Early Preparation for Surgery

Outline

Joint Replacement Surgery Home Safety Pain Management Physical Activity Nutrition & Weight Management Setting Goals

People who are prepared for surgery have… Better hospital

experiences Fewer

complications Smoother,

faster recovery

Things are changing … New standard of care: shorter hospital stay

8 hours – 2 days WHY? • Reduces risk of infection • Improved activity and sleep at home • Better use of resources

You will be sent home when you meet discharge criteria

Anatomy 101 – Hip X-Rays

NORMAL OSTEOARTHRITIS Pfizer 2004 – The Arthritis Society

Hip Precautions; For 6 weeks - 3 months post-op

No bending past 90º

L”-shape No crossing the legs No twisting

See p.10 “Before,

During and After

Anatomy 101 – Knee X-Rays

NORMAL OSTEOARTHRITIS

Pfizer 2004 – The Arthritis Society

Knee Precautions; For 3 months post-op

No pillow under knee No squatting,

kneeling or twisting See p.18 “Before,

During and After”

Activity Milestones

0-3 WEEKS: walk with a walking aid, use stairs 3-6 WEEKS: walk several blocks with a cane,

ride a stationary bike 6-12 WEEKS: walk longer without limp,

improved strength and balance Knee bend (studies): ~100° at 4-6 weeks,

~110-115 ° at 3 months, ~115-120 ° at 1 year

Helpful Surgical Resource

Ortho Connect - Canadian Orthopedic Foundation

Speak to someone who has had a joint replacement

GIVE BACK! Be a volunteer after your joint replacement.

Home Safety ‘Be prepared’

Home Set-up Install stair railings, grab bars Remove clutter, tripping

hazards Seats 2” above knee Foam cushion, bed blocks,

raised toilet seat, bath seat

Move frequently used items to waist-height

Bathroom Equipment

Raised toilet seat Bath stool or bench Rubber bath mats Grab bars

Other Equipment

Crutches 2-wheeled walker Long-handled

reacher

Long-handled shoe horn Elastic shoe laces Sock aid

Where To Get Equipment

Medical supply stores Rental or purchase Before you go:

• Check extended medical - prescription may be needed

• Measure, photograph or trace toilet bowl

• Note what side the taps are in the bathtub

Friends, family

Medical Equipment Provision Program Has replaced the Red Cross loan program Provides equipment for people with NO

other means to rent or buy If you need to access MEPP, application

forms will need to be completed in your Pre-Op education class once you have a surgery date.

Pain Management

What is Chronic Pain? Pain lasting > 3 months

the result of an over stimulated nervous system The nervous system gets better at what it practices.

Use ALL the tools in your tool box Calming Strategies

Meditation, breathing exercises Distraction: music, socialization, hobbies

Exercise, activity pacing, mobility aids Medication, complementary therapies

Use a pain diary to see what tools work best for you!

What medication is right for me?

Talk to your Doctor or Pharmacist about: Pain level Risks, side effects Drug interactions Medication timing

Where to start when managing arthritis pain

Acetaminophen (Tylenol Arthritis Pain Formula) • Lowest risk – caution with liver disease • Lasts 8 hours • Maximum dose 4000mg per 24 hour period

Creams and gels • Persistent and consistent application • Site specific (not as helpful for hip) • Wash your hands

Medications to use with Tylenol Non-Steroidal Anti-inflammatory (NSAID)

• Advil, Motrin (Ibuprofen), Aleve (Naprosyn) • Beware of side effects • Do not take with other NSAIDS like ASA

Arthotec, Celebrex – NSAID by prescription

Take NSAIDs once in awhile for inflammation or if maximum dose of Tylenol does not work, particularly at bedtime

Tylenol and NSAIDS can be taken together

Medical Cannabis Can be used in conjunction with all other medication

Non narcotic, non toxic, non pharmaceutical

Legal access through Health Canada

CBD helps with pain; THC makes you feel “high”.

Use:

High CBD and low THC

Ointment , suave or oil applied to affected area

Tinctures , oil or flower taken orally or by vaporizer

Do not smoke

When should I take medication? Pre-medicate 1 hour before known

triggers

Take Tylenol regularly for long term and keep track of 24 hour doses

NSAIDs for breakthrough. Try topical before oral NSAIDs.

Ice for inflammation, heat for stiffness

No driving when using narcotics

Narcotics for severe pain Only use when all other methods, used correctly, fail

Tylenol #3 - not helpful for OA pain

Tramadol - effective for some people; others have extreme nausea and sleepiness

Hydromorphone though highly effective, also highly addictive

Common side effects: drowsiness, constipation, nausea and itchiness

After surgery, your GP should help you ween from narcotics as soon as possible

Additional Reading (and a break!) Heal Your Knees: How to Prevent Knee

Surgery and What to Do If You Need It Klapper & Huey

Heal Your Hips: How to Prevent Hip Surgery and What to Do If You Need It Klapper & Huey

Total Knee Replacement & Rehabilitation; The Knee Owner’s Manual Brugioni & Falkel

Physical Activity

Benefits

Strong muscles less joint stress

Joint mobility

Endurance

Weight control

But it hurts! Start small, increase gradually Break up the activity (2, 3, or 4x/day) Minimize joint stress Water Exercise bike Walking aids

Respect your limitations

Avoid over-doing it

“2-hour pain rule” Extra joint pain for more than 2 hours after the exercise - you probably did too much, too fast!

Slow down and do less next time

Apply ice or heat to relieve symptoms

Move It! Gentle movement, 5 to 10 repetitions

Heel slides in bed Knee bending/straightening Pain-free, as often as possible

Stretch leg muscles, 20 – 30s hold

Stretching

Strength Arm and core muscles

Helps with transfers, daily activities Chair push-up, tightening “tummy” muscles

8 to 15 repetitions, work to fatigue Leg exercises – gluts, quadriceps

Quadriceps

Balance

Fitness Options Community Centers / Pools

Watermania Richmond

Physiotherapy clinics Knee/Hip Replacement

Exercise Guide

GLA:D Canada - http://gladcanada.ca/

HealthLink BC – Physical activity information and counselling

Nutrition A healthy body

supports healing A healthy immune

system fights infection

If underweight, get a referral to a Registered Dietitian

for assessment

Weight Management

Each extra pound = 4-6lbs of stress on joints Set a goal:

Do not lose more than 3lbs/wk

Limit calories from fluids

Look at what causes you to eat

Use a divided plate

Healthy Eating

Cover half your plate with vegetables and/or fruit Eat a variety of colors Eat whole grains whenever possible Try to have good sources of protein at

each meal

Calcium and Vitamin D

Promotes bone healing Vitamin D - decreases risk of falls, hip

fractures, cancer Aim for: 1200 mg -1500 mg calcium

for bone repair 800-2000 IU vitamin D

Protein Sources: Fish, eggs, meat, poultry, tofu, peas, beans, lentils, nuts and nut butters, milk, yogurt, cheese Supports muscle building, healing While healing, increase recommended daily protein and dairy by 20-50%

Iron and Surgery Low hemoglobin = anemia Fatigue, light-headed,

weak Low iron stores may delay

replacement of blood loss Choose iron-rich foods Discuss iron supplements

with your doctor

Constipation

Prevention is key Fiber: 25-35 grams/day from non-animal foods

Fluids: 8 cups (2L)/day Exercise Take extra precautions

before/after surgery

Reducing Post-op Risk Smoking

Higher risk of complications Hospital no-smoking policy www.quitnow.ca

Alcohol and recreational drugs

Chronic use before surgery increases the risk of post-op confusion

Inform Pre-admission clinic

Cutting back on substances improves post-op outcomes

Setting Goals

Short & Long Term Specific Action-based Realistic

What will help you get ready for surgery?

Goal Setting “I am going to eat healthy

VS. I am going to eat 7

servings of vegetables, 3 times this week

“I am going to walk around the park for 10 minutes, 3 times a week”

Tips to succeed

Write your goals down

Post them where you see them

Share your goals with friends and family

Have a back up-plan

What’s next?

Pre-op Education 1– 3 weeks before surgery

Pre-admission Clinic up to 2 weeks before surgery

Resources OASIS website www.vch.ca/oasis

OASIS Primary Education

The Arthritis Society www.arthritis.ca Arthritis Info Line: 1-800-321-1433

OrthoConnect www.canorth.org

Summary People who are prepared for surgery are more

likely to have a positive experience Set some goals: Exercise Home safety, equipment Nutrition Weight management Pain control

Questions?