Total Joint Replacement

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.

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

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.

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

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

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.

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

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

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.

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.

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.

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.

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

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

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

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

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.

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

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

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

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?

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?

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.

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. Visit www.sfsh.com for Powerpoint Click on surgery/total joint academy