Total Joint Replacement

EquipmentTalk to your healthcare team about equipment you mayneed after surgery such as: Hip and Knee Surgeryo Walker or crutcheso Caneo Elevated toilet seat or bedside commode Shoulder Surgeryo Immobilizero Sling Your healthcare team will let you know whatequipment to use after surgery. Call your insurance company to learn more aboutwhat equipment is covered. You may be able to borrow equipment from family,friends, and local resources.ExercisesBuilding strength is important to help you get ready for surgery. Activity you do before surgery helps yourecover faster. It strengthens your muscles to improve movement after surgery. Plan to exercise 2 to 3 timesa week before surgery. Every little bit helps!Simple exercises are: Deep breathing Water exercise Walking in waist-high water SwimmingLow-impact activity sessions, by the Arthritis Foundation, are held at many local senior centers and gyms.Check with your healthcare team to see what exercises are right for you.12

10-14 Days Before SurgeryHome changesYou may need to make changes in your home before surgery. This will help you to return home safely.You will need: To place often used cooking or working supplies within easy reach. A clean house.o Decreases the number of bacteria and lowers your chance of getting an infection. Good lighting in your hall, bathroom, and bedroom. Use:o Nightlightso Flashlight as needed Loose fitting, comfortable clothes and pajamas.o Your clothes need to be easy to reach. Slippers or shoes with backs.o Soles should be rubber for good traction. Check that any handrails are sturdy. Clear walking paths.o Remove throw rugs.o Keep electrical cords out of walking paths.o Move furniture and objects in your walking path. Chairs with arms and a firm seat in the living and kitchen areas. A rubber mat or non-skid adhesive on the floor of the tub or shower.MailArrange for someone to collect your mail or place it on hold at the post office.Preoperative classAttend a preoperative class if one is offered by your surgeon’s office or hospital. An online class may beavailable. Discuss class dates and times with yoursurgeon’s office.MedicinesTalk to your healthcare provider about whatmedicines to take before surgery. Have enough ofyour current daily medicines so that you do notrun out after surgery.*** Please be honest about your drug and alcoholuse. Drug and alcohol use can affect youranesthesia and pain management. Talk to yourprovider if you need help with ways to quit.13

Several Days Before SurgeryBills Pay bills so they are up to date through a few weeks after your return home.InfectionTell your surgeon’s office right away if: You have a cough, fever, rash, cold, or an infection within a week before surgery.Transportation Make sure you know how you will get to and from the hospital and your outpatient appointments. You are not allowed to drive yourself home from the hospital. Make sure that the passenger seat reclines and can fully move backward.14

Night Before SurgeryShowering The night before surgery, wash your hairand rinse it well. Use antibacterial (Chlorhexidine) soap andpat dry with a clean towel.o Washing with Chlorhexidine soap helpsto prevent infections after surgery.o Do not use Chlorhexidine soap on yourface, hair, ears, or genitals. Do not shave from your neck down oruse lotions or powder. Put on newly washed pajamas or clothes. Sleep on freshly laundered linens.Watch the video – Preparing for Surgery:CHG Skin Cleanser (Soap, Shower)Clear liquidsFollow your provider’s instructions on when to stop eating solid foods and drinking liquids.Clear liquids include: Tea - iced or hot (without cream, instant creamer, dairy or nut milk) Mineral, bubbly, or plain water Apple juice Clear soda Coffee (without cream, instant creamer, dairy or nut milk)Do Not Eat ice chips Chew gum Use mints Bring valuables — no jewelry including body piercing Bring your own medicines unless you are told to bring them15

Chapter 3: Hospital CareDay of Surgery Instructions Do not wear makeup, jewelry, fingernail polish or toenail polishDo not eat or drinko If instructed drink the complex carbohydrate drink before leaving for the hospital.Do not take insulin unless instructed by your healthcare provider Do not shave from your neck downAt the hospitalYou will: Complete any needed forms. Be taken to the pre-op area where you will be prepared for surgery. Put on a hospital gown and go to the bathroom. Review your anesthesia with your anesthesia team. Have an IV started in your vein. Be taken to the operating room for your surgery.You may: Be given medicine to help you relax.After your surgery is completed: Your surgeon will talk to your significant other or familymember about the outcome of the surgery. You will be taken to the recovery room for several hours.o Nurses will watch you closely until you are stable.o You may have a lightweight tube in your noseto give you oxygen. This may be removed when you are ableto breathe well without the oxygen.Your surgery team will: Visit you at least once each day. Look at your readiness to go home eachtime they visit.Watch the video - Your Surgery:What to Expect at the Hospital16

Preventing Falls***Call your healthcare team before you get out of your bed or chair. ***ActivityHelps to prevent possible complications. Plan to get out of bed on the day of surgery. Amember of your care team will help you get out ofbed. You may need help when you turn in bed.***Follow the joint precautions designed just for you.TherapistsYour therapist will work with your surgeonto develop a plan just for you.The therapists will teach you: Movements you need to avoid.Exercises to strengthen your muscles.How to walk and move safely.Deep Breathing Take deep breaths after surgery to prevent lungproblems, such as pneumonia. You will be given a special tool called an Incentive Spirometer.Use this to:o Practice deep breathing.o Use at least 10 times every hour while you are awake.Circulation Perform leg exercises to help your blood circulate. You may have snug stockings and/or sleeves wrapped around your legs or feet.o If present, the sleeves fill with air and then relax.o Increases blood flow to your legs and helps to prevent blood clots. You will be given medicine to reduce the chance of a blood clot.No smoking or using nicotine Smoking and nicotine can slow your healing. Your primary care provider can help you with ways to stop smoking or using nicotine.17

Managing Pain and DiscomfortPain is expected after your surgery. We have various ways to describe pain. Numbers, faces,and colors. We will use a tool that works for you. Your healthcare team will work with you tohelp you manage your pain.Rating your painYou will be asked to rate your pain on a scale from 0 to 10.Watch the video - Describing and Rating Your Pain18

Options for managing pain and discomfortA combination of medicines will work on different pain pathways. Non-medicine options work with medicineto help with pain management.Non-Opioid Medicines: Non-opioid medicines include:o Acetaminopheno Non-steroidal medicines which includeibuprofen, Celebrex, and meloxicam. Are usually given on a set schedule. You will not need to ask for non-opioidmedicines.Opioid MedicinesOral (by mouth) opioidsWatch the video - Managing Pain After Surgery(Multimodal Method) Used only if your pain is not controlled withscheduled non-opioid medicines and options thatdo not require medicine. The goal is to limit IV or oral opioid use. Using opioids for a long time increases the chance of misuse and abuse.o Can lead to substance use disorder (addiction).Opioids have side effects such as: Drowsiness Nausea which may impact being able to eat Slowing of bowel activity which can lead to constipation Increased chance of fallingOptions That Do Not Require Medicine Use of cold therapy like an ice pack can help with pain management. Change your position at least every 45 to 60 minutes during the day. Getting up and moving helpsto prevent stiffness and lessen pain.19

Managing Nausea You may have nausea after surgery. Medicine will be given, if needed.IV Fluids IV fluids may be stopped when youare eating and drinking well.Eating and Drinking Plan to eat solid foods as you areable to tolerate. You may:o Start with a liquid diet. It is normal to not be very hungryafter surgery. Your appetite willimprove as you continue to heal. Drink fluids and eat as you are able.Bowel Function You may not have a bowel movement right after surgery. Bowel function returns slowly due to many different reasons including anesthesia. Make sure you are drinking enough fluid. Get up and move as much as you are able. Talk to your provider if you feel that you need more help.20

Day After Surgery Instructions Continue to cough and deep breathe. Use the incentive spirometer 10 times every hour while awake. Walk to the bathroom with assistance. Eat as you are able. Drink fluids to keep hydrated. You will work with therapists to practice exercises, walking and climbing stairs.o Repeating exercises throughout the day will help you gain strength.Goals for Leaving the Hospital No signs of infection. Therapy goals met. Pain controlled with oral medicine. Eating and drinking without nausea or vomiting. Additional goals may be set for you by your healthcare team.Discuss discharge options and needed equipment with your nurse or your discharge planner.21

Chapter 4: Care at HomeYour path to recovery will continue after you go home. It is important to get adequate rest between yourtherapy and activities.Coping with stressSurgery can be a stressful event for anyone. It can be stressful to rely on others to help while you arehealing. Having support from friends and family is needed for a full recovery. Remember to ask for helpwhen you need it. Have realistic goals. Keep a positive outlook. Notice small achievements. Practice deep breathing and activities that help you relax.If you need more support talk to your healthcare provider.RelaxationMake sure you get good quality sleep. Somethings you can try to help you relax are: Slow deep breaths to reduce stress and pain.Peaceful images to help you relax.Meditate by spending time in quiet thought.Music that relaxes you.Medicine to prevent blood clots from forming You may need your blood examined to make sureyour medicine is working properly.Take for as long as directed by your provider.Contact your provider right away if you notice:o Easy bruisingo Nosebleedso Blood in your urine or stoolsChanges after surgeryYou may have: A decreased appetite A lower energy level Constipationo Drink plenty of fluids and use a stool softeneror laxative if needed22

Discomfort at HomeNumbness around the incision may be temporary or permanent. To lessen discomfort you can: Change your position at least every 45 to 60 minutes during the day. Use cold therapy such as an ice pack on your jointfor 20 minutes on and off for at least 20 minutes.o Use cold therapy as long as you have pain from surgery.o A gel pack, ice pack or bag of frozen corn or peas can be used.o Wrap cold therapy in a towel or place over clothing. Do not place directly on bare skin. Use non-opioid medicines such as Tylenol (acetaminophen) and Motrin (ibuprofen).o Take medicine 30 minutes before your planned therapy or exercise session.o Do not wait to take the pain medicine until the pain becomes severe. Your pain will lessen as you heal.o Decrease your pain medicine when you start to have less pain.Opioid MedicineWhen taking opioid pain medicines, safety is veryimportant. You may go home with a prescription for anopioid pain medicine. Store your pain medicines in a secure place. Do not drink alcohol while taking opioid pain medicine. If needed, take the opioid medicine only as prescribed. Contact your surgeon if pain is not relieved with opioidmedicine or pain is worse than it was in the hospital.For family members, call 911 if they notice: Slow or shallow breathing Difficulty breathing If it is difficult to keep you awakeWatch the video – Safe Use of OpioidsThrowing away opioid medicine To prevent misuse and abuse, do not keep your medicines for later use.Discard as soon as you are no longer taking them. Always follow the throw away instructions that come with your medicine. Remove the label or black out information on the label before you throw the bottle into the trash.o This protects your identityAsk about a take-back program in your communityo Check with your local police, fire station, city household trash services, or your pharmacist 23

RestrictionsKnee Surgery Do not kneel or twist the knee that youhad surgery on. Do not lie in bed with a pillow underyour kneeo Will lead to tightness in the back ofthe knee.o Can lead to permanent loss of kneefunction.Hip Surgery Do not twist to see the incision foryourself.Use mirrors if you’d like to view it.Shoulder Surgery Follow the instructions given to you by your healthcare team.Avoid Driving or operating heavy machinery until your surgeon tells you it is ok to do so. Operating a car or heavy machinery if you have used opioid medicine within 24 hours. Taking tub baths, swimming, or getting in a hot tub until your surgeon tells you it is safe.Wounds and DressingsYour incision may have sutures, staples, surgical glue or Steri-Strips.You may have a: Wound dressing over your surgical site.o Change the dressing as directed by your provider.Always wash your hands before caring for your wound to avoid infection. Look at your incisions, if visible, every day or when you change any dressings. Makesure your wounds look healthy.o Talk to your surgeon about when the bandages should be changed or removed.o Staples or sutures will likely be removed at your post-operative visit. Do not try toremove these yourself.o Surgical glue will dissolve over time. Your nurse or surgeon will let you know how longto keep the glue dry. Do not apply any creams, ointments or other substances to the incision unless your surgeon says it is safe.24

Chapter 5: Prevent ComplicationsBlood clotsA blood clot in the leg can move to the lung,leading to serious complications, including death.Prevention Snug stockings. Take your blood thinner medicine as directed. Exercise and walk as instructed.Decreased AppetiteIt is normal to have a decreasedappetite after surgery. This willimprove as you continue to heal. Eat several small meals daily. Follow your nutrition instructions. Drink at least seven (7) 8 ounceglasses of water. Contact your surgeon if you have nauseaor vomiting that does not go away. If instructed, add a protein supplementdrink to your diet.Weight lossAn ideal body weight puts the least amountof stress on your new joint. One pound ofweight loss takes off 4 pounds of joint stress.To lose weight: Follow your exercise and walking program. Talk to a dietitian about a healthyweight loss meal plan.o Your surgeon can refer you to adietitian if needed.Watch for Signs of Dehydration Feeling faint or passing outLack of energyDry skinDry MouthDark-colored urineVery little urineCracked lips25

Prevent Infections Ask visitors to wash their hands when theyenter your room. Wash your hands with soap and water oran alcohol-based hand cleanser.o Your caregiver needs to have cleanhands as well. Avoid people who may have the flu or acold. Wash your hands before changing thedressing over your incision. Keep your incision dry, unless your surgeonhas approved getting it wet. Eat a healthy diet and drink plenty of fluids to help prevent infection. Talk to your surgeon to see if you will need antibiotics before you have future dental or medicalprocedures.Watch the video – Infection Prevention Hand WashingContact your surgeon if you have signs of infection.Signs of Infection RedSoreSwelling around incisionFoul smellDrainageWarm to touchFever over 100.4 F (38 C) or chillsIncreased painContact your primary care provider if you have an infection in another place Bladder Sinus Teeth26

Chapter 6: When to Call Your ProviderFor All Patients Call 911 if you: Cannot breatheCough up bloodHave chest painFall to the ground and cannot get upHave increased anxiety when you try to take a breathFor All Patients Call Your Surgeon If you fallSigns of infection including: Temperature over 100.4 F (38 C) or chills Redness, heat, or swelling around the incision Pus or drainage from your incision that smells bad Pain that is more than it was in the hospitalBecome: Dizzy, lightheaded, or faintIf you are unable to: Urinate for 6 hours or more Have a bowel movement for 48 hours or moreIf you have: Bleeding from your wound or the wound opens up Have nausea or vomiting that will not go away Pain or a lot of tenderness in your upper or lower leg Redness of your lower leg Swelling in your foot, ankle, upper leg or lower legFor Hip Surgery Patients Call Your Surgeon If the leg that you had surgery on starts to turn in or outYou have a change in length of your legYou can feel a lump over your hipAn increase in numbness or tingling of your legIf you are unable to walk or put weight on your legFor Knee Surgery Patients Call Your Surgeon If you have new or increased pain in your knee or your knee has an odd shapeAn increase in numbness or tingling of your legIf you are unable to walk or put weight on your legFor Shoulder Surgery Patients Call Your Surgeon If you have new or increased pain in your shoulder27

Chapter 7: After Surger

Watch the video - Total Knee Replacement Knee Replacement What is total knee replacement? Your surgeon makes a cut over the front of your knee so that the damaged parts of your knee can be replaced with man-made parts. The man-made parts are: Usually made of metals, ceramics or plastics. Cemented or "press fit" into the bone.