Joint Camp Total Hip / Knee Replacement
Use this guide to help maximize your recovery Dear patient, After a total knee or hip replacement, it is important to approach your recovery with patience and a positive attitude. We are here to continue to support you during your recovery process, and want to provide you with useful information during this time. This guide will help you understand the process of preparing for and recovering from a total knee or hip replacement. With our help and guidance, we hope we can help make your recovery after surgery as smooth as possible. This material is provided as part of Huntsville Hospital s formal education program. It is considered an important tool in educating you about issues related to your health care. Because all health care must be based upon the patient s individual needs, this information should in no way replace instructions provided by your physician. We are dedicated to providing the care you need to have a safe, successful joint replacement experience and recovery. Thank you for trusting Huntsville Hospital to care for you. Huntsville Hospital Joint Replacement Team 2
Table of contents Joint Camp orientation... 4 Before surgery... 5 Total hip replacement... 6 Total knee replacement... 7 Complications of total hip and knee... 8 What to bring to the hospital... 9 Discharge planning... 10 Parking... 10 Day of surgery... 10 Lab work... 10 Pre-op area... 11 Recovery... 11 Pain relief... 11 Joint Camp... 12 Other medications... 12 Nutrition... 13 Bowel and bladder... 13 Drains and skin care... 13 Activity level after surgery... 14 Discharge instructions... 15 Frequently Asked Questions... 16 General activity guidelines... 18 3
Joint Camp orientation Joint Camp orientation covers many important topics including: Patient and caregiver (coach) role in the program Therapy exercises to start prior to surgery Review of medications that must be stopped before surgery Routine and activities during your hospital stay Information on insurance coverage for therapy, equipment and length of stay in the hospital Anesthesia options for surgery Therapy options after leaving the hospital Equipment needs after discharge from the hospital Details about life after joint replacement Information on medications, clothing and special needs Getting to know other patients going through Joint Camp Patients who attend Joint Camp orientation prior to surgery typically have a much better experience than those who do not. Staff is on hand to go over any and all questions, including insurance coverage information. Please bring your completed History & Physical form to orientation. You must request this form during your pre-admission testing appointment at the Medical Mall. To schedule your appointment for pre-admission testing, call (256) 265-2837. Please schedule your appointment 2-3 weeks prior to surgery. 4
Before surgery Before your surgery, you will need to: Try to have all lab work completed prior to attending Joint Camp orientation. Ask for a copy of your History & Physical form. Bring the completed form with you when you attend orientation. Attend a Joint Camp orientation class on a Monday morning from 8:15 to 11:30 a.m. at the Joint Camp unit. The class is held in the classroom located on the 5th floor of Huntsville Hospital. Begin discussing and planning your discharge plans with family and friends. Information will be provided at orientation about equipment needed, therapy and household arrangements. Notify your physician prior to surgery if you take arthritis/ anti-inflammatory medications, blood thinner medication or aspirin. Do not eat or drink anything after midnight the night before your surgery. You may take heart or blood pressure medications with a sip of water the morning of your surgery. No make-up, jewelry, hairpins or nail polish should be worn on the morning of your surgery. Leave all valuables and cash at home. Practice cough and deep breathing exercises. Practice your total joint exercises as instructed by the physical therapist during orientation. Complete a home safety assessment. Information will be provided in orientation. Call the Joint Camp manager at (256) 265-8343 if you have questions. 5
Total hip replacement Total hip replacement is a surgical procedure for replacing the hip joint. The joint is made up of two parts: The hip socket (acetabulum, a cup-shaped bone in the pelvis) The ball or head of the thigh bone (also called the femur) The ball fits into the socket. This structure allows the leg to move forward and backward, to the sides, and in a rotating motion. The ball glides or moves easily in the socket because of special tissue called articular cartilage, which covers and lines the socket. Sometimes the hip articular cartilage wears away leaving the bones unprotected and causing pain and stiffness. Another way the hip is protected is by a special lining that makes fluid (synovial fluid), which helps the bones slide over each other easily. If the joint becomes worn and swollen, more than the normal amount of synovial fluid is made and the extra fluid can cause swelling and damage to the joint. A part or all of the hip joint can be damaged to the point that the hip does not function and must be replaced. During the operation, the hip socket and the head of the femur (ball) are removed and replaced with smooth, artificial man-made prosthesis. The prosthesis is extremely strong and made of special, long-lasting material that is easily placed inside the body. Your physician will choose the right size for your body and will secure the prosthesis in place by a method that best suits you. 6
Total knee replacement A total knee replacement is a surgical procedure to replace a diseased knee joint with an artificial joint. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thighbone (femur) sits next to the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic button may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis. The posterior cruciate ligament (PCL) is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament either remains in place, is sacrificed, or may be substituted by an artificial post. Each of these options has different benefits and risks that should be discussed with your physician. 7
Complications of total hip and knee While they are elective procedures, total hip and knee replacements are considered major operations. On some occasions, patients experience complications or problems. Depending on how severe the complications, your hospital stay may be extended. Following the treatment program will help decrease your risk of complications. The most common complications that are not directly related to the hip or knee and do not usually affect the result of the operation include: Bladder infection or difficulty urinating Blood clots in the leg Temporary nausea and vomiting Complications that affect the hip or knee include: Differences in leg length (hip replacement) Stiffness (hip and knee replacement) Dislocation of the hip or knee Infection in the hip or knee Hematoma (swelling due to bleeding) in the thigh (hip replacement) or in the knee joint (knee replacement) Your physician will discuss the risks in detail prior to your surgery. You may want to write down the questions or concerns you have about your surgery prior to your next scheduled office visit. 8
What to bring to the hospital At Joint Camp, you will be able to wear your normal clothing on the first day after surgery. Because you will be exercising, out of bed and walking in the halls throughout the day, you should bring loose fitting clothing such as shorts or sweat pants. Bedroom slippers should have a non-skid sole and enclosed toe and heel. If you already have a walker, you should bring it to the hospital. Please remember to label any items with your name prior to your admission. Of course, you will want to bring a robe, socks and sweater or sweatshirt due to room temperature changes. Joint Camp checklist 1. Bring your personal walker with you. If you do not have a walker on the first day, please let your nurse or social worker know so that one may be ordered for you to use in the hospital. 2. Bring a list of your medications. Remember to take note of the dosage amount and when you take it. 3. Bring loose fitting clothing that allows plenty of room for the dressings, such as loose fitting shorts (knee patients) and one size larger shorts/pants than you normally wear (hip patients). 4. Nightgowns or pajamas for ladies and pajamas for men are appropriate. 5. Bring non-skid socks (one pair will be provided). 6. Bring your glasses, contact lenses and hearing aides. 7. Bring personal toiletries, including lip balm. 8. Bring a pen and note pad for writing notes and questions. 9. Bring a personal DVD player, movies or personal computer (the hospital provides free wi-fi). 10. Bring reading material, playing cards or handheld games. 11. Bring a list of phone numbers for family, friends and your pharmacy. 12. Bring a smile and a ready to work attitude. 9
Discharge planning Being aware of your discharge options and developing a discharge plan before you are hospitalized is very important. On average, most knee and hip replacement patients are in the hospital for three days. Shoulder replacement patients typically stay for two days. Therefore, patients do not have much time during hospitalization to develop a discharge plan. It is important that you attend Joint Camp orientation so that you can hear your options for discharge. You must also keep in mind that the type of insurance you have plays a role in what options are available to you for physical therapy following your surgery. Here are some of options for continued physical therapy: Home health physical therapy Home exercise program Outpatient physical therapy Inpatient rehabilitation facility for a short time The clinical resource manager will discuss these options in more detail at the Joint Camp orientation class. It is strongly recommended that you always have a second choice or plan for therapy in the event your first choice is not available due to insurance restrictions or non-availability of a bed at an inpatient rehab facility. Remember to plan ahead. Parking Valet parking is available at the hospital s main entrance on Gallatin Street, or you can park your own car in the visitor s garage next to the main entrance ($2.00 parking fee). Day of surgery Arrive at the hospital at the time you were instructed by your physician s office. Remember, do not eat or drink anything after midnight the night before your surgery. You may take heart or blood pressure medications with a sip of water on the morning of your surgery. Lab work In order to check your blood count (hemoglobin, hematocrit), you will have blood drawn the first two days after surgery. Some blood thinner medications require that you have blood work drawn each day you are hospitalized in order to monitor the level of that medication in your body. Your nurses will let you know if this applies to you. 10
Pre-op area The pre-op area is where you will be prepared for surgery. The nurses in the pre-op area will take your vital signs, ask you questions about your medical history, start your IV and shave/cleanse your surgery site with a special solution. If you are allergic to betadine, iodine or any other medicine/ food, please let the nurses know. You will remove your clothing and put on a hospital gown. Any articles of clothing, eyeglasses, etc., may be given to a family member until after your surgery. While in the pre-op area you will meet the anesthesiologist who will be responsible for your anesthesia during surgery. Risks and benefits associated with the different anesthetic options available will be discussed. The types of anesthesia include: 1) General, which provides loss of consciousness 2) Regional, which involves the injection of a local anesthetic to provide loss of sensation to a region of the body. This technique includes spinal and epidural blocks. While you are in surgery, your family will be asked to wait for you in Surgery Waiting. It is important for them to remain close so that they do not miss the surgeon s update on your procedure. Recovery After your surgery, you will move to the Post Anesthesia Care Unit (PACU) where you will receive care by a nurse who specializes in after-surgery care. He/she will work to ensure a smooth transition from the operating room to the nursing unit. You can expect to remain in this area a minimum of one hour or until you are considered medically stable. Remember to start your ankle pump exercises immediately. Your family cannot visit you while you are in the recovery area, but may wait in the room you have been assigned in the Joint Camp unit. Pain relief You will have some discomfort with this procedure, but your pain can be controlled a number of ways depending on your physician s choice and your needs. A patient controlled analgesia pump, also called a PCA pump, can deliver a constant rate of pain relief. The medication from this machine travels through your IV. This method of pain control allows you to press a button for additional doses when needed. Only you can press the button for additional medication family members should not press the button. Some medical conditions will prevent you from using this type of pain relief. Please tell your nurse if this method does not keep you comfortable. 11
Joint Camp When you leave the recovery room, you will be moved to Joint Camp. Here, you will be greeted by a team who specialize in caring for patients with total joint replacements. The Joint Camp staff will check your dressing and vital signs frequently even during the night. The nurses will instruct you on how to cough, deep breathe and use your breathing exerciser. It is important that you perform these breathing exercises because they help prevent pneumonia. Remember to perform your ankle pump exercises because they help circulate the blood and prevent blood flow complications (blood clots). Ankle pumps also help maintain muscle tone. The IV medications that are started before your surgery will continue until the IV is removed, usually on the first day after surgery. When the IV is removed, the nurse will turn your IV into a Hep-lock. The Hep-lock allows the nurse to give you IV fluids intermittently. Having a Hep-lock in place makes it easier for you to change your clothes. Other medications Your physician will restart your home medications the day after surgery. However, some medications such as ones for anti-inflammatory/arthritis (Naprosyn/Naproxen, aspirin, Motrin, etc.) may not be restarted initially. Please remember to bring a complete list (including dosage) of all medications you take on a daily basis with you to the hospital so the nurses have a record of all home medicines. Total hip and knee replacement patients will be placed on a blood thinner, also known as an anticoagulant. This medicine helps prevent blood clots. You may receive it in the form of an injection or pill. Walking and exercising also helps prevent blood clots. 12
Nutrition Upon your arrival in Joint Camp, you will be on a clear liquid diet. You should be able to return to your usual diet the first day after surgery. While at Joint Camp you can expect to eat breakfast each morning while sitting up in a chair in your room. Bowel and bladder You will be asked to empty your bladder while in the pre-op area. After surgery, patients are sometimes unable to start their stream of urine or completely empty their bladder and a Foley catheter has to be used. This is done after a straight cath (temporary catheter) has been used to help you empty your bladder. If you still cannot urinate on your own, a Foley will be placed and removed the day after your surgery. Drains and skin care Changing positions helps with blood circulation, which prevents pressure sores. You will have a trapeze bar attached to your bed. The nurses will show you how you can use this device to help reposition yourself in bed. You will have a large dressing on your surgical site, which will be checked frequently by the nurses. This dressing will be removed and replaced with a smaller one on the second day after surgery. Your incision may have skin clips that will stay in place from 7 14 days after your surgery. You should remember to keep the incision dry even when you are discharged home. Do not put any lotions or creams on your incision. After surgery, you may have a drain from your surgery site. This drain helps reduce the swelling by removing the blood from the incision area. The drain will typically be removed on the second day after surgery with your dressing change. You will be given a laxative the day before discharge if you have not had a bowel movement while in Joint Camp. 13
Activity level after surgery You will sit on the side of the bed with help on the day of your surgery and begin physical therapy the first day after your surgery. You will join your physical therapist and other patients who have had their joints replaced for group exercise two times a day. Therapy will continue twice a day until you are discharged. Joint Camp strongly recommends that a family member be involved in the rehab or recovery phase. It is important that the family member(s) feel comfortable and familiar with how to help you when you are discharged home. Keep in mind that the more you walk and perform your exercises, the quicker you will recover from the surgery. However, while you are in the hospital you will need to call your nurse before you get up to move around your room. For knee replacement patients, never place a pillow under your knee. Doing so could cause a problem with your new knee later on. A flat pillow CAN be placed under the ANKLE. 14
Discharge instructions Take your temperature in the morning and evening, and report any temperature of 101 degrees or higher to your physician. A low grade fever is not unusual for the first five days following joint replacements. Take a laxative every other day if you are not having a stool daily. Taking pain medication and a decrease in the amount of physical activity can contribute to constipation. Safety tips: o Move electrical cords out of the way o Remove throw rugs as they may cause you to trip and fall o Watch for small pets or objects on the floor that could cause you to fall o Do not lift heavy objects Notify your family physician, orthopedic physician or dentist that you have had joint replacement surgery. Notify your physician if you experience any burning and increased frequency that occurs with urination. 15
Frequently Asked Questions What should I wear at Joint Camp? Joint Camp patients should wear comfortable, loose-fitting clothing such as sweat pants (hip patients), short pants (hip & knee patients), comfortable shirts. Shoes should have an enclosed toe and heel such as tennis shoes since you will be walking the halls and exercising. Patients who spend all of their time in bed after surgery do not recover as quickly and experience more complications than patients who move around more. How much exercise should I do and how can I tell if I have done too much? Mild or moderate exercise is beneficial. Continue your total joint replacement exercises at least three times each day. When can I drive? Driving is an individual matter. Some people regain their coordination and reflexes quickly while others take several weeks. Your physician will let you know when it safe to drive. You should not drive if you are taking pain medication. Should I put lotion on my incision? No, not until the staples have been removed. 16
When can I go up and down stairs? It is important that you tell the nursing staff and physical therapists about any stairs you have outside and/or inside your home. The Joint Camp physical therapist will train you on how to properly go up/down stairs after surgery so that you may get around in your home without problems. What kind of shoes should I wear after surgery? High heels should not be worn the first three months after surgery. A well-fitting, flat, closed toe and heel, lace up shoe is safest. A good example would be tennis shoes. Socks with non-skid gripper bottoms keep your feet warm and prevent slipping. These are provided at Joint Camp. When can I increase my activities? It varies from patient to patient. Your physician will let you know when you can increase your activity level. Follow your physician s instructions. To give you an idea of the time frames, some examples are: Drive: 3 to 4 weeks Slow dance: 6 to 8 weeks Play golf: 10 to 12 weeks How long will my exercise therapy last? You can expect your rehab exercises to last 4 6 weeks depending on your individual needs. Your physician will check your condition closely and give you additional instructions. What equipment will I need to obtain for use in my home after surgery? A walker will be provided by the social worker if you do not already have one. Items such as a transfer tub bench/chair can be used to help you bathe safely in a shower/tub combination, but is optional. A shower cannot be taken for two weeks after surgery. If you have a shower stall, a shower stool can be used for support. A showerhead on a flexible hose is convenient but optional. An elevated toilet seat such as a portable potty chair is optional for knee replacement patients but is necessary for hip replacement patients. Grab bars are optional. Some patients who have had both knees replaced at the same time may want to consider an elevated toilet seat, but this is also optional. Importance of antibiotics after surgery A major concern of joint replacement surgeons is infection. Even years after surgery, it can be a potential problem. Infections occurring after six months are considered to be related to an infection occurring elsewhere in the body. Urinary tract infections are the primary cause for these delayed infections. Other possible causes include dental procedures, skin infection and respiratory infections. Infections should always be treated aggressively. Preventive antibiotics have been known to be effective in decreasing the occurrence of infection after dental procedures, kidney or bladder examinations. The American Heart Association has established guidelines for preventive treatment. Remember, let your family physician and dentist know that you have had a joint replacement. 17
General activity guidelines Walk within tolerance. Use an appropriate weight bearing walker, cane or crutches until your physician feels they are no longer needed. Be careful around pets when walking and using your assistive device. Check with your physician about when to resume sex. Talk to your physical therapist about body positions to avoid. No heavy lifting. Follow your physician s instructions. Keep pillows between your legs when lying down. When sitting up in a chair, keep your knees 3 6 inches apart. Do not cross your legs. Do not bend your hip beyond a 90 degree angle. Do not sit on low chairs, sofas, stools or toilet seats (hip patients only). Keep your knees below the level of your chest. Do not rotate your operative leg inward. Do not turn your toes inward. Do not bend over to touch your feet or pick up things from the floor. Use the special equipment designed to assist you with retrieval of objects, putting on socks and shoes (hip patients only). Do not squat. Do not lean forward at the waist while sitting in a chair, on the end of the bed or when rising from a toilet. Use an elevated commode seat. Get your physician s approval to take tub baths. You will need a stool or bench of the proper height. Do NOT sit in the bottom of the tub. Keep electrical cords out of your path. Be aware of telephone wires and bedspread corners. Be cautious of spills on the floor. Call your orthopedic physician s office to schedule a follow-up visit 7 14 days from the day of your surgery, unless otherwise instructed. 18
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Joint Camp Huntsville Hospital 101 Sivley Road Huntsville, AL 35801 (256) 265-8343 To support this program... Please contact us! 101 Sivley Road Huntsville, AL 35801 (256) 265-8077 huntsvillehospitalfoundation.org Every gift makes a difference! Your tax deductible donation to the Foundation will help provide lifesaving equipment, as well as health and hope to our patients. 20