2Overview Objectives Your Joints What is Total Joint Replacement? Preparing for a Total Joint ReplacementSurgery DayPostoperative and RecoveryDischarge
3ObjectivesGain valuable information on what to expect before, during and after surgeryDecrease your anxiety about the unknown and ease any worries you may haveGet answers to your questions and concerns
5The Knee JointFormed at the meeting of 2 major leg bones, the femur and the tibiaFemur: Thigh BoneTibia: Shin bonePatella: Knee CapCartilage: Elastic tissue to cushionLigaments: Connect bone to boneTendons: Connect muscle to bone
6The Hip Joint (ball and socket joint) Femur: thigh boneFemoral HeadFemoral NeckSocketAcetabulum- (cup-like)
7The Shoulder Joint (ball and socket joint) Ball: Upper ArmHumerusSocketGlennoid Fossa(dish-shaped portion of the outer scapula)
8What Causes the Pain? Arthritis Degenerative Joint Disease Affects the cartilage or lining on the ends of the bonesCartilage 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
10Total Knee Replacement Replaces parts of the tibia and femur where they meetReplaced with artificial parts called “Prosthesis”
11Uni-Compartmental Knee Also known as “partial knee replacement”Candidates include patients with osteoarthritis in only one part of the knee
12Total 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
13Hip ResurfacingEnd of the thigh bone (femur) is capped with a metal covering, much like the capping of a toothThis fits neatly into a metal cup that sits in the hip socketUnlike 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:OsteoporosisImpaired kidney functionKnown metal hypersensitivitiesDiabetesLarge areas of dead bone (avascular necrosis)
14Total Shoulder Replacement The ball (humeral head) and socket (glenoid bone) are replaced with metal and plastic components to alleviate pain and improve functionThe 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.
16Preparing your Home Arrange for special equipment needed Remove throw rugs and other tripping hazardsMove medications, phone, remote control within reachWiden pathways for using a walkerIf 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.
17Pre-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 basisList of allergies and your reactions to themList of your surgical/medical history
18Pre-Surgical Testing Appointment This visit may last 1 hourMedical tests performed (EKG, chest x-ray, blood test, urine sample)Medical/surgical history will be reviewedList of medications that you need to stop taking and which you need to take the morning of surgery will be providedHibiclens Soap will be given with instructionsAssessment by an anesthesiologist
19AnesthesiaGeneral or Spinal anesthesia is required to be administered before your hip or knee surgeryA femoral block for Total Knee ReplacementsGeneral anesthesia is required to be administered before your shoulder surgeryAn Inter-scalene BlockYou will meet your anesthesiologist prior to surgery in the preoperative testing process and in the preoperative holding areaYour anesthesiologist will review your history and discuss the best option for youAn 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 sedationEarlier to leave hospitalEarly intake of food and drinkExcellent pain controlLighter general anesthetic with speedier recovery from the anestheticLess chance of an overnight stay at the hospital
20Day before surgeryDo not shave legs the day before or day of surgery for knee or hip replacementShower with the Hibiclens Soap the night before and the morning of surgeryDo not eat or drink after midnight, including water, candy or gum
22Day of SurgeryTake any morning medications that you were instructed to take, sip of water onlyArrive at the hospital 1.5 hours before your scheduled surgery timeAt Progress West: Go to the 2nd floor- you will be escorted to your room and registered bedsideAt Barnes-Jewish St. Peters: Go to the hospital’s Main Entrance (A) and register in Admitting. You will be escorted to the preoperative area.
23Day of Surgery (cont.) What to bring to the hospital: Copies of Advance DirectivesLoose comfortable clothing, enough for 4 daysFlat, supportive walking shoes that are non-slip with an enclosed heelCPAP, if applicable
24Day of Surgery (cont.) What to expect: To be admitted to the hospital by the registration clerkTo meet a member of the anesthesia team to review earlier choices and assess for any changesTo be given a mild sedativeThat family and friends will be directed to the surgical waiting area
25Day of Surgery: Preoperative The staff will prepare you for surgeryYou will change into a hospital gownA name band will be verified and appliedAn IV will be started (using Lidocaine)Your medical/surgical history will be reviewedYour completed “Patient Home Medication List” will be reviewed and recorded
26Day of Surgery: Preoperative You will meet your Surgical TeamThe surgeon, with your assistance, marks the operative legThe anesthesiologist will review your choicesProphylactic antibiotic will be administeredRelaxing medication will be administered
27Day of Surgery: Operating Room Anesthesia will be administeredCatheter will be insertedLength of time for surgery is approximately 1 to 2 hours
29Day of Surgery: Post Anesthesia Care Unit Close monitoring until you are fully awakeYou will wake up with the following:Oxygen in noseBlood pressure cuff on armPulse oximeter on fingerCatheter in bladderSurgical bandage on incisionYour surgeon will speak to family and friends in the surgical waiting areaTKR will have a CPM machine placed in Recovery room
30Post SurgeryYou will be transported in your bed to your private room from the PACUYour nurse and tech will:Monitor vital signs closelyManage your painYou will receive a clear liquid meal tray progressing to an approved dietDuring the night you may still have:Oxygen in your noseIV fluidsCatheter in your bladder (this will be removed the next day)
31Progressing toward Recovery: Pain Management Patients may have a Patient Controlled Analgesia device called a PCAKnee replacement patients may have a femoral blockShoulder replacement patients may have and inter-scalene block
32Progressing toward Recovery: Pain Management Tell your doctor what pain medications have worked in the pastRequest pain relief when you begin to feel discomfortTo help the doctors and nurses better relieve your pain, report whether the pain relief measures are adequateIce packs will be in place to assist in decreasing swelling and relieve pain
33Your Hospital Stay Your stay will be several days All rooms are privateWifi is available throughout the hospitalDining on call at PW (you choose when and what you eat according to the diet allowed by your doctor)
34Recovery in the hospital In-room Physical TherapyPain medications administered by IV and then by mouthCoughing and deep breathing is importantFoot pumps and/or mechanical pumps may be used to prevent blood clots
35Common Complications Nausea First meal will be clear liquids Medication can be given if neededConstipationDaily stool softener administeredLaxative can be given if neededSwellingIce Therapy
36Serious Complications Surgical sight infectionOccurs in fewer than 2% of patientsHeart attack or strokeOccur even less frequentlyChronic illnessesMay increase potential for complicationsCan prolong recoveryBlood clotsMost common complicationBlood thinners will be startedDamage to nerves or blood vessels around the site of surgeryA rare occurrence
38Discharge PlanningDepending 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 managerVisits with you the day after surgeryAssists with the discharge planMakes arrangements for needed medical equipment
39Day of DischargeWe 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.
40Home CareNO 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.
41After 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 degreesAvoid high impact activities.
42Post surgery Activity Levels DangerousJogging or runningContact sportsHigh impact aerobicsExceeds recommendationsVigorous walkingSkiingTennisLifting 50 lbs or moreExpectedRecreational walkingGolfLight hikingBallroom dancingNormal stair climbing
43Your 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.