1. Total Joint Replacement
Pre-operative Class
Preparing for your surgery

2. Class Objectives The purpose of this presentation is to: Help you to feel more comfortable about your upcoming hospitalization Let you know what you can do to help in your own recovery

3. Preparing for your surgery

4. Before your surgery
You will meet with your physician approximately 2 weeks before your surgery:
You must have your labs, EKG and clearance from your PCP 2 weeks before surgery
You will receive phone calls from the hospital giving you details of when to come to the hospital.
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5. Reduce Risks, Complications
Stay active – Exercises for before your surgery are in your book and will be explained further by PT
Healthy diet - Before your surgery, avoid foods that increase inflammation in your body. Those foods include sugar and white flour; saturated fats from red and organ meat; trans fats from commercially baked cookies, cakes and pastries; and alcohol. Aim for fresh foods, including fresh fruits, vegetables and nuts
Manage diabetes – see your PCP if needed
Reduce, eliminate tobacco. Smoking increases your risk of developing wound infection so we encourage you to try to stop before your surgery Quit-Now can offer free advice
Reduce, eliminate alcohol. Hazardous alcohol use (3 or more drinks per day) can increase your risk of postoperative infections, cardiopulmonary complications and bleeding risk
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6. Prevent Surgical Site Infection
Dental work – must be completed 4 weeks prior to surgery and 12 weeks after your surgery
Shaving – do not shave your legs or use any hair removal products near the surgical site 5 days prior to surgery
Hand washing – Good hand hygiene is essential. Encourage your family and friends to utilize an antibacterial cleanser and to always wash their hand to prevent spread of infection.
You will be given skin preparation instructions by your surgeons office please follow them
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7. What to bring into hospital with you
If you have Advance Directives please bring them with you
Personal care items
Robe
Slippers – your leg/foot will be swollen following surgery so make sure they are not tight
Loose shorts, T-shirt/top
You don’t have to bring a pillow – if you want to bring your own pillow please make sure it is not in a white pillow case, easy to loose in hospital
If you use a CPAP machine at home bring it with you, we have distilled water in the hospital for you to use.
Please remove nail polish before you come into hospital
Please bring in your prescription medications in their bottles
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8. Surgery and Postoperative Recovery

9. Arriving at the hospital for surgery
If you are having your surgery at Livingston hospital enter the hospital through the main doors
Stay right, turn right twice to main cafeteria elevators.
Exit straight ahead to surgery waiting room
If you are having your surgery at Brighton enter through the main doors
Go up the elevators in front of you
Turn right to open sitting area and check in desk
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10. Day of Surgery Meet anesthesiologist to discuss options for anesthesia
e.g. epidural, nerve block. Please let him know if you have problems with motion sickness or nausea with surgery
You will have some medication prescribed before your surgery to help control your pain
Please inform your nurse if you get motion sickness or get nauseated from anesthesia
Only 2 members of your family are allowed in to pre op with you. All family members can wait in the surgical waiting room during your surgery.
Surgery will take between 1-2 hours and the patient will remain in the recovery room for 1-2 hours so from the beginning of the surgery to arriving on the unit may be up to 4 hours
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11. Recovery Room
You will wake up after your surgery in the recovery room.
Your nurse will ask how your pain is on the pain scale of 0-10, 0 no pain, 10 worst pain imagined
When you wake up you will have a dressing over your incision, a drain, SCD’s (sequential compression devices) on your legs, oxygen in your nose and IV fluids connected to an IV in your arm
For these reasons please do not try and get up by yourself, you will need nursing or PT assistance.
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12. Sequential Compression Devices (SCD’s)
Sequential Compression Device (SCD) is a method of DVT prevention that improves blood flow in the legs. SCD’s are shaped like “sleeves” that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots. You should wear your SCD’s any time you are in bed or sitting in a chair.
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13. Pain Management
Your caregiver will do everything they can to get you comfortable enough to participate in your recovery.
Caregivers will often ask you to rate your pain level on a scale of 0-10
Our goal is to Always keep your pain level at a 4 or less
Your pain will be managed with different medications including epidurals, local nerve blocks, IV medications and oral medications

14. When you arrive on the orthopedic unit
You will be able to eat/drink juice, jello, crackers, water, ginger ale when you get to the unit
Again your nurse will ask your pain level 0-10
We will show you how to use an incentive spirometer and encourage you to use in 10/hour
You will have your cold machine delivered to your hospital room to use on your knee
You may be seen by physical therapy today. If not nursing staff will help you sit on the side of the bed.
Your nursing staff will have to check on you frequently tonight so please be prepared
Discharge planning will meet with you to start planning your discharge home
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15. First day after surgery
You will have blood drawn.
Your orthopedic surgeon/PA will round on you. Your incision may be closed with surgical glue, sutures or staples depending on surgeon preference, you will have a dressing over your incision that will remain in place until day 7 after your surgery.
Your nurse will continue to assess your pain level and work on a plan with you to ensure it is controlled using scheduled Tylenol and opioid medication
A side effect of the pain medication is constipation so you will also be started on a bowel management program
Physical Therapy will continue to work with you today and nursing staff will help you to the bathroom and with your hygiene needs
Our discharge planners may meet with you again today to discuss your discharge and any equipment needs you may have
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16. Anticoagulation Therapy
Your surgeon will prescribe an anticoagulant to help prevent blood clots
There are many different medications we use for this, the anticoagulant will begin to be administered on post op day one and will continue as prescribed by your surgeon
You will receive information and instructions on how to take this medication from your nurse before you are discharged home
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17. Second Day After Surgery
You will again be seen by your orthopedic surgeon/PA, they will give you instructions for your discharge today
You will be able to shower today with help from the nursing staff
Physical therapy staff will work with you on exercises to regain strength and mobility needs to help you when you are discharged home
Please make sure you arrange to have someone available to drive you home today
Discharge instructions will be given to you by your nurse and prescriptions given to you which can be filled in our pharmacy, just ask your nurse to do this
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18. Possible complications following surgery
Blood clots – follow your surgeons instructions carefully to minimize this potential risk. Make sure you take your anticoagulation medication as instructed by nursing staff and continue doing your ankle exercises
Infection – follow instructions given at discharge to prevent infection. Your dressing should remain in place until day 7 after your surgery. Do not use any creams or lotions on your incision
Constipation – Your pain medication can make you constipated. Make sure you take laxatives following your discharge and eat a diet high in fiber and drink lots of water
Pain - Make sure you take your pain medication as instructed.
Swelling - Elevate your leg higher than your heart. Your leg will swell and this can add to your discomfort
CONTACT YOUR SURGEON OR HOME CARE PROVIDER IF YOU ARE CONCERNED ABOUT ANY OF THESE
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19. Discharge We want you to go home after your surgery
Patients recover better in their own home environment
Home physical therapy will be provided for two weeks to provide additional assistance with physical therapy and your mobility. This will continue until your postoperative appointment with your surgeon.
Your orthopedic surgeon can continue to manage your care with your PCP
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20. Total Joint Hotline Total Joint Hotline – 517 545 5303
If you have any questions about anything you have heard today, or have any concerns about your surgery please do not hesitate to contact us on the
Total Joint Hotline –
You can leave a message and we will return your call as soon as possible
If you have urgent questions please call your orthopedic surgeons office
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21. Physical Therapy
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22. What are some of your activity goals?
Physical Therapy
PT will see you
Day of surgery – most likely
Post op day 1 - morning and afternoon
Post op day 2/3 - as needed
What are some of your activity goals?
Thinking of the things you want to do can help motivate you to do the rehab
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23. Pre-op Exercises See “Pre-op exercise”
- Start with 5 reps, increase to 15 as able
We’ve targeted functional exercises
We also target your thigh muscle – quad sets
Do these exercises on a bed, no need to get on
the floor!
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24. Pre-op Exercises Word of Caution: Don’t hold your breath
Don’t aggravate anything
Don’t strain
- If an exercise hurts too much or you are
straining too hard, move on to the next one.
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25. Post–op Walking Walkers - Use front-wheeled walker
- Check for proper fit
- Avoid 4-wheeled walkers (ok to use later)
Walker will be ordered by physician’s office
We recommend buying a cane before surgery
Weight-bearing as tolerated
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26. Loan Closets
Loan closets in our area are : Brighton senior center Hartland Senior center Howell Methodist Church VFW American Legion
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27. Stairs
Does a walker fit on your entry steps? This is a very good option! You will lead with the stronger leg going up and the weaker leg going down
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28. 1 rail and 1 cane works well!
If your walker does not fit on each step we strongly recommend you have a railing installed
We will practice stairs in the hospital
Most people can manage stairs inside the home – assuming you have a railing
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29. OUTPATIENT PT
Outpatient PT will usually start 2 weeks after your surgery – determined by your surgeon
You can go to a St Joe’s facility (now named Probility) or a place of your choice – St Joe’s list available on table
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30. Online Resources http://www.stjoeslivingston.org/helpful-resources
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31. Home Care

32. Home Care Home Care begins the day following discharge
Continues for 2 weeks until follow-up appointment with surgeon
Nurse will do comprehensive evaluation
PT evaluation same day or next day, will continue 3 times a week
Focus for hip rehabilitation is strengthening
Focus for knee rehabilitation is range of motion
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33. Home Care Goals Maximize home safety & mobility
Help you manage pain, swelling, and constipation
We are the “eyes and ears” for the surgeon
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34. Typical Home Care Visit
Check vital signs
Monitor incision
Problem solve issues
Assess pain
Progress exercises
Gait and transfer training
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35. Tips for Preparing Your Home
Unobstructed pathways are important
Check every room for tripping hazards
Remove throw rugs
Check stair handrails
Night lights are helpful
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36. Tips for Bathroom Safety
TOILET
●access without stairs necessary
●equipment
   •commode
   •grab bars
   •riser
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37. Shower
•non-skid rubber bathmat •non-skid rug •NO SUCTION GRAB BARS •shower chair options if needed Shower seat Tub transfer bench •remove shower doors
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38. Additional Equipment
Reacher – very helpful, may want to get one ahead of time
Hip Kit - may be useful
Leg lifter
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39. Where you will spend your day
Elevate leg when possible
Managing stairs to living areas
You may decide to sleep in recliner for a few days after surgery
Chair with firm back and arm rests
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40. Tips to Make Life Easier
Arrange for help for 5 to 7 days
Prepare meals ahead of time
High protein, Fiber, Vitamin C
Cordless/cell phone
Arrange kitchen/bedroom items for easy reach
Pet suggestions
Contact Home Care with any issues, we are here to help!
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41. Post-Operative Guide IF YOUR LEG IS SWOLLEN: IF YOU ARE HAVING PAIN:
Elevate your leg: Lie down 4x/day for minutes and position your leg above your heart.
Ice your leg: Apply an ice pack or cold machine throughout the day (20 minutes on, 20 minutes off). Make sure you have something between your skin and the ice, unless using the prescribed ice machine.
If swelling does not improve call your surgeons office.
IF YOUR LEG IS SWOLLEN:
IF YOU ARE HAVING PAIN:
Take pain medications as directed by your surgeon.
Elevate and ice your leg as instructed above.
Please refer to your Total Joint Patient Guide pages 22 and 26.
If pain does not improve call your surgeons office.
IF YOU ARE HAVING CONSTIPATION:
Take an over-the-counter stool softener and laxative each day you are taking pain medication.
Eat a high fiber diet and drink plenty of water.
Walk as tolerated.
Please refer to your Total Joint Patient Guide page 22.
If no bowel movement by the 3rd day after surgery call your surgeons office.
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42. Manage Constipation Cocktail: 2oz Prune Juice 2oz Clear Soda
2oz Milk of Magnesia
follow with 8oz warm water
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43. Pre-Op Shopping List Tylenol Cane Rubber Bathmat
Mild soap such as Dial
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44. We are looking forward to helping you through each stage of your surgery and rehabilitation.
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45. Enjoy your new joint!
Your preparation and hard work will pay off You’ll be very glad you had the surgery We wish you well!
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