North Kansas City Hospital Total Knee Replacement Surgerykcorthopedics.com/docs/NKCH_Knee.pdf ·...

Nor th Kansas C i ty Hosp i ta l

S U R G E R Y

Total KneeReplacementTotal Knee

Replacement

Level 1Parking

★

PavilionEntrance

NORTH KANSAS CITY HOSPITAL • CAMPUS MAP

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T a b l e o f C o n t e n t s

Welcome Letter . . . . . . . . . . . . . . . . 2

Total Knee Replacement Surgery . . . 3

Things to Know Before Surgery . . . . 5

Exercises for Knee Surgery Recovery . . . . . . . . . . . . . . . . . . . 7

Surgery and Recovery . . . . . . . . . . 9

Discharge Options . . . . . . . . . . . . 13

Returning Home After Surgery . . . . 14

Preventing Falls at Home . . . . . . . . 18

When to Call Your Doctor . . . . . . . 19

Total Knee Mobility/Precautions . . . 20

How To Manage Your Pain . . . . . . 21

Nutrition Guidelines . . . . . . . . . . 23

High Fiber Foods . . . . . . . . . . . . 24

Total Joint Replacement

Program

N O R T H K A N S A S C I T Y H O S P I T A L

North Kansas City Hospital offers a class to help you learn more about your surgery

and plan for your care after discharge.

The class is offered every other Thursdayfrom 9 a.m. to noon.

Please call (816) 691-1688 to enroll in this class.

A staff member will provide the dates

of upcoming classes.

This packet of information hasbeen developed to provide you and your family with informationconcerning:

• Pre-hospitalization

• Your hospital stay at North Kansas City Hospital

• Discharge planning

For your convenience, parking is available

on Level 1 (Grape Level) of the parking garage.

As you enter the Pavilion, take the elevator

to the 9th Floor. Classes are held

in the Orthopedic Unit Classroom.

4 TOTAL KNEE REPLACEMENT SURGERY

During part or all of your stay, you will be on a medical/surgical unit that provides care for a variety of needs and specializes in the care oforthopedic problems. It is our role to serve as teachers and assist yourreturn to an optimal level of function during your brief stay with us.

Our nursing staff consists of RNs, LPNs and technicians who provide carefor you as well as other patients. The quickest and most efficient way toreach your nurse is by using your call button. A nurse or aide/tech willanswer your call and page someone to assist you. Shift changes occur at6:50 a.m. and 6:50 p.m. Your day and night nurses will be exchanginginformation at these times, but others can assist you.

You will have contact with a number of people during your stay. Amember of Environmental Services will clean your room daily. If you have tests through Laboratory, Radiology, Respiratory Therapy or EKG,those staff members also will be involved in your care. At mealtimes, the Food Service staff will deliver your tray. Your nurse will provide anyassistance you need with your meal or alterations to your diet and willmake an effort to check with you at each mealtime. If a procedure hasaltered the routine mealtimes, your meal will be ordered upon yourreturn to the room.

Your daily routine will be based around the activities scheduled that day,such as surgery, physical therapy or testing procedures. Usually yournurse cannot alter the times these events take place. For this reason, your bathing time and other care needs may be done in the morning, mid-afternoon or evening.

We encourage patient and family involvement in your care. To allow thenurse more time at the bedside to meet each individual need, it would behelpful if only one or two family members could be designated as yourspokesperson to receive updates from the nurse on your progress. Thisindividual could then update other family members.

In order to serve patients as efficiently as possible, North Kansas CityHospital evaluates many of its daily practices; therefore, things may notbe done the same way or by the same person as on a previous admission.If you have questions about hospital practices or your care, please feelfree to ask me or any staff member. It is important to us that you areknowledgeable about your illness, procedures, medications and dischargeplans. We will be happy to provide the resources you need to assist youduring your stay. Our goal is to make your hospitalization as comfortableas possible and yet help you maintain your independence. In order to succeed, we welcome any suggestions for improvement.

If I can be of further assistance, please ask your nurse to contact me, or you may call me at extension 1997.

Sincerely,

Marilyn May, Nurse Manager, 9th Floor Pavilion

Dear Patient and Family:

The staff and I

would like to thank you

for choosing

North Kansas City Hospital.

I would like to take

this opportunity to give

you some information

about our unit.

■

Our goal is to make

your hospitalization as

comfortable as possible

and yet help you maintain

your independence.

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Total Knee Replacement SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Total Knee Replacement Surgery

How a Joint Replacement WorksA joint is, quite simply, a moveableconnection between the ends of two or more bones. These ends arecovered by a smooth material calledcartilage and connected to each other by flexible ligaments. The joint is lined with a tissue called the synovium, which produces alubricating substance called “synovialfluid.” Muscles and tendons surroundand cross the joint and power itsmovement. For the human body tohave free and easy movement, all of these components must be working well.

Arthritis breaks the fine-tuningbetween bone, cartilage, synovium,ligament and muscle. Just how thearthritic process works is still not clear, but researchers do know itseffects on the joints. In osteoarthritis,the smooth cartilage covering the jointbecomes rough and worn thin, so thatthe bones rub directly against eachother, causing pain and inflammation.In rheumatoid arthritis, the synoviumbecomes inflamed and attacks cartilage.

N O T E S

In both cases, the joint can becomestiff and painful. Eventually, thearthritis sufferer avoids moving thejoint to avoid the pain, which onlyintensifies the condition by makingthe structure adjoining the joint weaker. This makes movementincreasingly difficult.

The knee joint consists of three parts:the femur (the end of the thigh bone),the tibia (the top of the shin bone) andthe patella (the knee cap).

The end of the femur has two curvedportions that work with the two cuplike portions of the upper end ofthe tibia. Together the ends of thefemur and tibia allow smooth motionin the normal knee and make up thehinge joint. The patella, or kneecap, isheld in place in front of the knee jointby muscles and tendons, and increasesthe efficiency of the thigh muscles.The patella works with the knee jointby sliding along a groove between thecurved portions of the femur.

In knee replacement surgery, the worn-out joint ends are replaced with

a prosthesis, or artificial knee, that is made of metal and strong plastic.


Healthy Knee Joint(from the front and side, with leg bent)

Shin bone(Tibia)

Fibula

Cartilage

Thigh bone(Femur)

Menisci

Ligaments

Knee cap(Patella)

Diseased Knee Joint

Cartilage worn,thin, or completelyabsent

Menisci weakor thin

Exposed bonepitted

Prosthetic Knee Joint

Prosthesis

Total Knee Replacement is a common procedure that replaces one or both sidesof the knee joint to relieve severe pain, to increase joint motion and to improvethe mobility of the knee joint. The procedure replaces damaged cartilage andbone with new surfaces.

In joint replacement surgery, the worn-out joint ends are replaced with a prosthesis,or artificial knee, that is made of metal and strong plastic. The diseased bone endsare cut away and the prosthesis is implanted in their place. This artificial knee is either attached to the bone with a cement-like material, or it may have anabsorbent coating into which, over time, the bone can grow directly.

N O T E S

Cartilage worn,thin or completelyabsent

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Before SurgeryBefore undergoing surgery, it is necessary to have a health evaluation exam doneprior to admission to the hospital. Your doctor will schedule it at the best time for you. At your exam a member of the health care team will take a medical history and perform a physical.

Your pre-operative preparation may include blood studies, urine analysis, electrocardiogram (EKG) and X-rays. If you have had an infection, dental surgery or have taken steroids in the past year, be sure to tell your doctor at this time, for these may affect your treatment program.

Prior to surgery you also will meet with an anesthesiologist who will discuss thetype of anesthesia to be used during surgery. Be sure to let the doctor know if youdesire a particular type of anesthesia.

In your total joint class, your instructor will discuss with you what to expect on the day of surgery. You will learn some simple coughing and deep breathingexercises as well as foot and ankle exercises. Your doctor may order a “ContinuousRange of Motion” (CPM) machine, which will exercise your knee. Your nurse will demonstrate how to use these items. It is very important you use the CPM as your doctor has ordered for your recovery to be as successful as possible.

Prior to surgery, your knee area will be prepared according to the preference ofyour surgeon. You will not be allowed to eat or drink anything after midnight,including no chewing gum. Check with your surgeon to find out if you shouldtake your usual daily medications with a sip of water on the day of surgery. You may be instructed not to take some of your home medications before surgery, particularly nonsteroidal anti-inflammatory drugs or blood thinners.

When you come to the hospital, you should bring a knee-length bathrobe and apair of sturdy flat slippers or shoes with an enclosed back and nonskid soles. Be sure to review the following page, “What You Should Bring to the Hospital” and“Please Leave the Following at Home” for a more complete list.

Things to Know Before SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Things to Know Before Surgery

N O T E S


WHAT YOU SHOULD BRING TO THE HOSPITAL

Insurance cards/information

Important phone numbers of family members

List of current medications with dosages (include name of medicine, how much you take, how often; vitamins; over-the-counter medicine; and dietary supplements, such as herbal products)

Robe

Eyeglasses (if necessary) with hard case

Hearing aid (if necessary) with extra batteries

Contacts and supplies (if necessary)

Dentures, denture cup (if necessary)

Personal care items: toothbrush, comb, brush

Makeup, if desired

Shaving equipment (an electric razor is necessary if you are on blood thinners)

Full set of loose fitting clothing (i.e., socks, elastic waist pants, underwear)

Non-skid, comfortable shoes with enclosed backs that are not tight; elastic shoelaces are helpful

Walker, if you have one

Medications

We encourage you to wear hospital gowns during your stay. While they arenot particularly fashionable, they are very practical and will allow you tomove about more freely.

PLEASE LEAVE THE FOLLOWING AT HOME

Money

Credit cards

Purse

Jewelry…all patient rooms have a clock, so a watch will not be needed

All other valuables

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Exercises for Knee Surgery RecoveryN O R T H K A N S A S C I T Y H O S P I T A L

Exercises for Knee Surgery Recovery

Breathing Exercises Breathing exercises will help protect you from pneumonia, and the muscle exercises willassist in the prevention of blood clots and speed your healing process.

Breathe in as deeply as you can

Hold for one to two seconds

Breathe out completely

Repeat steps 1, 2 and 3 several times.

Breathe as deeply as you can

Cough deeply from your abdomen (not a shallow throat cough)

Repeat this exercise every hour.

Calf Pumping (Ankle Exercise) This exercise helps promote circulation. It also helps tone and strengthen the muscles ofthe lower leg.

Lie flat in bed or with the head of the bed slightly elevated

Point your toes toward the foot of the bed

Point your toes toward your head

Repeat the exercise 10 times an hour, one leg at a time or both legs together.

N O T E S

In order to help speed your recovery following knee surgery, you should begin

practicing these exercises BEFORE your surgery. Exercise within limitations of pain.


Quadriceps Setting Exercise (Quad Sets) This exercise is important to maintain and strengthen the quadricep muscles. These arethe muscles on the top of the thigh that are used to straighten the leg. Put your hand onyour thigh and you will feel the muscle move as you do this exercise.

Lie flat in bed or with the head of the bed slightly elevated

Press the back of your knee downward against the bed and tighten your thigh muscle

Hold this position for five seconds, then release

Repeat this exercise 10 times per hour, one leg at a time or both legs together.

Straight Leg RaisesThis exercise is important to maintain and strengthen the knee and hip muscles. Before surgery, you may do this exercise on both legs if tolerated.

Bend one leg. Keep other leg as straight as possible and tighten muscles on top of thigh

Slowly lift straight leg 10 inches from bed and hold two seconds

Lower leg, keep muscles tight for two more seconds, then relax

Repeat this exercise 10 times at least once a day.

N O T E S

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Surgery and RecoveryN O R T H K A N S A S C I T Y H O S P I T A L

Surgery and Recovery

On the day of your surgery, a memberof the Operating Room staff will meetyou. Once settled, an intravenous line(IV) will be started to provide youwith fluids during surgery. You willbe positioned for the anesthesia.

During your surgery, your family andfriends can wait in the surgical waitingarea. The receptionist will updatethem on your progress and informthem when you are being broughtback to your room.

When you awaken in the RecoveryRoom, you will have a bulky bandageon your leg and a drainage tube(hemovac) coming from the bandage.The nurse will be monitoring yourrecovery with frequent checks of yourvital signs such as your blood pressure,temperature, breathing and heart rate.The circulation in your legs and feetalso will be monitored.

After you have recovered from theanesthesia, you will be brought backto your hospital room where yournurse will continue to monitor yourvital signs, circulation and any discomfort you might have. Duringthis postoperative recovery period,you should try to cough, take deepbreaths and pump your feet.

N O T E S

After SurgeryBecause your activity will be less thannormal for a couple of days followingyour knee replacement surgery, it isimportant for you to do several thingswhile in bed.

• Continue deep breathing andcoughing to prevent congestion inyour lungs. This routine should beperformed every one to two hourswhile you are awake. If you needhelp to keep your lungs clear, a respiratory therapist may be calledand will recommend exercises or treatments.

• You may be fitted with white elasticstockings, sequential compressiondevices and/or foot pumps to prevent blood clots during hospitalization to help increaseblood flow. Your nurses will takethese off periodically. Never put a pillow under your knee.

• It is essential to drink fluids tomaintain good kidney function,because with bed rest there is anincreased possibility of infection. It is important not to postpone urination. Call your nurse if youneed assistance.

• Change your position in bed frequently to prevent skin irritation.The trapeze is useful to help you liftyour buttocks off the bed. When lifting, do not push down on thebed with the leg that was operatedon. Your nurse will help you tiltonto your side. Tell your nurse ifyour buttocks or heels feel sore orhot. Several procedures can be doneto relieve this discomfort.


• Do the exercises you learned priorto surgery. They will enhance thereturn of blood to your legs andkeep your muscles strong. Moveyour feet up and down 10 timesevery one to two hours while awaketo keep the circulation active anddecrease the chance of blood clots.

Your Incision and BandagesThe bandages covering your incisionwill be changed as needed by thenurses and doctors. It is not unusualto see red or brownish drainage onthe bandage. This will graduallydecrease and usually stops in aboutone week. It is not unusual for thearea surrounding your incision to bebruised. Your incision may containstitches or staples that are visible.These will be removed when healingpermits, usually after 7-10 days.

Calf Pumping (Ankle Exercise)

Quadriceps Setting Exercise (Quad Sets)

Straight Leg Raises

N O T E S

MedicationDuring your postoperative period,you may experience pain in yourknee. There are many ways to relieveyour discomfort, including medica-tion, ice bags, position changes andrelaxation exercises. Injections of painmedicine are usually given during thefirst 48 hours, and once you are able to eat and drink, oral medicine willhelp minimize your discomfort. Your nurse will help you identifywhich medications will make youmost comfortable.

Other medications that may be prescribed include the following:

• Aspirin, warfarin (Coumadin®) orenoxaparin (Lovenox®) may begiven to help prevent the formationof blood clots.

• A laxative, such as docusate,bisacodyl or milk of magnesia,may be given to soften the stool andpromote regular bowel function.Constipation can occur for manydifferent reasons, including medica-tion, inactivity and diet. Your nursewill help you with the necessarysteps to avoid constipation.

• Iron tablets may be ordered by yourdoctor to assist your body to rebuildits own blood supply and recoverfrom the normal blood loss thatoccurs during surgery.

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N O T E S

Getting Out of BedThe nurse will come to your bedside and teach you the correct way to get out ofbed: keeping the operated knee straight and the leg out to the side. Tell the nurseif you become dizzy. This is common and will pass as you get used to being up.

Prop up with elbows.

Keeping knees apart, continue to move lower extremities to edge of bed.

Continue with same motionuntil lower extremities areover edge of bed and feet are flat on floor.

walking progresses, you will learn togo up and down stairs independently.

Active motion of the knee will beginwith a physical therapist in the gym.Motion will begin slowly and increasedaily. You will continue to practiceactive straight-leg raises and isometricexercises. You also will start activeknee straightening exercises. Some physicians will order polar packs(cold therapy) to help decreaseswelling and pain in your knee.

At the time of discharge, you shouldbe able to walk independently with awalker on level surfaces and stairs.And, over time, your ability to bendand straighten your knee will continueto improve. Your doctor may orderoccupational therapy as well.

Occupational TherapyThe Occupational Therapist willassess your ability to continue on withyour daily activities. The OccupationalTherapist will recommend assistivedevices or other equipment, as needed.

Stair ClimbingA variety of techniques are used toascend and descend stairs. The methodyou use is dependent on the type ofsteps you have, the particular assistivedevice (i.e., walker) you use and yourweight-bearing status.

• Going Up Steps: Step up first withthe non-surgical leg then followwith the operated leg.

• Going Down Steps: Step down firstwith the operated leg, then followwith the non-surgical leg.

“UP WITH THE GOOD, DOWN WITH THE BAD”

Continuous Passive Range of Motion MachineThe continuous passive range ofmotion (CPM) machine provides passive range of motion for your kneewhile you are in bed by moving yourknee joint for you. This keeps yourknee from getting stiff, yet does notstrain the knee muscles while they are healing.

If appropriate, your doctor will prescribe a CPM machine for you and will determine the initial machinesetting. On a daily basis the bendingprogression of your knee will be evaluated and the machine’s settingsadjusted if necessary. Your nurse willteach you the proper way to get inand out of the CPM machine andanswer any questions you may have.Your physician will order the numberof times and length of time to use theCPM. It is also very important we puta pillow under your heel to get fullextension of the knee. This is doneseveral times a day. Never put a pillowunder the knee or leave your leg in theCPM when it is not running. This canincrease the risk of blood clots.

Physical TherapyThe day after surgery you will beready to get out of bed and sit in achair. You also will start physical therapy. You will be taken to the gymby wheelchair with your leg elevatedand supported.

The physical therapist will reviewknee exercises. These can be practicedwhile in bed. Initially, carefully guidedmotion of the knee is allowed, unlessyou are using the CPM machine. Inthe gym, you will be instructed howto walk using a walker. As your

N O T E S


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Our goal is for patients to go home with home health care after their stay on the

Orthopedic Unit of the hospital. Listed below are possible options for continued

care upon leaving the hospital setting.

Home HealthHome Health Services are provided to most individuals who have a total kneereplacement. Home Health may consist of physical therapist visits, nursing visits,and/or occupational therapist visits, with physical therapy providing the majorityof the services. The number of visits varies depending on your surgeon’s orders,but is typically either three or five days per week. Home Health is designed toassist you in your recovery while it is difficult for you to get out of your home andis covered by most insurance companies.

Acute RehabilitationNorth Kansas City Hospital offers an on-site Acute Rehab Unit. This level of careis often not authorized by insurance companies following total joint replacement.Acceptance in acute rehab is determined on an individual basis by the Rehab UnitAdmission Coordinator and is driven by very strict Medicare guidelines. Theaverage length of stay is 7-10 days. Patients typically receive therapy four timesper day for a total of three hours per day.

Skilled Nursing UnitSkilled nursing is a lower level of care from acute rehab where patients typicallyreceive therapy once daily. If skilled nursing is required after surgery, NorthKansas City Hospital social workers will facilitate this transition to a local skillednursing facility of the patient’s choice. A list of area skilled nursing facilities willbe available at the total joint replacement class and upon admission. Skilled nursing units are located within local nursing homes. The average length of stayvaries. It is determined by progress in physical therapy and insurance approval.

Discharge OptionsN O R T H K A N S A S C I T Y H O S P I T A L

Discharge Options

N O T E S


Returning Home After SurgeryN O R T H K A N S A S C I T Y H O S P I T A L

Returning Home After Surgery

Preparing to Return HomeIf you live alone, some additional help may be needed for at least four weeks, or until you are able to get around without help. Long before your discharge, it isvery important that the necessary arrangements be made toward your releasefrom the hospital (including help at home and a ride home). Included in yourpacket of information is a questionnaire that will help determine what type ofadditional help you may need.

Case Management/Social Services can provide you with information on how toget help at home. They will assist you in obtaining home equipment if needed.Coverage for such items is dependent on your insurance policy benefits.

When the staples or stitches are removed from your incision, they may be replacedby small pieces of special paper adhesive tape called “steri-strips.” After a fewdays they will begin to fall off by themselves. This is normal. You will need tokeep your incision clean and dry and watch for signs and symptoms of infection(i.e., redness, draining, warmth and fever). Your nurse will instruct you if anyadditional care is needed.

You will be discharged from the hospital on the medications you were takingbefore you were admitted. Your doctor may prescribe additional medication suchas Lovenox® or another type of blood thinner. Continue to eat a well-balanceddiet, high in carbohydrates and proteins to aid in tissue healing. If you were on a special diet in the hospital, a nurse or dietitian can answer any questions youmay have.

Included in your packet

of information is a

questionnaire that will

help determine what

type of additional help

you may need.

N O T E S

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Hints for HomeFollowing are some important thingsfor you to remember during yourdaily activities, (bathing, dressing and household duties) and during thenecessary adjustments for 6-8 weeksafter you go home. The therapist canprovide some suggestions for yourparticular needs. A firm chair withoutwheels and with sturdy arms may beeasier to use for a period of time afteryou leave the hospital. Your nursealso will review these points with you.

• Reorganize your cabinets, refrigera-tor, closets and work spaces so thatfrequently used items are withineasy reach.

• Sit on a high stool or built-up armchair while working in one spot,especially if you tire easily.

• Clear the pathways between the living area, bedroom and bathroomof furniture and clutter so they arewide enough for a walker to passthrough. This will help make yourreturn to home safe.

Bathing• Do not sit on the floor of the tub.

Tub benches and shower chairs may be appropriate for your situation.An Occupational Therapist can helpyou determine what equipment isnecessary for bathing.

• Traction strips or a non slip/skidbath mat for the shower stall or tubhelp prevent slipping.

• You can use a long-handled spongeto wash your feet.

DressingBy the time you are discharged, if youcannot reach your feet yet and there isno one available to help you, you canuse a special device to put on socks(sock donner).

A long-handled shoehorn can be usedto slip shoes on. Remember to wearwell-fitted shoes with a back and noheels. Elastic shoelaces can be used toslip shoes on and off without tying oruntying. You also can use Velcroenclosures.

Safety• Wear good, sturdy shoes with an

enclosed back when walking.

• Throw rugs and slippery floors are a safety hazard. Remove all throwrugs from your floors.

• Watch for hazards such as wet spotsor electrical cords on the floor.Remember to use your walker forany walking.

• Safety rails are suggested for use inyour bathroom.

• Be especially cautious outside yourhome or in unfamiliar places. In thewinter, rubber-soled boots should beworn for walking in the snow.

• Use handrails (if present) whenwalking up/down stairs or steps.

N O T E S


Driving and TravelYou may be a passenger in a car for 1-2 hours at a time. Check with yourdoctor to determine when you mayresume driving a car. You also mayneed to check with your car insurancecompany before driving so that theyare aware of your surgery.

The metal hardware in your knee may activate the detection devices atairports. Your doctor will give you ametal identification card, if needed.

Follow-Up CareYour doctor will want to see you afteryou go home to follow your recoveryprogress. It may be most convenientto make this appointment before youleave the hospital. Do not hesitate to call your doctor if you have anyquestions during your recovery.

Use of WalkerBe sure that you know how long youare to use your walker and exactlyhow you are to use it. If you have any questions about this, please askyour doctor. Your home health or outpatient therapist will progress youto the next appropriate level.

Care of Your IncisionLook at your incision every day for 7-10 days. After your staples havebeen removed, you should wash theskin gently with soap and water daily.Ask you doctor whether or not tocover your incision while showering.

Prevention of InfectionIt is important to do everything possible to prevent infection. If youhave a fever (temperature above 100),swelling, redness, or tendernessaround your incision or drainage,please call your doctor immediately. If you suspect you have an infectionanywhere else in your body, it is very important to notify your doctorimmediately. Prior to dental appoint-ments or any invasive procedures,please remind your doctor or dentistof your knee replacement. In all thesecircumstances, your doctor shoulddetermine whether antibiotics are necessary to treat and/or preventinfection.

PainYou may feel some discomfort in yourknee area for some time after yoursurgery. As long as it does not increaseor become severe, it is usually nothingto worry about. If your pain doesincrease after you go home or persistsfor a long time, call your doctor.

Activity LevelAn artificial knee is composed ofmechanical parts that are subject towear and tear. In order to get the maximum useful life from your knee,it is important that these parts not beexposed to excessive stresses andstrains. You should not run or jumpand should not take part in activitiesthat place excessive stress or wear onthe joint.

Sexual RelationsSexual activity is possible with properprecautions. Remember that the posi-tion of your replaced knee is veryimportant during the first three monthsafter surgery. Ask your doctor or nurseif you have questions or concerns.

N O T E S

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CHECKLIST

The following is a checklist of items you may want to ask your doctor, nurse or therapist.

Amount of weight bearing allowed, and for how long

Need for any special devices – sock donner, reacher, etc.

What type of equipment is needed for the toilet/tub/shower

How to get home (family car, wheelchair van, or ambulance – check your insurance coverage)

Length of time to follow knee mobility/precautions

Sexual activity

Need to raise the height of the bed

Follow-up appointment

Need for help at home, especially if you live alone

When you are able to drive

When you need to see or call your doctor


Preventing Falls At HomeN O R T H K A N S A S C I T Y H O S P I T A L

Preventing Falls At Home

By increasing your awareness of the safety issues around the home, you can prevent falls.

How Do You Prevent a Fall? • Proper use of a walker or an assistive device.

Do not carry any objects in your hands. Use awalker basket, walker bag or utility cart to transport objects.

Make sure that all the legs of the walker or otherassistive device are on the floor.

Keep your walker or other assistive device withyou at all times. Do not hold on to furniture. Itmay not be firm enough to support you.

• Proper hand placement while standing up and sitting down. While getting up from a chair, push up from thearms of the chair, get your balance and then reach for the walker. Do not pullon the walker. It will fall on you.

While sitting down, reach back with both handsto the arms of the chair before sitting.

Other General Considerations 1. Wear shoes that fit well and that have soles that

do not slip.

2. Wear your glasses (if you use them).

3. Call for help if you feel dizzy or weak when youtry to get up.

4. Remove throw rugs and other objects from thewalkways. They could catch in walker legs.

5. To clean up spills, use a reacher, or sit in a chairand use your feet.

6. Use a night light to see your way to the bathroom at night.

7. Follow your doctor’s recommendations for exer-cises to keep your arms, legs and bones strong.

8. If someone has to help you walk, wear a gait belt.

9. Use a non-slip bath mat, traction strips and/orgrab bars in the tub or shower stall.

How Do You Get Up After You Have Fallen? • First, check for injuries.

1. Do not panic. Think!

2. Make sure you can move all four limbs without pain.

3. If you cannot move one or more limbs, call for help. Cordless phones in the walker bag or in a robe pocket are handy, even in the bathroom.

• To get up 1. In a seated position, scoot over and back up to

a sturdy piece of furniture.

2. Place your hands on the furniture behind you.

3. Bring the knee of your non-surgical leg forward so that your foot is placed flat on the floor.

4. Using the non-surgical leg, push yourself up so that you come to a seated position on the furniture behind you.

5. Assistance of a second person may be required.

6. If you feel intense pain at any time or if you are unable to get to the furniture, stop and call for help. Do not try to get up.

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Your doctor should be contacted if any of the following signs appear:

• Fever above 100 degrees by mouth. Check your temperature every evening for7-10 days after you leave the hospital.

• Changes in the incision. Report any increase in redness, swelling, drainage orwarmth around the area of your incision. These may be signs of infection.

• Sudden increase in pain. A mild amount of pain is normal. Report any suddenincrease in your pain, inability to walk or difficulty straightening your leg.

In case of a fall, contact your doctor for further instruction.

When to Call Your DoctorN O R T H K A N S A S C I T Y H O S P I T A L

When to Call Your Doctor

N O T E S


Bend your knee as much as you can. Straighten your knee all the way.

Pick your foot up as you turn.

Point and flex your toes to promote circulation, tone and strengthen the muscles of the lower leg.

After Knee Replacement Surgery, practice these

important rules and exercises to help aid in

proper healing and maintain total knee mobility.

Total Knee Mobility/PrecautionsN O R T H K A N S A S C I T Y H O S P I T A L

Total Knee Mobility/Precautions

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How To Manage Your PainN O R T H K A N S A S C I T Y H O S P I T A L

How To Manage Your Pain

People used to think that pain was something they

“just had to put up with.” But with current treatments,

that’s no longer true. Today, you can work with your

nurses and doctors to prevent or relieve pain.

Pain is a sensation that hurts enough to make you uncomfortable, whether youfeel distress or severe discomfort, and it can be defined only by the person who isfeeling it.

Pain control can help you:• enjoy greater comfort while you heal.

• get well faster. With less pain, you can start walking, breathing better and getyour strength back more quickly. You may even leave the hospital sooner.

• improve your results. People whose pain is well controlled seem to do better.

Help the doctors and nurses “measure” your pain.• They may ask you to rate your pain on a scale of 0 to 10 or to choose a word

that best describes the pain.

• You also may set a pain control goal (such as having no pain that’s worse than3 on the scale).

• Reporting your pain as a number helps the doctors and nurses know how wellyour treatment is working and whether to make any changes.

• They may ask you to use a “pain scale” like the one on the following page.


Are there any general guidelines for relieving pain?It is important to try to prevent the pain before it starts or gets worse by usingsome pain-relief method on a regular schedule. If pain begins, don’t wait for it toget worse before doing something about it. Often it is necessary to take painmedication around the clock.

Will I become addicted if I use narcotics for pain relief?No. Narcotic addiction is defined as dependence on the regular use of narcoticsto satisfy physical, emotional and psychological needs rather than for medicalreasons. Pain relief is a medical reason for taking narcotics. If you have pain, thenarcotics work on the pain.

Tell the doctor or nurse about any pain that won’t go away.• Don’t worry about being a “bother.”

• Pain can be a sign of problems.

• The nurses and doctors want and need to know about it.

• Report if you are constipated, which is a common side effect of narcotics.

0-10 NUMERIC PAIN INTENSITY SCALE

0 1 2 3 4 5 6 7 8 9 10No Moderate WorstPain Pain Pain

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Food helps

promote healing,

so it is very important

to eat after surgery.

A healthy diet is an

important part of your

overall health as well.

During your hospital

stay, a dietitian

may visit you

to answer your

nutrition questions.

The following

information will help

you continue your

healthy diet once

you go home.

For more information

on individual

calorie needs, go to

MyPyramid.gov

Nutrition GuidelinesN O R T H K A N S A S C I T Y H O S P I T A L

Nutrition Guidelines

GRAINS Make half your grains wholeEat at least 3 oz. of whole grain cereals, breads, crackers, rice or pasta every day.

1 oz. is about 1 slice of bread, about 1 cup of breakfast cereal or 1/2 cup of cooked rice, cereal or pasta.

VEGETABLES Vary your veggiesEat more dark green veggies like broccoli, spinach and other dark leafy greens.

Eat more orange vegetables like carrots and sweet potatoes.

Eat more dry beans and peas like pinto beans, kidney beans and lentils.

FRUITS Focus on fruitsEat a variety of fruit.

Choose fresh, frozen, canned or dried fruit.

Go easy on fruit juices.

MILK Get your calcium-rich foodsGo low-fat or fat-free when you choose milk, yogurt and other milk products.

If you don’t or can’t consume milk, choose lactose-free products or other calcium sources such as fortified foods and beverages.

MEAT and BEANS Go lean with proteinChoose low-fat or lean meats and poultry.

Bake it, broil it or grill it.

Vary your protein routine – choose more fish, beans, peas, nuts and seeds.

FATS, SUGARS and SALT (SODIUM)Make most of your fat sources from fish, nuts and vegetable oils.

Limit solid fats like butter, stick margarine, shortening and lard, as well as foods that contain these.

Check the Nutrition Facts label to keep saturated fats, trans fats and sodium low.

Choose food and beverages low in added sugars. Added sugars contribute calories with few, if any, nutrients.


High Fiber FoodsN O R T H K A N S A S C I T Y H O S P I T A L

High Fiber Foods

High Fiber Food Sources• Beans • Oatmeal

• Bran cereal • Potato with skin

• Fresh or frozen peas and lima beans • Nuts

• Fruit (especially apples, peaches, • Whole wheat bread, crackers, pears, raisins, strawberries) pasta, etc.

• Vegetables (especially broccoli, carrots, cabbage, brussel sprouts, spinach, corn)

Tips to Add Fiber to Your Diet• Eat whole grain cereals and breads instead of the refined versions. Any cereal

with at least 3 grams of fiber per 1 oz. serving is a good choice.

• Use whole grains (oatmeal, bran flakes, etc.) as fillers or topping for meatloafor meatballs, casseroles and coating for oven-fried chicken or fish.

• Eat 5 servings of fruit and vegetables every day.

• Double the vegetables in stew, soups, casseroles and spaghetti sauce. Cut the meat in half.

• Eat fruit instead of drinking juice.

• Eat dry beans or peas (legumes such as red beans, navy beans, etc.) at least 3 times per week.

• Add beans to soups, chili, salads and casseroles.

• Add more fiber to your diet gradually. If you add fiber too quickly it may causegas, cramping, bloating or diarrhea.

• Drink plenty of fluids – at least 8 cups every day.

High Protein FoodsProtein is a nutrient needed by the body for normal growth, wound healing and the ability to fight infection. After having a surgery it is especially important to make sure you eat enough high protein foods. Protein canbe found in meat as well as many other foods.

Sources of Protein• Beef • Milk • Peanut butter

• Fish • Cheese • Nuts

• Poultry • Yogurt • Beans

• Eggs

A high fiber diet

is used to help

prevent constipation

after surgery.

N O T E S

I-35 and Armour 210North Kansas City, MO

(816) 691-2000www.nkch.org

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