Total Knee Replacement

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1 Total Knee Replacement Pre-operative Joint Class Updated: November 2017

2 Where to Begin Thank you for attending the UNC REX Joint Replacement Class today This presentation is designed to prepare you for your upcoming surgery and your stay in the hospital

3 Joint Replacements at Rex Shorter hospital stay Most patients are able to go home the day after surgery Ex: Monday surgery, home Tuesday or Wednesday Most patients will be walking within hours of surgery We perform approximately 2,000 elective total joint replacements each year! 96% of our patients go directly home after surgery

4 Day of Surgery Registration Go to the Main Entrance and registration will be on the right Pre-op Surgery Usually lasts 1 to 2 hours Surgical waiting room The surgeon will visit family after surgery in the main surgical waiting room

5

6 Recovery Room (PACU) Day of Surgery You will spend at least 1 hour in recovery Arrival to Room 6 th floor Orthopedics (west wing of patient tower) Private room, walk-in shower, elevated commode seat, closet Recliner a guest may stay the night

7 Arrival to Your Room Your nurse and your nursing assistant will greet you Vital signs Head to toe assessment Pain assessment Admission questions Discuss plan of care They will need about 10 minutes to settle you, and they may ask for privacy from family/friends while doing so

8

9 What to Bring for Your Stay Clothing comfortable, loose fitting We provide non-skid socks Shoes supportive with closed heel (avoid flip flops, bedroom slippers, etc.) Personal hygiene products and undergarments Assistive devices Glasses, hearing aids, dentures, CPAP, walker A copy of your advance directive Living will, healthcare power of attorney

10 What NOT to Bring Do not bring unnecessary valuables to the hospital Jewelry, wallet, purses, etc. Do not bring home medications Medications from home will only be allowed by physician order in cases where the hospital pharmacy can not provide the medication or a suitable substitute

11 Rounding After surgery, the nursing staff will be visiting you frequently Hourly rounding Your surgeon and/or their PA will round each morning after surgery Usually between 5:30 and 7:30 am It is the best time to address any questions or concerns

12 Visitation There are no specific visiting hours for the orthopedic unit Your primary caregivers are encouraged to be present Caregivers/family are welcome to visit, and they are encouraged to be a part of therapy sessions if possible Important: Plan to have someone to assist you at home for at least the first 48 hours

13 Rex Room Service You are encouraged to eat after surgery Start off with lighter foods/plenty of fluids Nausea and vomiting is common after anesthesia Room Service Ordering is available between 6:45am and 6:45pm Meals typically take about an hour (+/-) to arrive to your room

14 UNC REX is tobacco free Tobacco NO smoking, chewing, or vapor Patients who use tobacco are at increased risk for complications after a knee replacement

15 Preventing Pneumonia Pneumonia can be a complication after surgery An incentive spirometer is used to help prevent post-op pneumonia Nursing staff will provide you with instructions for use on arrival to your room You will be encouraged to use it 10 times per hour while awake

16 Preventing Blood Clots You will be at risk for developing a blood clot after your surgery Your doctor has likely discussed the need for taking a blood thinner after your surgery It may start the day of surgery, or the day after It is important that you continue to take your blood thinner as prescribed

17 Preventing Blood Clots Plexi-pulses, or foot pumps Soft wraps are placed around your feet They can help prevent a deep vein thrombosis, or DVT (blood clot)

18 Hand washing can help prevent infection patients, visitors, staff You will receive antibiotics through your IV during your hospital stay Preventing Infection Many surgeons recommend preventative antibiotics prior to dental work for life

19 Preventing Falls You will be at risk for falling because of your surgery, pain medications, IV lines, tubes Anytime you feel like you need to get out of bed for any reason, please call for assistance and wait for a staff member to assist you Call don t fall!

20 Using the Bathroom Most patients have a urinary catheter in place for a few hours after surgery The catheter is typically removed after your anesthesia has worn off and after you have worked with physical therapy for the first time We encourage you to walk to the bathroom staff will assist you

21 Bowel Movement Medications given during and after surgery may cause constipation You will be given stool softeners after surgery It is important to drink plenty of fluids, and to walk Walking is important to help stimulate your bowels after surgery Be proactive!

22 Incision The large elastic wrap bandage dressing on your knee will be removed on the morning after surgery, or the following day Before leaving the hospital, your nurse will give you instructions regarding dressing and wound care

23 Pain Pain is expected after a knee replacement Your surgeon may order several different medications that work in different ways to help with pain The nursing staff will offer repositioning, ice, and even walking to help manage your pain

24 Pain Your nurse will frequently ask you to rate pain from 0 to 10 0 = no pain 10 = the worst pain you can imagine Most patients will say that a 4 is tolerable and a realistic goal It is our goal to help control your pain We may not be able to take ALL the pain away Stay ahead Please share concerns/questions/preferences with your nurse Communication is key!

25 Questions/Concerns

26 Rehabilitation

27 Patient Family Surgeon Physical Therapist Nurse Occupational Therapist Case Management Team

28 Starts the day of surgery First Visit: Physical Therapy Questions: Home set up, equipment, what you were doing at home before surgery, stairs Move Sit edge of bed (dizziness or nausea is not unusual) Standing with walker Walking distance as tolerated (determined by PT) Yes, you can walk with this stuff

29 Physical Therapy PT will see you twice a day Goal is to progress walking and functional mobility Each visit will increase your activity/mobility Walk further More exercises Functional activities Strengthening PT works closely with nursing to ensure your pain is managed for participation Safety!

30 Range of Motion Heel slides Knee bends Exercises Strengthening Quad sets Glute sets Walking Out of Bed

31 Stairs Not as hard as most people think May go to the gym to practice stairs Know exactly how many stairs you have and where your hand rails are!

32 Occupational Therapy Assist with Activities of Daily Living (ADL s) Bathing and dressing Tub/shower transfers in the rehab gym Reacher: the universal tool

33 Case Management Coordinate and set up discharge plans Discharge plans may include home health services and/or durable medical equipment Communicate discharge plans with the team (MDs, RNs, PT/OT) Make plans in advance to have someone stay with you 2 to 3 days around the clock

34 Equipment Total knee replacement patients will receive a rolling walker and 3-in-1 commode Equipment will be delivered to your hospital room before you leave unless you already own Cost of equipment will be billed through insurance

35 Home Health Physical Therapy Some patients will have Home Health Physical Therapy ordered by their surgeon Our Case Manager will set up home health 3 days a week for 2 weeks, then start outpatient PT Sessions are about 1 hour Every attempt is made for the first home health visit within 24 hours of discharge (ex: discharge home Tuesday, first visit on Wednesday)

36 Outpatient Physical Therapy Most patients will have outpatient Physical Therapy ordered by their surgeon Helps get you out and about! If you are starting with outpatient PT after surgery, be sure to schedule your first few appointments in advance

37 Ongoing Activity Avoid: High impact activities Maintain regular exercise program Walking Aquatics Biking

38 Privacy As excited as you are to see your loved one out of bed the day of surgery, please do not take photos or videos of Rex staff members

39 Thank You! Our orthopedic staff will provide you with excellent care while recovering from your surgery Thank you for choosing Rex Orthopedics for your new knee!

40 Questions/Concerns?

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