Presentation on theme: "Total Joint PREP Class Knee Replacement"— Presentation transcript:
1 Total Joint PREP Class Knee Replacement T. Andrew Israel, MDLuther Midelfort Orthopaedic & Sports Medicine Center
2 Goals for you and your family attending this class Recognize knee replacement is a reliable operation to relieve pain and restore function.Describe what to expect of the knee replacement procedure.Discuss the risks of knee replacement surgery.
3 Goals of your knee replacement Improve your quality of lifeRelieve your painRestore function (knee movement, alignment)Increase activity
4 Knee ArthritisLoss of cartilage leads to narrowing of the joint space.See the bone spur formation?
5 Knee ArthritisAs the cartilage wears, bone spurs develop which can cause stiffness
6 Surgical Technique -Resurface the bony surfaces with metal and plastic -Balance the ligaments-Restore alignment and motion (straighten the leg)
7 Metal and plastic are used Implant materialsMetal and plastic are usedThe metal is usually a cobalt-chrome alloy.The plastic is UHMWPE or “poly”.
8 Implants -The end of the femur is capped with a metal component. -The end of the tibia may have a metal plate or plastic.-A plastic spacer goes between the metal cap and plate.
9 ImplantsIf the back of the kneecap is worn, it is resurfaced with a plastic button
10 Surgical Technique Incision Made in front of the knee, usually from above the kneecap down to bump on shin boneLength of the incision depends on the thickness of soft tissueSurgeon will make the incision long enough to see the area around the kneeSurgical techniques continue to improve as technology advancesSurgeon will use techniques to spare muscle
11 Day of SurgeryYour surgeon will meet you in SurgiCenter to initial your knee and answer final questions.Family can wait with you in the SurgiCenter.You will go to the Operating Room (OR) first, then to Recovery (PACU).Surgery lasts 1-2 hours, recovery 1-2 hours.Finally, you will go to the Med-Surg Unit 4500.
12 Post-op TherapyPhysical & Occupational Therapy is important for a good outcome.Your participation will improve your resultYou may have a machine that bends the knee – called a CPM.Therapy starts the day after surgeryGet you out of bedBend the knee!Straighten the knee!Walk with a walker
13 Other DoctorsAdditional Doctors take care of non-orthopedic issues (such as high blood pressure or diabetes).If you have an Internal Medicine doctor here they will see you after surgery.If your regular doctor does not see patients in the hospital, a Hospitalist will see you after surgery.If you are not getting a medication you think you should, please ask.
14 Blood Clot PreventionYou are at risk of a blood clot after knee surgery.You will receive medication (warfarin or aspirin) after surgery to prevent blood clots.TED hose should be worn for 3 weeks after surgery, you may remove these at night.SCD (calf squeezers) are used when you are in the hospital and should be worn whenever you are in bed.
15 Risks of Surgery Blood Clots High risk (>20%) if no treatmentClots can go to the lungs and be fatalYour risk is reduced to <1% if treated with medication, squeezersGetting out of bed and walking helps to prevent blood clots
16 Risks of Surgery Infection You will get antibiotics at the time of surgery and for 24 hours after surgery.Surgeons, assistants and scrub techs wear “spacesuits”.Using all precautions, risk of infection is ~1%.Infection may occur months or years after surgery.An infection may mean removal of your implants.
18 Risks of Surgery Blood loss Tourniquets are used during surgery.There may be some bleeding into the knee after surgery.Your surgeon may use a drain in the knee and give you some blood back.Your blood count will be checked each morning after surgery.If you have symptoms from a low blood count, you may need a blood transfusion.
19 Risks of Surgery - Stiffness It is painful to move the knee after surgery and some people get stiff.You need to work hard to prevent stiffness.Work on both getting the knee straight (0 degrees) and bending the knee (90 degrees.)Goal is more than 90 degrees flexion by the first weekIf you have limited motion at 6 weeks, your surgeon may need to perform treatment under anesthesia.
20 Risks of Surgery Need for Revision We encourage patients to wait as long as possible before knee replacement.Implants wear with time…~90% of implants last 12 yearsRevision surgery may involve changing the plastic or changing one or both metal parts.Revision surgery is more challenging with a more difficult recovery.
21 Risks of Surgery Medical Complications Surgery is a stress to your body.Heart and lung problems, stroke, stomach problems, constipation all may occur.A physical with your regular doctor and an EKG are required before surgery.Despite precautions, unforeseen medical complications may still occur.
22 Risks of Surgery Anesthetic Complications You will meet the Anesthesia providers the day of surgery.They will discuss anesthetic options such as; general, spinal, epidural, nerve blocks.Nausea and vomiting are common but more serious side effects or complications may occur.Please tell the anesthesia provider of any past experience with anesthesia.
23 SummaryKnee replacement is a reliable operation to relieve pain and restore function.As with any operation, there are associated risks.All of the precautions we take are to minimize risk and provide for a “routine” operation.The purpose of this talk is to provide you with information about knee replacement.
25 Patient Resource and Education Program Joint PREP ClassPatient Resource and Education ProgramWelcome to our Joint PREP class. PREP stand for Patient Resource and Education Program.My name is__________________ from the Orthopedic center. I will be hosting today's program.Today our presenters will be Dr._____________ one of our Orthopedic Total Joint Reconstruction surgeons Myself ________________Physical Therapy ________________ Occupational Therapy ________________RN Case manager/Social Services_________________There will be time after each presentation to ask questions.We have pens if you would like to take notes. There is a space for notes in the back of the Mayo total joint booklet in your folder.There will time to ask questions after each presenter.We will be having a break after the nursing presentation.Restrooms are located outside the door on your left.At this time I'd like to introduce Dr.__________________As we greet the pts. & family/friend as they arrive, point out the refreshments, give them a name tag and have their family/friend make their name tag. Check and see if they brought their folder and if not give them a new one.
26 Goals for you and your family Discuss steps to take to get ready for the surgical procedure.Discuss what to expect of the surgical experience.Identify what you need to do to achieve the best outcome.Recognize why it is important for you to participate in your plan of care.Thank you Dr. ________________As we continue this afternoon we will :Read slide bullets
27 Plan AheadFinish any planned dental work at least 2 weeks before your surgery date.Plan for your return home.Identify who will take care of you after surgery.Plan for about 2 weeks.Simplify meals. Plan for 2 weeks of easy or nopreparation meals.Prepare your home now- take notes todayand get started!There are things you can do to prepare for you surgery.Finish any planned dental work at least 2 weeks before your surgery date.Have your teeth in healthy condition. Bacteria in your mouth may enter your bloodstream and cause infection in the new joint If you have current work being done plan to finish before your surgery.Plan for your return homeIdentify who will take care of you after surgery. Plan for about 2 weeks. This is 24 hours every day of the week.If you do not have someone who is able to care for you after surgery social services will discuss options with you.Simplify meals. Plan for 2 weeks of easy or no preparation meals.Prepare your home:If upstairs bedroom: prepare room on main floor, or arrange things to go upstairs only once a day.Remove throw rugs and clutter from traffic pathsArrange bedroom for extra space to get in/out of bed with assistive devicesPlace sturdy chair that is easy to get up from.Prepare your home now- take notes today and get started
28 Plan Ahead Appointments: Regular doctor for pre-surgery;Blood work, EKG, Physical exam, discuss medications.Surgeon for final discussion and update.Stop smoking – talk to your regular doctor to get help.Call your surgeon if you get a fever, cold, infection or rash before your surgery date.Read slide. There is a stop smoking brochure in your folder for more information.
29 What to bring to the hospital Loose comfortable clothingComfortable nonskid walking shoesPersonal itemsCopy of your advanced directivesInsurance cardsMedication list, inhalers, C-PAP maskAny assistive devices you havePrepaid long distance calling card (optional)Your Total Joint Replacement information folderLoose comfortable Clothing: Jogging suits or sweatpantsComfortable non-skid walking shoes: Velcro closures or elastic laces are handy.Personal items; toiletries, books, magazinesCopy of your Advance DirectivesInsurance cardsMedication list, inhalers, C-PAP maskAny Assistive devices that you already have. Bring your walker, or crutches.Prepaid long distance calling cards (optional)Your Total Joint Replacement information folder from class.We will be using this folder though out your hospital stay
30 What not to bring to the hospital Valuables/JewelryCredit cards, check book or large sums of moneyYour medications (except inhalers)-All Valuables/jewelry, even your wedding band if it comes off easily-Credit Cards, check book or large sums of money-Your medications- except inhalers
31 The day before surgery A SurgiCenter nurse will call you to: Review your medicationsTell you what medications to take and not take the day of surgeryUpdate your health history and review allergiesReview eating, drinking and smoking restrictionsGive hygiene instructionsTell you what time to arrive at Luther HospitalA SurgiCenter nurse will call you to:Review your medicationsTell you what medications to take and not take the day of surgeryUpdate your health history and review allergiesReview your eating, drinking and smoking restrictionsNothing to eat, chew or smoke after midnight. No mints, hard candy or chewing gumYour surgery may be delayed if you eat anything after midnightMay have clear liquids up to 2 hours prior to the time of surgery:WaterClear juices without pulp such as apple juice,Clear broth,Clear Jello,Black coffee or tea,PopsiclesGive hygiene instructionsTake a bath or shower the evening before or the morning of surgery..Shampoo hair - it may be a while before able to do this after surgery.Do not shave your surgical site.Tell you what time to arrive at Luther hospital
32 Day of surgery Take medications at home as instructed. Check in at Luther HospitalRegistrationDesk.Read Slide
33 Day of Surgery (continued) You will be taken to the SurgiCenterYou will be asked your name and date of birth by everyone who has contact with you – this is done for your safety.Family and Friends are welcome. Try to limit to 2 people on day of surgery.Read SlideFamily/friendsWill be allowed to stay with you until you are taken to surgery.
34 SurgiCenterNursing admission in the SurgiCenter- We will ask you many questions and discuss your:Medical historyPlan of careRights and ResponsibilitiesSafetyAnesthesia visitSurgeon visitNursing admission in the SurgiCenter- We will ask you many questions and discuss your:Medical historyPlan of careRights and ResponsibilitiesSafetyIn the SurgiCenterIf you do have jewelry, remove and give to your family/friend.Dentures, glasses and hearing aids may stay in place until you are taken to surgery.Anesthesia staff will:Discuss the type of anesthesia available for your procedurePerform a brief examinationStart IVSurgeon will:Review the consent for your procedure and will sign your surgical siteAnswer your last minute questions.
35 SurgiCenter (continued) If ordered for your surgery: blood work, x-rays, clip hair at the surgery site.Your personal items are stored and later taken to your hospital room.Leg squeezers (SCDs Sequential Compression Devices) and TED hose are applied.READ SLIDE(Picture of SCDs on next slide)
36 Leg Squeezers – SCDsThis is a picture of the leg squeezers
37 Going to the Operating Room The Surgery RN will take you to the operating roomFamily/FriendsWill be directed to the main lobby Family LoungeThey should register with the volunteer and will be given a beeper and contacted when the surgery is finished
38 Operating Room (OR) Monitors Antibiotics Anesthesia Surgical scrub Foley catheterTime in operating room areaOR Staff will communicate to your family if the surgery is 2-3 hoursStaff will hook you up to equipment that will monitor heart, lungs, breathing and blood pressure throughout the surgery.You will be given an antibiotic through your IV.Anesthesia will be given to youOnce you are asleep:An antibacterial scrub is done to your surgical site; this may leave your skin with a bluish or brownish color that eventually washes off.A catheter will be placed in your bladderYou will be in the operating room area about 3 hours.If the surgery is taking longer than 2 hours and not expected to finish soon, the Operating Room staff will try to call your family in the Family Lounge to let them know of the change in time.
39 Recovery Room/Post Anesthesia Care Unit (PACU) You will be in recovery for about 1 hour.You will have Monitors and Oxygen onYour nausea and pain are monitored and controlledWhen you are ready, you will be transferred to a hospital room.When you are ready and nausea and pain are controlled (not eliminated),you will be brought to your hospital room.You will be in the PACU Recovery Room about one hour to make sure you are stable.
40 Arrival in your Hospital Room You will have…Oxygen – to help breathing and healingA foley catheter – to measure urine outputAn IV – to give you fluids and medicationIncentive spirometer – to encourage you to take deep breaths to prevent congestion in your lungs.A pulse oximeter – a device that fits on your finger to measure blood oxygen levelRead slideShow incentive spirometer. This is used to encourage you to take deep breathes.(Pulse Oximeter is on next slide)
41 Pulse OximeterThis is a picture of the pulse oximeter monitoring your oxygen level
42 Arrival in your Hospital Room (continued) We will check on you, take your vital signsStart your NutritionActivity as you tolerateWork together with you to keep you safe.Help you with control of pain and nauseaWhen settled in your room, the nurse willlisten to your heart and lungscheck color, movement, and feeling in your surgical legtell you about your room and equipment used for your care.Nutrition - Sips of water and/or ice chips --- then clear liquids if not nauseatedActivityBed restMay stand at bedside if your doctor ordersStaff will reposition you every 2 hours to prevent pressure soresKeeping you safeYou will need to tell us your name and birth date before receiving medicine or having a procedure i.e. blood testsWe will continue to help you with control of pain and nausea
43 Pain Management Read slide While you have an IV in you may have a Pain pump. This allows you to safely give yourself pain medication through your IV. Only the patient should push the button for pain medication.You may begin to take your pain pills by mouth when you are able.Ask your nurse for pain medicine before your pain becomes too intense
44 After Knee Surgery We will care for your skin and incision You may have a drain in your knee incision areaYou may have a Cryo Cuff or ice pack on your kneeYou will have a continuous passive motion (CPM) machineWe will care for your skin and incisionYou may have a drain in your knee incision areaYou may have a Cryo Cuff or ice pack on your kneeA CryoCuff is a device filled with cold water and placed on your knee to minimize swelling. (Show )You will have a continuous passive motion (CPM) machineCPM will be used to gently move your knee while you are in bed. (Picture next slide)
45 Continuous Passive Motion Machine (CPM) Your leg rests in the lambs wool cradle as the CPM gently bends your knee.
46 You are a Partner in your care! Post operative day ONEBlood workMedicationPain control *Anticoagulation – WarfarinCatheter and drain removed.Nutrition as you tolerateActivity-Physical Therapy and Occupational TherapyWork together to keep you safe.You are a Partner in your care!Blood work - Blood will be drawn dailyMedication for Pain Control – Continue using pain scale to rate pain Anticoagulation with warfarinCatheter and drain removedNutritionIf not nauseated, you will progress to your usual dietActivityPhysical therapists and Occupational therapist will begin working with youUp in chair for lunch and supperStaff will continue to reposition you every 2 hours while you are in bed.Keeping you safeCall for assistance/Do not get up by yourself!White BoardPlans for each day in the hospital will be on a white board in your room so you know what to expect each day. It will also be used as a communication tool for the nursing staff, Physical Therapy, Occupational Therapy and you and your family.
47 Post operative day TWO plan The person who will be taking care of you after you go home needs to come to the hospital to learn about:SafetyIncision careActivity – Physical and Occupational TherapyMedication for pain control and anticoagulationThe person who will be taking care of you after you go home needs to come to the hospital for about 2 hours to learn:SafetyIncision careActivity – Physical and Occupational TherapyMedication for pain control and anticoagulationOnce you have began taking pain pills you may want to ask your nurse to bring pain pill at each meal (to prepare for therapy) and at bedtimeYou may have problems with constipation, do what works for you or ask to keep taking stool softener and/or laxative if no bowel movement after surgery.
48 Day THREE/Discharge day. Prepare for discharge to home or transitional care unit.The person who will be taking care of you after you go home needs to come to the hospital again to learn about and get discharge instructions for:Incision careTEDS and how to keep swelling downHow to take pain medications correctlyAnticoagulation – Warfarin and blood workAntibiotic coverage cardWhen to contact your SurgeonYou are a Partner in your care!Day THREE/Discharge dayPrepare for discharge to home or transitional care unit.The person who will be taking care of you after you go home needs to come to the hospital again to learn about and get discharge instructions for:Discharge Instructions - Staff will go over discharge instructionsIncision care: we will provide you with a kit to take home with all the supplies you will need. (Show Kit)Ted hose to decrease swelling- on during the day, off at night – for 3 weeks.Medications: You will be given a list of medications you will take at homeBlood work: lab draws twice a week for warfarin for 3 weeksAntibiotic coverage card: Will be given to you at discharge- show this card before having any dental workYou will be instructed of when and how to contact your surgeon for concerns
49 Elevation of your leg Elevate knee above hip and toe above knee to decrease swelling and painRead slide ( Use pointer or point to the knee and toe elevation)
50 After DischargeA person to care for you will need to be available 24 hours a day to:assist you at home the first two weeksdrive you to appointmentsencourage you in your therapy and progressRead slide above…
51 Bathing You may shower when your incision is dry (no drainage) Place a new dressing on the incision after showerDo not submerge the incision in a bathtub, pool, hot tub, etc, until the incision is completely healedRead slideYou can shower and allow soap and water to run over the incision and either air dry or pat dry.
52 DrivingTalk with your surgeon about when you will be allowed to drive again.You must be:off narcotic pain medicines to driveable to sit in car comfortablyable to move foot from gas to brake pedal easilyYou need a valid driver’s license!Practice in a safe area.Read slide
53 At your appointment we will: A Follow-Up Appointment with your surgeon will be made days after surgeryAt your appointment we will:Remove your staplesGive you care instructions about your:IncisionBathingTEDSAssistive devicesMedications – warfarin and pain controlJoint replacement - dental procedures and antibioticsRead slide
55 Start getting ready for surgery. Make your plans. Watch the Total Joint Replacement Video atClick on Medical Services,then Orthopedics CenterThank you!Read slide and refer to web site cardTake a 10 minute break.Rest roomsWater to drinkAfter BreakPTOTRN Case ManagerAfter class THE ENDThank everyone for comingIf you have any question that come up after you leave today refer to the cards inside your folder for numbers to call…..
56 Joint PREP Physical Therapy Total Knee Replacement
57 Home Preparation Become familiar with exercise handout If you have a walker, practice using it and make sure you can get through your house with it.
58 Physical Therapy Your therapy will start the day after your surgery Activities include getting into a chair, walking and working on the exercisesTherapy will continue twice daily until goals are met or you are discharged from hospital
59 Includes in/out of bed, getting out of a chair, walking and stairs Therapy GoalsIndependence withmobilityIncludes in/out of bed, getting out of a chair, walking and stairsIndependence with anexercise program tocontinue at home
60 Therapy Goals Cont’dLearn appropriate use of walking devices such as walker/crutchesCan bring your own to hospital to make sure it’s sized correctly and get familiar with it’s use
61 Goals ContinuedYour family member or friend should be available on the 2nd or 3rd day after your surgery to become familiar with the exercises and any assistance that you will need at home.
62 RangeofMotionGaining full kneeextension(straightening)IsKEY!
63 Goal is 90 degrees of flexion (bending) by the Range of Motion cont’dGoal is 90 degrees of flexion (bending) by theend of thehospital stay
64 Range of Motion CPM (continuous passive motion) You will use this machine while in the hospital
65 Exercise after Discharge WALK!Continue with exercises from hospitalOutpatient PT if ordered by your surgeon
68 Why Occupational Therapy? Your occupational therapist (OT) is trained in the field of rehabilitation and is concerned about your safety in performing activities of daily living
69 Activities of Daily Living Your OT will show and teach you ways to safely do your daily tasksDressingBathingToiletingYour goals for OT include:Increased IndependenceIncreased StrengthIncreased Mobility
70 Adaptive Equipment Reacher Sock aid Long-handled shoe horn Your OT will help you order/purchase adaptive equipment if it is needed to assist you with dressing and bathingReacherSock aidLong-handled shoe hornDressing stickElastic shoelacesLong-handled bath spongeTub/shower chair or transfer benchRaised toilet seat
71 Before surgery… Prepare your home with safety in mind Remove throw rugs and clutter from traffic pathsRearrange your kitchen so you can easily reach often-used itemsInstall grab bars in bathrooms
72 In the hospital…Occupational therapy will begin the day after your surgeryYou will be seen by your OT once a day
73 Day OneYour OT may…Learn about your home set-up and help available to you at homeBegin home safety instructionDiscuss home equipment needsInstruct you in an upper body exercise program
77 Day Three Your OT may… Work with you on safety with room maneuvering Help you practice getting in and out of a tub with the use of a tub bench or chairEncourage you to participate in a bathing/dressing session to determine the level of assistance you may need
81 Social Services and Case Management Joint PREPSocial Services and Case Management
82 Department RoleSocial Services and Case Management staff can assist with:-Insurance concerns-Home Health Services-Skilled Nursing Care-Community Services and referrals-Power of Attorney for Health Care-Counseling and Advocacy
83 Insurance AssistanceOnce you and your Doctor decide you will proceed with surgery you should :-Pre-register at the front counter-Notify your insurance company-Get your insurance company’s approval.
84 Insurance Verification continued Insurance plans vary in what is required to authorize your surgery.Our insurance notification may not be enough. Some plans require you to call too.Many Medicare Advantage plans require prior authorization.Your insurance company may take days to complete this process.
85 During your stayDoctor decides when you are ready for discharge to the next level of care.The next level of care might be:home with or without Home CareNursing homeRehabilitation HospitalTransitional Care Unit/Swing Beds
86 During your stay The usual hospital stay is 3 nights and 4 days. Talk with your Case Manager about services you want after discharge as soon as possible.Check your insurance to see if it limits who you can use.
87 Options for continuing care once you can leave the hospital Transitional Care Units or Swing BedsSkilled Nursing FacilitiesHome Care optionsHome with outpatient services.
88 Transitional Care Units Bloomer, Barron and Osseo Transitional Care Units are owned by Luther Midelfort .Other Transitional Care units include Durand, Stanley, Spooner, Hayward, and Medford to name a few.Medicare pays for your transitional care stay like it would if you went to a nursing home.
89 Continuing Care Discharge Options Transitional Care Units (also referred to as Swing Beds) provide continued skilled nursing and rehabilitation care after your hospital stay.Can provide closer medical monitoring and more intensive rehabilitations therapies than regular nursing homes.
90 Nursing Homes (skilled nursing facilities) Area nursing homes offer a range of services from short term rehabilitation stays to long term medical and residential care.Eau Claire area skilled nursing facilities include:ClairemontDoveOakwood VillaSyverson
91 Other nursing homes include but not limited to: Chippewa Manor-Chippewa FallsWissota Health and Regional Vent Unit-Chippewa FallsCornell Care Center- CornellAmerican Lutheran Home-Mondovi/MenomonieHetzel Care Center-BloomerDunn County Health Care CenterColfax Area Nursing home-ColfaxDallas Health Care-DallasPepin Manor-PepinSpring Valley Nursing Home- Spring Valley
92 Medicare Skilled coverage Medicare requires the following to pay for your nursing home or transitional care stay:1. You have a skilled nursing or rehab need (PT/OT)2. You participate in therapies and show progress.3. That you have a qualified 3 day stay at a hospital.
93 Home Care options Medicare will pay for home care services: -if you are homebound-if you have skilled nursing needs.-if you have skilled therapy needs.Medicare does not pay for:Help with meals, grocery shopping, etc.ShoppingPersonal Care (bathing, dressing, etc.)Housekeeping services
94 What are Advance Directives? Written documents that tell your Doctor what you want for care when you are unable to speak for yourself.Allow you to describe the type of medical treatment you would like to receive or not receive.Allow you to identify the person you wish to be your decision maker if you are unable to make your own decisions.
95 How do you get an Advance Directive? Luther Hospital Social ServicesLuther Hospital ChaplaincyYour personal attorney
96 2 types of Advance Directives Declaration to Physicians or Living WillThe Power of Attorney for Health Care
97 Power of Attorney for Healthcare With this document, you appoint a family member or friend to follow you wishes and act as your health care agent.Your Health Care agent will make decisions for you only when you are unable to make your own.This document is recommended because it is much more flexible that the Living Will and gives health care providers a person to discuss your wishes with.This document also lists what you want in different situations when you are unable to speak for yourself.
98 Safekeeping of Advance Directives You should always keep the original document.Copies can be given to family members.A copy can be brought to your doctor’s office or to the hospital to be kept in your medical record.It is important that you discuss your wishes with family and friends close to your.Decision making becomes easier when these discussions have taken place and your wishes are clear.