3. welcome
Patient Name
Surgery Date Estimated Arrival Time
Return to your orthopedic physician for your final preoperative check up on:
Date Time
Please bring this book with you to
• Every office visit
• Your joint replacement class
• The hospital on the day of surgery
• All physical therapy or occupational therapy visits after surgery
Pre-op Physical date/time
Physician
Clinic
Joint Replacement Class date/time
Lab Work date/time
7. GENERAL INFORMATION
Thank you for choosing Redwood Area Hospital to help
restore your quality of life with joint replacement surgery and
rehabilitation. Redwood Area Hospital has developed an
extended partnership with the Orthopaedic & Fracture Clinic,
based in Mankato, to provide total joint replacement surgery.
The health professionals at Redwood Area Hospital developed
this book to help you through your joint replacement surgery
and recovery. Our goal is to involve you in your treatment and
recovery through each step of the program.
You play a key role in your recovery success. We will work
together, as a team, to get you back to a more active lifestyle.
Your team includes YOU, your family, physicians, physician
assistants, anesthetists, nurses, certified nursing aides,
pharmacists, social worker, dietitian, and physical and
occupational therapists specializing in total joint care. We
want you to understand every step of the process and to
have the necessary information to recover successfully.
Bring this book with you when you come to the hospital for
your surgery. Physicians, nurses, therapists and discharge
planners will work with you and your family to create your
recovery plan. Staff will refer back to the information in this
book and answer any questions you have.
This book is a learning tool and should not be used
as a substitute for medical or professional advice.
The Purpose of the Joint Handbook
The best results in joint surgery come from being prepared.
This includes learning more about the surgery and recovery
process, preparing your body, preparing your home, and
planning ahead for your care after you leave the hospital.
Communication is essential to this process.
Joint Handbook 3
You may want
to refer to
this handbook
throughout
the first year
after your
surgery.
8. This Joint Handbook is a communication and education tool
for you and your care team. It is designed to educate you so
that you know what to expect every step of the way, what
you need to do, and how to care for your new joint.
Remember, this is just a guide. Your care team may add to
or change any of the recommendations. Always use their
recommendations first and ask questions if you are unsure
of any information. You may want to refer to this handbook
throughout the first year after your surgery.
Your Healthcare Team
Your healthcare team will work with your orthopedic surgeon
and primary physician to help you through your journey—
from preparing for surgery through your recovery at home.
Members of your health care team include:
Orthopedic Surgeon
The orthopedic surgeon is a skilled physician who will
perform the surgery to replace your joint. A physician
assistant often helps during surgery, doing tasks which could
include opening and closing the wound and cutting out tissue.
Primary Physician
Your primary physician will provide medical clearance for you
to have surgery through a health history and physical exam
no more than 30 days before your surgery date. Your primary
physician will also see you during your hospital stay when the
orthopedic surgeon is not in the hospital.
Nursing Staff
Nursing staff will teach, support and guide you. They will
coordinate your plan of care and help you with mobility,
treatments (ice, wound care, etc.), personal care and pain
management.
Physical Therapy Staff
A physical therapist and physical therapist assistants will guide
you in the important work of returning you to daily activities.
They will also help you learn to get in and out of bed, walk
with your walker and lead you through your exercise program
to get the most strength and motion from your new joint.
4 Joint Handbook
Most patients
will be
hospitalized for
approximately
four days after
surgery.
9. Occupational Therapy Staff
Occupational therapists and occupational therapy assistants
will teach you how to do daily tasks, such as getting in and
out of bed, dressing, personal hygiene and household chores.
Their goal is to help you live as independently as possible,
following the precautions outlined by your surgeon or primary
physician. This may involve using adaptive equipment, such
as a sock aid.
Social Worker and Patient Care Coordinators
The social worker and patient care coordinators will work
closely with you to help plan your discharge. They will also
work with your family and friends to identify support systems
or community resources available to help aid in your recovery.
They will help you understand what your insurance benefits
cover during your hospital stay and recovery process.
Your healthcare team may also include other healthcare
providers, home health care, dietary and respiratory care.
Frequently Asked Questions
What are the possible complications associated
with joint replacement?
While uncommon, complications can occur during and after
surgery. Some complications include infection, blood clots,
implant breakage, improper alignment, dislocation, and
premature wear, any of which may necessitate implant
removal/replacement surgery. While joint devices are
generally successful in reducing pain and restoring function,
they cannot be expected to withstand the activity levels
and loads of normal, healthy bone and joint tissue. Even
with extremely successful implant surgery, patients still
experience some pain and stiffness.
No implant will last forever, and factors such as a patient’s
post-surgical activities and weight can affect longevity. Be
sure to discuss these and other risks with your surgeon.
Joint Handbook 5
You will get
out of bed
and into a
chair the
same day of
your surgery.
10. What are the major risks?
Most surgeries go well, without any complications. Infection
and blood clots are two serious complications. To help avoid
these complications, your surgeon may prescribe antibiotics
and blood thinners. Surgeons also take special precautions in
the operating room to reduce the risk of infection.
How long does it take to recover from the surgery?
You will get out of bed and into a chair the same day of your
surgery. Once you are in your hospital room and your vitals
are stable, a nurse or staff member from physical therapy will
get you up. The next morning, most patients get up, sit in a
chair and should be walking with a walker. Every day you will
make progress, so try to stay positive. Recovery takes about
six weeks, but varies for each person.
How long will I be in the hospital?
Most patients will be hospitalized for approximately four days
after surgery. There are several goals that must be reached
before discharge.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after being
discharged from inpatient care. Some patients may transfer
to the hospital’s swing bed program for transitional care or to
a nursing home for ongoing physical therapy or nursing care.
How will I be billed for my total joint replacement?
You will receive separate bills from your primary physician,
surgeon, radiology, and the hospital. Your hospital bill will
include your surgical care, inpatient care, rehab and other
hospital services as needed for your recovery.
Will I need help at home?
Yes, for the first several days or weeks you will need some-
one to assist you with meal preparation and other tasks at
home. Ask relatives, friends or people from your church or
6 Joint Handbook
Ask relatives,
friends or
people from
your church
or community
if they are
willing to
help you
while you are
recovering.
11. community if they are willing to help you while you are
recovering. Make arrangements for transportation to and
from physical therapy, which will be two or three times
per week for approximately six weeks. You may also need
transportation for lab work.
If you live alone, make arrangements for someone to stay
with you after surgery. Most people go home on approximately
the fourth day after surgery, unless insurance covers the
hospital’s swing bed service (transitional care) or a nursing
home. Medical insurance does not cover extended care
simply because you live alone, so it is a good idea to have
a back-up plan.
Preparing your home ahead of time can minimize the
amount of help needed. Have the laundry done, house
cleaned, yard work completed, clean linens put on the
bed and single-portion frozen meals ready.
Will I need physical therapy when I go home?
Yes, you will have ongoing physical therapy needs. The patient
care coordinators or social services will discuss options and
arrange for ongoing physical therapy at time of discharge
based on your unique needs. Therapy will last approximately
six weeks.
Will I have pain after surgery?
Yes, you should expect to have pain after surgery.
Our goal will be to effectively manage your pain level
by using a combination of prescription medications and
other interventions such as position changes and ice
to promote comfort.
How long, and where will my scar be?
Surgical scars will vary in length. The average scar
is 6-8 inches long. There may be some long-term
numbness around the scar.
Joint Handbook 7
12. Will I need a walker, crutches or a cane?
Yes, we recommend you use a walker, crutches, or a cane for
about six weeks. The physical therapist will determine which
device is most appropriate when you are discharged from the
hospital. Patient care coordinators will assist in arrangements
for equipment with a durable medical equipment provider and
your insurance company, as needed.
How long until I can drive?
If the surgery was on your right leg, your driving could be
restricted as long as six weeks. Your surgeon will give you
clearance when it is safe to resume driving.
The ability to drive depends on whether surgery was on
your right leg or your left leg and the type of car you have
(automatic or manual transmission). Before you consider
driving, you should have good control of your affected leg
and be off narcotic pain medication at least during the day.
When will I be able to return to work?
Typically, patients take at least six weeks off from work,
unless their jobs are inactive, desk-bound positions and
they can return to work with crutches. An occupational
therapist can make recommendations for joint protection
and energy conservation on the job.
How often will I need to be seen by my orthopedic
doctor following surgery?
You will see your orthopedic surgeon for your first follow-up
appointment approximately two to three weeks after
discharge. The frequency of follow-up visits will depend
on your progress. Many patients are seen at 2 weeks to
6 weeks, 12 weeks and then every couple of years.
8 Joint Handbook
13. Are there any permanent restrictions following this surgery?
High-impact activities, such as running, singles tennis, and
basketball are not recommended after joint replacement
surgery. Injury-prone sports, such as downhill skiing are also
restricted.
• After KNEE replacement, kneeling is not recommended
as it can loosen the cement and artificial joint.
• After HIP replacement, you should not bend your hips
more than 90 degrees or cross your legs.
Read more about joint replacement precautions on page 36.
What physical/recreational activities may I participate
in after my recovery?
You are encouraged to participate in low-impact activities
such as walking, dancing, golf, hiking, swimming, bowling
and gardening.
Will I notice anything different about my replaced joint?
Some patients may notice some clicking or noise with certain
movements of their joint. You may also have a small area of
numbness to the outside of the scar.
How long will my new joint last?
Just as your original joint wore out, a joint replacement may
wear over time as well. An artificial joint’s life expectancy can
be impacted by an individual’s age, weight, activity level and
medical conditions.
It is important to remember that this is a medical device
subject to wear that may lead to mechanical failure. The most
common reason for a second joint replacement is loosening
of the artificial surface from the bone. While it is important to
follow all of your surgeon’s recommendations after surgery,
there is no guarantee that your particular implant will last for
any specific length of time.
Joint Handbook 9
14. 10 Joint Handbook
YOUR NEW JOINT
Knee
Total knee replacement surgery
removes the damaged bone and
cartilage from your joint and replaces
it with an artificial joint made of
metal and wear-resistant plastic.
The artificial joint is held in place
with bone cement or by your bone
growing into the artificial joint
materials. The upper part of the
artificial joint fits into your thigh
bone. The lower part fits into your
shin bone. If the underside of your
knee cap is damaged, a round plastic
piece will be cemented onto it. The
three parts touch and glide against
each other just as a normal knee
joint does, allowing your knee to bend.
Hip
Total hip replacement surgery
removes damaged bone and
cartilage from your hip joint and
replaces it with an artificial joint
made of metal and wear-resistant
plastic. The artificial joint is held
in place with bone cement or by
your bone growing into the artificial
joint materials. An artificial ball,
connected to a stem, replaces the
ball of your thigh bone. An artificial
cup, shaped like a bowl, replaces the
worn socket. These parts connect
to create a new artificial hip that
works almost like your own hip joint.
All parts have smooth surfaces for
comfortable movement once you
have healed from the surgery.
17. BEFORE SURGERY
What to do before surgery
Additional information about the items on this checklist
can be found on the following pages.
q Obtain a preoperative history and physical from your
primary care provider not more than 30 days prior to
your surgery date.
q Attend Joint Replacement Class approximately two weeks
before surgery. Redwood Area Hospital surgery staff will
contact you to schedule.
q Practice the preoperative exercises you learn
at Joint Replacement Class.
q Consider discharge plan options.
q Consider adaptive equipment needs.
q Stop medications that may increase bleeding 10 days
before surgery, including over-the-counter medications
and herbal supplements, as directed by your primary
physician during your preoperative physical.
q Complete required bloodwork at Redwood Area Hospital
laboratory no more than seven days before your surgery
(closer to your surgery date is better). If you have had a
blood transfusion or were pregnant in the last three months,
your blood work needs to be done within three days of surgery.
q Surgical scrub solution and instructions will be given
to you in the pre-op class. This is to be done the night
before surgery and the morning of surgery. Completing
the scrub is a very important step to help prevent infection.
Your Health History and Physical Exam
After you are scheduled for surgery, you need to see your
primary physician for a preoperative exam (health history and
physical). Your primary physician will provide medical clearance
to have surgery. The exam will evaluate your current health
status and determine if additional test or consults are
necessary before surgery. Try to schedule this appointment
no more than 30 days before your surgery date.
Joint Handbook 13
Complete
required
bloodwork
at Redwood
Area Hospital
laboratory
no more than
seven days
before your
surgery
18. Please talk with your doctor about how to take your
medicines before surgery. If you currently take any
medicines, make sure your doctor provides you with the
following information:
• Directions for taking your medicines the morning of surgery
• Directions for stopping any prescription medicines
before surgery
• Directions for stopping any over-the-counter medicines
before your surgery, including herbal medicines. These
medicines include aspirin products and non-steroidal
anti-inflammatories such as ibuprofen (Advil®
and Motrin®
),
naproxen (Aleve®
), prioxicam (Feldene®
), nabumetone
(Relafen®
), oxaprozin (Daypro®
) and so on. Some of these
medicines may need to be stopped several days before
your surgery.
Joint Replacement Class
Prior to your surgery, you will be attending a Joint Replacement
Class. This is your time to learn about what to expect over
the next few weeks and, more importantly, what will help
speed your recovery. During Joint Replacement Class,
members of your care team will be there to answer your
questions and other vital information will be discussed.
We highly recommend that you bring your spouse, friend or
family member (who will be caring for you after the surgery)
with you to Joint Replacement Class. This person will act as a
coach throughout your journey, helping you with your exercises,
and keeping you motivated for a full recovery.
This is your opportunity to learn what is in store for you
in the upcoming days and weeks and what you can do to
make the surgery a success.
Feel free to ask any questions you may have. The more
you know, the better prepared you will feel.
Please bring insurance cards, social security number,
emergency contact information, email address and medication
list so we can get you preregistered during the class.
14 Joint Handbook
19. Joint Replacement Class outline:
• Meet and greet your hospital care team
• What to expect
• Hospital preregistration
• Preoperative questions
• Learn your breathing exercises
• Learn your preoperative exercises
• Learn about assistive devices and joint protection
• Discharge planning/insurance/obtaining equipment
• Insurance authorization
• Questions and answers
Respiratory Exercises (Breathing Exercises)
After joint replacement surgery, small airways in the lungs
can collapse and create an ideal environment for pneumonia
or other respiratory complications. Performing respiratory
exercises will help you prevent respiratory complications.
Deep breathing, coughing, and incentive spirometer
exercises may speed your recovery and lower your risk of
lung problems. Learn the following exercises and practice
them every day before your surgery.
Deep breathing
To deep breathe correctly, you must use your abdominal
muscles, as well as your chest muscles.
• Breathe in through your nose as deeply as possible.
• Hold your breath for 5 to 10 seconds.
• Let your breath out through your mouth, slowly and
completely. As you breathe out with pursed lips (like
blowing out a candle) your stomach should be going in.
Exhale twice as long as you inhale.
• Rest and then repeat these steps 10 times.
Joint Handbook 15
20. Coughing
To help you cough:
• Take a slow deep breath. Breathe in through your nose
and concentrate on fully expanding your chest.
• Breathe out through your mouth and concentrate
on feeling your chest sink downward and inward.
• Take a second breath in the same manner.
• Take a third breath. This time hold your breath for
a moment, then cough vigorously. As you cough,
concentrate on forcing all the air out of your chest.
• Repeat this exercise two more times.
An incentive spirometer is a hand-held breathing exercise
device to help you inflate your lungs after surgery. This will
help keep your lungs healthy after surgery. It will be at your
bedside for you to use while you are awake.
Pre-Op Exercises
Because of your damaged joint, you have likely been less
active and your muscles have become weak. Replacing the
joint will fix the joint problem, but you will need to exercise
regularly to strengthen your muscles and properly support
your new joint.
Beginning an exercise program before surgery can greatly
enhance your recovery. Your therapy team will assign exercises
to you during Joint Replacement Class that fit your unique
needs. You are the best judge of how much exercise your
body can handle. If an exercise causes you pain, decrease
repetitions or stop doing that exercise. All exercises diagrams
are found in the Exercise Mobility section of the handbook.
Try to exercise once or twice every day before surgery.
You may find it most comfortable to do your exercises lying
down on your bed.
16 Joint Handbook
An incentive
spirometer is
a hand-held
breathing
exercise
device to help
you inflate
your lungs
after surgery.
This will help
keep your
lungs healthy
after surgery.
It will be at
your bedside
for you to use
while you are
awake.
21. Using a Walker
1. Stand upright and look ahead.
2. Keep walker centered, elbows stay bent.
3. Advance walker 1-2 feet.
4. Step forward with affected leg.
5. Pushing down on walker for support, bring
unaffected leg past the other leg.
6. Repeat above sequence for each step.
CAUTION: Avoid leaning too close to front or
side of walker to avoid tipping. Wear safety
belt if assistance is needed. Tipping can also
result from leaning on your walker. Do not
move your walker too far ahead of you. Be on
guard for wet and slippery areas. Consider a
walker with brakes for safety.
Going up stairs with a walker
1. Place walker turned sideways with opening
toward you; 2 legs of the walker on the step
you are standing on and 2 legs on the step
you are advancing to.
2. Support your weight through your arms
on your walker and a railing, if available.
3. Bring your “good leg” up the stairs
(unaffected leg leads); then follow with
your affected leg to the same step
“Up with the good”.
4. Advance walker to the next step.
5. Use railing whenever possible.
Going downstairs with a walker
1. Similarly to going up stairs, again place
walker turned sideways with opening
toward you; 2 legs of the walker on the
step you are standing on and 2 legs on the
step you are advancing to. Support your
weight through the walker and a railing.
2. Your affected leg, or the “bad leg,” will step down first.
“Down with the bad.” Then your unaffected leg follows.
Joint Handbook 17
See page
31 in the
Exercises
and Mobility
section of
your joint
handbook for
daily activity
directions and
guidelines.
22. Activities of Daily Living
The occupational therapists at Redwood Area Hospital will
make sure you can manage daily activities after your surgery.
The therapist will show you how to use adaptive equipment
and give you tips on how to limit the amount of bending
required for daily activities, such as dressing.
Whatever activities you are doing, problems can be kept to a
minimum by following the directions of your therapists. See
page 37 in the Exercise and Mobility section of your joint
handbook for daily activity directions and guidelines.
The adaptive equipment shown on the next page can be
purchased prior to surgery from:
AMERICAN LEGION POST
100 Industrial Dr., Redwood Falls 507-644-2571
GUIDEPOINT
216 S. Washington St., Redwood Falls 507-637-8742
OLIVIA DRUG CO.
102 S. 9th St., Olivia 320-523-1630
PAGE SNYDER DRUG
801 Depue, Olivia 320-523-2110
RANDY’S FAMILY DRUG
212 1st Ave. S., Sleepy Eye 507-794-3631
RICE HOME MEDICAL
1020 E. Bridge St., Redwood Falls 507-637-2330
SWARD KEMP-SNYDER DRUG
207 S. Washington St., Redwood Falls 507-637-2911
VFW
825 E. Bridge St., Redwood Falls 507-627-5845
WAL-MART
1410 E. Bridge St., Redwood Falls 507-644-6000
Your healthcare plan may cover the cost of the equipment.
The patient care coordinator can work with you to determine
your insurance coverage for adaptive equipment.
18 Joint Handbook
23. Adaptive Equipment Used
Bath bench –
extends over the side of the
tub to help you bathe safely.
Place the bath bench in the
tub or shower and elevate to
the appropriate height.
Long-handled bath sponge –
to assist you with washing your
lower legs and feet. The long-
handled sponge is useful to
avoid bending. You can also
wrap a towel around the sponge
to help with drying off.
Raised toilet seat –
to use on your toilet at home
to reduce stress to your hips
and knees.
Seat cushion –
to use on a chair to elevate the
seat to the appropriate height.
Joint Handbook 19
24. Reacher –
to help pick up dropped items
and put on underwear or pants.
Sock aid –
to put on socks without bending
hips or knee.
Long-handled shoehorn –
to avoid bending when putting
your shoes on. Place the
shoehorn inside the back of your
shoe and push your heel down
into the shoe.
Elastic shoelaces –
to provide firm support, yet
stretch to allow your feet to slip
in or out of the shoes without
having to untie and retie them.
20 Joint Handbook
25. Discharge Planning
Plan ahead for leaving the hospital
Making plans for when you leave the hospital is a very
important part of your total joint replacement recovery. Your
health care team will work with you and your family to help
develop your discharge plan. By using this plan, you and your
family can make most discharge arrangements before your
surgery. A discharge plan is one of the following:
Home
You can return home if you can do the following
at the time of discharge:
• Get in and out of bed and a chair with minimal help.
• Walk with your walker, crutches or cane.
• Walk the distance from your bedroom to
your bathroom and kitchen.
• Go up and down stairs safely, if needed.
You also need to have help from either family or friends
on a regular basis until you regain your independence and
self-confidence in walking and in daily living activities.
Skilled nursing facility / swing bed
Some patients need more help and services than what can
reasonably be provided at home, such as daily skilled nursing
care or daily skilled rehabilitative therapy or both.
If you have recovered from your acute hospital stay, but still
need some form of daily skilled nursing or skilled rehabilitation
service, you may be eligible for “Skilled Swing Bed” care
under Medicare or “Transitional Care” under private insurance.
In a skilled nursing facility or Redwood Area Hospital’s swing
bed program, you can continue your rehabilitation and have
your medical needs monitored until you can safely return
home. Therapy sessions focus on building strength, endurance
and self-care skills. You will be cared for by a team of health
care professionals who will work with you and your family so
you can return home as soon as possible.
Joint Handbook 21
26. To prepare for your stay at a skilled nursing facility / swing
bed, there are a few things you can do before your surgery:
• Choose more than one skilled nursing facility where you
would be comfortable, that have the rehab services you
require after a total joint replacement and are approved
by your insurance company. If possible, visit each before
your surgery.
• Talk with the patient care coordinator or social worker
about skilled nursing facilities or skilled swing bed and your
insurance options.
Home with Home Care
Some patients can return home at discharge but need
some help beyond what family and friends can provide.
Your health care team will help to determine what your
home care needs are.
While you’re in the hospital, a discharge planner will see if
you qualify for visits from home health providers, such as
physical or occupational therapists, home health aides or
nurses. They could come into your home to help you with
walking, strengthening exercises, daily living tasks and safety
issues, and to monitor your medical condition.
Health Care Directive
A health care directive (previously called a living will) gives
your family direction on what medical care you want or don’t
want if you can’t communicate. This document gives you a
chance to write out your wishes, which must will be legally
respected.
All people, even those not currently ill or having surgery,
should make sure their loved ones are aware of their wishes.
A health care directive is a way to do that.
If you have a health care directive, bring a copy of it with
you when you come to the hospital for surgery. It will be a
permanent part of your medical record. If you don’t have a
health care directive and would like more information, Redwood
Area Hospital will provide you with resources and forms.
22 Joint Handbook
27. Before Surgery
Stop Smoking. It is essential to stop smoking before surgery.
Smoking reduces the size of your blood vessels and decreases
the amount of oxygen circulated in your blood. Smoking can
also increase clotting which can cause problems with your
heart. Smoking increases your blood pressure and heart rate.
If you quit smoking before you have surgery you will increase
your ability to heal.
Please discuss options for smoking cessation with your
primary physician. Additional smoking cessation resources,
tools and support are offered through QUITPLAN®
Services,
a free quit-tobacco service available to Minnesota residents.
Ten Days Before Surgery
Stop medications that increase bleeding. Ten days before
surgery, stop all anti-inflammatory medications as directed by
your physician, such as aspirin, Motrin®
, Naproxen, Vitamin E,
etc. These medications may cause increased bleeding. If you
are taking prescription blood thinner, you will need special
instructions for stopping the medication.
Complete required bloodwork at Redwood Area Hospital not
more than seven days before surgery (closer to your surgery
is better). If you have had a blood transfusion or were pregnant
in the last three months, your blood work needs to be done
within three days of surgery.
If you need a blood transfusion, the blood you will receive is
allogenic. Allogenic blood may come from any healthy adult.
Blood collection agencies carefully screen donors and test
blood. Potential donors who do not qualify are not allowed
to donate. Blood that tests positive for any disease is thrown
away and the donor is contacted.
We will be monitoring your lab work closely after surgery to
make sure your hemoglobin doesn’t drop too low. It is important
to eat a balanced diet before and after surgery to minimize
the need for a transfusion. It is also important to stay
hydrated before and after surgery. It is not uncommon
Joint Handbook 23
28. to get a blood transfusion and we have well trained staff to
help you through this process if you do need a transfusion.
Prepare your home for your return from the hospital. Have
your house ready for your arrival back home to allow for
an easier transition. Don’t let household chores slow your
recovery or make it more painful. Plan now so you’ll have
less to do after surgery.
Pre-operative home checklist:
q Prepare and freeze meals ahead of time and have enough
food on hand, or arrange for someone to go shopping for you.
q Change bed linens, etc. before leaving for the hospital.
q Have a pair of shoes and slippers with good support and
non-skid soles.
q Have easy access to a bed and bathroom on the floor level
that you will be spending most of your time. Choose a
bathroom with a door wide enough to accommodate a walker.
q Install commode rails and/or an elevated seat.
q Install a hand rail, if possible, for any stair steps you may
be using routinely.
q Clear clutter and stray cords from floors to prevent falls.
q Arrange for an adult to stay with you, if needed, for your
first few days at home.
q Ask someone to help care for children or pets until
you feel better; and bring in the mail.
q Finish any yard work or gardening and arrange for someone
to mow the lawn during your recovery.
q Have some treats ready to take your mind off the pain.
Rent a few videos, or check out some library books.
q Take care of any financial matters such as paying bills,
having cash on hand, etc.
q Arrange your kitchen with items within easy reach
without having to bend or use a step stool.
q Place your phone within easy reach of where you will
spend most of your day with emergency numbers handy.
q Have a comfortable chair or couch with arms to help you
when standing up.
24 Joint Handbook
Do not eat
or drink
anything
after
midnight,
EVEN
WATER,
unless
otherwise
instructed by
anesthesia to
do so. Your
surgery may
be delayed
or cancelled
if you don’t
follow this
instruction.
29. q Tend to any routine scheduled procedures, like haircuts,
etc. before surgery.
q Delay teeth cleaning from six weeks prior to surgery until
four months following surgery. You will need an antibiotic
prior to any dental work following your surgery.
q Fill your vehicle’s gas tank before leaving for the hospital.
q Arrange to have someone drive you to the grocery store,
religious services, family events and doctor and therapy visits.
Keep a list of people who are willing to take turns driving.
q If you don’t have people to help you, talk with your social
worker or patient care coordinator. He or she can put you
in touch with resources in your area.
The Day Before Surgery
Find out your arrival time at the hospital. The surgery
department will notify you with your arrival time the day
before surgery. You will be asked to come to the hospital
approximately two hours before the scheduled surgery to
give the nursing staff sufficient time to start IVs, prep you
for surgery and answer questions. It is important that
you arrive on time to the hospital because some-
times the surgical time is moved up at the last
minute and your surgery could start earlier. If you
are late, it may create a significant problem with
starting your surgery on time. In some cases,
lateness could result in cancelling your surgery
to a different day.
Do not eat or drink anything after midnight, EVEN
WATER, unless otherwise instructed by anesthesia
to do so. Your surgery may be delayed or cancelled
if you don’t follow this instruction.
Joint Handbook 25
30. Pack your personal items for your hospital stay. For your
convenience during your hospital stay, consider the following
suggestions:
* Flat shoes or tennis shoes
* This Joint Handbook
* A copy of your healthcare directive, if you have one
* A current list of your medicines, including the
dosages and the times you take them
* Personal care items such as comb, deodorant, make-up and
shaving kit (Toothbrush, toothpaste and skin care products
will be provided at the hospital.)
* If you wear glasses or contacts, bring storage containers
for them (Be sure to put your name on the container.)
* Loose-fitting shorts or undergarments to wear under your
hospital gown and robe (When you attend physical therapy
sessions, this will give you more privacy.)
* Clothing you intend to wear home, including socks,
shoes (comfortable, supportive, with nonslip soles),
undergarments, shirt and loose pants or a sweat suit
(Bring a warm coat if it’s cold outside. As part of your
therapy, you will practice dressing with these items.)
* A book or magazines (All patient rooms have a television.)
* Phone numbers (include work numbers) of family
and friends, and some writing materials
* If have your own or borrowed crutches or walker, bring
them so they can be correctly fitted to you. Be sure to label
the crutches or walker with your name.
* You may bring battery-operated items.
* Don’t bring valuables—leave them home or with your family.
26 Joint Handbook
31. Skin prep prior to surgery. Your surgeon recommends a
special surgical scrub to reduce the amount of germs on your
skin prior to surgery. Preparing the skin prior to total joint
replacement is an important first step in preventing infection.
When you come to the hospital for your joint replacement
class, you will be given the skin scrub supplies to use
at home. Follow these instructions exactly. If you have
questions, please ask.
Preoperative showers are recommended to ______________
your risk of infection.
The night before surgery please follow these
special instructions:
1. Do not shave the leg that will be operated on.
2. You may shave your beard.
3. Shampoo your hair with normal shampoo.
4. Take a bath or shower. Apply one packet of the
chlorhexidine gluconate scrub solution that was provided
to a clean washcloth, wash from the waist to the ankle.
DO NOT USE SCRUB SOLUTION ABOVE THE CHIN.
Do not use the scrub if you have a sensitivity to it.
5. Turn off the water or step out of the shower spray to
give the solution time to activate. Gently wash the area
where your incision will be located for 5 minutes.
6. Turn the water back on and rinse well.
7. DO NOT wash with your regular soap after washing
with the scrub solution.
8. Dry with a fresh clean towel.
9. Put on freshly laundered clothes after your bath and scrub.
10. DO NOT apply any lotions, deodorants, powders
or perfumes to the areas you have washed with
the scrub solution.
11. Please call your physician if you develop any cold
or flu symptoms before surgery (fever, nausea,
congestion, diarrhea, or chills), or any symptoms
of a toothache.
Joint Handbook 27
Preparing
the skin prior
to total joint
replacement
is an important
first step in
preventing
infection.
32. The Morning of Surgery
Repeat the surgical scrub the morning of your surgery.
Please follow these special instructions:
1. Do not shave the leg that will be operated on.
2. Take a shower using the chlorhexidine gluconate
solution provided, scrub from waist to ankle only.
3. Turn off water and gently wash the area where
your incision will be located for five mintues.
4. Turn the water on and rinse well.
5. Thoroughly rinse your skin.
6. Dry with a fresh, clean dry towel.
(Used towels harbor organisms and germs.)
7. Dress in clean clothes.
8. DO NOT apply any lotions, deodorants,
powders or perfumes to the areas you have
washed with the scrub solution.
Do not take any medications unless directed by anesthesia.
Do not drink or eat any additional food or liquids, or water.
Please leave valuables at home. Your jewelry, valuables and
large amounts of money are safest at home. Please do not
bring these items with you to the hospital.
Do not wear makeup. Any makeup must be removed before
your procedure.
28 Joint Handbook
35. EXERCISE AND MOBILITY
Pre-op and Post-op Exercises
Your therapist will tailor exercises to your specific needs.
Only do the exercises that are assigned to you.
� 1. ANKLE PUMPS
Bend both of your ankles up,
pulling your toes toward you, then
bend both of your ankles down,
pointing your toes away from you.
20 reps, 3 times per day.
� 2. QUAD SET
Tighten the muscles on the top
of your thigh by pushing the back
of your knee down into the bed.
Hold for 5 seconds and relax.
20 reps, 3 times per day.
� 3. HEEL SLIDE
Bend your hip and knee by
sliding your heel up toward your
buttocks while pulling on the
band, keeping your heel on the
bed. Hold for 5 seconds and
relax, sliding your heel back down
to the starting position. Keep your
kneecap pointed up toward the
ceiling during the exercise.
20 reps, 3 times per day.
4. BUTTOCKS SQUEEZES
(GLUTEAL SETS)
Tighten your buttocks muscles
by squeezing the muscles
together. Hold for 5 seconds.
20 reps, 3 times per day.
Joint Handbook 31
KNEE
36. 5. SHORT ARC QUAD
Place a foam roller under the
knee. Straighten the leg. Hold
for 5 seconds, then lower down
slowly. The back of your knee
should stay in contact with the
foam roller.
20 reps, 3 times per day.
6. HAMSTRING SETS
Bend your affected knee a little
and tighten the muscle along
the back of your thigh by digging
your heel into the bed. Hold for
5 seconds.
20 reps, 3 times per day.
7. LEG PROP
This may be performed lying
down (pictured) or sitting (not
pictured). Prop your leg under
the ankle with the foam roll or a
rolled towel. Place your icepack
around your knee, and allow
your leg to hang straight. You
will feel a strong stretch behind
your knees. Hold this stretch for
at least 5 minutes and up to 10
minutes at a session.
Repeat 3 times per day.
8. DANGLING
Slide to edge of bed and slowly
lower leg allowing knee to bend.
Foot should not come in contact
with floor.
Repeat 3 times per day.
32 Joint Handbook
KNEE
37. 9. STRAIGHT LEG RAISES
Bend your unaffected leg with
foot flat on the bed. Raise your
affected leg up about 12 inches,
keeping your knee straight. Hold
for 5 seconds. Slowly lower your
leg down and relax.
20 reps, 3 times per day.
10. CHAIR KNEE FLEXION
Keeping your foot on the floor,
slide foot of affected leg back,
bending knee until a good
stretch is felt.
Hold 10 to 15 seconds.
You can also sit in a rocking chair
and rock gently so that your knees
bend and straighten as you rock.
20 reps, 3 times per day.
11. LONG ARC QUADRICEPS
Sitting in a chair, extend your knee
as far as possible, holding for a
count of 5 seconds, then slowly
lower your leg down to the floor.
20 reps, 3 times per day.
12. PRONE KNEE HANG
Lying on your stomach with your
thighs supported by the bed,
allow your knees and legs to
hang off the end of the bed. You
will feel a strong stretch behind
your knees. Hold this stretch for
at least 5 minutes and up to
10 minutes at a session.
Repeat 3 times per day.
Joint Handbook 33
KNEE
38. Pre-op and Post-op Exercises
Your therapist will tailor exercises to your specific needs.
Only do the exercises that are assigned to you.
1. ANKLE PUMPS
Bend both of your ankles up,
pulling your toes toward you, then
bend both of your ankles down,
pointing your toes away from you.
20 reps, 3 times per day.
� 2. QUAD SET
Tighten the muscles on the top
of your thigh by pushing the back
of your knee down into the bed.
Hold for 5 seconds and relax.
20 reps, 3 times per day.
3. BUTTOCKS SQUEEZES
(GLUTEAL SETS)
Tighten your buttocks muscles
by squeezing the muscles
together. Hold for 5 seconds.
20 reps, 3 times per day.
4. HEEL SLIDE
Bend your hip and knee by
sliding your heel up toward your
buttocks while pulling on the
band, keeping your heel on the
bed. Hold for 5 seconds and
relax, sliding your heel back
down to the starting position.
Keep your kneecap pointed
up toward the ceiling during
the exercise.
20 reps, 3 times per day.
34 Joint Handbook
HIP
39. 5. HIP ABDUCTION SLIDE
Slide one leg out to the side.
Keep kneecap pointing up.
Gently bring leg back to pillow.
You may want to use a cookie
sheet under your heel or a
garbage bag on the bed to help
it slide easier.
20 reps, 3 times per day.
6. SHORT ARC QUAD
Place a foam roller under the
knee. Straighten the leg. Hold
for 5 seconds, then lower down
slowly. The back of your knee
should stay in contact with the
foam roller.
20 reps, 3 times per day.
7. HAMSTRING SETS
Bend your affected knee a little
and tighten the muscle along
the back of your thigh by digging
your heel into the bed. Hold for
5 seconds.
20 reps, 3 times per day.
8. LONG ARC QUADRICEPS
Sitting in a chair, extend your knee
as far as possible, holding for a
count of 5 seconds, then slowly
lower your leg down to the floor.
20 reps, 3 times per day.
Joint Handbook 35
HIP
40. PRECAUTIONS AFTER JOINT
REPLACEMENT
After joint replacement surgery, and for the next 6-8 weeks, you
will need to follow the precautions listed below. Please review
and talk to your surgeon or health care team about questions
you may have. Some precautions are suggested long term.
After joint replacement surgery, the goal is to strengthen
the muscles surrounding the joint.
To keep good blood circulation and to prevent blood clots
in your legs:
• Do NOT cross your legs at the knees or ankles.
• While awake, DO stand up and move every 30 minutes
(this will also help with stiffness).
To promote healing, do NOT put a pillow under the knee joint
only. It is okay to elevate your leg by placing the pillow from
your knee to your ankle.
To prevent infection do NOT soak in water (bath, pool,
hot tub, etc.) until your surgeon says you can. It is okay
to shower 24 hours after drainage has stopped.
Total Knee Precautions
• Do not kneel.
• Do not put pillow or bolster under knee.
• Do not pivot on the affected leg. Pick your feet up
and take small steps to turn.
Total Hip Precautions
Care must be taken to prevent your new hip from coming out
of the socket, or dislocating from the pelvis. Following some
simple hip precautions will help keep the risk of dislocation at
a minimum. Your doctor will advise you on how long you may
need to follow these precautions.
• Do not lie on the affected hip.
• Do not allow your affected leg to drop down toward
the bed when lying on your unaffected side.
• Do not cross your legs at knees or ankle.
36 Joint Handbook
41. • When lying down, do not bend forward to pull the blankets
from around your feet. Use a reacher.
• Do not bend at the waist beyond 90 degrees.
• Do not lift your knees higher than your hips.
• Do not pivot on the affected leg. Pick your
feet up and take small steps to turn.
• Do not turn your feet inward or outward – keep your
toes pointing forward in line with your nose.
• Avoid low toilets or chairs that would cause you
to bend at the waist beyond 90 degrees.
• Do not bend way over to pick up things on
the floor – use your reacher.
DAILY ACTIVITIES GUIDELINES
Below are some guidelines to make your daily activities
easier and safer by using adaptive equipment.
Sitting Down in a Chair
1.Back up to the center of the chair until you feel
the chair on the back of your legs.
2. Slide out the foot of the affected leg, keeping the
strong leg close to the chair for sitting.
3. Reach back for the arm rest one at a time.
4. Slowly, lower your body to the chair, keeping the
affected leg forward as you sit.
Standing Up From Chair
Do NOT pull up on the walker to stand!
Sit in a chair with arm rests when possible.
1. Extend your affected leg so the knee is lower
than your hips.
2. Scoot your hips to the edge of the chair.
3. Push up with both hands on the armrests.
If sitting in a chair without armrests, place
one hand on the walker while pushing off
the side of the chair with the other.
4. Balance yourself before grabbing for the walker.
Joint Handbook 37
42. Toileting
• Use a raised toilet seat at or above knee height.
• Sit by using the proper seating technique.
• Do not twist your trunk to wipe, instead reach behind.
Lower Body Dressing: Pants,
Underwear, Socks and Shoes
• Gather your socks and shoes, dressing
aids and walker. Place them within easy
reach.
• Sit on a high, firm chair.
• Wear proper fitting, comfortable clothing.
• Always dress your affected leg first.
• Use devices such as a reacher,
long-handled shoe horn, sock aid
and elastic shoelaces.
How to put clothes on:
1.Lay out your skirt, pants or underwear as you normally would.
2. Sit down. Use the reacher to pinch the waist of the garment.
3. Lower the garment to the floor. First, slip it over
your affected leg. Then slip it over the other leg.
4. Use the reacher to pull the garment up and over your knees.
5. Stand up, with your walker in front of you.
Be sure to keep your balance.
6. Pull the garment up and over your hips.
7. Sit down to button or zip the garment.
How to take clothes off:
1. Sit down to unbutton or unzip your garment.
2. Stand up, with your walker in front of you.
Be sure to keep your balance.
3. Pull the garment down and over your hips.
4. Then push the garment down and over your knees.
38 Joint Handbook
43. 5. Sit down.
6. Lower the garment to the floor using your reacher. Slip it
over the weaker leg first. Then slip it over your stronger leg.
Putting on socks:
1. Place the sock aid into your sock or
stocking. Make sure the heel of your
sock is at the back of the sock aid.
2. Hold the sock aid by the straps with
both hands. First, start with the foot
of your affected leg. While holding the
straps, drop the sock aid to the floor in
front of the foot on your weaker leg.
3. Slip your foot into the sock aid. Then pull on the straps to
pull the sock aid onto your foot.
4. Pull until the sock is up your leg. Keep pulling until the sock
aid comes out of your sock.
5. Follow the same steps to put a sock on the other foot.
Removing socks:
1. Hold your reacher. Slide or push down
your sock along the back of your leg
and heel.
2. Use your reacher to pick up your socks
from the floor.
Shoes:
It is important to have proper fitting shoes
that support your ankles. Elastic shoe laces
will make tying your shoes unnecessary.
To put shoes on:
1. With your reacher, pinch the tongue of the shoe.
2. Then use the reacher to line up the shoe with your toes.
3. Slide your foot into the shoe. You may want to use a
long-handled shoe horn in the back of your shoe.
Joint Handbook 39
44. Getting into Bed
1. Position yourself midway between the foot and head of the bed.
2. Back up to the bed until you feel it on the back of your legs.
3. Reaching back with both hands, sit down on the edge
of the bed and then scoot back toward the center of the
mattress. (Silk pajama bottoms, satin sheets, or sitting
on a plastic bag may make it easier.)
4. Move your walker out of the way, but keep it within reach.
5. Scoot your hips around so that you are
facing the foot of the bed, lifting your
leg into the bed while scooting around.
(If this is your surgical leg, you may use
a leg lifter, cane, belt or your elastic
band to assist with lifting that leg into
the bed.)
6. Keep scooting and lift your other leg into the bed, using
an assistive device. Do not cross your legs to help lift your
leg into bed.
40 Joint Handbook
45. Lying in Bed
1. Keep a pillow between your legs when lying on your
back. Position your leg such that your toes are pointing
to the ceiling – not inward or outward.
2. To roll from your back to your side, bend your knees
slightly, and place a large pillow (or two) between your
legs so that your affected leg does not cross the midline.
Roll onto your side.
When Getting Out of Bed
1. Scoot your hips to the edge of the bed.
2. Sit up while lowering your non-surgical leg to the floor.
3. If necessary, use an assistive device, such as a leg-lifter,
to lower your surgical leg to the floor.
4. Scoot to the edge of the bed.
5. Use both hands to push off the bed. If the bed is too low,
place one hand in the center of the walker while pushing
up off the bed with the other.
6. Balance yourself before grabbing for the walker.
Getting into the Tub Using a Bath Seat
1. Place a rubber mat in your shower or bath
to prevent slipping.
2. Select a bath seat that is tall enough so you do
not bed more than 90 degrees at the hip.
3. Place the bath seat in the tub facing the faucets.
4. Back up to the tub until you can feel it at the back of
your knees. Be sure you are in line with the bath seat.
5. Reach back with one hand for the bath seat.
Keep the other hand in the center of the walker.
6. Slowly lower yourself onto the bath seat,
keeping the surgical leg out straight.
7. Move the walker out of the way, but keep it within reach.
8. Lift your legs over the edge of the tub, using a leg
lifter for the surgical leg, if necessary. Hold onto the
shower seat or railing.
Joint Handbook 41
46. 9. Use long-handled bath sponge and hand held
showerhead to wash your legs and feet.
Note: Although bath seats, grab bars, long-handled bath
brushes and hand-held showers make bathing easier and
safer, they are typically not covered by insurance. Use a
rubber mat or non-skid adhesive on the bottom of the
tub or shower. To keep soap within easy reach, make a
soap-on-a-rope by placing a bar of soap in the toe of a pair
of pantyhose and attach it to the bath seat.
Getting Out of the Tub Using a Bath Seat
1. Lift your legs over the outside of the tub.
2. Scoot to the edge of the bath seat.
3. Push up with one hand on the back of the bath seat while
holding on to the center of the walker with the other hand.
4. Balance yourself before grabbing the walker.
Using a Walker
1. Stand upright and look ahead.
2. Keep walker centered, elbows stay bent.
3. Advance walker 1-2 feet.
4. Step forward with affected leg.
5. Pushing down on walker for support, bring
unaffected leg past the other leg.
6. Repeat above sequence for each step.
CAUTION: Avoid leaning too close to front or
side of walker to avoid tipping. Wear safety
belt if assistance is needed. Tipping can also
result from leaning on your walker. Do not
move your walker too far ahead of you. Be on
guard for wet and slippery areas. Consider a
walker with brakes for safety.
42 Joint Handbook
47. Joint Handbook Joint Handbook 43
Going up Stairs With a Walker
1. Place walker turned sideways with
opening toward you; 2 legs of the walker
on the step you are standing on and 2 legs
on the step you are advancing to.
2. Support your weight through your arms
on your walker and a railing, if available.
3. Bring your “good leg” up the stairs
(unaffected leg leads); then follow with
affected leg to the same step.
“Up with the good”
4. Advance walker to the next step.
5. Use railing whenever possible.
Going Downstairs With a Walker
1. Similarly to going up stairs, again place
walker turned sideways with opening
toward you; 2 legs of the walker on the
step you are standing on and 2 legs on the
step you are advancing to. Support your
weight through the walker and a railing.
2. Your affected leg, or the “bad leg,”
will step down first. “Down with the bad.”
Then your unaffected leg follows.
48. Getting into the Car
1. Position the car seat all the way back; recline the seat back
to get in and out, but always have it in the upright position
for travel.
2. Place a plastic bag on the seat to help you slide.
3. Back up to the car until you feel it touch the back
of your leg.
4. Hold onto an immoveable object (car seat, dashboard)
and slide the affected leg straight. Be careful not to hit
your head as you sit down. Lower yourself to the car seat.
5. Lean back as you lift the affected leg into the car.
You may use your cane, leg lifter or other device to assist.
Around the House
Do not lift heavy objects for the first three months and then
only with your surgeon’s permission.
Kitchen
• Do NOT get down on your knees to scrub floors.
Use a mop and long-handled brushes.
• Plan ahead! Gather all of your cooking supplies
at one time. Then sit to prepare your meal.
• Place frequently used cooking supplied and utensils
where they can be reached without too much bending
or stretching.
• To provide a better working height, use a high stool
or put cushions on your chair when preparing meals.
Bathroom
• Do NOT get down on your knees to scrub the bathtub.
• Use a mop or other long-handled brushes.
44 Joint Handbook
51. AT THE HOSPITAL
Your Surgery
You will be prepared for surgery in your inpatient room. This
includes starting an IV. Your surgical nurses and anesthetist
may interview you. When the surgical team is ready, you’ll be
taken to the operating room. There you’ll be given anesthesia
to help you sleep through surgery, or to make you numb from
the waist down. During the surgery, the damaged bone is
cleaned away, and the new joint is put into place. The incision
is closed with surgical staples. The surgery time varies from
2 to 3 hours. The surgeon will talk with your family when
surgery is over.
What You Need to Know About Anesthesia
Anesthesia is a medicine that blocks the feelings of pain and
sensation during surgery. You will receive other pain medicine
to give you pain relief during and after surgery.
You will meet a registered nurse anesthetist who will review
your medical history and talk with you about your anesthesia
options. Your choice depends on your surgery, your medical
and surgical history, and your physical condition.
The two types of anesthesia used for joint replacement
surgery are general and regional anesthesia.
General anesthesia
Definition: General anesthesia puts you to sleep during
surgery. It acts mainly on your brain and nervous system
and affects your entire body. You receive it through your
IV or by inhaling it. A breathing tube helps you breathe while
you are under anesthesia.
Benefits: General anesthesia is appropriate for longer or
more involved surgery. It may also be used if the position
you’ll be in during surgery is uncomfortable.
Side effects: Minor side effects, such as sore throat,
headache, hoarseness, nausea and drowsiness are the most
common. These side effects usually go away in 1 day.
Joint Handbook 47
The surgery
time varies
from 2 to 3
hours. The
surgeon will
talk with
your family
when surgery
is over.
52. Regional anesthesia
Regional anesthesia blocks sensation to a limited area of
your body. It is usually given with light sedation, which allows
you light sleep while your surgery area is numbed. Spinal
anesthesia can numb the lower half of your body for up to
3 to 4 hours. You receive an injection between the vertebrae.
Benefits: Less medicine is needed so you wake up more
quickly with less chance of nausea. Regional anesthesia
can be less stressful to your heart and lungs than general
anesthesia can be.
Side effects: Minor side effects such as small headaches or
trouble urinating are the most common. These side effects
usually go away a few days after surgery.
Depending on the anesthesia used, you may wake up with
an oxygen mask on. You may also have blurred vision, a dry
mouth and chills. Your nurse will monitor all your vital signs
and help you if you experience any side effects from the
anesthesia.
You may have some discomfort and pain when you awaken.
Everyone has a different pain threshold and reacts to pain
differently. Your nurse will work with you to make you as
comfortable as possible.
Recovering After Surgery
Following surgery, you will be taken to a recovery area where
you may remain for about an hour. Don’t be alarmed if it
takes longer. During this time, pain control is established,
your vital signs will be monitored, and an x-ray will be taken
of your new joint.
You will then be taken back to your room where a nurse will
care for you. Effective pain management will be an essential
part of your recovery. Soon, healthcare providers will help get
you up and moving. It is very important that you begin ankle
pumps every hour on this first day. This will help prevent
blood clots from forming in your legs. You should also being
using your incentive spirometer and doing the deep breathing
exercises you learned in class (see page 53).
48 Joint Handbook
It is very
important that
you begin
ankle pumps
every hour on
this first day.
This will help
prevent blood
clots from
forming in
your legs.
53. You will begin physical therapy twice a day starting the day
of surgery and occupational therapy once a day starting the
day after surgery for the duration of your inpatient stay.
How to Manage Your Pain After Surgery
Managing your pain will be a team effort between you and
your care team. It is important to alert staff when your pain is
starting to increase so that something can be done before your
pain becomes difficult to control. It is also important to let any
of your care providers know what is working and what is not.
Throughout your recovery, take pain medication as directed
prior to increased activity.
Types of pain
Pain can last less than 3 to 6 months (acute), last a long time
(chronic) or be severe and intense (breakthrough). Pain can
come and go with injury, recovery and/or illness.
Your right to pain management
All patients have the right to have their pain managed. Proper
treatment of pain is necessary for you to achieve the best
results during your recovery.
If you do not think that your pain is being treated well, please
tell your nurse or physician. He or she will talk with you about
your pain and your pain management needs.
Pain scale
Using a number scale (zero to 10) to rate your pain will help
the health care team members know the severity of your
pain and help them make decisions about how to manage it.
Joint Handbook 49
CHOOSE THE FACE THAT BEST DESCRIBES HOW YOU FEEL
Don’t wait
for pain to
get worse
before taking
medicine.
Some
medicine
takes up to
30 minutes to
start working.
54. Your role in managing pain
Since you are the only one who knows where and how
severe your pain is, you have an important part in managing
your pain.
If you have pain, tell your nurse or physician.
All of the following information will help your physician(s)
prescribe the right medicine and therapy for your pain, and
avoid serious complications (side effects).
Tell your nurse or physician:
• Where you feel pain and how much pain you have
(use words to describe how the pain feels).
• What makes your pain better or worse.
• What methods of pain control have worked or have
not worked well in the past.
• If you take pain medicines on a regular basis.
• If you have allergies or reactions to pain medicine(s).
• Your goals for managing your pain.
• What vitamins, herbal and natural products you are taking.
• If you smoke.
• If you drink more than two alcoholic drinks each day.
• If you take illegal (street) drugs.
• If you are in a Methadone maintenance program.
Treatments for pain
Managing your pain is more than taking prescription (opioid)
pain medicine. There are many different types of treatments
for pain including medicines, physical therapy, heat or cold,
managing swelling, and others.
50 Joint Handbook
55. Pain medicine side effects
All medicines have some side effects, but not everyone gets
them. When side effects occur, it is usually within a few
hours after taking the medicine. Most side effects can be
managed and go away in time.
Tell your doctor or nurse right away if you have:
• Constipation
• Sleepiness
• Dizziness
• Itching and/or rash
• Nausea and vomiting
• Slowed breathing
• Confusion
Ways pain medicine is given
There are many ways to give medicine for pain. Your doctor
will help you decide which way might be best for you:
• Tablets or pills
• Intravenous (into a vein)
• Transdermal (through the skin)
• Injection
• Nerve block
When medicines are used correctly to manage pain, addiction
rarely occurs. If you have concerns about this issue, please
talk with your nurse or doctor.
Pain control is vital to help your joint heal properly.
The right pain control can help you be more comfortable,
get back to your normal routine and promote healing.
Joint Handbook 51
56. Take pain medicine before your pain begins or when pain first
begins for the first several days after you go home as ordered
by your physician. If you know your pain may get worse with
activity, take your pain medicine before the activity. Don’t
wait for pain to get worse before taking medicine. Tablets or
pills may take up to 30 minutes to begin working.
Before you go home
Your doctor or health care team will give you directions
for managing your pain at home. Be sure to have written
instructions with a health care provider’s name/number
who will manage your pain after you go home.
It is important you follow your doctor’s directions for taking
pain medicine. If you need help, ask your doctor or pharmacist.
If you have concerns or side effects from pain medicine,
call the doctor who prescribed the medicine, or call your
primary physician.
52 Joint Handbook
57. What to Consider About Visitors
The first few days after your surgery are filled with a lot of
activity as you learn how to use your new joint. Your health
care team will balance this activity with rest periods. Family
and friend support is also essential to your healthy recovery
and should be balanced with your rest needs.
The hospital a place for you to rest and recover, so you can
build up your strength to return home. For this reason, you
may prefer to ask visitors to see you and your family after
you go home.
Care Equipment Used After Surgery
After your surgery, you may need to use some special
equipment to help speed your recovery depending on
your surgeon and procedure.
Abductor pillow
An abductor pillow is a triangle-shaped pillow that is strapped
in place between your legs to help prevent hip dislocation
when resting or sleeping in bed.
Cold therapy equipment
An ice pack will be provided for cold therapy on your incision
and new joint. You will be encouraged to ice your joint every two
hours for several days. This will help reduce swelling and pain.
Antiembolism socks/TEDs (white elastic socks)
Antiembolism socks/TEDs stockings (white elastic socks)
reduce the chance of blood clots forming in your legs after
surgery. Because you are not active after surgery, the blood
flow to your legs and feet is reduced. This slower blood
circulation can cause blood clots to form. The stockings
prevent the blood flow from slowing down.
Incentive spirometer
An incentive spirometer is a breathing aid that helps keep
your lungs healthy after surgery. Use it along with your deep
breathing and coughing exercises every hour while awake
Joint Handbook 53
58. after surgery.
Adductor canal pain pump (Total knee surgery)
A femoral pain pump is a small disposable pump filled with
local anesthetic medication to help relieve your pain after
surgery. This pump continuously delivers the medication
through a catheter which blocks the pain in the area of your
procedure.
Sequential compression device (SCD)
A SCD machine may be used to increase circulation and help
prevent blood clots. The SCD consists of plastic leggings.
After the wraps are applied, air is pumped in and then
released. This pumping action helps improve circulation
and prevent blood clots.
Patient Care Plan
A smooth and speedy recovery depends on your help and
cooperation. Your participation is essential in reaching your
goal to return home and avoid complications.
Many patients wonder how long they will need to stay in the
hospital after surgery. Your health care team will work with
you to determine discharge and needs when you return
home.Your hospital stay will follow a specialized care plan
individualized to your needs. The progress you make toward
going home will be measured by how you meet the daily
goals outlines in the plan. These goals include pain
management, activity and preventing complications.
Preventing Complications (Problems)
Your caregivers will do many things to reduce your
chance of developing complications after surgery.
• Your blood pressure, temperature and pulse will be
taken often after surgery.
• Your affected leg will be checked often for movement,
54 Joint Handbook
59. feeling, circulation and pulse.
• To improve circulation and strength, you will do thigh
squeezes, buttock squeezes, ankle pumps and ankle circles.
• You may wear white elastic socks or sequential compression
device to support your muscles, promote circulation and
prevent blood clots.
• You will receive medicine that helps prevents blood clots.
• You will do deep breathing, coughing exercises, and use
an incentive spirometer to help your respiratory system.
• You will be encouraged to be as active as allowed.
• Your dressing will be checked regularly. Depending on the
dressing used by your surgeon, it may be changed daily or
it may not be changed until your follow-up visit. The sutures
or staples are usually removed at your first clinic visit after
you leave the hospital.
• You may have a small tube connected to a wound drain or
collection container. It will draw out excess blood and fluid
from the area around your incision. This small tube will be
removed one to two days after surgery.
• You will have an IV for one to two days. It is important to
drink six to eight glasses of fluid each day.
• Your inactivity and pain medicine combined can cause
constipation. To help avoid this, drink plenty of fluids,
include fiber in your diet, and increase your activity as you can.
Talk to your nurse about bowel concerns if you are
uncomfortable and the actions above aren’t working.
• Avoid touching your incision site, IV site or drainage
tube to prevent infection.
If you have questions about these care activities,
ask your doctor or nurse.
Joint Handbook 55
Keeping your
hands clean
is the number
one way to
prevent the
spread of
infection.
Clean your
hands after
using the
bathroom;
after
sneezing,
blowing
your nose
or coughing;
before eating;
or whenever
your hands
are dirty.
60. Hand Hygiene
While you are in the hospital, you can take an active role
in preventing infections by practicing good hand hygiene.
Keeping your hands clean is the number one way to prevent
the spread of infection. Clean your hands after using the
bathroom; after sneezing, blowing your nose or coughing;
before eating; or whenever your hands are dirty.
• Keep your hands clean. Clean your hands with soap and
water or an alcohol-based hand rub before eating food, after
using the restroom, after blowing your nose, coughing or
sneezing, and before touching your eyes, nose or mouth.
• Remind your healthcare provider to clean their hands before
caring for you. This is especially important if they are
handling a dressing or touching an incision. Clean hands
are still important even if they will be putting on gloves.
56 Joint Handbook
63. CARE AT HOME
When to Call Your Doctor
Once at home, call your primary physician if you have
any of the symptoms below:
• An increase in pain
• Pain or swelling in the calf or leg
• Unusual redness, heat or drainage at the incision site
• Fever of 101° F or higher
• Trouble breathing or chest pain (call 911)
Pain Management at Home
You will likely need to continue to take your medications
for pain as prescribed when you go home. Remember
it is essential to have good pain management to promote
recovery and be able to participate in your therapies.
You may need to take your medication as prescribed
30-45 mintues before your scheduled therapy.
When you see your surgeon for the first follow-up
appointment, discuss a timeline for when you should
wean off prescription pain medication.
When you think you are ready, try substituting Extra
Strength Tylenol®
in place of one dose of narcotic pain
medication. Gradually increase the number of substitutions
until you are no longer taking narcotics.
If you are taking a blood thinner, check with your doctor prior
to taking any other type of pain relievers. Many common,
over-the-counter pain relievers may interact with your blood
thinner and cause problems.
Prevent Constipation
Changes in daily routine, as well as taking narcotic pain
medicine, can result in constipation. Take measures to
prevent constipation before it becomes a problem.
• Eat fiber-rich foods like grains, fresh fruits and vegetables
to help keep your system moving.
Joint Handbook 59
64. • Drink plenty of water. This adds fluid to the colon and bulk
to the stools, making bowel movement softer and easier
to pass.
• Avoid liquids that contain caffeine, such as coffee and
cola drinks. Caffeine flushes your colon of fluids and causes
dehydration. Stools become dryer and harder to pass.
• Avoid alcohol. It also causes dehydration and contributes
to constipation.
• Incorporate a daily walk or two into your exercise routine
to keep your system well-balanced.
• Wean yourself off narcotic medications as soon as possible.
• In the event you do become constipated, use stool softeners
or laxatives such as milk of magnesia, if necessary.
Blood Clots and Anticoagulants
Blood clots after surgery can cause serious problems.
However, there are steps that can be taken to prevent them.
• If directed, wear compression stockings (TEDs).
• Adhere to daily exercises.
• Go for daily walks.
• Take any prescribed anticoagulant or blood thinning type of
medication. This may include Coumadin, Lovenox, or Xarelto.
If taken according to your surgeon’s instructions, anticoagulants
are safe and effective. However, in some cases there may
be warning signs that prompt treatment is needed. If you
fall, have a traumatic injury, or if you experience any of the
following, call your surgeon or primary physician immediately.
DO NOT WAIT AND HOPE THE SYMPTOMS WILL GO AWAY.
• Bleeding or oozing from surgical wound
• Bleeding at the site of an injection
• Nosebleeds
• Blood in your urine
• Coughing or vomiting blood
• Excessive bleeding when brushing your teeth
60 Joint Handbook
65. • Spontaneous bruising (a bruise not caused by a blow or any
apparent reason)
• Pain or swelling in any part of your leg, foot or hip
• Dizziness, numbness or tingling
• Rapid or unusual heartbeat
• Chest pain or shortness of breath
• Vomiting, nausea or fever
• Confusion
Things to avoid while on anticoagulants
Certain medications, foods and activities can interact
negatively with anticoagulants. It is important to take proper
steps to avoid any potential complications.
• Check with your doctor before taking over-the-counter drugs
like aspirin, aspirin-containing compounds, non-steroidal
medications and even vitamins or herbal supplements.
• Be consistent in the amount of dark green leafy vegetables
you eat each day.
• Avoid drinking alcohol while on anticoagulants.
• Postpone any procedures that would cause bleeding
such as dental work, minor surgical procedures, etc.
• Avoid any activity that may result in injury. This includes
such hobbies that use power tools or sharp instruments
that could break the skin.
What to do if you suspect blood clots in the legs
Prompt treatment usually prevents further complications.
• Call your surgeon or primary physician IMMEDIATELY
if there is swelling in your thigh, calf or ankle that does
not decrease if you lie down with your feet elevated
above heart level.
• Contact your surgeon or primary physician if there is pain
and tenderness in the calf of EITHER leg. DO NOT take
a “wait and see if it gets better” attitude. If a clot occurs,
it may be necessary to be admitted to the hospital to
receive intravenous blood thinners for a short period of time.
Joint Handbook 61
66. Pulmonary embolus
A pulmonary embolus is a blood clot that breaks away from
the vein and travels through the blood into the lungs. This can
be life threatening!
• CALL 911 IMMEDIATELY if you experience sudden
chest pain, difficult or rapid breathing, shortness
of breath, sweating or confusion. DO NOT take the
time to call your surgeon.
The best way to avoid a pulmonary embolus is to recognize
and treat any potential blood clots. If you suspect a blood
clot, call your surgeon, primary physician or the emergency
room IMMEDIATELY.
Prevent Infection
Take a proactive approach to prevent infection. Taking proper
care of your incision is the first step. The second step is to
notify your healthcare provider prior to any procedure which
may break the skin. This also applies to any dental procedures.
• During the first two years after knee replacement,
you are susceptible to infection.
• Obtain a prescription for antibiotics prior to any procedure
or dental procedure including dental cleanings. Your
provider will tell you how many doses you need to take.
• If you see a new doctor, be sure to include the joint
replacement surgery in your medical history.
Signs of infection
Infections, although rare, do sometimes occur after surgery.
It is important to note any changes in your incision.
• Some redness, heat, swelling or bruising around the incision
is perfectly normal. Call your surgeon or primary physician if
the redness increases and pain doesn’t subside.
• Report any fever or night sweats to your surgeon or primary
physician.
62 Joint Handbook
67. • Call your surgeon or primary physician if you notice any
signs of infection, such as increase in drainage, if the clear
discharge changes color or if an odor is present.
• Contact your surgeon or primary physician if you notice
an increase in pain (not associated with normal exercise).
Care for Your Incision
• Keep your incision clean and dry.
• Keep your incision covered with a light, dry dressing
until instructed otherwise.
• Do not use lotions, rubs, ointments, etc. on your wound
unless directed to do so by your surgeon.
• Examine your wound daily and notify your surgeon
or primary physician if there is increased drainage,
redness, pain, odor or heat.
• Always wash your hands before touching your incision site.
Changing your dressing
• Your dressing may need to be changed daily. If you have
home health care, the nurse may help change the dressing
for you.
• If you need to change the dressing yourself, first wash your
hands thoroughly with warm soapy water for 20 seconds,
rinse and dry.
• Assemble and open all dressing materials as ordered
by the physician.
• Remove the old dressing pads.
• Examine your incision and notify your surgeon or primary
physician if you notice any signs of infection, such as
increase in drainage, if the clear discharge changes color
or if an odor is present.
• Follow the specific dressing changing instructions.
• If your dressing includes a large dressing pad, pick up the
dressing pad by the corner. Be careful not to touch the part
of the pad that is laid over the incision. This could introduce
bacteria into the wound and cause an infection.
Joint Handbook 63
68. • Cover the incision with the dressing pad. If you had a drain
in place, position one pad crosswise to form a “T” to cover
the opening.
• Secure the pads with tape or according to the discharge
instructions.
Controlling Swelling
Swelling is common after total joint replacement.
It may be worse after exercise. To help control swelling,
follow the steps below.
Ice your knee
Place Active Ice®
gel pack in the joint wrap and place over
your surgical joint. Don’t place ice directly on the skin. Don’t
use ice for more than 20 minutes at a time. You can repeat
the ice process as directed in your discharge instructions.
Elevate your leg
Elevate your leg above your heart. Ask your healthcare
provider about safe positions to do this. Do not place pillow
directly under knee.
Do ankle pumps
Continue doing ankle pumps (see page 31 for diagram). They
help reduce swelling, improve circulation, and prevent blood
clots. Point, then flex both feet slowly. Repeat this 10-30
times each hour.
Frequently Asked Questions
When will swelling go away?
The majority of swelling will be gone in 6-12 months.
An increase in activity may increase swelling.
Why does my joint click?
Some popping or clicking is normal. The metal and plastic
components of the artificial knee can make some noise.
When will the numbness go away?
Some numbness is normal after joint replacement surgery
as sensory nerves are interrupted due to the incision.
This will improve, but a small area may remain.
64 Joint Handbook
69. How long will I be on pain medication?
You will likely require some form of pain medication for
about three months. Initially, you will be on a narcotic pain
medication. Most people are able to wean off their strong
pain medication after one month, and then are able to switch
to Tylenol®
, in consultation with your physician.
Can I sleep on my side?
Yes, when it is comfortable. If you’ve had a hip replacement, do
not lie on the affected hip. Place a pillow between your knees.
How long will I have to wear my TEDS if they are prescribed?
Expect to wear them for about a month, unless otherwise
advised by your surgeon.
When can I use a cane?
Most people begin use of a cane two or three weeks after
surgery and many do not use an assistive device after four
to six weeks.
How often should I ice my joint?
Icing your joint 15-20, minutes a few times per day,
will help reduce pain and swelling.
How do I know if I have an infection?
Warning signs of infection are: persistent fever, chills,
drainage from wound, increased redness, tenderness,
or swelling of the wound.
Why is my joint so stiff?
Fluid and swollen tissue take up space around the joint
and impede motion. This usually subsides within 3-6 weeks.
Pain may also inhibit motion.
When can I shower or get my incision wet?
At home, you may shower 24 hours after drainage stops.
When drying, pat the area with a clean, dry towel. Do not rub.
When can I immerse my joint in a bathtub or swimming pool?
Generally, around four weeks after surgery.
When do I get my staples out?
Approximately two weeks after surgery.
When will the pain go away?
Sharp pain gradually subsides and is replaced with a deeper,
more achy pain. Ice, elevation and pain medication help.
Joint Handbook 65
70. What can I do about constipation?
This is a very common issue following surgery and is
aggravated by narcotic pain medications. Stool softeners
may be the best prevention. Ask your surgeon or primary
physician if the problem continues.
What can I do about insomnia?
This is a very common complain following joint replacement
surgery. Taking your pain medications regularly and icing
often will help. As some time passes after surgery you
will generally begin to sleep better. You may contact your
physician if you have concerns.
How much range of motion do I need?
Everyone’s range of motion varies and depends on individual
factors. We will be working towards 0-120 degrees for knees
and 90 degrees for hips to allow for normal walking and posture.
Is bruising normal?
Bruising amounts vary. It is normal around the joint.
Follow up with your doctor if bruising increases.
66 Joint Handbook
71. Redwood Area Hospital
100 Fallwood Road
Redwood Falls, MN 56283
(507) 637-4500
redwoodareahospital.org
1431 Premier Drive
Mankato, MN 56001
(507) 386-6600
ofc-clinic.com
72. Redwood Area Hospital
100 Fallwood Road
Redwood Falls, MN 56283
(507) 637-4500
redwoodareahospital.org
1431 Premier Drive
Mankato, MN 56001
(507) 386-6600
ofc-clinic.com
