Total Joint Replacement Guide

Transcription

1 Ttal Jint Replacement Guide 1

2 Cntents Intrductin Welcme Letter 3 Yur Jint Replacement Team 4 Preparing fr Surgery Pre-Operative Appintments 5 Preparing yur bdy 6 Hme Exercise Prgram 7 Hme Planning and Preparatin Recmmendatins 11 Surgery Preparatin Checklist 12 Surgery Risk f Surgery 13 Anesthesia and Pain Cntrl 14 Day f Surgery Schedule 15 Cmmnly Asked Questins 16 Recvery The Rad t Recvery 17 Physical Therapy 18 Precautins after Surgery 19 Cmmnly Asked Questins 20 Ging Hme Leaving the Hspital 21 Hme Health Care Services 21 Rehabilitatin Hspital 21 Discharge Instructins 22 Pst-Operative Physical Therapy Prtcl - Hip Replacement 24 Pst-Operative Physical Therapy Prtcl - Knee Replacement 25 Nutritin 26 Imprtant Things t Remember 27 2

3 Welcme Welcme t TOC! Thank yu fr chsing Tallahassee Orthpedic Clinic (TOC), we lk frward t helping yu feel better! At Tallahassee Orthpedic Clinic, we prvide cmprehensive pre-perative and pstperative rehabilitatin services fr ur patients underging ttal jint replacement. Our gal is t make yur recvery and rehabilitatin as easy and prductive as pssible. We are cmmitted t keeping yu infrmed and we will d everything we pssibly can t make yur time with us as pleasant as pssible. In this packet, yu will find imprtant instructins and infrmatin t prepare yu fr yur surgery in educatinal packet. It will answer many questins yu may have, and clearly utline the things yu need t d befre, during and after yur surgery. Planning tls, advice n medicatins, diet and exercise are als included. Please take time t read the material carefully. It is ur pleasure t assist yu in yur perative experience and recvery. If yu have any questins, please d nt hesitate t call. Sincerely, Yur TOC Jint Team Imprtant phne numbers Tallahassee Orthpedic Clinic Main Clinic TOC Physical Therapy tlhc.cm 3

4 Welcme Yur Jint Replacement Team Befre, during and after yur surgery yu will cme in cntact with many different members f ur rthpedic team. These are sme f the peple yu may encunter during yur stay: Orthpedic Surgen Yur rthpedist is the dctr wh perfrms the actual jint replacement surgery and is respnsible fr yur verall health during yur hspital stay and fllwing yur surgery. Physician Assistant and/r Nurse Practitiner Yur Physician Assistant and/r Nurse Practitiner assists the physician in perfrming prcedures and fllw up care during yur hspital stay. Anesthesilgist r Nurse Anesthetist Yur anesthesilgist is the dctr wh administers anesthesia during yur surgery, mnitrs yur vital signs during and after yur surgery, and versees pst-surgical pain cntrl. Nurse Befre and during yur hspital stay, yu will meet a number f nurses wh perfrm different jbs. Sme nurses attend t yur daily health care needs in the hspital; thers assist surgens in the Operating Rm, while thers wrk in hspital admissins and, in sme cases, visit patients at hme. Nurses are amng the mst visible health care prfessinals in the hspital. Medical Assistant/Patient Care Assistant Yur medical assistant/patient care assistant will help yu and yur registered nurse with all yur daily needs. Physical Therapist Yur physical therapist is trained t assist yu in regaining strength and mtin in yur new jint. A physical therapist will wrk with yu during yur hspital stay and the first few weeks after yu return hme. Occupatinal Therapist Yur ccupatinal therapist is trained t teach yu hw t perfrm the activities f daily living, such as dressing and bathing after yur surgery. Nurse Case Manager Yur Nurse Case Manager will develp a discharge plan fr yu fr ptimal recvery. 4

5 Preparing fr Surgery Pre-Operative Appintments Preparing fr yur replacement surgery begins several weeks befre the date f the surgery. Cmpleting these visits as scheduled will help avid any delays r cancellatins n the day f surgery. If instructed, appintments may include: Pre-Operative Medical Clearance: Apprval frm yur primary care physician and/r indicated specialist is required fr yu t underg surgery. This includes a physical examinatin and preadmissin testing. Physician: Date: Time: Pre-Operative Jint Replacement Educatin Class: This class is designed t review imprtant infrmatin cvered in this guide and answer any questins yu might have abut yur surgery. Lcatin: Date: Time: Pre-Operative Physical Therapy Assessment: Physical therapy is a key cmpnent f yur recvery. Yur surgen may recmmend yu t ne f ur physical therapist wh will cmplete an assessment and develp an exercise prgram designed persnally fr yu. Therapist: Date: Time: Pre-Operative Appintment: Lcatin: Date: Time: Surgery: Lcatin: Date: Time: Pst-Operative Appintment: Lcatin: Date: Time: 5

6 Preparing fr Surgery Preparing Yur Bdy In the weeks befre yur surgery yu may als be asked t: Maintain a healthy diet. Gd nutritin is imprtant befre and after yur surgery. This will help make sure yu will have the strength pst-surgery fr rehabilitatin. Please refer t page 20 fr an example f a balance diet. Stp smking. Smking is a leading risk factr fr surgical cmplicatins and prblems with wund healing. Please stp smking as far in advance f yur surgery as pssible. Mnitr yur bld sugars. If yu are a diabetic, make sure yu are clsely mnitring yur bld sugars. If they are cnsistently elevated, ntify yur Primary Care Physician. It may be best t pstpne yur surgery t avid infectin and prblems with healing. Eliminate certain medicatins. Seven days prir t surgery, please stp taking any aspirin r antiinflammatry prducts such as Advil, Ibuprfen, Mtrin, Aleve, etc., r any herbal supplements cntaining vitamin E. This des nt include Celebrex. Stp eating and drinking. D nt eat r drink anything after midnight the night befre yur surgery. This includes water, cffee, tea, gum, cugh drps r breath mints. The mrning f yur surgery yu may brush yur teeth and rinse yur muth, but d nt swallw. If yu are instructed t take medicatins, please take them with a small sip f water nly. Have a dental examinatin. Althugh infectins in jint replacements are uncmmn, ne can ccur if bacteria enter the bldstream smewhere in yur bdy. Therefre, yu shuld arrange t have dental prcedures prir t yur surgery. Begin exercising under a physician s instructins. Special exercise may lead t a faster recvery and help decrease cmplicatins. Yur physical therapist will prvide yu with a hme exercise prgram, please refer t page 7-10, that yu can begin nw. 6

7 Preparing fr Surgery Hip Replacement - Hme Exercise Prgram 7 7

8 Preparing fr Surgery Hip Replacement - Hme Exercise Prgram Cntinued 8 8

9 Preparing fr Surgery Knee Replacement - Hme Exercise Prgram 9 9

10 Preparing fr Surgery Knee Replacement - Hme Exercise Prgram Cntinued 10 10

11 Preparing fr Surgery Hme Planning and Preparatin Recmmendatins: If yur bedrm is upstairs, yu may need t set up a temprary sleeping area n the first flr. Remve all thrw rugs, lse rugs, electrical crds and clutter frm hallways/walking areas. Check yur cabinets fr items yu rutinely use and place them n a level where yu will nt need t bend r get n a step stl t reach them. Have extra pillws r pads fr chairs, sfas and autmbile seats t elevate the seat t insure prper alignment f yur new jint. Safety bars in the shwer and near stair railings may be helpful. Ensure yu have all the necessary medical equipment yu will need during yur recvery. TOC will supply yu with a 2 Wheel Rlling Walker at yur pre-perative appintment. Other equipment t cnsider include: Ice packs Lng handled bath spnge Raised tilet seat Shwer/bath bench Cnsider activities that yu will be able t perfrm during yur recvery such as reading materials, electrnics r hand crafts such as knitting. 11

12 Preparing fr Surgery SURGERY PREPARATION CHECKLIST Preparing fr yur return hme: Create a recvery envirnment at hme Pick-up medical equipment frm TOC Plan fr transprtatin t and frm the hspital Have a supprt team in place t assist yu with any needs What TO take t the hspital: This handbk Cmfrtable, lse-fitting clthing Supprtive, slip n shes with nn-skid sles (N crcs, flip-flps, slippers r backless shes) Tiletries Glasses, hearing aids and/r dentures with the necessary strage cntainers A list f medicatins, including the nes yu have recently stpped taking at yur physicians request Emergency Cntact List with phne numbers What NOT t take t the hspital: Medicatins, unless asked by yur physician Valuables including jewelry, cash and credit cards The day befre yur surgery: D nt eat r drink after midnight (unless instructed therwise by yur physician.) Shwer with special sap that was prvided t yu at yur pre-p appintment. Ntify yur physician if yu develp a sre thrat r fever. Get a gd night s rest. Set yur alarm! The day f yur surgery: Brush yur teeth and rinse, d nt swallw. As instructed by yur dctr, take rutine medicatins with nly a sip f water. Wear cmfrtable, lse-fitting clthing. Leave valuables at hme r with a family member. Please arrive at hspital as yur instructed time. 12

13 Surgery Risks f Surgery As with any type f surgical prcedure, there are certain risk assciated with jint replacement surgery. Thugh cmplicatins are rare and extensive measures are taken t minimize these risk, it is imprtant that yu are aware f pssible prblems such as, but nt limited t: Persistent Pain Change in leg lengthy (slightly shrter r lnger) after hip replacement Dislcatin f implant Need fr future surgery Nerve damage Bne fracture Infectin Lsening r failure f implant Bld clts f the legs r lungs Stiffness Swelling Yur surgery team will review these risks with yu and answer any questins yu may have. Once yu have discussed the peratin thrughly yu will be asked t sign a cnsent frm t cnfirm that yu understand the risks and cmplicatins that cuple ccur with having jint replacement surgery. 13

14 Surgery Anesthesia and Pain Cntrl Anesthesia fr yur surgery will be prvided by an anesthesilgist and nurse anesthetist. There are several chices f anesthetic techniques that may be chsen fr ttal jint replacement surgery. Typically general anesthesia is utilized fr Ttal Hip r Ttal Knee Replacements. Yu and yur rthpedic surgen and/r anesthesilgist will discuss these ptins prir t surgery and agree upn a plan fr yur anesthetic. General Anesthesia In this case yu are cmpletely unaware f yur surrundings and will nt respnd t stimulatin. This can be prvided in many different ways. The mst cmmn ways include: A cntinuus intravenus infusin that keeps yu asleep An intravenus medicine that puts yu t sleep. A breathing tube is then placed either int the back f yur thrat r further dwn int yur trachea (windpipe) t prtect yur airway. Spinal Anesthesia Invlves the insertin f a hllw needle and a small, flexible catheter int the space between the spinal clumn and uter membrane f the spinal crd (epidural space) in the middle r lwer back t achieve reginal anesthesia. Blcks feeling f pain and sensatin during surgery in cases where general anesthesia is nt required r recmmended. Pain Cntrl Pain cntrl begins in the Operating Rm with the administratin f medicatin directly int the surgical area. This is a cmbinatin f shrt and lng acting lcal anesthetic that decreases pstperative pain after ttal jint replacement surgery. The effects f this medicatin can last fr up t 72 hurs. Emphasis is t stay ahead f the pain. All patients experience pain differently and we will wrk tgether t prmte cmfrt while yu recver. Yu will receive additinal pain medicatin n as needed basis. 14

15 Surgery Prepping fr Surgery: The day yu cme in fr surgery is a very busy day. As much as 7 hurs can pass until yu are finished with yur whle surgical prcess and sent t yur hspital rm. Please infrm yur family f this s they can be prepared fr the lng wait. Yur surgery day includes: Pre-admit testing: (1 2 Hurs) Here yu will meet the nurse wh will crdinate yur preperative care and yu all will review all f yur paperwrk, draw lab wrk and perfrm preperative teaching. Pre-peratin Hlding Area: (1 2 Hurs) This is the area yu will be in immediately befre yu are taken int surgery. While yu are here, yu will: Meet with the anesthesilgist and surgical nurse abut yur surgery. Have an IV started t give yu fluids and antibitics. Have yur surgical site marked by yur surgen and prepared fr surgery. During Surgery: Surgery: (2 4 Hurs) Inside the perating rm, yu will be cared fr by yur anesthesilgist, nurse anesthetist and yur perating team. The length f yur surgery will depend upn the cmplexity f the prcedure. Smetimes there are unfreseen delays in the surgery schedule that culd als affect the length f time spent in the surgery area. After yur surgery, yur nurse anesthetist will slwly awaken yu. While yu are in surgery, yur friends and family can wait in the waiting rm and yur surgen will ntify them when yur surgery is finished. After Surgery: Pst Anesthesia Care Unit: (1 Hur) After surgery yu will be transprted t the recvery rm where the specially trained staff will care fr yu as yu awaken frm anesthesia. Yur bld pressure, pulse, respiratry rate and heart rate will be checked frequently t insure that yu are stable. Nurses will assess and treat yur pain and any nausea yu may experience. Yur new jint replacement will be x-rayed, yur surgical site will be cvered with a dressing and antiemblic stckings will be applied t yur leg/legs. When yu are ready t leave the recvery rm, yu will be transprted t yur hspital rm. Yur family r friend will be able t jin yu at this time. 15

16 Surgery Cmmnly Asked Questins Hw lng will the surgery last? The actually surgery lasts abut 2 t 4 hurs. Yur will be in a preperative hlding area apprximately 2 hurs befre surgery and in the recvery rm apprximately 1 hur after surgery. In ttal, yur entire surgical prcess can take between 4 t 7 hurs. Where des my family and friends wait while I m in surgery? The preadmissin nurse will direct yur family and friends t the surgical waiting rm. Hw lng will I be in the hspital? Everyne recvers frm surgery differently but with preparatin, gd use f educatin materials and barring cmplicatins, yu can expect yur stay in the hspital t be apprximately 2 t 3 days. What shuld I expect after surgery? Due t medicatin, yu will be drwsy fr a few hurs after surgery. A physical therapist will visit yu the day f yur surgery. Mbility will begin the day f surgery with assistance frm yur physical therapist r ccupatinal staff. 16

17 Recvery The Rad t Recvery Pain management Jint replacement surgery is designed t reduce the amunt f pain yu are currently experiencing. Hwever, yu will have sme discmfrt fllwing surgery as yur incisin heals and yu get used t yur new jint. Our medical staff will d everything pssible t attend t yur cmfrt. Althugh nt all pain can be eliminated, pain relief medicatin can safely lessen the pain yu feel after surgery. Cmmunicatin with yur health care team is essential. Tell yur health care prviders hw yu feel and hw well pain relief measures are wrking fr yu. Pain medicatins can be delivered in difference ways: Intravenus Line (IV): Begin t wrk quickly but generally d nt prvide prlnged relief. Oral Medicatins (Pain Pills): Prvide lnger lasting pain cntrl Mbility Getting up and mving is prbably the mst imprtant part f yur recvery and mst effective way t decrease yur risk f develping a cmplicatin after surgery and t decrease yur verall pain. Yur nursing and therapy staff will wrk tgether t get yu mving. Until given permissin by yur physical therapist, always have a member f yur health care team assist with activity. Bladder Care Yu will have a urine catheter inserted during surgery. Mst patients catheter will be remved immediately after surgery but sme will require the catheter t stay in fr 24 hurs depending n their medical needs. Bwel Care The narctics yu are taking fr pain cntrl can cause cnstipatin. Yu will be n stl sftener t avid this. Other ways t keep yur bwels regular are drinking water, including fiber t yur diet and being active. Respiratry Care Fllwing surgery, cngestin in yur lungs may ccur, which can lead t pneumnia. T prevent pneumnia, yur nurse will instruct yu n cughing and deep breathing as well as using a device called an incentive spirmeter (IS). Getting Rest It is imprtant t find time t rest in rder t participate effectively in yur rehabilitatin. During the day, yu shuld create a balance between hard wrk in rehabilitatin and restrative dwn time. Preventing Bld Clts Bld clts can frm when circulatin is impaired. T prevent bld clts, yu will have elastic stckings called TED Hse and cmpressin sleeves called Sequential Cmpressin Device (SCD) used while yu are in bed during the hspital stay. Yur surgen will start yu n a bld thinner. 17

18 Recvery Physical Therapy During yur hspital stay and fllwing yur return hme, physical therapy will be critical t yur recvery frm jint replacement surgery. A physical therapist will being wrking with yu the day f surgery t gradually increase yur activity. Yu will wrk with physical therapy twice a day. Expect t feel tired, but remember that activity is vital t yur recvery. Here are the activities yu can expect: Day f Surgery: Yur physical therapist will review beginning exercises with yu. With assistance frm yur physical therapist r nursing staff, dangle at the edge f the bed. Yu will be encuraged t take sme steps with a walker and sit in a chair. Day ne after surgery: Sit up in the chair fr at least tw meals, practice exercise prgram and walk with a walker in the hallway in the mrning and afternn. We encurage yu t walk and exercise mre frequently, if yu are able, and t put n cmfrtable clthes. Day tw after surgery: Walk t the bathrm as needed. Sit up fr all f yur meals. Practice yur exercises n yur wn and with the therapist twice a day. Get in and ut f the bed with minimal help. Be instructed n and practice ging up and dwn steps. If yu have met yur therapy gals and are medically stable, yu can discharge hme fllwing afternn therapy. Day three after surgery: Practice yur exercises n yur wn and with the physical therapist. Mst are discharged hme n this day fllwing mrning physical therapy. 18

19 Recvery Precautins after surgery After yur surgery, it is imprtant that yu fllw the fllwing precautins: D nt take aspirin prducts while yu are n an anticagulant (bld thinner) unless instructed by yur surgen r primary care physician. If yu underg a surgical prcedure f any kind, infrm yur physician that yu have had a ttal jint replacement s that yu will be given antibitics. Yu will be given antibitics t take befre having any dental wrk (cleaning, caps, extractins, etc.) r any ther invasive prcedure. Take pain medicatins nly as needed. Tylenl is a cmpnent f prescribed medicatins such as Perccet, Vicdin, Lrtab and Nrc. Therefre, yu shuld infrm yur physician f additinal dses f Tylenl yu may take ver the cunter. This will insure yu are taking an acceptable amunt f Tylenl. Antibitic Prphylaxis is recmmended prir t invasive prcedures fllwing Ttal Jint Replacements. Prphylactic antibitic regimen includes administratin f the antibitic in ne single dse prir t the prcedure. This is a lifelng recmmendatin fllwing Ttal Jint Surgery. Invasive and Surgical prcedures are nt recmmended in the first 3 mnths while recvering frm Ttal Jint Replacement. 19

20 Recvery Cmmnly Asked Questins When d I see my dctr after surgery? Yur surgen r anther staff member will visit yu daily while yu are in the hspital. Yu will have a pst-perative appintment 10 t 14 days after yur surgery s yur surgen can review yur prgress. When d my stitches r staples cme ut? 10 t 14 days after yur surgery. What are the signs f infectins I shuld watch fr? Signs f infectin include tense, painful redness, swelling and thick yellwish drainage frm yur incisin. A persistent temperature f 101 degrees ften accmpanies the symptms. Hw lng d I have t wear surgical stckings? Fr 2 t 4 weeks, unless instructed therwise by yur surgen. If they are uncmfrtable, yu d nt have t sleep in them and yu may take them ff a few times a day fr ne hur at a time. When can I shwer? The general recmmendatin is that yu may shwer nce discharged hme. Take precautins t nt get surgical dressing (Aquacel/Mepilex) saturated r incisin wet until after staples/ sutures are remved. What can I begin driving a car? D nt drive until yu are n lnger n pain medicatin and have apprval frm yur surgen. When can I resume taking my nrmal medicatins? Yu may resume taking yur medicatins as directed by yur surgen r primary care physician. Over-the-cunter anti-inflammatry medicatins such as: Advil, Mtrin, Ibuprfen and Aleve may be taken after the anticagulant has been cmpleted. 20

21 Ging Hme Leaving the Hspital Tgether we will create a plan t meet yur gals fr a safe discharge. This plan will include assisting yu t btain any equipment r ther supprt yu may need. Mst patients return t their hme n the third day after surgery. In rder t g hme yu may need t meet the fllwing criteria: Be in stable medical cnditin Be able t get in and ut f bed with minimal help Demnstrate safety with mbility using walker When yu g hme yu will cntinue yur rehabilitatin with a hme exercise prgram as instructed by yur physical therapist during yur preperative evaluatin and stay at the hspital. The gal f any Ttal Jint Replacement is t assist yu return t nrmal functinal activity. Yu will find it easier t nrmalize if yu return t yur rutine activities at hme. Hme Health Care Services Yur surgen may determine that yu need hme health care upn leaving the hspital. If s, we will identify yur needs and set up a prgram designed fr yu. Many different hme care agencies can prvide the necessary services that includes in-hme physical therapy. Outpatient Yur surgen may determine yu are eligible fr utpatient physical therapy. Patients are required t have a prescriptin frm yur surgen fr utpatient physical therapy. The purpse f this supervised therapy is t fcus n increasing yur strength and mbility. Sub-Acute Rehabilitatin at Skilled Nursing Facility While many patients underging ttal jint replacement return directly t their hmes after 2 t 3 days fllwing their surgery, yur surgen may determine that yu need mre therapy befre yu can return hme, and might recmmend that yu be admitted t a sub-acute rehabilitatin facility fr a shrt stay f 7 t 10 days. If yu meet the criteria fr admissin, yu can expect intensive therapy mnitred by a physician and staff wh specializes in rehabilitatin. The majr gal f the rehabilitatin unit is t imprve yur ability t perfrm nrmal activity f daily living. While at the rehabilitatin hspital, yu will be expected t: D as much as pssible fr yurself, within safety guidelines. Participate in physical and ccupatinal therapy sessins each day. Schedule visits and ther activities arund physical therapy times in rder t receive maximum benefits frm yur sessins. 21

22 Ging Hme Discharge Instructins Tgether we will create a plan t meet yur gals fr a safe discharge. This plan will assist yu in the transitin frm hspital t yur hme. Appintments: Yur first fllw-up appintment with yur surgen is usually 10 t 14 days frm the day f yur surgery. Medicatins: at the time f yur discharge, yu will be given written prescriptins fr any necessary medicatins. These may include the fllwing: Anticagulant (Bld Thinner) A bld thinner that may be prescribed during yur hspital stay and pssible fr a few weeks fllwing yur discharge. While n bld thinners yu cannt take any aspirin-cntaining r arthritic medicatins (unless instructed by yur surgen). Tylenl Fr milder pain, yu may use Extra-Strength Tylenl. Fllw directins n the Tylenl package and infrm yur surgen f cnsistent use. Laxatives Since many pain medicatins can cause cnstipatin, yu may use an ver-thecunter laxative and/r stl sftener as needed until yur bwel functin returns t nrmal. Vitamins Ask yur physician which vitamin supplements are imprtant fr yur recvery and cntinued health. Vitamins C and E may be recmmended. Physical Therapy: Physical therapy is required fr all ttal jint replacement patients. Walker: All ttal jint replacement patients will be required t use a walker after being discharged frm the hspital. Ttal jint patients shuld bear weight n the new jint side nly as recmmended by yur surgen. In mst cases, yu will be a walker fr fur t six weeks frm the date f yur surgery. Exercises: It is imprtant that yu cntinue yur Hme Exercise Prgram several times a day. As yu feel strnger, increase the number f repetitins in each sessin. Yu may resume sme recreatinal activities 4 t 6 weeks fllwing yur surgery. Bruising: sme bruising might appear n yur bdy due t the pling f bld in different areas while yu are resting in the hspital bed. D nt be alarmed at the bruising, it will g away in a week r s. Swelling: Sme swelling ver yur incisin is nrmal. T help minimize swelling, yu can place ice packs ver the incisin. It is nt uncmmn fr yu t experience warmth at incisin site fr many weeks fllwing surgery. 22

23 Ging Hme Antibitics: Befre yu have any dental wrk, call yur dentist s ffice fr a prescriptin f antibitics that are t be taken 24 hurs befre yur dental prcedure. See yur primary care physician if yu suspect any kind f active infectins such as bladder infectins, an infected wund r an upper respiratry infectin. Yu may need antibitics t fight these infectins and prtect yur jint replacement. If yu are planning any surgical prcedures, let yur surgen knw that yu have had a jint replacement and that yu will need prphylactic antibitics befre, during and after yur surgery. The rthpedic recmmendatin is t wait 3 mnths fllwing ttal jint replacement surgery t have any elective invasive r surgical prcedures dne. Hygiene: Unless instructed differently by yur surgen, it is imprtant nt t get yur incisin wet, until yur suture r stables are remved. If yur surgical dressing is sealed, it is k t shwer but d nt get yur incisin wet. Care f Yur Incisin: Yur incisin shuld remain dry and clean. D nt get yur incisin wet until after yur staples are remved. D nt apply creams, ltins r pwders t yur incisin while the staples are in r drainage is present. After yur dressing is remved at yur pst-perative appintment, Steri-Strips will be applied t yur incisin. D nt remve the Steri-Strips. They will fall ff n their wn. It is recmmended t nt shwer fr a full 24 hurs after sutures/staples are remved. Travel: Yu will be allwed t travel apprximately 4 t 6 weeks after yur surgery. Yu may be given a jint replacement card t carry with yu in case yur replacement sets ff security alarms at airprts. The sensitivity f metal detectrs is extremely variable. Persnnel may nt accept the card and may elect t screen yu by using a hand held device. Mst are respnsive t the explanatin that yu have a ttal jint in place. 23

24 Ging Hme Pst-Operative Physical Therapy Prtcl- Ttal Hip Replacement The gal f hip replacement surgery is s that yu can return t yur nrmal functinal activities. Belw yu will find a physical therapy prtcl designed t fcus n yur therapy gals and utcmes. Phase I (0-2 Weeks): Gals include: Minimize swelling, heal incisin Hip precautins Increase range f mtin Muscle Strengthening and Gait Training Advance t using cane Criteria fr prgressin t Phase II: Active hip range f mtin frm 0 t 90 degrees Vluntary quadriceps cntrl Independent ambulatin with an assistive device (2 wheel walker/cane), antalgia r deviatins N assistance required with ambulatin/transfers Independent with Hme Exercise Prgram Phase II (3-6 Weeks): Gals include: Maintain minimal swelling Increase range f mtin Maintain hip precautins Imprve strength, endurance and stretch Advance t independent ambulatin withut an assistive device Criteria fr prgressin t Phase III: Independent ambulatin withut an assistive device, antalgia r deviatins Active range f mtin frm 0 t 90 degrees Vluntary quadriceps cntrl Mild cmplaints f pain and inflammatin Ability t cntinue Hme Exercise Prgram Phase III (6-12 Weeks): Gals include: Prgress exercises by adding resistance and repetitins Cntinue all strengthening and stretching exercises as instructed by therapist and physician Independent step ver step stair climbing Pain free active range f mtin Independent with Hme Exercise Prgram 24

25 Age apprpriate balance and prpriceptin Minimal Pain Ging Hme Pst-Operative Physical Therapy Prtcl - Knee Replacement The gal f knee replacement surgery is s that yu can return t yur nrmal functinal activities. Belw yu will find a physical therapy prtcl designed t fcus n yur therapy gals and utcmes. Phase I (0-2 Weeks): Gals include: Minimize swelling, heal incisin Increase range f mtin Gain Strength Advance t using cane Criteria fr prgressin t Phase II: Acceptable range f mtin 0-5 extensin, flexin Adequate Strength 4/5 Cmfrtable with cane/walker fr ambulatin N assistance required with ambulatin/transfers Independent with cane up/dwn a few steps Independent with Hme Exercise Prgram Phase II (3-6 Weeks): Gals include: Maintain minimal swelling Increase range f mtin Imprve strength and endurance Advance t independent ambulatin withut an assistive device Criteria fr prgressin t Phase III: Independent f assistive device fr ambulatin and transfers Imprve range f mtin 0 extensin t flexin Adequate strength f 4+/5 Mild cmplaints f pain and inflammatin Ability t cntinue Hme Exercise Prgram Phase III (6-12 Weeks): Gals include: Cntinue all strengthening and stretching exercises as instructed by therapist and physician If accessible, cntinue with a statinary bike Cntinue with patella and scar mbilizatins Independent with Hme Exercise Prgram Minimal Pain 25

26 Ging Hme Nutritin After Yur Surgery Calrie and prtein needs are greater after yur surgical prcedure. It is recmmended that yu aim fr 3 meals a day and snacks as tlerated. It is als imprtant t include 1 2 prtein surces at each meal. Gd nutritin may help with healing and help yu maintain the strength yu need t prmte yur recvery. It is imprtant t fllw a balanced diet rich in nutrient dense fds befre and after yur surgery. Yur guidelines fr intake will depend n yur size and calrie needs. In general, a balance diet will include: FOOD GROUP DAILY INTAKE EXAMPLES Milk Dairy 2 3 servings (1 cup = 1 serving) Ygurt Cheese Apples Fruits 2 4 servings (1/2 cup = 1 Oranges serving) Bananas Berries Spinach Vegetables 3 4 servings (1/2 cup = 1 Carrts serving) Brccli Onins Chicken Fish Prtein 2 3 servings (3 unces = 1 Prk serving) Beef Eggs Bread Cereal Fiber 6 10 servings (1/2 cup r 1 Rice slice = 1 serving) Ptates Beans Pasta Oil Fats & Sweets Use sparingly Candy Sft Drinks *If yur physician prescribed yu any diet restrictins, it is imprtant t always fllw them. 26

27 Ging Hme Imprtant Things t Remember Make an appintment t see yur surgen 10 t 14 days after yur surgery Eat well balanced meals and drink plenty f liquids Place ice packs ver yur incisin t decrease swelling and pain. 20 minutes n, 20 minutes ff, up t 6 times per day. Elevate yur leg Call yur surgen if yu experience: A persistent temperature greater than 100.5⁰ Severe pain that is nt relieved by medicatin Increased redness, swelling r tenderness in yur incisin Persistent drainage frm yur incisin Chest pain r shrtness f breath D nt drink alchl r drive while taking pain medicatin As part f TOC s cmmitment t quality assurance and quality imprvement, as well as satisfying Medicare guidelines, we are extending the reach f ur pst-perative care pprtunities t include the cllectin f patient reprted utcmes fr patients receiving a ttal jint replacement. Please, thrughut yur recvery, cntinue t respnd t ur survey requests, s that we can maintain knwledge f yur prgress. 27