ball

• Perform 10 times, 3 times/day

Isometric Hamstring Set

• Lay on back with knee bent

• Press your heel into the ground

• Perform 10 times, 3 times/day

Straight Leg Raise

• Lay on back

• Lift leg toward ceiling

• Keep back flat against floor

• Perform 10 times, 3 times/day

Pack Your Bags!

● Photo ID

● Good non-slip shoes (no flip-flops or sandals)

● Toiletries

● Walker- 2 wheeled or standard

● Inhalers/CPAP machine (if you have them)

● Clothes for 2-3 days (comfortable, loose-fitting clothes recommended)

● Joint Replacement Binder

5 Days Before Surgery

● Start using your pre-surgical prescriptions from the pharmacy of your choice – Chlorhexidine Gluconate (Hibiclens) Liquid Soap –

use with each shower or bath – Mupirocin Nasal Ointment - use twice daily – See your joint binder for detailed instructions

The Day Before Surgery

● Remove all nail polish on your toes

● Remove all jewelry, including rings

● Call 920-887-4336 the business day before surgery between 8am and 3pm – You will learn your arrival time, eating instructions, and

what medications to take – Report any signs of illness, infection, or open areas on

the skin of your surgical leg – Pre-surgical skin wipes: Use the first package of wipes

before bed; see binder for details

Day of Surgery

● Nothing to eat or drink after midnight. You may have sips of water as instructed by the pre-op nurse

● Use second package of pre-surgical wipes before coming to the hospital

● When you arrive at BDCH – Enter through the Main Entrance – Take the elevator by the stairs to

the second floor of the hospital – Check-in at the volunteer desk as

you exit the elevator

Before the Operating Room

● You will change into a hospital gown

● Nurse will review your health history

● IV will be started

● TED hose stockings and compression pumps will be placed on your non-surgical leg to help prevent blood clots

● Anesthesia staff and your surgeon will visit you

Anesthesia

• You will discuss the anesthesia options with the anesthesia staff on the day of surgery – Spinal anesthetic combined with sedation – Nerve block – General anesthesia

What to Expect After Surgery

● You will have a sterile dressing applied

● You will go to the recovery room for about 60 minutes

● A urinary catheter will be in place

● You will go to a private room on the 3rd floor of the hospital for the rest of your stay

Your Inpatient Stay 101

• Hourly Rounding

• Call, Don’t Fall!

• Hand Hygiene

• Movement is Medicine!

• Room Service: 7AM – 6PM

Post-Operative Pain

• You will have pain after your surgery

• It is normal for your pain to increase with walking and exercise – Your nerves are extra-sensitive

• Hurt ≠ Harm

• Tip for success: Work hard at your rehabilitation. Stay focused on a long-term goal, such as full, pain-free use of the new joint.

Pain Management

• Ice • Elevation • Movement • Distraction • Deep breathing • Pain Medication – More is not always better!

– Possible common side-effects • Sleepiness, nausea, constipation, dry mouth

Blood Thinners

● Most patients will use aspirin 81mg twice daily to help prevent blood clots

● Patients who normally use blood thinners or have a history of blood clots will have their medication tailored to their needs in coordination with their primary care physician

Physical Therapy: Day of Surgery

Physical Therapy Evaluation

• Training for exercises – Ankle pumps and quad sets 10 times/hour while awake

• Sit up on edge of bed/walk to chair

Post-Op Day #1

• Physical Therapy – Two sessions: AM and PM

• Adjust walker, progress exercises and walking • Stair climbing if planning to discharge

• Occupational Therapy Evaluation – One session: AM – Training in assistive devices – Preparation for independence in basic self-cares – Swelling reduction exercises

• Meet with Case Management • Possible discharge?

Post-Op Day #2

• Physical Therapy – One session: AM

• Add exercises as appropriate, review home exercise program • Walk • Stair climbing

• Occupational Therapy – One session: AM

• Get ready to go home!

• Discharge by 11:00 AM if medically cleared and safe for discharge

Hip Precautions

• Posterolateral approach – No bending (hip flexion) beyond 90° – No crossing leg (hip adduction) past midline – No turning the leg so the toes point in (hip internal rotation)

• Follow these precautions for 6 weeks after surgery to minimize risk for dislocation

• You can be independent in caring for yourself with the help of assistive devices

Assistive Devices

• Most people can be independent in caring for themselves when they leave the hospital.

Case Management

• Your Case Manager will meet with you while you are in the hospital

• Case Management communicates with therapy, your surgical team and nursing to ensure a safe plan for you when you leave the hospital

Plans for Discharge

Home with Outpatient Physical Therapy – If you have not received a call to schedule your

therapy prior to surgery, contact the Nurse Navigator – Case management will confirm your therapy

appointment and send your operative report if needed

– Plan for therapy 2x/week for up to 12 weeks

Plans for Discharge

Home with Home Health Care – Check your insurance for “in network”

provider and coverage requirements

– Case management will arrange home care/therapy with the provider of your choice

– Have a back-up plan if they are full and are not able to accept new patients

Plans for Discharge

Short-Term Rehab Facility • Check with your insurance to find out

specific requirements and which facilities are in your insurance network – Authorization process does not begin until

after surgery.

• Chest X-ray will be performed prior to discharge to short-term rehab

• Have a back-up plan. Your preferred facility may not have a room available, or you may be doing better than you expected!

You’re Ready to Leave the Hospital!

• A Pharmacist will teach you about any new medications

• Your Surgeon will medically clear you for discharge

• A waterproof Aquacel dressing will be applied – Stays in place until your post-op visit with the surgeon

• You will complete your morning Physical and Occupational Therapy

• Your Nurse will go through your Discharge Instructions

• You will be discharged by 11:00 AM – Have your ride set-up!

Home Safety

• Take precautions to avoid falls

• Use any assistive devices that are recommended by your therapists

• Do things in the safest way you know how

• Avoid walking on uneven surfaces early after surgery

• Watch for water or ice to prevent slipping – Good footwear is important!

After Discharge

• Follow-up appointment at Institute for Movement and Orthopedics – 14-16 days after surgery – Staples will be removed – Continue to wear TED stocking on

surgical leg for 6 weeks

● No driving for at least 2-3 weeks, or while taking narcotic medications

Key to Success

• You are the most important factor in your recovery! – Work hard – Be safe – Stay positive

Questions?