- [Narrator] Welcome to the Joint Replacement Class
at TriStar Centennial Medical Center.
The first portion of this class will be taught
by an orthopedic nurse navigator or educator
and the second portion of this class will be taught
by a member of our physical therapy team.
Our program mission statement is to become
the best joint replacement center in the nation
by providing our patients passionate care
while achieving exceptional outcomes
through the use of research- and evidence-based practices.
Today we're going to educate you
on total joint replacement surgery
and share some expectations of before and after your surgery
in hopes of alleviating any stress or anxiety
you may be feeling.
If you have any questions,
please notify your surgeon's office.
In preparation for your surgical procedure,
you must be cleared medically,
listen to the joint education class
and go through pre-admission testing.
While going through pre-admission testing,
you will receive a special cleanser.
This cleanser is to be used
the night before your surgical procedure
and the morning of your surgical procedure,
unless instructed differently.
The cleanser comes with a new, clean loofah
that is to be used to apply the cleanser.
Please do not use an old wash cloth.
Use the cleanser from head to toe,
keeping it out of your eyes, ear canals and mouth.
When drying off after using the cleanser,
please use a clean, fresh towel.
Once you are dry, do not apply any lotions,
creams, makeup or powder to your skin.
The cleanser pack will come with detailed instructions
and a diagram on how to use.
Remove any nail polish and acrylic from your fingernails.
Do not write on your legs.
Your surgeon will initial
the surgical site in the holding room.
No eating or drinking after midnight
the day before your surgical procedure.
You will be given a bottle
of Ensure Pre-Surgery Clear Nutrition drink
during pre-admission testing
to drink the morning of your surgery.
Please drink it before you arrive at the hospital.
The drink helps your body prepare for
and recover from surgery.
If you are lactose intolerant,
on a gluten-free, kosher or halal diet,
you may consume the Ensure Pre-Surgery drink.
Please contact your surgeon's office
with any additional questions.
Please identify a coach or caregiver
that can actively participate with your care after surgery.
You will have medications in your system
that can prevent you from remembering
the post-operative education
your navigator will review with you.
Also, it is important for your coach or caregiver
to be present during your physical therapy
and occupational therapy sessions
which occur the day of your surgical procedure
and the morning after your surgical procedure.
Their presence will help facilitate
a smooth and safe transition from a hospital setting
to an in-home setting.
Whether it be a family member or friend,
please have transportation set up
to carry you from the hospital to your home.
Discharge planning starts in your physician's office
before you are admitted to the hospital
for your surgical procedure.
What this means is once discharged from the hospital,
most of our patients attend outpatient physical therapy.
Please get a preferred list from your surgeon's office
and select one of your choice.
Please visit where you plan to attend
outpatient physical therapy and set up your appointments.
Ask your surgeon's office what day
to set up your first appointment
and how many sessions to set up per week.
Admission to a rehab facility is less likely
in single joint replacements
and most patients go home the day after surgery.
If a facility is necessary for you,
your surgeon will let you know.
We ask you to bring several things with you
on the day of your surgery.
Please bring your educational booklet
that you receive from your surgeon's office.
We will continue to add additional education to the booklet.
Please bring loose-fitting, comfortable clothing.
Clothing that works well would be shorts and a t-shirt,
gown with robe and loose fitting pajama pants.
Remember to bring clothing
that you are comfortable wearing in the hallways
where you will be walking.
Please bring your own personal preferred hygiene items.
If you forget, we do have shampoo, soap,
toothbrush and toothpaste.
If you wear a home C-pap machine while sleeping,
please bring it along with the tubing and mask.
We will provide distilled water.
Bring a copy of your living will
and durable power of attorney for healthcare.
If you have a rolling walker which has rolling wheels
in the front and tennis balls or skis in the back,
please put your name on it and bring it to the hospital.
If you do not have a rolling walker
and you have not had a piece of medical equipment
covered by insurance in the past five years,
your inpatient case manager can order you a rolling walker
to be delivered to your hospital room
before you are discharged home.
You may also purchase a rolling walker
at a medical supply company before your surgery
and bring it to the hospital day of your surgery.
Please put your name on your walker.
Please bring a list of the medications
you are currently taking.
Have the name, dosage and how often
you take the medications written down.
Also include a list of your allergies.
Please leave your jewelry, large amounts of money
and valuables at home.
Only debit and credit cards, no cash,
are being accepted throughout the hospital
to help contain the spread of germs.
On the day of surgery, you may park in garage B,
which is located on the corner
of Patterson Street and 23rd Avenue.
You may park on levels B1 through B3.
Enter the hospital via the connector located on level B3.
Follow the connector to the hospital entrance
where COVID-19 screening is currently set up.
After being screened and cleared to enter,
you will be given a green armband.
One support person will be allowed
to enter the hospital with you after being screened as well.
Continue down the hallway to the elevators
which are to be taken to the eighth floor.
Please arrive on the eighth floor pre-op
at the instructed time on the day your surgery is scheduled.
The eighth floor pre-op is in
Centennial Medical Center's main tower.
A nurse will escort you to a pre-op room
where they will take vital signs, review records,
and you will change into a gown.
Questions will be asked repeatedly by different caregivers
such as, what is your name, date of birth,
and what procedure are you having done?
This is for your safety.
While in the holding room,
oxygen will be placed by nasal cannula,
an IV will be started, your surgeon will speak to you,
anesthesia will speak to you,
and medications will be given to help you relax
and some for post-operative pain and nausea.
After surgery, you will recover in the PACU,
which is the Post Anesthesia Care Unit.
You will be in this unit from one hour up to four hours.
Your nurse in the PACU
will administer pain medications if needed.
If oral pain medications are needed,
a snack provided by your nurse is to be eaten
before these medications are administered.
Oral pain medications taken on an empty stomach
cause nausea and vomiting.
Your nurse will monitor vital signs
and check surgical dressings and drains.
Your nurse will ask you to cough and deep breathe
to exercise your lungs and to begin performing ankle pumps.
Ankle pumps are simply pushing your toes down
and pulling back up.
It is the same motion you do
when pressing a gas pedal in a car.
You will be asked to do 10 ankle pumps
every hour you are awake.
This motion promotes good circulation.
Once you are ready to leave the PACU,
you will be transferred to the Orthopedic Nursing Unit
located on the seventh floor.
Family will be waiting for you to arrive
in your assigned room.
Once in your room, your vital signs will be checked
and your pain level will be monitored routinely.
Exercises and mobility begin day of surgery.
You will be on a clear liquid diet.
Once your body can tolerate a clear liquid diet,
then your nurse will advance you to a regular diet.
The Orthopedic Unit is a room service unit.
You will be given a food menu
with the room service number printed on the front.
Please call this number to order each meal.
If you do not call to order your meal,
you will not receive a meal.
Again, it is very important to get regular food
in your stomach before you are given oral pain medications.
Oral pain medications can be given once you have eaten.
Pain medication is very constipating
so stool softeners will be started at bedtime.
Continue performing ankle pumps
10 times every hour you are awake,
which is pressing your toes down and pulling back up.
It is the same motion you do
when pressing the gas pedal in a car.
An incentive spirometer will be provided.
It is a device you breathe or suck in at the mouthpiece
10 times every hour you are awake.
The purpose of the incentive spirometer
is to promote deep breathing
and filling your lungs with air,
which will aid in preventing post-operative pneumonia.
Please use the incentive spirometer
while you are in the hospital
and after discharge from the hospital.
Pain management is very important after surgery.
You have been managing an arthritic type pain
and now we will be managing post-operative pain.
Your nurse will ask you to rate your pain
on a numeric pain scale with zero being no pain
ranging to 10 being the worst pain you have ever felt.
Please be open and honest with your nurse
when rating your pain.
It is critical for the management of your pain.
You should be medicated every four hours as needed.
The last time you received pain medication
will be displayed on your hospital television.
Please remember it is important to stay ahead of the pain.
Our goal for you is comfort.
We want to minimize your pain
to tolerate movement and therapy
but we cannot promise to take all your pain away.
Pain, inflammation and bruising is to be expected
after joint replacement surgery.
Post-op day one is the day after surgery.
This is the day most of our patients discharge home.
This is a very busy day.
When you wake up, make sure your breakfast has been ordered.
This can be done the night of your surgery
or the following morning when you wake up.
Your nurse will come in and remove your oxygen
if it hasn't been removed already.
Your IV will be disconnected from IV fluids.
Your foley catheter will be removed if one is placed.
If you had your knee replaced,
your nurse will remove the surgical bandage
and apply a waterproof bandage that stays in place
over your incision for seven days.
This bandage is safe to shower in.
You may not soak or submerge your incision in water.
If you have your hip replaced,
the waterproof bandage that remains
over your incision for seven days
is placed in the operating room after surgery.
This bandage is safe to shower in.
You may not soak or submerge your incision in water.
All patients will be given
two emergency bandages to take home.
Once your waterproof bandage is in place
and the drains removed if placed,
you can shower or sponge bathe and put your clothes on.
Your breakfast will arrive between 7 am and 8 am.
Please eat your breakfast
and take your oral pain medication.
Physical therapy and occupational therapy
will come work with you after breakfast.
After the completion of therapy and you have been cleared
for discharge by your surgeon and the hospitalist,
your nurse will review your hospital paperwork
for you to sign and help you pack up your belongings.
A transporter will take your from your hospital room
down to your ride home in a wheelchair.
When you arrive home,
continue using you incentive spirometer,
doing your ankle pumps and staying ahead of your pain
by taking your pain medications every four hours as needed.
- [Narrator] Pre-operative joint replacement education.
Welcome to the physical therapy portion
of the pre-op joint replacement education.
Once your surgery is complete,
faithful physical therapy
and closely following the guidelines
that your surgeon set out for you
are the most important parts of your recovery
and you did not come this far to not go the distance.
Why do I need a joint replacement?
By the time you schedule a joint replacement surgery,
you've usually been dealing with pain for a long time
and have exhausted your other options for relief.
You have not reached this point lightly.
We are excited to be part of your journey
to an improved quality of life.
As we move through this part of the presentation,
please keep in mind that every patient, joint,
surgery and surgeon is different.
This is an overview and your specific surgeon
might have different instructions for you.
If that is the case, please do as they say.
Joint replacements are considered an elective surgery
which means that your surgeon expects
you to have prepared everything you need
for a safe recovery in advance.
That is an important purpose of this presentation.
We want you to have time to get
everything you will need ready.
This includes making sure that you have a ride
to and from the hospital ready for when you're discharged,
making sure you have rides to and from
your upcoming physical therapy appointments
as you'll not be able to drive immediately,
making sure that you have people available at home
with you to assist meeting your needs after surgery,
making sure you have equipment
you'll need to recover safely,
and making sure you've prepared your home
with any adjustments necessary
such as installing grab bars in the bathroom,
improving lighting or removing throw rugs.
Again, the expectation is that all of these things
are finished before your surgery
in order to have the best recovery possible.
Here we have a diagram of the hip joint.
Here we have a diagram of the knee joint.
What can you expect in the hospital for physical therapy?
- Initiated day of surgery if up to floor by 6PM
- Completed twice a day until day of discharge
- Day of discharge, group therapy in AM
- Initiated on the day of surgery and once a day until day of discharge
[End slide contents]
If your surgery is finished
and you are appropriate for therapy by 6 pm,
you can expect to see the physical therapist
and the occupational therapist together.
It is not uncommon for patients
to have a fuzzy recollection of this therapy session
which is why it's incredibly important
to have your coach or your advocate
present with you and available to take notes,
ask questions and track what's going on.
Depending on how the patient is doing,
that therapy session might simply include
standing up and walking to the bathroom,
or walking in the hallway.
It might also include performing the car transfer
and stair training in the rehab gym.
These will be performed prior to discharge
by each patient, so if they're not done at the first session,
then they'll be done the following morning
or at the next session.
Hip and knee replacement patients should expect
physical therapy sessions twice each day
there in the hospital just like the two sessions
we expect patients to perform on their own at home daily
once they've left the hospital.
Goals prior to discharge from the hospital.
Please keep in mind that our physical therapy
is patient-specific, so our goals
will be tailored to each individual patient.
For example, if you have not walked 100 feet
on your own in the past year,
we will make sure that your goal is appropriate for you.
That said, we want to make sure
each patient is safe for discharge.
We would love for you to be able
to walk 100 feet using your rolling walker.
We would love for you to be independent
with any surgical precautions that we might find out about
after surgery such as weight baring status changes.
We would love for you to be independent and safe
with your bed mobility and commode transfers.
We would love for you to be able to complete
the education on stair training, car transfers,
getting in and out of the bathtub,
and we would also love for you to be independent
with your basic home exercise program.
All of these things will take place
before leaving the hospital.
Prior to surgery.
In terms of physical therapy,
one of the most important considerations after surgery
is a patient's safety getting around.
Walking, standing, sitting.
Goal number one is reducing the risk of falls.
So number one, make modifications.
As soon as you complete this presentation,
I want you to pretend that you are being driven home
from the hospital after your surgery.
From the time you pull up to your home,
I want you to visualize each step that you will have to take
in order to get from the vehicle into your home and settled.
I want you to identify any fall risks
so that you can address them before your surgery.
The goal is not to overwhelm you with this process
but rather to encourage you to be proactive.
I'll talk you through some thoughts to consider.
Remember, you are using a rolling walker to get around.
If you have difficulty
getting in and out of your vehicle now,
it will likely be more challenging after your surgery
so think about your options.
Are you able to bring a different vehicle to the hospital?
Are you able to borrow one?
How many entrances do you have to choose from
in order to get into your home?
The one that you use now might not be
the easiest and safest one after surgery.
Which is the safest entrance to use after surgery
when you have the rolling walker?
Do you have to go up any steps?
If so, how many steps are there?
How stable are they?
Do you have any handrails that you can use?
Are there handrails on both sides of you or just one?
You might need to consider installing grab bars
or handrails if not.
If that is not an option, make sure you plan ahead
and perhaps have some additional folks at your house
or your home when you arrive
in order to assist you getting inside safely.
Make sure the people that are helping
are not at risk of injury themselves.
Next, make sure you temporarily remove
any welcome mats or throw rugs to reduce your fall risk.
You'll be using the rolling walker
so you wanna make sure to remove all obstacles
because you want a clear pathway through your home.
Are you able to fit the rolling walker into the bathroom?
Think about sitting down and standing up from the toilet.
Do you have grab bars or maybe a stable piece of furniture
like a vanity to push up from?
Do you have a walk in shower
or will you need to get your leg
over a bathtub in order to take a shower?
Regardless of your setup, a stable chair
or preferably a bench for the shower, is helpful.
Is your bed high up off the ground?
Will you need a stable stool in order to get into bed?
Do you have an alternative option
in case your bed is not a safe height?
In general, you want to avoid low chairs,
soft chairs, and chairs that do not have good arms,
or armrests, to push up from.
If you complete this exercise and realize
that your home is not a safe place to recover,
think about your other options.
Is there someplace else you could recover temporarily?
The important thing is that you can work on this now.
Number two, arrange for assistance at home.
It is a much better plan to have more assistance
and more support lined up then you actually need,
than to realize after surgery that you need more help
and need to request it.
Number three, arrange for transportation as needed,
especially to and from your physical therapy appointments.
Again, our goal is to reduce the risk
of falling after surgery.
We want our joint replacement patients
to use a rolling walker, very basic,
very standard, nothing fancy.
We just want the wheels in the front
and two prongs in the back.
We do not want patients to use a rollator,
or a walker with four wheels.
Those are too unstable.
Patients should expect to stay on the walker
for a minimum of two weeks if they're a knee patient
and one week if they're a hip patient.
However, patients should not
discharge themselves unilaterally from using a walker.
If you feel like you're ready,
then you should talk with your outpatient physical therapist
and the two of you make that decision together.
A rolling walker is only helpful if you use it.
This means both hands are on the rolling walker
in case you need to stabilize yourself for any reason,
which also means that you are not going to carry
a plate of food and a glass of water
from the kitchen to the living room dining room.
This is why we want someone to be there to help you.
There are strategies, like putting a bag or a basket
on the walker to help you get items
from one room to another.
We want you to know that everything you see in the movies
with the walkers is wrong.
We don't want you to stand
with them really far out in front of you
and we don't want you to pick them up off the ground.
Think of the walker as an extension of your body.
It's gonna move with you.
You want to stand tall with good posture.
You want your hips to be in line with the back prongs
of the walker and your body is staying in the little box.
The rolling walker is not helpful
if you walk into a room and leave it by the doorway,
which I've seen plenty of folks do.
Please use your rolling walker all the time
until you and your therapist decide
that you don't need it anymore.
It's very important that you have the rolling walker
in the vehicle transporting you from the hospital home
in case you need to get out of the vehicle
for any reason on your way home.
If you are planning to bring a rolling walker from home,
go ahead and put it in your trunk today
so that you don't forget it.
However, we do not want you to bring the walker
into the hospital.
For infection control, please leave it in your vehicle.
At the hospital, you'll use a rolling walker
that belongs to us.
If you're planning to borrow a walker
from a friend or relative or if you have one
up in the attic or down in the basement,
please go ahead and get it out soon
to make sure that it still works,
especially if it's 40 years old
and your grandmother used it.
We need for you to make sure that it is still safe to use.
Not having an appropriate rolling walker
can cause delays leaving the hospital
so please make sure the one that you're using is safe.
If you don't have one and are planning to get it
through insurance at the hospital,
we will make sure that you have it before you leave.
- Borrow or purchase from pharmacy
- Straight handle
- Adjustable Height
- Therapist will progress you from walker to cane
- Used on opposite side of surgical leg
[End of slide contents]
Knee replacement patients usually progress to a cane
with instruction from their outpatient physical therapist.
Cryotherapy for knees, Polar Pak.
- Freeze 8 water bottles (change every 6-8 hours)
- Run continuously when not walking/showering/therapy three times a week.
- Use gel pack/ice pack behind knee.
- Layer of protection between pad and skin (thin towel or pillow case)
- How to get to bathroom with all this on?
[End of slide contents]
Before I talk about the Polar Pak,
I wanna share with you some guidelines
that you are going to follow once you get home.
These guidelines will be reviewed with you
in the hospital as well.
During the day, make sure that you get up and walk around
five minutes out of every hour the first week after surgery
and 10 minutes every hour the second week after surgery.
Now again, this is during the day.
We want you to sleep through the night if you can.
Once you're done walking around,
we want you to perform your hourly exercises.
By that, we mean 10 ankle pumps,
where you put your foot on the gas,
10 glut squeezes, where you tighten up,
or you squeeze your butt muscles together,
10 knee presses where your leg is extended
as straight and you are pushing your knee down
into the bed or the sofa, wherever you are.
We also want you to do 10 breathing exercises
with the incentive spirometer
that you'll get at the hospital.
When you're finished, we want you to ice your surgical leg
and rest with your legs elevated
until you get up and walk around again the next hour.
If you're a knee patient, when you're resting,
we want you to make sure that your knee is straight.
We don't want it to be bent.
It always needs to be straight
or extended when you're resting.
Never put a pillow under your surgical knee.
This is very important.
Also, make sure that your legs are elevated
when you're not walking around in order to reduce swelling.
In addition, make sure that you spend 30 minutes
three times each day with your surgical leg
elevated above your heart.
The easiest way to accomplish this
is usually for your upper body to be flat
with you lying down and your surgical leg
above your heart supported by a pillow,
perhaps a wedge pillow.
Walking, hourly exercises, elevating, resting,
and icing are all critical components of your recovery.
Cryotherapy for knees, the Polar Pak.
If you're a knee patient, you'll be provided
a Polar Pak to use at home.
The Polar Pak has very clear and detailed instructions
on the lid and there are pictures
included in those instructions.
Make sure you do not put the white part of the pad
in direct contact with your skin
in order to avoid irritation.
We always want a clean barrier between the pad and the skin.
Leave the Polar Pak on at night
and any time you're not up walking around.
Be very careful, however, to take the Polar Pak
off your leg prior to standing up
in order to reduce the risk of a fall.
This is especially important to consider at night
if you need to get up and use the bathroom
because you'll likely be tired and groggy.
You might be wearing an immobilizer brace
if that is something that your surgeon asks you to do.
So, make sure that you take the Polar Pak off
before you walk around.
Cryotherapy for hips.
Hip patients are also expected to ice their surgical leg
however, a Polar Pak will not be provided.
Please have ice packs
already in the freezer before your surgery.
Hip patients should also provide a clean barrier
between their skin and the ice pack.
Six week goals.
Number one, walk without a limp or an assistive device.
Number two, be able to perform a single leg stance
on your surgical side for 10 seconds.
Number three, be able to perform reciprocal stairs
with or without the use of a rail.
Number four, be able to perform a sit to stand
from a chair without pushing up from the arms.
And if you're a knee patient,
be able to achieve active range of motion
which means that you are bending your knee,
the therapist is not bending your knee,
active range of motion of zero to 120 degrees.
That means your knee is straight and flat
at zero degrees and you get a bend of 120 degrees
back towards your bottom.
- Go beyond walking/standing limitations
- No pillows under surgical leg
- Get on treadmill for six weeks
- Use weight machines for three months
- Leg weights over 2# for six weeks
- Leg weights over 5# for three months
- No resistance on cardo for three months.
[End of slide contents]
Basically, we don't want you to go rogue
and we don't want you to do too much too soon.
It is absolutely possible to do too much too soon
after your surgery and we want to avoid that.
Please stick closely to the plan
that your surgeon and therapist have given you for recovery.
It might seem very simple and therefore not important
but following this plan can help avoid
Five minutes of walking and standing each hour
for the first week means just that.
It doesn't mean 20 or 30 or 50 minutes walking and standing.
Unfortunately, we have plenty of stories
of patients who decided to cook Thanksgiving dinner
or they went to a party and they felt great
standing up for hours only to wake up the next day
unable to walk due to swelling.
These patients have even asked us
to share their experiences with you
so that y'all don't have to go through what they did.
If you are wanting to get back to a specific activity,
please don't just start back on your own without consulting
your outpatient physical therapist or your surgeon.
If it is not on your list of physical therapy exercises,
we don't want you to be doing it
without specific permission.
You should, however, be performing
your physical therapy exercises from
your outpatient therapist one time every morning
and one time every afternoon.
So that's two physical therapy sessions every day
and on the days that you go to the outpatient clinic,
that counts as one session and you would then do
only one more session on your own
at home for a total of two.
The big key is to not overdo.
- Call your Orthapaedic Clinic PT if knee AROM is not 5-105 degrees by 3 weeks
Call us if you or your therapist has questions about Pain medicine or you
have issues such as:
- Begin scar massage 21 days post op. Continue for three months.
[End of slide contents]
We do want you to communicate
any concerns that you have immediately.
Thank you so much for your time.
We wish you the best and we're excited to see you.
Thanks for listening.