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2. What We Will Cover Today
How to prepare for surgery
What to expect after surgery
Recognizing and preventing complications
Staying active after surgery

3. Preparing for Surgery
Patient Guide for total hip or total knee replacement
Review it
Bring it to all visits
Hospital
Surgeon
Therapist

4. Enlist a Coach Find someone to be your coach Family member
Close friend
Every patient benefits from the assistance and motivation of a coach
Value of Coaches
Build Confidence
Support
Faster Recovery / Home Earlier
Improved Results

5. Make Discharge Plans
Have someone available to drive you home from the hospital following afternoon PT on post-op day # 2
Important to arrange transportation prior to surgery
Have someone who can help you at home for days.

6. Obtain Equipment Sock aid Long-handled reacher Raised toilet seat
Shower seat
Please bring your walker or crutches with you on day of surgery (If you own or have access to an assistive device already)

7. See your Medical Doctor
Will make sure you are ready for surgery
May order lab tests
May need cardiac work up

8. Report any Infections or Cuts
Tell your surgeon if you have any cuts or infections
Any untreated infection could travel to the prosthesis post operatively and cause a wound infection

9. Medication Instructions
Stop medications that may increase bleeding 7 days before surgery
Aspirin
Anti-inflammatory medications
Vitamin E
Herbal Medications
Please contact prescribing physician regarding blood thinners administered for cardiac and/or medical problems

10. Medication Instructions
Usually okay to take
Acetaminophen (Tylenol)
Always check with your surgeon

11. Coumadin Must get specific instructions from your surgeon
Anti-coagulant: Helps prevent blood clotting
Levels will be checked twice a week upon discharge

12. Arixtra (Fondaparinux)
14 day regiment per Doctors order starting POD 1
Self injectable shot
A Demonstration and Education will be done before discharge
Arixtra Kit will be provided

13. Xarelto (Rivaroxaban)
14 day regiment per Doctors order starting POD 1 (Duration of Xarelto may vary depending on surgery or surgeon)
Oral anticoagulant / Blood thinner

14. Day Before Surgery Pre - Registration to call you at home
Surgery department will contact you regarding your day/time of surgery or if the schedule has been changed
Nothing to eat or drink after midnight prior to surgery—even gum

15. What to Bring to the Hospital
Loose-fitting clothes
Shorts, sweats, etc
Walking/Gym Shoes
Leave valuables and large amounts of cash at home
Health Insurance card, ID, & credit card

16. Hospital Care

17. Day of Surgery Check with your surgeon regarding medications for:
Blood pressure
Heart
Thyroid
Do NOT take medications for diabetes

18. Day of Surgery Report to 2nd floor – Ambulatory surgery (A elevator)
Preparation for surgery
IVs
Blood work
Consent
Family to wait in surgical area
Surgeon will speak with your family immediately following surgery

19. In the Hospital after Surgery
What to Expect:
In the Hospital after Surgery

20. After Surgery Pain control: at discretion of your physician PCA
Pain Cocktail
Incentive spirometer
Helps clear lungs
Helps you feel better
Rest immediately following surgery
Clear liquids when ready and then advance
Physical Therapy/Nurse to sit patient up at side of bed & ambulate Day of Surgery.

21. Pain Management: Patient Responsibility
Intercept the pain; ask for medication when the pain starts to escalate – do not wait.
Take your pain medication on a regular basis.
Tell the nurse if the medication is not effective.
Ask questions; be sure you understand the pain management efforts that are in place.
Our aim is to manage the discomfort so that you can eat, sleep and move around

22. Post-Op Day 1 - Discharge
Blood work and vital signs in the a.m.
Out of bed in recliner by 7 a.m. Dressed and bathed with the assistance of Nurse or PCT
Breakfast will be served between 7 and 7:30 a.m.
Walk after breakfast with physical therapist
1:1 Therapy in the A.M. & Group therapy in the afternoon

23. Group Therapy Exercise as a group Support and encourage each other
Camaraderie
Coach participation

24. Discharge Day Monday - Sunday Independent ambulation/stairs
Discharge instructions
Therapist – Exercise Program
Nurse Education
Social Work / Case Manager– Finalize discharge plan

25. First Post-Op Visit Surgeon’s office
Typically two to three weeks for first follow up

26. Post-Hospital Care Sub-Acute Rehab Home Services Outpatient Services
Nurse
Blood Work
Therapy
Outpatient Services

27. Sub-Acute Rehab Insurance Rules
Transportation: Not covered under most plans
Back-up plan, if no one to assist at home or discharge plan changes
PCP preference/privileges
Visit location before surgery

28. Home Services Physical Therapy Nursing Caregiver (out of pocket)
Progress to Outpatient Services

29. Outpatient Services Please select location prior to surgery
Physical Therapy
Lab
Equipment
Caregiver

30. Recognizing & Preventing Complications

31. Some Potential Complications
Blood Clots
Infection
Pneumonia
Hip Dislocation

32. Blood Clots
Swelling in calf, thigh or ankle that does not go down with elevation
Pain or tenderness in calf
Can be in either leg
Please notify your physician

33. Pulmonary Embolism Sudden chest pains Difficulty or rapid breathing
Shortness of breath
Sweating
Confusion
Call 911

34. Preventing Blood Clots
Ankle pumps
Early walking
Blood thinners
Coumadin
Arixtra or Lovenox
ASA

35. Preventing Infection
Weight loss if indicated (discuss with your PCP/surgeon) the importance of optimizing body mass index (BMI) which compares weight to height
Quit smoking
If you have diabetes, test your blood sugar level and keep it under control
Make an appointment with your dentist prior to your total joint replacement to ensure good dental health as an infection in your mouth could spread to the newly implanted joint

36. Preventing Infection
Practice good skin hygiene prior to surgery (showering/use of antiseptic cloths)
Notify your surgeon if you develop a cold, fever, infection of any type or a blister, abrasion, pimple or lesion of any type to the area that your surgeon will be operating on or in another area (e.g. ingrown toenail, dental problems, urinary tract infection) as an underlying infection could spread to a newly placed total joint implant
If there is any question regarding a potential infection prior to your surgery, it is better to post-pone your procedure than risk a joint infection

37. Signs/Symptoms of Infection
Red wound
Increasingly painful
Increasingly swollen
Draining
Temperature elevation > 101°
Notify your physician

38. Preventing Infection
Keep incision clean
Avoid immunosuppressive drugs

39. Signs/Symptoms Pneumonia
Cough
Fever
Shortness of Breath

40. Preventing Pneumonia
Deep breathing
Get moving
Incentive Spirometer

41. Dislocation of Hip Risk to total hip replacement patients
Follow hip precautions
Sudden increased pain & inability to walk

42. Discomfort Take oral pain medication Ice pack
After PCA discharged on POD #1
Every four to six hours
Before therapy sessions
Ice pack

43. Rest Don’t sleep too much during the day
Get out and get back to normal
Enjoy your new joint
Walk after surgery

44. Advance Directives
Advance Directives are documents that state your choices about medical treatment or name someone to make decisions about your medical treatment if you are unable to make these decisions yourself.

45. Living Will
A Living Will is a document that tells your doctor or other health care provider whether or not you want death-delaying treatments or procedures administered to you if you are in a terminal condition.
It is called a living will because it takes effect while you are still living.

46. Durable Power of Attorney for Health Care
A Durable Power of Attorney for Health Care is a legal document that allows you to appoint another individual to act on your behalf for medical decision-making if you become temporarily or permanently unable to make those decisions yourself.

47. Physical Therapy
*The physical therapist may attempt to perform the initial evaluation the same evening of your surgery in order to:
-fit you for a correct size walker
-assist you to move to the bed side
chair or dangle your legs at the
side of the bed.
* It is GOOD to move after your surgery!

48. Explore Chicago Board
Tourist figures help you track walking distance in feet
Helps you visualize your goal
Race toward a Chicago destination
Encourages you to perform your best
Goal is to walk 2000 feet before you leave

49. Physical Therapy – POD 1 Physical Therapy – 2 times each day.
1. Evaluation/Individual Session
7:00 am –12:00 am
2. Physical Therapy Group or individual session

50. Physical Therapy – POD 2 Physical Therapy Individual session
7:00 am –12:00 am
Walking, stairs, & bed mobility
Physical Therapy PM Group
1:00 pm
Patients are discharged after PM group, approximately around 3:30 pm

51. Physical Therapy – POD 3 or later
Physical Therapy Individual session
7:00 am –12:00 am
Walking, stairs, & bed mobility
Discharge after morning therapy session. Discharge coordinated for 11am or earlier.

52. Physical Therapy
Discharge – The physical therapist will make sure you have the equipment you need on the day of discharge. Your discharge needs will be determined on an individual basis.

53. Physical Therapy Important things to remember:
Please get dressed every day. The nursing staff will help you get dressed in the a.m.
Wear comfortable clothes to exercise in, i.e. shorts and T-shirt.
It is important to be up and moving after the surgery with the assistance of a Nurse, PCT or Therapist.

54. Physical Therapy Pain Management Ice packs Ask for pain medicine
Recommend asking for pain medicine at least 30 minutes before the group sessions
Use leg rest on recliner to elevate your legs

55. Physical Therapy Hip Precautions Do not bend at hips greater than 90°
Do not turn operated leg in (pigeon toed)
Do not cross legs

56. Physical Therapy Range of motion after knee replacement
0-90° in the first 2 days
Elevate leg on leg rest of recliner with towel roll/pillow under ankle to work on straightening
DO NOT put pillow under the knee!
Dangle legs during mealtimes to work on bending
Good luck! We look forward to working with you after your surgery.

57. Occupational Therapy Adaptive Equipment ADL training and instruction
Hip Precautions
Do not bend at hips greater than 90°
Do not turn operated leg in
Do not cross legs

58. Incentive Spirometry:
Keep Lungs Clean

59. Primary Goals DEEP BREATHING ENCOURAGE LUNG EXPANSION
PREVENT AIRWAY OBSTRUCTION
KEEP LUNGS HEALTHY
PREVENT MUCUS BUILD UP IN THE LUNGS
PROMOTE EFFECTIVE COUGH

60. Using Your Spirometer
1. Sit upright or as far as you can 2. Close lips around mouthpiece 3. Breathe in slowly and deeply 4. Hold breath for 2 to 3 seconds, then exhale slowly and allow the piston to fall to the bottom of the column.

61. Using Your Spirometer
5. The volume indicator shows your best effort. 6. Use the indicator as a goal to work toward each breathing exercise. 7. Repeat steps 2-4 ten times an hour, if feeling lightheaded remove mouthpiece from mouth and take some normal breaths. Note: After each set of 10 breaths, cough to keep lungs clear. Use a pillow to support any incision during coughing.

62. References
Agency for Healthcare Research and Quality. National Guideline Clearinghouse: Incentive Spirometry, 2011 Accessed 8/29/2013 Merck Manual for Home Health Care. Chest Physical Therapy Accessed 8/29/2013 Restrepo RD, Wettstein R, Wittnebel L, et al. Incentive spirometry: Respir Care. 2011;56(10): PMID:

63. Thank You for Attending!
Our goal is to ALWAYS provide Excellent Care.
Please let us know if we can help you in any way. Call Us with Questions or Concerns.
Please complete phone survey when called 1 -2 weeks after discharge.