Total Joint Replacement

ProgramPre-operative Education

Objectives for Today

• Understanding your procedure

• What to expect during the hospital stay

• Physical / Occupational therapy

• Pain management• How to care for

yourself at home

• Role of the caregiver / coach

• Discharge planning

Understanding the Procedure

• Total Knee / Hip Replacement

• Unicondylar Knee Replacement

Goal with surgery is to lessen pain and restorefunction.

Procedures

Total Knee Replacement • Removal of damaged bone and

cartilage from your thighbone, shinbone and kneecap with insertion of an artificial joint (prosthesis)

Procedures (continued)

Total Hip Replacement:• Removal of damaged bone

and cartilage from your thighbone and hip bone with insertion of an artificial joint (prosthesis)

Procedures (continued)

Unicondylar Knee

Replacement• Replaces only half of the

knee joint with a prosthesis

Preparing for Surgery

The Guidebook• FAQ’s

• Pre-op Checklist

• Pre-op Exercises• Hospital Stay

The Guidebook

• Caring for Yourself at Home

• Role of the Caregiver / Coach

• Discharge Instructions

• Resuming Activities

Bring the Guidebook with you to hospital and alldoctor appointments.

The Orthopedic Center

Pre-Surgery Staff

Medical Clearance

• Appointment with your primary care doctor

• Instructions to stop or change any medications

• Lab work• EKG, Chest Xray• Blood Donation

• Additional Consults

Phone Call from Pre-Op Team

• Insurance

• Health history

• Medication history

• Advanced Directives

Day of Total Joint Surgery

Things to do at home BEFORE arriving at the hospital

•Bathing, showering and oral hygiene are to be completed before you leave your home. Follow Bactroban prescription as prescribed. Please do not shave below the face for 24 hours prior to surgery.

•Remember not to swallow any water when brushing your teeth.

•If you wear contacts, leave them at home & wear your glasses.

•NO artificial nails.

•Remove nail polish, jewelry and piercing.

•Remember to bring any papers with you that you received at the Surgeon’s Office and/or Pre-Surgery.

•Leave valuables at home or with a family member - please lock valuables in a vehicle until after surgery.

Arrival at the Hospital

• Arrive at the hospital at your appointed time.

• Use elevators by Emergency Department.

• Register with the 4th Floor Short Stay Unit Secretary in the Surgical Waiting Area.

• Remember to bring your insurance card and photo ID.

• Sign your registration paperwork.

• Family members/visitors will be asked NOT to eat or drink in patient room BEFORE

surgery.

• Your family members will be given a number to track your progress.

What to expect after registration

• You will be assigned to your room at the Short Stay Unit.

• You will be asked to take everything off and put on a hospital gown

• If you wear dentures you will be asked to remove them; they will be placed in a

labeled container with your name on it.

• You will be asked to use antiseptic wipes to clean your body.

• The RN will be in to take your vital signs, start an IV for your pre-surgery antibiotics,

shave the surgical area.

• If you have any questions regarding your surgery or from your Pre-Surgery

Information, please ask your RN (now).

• The Anesthesiologist will be in to discuss/explain your anesthesia options and to sign

consent form.

Ready to leave for the OR

• A trip to the bathroom may be necessary before going to the OR.

• You will be transported to the OR Holding Area to wait to see your surgeon prior to your surgery. Your family will wait in the OR waiting area.

• The nurse, who will stay with you in the OR during your surgery, & the CRNA (Certified Nurse Anesthetist) will conduct an interview with you to go over your medications & recent changes in your health.

• Multiple people will be asking you 1) why you are here today, 2) your name, 3) your birthday, 4) what procedure (surgery) you are having done today, 5) what joint is being operated on today. It is not that they do not know or remember BUT these are several check points to ensure your safety.

• The OR Holding Area may feel cold; do NOT hesitate to ask for a warm blanket.

Last minute questions before surgery

• Finally your surgeon will come into the OR Holding Area to answer any last

minute questions you may have about your surgery & to check if your health has

not changed since the last time you were seen by your surgeon.

• Remember now is the time to ask your questions.

• After speaking to the surgeon you will receive some medication through your IV

to help you to relax. You may or may not remember going to the actual Operating

Room.

• You are now ready to leave the OR Holding Area. You will be transported to the

OR Room for your surgery.

Surgery

• Don’t be surprised → the OR Room is a BRIGHT Place.

• You will slide over to the Operating Table, with the assistance of your

nurse & CRNA.

• If you are receiving a spinal anesthetic → you may be asked to sit up

briefly.

• You will have on the following equipment: EKG leads on your chest, blood

pressure cuff on your arm and an oxygen monitoring device on your

finger.

Surgery Time

• Time required for a particular surgery varies. Some joint replacements required

about an hour; some complex procedures may take longer.

• You may be in the OR longer than the duration of the surgery for additional

reasons.

• Allow an additional 20 minutes at the beginning of surgery for the anesthesia.

• Allow another additional 20 minutes at the end of surgery to get to the Recovery

Room.

• Please Note: Your surgery may NOT begin as scheduled due to the progress of

the surgery prior to you. Each patient/case is different.

Post Operatively

• You will be placed in your bed immediately following surgery.

• You will NOT have to be moved more than one time upon the completion of your

surgery.

• Upon the completion of your surgery, your surgeon will contact your family to

discuss the outcome of your procedure.

Recovery Room

• After surgery, there is a short stay in the recovery room, also called PACU (Post Anesthesia Care Unit).

• You will remain there until you are fully awake and your vital signs are normal.

• If you had a spinal anesthetic, you may remain in the PACU until your toes and feet are moving. This signifies that the spinal anesthetic is wearing off.

• You will have an x-ray of your hip or knee replacement to ensure there are no problems.

• PACU Staff will be asking you several questions, are you feeling any discomfort, are you warm enough, etc.

• Please speak up if you are having any pain or nausea.

• When you are ready to go to your hospital room, your family will be contacted that you will be transported to your assigned room in the Orthopedic Center. They will “meet” you there.

The Orthopedic Center

Therapy

Pre-Op Presentation

Preparing for Surgery

Home environment•Remove throw rugs

•Have a chair with arm rests available for use

•Put often used items within easy reach

•Install a railing on your stairs

•Install grab bars in your shower

•Remove clutter from walkways and bathrooms

Additional Considerations

• Become familiar with your exercises prior to surgery

• Pack comfortable clothing and shoes for your hospital stay

• Arrangements for other needed equipment will be made prior to discharge

home

Post-Op Day 0

• Physical therapy will see you later in the day to work on some/all of the following:

• Sitting up

• Standing or walking

• Exercise/Range of Motion

• You may feel “woozy”, but care will be taken to start moving safely

• Early mobilization promotes:

• Healing

• Decreasing the effects of the anesthesia

• Quicker independence and return home

Post-Op Day 1

• Nursing will help you into your recliner by 7 am

• OT will evaluate and work on activities of daily living (ADLs) so that you are able

to dress, transfer, and care for your needs

• PT will address your mobility, range of motion, and strength.

• A towel roll may be placed under your heel to promote knee straightening

• A cold pack will be used 6-8 times a day for 20 minutes to help with pain and

swelling

Post-Op Day 1 (continued)

• You will have physical therapy 2 times today prior to discharge

• Nursing will walk with you to your exercise sessions

• When deemed safe, you and your coach will be encouraged to walk in

the hallways

The Orthopedic Center

Social Services Staff

Plan today for tomorrow’s recovery

• Call your insurance company to confirm coverage for outpatient therapy

and medical equipment.

• Talk to your family/friends about your need for reliable transportation to

follow-up doctor appointments and outpatient therapy.

• Talk to your family/friends about the care and assistance you will need

from them when you are discharged home.

• Please call Social Services with any questions or concerns at 814-375-

6523.

Equipment

• Rolling Walker

• Bedside Commode

• Hospital Bed

• Insurance Coverage

Preparing your Home

• Chair with arm rests

• Recliner chairs OK

• Special bed not necessary

• Remove throw rugs

• Prepare frozen meals

• Arrange for someone to care for pets

What to Bring to the Hospital

• Loose - fitting clothes (shorts, T-shirts)

• Battery-powered items only

• Any shoe or leg orthotics

• Your Guidebook

• Your walker

• Leave valuables, cash and medications at home

Transition to Home

Making the discharge plan:

• Patient and family interview

• Surgeon

• Physical Therapist

• Discharge Planner

Transition to Home (continued)

Discharge planning options:

• Home with Outpatient Services

• Home with Home Health PT

• Sub-acute Rehab

• Insurance plans and authorizations

Role of the Caregiver/Coach

• Assist with mobility

• Dressing changes

• TED stockings

• Observe patient

The Orthopedic Center

Nursing Staff

Preventing Postop Complications

•Blood Clots / Pulmonary Embolus

• TEDS, Ankle Pumps, Early Ambulation

•Pneumonia

• Incentive Spirometer, Cough & Deep

• Breathing

Preventing Complications (continued)

• Infection• Frequent Vital Signs, Inspect Incision,

• Antibiotics

• Nausea and Vomiting• Medications

• Constipation• Medications and Frequent Mobility

Pain Scale

Zero = No Pain

4 = “I am comfortable”

>4 = Discomfort

Pain prevents:

•Sleeping

•Conversation

•Mobility

Remember…

• We can’t make the pain go completely away

• We aim to manage the discomfort so that you can eat, sleep and move around

Pain Management

• Pain will be controlled with a variety of oral

medications, which you will receive on a regular

schedule throughout your stay.

• If you have questions about the pain control regiment

or the pain you are experiencing please speak with

your nurse.

• Can cause constipation.

Types of Discomfort

Incisional

• Soreness, Pressure

• Treat with pain medications

Swelling / Bruising

• Tightness around the incision/joint

• Treat with compression and elevation

Additional Comfort Measures

• Ice packs

• Position Changes

• Get up and walk

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.

Don’t you forget?

•We can’t make the pain go completely away

•We aim to manage the discomfort so that you can

eat, sleep and move around

•We will do all we can to ensure your comfort and

safety

Coaches can Stay

• Family member or friend

• Provides comfort, motivation

• Observe and assist with therapy sessions

• Gain confidence for discharge to home

Postop Activity on Surgery Day

• Heels off bed

• Out of bed to chair

• Walk in the halls

• Knees – no pillow under operative knee

• Hips – do not cross legs

Anticoagulation

• Use will be determined by your physician.

• Most patients will be prescribed Aspirin 325mg

twice daily for 30 days.

• Coumadin and Lovenox will only be utilized

occasionally.

Dressing Change Procedure

• Do not remove dressing until Day 7

post-op, unless directed otherwise.

• You may shower 2 days after

surgery.

• Notify doctor of fever, incisional

redness, drainage, odor or

complaints of increased pain

Caring for Yourself at Home

• Change positions often

• Follow your joint precautions

• Walk daily and steadily; increase your distance

Pearls of Recovery

• Pick one day each week to measure progress

• Do your exercises regularly

• Eat healthy

• DO NOT SMOKE

Medications

• Take pain medication regularly exactly as prescribed.

• Speak to your surgeon about when to decrease or

discontinue pain meds.

• Take stool softeners.

• Resume pre-op medications.

Discharge to Home

• Front seat of your own vehicle

• Stop along the way if your ride

is more than 2 hours or you

become uncomfortable

Good Luck with Your Surgery!

Thank you for coming!