Virtual joint class transcript

00:00

- [Narrator] Welcome to the Joint Replacement Class

00:02

at TriStar Centennial Medical Center.

00:05

The first portion of this class will be taught

00:07

by an orthopedic nurse navigator or educator

00:10

and the second portion of this class will be taught

00:12

by a member of our physical therapy team.

00:16

Our program mission statement is to become

00:18

the best joint replacement center in the nation

00:21

by providing our patients passionate care

00:24

while achieving exceptional outcomes

00:26

through the use of research- and evidence-based practices.

00:30

Today we're going to educate you

00:32

on total joint replacement surgery

00:34

and share some expectations of before and after your surgery

00:38

in hopes of alleviating any stress or anxiety

00:41

you may be feeling.

00:42

If you have any questions,

00:44

please notify your surgeon's office.

00:48

In preparation for your surgical procedure,

00:50

you must be cleared medically,

00:52

listen to the joint education class

00:55

and go through pre-admission testing.

00:57

While going through pre-admission testing,

01:00

you will receive a special cleanser.

01:02

This cleanser is to be used

01:03

the night before your surgical procedure

01:05

and the morning of your surgical procedure,

01:08

unless instructed differently.

01:10

The cleanser comes with a new, clean loofah

01:12

that is to be used to apply the cleanser.

01:15

Please do not use an old wash cloth.

01:18

Use the cleanser from head to toe,

01:20

keeping it out of your eyes, ear canals and mouth.

01:25

When drying off after using the cleanser,

01:27

please use a clean, fresh towel.

01:30

Once you are dry, do not apply any lotions,

01:33

creams, makeup or powder to your skin.

01:38

The cleanser pack will come with detailed instructions

01:41

and a diagram on how to use.

01:44

Remove any nail polish and acrylic from your fingernails.

01:48

Do not write on your legs.

01:50

Your surgeon will initial

01:51

the surgical site in the holding room.

01:54

No eating or drinking after midnight

01:56

the day before your surgical procedure.

01:59

You will be given a bottle

02:00

of Ensure Pre-Surgery Clear Nutrition drink

02:04

during pre-admission testing

02:06

to drink the morning of your surgery.

02:08

Please drink it before you arrive at the hospital.

02:12

The drink helps your body prepare for

02:14

and recover from surgery.

02:16

If you are lactose intolerant,

02:18

on a gluten-free, kosher or halal diet,

02:21

you may consume the Ensure Pre-Surgery drink.

02:24

Please contact your surgeon's office

02:26

with any additional questions.

02:30

Please identify a coach or caregiver

02:32

that can actively participate with your care after surgery.

02:36

You will have medications in your system

02:38

that can prevent you from remembering

02:40

the post-operative education

02:42

your navigator will review with you.

02:44

Also, it is important for your coach or caregiver

02:47

to be present during your physical therapy

02:49

and occupational therapy sessions

02:52

which occur the day of your surgical procedure

02:54

and the morning after your surgical procedure.

02:57

Their presence will help facilitate

02:59

a smooth and safe transition from a hospital setting

03:03

to an in-home setting.

03:06

Whether it be a family member or friend,

03:08

please have transportation set up

03:10

to carry you from the hospital to your home.

03:15

Discharge planning starts in your physician's office

03:17

before you are admitted to the hospital

03:19

for your surgical procedure.

03:22

What this means is once discharged from the hospital,

03:25

most of our patients attend outpatient physical therapy.

03:28

Please get a preferred list from your surgeon's office

03:31

and select one of your choice.

03:33

Please visit where you plan to attend

03:35

outpatient physical therapy and set up your appointments.

03:39

Ask your surgeon's office what day

03:41

to set up your first appointment

03:43

and how many sessions to set up per week.

03:47

Admission to a rehab facility is less likely

03:50

in single joint replacements

03:52

and most patients go home the day after surgery.

03:55

If a facility is necessary for you,

03:58

your surgeon will let you know.

04:01

We ask you to bring several things with you

04:03

on the day of your surgery.

04:05

Please bring your educational booklet

04:07

that you receive from your surgeon's office.

04:09

We will continue to add additional education to the booklet.

04:13

Please bring loose-fitting, comfortable clothing.

04:16

Clothing that works well would be shorts and a t-shirt,

04:19

gown with robe and loose fitting pajama pants.

04:23

Remember to bring clothing

04:24

that you are comfortable wearing in the hallways

04:26

where you will be walking.

04:28

Please bring your own personal preferred hygiene items.

04:31

If you forget, we do have shampoo, soap,

04:35

toothbrush and toothpaste.

04:37

If you wear a home C-pap machine while sleeping,

04:40

please bring it along with the tubing and mask.

04:44

We will provide distilled water.

04:47

Bring a copy of your living will

04:49

and durable power of attorney for healthcare.

04:52

If you have a rolling walker which has rolling wheels

04:55

in the front and tennis balls or skis in the back,

04:58

please put your name on it and bring it to the hospital.

05:01

If you do not have a rolling walker

05:03

and you have not had a piece of medical equipment

05:06

covered by insurance in the past five years,

05:09

your inpatient case manager can order you a rolling walker

05:13

to be delivered to your hospital room

05:15

before you are discharged home.

05:17

You may also purchase a rolling walker

05:20

at a medical supply company before your surgery

05:23

and bring it to the hospital day of your surgery.

05:26

Please put your name on your walker.

05:30

Please bring a list of the medications

05:32

you are currently taking.

05:34

Have the name, dosage and how often

05:37

you take the medications written down.

05:40

Also include a list of your allergies.

05:44

Please leave your jewelry, large amounts of money

05:47

and valuables at home.

05:49

Only debit and credit cards, no cash,

05:52

are being accepted throughout the hospital

05:54

to help contain the spread of germs.

05:59

On the day of surgery, you may park in garage B,

06:02

which is located on the corner

06:03

of Patterson Street and 23rd Avenue.

06:06

You may park on levels B1 through B3.

06:10

Enter the hospital via the connector located on level B3.

06:15

Follow the connector to the hospital entrance

06:17

where COVID-19 screening is currently set up.

06:20

After being screened and cleared to enter,

06:23

you will be given a green armband.

06:25

One support person will be allowed

06:27

to enter the hospital with you after being screened as well.

06:31

Continue down the hallway to the elevators

06:34

which are to be taken to the eighth floor.

06:39

Please arrive on the eighth floor pre-op

06:42

at the instructed time on the day your surgery is scheduled.

06:47

The eighth floor pre-op is in

06:49

Centennial Medical Center's main tower.

06:53

A nurse will escort you to a pre-op room

06:56

where they will take vital signs, review records,

06:59

and you will change into a gown.

07:02

Questions will be asked repeatedly by different caregivers

07:06

such as, what is your name, date of birth,

07:09

and what procedure are you having done?

07:11

This is for your safety.

07:15

While in the holding room,

07:16

oxygen will be placed by nasal cannula,

07:19

an IV will be started, your surgeon will speak to you,

07:24

anesthesia will speak to you,

07:26

and medications will be given to help you relax

07:29

and some for post-operative pain and nausea.

07:33

After surgery, you will recover in the PACU,

07:36

which is the Post Anesthesia Care Unit.

07:39

You will be in this unit from one hour up to four hours.

07:43

Your nurse in the PACU

07:45

will administer pain medications if needed.

07:48

If oral pain medications are needed,

07:50

a snack provided by your nurse is to be eaten

07:53

before these medications are administered.

07:56

Oral pain medications taken on an empty stomach

07:59

cause nausea and vomiting.

08:03

Your nurse will monitor vital signs

08:05

and check surgical dressings and drains.

08:08

Your nurse will ask you to cough and deep breathe

08:11

to exercise your lungs and to begin performing ankle pumps.

08:16

Ankle pumps are simply pushing your toes down

08:19

and pulling back up.

08:21

It is the same motion you do

08:23

when pressing a gas pedal in a car.

08:26

You will be asked to do 10 ankle pumps

08:29

every hour you are awake.

08:31

This motion promotes good circulation.

08:37

Once you are ready to leave the PACU,

08:39

you will be transferred to the Orthopedic Nursing Unit

08:42

located on the seventh floor.

08:45

Family will be waiting for you to arrive

08:47

in your assigned room.

08:48

Once in your room, your vital signs will be checked

08:51

and your pain level will be monitored routinely.

08:54

Exercises and mobility begin day of surgery.

08:58

You will be on a clear liquid diet.

09:00

Once your body can tolerate a clear liquid diet,

09:03

then your nurse will advance you to a regular diet.

09:06

The Orthopedic Unit is a room service unit.

09:10

You will be given a food menu

09:12

with the room service number printed on the front.

09:16

Please call this number to order each meal.

09:18

If you do not call to order your meal,

09:21

you will not receive a meal.

09:22

Again, it is very important to get regular food

09:26

in your stomach before you are given oral pain medications.

09:30

Oral pain medications can be given once you have eaten.

09:34

Pain medication is very constipating

09:36

so stool softeners will be started at bedtime.

09:39

Continue performing ankle pumps

09:41

10 times every hour you are awake,

09:44

which is pressing your toes down and pulling back up.

09:48

It is the same motion you do

09:50

when pressing the gas pedal in a car.

09:53

An incentive spirometer will be provided.

09:56

It is a device you breathe or suck in at the mouthpiece

10:00

10 times every hour you are awake.

10:03

The purpose of the incentive spirometer

10:06

is to promote deep breathing

10:08

and filling your lungs with air,

10:09

which will aid in preventing post-operative pneumonia.

10:13

Please use the incentive spirometer

10:15

while you are in the hospital

10:17

and after discharge from the hospital.

10:21

Pain management is very important after surgery.

10:25

You have been managing an arthritic type pain

10:28

and now we will be managing post-operative pain.

10:32

Your nurse will ask you to rate your pain

10:34

on a numeric pain scale with zero being no pain

10:38

ranging to 10 being the worst pain you have ever felt.

10:42

Please be open and honest with your nurse

10:44

when rating your pain.

10:46

It is critical for the management of your pain.

10:49

You should be medicated every four hours as needed.

10:53

The last time you received pain medication

10:55

will be displayed on your hospital television.

10:58

Please remember it is important to stay ahead of the pain.

11:02

Our goal for you is comfort.

11:04

We want to minimize your pain

11:06

to tolerate movement and therapy

11:08

but we cannot promise to take all your pain away.

11:12

Pain, inflammation and bruising is to be expected

11:15

after joint replacement surgery.

11:20

Post-op day one is the day after surgery.

11:22

This is the day most of our patients discharge home.

11:25

This is a very busy day.

11:27

When you wake up, make sure your breakfast has been ordered.

11:31

This can be done the night of your surgery

11:33

or the following morning when you wake up.

11:36

Your nurse will come in and remove your oxygen

11:39

if it hasn't been removed already.

11:41

Your IV will be disconnected from IV fluids.

11:44

Your foley catheter will be removed if one is placed.

11:47

If you had your knee replaced,

11:49

your nurse will remove the surgical bandage

11:51

and apply a waterproof bandage that stays in place

11:54

over your incision for seven days.

11:57

This bandage is safe to shower in.

12:00

You may not soak or submerge your incision in water.

12:04

If you have your hip replaced,

12:05

the waterproof bandage that remains

12:07

over your incision for seven days

12:09

is placed in the operating room after surgery.

12:13

This bandage is safe to shower in.

12:15

You may not soak or submerge your incision in water.

12:19

All patients will be given

12:20

two emergency bandages to take home.

12:23

Once your waterproof bandage is in place

12:25

and the drains removed if placed,

12:27

you can shower or sponge bathe and put your clothes on.

12:31

Your breakfast will arrive between 7 am and 8 am.

12:35

Please eat your breakfast

12:36

and take your oral pain medication.

12:38

Physical therapy and occupational therapy

12:40

will come work with you after breakfast.

12:43

After the completion of therapy and you have been cleared

12:46

for discharge by your surgeon and the hospitalist,

12:50

your nurse will review your hospital paperwork

12:52

for you to sign and help you pack up your belongings.

12:56

A transporter will take your from your hospital room

12:59

down to your ride home in a wheelchair.

13:02

When you arrive home,

13:03

continue using you incentive spirometer,

13:06

doing your ankle pumps and staying ahead of your pain

13:09

by taking your pain medications every four hours as needed.

13:16

- [Narrator] Pre-operative joint replacement education.

13:21

Welcome to the physical therapy portion

13:24

of the pre-op joint replacement education.

13:28

Once your surgery is complete,

13:30

faithful physical therapy

13:32

and closely following the guidelines

13:35

that your surgeon set out for you

13:37

are the most important parts of your recovery

13:41

and you did not come this far to not go the distance.

13:48

Why do I need a joint replacement?

13:51

By the time you schedule a joint replacement surgery,

13:55

you've usually been dealing with pain for a long time

13:59

and have exhausted your other options for relief.

14:02

You have not reached this point lightly.

14:06

We are excited to be part of your journey

14:08

to an improved quality of life.

14:12

As we move through this part of the presentation,

14:15

please keep in mind that every patient, joint,

14:19

surgery and surgeon is different.

14:23

This is an overview and your specific surgeon

14:28

might have different instructions for you.

14:31

If that is the case, please do as they say.

14:37

Joint replacements are considered an elective surgery

14:41

which means that your surgeon expects

14:45

you to have prepared everything you need

14:48

for a safe recovery in advance.

14:52

That is an important purpose of this presentation.

14:56

We want you to have time to get

14:59

everything you will need ready.

15:02

This includes making sure that you have a ride

15:06

to and from the hospital ready for when you're discharged,

15:10

making sure you have rides to and from

15:13

your upcoming physical therapy appointments

15:16

as you'll not be able to drive immediately,

15:19

making sure that you have people available at home

15:23

with you to assist meeting your needs after surgery,

15:28

making sure you have equipment

15:29

you'll need to recover safely,

15:33

and making sure you've prepared your home

15:36

with any adjustments necessary

15:39

such as installing grab bars in the bathroom,

15:42

improving lighting or removing throw rugs.

15:45

Again, the expectation is that all of these things

15:49

are finished before your surgery

15:52

in order to have the best recovery possible.

16:00

Here we have a diagram of the hip joint.

16:07

Here we have a diagram of the knee joint.

16:14

Physical therapy.

16:16

What can you expect in the hospital for physical therapy?

16:21

[Slide contents]

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

Occupational Therapy

• Initiated on the day of surgery and once a day until day of discharge

[End slide contents]

If your surgery is finished

16:24

and you are appropriate for therapy by 6 pm,

16:28

you can expect to see the physical therapist

16:32

and the occupational therapist together.

16:35

It is not uncommon for patients

16:37

to have a fuzzy recollection of this therapy session

16:41

which is why it's incredibly important

16:44

to have your coach or your advocate

16:47

present with you and available to take notes,

16:51

ask questions and track what's going on.

16:55

Depending on how the patient is doing,

16:57

that therapy session might simply include

17:01

standing up and walking to the bathroom,

17:05

or walking in the hallway.

17:07

It might also include performing the car transfer

17:11

and stair training in the rehab gym.

17:16

These will be performed prior to discharge

17:19

by each patient, so if they're not done at the first session,

17:24

then they'll be done the following morning

17:27

or at the next session.

17:29

Hip and knee replacement patients should expect

17:33

physical therapy sessions twice each day

17:37

there in the hospital just like the two sessions

17:41

we expect patients to perform on their own at home daily

17:47

once they've left the hospital.

17:53

Goals prior to discharge from the hospital.

17:58

Please keep in mind that our physical therapy

18:02

is patient-specific, so our goals

18:05

will be tailored to each individual patient.

18:09

For example, if you have not walked 100 feet

18:12

on your own in the past year,

18:15

we will make sure that your goal is appropriate for you.

18:19

That said, we want to make sure

18:22

each patient is safe for discharge.

18:25

We would love for you to be able

18:28

to walk 100 feet using your rolling walker.

18:33

We would love for you to be independent

18:36

with any surgical precautions that we might find out about

18:41

after surgery such as weight baring status changes.

18:50

We would love for you to be independent and safe

18:55

with your bed mobility and commode transfers.

19:00

We would love for you to be able to complete

19:04

the education on stair training, car transfers,

19:10

getting in and out of the bathtub,

19:14

and we would also love for you to be independent

19:17

with your basic home exercise program.

19:22

All of these things will take place

19:25

before leaving the hospital.

19:30

Prior to surgery.

19:34

In terms of physical therapy,

19:36

one of the most important considerations after surgery

19:41

is a patient's safety getting around.

19:44

Walking, standing, sitting.

19:47

Goal number one is reducing the risk of falls.

19:53

So number one, make modifications.

19:56

As soon as you complete this presentation,

20:00

I want you to pretend that you are being driven home

20:04

from the hospital after your surgery.

20:08

From the time you pull up to your home,

20:11

I want you to visualize each step that you will have to take

20:16

in order to get from the vehicle into your home and settled.

20:22

I want you to identify any fall risks

20:26

so that you can address them before your surgery.

20:30

The goal is not to overwhelm you with this process

20:34

but rather to encourage you to be proactive.

20:38

I'll talk you through some thoughts to consider.

20:42

Remember, you are using a rolling walker to get around.

20:49

If you have difficulty

20:51

getting in and out of your vehicle now,

20:54

it will likely be more challenging after your surgery

20:58

so think about your options.

21:01

Are you able to bring a different vehicle to the hospital?

21:05

Are you able to borrow one?

21:09

How many entrances do you have to choose from

21:13

in order to get into your home?

21:16

The one that you use now might not be

21:19

the easiest and safest one after surgery.

21:24

Which is the safest entrance to use after surgery

21:29

when you have the rolling walker?

21:32

Do you have to go up any steps?

21:34

If so, how many steps are there?

21:38

How stable are they?

21:40

Do you have any handrails that you can use?

21:44

Are there handrails on both sides of you or just one?

21:52

You might need to consider installing grab bars

21:55

or handrails if not.

21:59

If that is not an option, make sure you plan ahead

22:03

and perhaps have some additional folks at your house

22:07

or your home when you arrive

22:09

in order to assist you getting inside safely.

22:15

Make sure the people that are helping

22:17

are not at risk of injury themselves.

22:22

Next, make sure you temporarily remove

22:26

any welcome mats or throw rugs to reduce your fall risk.

22:31

You'll be using the rolling walker

22:34

so you wanna make sure to remove all obstacles

22:38

because you want a clear pathway through your home.

22:43

Are you able to fit the rolling walker into the bathroom?

22:49

Think about sitting down and standing up from the toilet.

22:53

Do you have grab bars or maybe a stable piece of furniture

22:58

like a vanity to push up from?

23:03

Do you have a walk in shower

23:05

or will you need to get your leg

23:07

over a bathtub in order to take a shower?

23:12

Regardless of your setup, a stable chair

23:16

or preferably a bench for the shower, is helpful.

23:21

Is your bed high up off the ground?

23:25

Will you need a stable stool in order to get into bed?

23:31

Do you have an alternative option

23:33

in case your bed is not a safe height?

23:38

In general, you want to avoid low chairs,

23:42

soft chairs, and chairs that do not have good arms,

23:46

or armrests, to push up from.

23:50

If you complete this exercise and realize

23:53

that your home is not a safe place to recover,

23:56

think about your other options.

23:59

Is there someplace else you could recover temporarily?

24:03

The important thing is that you can work on this now.

24:09

Number two, arrange for assistance at home.

24:13

It is a much better plan to have more assistance

24:17

and more support lined up then you actually need,

24:22

than to realize after surgery that you need more help

24:26

and need to request it.

24:30

Number three, arrange for transportation as needed,

24:36

especially to and from your physical therapy appointments.

24:42

Equipment.

24:45

Rolling walker.

24:48

Again, our goal is to reduce the risk

24:51

of falling after surgery.

24:54

We want our joint replacement patients

24:59

to use a rolling walker, very basic,

25:03

very standard, nothing fancy.

25:06

We just want the wheels in the front

25:10

and two prongs in the back.

25:12

We do not want patients to use a rollator,

25:17

or a walker with four wheels.

25:19

Those are too unstable.

25:24

Patients should expect to stay on the walker

25:26

for a minimum of two weeks if they're a knee patient

25:30

and one week if they're a hip patient.

25:33

However, patients should not

25:36

discharge themselves unilaterally from using a walker.

25:42

If you feel like you're ready,

25:44

then you should talk with your outpatient physical therapist

25:48

and the two of you make that decision together.

25:53

A rolling walker is only helpful if you use it.

25:58

This means both hands are on the rolling walker

26:01

in case you need to stabilize yourself for any reason,

26:06

which also means that you are not going to carry

26:09

a plate of food and a glass of water

26:12

from the kitchen to the living room dining room.

26:17

This is why we want someone to be there to help you.

26:21

There are strategies, like putting a bag or a basket

26:25

on the walker to help you get items

26:28

from one room to another.

26:31

We want you to know that everything you see in the movies

26:35

with the walkers is wrong.

26:38

We don't want you to stand

26:41

with them really far out in front of you

26:44

and we don't want you to pick them up off the ground.

26:47

Think of the walker as an extension of your body.

26:51

It's gonna move with you.

26:54

You want to stand tall with good posture.

26:58

You want your hips to be in line with the back prongs

27:02

of the walker and your body is staying in the little box.

27:07

The rolling walker is not helpful

27:10

if you walk into a room and leave it by the doorway,

27:14

which I've seen plenty of folks do.

27:17

Please use your rolling walker all the time

27:20

until you and your therapist decide

27:23

that you don't need it anymore.

27:27

It's very important that you have the rolling walker

27:30

in the vehicle transporting you from the hospital home

27:35

in case you need to get out of the vehicle

27:38

for any reason on your way home.

27:41

If you are planning to bring a rolling walker from home,

27:46

go ahead and put it in your trunk today

27:49

so that you don't forget it.

27:52

However, we do not want you to bring the walker

27:56

into the hospital.

27:58

For infection control, please leave it in your vehicle.

28:02

At the hospital, you'll use a rolling walker

28:06

that belongs to us.

28:08

If you're planning to borrow a walker

28:11

from a friend or relative or if you have one

28:14

up in the attic or down in the basement,

28:18

please go ahead and get it out soon

28:21

to make sure that it still works,

28:23

especially if it's 40 years old

28:26

and your grandmother used it.

28:28

We need for you to make sure that it is still safe to use.

28:34

Not having an appropriate rolling walker

28:36

can cause delays leaving the hospital

28:39

so please make sure the one that you're using is safe.

28:43

If you don't have one and are planning to get it

28:46

through insurance at the hospital,

28:49

we will make sure that you have it before you leave.

28:53

Straight cane.

[Slide contents]

Straight cane

• 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]

28:55

Knee replacement patients usually progress to a cane

28:59

with instruction from their outpatient physical therapist.

29:04

Cryotherapy for knees, Polar Pak.

[Slide contents]

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]

29:11

Before I talk about the Polar Pak,

29:15

I wanna share with you some guidelines

29:18

that you are going to follow once you get home.

29:23

These guidelines will be reviewed with you

29:26

in the hospital as well.

29:29

During the day, make sure that you get up and walk around

29:34

five minutes out of every hour the first week after surgery

29:40

and 10 minutes every hour the second week after surgery.

29:45

Now again, this is during the day.

29:48

We want you to sleep through the night if you can.

29:53

Once you're done walking around,

29:56

we want you to perform your hourly exercises.

30:01

By that, we mean 10 ankle pumps,

30:05

where you put your foot on the gas,

30:09

10 glut squeezes, where you tighten up,

30:12

or you squeeze your butt muscles together,

30:17

10 knee presses where your leg is extended

30:22

as straight and you are pushing your knee down

30:27

into the bed or the sofa, wherever you are.

30:32

We also want you to do 10 breathing exercises

30:36

with the incentive spirometer

30:38

that you'll get at the hospital.

30:42

When you're finished, we want you to ice your surgical leg

30:47

and rest with your legs elevated

30:50

until you get up and walk around again the next hour.

30:56

If you're a knee patient, when you're resting,

30:59

we want you to make sure that your knee is straight.

31:03

We don't want it to be bent.

31:05

It always needs to be straight

31:07

or extended when you're resting.

31:10

Never put a pillow under your surgical knee.

31:15

This is very important.

31:17

Also, make sure that your legs are elevated

31:22

when you're not walking around in order to reduce swelling.

31:27

In addition, make sure that you spend 30 minutes

31:32

three times each day with your surgical leg

31:36

elevated above your heart.

31:39

The easiest way to accomplish this

31:41

is usually for your upper body to be flat

31:45

with you lying down and your surgical leg

31:49

above your heart supported by a pillow,

31:52

perhaps a wedge pillow.

31:55

Walking, hourly exercises, elevating, resting,

32:01

and icing are all critical components of your recovery.

32:07

Cryotherapy for knees, the Polar Pak.

32:11

If you're a knee patient, you'll be provided

32:14

a Polar Pak to use at home.

32:18

The Polar Pak has very clear and detailed instructions

32:22

on the lid and there are pictures

32:26

included in those instructions.

32:29

Make sure you do not put the white part of the pad

32:34

in direct contact with your skin

32:37

in order to avoid irritation.

32:40

We always want a clean barrier between the pad and the skin.

32:47

Leave the Polar Pak on at night

32:49

and any time you're not up walking around.

32:53

Be very careful, however, to take the Polar Pak

32:57

off your leg prior to standing up

33:00

in order to reduce the risk of a fall.

33:04

This is especially important to consider at night

33:07

if you need to get up and use the bathroom

33:11

because you'll likely be tired and groggy.

33:15

You might be wearing an immobilizer brace

33:18

if that is something that your surgeon asks you to do.

33:22

So, make sure that you take the Polar Pak off

33:26

before you walk around.

33:29

Cryotherapy for hips.

33:32

Hip patients are also expected to ice their surgical leg

33:36

however, a Polar Pak will not be provided.

33:40

Please have ice packs

33:42

already in the freezer before your surgery.

33:47

Hip patients should also provide a clean barrier

33:51

between their skin and the ice pack.

33:55

Six week goals.

33:58

Number one, walk without a limp or an assistive device.

34:04

Number two, be able to perform a single leg stance

34:09

on your surgical side for 10 seconds.

34:13

Number three, be able to perform reciprocal stairs

34:17

with or without the use of a rail.

34:20

Number four, be able to perform a sit to stand

34:26

from a chair without pushing up from the arms.

34:32

And if you're a knee patient,

34:35

be able to achieve active range of motion

34:39

which means that you are bending your knee,

34:42

the therapist is not bending your knee,

34:45

active range of motion of zero to 120 degrees.

34:51

That means your knee is straight and flat

34:55

at zero degrees and you get a bend of 120 degrees

35:03

back towards your bottom.

35:07

Don't.

35:10

[Slide contents]

Don't:

• 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

35:14

and we don't want you to do too much too soon.

35:17

It is absolutely possible to do too much too soon

35:23

after your surgery and we want to avoid that.

35:28

Please stick closely to the plan

35:31

that your surgeon and therapist have given you for recovery.

35:35

It might seem very simple and therefore not important

35:40

but following this plan can help avoid

35:43

serious complications.

35:46

Five minutes of walking and standing each hour

35:50

for the first week means just that.

35:54

It doesn't mean 20 or 30 or 50 minutes walking and standing.

36:00

Unfortunately, we have plenty of stories

36:03

of patients who decided to cook Thanksgiving dinner

36:06

or they went to a party and they felt great

36:10

standing up for hours only to wake up the next day

36:15

unable to walk due to swelling.

36:18

These patients have even asked us

36:20

to share their experiences with you

36:24

so that y'all don't have to go through what they did.

36:28

If you are wanting to get back to a specific activity,

36:32

please don't just start back on your own without consulting

36:36

your outpatient physical therapist or your surgeon.

36:41

If it is not on your list of physical therapy exercises,

36:47

we don't want you to be doing it

36:49

without specific permission.

36:53

You should, however, be performing

36:57

your physical therapy exercises from

37:01

your outpatient therapist one time every morning

37:06

and one time every afternoon.

37:08

So that's two physical therapy sessions every day

37:13

and on the days that you go to the outpatient clinic,

37:17

that counts as one session and you would then do

37:22

only one more session on your own

37:24

at home for a total of two.

37:30

The big key is to not overdo.

37:36

Do.

[Slide contents]

Do:

• Call your Orthopaedic 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:
  • Constipation
  • Itching
  • Rash
  • Drainage
• Begin scar massage 21 days post op. Continue for three months.

[End of slide contents]

37:38

We do want you to communicate

37:41

any concerns that you have immediately.

37:48

Thank you so much for your time.

37:50

We wish you the best and we're excited to see you.

37:56

Thanks for listening.