Preparing for your Knee Surgery

Preparing for your Knee Surgery

Please bring this handbook with you when you are admitted to the hospital. Table of Contents Introduction...4 Benefits of Surgery...4 Risks of Surgery...4 Preparing for Your Surgery...4 Before Your Surgery...5 Pre-admission...5 Preoperative Shower/Bath...5 Family/Visitor Information...6 Map...6 Getting Ready for the Hospital...7 Admission Process...7 Before Surgery...7 Pain Management...8 Using Your PCA Pump...8 Nausea...9 Medicine to Prevent Blood Clots...9 Tubes...10 Intake and Output...10 Nutrition...10 Elimination...10 Breathing & Coughing...10 Medication Management While You Are at the Hospital...11 Activity...11 Fall Prevention...12 Help Us Take Care of You...12 Common Devices Used After Surgery...12 Therapy & Activity...13 Helpful Hints...14 Home Safety and Specific Items Ideas...15 Before You Go Home...15 Discharge Process...15 Take Home Prescription Medication...16 Incision Care...16 Daily Activities for a Total Knee Patient...16 Home Exercise Program...17 Precautions...19 When to Call Your Physician...20 6012-0617 JUNE 06 3

Introduction This handbook is meant to provide you and your family with information regarding preparing for your total knee surgery and recovery. Share the information in this handbook with your family. Benefits of Surgery» Correct injury» Reduce or eliminate pain» Gain or improve mobility» Gain or increase activity level» Improve quality of life Risks of Surgery» Respiratory problems (pneumonia)» Blood clots» Nerve damage» Loosening of the knee prosthesis» Fracture or dislocation» An infection can occur after surgery:* Your intact skin is important protection from infection. It is normal (and helpful) for all people to have germs on their skin and in some parts of their body. Staphylococcus, commonly called "Staph", is an example of bacteria all people have on their skin. Most surgery requires an incision. This opening in your skin can allow germs to enter the body. If germs, including your normal germs, enter the body through a surgical incision, an infection might occur. Before the incision is made, antiseptics will be applied to your skin to try to kill as many germs as possible, but it is impossible to remove all bacteria from skin. Antibiotics may also be given before surgery to help prevent infection. What are the chances that I get an infection after surgery? Any person who has a surgical operation could get an infection. The risk of infection depends on the type of operation, how long you must be in the hospital, and your overall health before surgery (for example, nutrition, blood sugar level if you are diabetic, obesity, age, weak immune system, or if you have other illnesses). What can I do to minimize my risk of infection? Before surgery, improve your general state of health as much as possible. For example, be at an optimal weight and nutritional state. Talk to your physician about ways to improve your health. Preparing for Your Surgery Part of planning for your surgery should include planning for your return home after surgery. By learning how your surgery will affect your life, you can prepare for assistance at home. You may be asked to give information that will assist your caregivers in preparing you for home. You should consider family, friends, or community agencies in your aftercare. If help at home is not possible, arrangements may need to be made to stay in an extended care facility within your community for a few weeks. A social worker is available at the hospital to help you plan your aftercare. 4

Before Your Surgery A complete medical history/examination is needed to help your physician and nurse set up a plan of care. They will ask you questions about your general health and specific information on why you are here for surgery. Physician Visit Some routine pre-op tests may include: EKG, chest x-ray, laboratory and tests. You may have some health problems that make surgery risky. Examples of these conditions are: obesity, heart or lung disease, tooth or gum decay, infection and other health problems. Tobacco Use Smoking interferes with your lung's ability to clear itself of secretions. These secretions tend to accumulate after surgery and anesthesia. If these secretions are not cleared, an infection could result, possibly leading to pneumonia. Follow your physician's advice about smoking and tobacco use. Talk to your caregiver about tobacco cessation information. Activity Visit A physical therapist may show you a home exercise program to do before your surgery to improve your physical condition. These exercises strengthen muscles, improving the movement of your knee. The therapist will show you how you will have to move after your surgery. You will need a walker or a pair of crutches to help you walk after your surgery. If your physician and therapists feel you need more help with exercise, you may be referred to outpatient therapy or a home health agency. Pre-Admission A nurse will discuss the surgery and recovery with you and your family. You and a nurse will talk about past medical history and medications you take. You may see a film about your surgery. This is a chance to ask questions and voice concerns you may have. The nurse will tell you when to stop eating, drinking and give you medication instructions prior to surgery. You may eat as usual until midnight the evening before the surgery, unless advised otherwise by you surgeon. When we refer to "nothing by mouth" this includes water, chewing gum, breath mints, cough drops etc. You may brush your teeth and rinse your mouth without swallowing liquids. Do not drink alcohol for at least 12 hours before your arrival. Do not smoke or chew tobacco after midnight. This is for your safety. Failure to observe these requirements may result in delay or cancellation of your surgery. A nurse will contact you one working day before surgery to tell you what time to arrive at the hospital before your surgery. You will be reminded when to quit eating and drinking. Preoperative Shower/Bath with Chlorhexidine Soap (CHG) Everyone s skin normally has some germs including Staph. Before surgery, you can play an important role in your own health by reducing the number of germs on your skin as much as possible. Carefully washing with a special antimicrobial soap before surgery will reduce the number of germs on your skin and decrease the chance of infection. You will be given a bottle of special soap that contains chlorhexidine gluconate (CHG)**. The soap is liquid and Altru uses Endure brand. If for some reason you misplace the soap given to you, another easy to find brand name soap is Hibiclens and can be purchased at a pharmacy or Walmart. If you are allergic to chlorhexidine** please let your surgeon s office know. WARNINGS» Do not drink the soap.» Do not use the CHG near your eyes to avoid permanent injury.» Do not use the CHG near your ears to avoid permanent injury. 5

INSTRUCTIONS» Shower or bathe with the CHG soap the night before your surgery and again the morning of surgery. Using the soap twice works better one time.» Apply the CHG soap to your entire body ONLY FROM THE NECK DOWN.» Wash thoroughly, paying special attention to the area where your surgery will be performed. Try to leave the soap on your skin for a few minutes before rinsing.» With each shower or bath, wash your hair as usual with your normal shampoo.» Do NOT shave the area of your body where your surgery will be performed.» Do NOT use lotion, cream, or powder.» Wear clean clothes. **CHG soap should not be used by people allergic to chlorhexidine. Family/Visitor Information Your friends and family are welcome to visit with you during your stay at the hospital. The visiting hours are posted for each department and may be obtained at the front desk. Visitor and family parking areas are in the front of the hospital. A patient/family handbook is located in each waiting area and by each bed which contains information such as cafeteria hours, dialing instructions, visiting hours, etc. Your visitors are also welcome to dine in our cafeteria or make use of our 24-hour food vending areas, which are located on the first level of the hospital. While you are in surgery, your family will be told where they can wait. When you are ready to leave the hospital, your family member or friend may drive from the visitor's parking area to meet you under the front entrance canopy. The nursing staff will assist you in making these arrangements and will escort you to the front entrance. In consideration of everyone's health, Altru Health System is a tobacco-free institution. Smoking and other tobacco products are not permitted on Altru premises. Thank you for your support in keeping our environment safe and clean. 6

Getting Ready for the Hospital» Bring comfortable clothes (sweat suits, or loose clothing are best) and non-skid shoes to wear once activity has started.» Personal care products such as shampoo, comb, brush, etc.» Short robe (button or snap down the front is preferred)» Walker or crutches if you already have them at home (Please label them with your name.) Admission Process Upon your arrival at the hospital, you will need to stop at the registration desk in the front lobby to be registered. The registration staff will check you in, update your hospital chart and give you a hospital ID bracelet. You will then be directed to the surgical admission center of the Same Day Surgery Department or a hospital room. Your family may accompany you throughout the admission process if you wish. During the admission process to Altru Health System you can expect that:» You will be provided an orientation to the room setup and hospital routines.» The nurse(s) will be asking you many questions in order to obtain an understanding of why you are being admitted to the hospital and what special needs you require during your stay in the hospital.» You may have lab or x-rays performed.» You will have nurses and other healthcare disciplines working with you.» You may not drink, eat, or take any medications until the physician orders that this is permitted.» You will be weighed, and have your vital signs and history taken by the nurse. Each nurse cares for multiple patients and makes every attempt to provide you with what you need as soon as possible. If you receive care that does not meet or exceed your expectations please ask to speak to the charge nurse or manager. Before Surgery After you arrive, your pre-op instructions will begin. If you have not already been contacted by pre-admission your nurse will complete your admission record, and explain our hospital routines with you. You will put on a gown and place your clothing in a garment bag. Any lab work or procedures your physician has ordered will be done and results obtained before surgery. If you have not already done so you will be asked to sign a surgical consent form. This form gives your surgeon the legal right to do the surgery and states that you understand the nature of the operation and any risks that are associated with this type of surgery. If you have any questions about the form, feel free to discuss them with your caregiver. Altru has initiated the KISS program which stands for Korrect Identification Surgical Site. What this means is for any procedure involving right/left distinction, multiple structures (such as fingers, and toes) or multiple levels (as in the spinal procedures), must be marked so that the mark is visible after the patient has been prepped and draped for surgery. Your surgeon will initial the site pre-operatively. You can also mark the surgical site if you wish. Immediately before the surgery, your caregivers will verbally confirm and document that we have the correct patient, marked the correct site and side, the correct procedure is being performed and the patient is in the correct position. You will be asked to remove:» Dentures» Hair pins, wigs, etc.» Jewelry, including body piercings» Glasses, contact lenses» Nail polish» Valuables» Make-up» All underwear, after receiving your gown Shortly before going to surgery, you will be asked to empty your bladder (urinate). 7

Holding Room You will most likely go to the Holding Room about one half to one hour before your operation is scheduled to begin. The Holding Room is where your final surgery preparation is completed. A limited number of family members may accompany you. You will meet your physician and nurse of anesthesia. They will review your medical history and explain the anesthesia. This is a time to ask questions if you have any. Before going to surgery, your IV will be started and you will be given medication intravenously that will help you relax. Operating Room In the Operating Room you will be aware of much activity. Anesthesia staff will be with you monitoring several of your body functions from the moment your anesthesia starts until after your operation is done. Surgical nurses will also be assisting the surgeon. You will have heart monitor leads on your chest and a blood pressure cuff on your arm which takes readings automatically. Both of these procedures are routine. The Operating Room is cool and brightly lit. Recovery Room After surgery, you will go to a recovery area. Here you will be closely watched as you recover from your anesthesia. The staff will take many readings of your vital signs, such as pulse and blood pressure, until they are certain that you are ready to return to your room. Family is not permitted in the recovery area. Your Room Once you are in your room on the nursing unit, the nurses will continue to take frequent readings of your vital signs. A patient/family handbook is located by each bed which contains information such as room service, dialing out instructions, billing information, etc. Pain Management The goal of Altru Health System is for every patient to be as pain free as possible. You should expect to feel some discomfort after surgery. Your level of discomfort will be evaluated before and after surgery. Keep the nurse informed about your comfort level after surgery. Tell the nurse where the pain is located and how strong it is on a scale of 0-10. Please feel free to talk to your caregiver about you pain and pain relief measures. Below are some examples of pain management methods that may be used.» Pain pills by mouth.» Through an IV line.» PCA Pumps: Your physician may order a PCA (Patient Controlled Analgesia) for you to use helping to manage your pain.» Epidural - medication dripped slowly through a tube into areas of your spine. Cooling device (Cryocuff): This device sends chilled water through a pad placed over your knee. Using Your PCA Pump Controlling your pain during recovery is important. The PCA pump allows you, the patient, to control the amount of pain medication you receive. These are safe and easy to use. Warning to Patient and Family: NO ONE but the patient should press the PCA button. Talk to the nurse if you have questions. Pain Control Pain control helps the natural healing process. Without the fear of pain, you should feel less anxious and be able to relax. Pain medications (including narcotics) are not addictive when the medication is prescribed for a short time and stopped gradually. 8

How the PCA Works With the PCA, you are the key to managing your pain. Your caregivers will work closely with you. You will be asked to rate your pain on a scale of 0 (no pain) to 10 (worse pain you can imagine). Your responses will guide your caregivers in setting the dosages of pain medication to meet your needs. Your PCA pump is attached to medication and tubing which hooks into your IV line. You will be given a button that is attached to the pump to push when you need your pain medication. When you push this button, a set amount of pain medication will flow into your IV. Do not wait until your pain gets worst to give yourself pain mediation. If you wait too long, it may be difficult to get comfortable again. You may push this button as often as you need to. The PCA is set up with specific instructions on how much medication and how often you receive pain medicine. The PCA pump lets you decide when you want to get pain relief. The PCA pump is designed so that you cannot give yourself too much medication, protecting you from overdose. If your pain isn't being controlled let your caregiver know as soon as possible. They can change the settings on the PCA pump to help you get more pain relief. Side Effects Your pain medication may cause some side effects, which can be eliminated. Tell your caregiver if you have any of the following:» Nausea» Difficulty urinating» Constipation» Confusion» Excessive sleepiness Nausea Occasionally, some people feel nauseated after surgery. If you feel like vomiting, please tell your nurse. Medicines may be ordered. Medicine to Prevent Blood Clots After surgery you will be started on blood thinning medication (anticoagulants) that help prevent clots in your legs. It may be given in shots or in pills. If you are taking anticoagulant medication, report any abnormal bleeding to your physician or nurse immediately! Examples of abnormal bleeding» Blood in urine (red or smoky color)» Nosebleeds» Excessive bruising» Blood in stools (tarry or bright red color) You should wear identification stating that you are taking anticoagulants or blood thinner medication. This should continue to be worn for two weeks after you quit taking the medication. Pain Scale 9

Tubes After your surgery, you may find a tube or tubes attached to your body. The number and reasons for the tubes depend on the type of surgery you have had. You may have:» An intravenous line (IV). This carries fluids or medications to your body until you are able to take them by mouth.» A catheter to drain urine from your bladder.» A wound drain in or near your surgery incision that is attached to a suction source.» A tube to your stomach (NG) entering through your nose to keep your stomach empty. I & O (Intake and Output) Your nurse will need to keep an accurate record of the fluids you drink and/or receive through your IV. Since an accurate record of urine will also be kept, please use the bedpan, urinal or the toilet seat-measuring pan when using the bathroom. Your nurse will empty and record the amount of urine in your records. A record of I&O will be kept until your nurse tells you it is no longer necessary. You can assist your nurse by informing them of the fluids you drink. Nutrition You will be given liquids to drink when your stomach "awakens" after surgery. If you are not having nausea, you will be started on your normal diet. Elimination (Toileting) Void As mentioned earlier, the tube (urinary catheter) in your bladder may be removed in 1 to 2 days. Once removed, you can use a bedpan, the commode, or bathroom when you need to void. Bowels You will be on a liquid diet right after surgery, with more choices as your appetite improves. By the second day your bowel function should start to get back to normal. If constipation becomes a problem, tell your nurse, as a laxative, stool softener, or enema may help. Drink plenty of fluids including juice and eat fruits, vegetables and bran. Breathing and Coughing Deep Breathing 1. Hold both hands over your lower rib cage. 2. Breathe in as deeply as possible through your nose, moving your rib cage out as you breathe. 3. Breathe all the air out slowly through your mouth, pursing your lips as if you were blowing out a candle. You should feel your ribs move in. 4. Repeat five times with a short rest between each breath. 5. Do this every 2 hours while you are awake. A device called an incentive spirometer may be ordered to help you take deep breaths. Deep breathing can help prevent pneumonia or other problems that could slow your recovery. Coughing 1. Take a slow, deep breath into your lungs, through your nose and hold it. 2. As you breathe out, cough deeply twice from your lungs, making "Ha, Ha" sounds with your mouth slightly open. 3. Repeat this every 2 hours while you are awake. 10

Medication Management While You are at the Hospital» Share with physician, surgeon and healthcare professionals a list of your current medications, vitamins, herbals and supplements.» Make sure the physician or nurse checks your wristband and asks your name before giving you medicine.» Ask your physician or nurse how a new medicine will help. Ask for written information about it, including its brand name and generic name.» Ask your physician or nurse about the possible side effects of your medicine.» Don't be afraid to tell the physician or nurse if you think you are about to get the wrong medicine.» Know what time you normally get a medicine. If you don't get it then, tell your physician or nurse.» Tell your physician or nurse if you don't feel well after receiving a medicine. If you think you are having a reaction or experiencing side effects, ask for help immediately.» If you are not feeling well enough to ask questions about your medicine, ask a relative or friend to ask questions for you and to help you make sure you get and take the right medicines. Before you leave the hospital, make sure that you understand all of the instructions for the medicines you will need to keep taking, and ask any questions Activity» Once you are awake you will be shown how to do exercises in bed.» You will be assisted into a chair the day of surgery or day after surgery for meals and short periods of time.» You will be taught how to pivot into a chair with a walker. Walking 1. You will be kept in bed until you physician allows you to get up. The nurse will teach you the proper procedure to get you out of bed. If you need more assistance, please call your nurse. 2. Walk as directed by your physician and nurse. Fall Prevention Why You Might be at Risk for Falls While in the Hospital» Bedrest - staying in bed can make your muscles shrink and lose strength. Also, after you get up from lying down, low blood pressure may make you dizzy.» Being in a new environment - it is more common to fall when you are in unfamiliar surroundings. It may also make it more difficult for you to rest, making you more susceptible to falling.» The normal aging process - as we get older, normal age-related changes like slower reflexes, weak or brittle bones, stiff joints, and decreased vision can make you more prone to fall.» Always ask for help if you feel dizzy, disorientated, or confused. Be Aware of the Bathroom Risk One of the most common situations in which falls occur involves getting to or from the bathroom or trying to use a bedside commode. This may be due to the fact that most of us view toileting as a very private function and may not want to ask for help, even when we need it. Or we may be unwilling to wait for help to arrive. How to Stop Falls You can avoid a fall by working with your healthcare providers, asking them to help when you need it, and following a few reminders:» Use handrails or grab bars» Get up from a lying position slowly 11

» Wear shoes or slippers with non-skid soles when you walk (don't walk in nylons or socks on non-carpeted floors)» Use call lights for assistance - they are located at your bedside and in the bathroom» Keep bedside table and things you need within easy reach If You Do Fall» Stay calm. It may feel embarrassing or scary to fall, but most falls are not serious.» Call for help. If you can reach it, use your call light and call out for help.» Don't get up on your own. Stay where you are until help arrives - you might be injured.» Report any symptoms of pain or injury to your caregivers. Did you know one of the leading adverse events in healthcare facilities today is falls, and that your risk of falling increases with your age? Nurses will be assessing you frequently for your risk of falling. Your nurse will consider the following to assess your potential for falling:» History of a fall in the last six months» Unsteady walk» Confusion or disorientation» Frequent need to go to the bathroom» Your medical condition - fatigue or weakness» Medications you are taking - some of them alone or in combination may make you feel light-headed, dizzy, or drowsy.» Any time you have had a procedure when anesthesia is given, or if you are moved to a new nursing unit. Depending on your level of fall risk, certain precautionary measures may be implemented. These may include:» A bed alarm may be placed on your bed - this will sound as a reminder to you to not get out of bed without assistance. This also alerts caregivers.» You may be asked not to walk or to get up without staff assistance.» We may need to ask your family/friends or our staff to sit with you if you become restless and frequently forget to call for help before getting up.» Physical therapy may be ordered to assist you in gaining strength and mobility if needed. Help Us Take Care of You» Look for our name badge. Expect us to introduce ourselves. We want you to know who we are.» Remind us if we forget to wash our hands or use a hand sanitizer before we treat you. Clean hands help to keep you safe.» Expect us to ask your name and read our wristband before we treat you or give you medications. If we don't ask, please tell us. Common Devices (aides) Used After Surgery Compression stockings and/or TED hose may be applied to your legs before and/or after surgery. The stockings or hose will help to improve blood circulation to the lower legs preventing blood clots. If either the compression stockings or TED hose feel tight or uncomfortable, please inform your nurse. Continue wearing your TED hose at home until your physician says you don't need them. Take the TED hose off for at least 1/2 hour twice a day. Bathe the skin and inspect the dressing/incision during this time. Inform your physician if you see any redness or feel any sore areas on your leg. Trapeze Bar The trapeze bar above your head is there to assist you in moving about while you are in bed. Use only your unaffected leg (the leg on which you did not have surgery) to lift yourself. 12

Knee Machine Your physician may or may not prescribe a machine to bend and straighten your knee. The name of this machine is a Continuous Passive Motion Machine (CPM). You may be allowed to lie on your side with your leg out of the machine once a day/night for 1-2 hours. in the hallway with nursing staff. Your therapist will progress you to walking with crutches when ready. You will also be shown how to walk up and down stairs before you are discharged. During your hospital stay, you will continue with the exercise program as you prepare to go home and will continue it when you get home. Some patients may require additional physical or occupational therapy at a rehabilitation facility. Your physician or therapist will discuss possible options with you. Occupational Therapy After surgery you may be seen by Occupational Therapy. In preparing you to go home, they will assist you with increasing your endurance and function for independence. The following instructions/activities will be given: CPM Machine Knee Brace Your physician may order a knee brace (immobilizer) used to help straighten your knee for short periods of time. Therapy and Activity Exercises and Physical Therapy After surgery, you will receive physical therapy at your bedside twice daily. You will start the exercises as soon as the afternoon of your surgery, or the following morning with the therapist s assistance. You will be asked to do the exercises on your own during the day, as well as when the therapist is present. If you have crutches or a walker bring them with you so that they can be adjusted to fit you properly. Be sure to label them with your name. You may begin walking with a walker and assistance as soon as the first day after surgery. You will be instructed in the proper way to get up and sit on the side of the bed. When you are ready to walk you may walk to the bathroom and» The correct methods for putting on/taking off clothing within precaution levels for your new total joint.» Meal preparation methods with use of walker/crutches will be trialed and/or discussed with you.» The correct methods for getting in and out of bed, up and down from the toilet and chair and in and out of the car.» The use of assistive aides can improve your independence and safety, such as toilet risers, grab bars, shower chairs, assistive dressing equipment, etc. Your therapist will recommend assistive aids to help you when you go home.» Your home program will be reviewed with you and your caregivers. Movement Restrictions To avoid injury to your new knee, you must remember the following:» Adhere to your specified weight bearing status and walk as you were taught in physical therapy.» Do not kneel or squat on your surgical knee.» Do not pivot on the surgical knee. When you turn, take mini steps. 13

» Do not force your knee to bend.» Do not cross your legs at the knees or ankles.» When you sit down, slide your surgical leg forward out in front of you before sitting down.» Sit down easily; do not plop into a chair. Helpful Hints» Discuss plans about returning to work with your physician.» Check with your physician before making plans for lengthy trips. Your metal prosthesis may set off security alarms at airports.» Before minor surgery, dental work, or procedures (i.e. cardiac cath, bladder exam, etc.), remind your physician or dentist that you have a prosthesis. Antibiotics may be needed to prevent infection.» Keep your appointments with your physician.» Discuss with your physician exercise activities you would like to do. Your physician may suggest low impact exercises like walking, dancing, bike riding and golf.» Call your physician if you have any signs of infection (urinary infection, abscessed teeth, etc.), as early treatment is needed. Your new knee is a foreign item in your body. Germs from other parts of your body may move to your new knee and cause infection. Home Safety and Specific Items Ideas» To prevent falls, remove or watch out for: - Scatter rugs on floor - Electrical cords, phone cords, etc. - Pets that run in your path - Water spills on floors - Slippery floors - Ice or mildew on outdoor steps» Sit on a kitchen stool or chair with your surgical leg out when doing countertop tasks.» Some ways to carry items from place to place: - Use a utility cart with wheels, pushing it ahead of your walker. This will free up your hands and reduce the number of trips you make to complete a task. - Use a back pack, fanny pack, apron with many pockets or a walker basket or bag.» Slide objects on a tray along the countertops rather than carry them.» Carry hot liquids in containers with lids.» Use a reacher to grab objects on the floor.» Entry to your home: - Hand rails on all stairways should be installed if there are none.» A toilet seat riser or portable toilet rails can be installed to help with moving in the bathroom. Your bathroom should be accessible with your walker.» Make sure you have enough room to approach the side of the bed with walker or crutches - approximately 2½ - 3 feet.» Kitchen table: - Have someone pull your table closer to your counter to allow you to reach from your counter area directly to your table. (You will not be able to carry anything when you use your walker or crutches.) - Re-arrange frequently used kitchen items within easy reach. - Use pre-fixed meals, such as TV dinners or Meals on Wheels services, always plan to keep preparation simple. - You will need help with heavy cleaning tasks, i.e. vacuuming, washing floors, stripping beds, etc. These preparations will make your return home easier. You will be learning techniques during your hospital stay that are important for you to follow when doing daily activities. It will be very important that you do as much as possible for yourself during your hospital stay, as well as when you are discharged. Your caregiver will be there to monitor and guide you, but should allow you every opportunity to regain your independence as soon as possible. 14

Before You Go Home On the average, most patients are able to return home in about four days, or once you are safe doing activity and self cares or have a caregiver to help if needed. The recovery period will depend on your health. You must continue to follow the instructions given to you for several months to get the total benefit of your new knee joint. You will go home when your medical status is stable and:» You get good pain relief when you take pain pills.» You are able to bend your knee at the range your physician recommends.» You are able to move without help: in and out of bed; in and out of chairs; and on and off the toilet.» You are able to care for yourself.» You are able to walk on level surfaces when using your walker or crutches.» You are able to walk stairs (with help) using your walker or crutches.» You are able to do your exercise program on your own. If you are unable to do any of these things, your caregiver will be taught to help you at home. If you have no one to help you at home, a social worker can help you make discharge plans. Your first check-up appointment will be arranged for you. At this appointment, your physician will see how your new knee is healing and how you are able to move it. A physical therapist may be asked to re-check your joint functions and your muscle strength. These appointments are made to detect any problems you may have, so keep all arranged appointments. Discharge Process During the discharge process at Altru Health System you can expect that:» Your physician must see you first and then decide when you may go home.» The discharge time may be determined by criteria set by your physician.» Your nurse will instruct you on the discharge process and paperwork necessary.» A plan for your discharge medications and follow-up appointment will be made.» Arrangements need to be made for your take home medications and other supplies.» Other Altru Health System disciplines may need to visit you and assist in your discharge.» Your belongings will be packed with your assistance if able» Altru Health System staff must escort you to the lobby front door. Frequent asked questions:» Do I need to restrict activity such as housework or childcare?» How much can I lift?» Can I drive a car?» When can I drive?» When can I resume sexual activity?» What about sports?» Do I have a special diet?» What kinds of medication do I take? What side effects are possible?» Will I need help at home?» What are the supplies that I may need? Where can I get them?» Who do I call if I have questions when I get home/» When and how can I bathe/shower? Tips for managing pain at home:» Take your pain medication routinely as directed by your healthcare provider. This will help keep your pain under control.» It is important to take your pain pills with food to prevent nausea. 15

» Follow your healthcare provider's recommendations for ice, elevation, rest, etc.» Listening to music, watching television or videos may help distract you from your pain. Take Home Prescription Medication Your physician may order a prescription medication for you after your surgery. You will have the option of purchasing your medication at Altru's Retail Pharmacy or taking your prescription to a pharmacy of your choice. Altru's Retail Pharmacy accepts cash, checks or credit cards. Altru's Retail Pharmacy is located on the main level of the hospital. Please bring your insurance card with you. Phone: 701.780.3444 Hours of operation: Monday-Friday, 9 a.m. - 7 p.m. Saturday & Sunday 9 a.m. - 6 p.m. Incision Care» Inspect your incision every day at home.» Keep your incision clean and dry to prevent infection.» If you have staples or sutures in place, do not get your incision wet.» You may change the dressing (as shown to you in the hospital) if it becomes soiled or falls off. Wash your hands before changing the dressing.» If you go home with staples in place, ask your physician when the staples should be removed. Plan this around two to three weeks after surgery.» Report any drainage from the incision and any excessive swelling, fever, redness, increased pain, or change in skin color or temperature around the incision. Daily Activities for the Total Knee Patient Sitting Sitting may be easier if you sit on a chair that is not too low, allowing your hips to be higher than your knees. It may also be more comfortable to elevate your operated leg to decrease swelling. You have no restrictions on bending forward at the hip. Lying In Bed Do not put a pillow under your leg because this may cause stiffness in your hip and knee, making it difficult to straighten your leg. Tub Transfer We suggest you use a chair in the tub for a sitting shower, or that you sponge bathe. There should be a rubber mat or a nonskid surface on the tub floor to prevent slipping.» Using the walker, back up to the side of the tub, stop next to the chair.» Reach back with one hand for the back of the chair and the other hand should remain on the walker.» Sit down on the chair, keeping operated leg out, lift legs over the side of the tub and turn to face the faucet.» You may wash and dry yourself while sitting in this position.» To transfer out of the tub, turn in the chair while lifting your legs over the side of the tub. Pushing off from the chair, stand up outside of the tub. Note: You may want to consider installing a bathtub safety rail or grab bar as well as using a long-handled sponge and a handheld shower nozzle to increase safety during bathing. Remember to get your physician s permission before bathing or getting down into the tub. 16

Shower Transfer You may choose either to stand or to use a chair in the shower. There should be a rubber mat or nonskid surface on the floor to prevent slipping. We recommend that you walk into the shower with your walker for safety. Place the walker in the shower stall and bring your operated leg over the lip of the shower. Then bring your nonoperative leg into the shower. Position yourself either standing or sit on a chair. Remember: You should shower only when your physician gives you permission. Toilet Transfer With or without a raised toilet seat: back up to the toilet until you feel the back of your knees touching it. Keep one hand on the walkers middle bar, while reaching back for the edge of the raised seat with your other hand. Reverse the procedure for getting up by placing one hand on the walker and the other hand on the raised seat. Remember: Have your balance before grabbing onto the walker with your other hand. Do not use your walker to pull yourself up. Car Transfer» Back up to the car with your walker.» Lower yourself slowly to the seat.» Slide back into the car far enough to allow room to bring your operated leg into the car with ease, placing a large plastic garbage bag on the seat, to assist you in.» Do not drive without your physician s permission. Home Exercise Program Do all exercises slowly; do 3 times a day. Do exercises until your recheck with your surgeon (4-6 weeks). 1. QUADRICEPS SETTING: Place a rolled up towel under your knee. Tighten the quadriceps muscle in the front of your thigh by pushing the back of your knee downward against the towel roll. Attempt to straighten your leg. Your heel should come up slightly from the bed. Do this exercises slowly and hold 5 seconds. Repeat 10-15 times. 2. HAMSTRING SETTING: Tighten the hamstring muscle in the back of your thigh by digging your heel into the bed. Allow your knee to bend very slightly. Do this exercise slowly and hold this position for 5 seconds. Repeat 10-15 times. Sliding into the car as far as possible supports your leg. Carefully lift your leg into your car. 17

3. STRAIGHT LEG RAISE: Keeping your knee straight, slowly raise your leg off the bed. You may bend the opposite knee as this will support your back and allow you to perform the exercise more easily. Raise leg to the height of the opposite knee. Let leg down at a slower speed than you raised it up. Repeat 10-15 times. 7. KNEE RANGE OF MOTION: Sit in chair, may put rolled towel under knee if needed. Slowly bend and straighten involved knee. Repeat 10-15 times. 4. HEEL SLIDING: Lie on back. Slowly, bend the knee, sliding the heel up to the opposite knee. Repeat 10-15 times. 5. HIP ABDUCTION: Keep leg straight and toe pointing to ceiling. Swing entire leg out to the side. If your physical therapist allows it, use lbs. on the ankle. Repeat 10-15 times. 18

Precautions DON TS» Don t jump or run on your new knee.» Don t force your knee to bend, but bend it actively and naturally.» Don t apply heat directly to your knee until tissues heal and swelling is minimal.» Don t place a pillow under your knee for a long period of time, especially when lying on your back during sleeping or resting periods.» Don t walk without assistive devices until your knee is stable and strong enough (usually at your physician s discretion).» Don t rotate your knee in or out, particularly when walking or doing your exercises. Try to keep your knee pointed straight ahead.» Don t walk on uneven or rough surfaces (gravel, open fields, etc.).» Don t kneel on your operated knee.» Don t cross your legs. Don t pivot or twist on your operated leg. DO S» Do continue your exercise program at home.» Do walk cautiously.» Do gradually increase the speed and distance of your walking.» Do return to clinics and physical therapy as scheduled.» Do keep operated leg in line with your body when you walk.» Do use your walker or crutches until your physician advises otherwise. Don t cross your legs. 19

When to Call Your Physician If you experience:» Fever» Increased pain not relieved by medications or rest» Increase in swelling not relieved by elevation and ice» Redness or drainage from the wound» Severe nausea» Shortness of breath or trouble breathing» Chest congestion» Chest pain» Abnormal cough 20