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Overview Objectives Your Joints What is Total Joint Replacement?

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Presentation on theme: "Overview Objectives Your Joints What is Total Joint Replacement?"— Presentation transcript:


2 Overview Objectives Your Joints What is Total Joint Replacement?
Preparing for a Total Joint Replacement Surgery Day Postoperative and Recovery Discharge

3 Objectives Gain valuable information on what to expect before, during and after surgery Decrease your anxiety about the unknown and ease any worries you may have Get answers to your questions and concerns

4 Your Joints

5 The Knee Joint Formed at the meeting of 2 major leg bones, the femur and the tibia Femur: Thigh Bone Tibia: Shin bone Patella: Knee Cap Cartilage: Elastic tissue to cushion Ligaments: Connect bone to bone Tendons: Connect muscle to bone

6 The Hip Joint (ball and socket joint)
Femur: thigh bone Femoral Head Femoral Neck Socket Acetabulum- (cup-like)

7 The Shoulder Joint (ball and socket joint)
Ball: Upper Arm Humerus Socket Glennoid Fossa (dish-shaped portion of the outer scapula)

8 What Causes the Pain? Arthritis Degenerative Joint Disease
Affects the cartilage or lining on the ends of the bones Cartilage becomes worn so movement is not smooth within that joint, and the grinding is painful (bone-on-bone) Pain, stiffness and loss of function are common

9 What is Total Joint Replacement?

10 Total Knee Replacement
Replaces parts of the tibia and femur where they meet Replaced with artificial parts called “Prosthesis”

11 Uni-Compartmental Knee
Also known as “partial knee replacement” Candidates include patients with osteoarthritis in only one part of the knee

12 Total Hip Replacement Incision made in the side of the thigh
Removal of the neck of the femur (thighbone) and insertion of a stem deep inside the bone to connect with the pelvic socket and liner

13 Hip Resurfacing End of the thigh bone (femur) is capped with a metal covering, much like the capping of a tooth This fits neatly into a metal cup that sits in the hip socket Unlike traditional hip replacement, hip resurfacing doesn't replace the "ball" of the hip with a metal or ceramic ball. Instead, the damaged hip ball is reshaped and capped with a metal prosthesis. The damaged hip socket is fitted with a metal prosthesis — similar to what is used in a conventional hip replacement. With newer materials, the artificial joint implants used for total hip replacement last about 15 years. This isn't an issue for older people who receive a hip replacement late in life. But hip resurfacing might be a better choice for younger people because the procedure leaves more bone intact, which can make it easier to perform a total hip replacement if needed later. Resurfacing generally results in a bigger hip ball than what is typically used in a conventional hip replacement, which may reduce the risk of dislocation. But newer implants used for conventional hip replacement now offer the option of a larger hip ball, similar in size to what results from hip resurfacing procedures. Hip resurfacing is technically more difficult and generally requires a larger incision than what is used for a conventional hip replacement. And the risk of complications is slightly higher with hip resurfacing — even when controlling for factors such as your age, sex and activity levels. Hip resurfacing isn't recommended for people who have: Osteoporosis Impaired kidney function Known metal hypersensitivities Diabetes Large areas of dead bone (avascular necrosis)

14 Total Shoulder Replacement
The ball (humeral head) and socket (glenoid bone) are replaced with metal and plastic components to alleviate pain and improve function The shoulder anatomy (Fig. 1) Similar to the hip joint, the shoulder is a large ball and socket joint. It is made up of bones, tendons, muscles and ligaments which hold the shoulder in place but also allow movement. Bones of the shoulder joint include: the clavicle (collar bone), scapula (shoulder blade), and humerus (arm bone). The clavicle attaches the shoulder to the rib cage and holds it out away from the body. (Fig. 2) The clavicle connects with the large flat triangular bone, the scapula (shoulder blade) at the acromioclavicular joint (A.C. joint or the acromion). The rounded head of the humerus, or arm bone, rests against the socket in the shoulder blade. In a total shoulder replacement, a metal ball is used to replace the humeral head while a polyethylene cup becomes the replacement of the glenoid socket. The primary indication for a total shoulder replacement is pain which will not respond to non-operative treatment. Pain may be the result of abnormalities and changes in the joint surfaces as a result of arthritis or fractures. The primary goal of total shoulder replacement surgery is to alleviate pain with secondary goals of improving motion, strength and function.

15 Preparing for Total Joint Replacement

16 Preparing your Home Arrange for special equipment needed
Remove throw rugs and other tripping hazards Move medications, phone, remote control within reach Widen pathways for using a walker If living alone, arrangements need to be made for someone to assist you or to go to a Skilled Nursing Facility for a short period of time.

17 Pre-Surgical Nurse Contact
You will speak with the pre-test nurse prior to your pre-surgical testing appointment. The information needed is: List of physicians you see on a regular basis List of allergies and your reactions to them List of your surgical/medical history

18 Pre-Surgical Testing Appointment
This visit may last 1 hour Medical tests performed (EKG, chest x-ray, blood test, urine sample) Medical/surgical history will be reviewed List of medications that you need to stop taking and which you need to take the morning of surgery will be provided Hibiclens Soap will be given with instructions Assessment by an anesthesiologist

19 Anesthesia General or Spinal anesthesia is required to be administered before your hip or knee surgery A femoral block for Total Knee Replacements General anesthesia is required to be administered before your shoulder surgery An Inter-scalene Block You will meet your anesthesiologist prior to surgery in the preoperative testing process and in the preoperative holding area Your anesthesiologist will review your history and discuss the best option for you An Interscalene block (ISB) is a nerve block in the neck used to either: 1) provide a heavy numbness in the shoulder and arm (in the same way that a dentist can numb a tooth) so that shoulder surgery can be carried out "awake" or under mild sedation and/ or 2) to provide excellent pain relief for shoulder surgery carried out under general anaesthesia. The benefits of an interscalene nerve block (ISB) for shoulder surgery are: Reduced risk of nausea and vomiting and sedation Earlier to leave hospital Early intake of food and drink Excellent pain control Lighter general anesthetic with speedier recovery from the anesthetic Less chance of an overnight stay at the hospital

20 Day before surgery Do not shave legs the day before or day of surgery for knee or hip replacement Shower with the Hibiclens Soap the night before and the morning of surgery Do not eat or drink after midnight, including water, candy or gum

21 Surgery Day

22 Day of Surgery Take any morning medications that you were instructed to take, sip of water only Arrive at the hospital 1.5 hours before your scheduled surgery time At Progress West: Go to the 2nd floor- you will be escorted to your room and registered bedside At Barnes-Jewish St. Peters: Go to the hospital’s Main Entrance (A) and register in Admitting. You will be escorted to the preoperative area.

23 Day of Surgery (cont.) What to bring to the hospital:
Copies of Advance Directives Loose comfortable clothing, enough for 4 days Flat, supportive walking shoes that are non-slip with an enclosed heel CPAP, if applicable

24 Day of Surgery (cont.) What to expect:
To be admitted to the hospital by the registration clerk To meet a member of the anesthesia team to review earlier choices and assess for any changes To be given a mild sedative That family and friends will be directed to the surgical waiting area

25 Day of Surgery: Preoperative
The staff will prepare you for surgery You will change into a hospital gown A name band will be verified and applied An IV will be started (using Lidocaine) Your medical/surgical history will be reviewed Your completed “Patient Home Medication List” will be reviewed and recorded

26 Day of Surgery: Preoperative
You will meet your Surgical Team The surgeon, with your assistance, marks the operative leg The anesthesiologist will review your choices Prophylactic antibiotic will be administered Relaxing medication will be administered

27 Day of Surgery: Operating Room
Anesthesia will be administered Catheter will be inserted Length of time for surgery is approximately 1 to 2 hours

28 Post Surgery and Recovery

29 Day of Surgery: Post Anesthesia Care Unit
Close monitoring until you are fully awake You will wake up with the following: Oxygen in nose Blood pressure cuff on arm Pulse oximeter on finger Catheter in bladder Surgical bandage on incision Your surgeon will speak to family and friends in the surgical waiting area TKR will have a CPM machine placed in Recovery room

30 Post Surgery You will be transported in your bed to your private room from the PACU Your nurse and tech will: Monitor vital signs closely Manage your pain You will receive a clear liquid meal tray progressing to an approved diet During the night you may still have: Oxygen in your nose IV fluids Catheter in your bladder (this will be removed the next day)

31 Progressing toward Recovery: Pain Management
Patients may have a Patient Controlled Analgesia device called a PCA Knee replacement patients may have a femoral block Shoulder replacement patients may have and inter-scalene block

32 Progressing toward Recovery: Pain Management
Tell your doctor what pain medications have worked in the past Request pain relief when you begin to feel discomfort To help the doctors and nurses better relieve your pain, report whether the pain relief measures are adequate Ice packs will be in place to assist in decreasing swelling and relieve pain

33 Your Hospital Stay Your stay will be several days
All rooms are private Wifi is available throughout the hospital Dining on call at PW (you choose when and what you eat according to the diet allowed by your doctor)

34 Recovery in the hospital
In-room Physical Therapy Pain medications administered by IV and then by mouth Coughing and deep breathing is important Foot pumps and/or mechanical pumps may be used to prevent blood clots

35 Common Complications Nausea First meal will be clear liquids
Medication can be given if needed Constipation Daily stool softener administered Laxative can be given if needed Swelling Ice Therapy

36 Serious Complications
Surgical sight infection Occurs in fewer than 2% of patients Heart attack or stroke Occur even less frequently Chronic illnesses May increase potential for complications Can prolong recovery Blood clots Most common complication Blood thinners will be started Damage to nerves or blood vessels around the site of surgery A rare occurrence

37 Discharge

38 Discharge Planning Depending on your physical and clinical status you will be discharged home three days after your surgery. Your progress and readiness for discharge will be assessed daily. Your case manager Visits with you the day after surgery Assists with the discharge plan Makes arrangements for needed medical equipment

39 Day of Discharge We will be sure that you have the proper equipment for your home. Your nurse will review discharge instructions with you and your care partner or family member. Your instructions will include your first postoperative appointment with your surgeon in 7 to 10 days. If you have not progressed to the point where you can safely return home, inpatient rehabilitation may be recommended. This allows for further work with therapists and 24-hour support.

40 Home Care NO baths, only showers, until the incision is thoroughly healed. It is important to eat a balanced diet at this time! Exercise is critical. Home health visits will be scheduled until you have reached a point where you can go to outpatient physical therapy. Driving is usually approved about 4-6 weeks after surgery.

41 After Total Joint Replacement
More than 90 percent of patients report a dramatic reduction in pain. Full range of motion is not expected, particularly in patients with limited motion before surgery. About 115 degrees Avoid high impact activities.

42 Post surgery Activity Levels
Dangerous Jogging or running Contact sports High impact aerobics Exceeds recommendations Vigorous walking Skiing Tennis Lifting 50 lbs or more Expected Recreational walking Golf Light hiking Ballroom dancing Normal stair climbing

43 Your success is very important to us
Your success is very important to us. We strive to provide an excellent patient experience. Please let us know if there is anything that we can do to improve your care.

44 Any Questions??

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