1. Total Joint Replacement

2. Before Surgery Prepare Home Walker/Crutches/Cane
Remove rugs, railing for the stairs, bath bench, toilet seat riser, or grab bars.
Walker/Crutches/Cane
Make sure to set up a ride home after discharge and a caregiver for approximately 1 week.

3. Will receive two phone calls before surgery
Insurance confirmation - demographic information
Nurse registration – to review medical history and medications and confirm scheduled procedure
Any patient on a blood thinner needs to speak with their primary doctor and surgeon regarding use 1-2 weeks before surgery
Overnight bag
All labeled medications in the prescription bottle (except pain medication), loose fitting shoes, and comfortable clothes
CPAP if used for sleep apnea

4. Day of Surgery
Nothing to eat or drink after midnight including coffee, water, gum, hard candy, etc.
Shower as instructed the night before/morning of surgery.
Medications as instructed during pre- procedure phone call with nurse.

5. After Surgery Surgeon will speak with family after the procedure.
Expect to be in recovery for 1-2 hours after surgery.
Wi-Fi is available within the building

6. Overnight Stay Expect to stay 1-3 days See joint recovery plan
Family allowed overnight; one visitor meal provided per day
Equipment
Reason
Ted hose (white socks)
Prevent blood clots
Athrombics (leg massage)
Ice (polar cooler or packs)
Decrease swelling/pain
Incentive spirometry (volurex)
Prevent respiratory complications
Continuous Passive Motion (CPM)
Assist with range of motion for Total Knees

7. Pain Goal: Well Controlled Pain Levels Scale 0-10
Pain should be tolerable but not likely pain free.
Be proactive, it is easier to control pain than catch up to severe pain.
An anesthesiologist will discuss pain control options
prior to surgery.

8. Additional Pain Medications
Common Medications
Narcotics
Additional Pain Medications
Antibiotics
Morphine
Dilaudid
Tramadol
Oxycodone
Hydrocodone
Possible Side Effects
Constipation
Nausea
Itching
Drowsiness
Dizziness
Tylenol
Gabapentin
Celebrex
Toradol
Vistaril
Valium
Naropin
Exparel
Side effects vary based on the medication given.
Ancef
Clindamycin
Vancomycin
Keflex
Possible Side Effects:
Rash
Flushed face

9. Common Medications Cont.
Blood Thinners
Nausea & Vomiting Prevention
Stool Softners
&
Laxatives
Fragmin then
Aspirin
Xarelto then
Coumadin
Possible Side Effects:
Mild bleeding
Bruising
Zofran
Benadryl
Scopolamine Patch
Decadron
Reglan
Phenergan
Drowsiness
Dizziness
Constipation
Colace
Miralax
Senna
Milk of Magnesium
Prunes or Prune
juice
Abdominal
Cramping
Diarrhea

10. Physical Therapy:
Therapy begins the day of or day after surgery, depending on your doctor. You are expected to participate in 2 sessions per day.

11. Total Knee Replacement
Patients who have had a total knee replacement will begin outpatient therapy within a few days of leaving the hospital.
If you are able to schedule your appointment before you come for surgery, you will have a better chance of getting the date and time you prefer.
A prescription for therapy (2-3 times a week) will be given to you prior to discharge.

12. Total Hip Replacement Standard Total Hip
Hip precautions – to be followed for 8 weeks unless your surgeon specifies otherwise.
Do not bend your hip into more than 90 degrees of flexion (right angle).
Do not cross your legs, either at the knee or the ankle.
Do not let your toes (hip) rotate inward.

13. Anterior Total Hip
No precautions to follow, unless specified by your surgeon.
Outpatient therapy will be ordered after your first follow up appointment if needed.

14. Post-Op Activities
Please consult your physician with specific questions about returning to activities.
Driving – per physician guidelines
Kneeling – 8 weeks
Dancing – 8 weeks
Bicycling – 4-8 weeks
Golfing – 6-8 weeks

15. Exercises
Quad Sets – squeeze top of thigh, pushing knee flat. Hold for 10 seconds. Repeat 20 times.

16. Exercises
Hamstring sets – tighten muscles on back of thigh, digging heel down and back. Hold 10 seconds. Repeat 20 times.

17. Exercises
Heel slide – bend knee as far as you comfortably can. Hold 5 seconds. Repeat 20 times.

18. Exercises
Short arc quad – with a rolled towel or coffee can under knee, tighten muscles on top of thigh and straighten knee. Hold 10 seconds. Repeat 20 times.

19. Exercises
Straight leg raise – keeping knee straight, lift leg 6-8 inches off bed. Hold 5 seconds. Repeat 20 times.

20. Exercises
Long arc quad – from a seated position, straighten knee. Hold 5 seconds. Repeat 20 times.

21. Arm Exercises Chair push-ups Bicep curls Shoulder raises
Side (lateral) shoulder raises

22. Frequently Asked Questions
Why do I have to start therapy so soon?
How often/how long will I have to go to outpatient therapy after my knee replacement?
Do I still have to do my exercises at home after I start therapy?
Can I just do my exercises at home and skip outpatient therapy?

23. FAQ, continued
Why do I need someone to stay with me after I leave the hospital?
How long will I need a walker/crutches?
Will we practice the stairs?
Will I see my doctor before I leave?

24. Discharge Planning
A RN will speak with you either the day of or day after surgery reguarding any needs or plans for at home.
Assist with ordering equipment
Assist with setting up Home Health Care or Rehab services if needed.

25. Each surgery is unique and each person heals differently.
Please don’t compare your surgery to anyone else’s or even to a previous surgery that you’ve had.
Each surgery is unique and each person heals differently.
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