Joint Replacement Camp
Joint Replacement Patient,
The doctors and staff at Sarah Bush Lincoln Health Center are pleased that you have chosen us to provide your total joint care. We are committed to providing quality medical care and excellent service to ensure the best possible outcomes for total joint replacement.
We would like to briefly discuss the process of undergoing total joint replacement. Your surgeon has already discussed why you need the operation. This booklet is designed to offer additional information on your preparation for the operation, the procedure itself, and the road to recovery after your procedure.
It is important for you to realize that you will be responsible for a major portion of your post-operative rehabilitation, but rest assured there will be many healthcare professionals to guide you through the process. Modern medicine has made it possible for a stiff and painful joint to be replaced with one that is nearly the same as a normal healthy joint. As long as you follow the instructions of your doctors, nurses, and therapists, and are willing to follow the recommended exercises and rehabilitation, you will soon be on your way to a more active lifestyle.
Please use this booklet as your guide through the total joint replacement process. This booklet is just a guide and your doctors, nurses, or therapists may add or change the recommendations based on your personal needs. This booklet will cover the following:
• What is total joint replacement?
• Pre-operative care and planning for total joint replacement
• Post-operative care
• Pain management
• Physical therapy
• Frequently asked questions
Arthritis is a disease of the articular cartilage, the smooth cushion that pads and protects joints. In a healthy joint, this cushion prevents two bones from rubbing against each other. Over time, or following injury, the cartilage begins to wear away leading to bone-on-bone contact. The nerve endings surrounding the bones become irritated resulting in pain, swelling, and stiffness associated with arthritis.
Total Joint Replacement
Although hips and knees are the most common joints replaced, this procedure can be performed on other joints, including the ankle, foot, shoulder, elbow, and fingers. Total joint replacement removes an arthritic or damaged joint and replaces it with an artificial joint, called prosthesis. The materials used in a total joint replacement are designed to enable the joint to move just like a normal joint. The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Several metals are used, including stainless steel, alloys of cobalt and chrome, and titanium. The plastic material, polyethylene, is durable and wear resistant. Plastic bone cement may be used to anchor the prosthesis to the bone.
There are no guarantees regarding how long your new joint will last. Various factors such as weight, activity and bone quality can affect the usable life of your new prosthesis. Current studies indicate that the average prosthesis can last 15 to 20 years. As new materials and procedures become available, these expectations may continue to improve.
Since each person’s condition is unique, needs may differ between people and types of procedures. Your surgeon will discuss with you choices and recommendations tailored to meet your needs.
Your surgeon’s office will make all the necessary arrangements for you. You will be asked to complete the following steps to prepare for your procedure:
• An appointment date will be set for pre-admission testing. It is very important to keep this appointment. You will be asked to complete a four-page health history form that will provide us with information needed to guide your care. Your surgeon or the anesthesia department may require a blood work-up or other testing. You will meet with a representative of the anesthesia department to address any questions or concerns.
• Be sure to bring your medications in their original containers or a detailed listing of medication names, doses, and frequency with you to the pre-admission appointment.
• You may be asked by your surgeon or anesthetist to see your primary care doctor or practitioner for a check-up and/or diagnostic testing to assure that you are in the best possible medical condition to undergo the procedure.
• Your doctor will discuss the risks, benefits and alternatives of the surgical procedure and you will be asked to sign a consent form in agreement with the informed consent discussion. This is a time for you to ask questions in order to fully understand what you are agreeing to have done and to fully understand how you can be an active partner in the best possible outcome from the operation.
Preparing for Your Operation
2014 Classes held 12:30 pm to 2:30 pm | Register Online
Washington Room - Lumpkin Family Center for Health Education
at Sarah Bush Lincoln Health Center
September 9, 25
October 7, 23
November 13, 25
December 9, 18
Two weeks before your operation
• Pre-admission testing should take place one to two weeks prior to your operation.
• Review your medications with your surgeon and anesthesia representative. Follow any special instructions given regarding all medications, including prescription and over-the-counter medications and all vitamins and minerals.
• Medications that increase bleeding You will be asked to stop taking all anti-inflammatory medications, such as aspirin, Motrin, Naproxen, Glucosamine, and Chondroitin. You will receive special instructions from your doctor and anesthesia representative if you are taking Coumadin, Plavix, or Trental.
One week before your operation
This is an excellent time to begin preparing your home for your return after your procedure. Some things to consider include:
• Clean your home.
• Put clean linens on the bed.
• Prepare meals and freeze them in single-serving containers.
• Tend to yard work.
• Pick up throw rugs and tack down loose carpeting.
• Remove electrical cords and other obstructions from walkways.
• Obtain a portable telephone and a television remote control, if you don’t already have them.
The night before your operation
Do not eat or drink anything after midnight, NOT EVEN WATER, unless otherwise instructed. If you have been instructed to take a medication after midnight, do so with water and only enough water to swallow the medication. In addition, do not chew gum or smoke.
What to bring to the hospital
• Personal hygiene items (toothbrush, deodorant, razor, hairbrush, etc.).
• A loose-fitting robe.
• Assistive devices, such as hearing aides, glasses, etc.
• CPAP machine (if used at home).
• Do not bring valuable jewelry or large amounts of cash.
On the Day of Your Operation
What to do
Enter through the Visitors Entrance of the Health Center and check-in at the Surgery Reception Area, located just past the elevators. The receptionist will verify information with you, including whom you wish the surgeon to speak with regarding your progress following your operation. Under certain circumstances, females may be asked to provide a urine specimen to rule out the possibility of pregnancy. The receptionist will notify the operating room that you have arrived.
What to expect
In the preoperative holding area, you will change into a hospital gown. Any personal items or jewelry should be given to your family at this time. An IV will be started from which medications can be given throughout your operation and recovery process. You will meet with the anesthesia and operating room team who will be caring for you throughout the surgical procedure. You are encouraged to ask any and all questions that you may have.
Following your operation, you will be taken to the Post Anesthesia Recovery Room (PACU). You will remain in this area for about one to two hours before being transferred to your room on the Adult Care Unit (ACU). Your surgeon will speak to your family members regarding the surgical outcome. During this time, your vital signs will be closely monitored and your pain controlled. Most of the discomfort occurs during the first 12 to 24 hours following your operation. You will receive pain medications through one of three methods:
• IV (intravenous)
• PCA pump (Patient Controlled Analgesia). A preset pump connected to your IV delivers small doses of pain medication at preset times. The pump will also be set to allow you to give yourself additional medication, if needed.
• Epidural Pain Control (Nerve Blocks). This provides a continuous infusion of local anesthetic and/or narcotic to the surgery site to manage pain and controls the dosage. If used, the anesthesiologist in either the holding area or operating room will start this method.
Controlling pain is important to the recovery process. If the pain medication is not working, please let your care team know so adjustments can be made.
Following Your Surgery
You will be drowsy and remain in bed the day of your operation. You will begin using the compression pumps as soon as possible on the first day to prevent blood clots from forming in your legs. You will begin using the CPM (Continuous Passive Motion) machine. It is very important to use your incentive spirometer as directed to expand your lungs and prevent pneumonia.
You will be assisted, as needed, getting out of bed, bathing, sitting in a recliner in your room, and walking. Your surgeon, physical therapist, and occupational therapist will visit with you to check your progress. Pain medication will continue to be administered in the same manner as the day of your procedure. X-rays will be taken of your new joint. You will continue to use the CPM machine while in bed. A case manager will visit with you about preparations for going home.
You will be assisted with getting out of bed and walking. The surgical dressing will be changed. The IV pain medication and nerve block will be stopped and you will begin taking pain medication by mouth. You will continue to use the CPM machine while in bed.
The morning will be similar to Day Two. The decision to go home or to a rehabilitation unit will be made by you, your surgeon, your physical therapist, and your insurance company. Every attempt will be made to have this decision finalized in advance. If you are going to a rehabilitation unit, you are generally transferred following your morning physical therapy session.
If you are Going to a Rehabilitation Facility
It may be necessary to go to a rehabilitation facility in order to recover enough to return home independently. A case manager will assist you and your family in making these arrangements.
If you are Going Directly Home
Someone responsible needs to drive you home. Your driver should avoid bringing a van or truck, as these vehicle types are usually too difficult to get into following a joint replacement operation. If this is not possible, the case manager can help with arranging transportation, although the cost is generally not covered by insurance.
You will receive written “going home” instructions concerning medications, physical therapy, activity, and follow-up appointments. The case manager will arrange for equipment and home health visits through the agencies of your choice. You will be informed as to when and where you will continue your physical therapy. These options will be discussed with you when you are close to going home.
Your doctor will decide when you can go home based on how well you are healing and your mobility. In the hospital, nurses, therapists and doctors will watch you closely to make sure you are doing everything correctly and safely. Once you are at home, there will be different obstacles that you did not have in the hospital or rehabilitation facility. Important things to remember when going home include:
• Do sit in a stable, high-seated chair with two armrests so that you can push off from the chair when standing up. If the seat is too low, place a pillow in the seat of the chair.
• Do use a “reacher” to retrieve items from the floor.
• Do have someone put your pet dog or cat in another room with the door closed until you are safely seated.
• Do have someone remove scatter rugs and hallway runners and tape down edges of area rugs. • Do remove unnecessary furniture to provide wide pathways for yourself.
• Do keep all cords out of the way.
• Do make sure your home is well-lit, including night light, a bedside light, and entry lights.
• Do be very careful in the bathroom or kitchen where water could be on the floor.
• Do use a raised toilet seat at home and the handicap toilet away from home.
• Do use any safety bars or a shower chair as recommended by your therapist.
• Do place a pillow between your legs in bed to remind yourself not to cross them.
• Take your pain medicine only as directed. It is recommended that you schedule a dose of pain medication at least 30 minutes prior to physical therapy.
• Gradually wean yourself from prescription medication to Tylenol. Do not take anti- inflammatory medications until instructed by your doctor.
• Change your position at least every 45 minutes throughout the day.
Caring for your incision
• Keep your incision clean and dry.
• Keep your incision covered with a light dressing until your surgeon tells you it is no longer necessary.
• You will be able to shower after the staples are removed, typically 10 to 14 days after your operation.
• Notify your surgeon or visiting nurse if there is any increased drainage, redness, pain, swelling, or heat around the incision.
• Take your temperature if you feel sick. Call your doctor if it exceeds 100.5°F.
• When your staples have been replaced by steri-strips (little white paper over the incision), allow them to fall off on their own. This usually occurs in seven to 10 days.
• You may experience a poor appetite following your operation. It is important that you drink plenty of fluids such as water, juice, milk and light soups to keep from getting dehydrated. Your desire for solid food will return.
• You may have difficulty sleeping. This is not abnormal. Try not to sleep or nap too much during the day.
• It is common for your energy level to be decreased for the first month.
• Pain medication contains narcotics, which promotes constipation. Try eating more fruits and vegetables and food that have a high-fiber content. Use stool softeners as needed.
Recognizing and Preventing Potential Complications
Blood clots in the legs
An operation may cause the blood to slow and coagulate in the veins of your legs, creating a blood clot. Because of this, your doctor may want you to take blood thinners after your procedure. The most common form of blood thinners prescribed after total joint replacement is an injectable form of Heparin (also known as Lovenox, Arixtra). It is usually used for seven to 10 days. If your recovery at home includes these injections, you and a family member will be instructed on how to administer them.
You will also be asked to wear special white stockings for approximately four weeks following your procedure. These stockings are used to compress the veins in your legs. This helps to keep swelling down and reduce the chance of blood clots.
Signs of blood clots in the arms and legs:
• Swelling that does not go down when elevated.
• Pain, tenderness, or warmth in the leg.
• It is important to note that these signs can occur in either leg.
Prevention of blood clots:
• Compression pumps.
• Compression stockings.
• Blood thinners.
An unrecognized blood clot in your legs can break off and go to your lungs. This is a pulmonary embolus, and it is an emergency. Call 911 if you suspect a pulmonary embolus!
Signs of an embolus:
• Sudden chest pain.
• Difficult and/or rapid breathing.
• Shortness of breath.
• Unexplained fever.
Prevention of a pulmonary embolus:
• Prevent blood clots in the legs.
• Recognize a blood clot in the legs and call your doctor immediately.
Infection Signs of infection:
• Increased swelling, redness, or pain at the incision site.
• Change in color, amount, odor of any drainage.
• Increased pain in or around incision.
• Fever greater than 101° F. Prevention of infection
• Follow instructions regarding care of your incision.
• Report any of the above signs immediately to your doctor.
• Notify your dentist that you have had a total joint replacement.
• You may be prescribed preventive antibiotics when having dental work or any other potentially contaminating procedures. Your doctor can order these antibiotics for you. This generally continues for two years after your procedure.
Answers to Frequently Asked Questions
1. How long does the operation take?
We reserve approximately two to two and a half hours for your operation. Some of this time is used by the operating room staff to prepare for the procedure.
2. Will I be asleep during the operation?
You may have a general anesthetic, which most people call “being put to sleep.” Some people may have a spinal or epidural anesthetic, which numbs only the legs. Either way, you will be asleep during the operation. The choice is between you and the anesthesiologist.
3. Will the operation be painful?
You will have discomfort following the operation, but we will keep you comfortable with appropriate medication. Generally, most people are able to stop very strong medication within one day. Most people control their own medicine with a special pump that delivers the drug directly into an IV or epidural catheter.
4. Who will be performing the operation?
Your orthopedic surgeon will perform the operation. Assistants will help.
5. When will my pain go away?
You can expect to have some pain for several weeks. Everyone is different, so the amount of pain varies from person to person. However, the pain you experience will be different from the deep, aching pain you may have experienced prior to the operation. Your new prosthesis should eventually relieve the pain and stiffness you had prior, while movement at the joint should improve.
6. How long will I have to use my walker or crutches?
This is different for each individual. You can expect to be getting up and walking one to two days after your operation. Your physical therapist will work with you until you are safely walking with either crutches or a walker. You can expect to be using a walker between four and eight weeks. Your surgeon will periodically X-ray your new joint to check the healing process and will tell you when you no longer need support. If your progress is slow, you may need the walker for a longer period of time. As you progress, your doctor or therapist may suggest the use of a cane. Eventually, you may not need any assistive device, depending on your general health prior to your operation.
7. Is there anything I can do that will damage my new joint?
Your new joint will be very strong and secure. However, there are some precautions that MUST be followed to ensure that your joint stays in good condition. Your doctor, nurses, and therapist will provide you with information throughout the recovery process.
8. How long will my new joint last and can a second replacement be done?
Most joints last 15 to 20 years or longer, however, there is no guarantee. A second replacement may be necessary.
9. Why do they fail?
The most common reason for failure is loosening of the artificial surface from the bone. Wearing down of the cup liner may also result in the need for a new liner.
10. What are the major risks?
Most operations go very well without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are 1 percent or less.
11. Will I need blood?
You may need blood after your operation, although newer techniques are making this less common.
12. How long will I be incapacitated?
You will probably stay in bed the day of your operation. The next morning you will get up, sit in a recliner and should be walking with a walker later that day or early the next.
13. How long will I be in the hospital?
This will depend on your individual case and your general health before your operation, but the average stay is three to four days. Before going home, you should be able, or nearly able, to do the following:
• Get in and out of a chair by yourself.
• Walk independently with an assistive device.
• Show an understanding of your home exercise program.
• Recall all of the precautions for your new joint.
14. Where will I go after I leave the hospital?
Many people are able to go home directly from the hospital. Some may transfer to a rehabilitation center and stay for five to 10 days or longer as needed. Your case manager will make the necessary arrangements.
15. Will I need help at home?
Yes. The first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, etc. If you go directly home from the hospital, your home care coordinator will arrange for a nurse, physical therapist, and occupational therapist to come to your house as needed. You may need to ask family or friends to help, if possible. Making preparations ahead of time can minimize the amount of help you will need. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single portion meals prepared will reduce your need for extra help.
16. What if I live alone?
Two options are usually available for those who live alone. You may either transfer to rehabilitation center or you may go directly home with a home health nurse and a home physical therapist to assist you.
17. Will I need any equipment?
Yes. A tub bench and grab bars in the tub or shower will be helpful. Your occupational therapist may also recommend a “reacher,” a sock aid, a long-handled shoehorn, elastic shoelaces, a long-handled sponge or back brush. Your case manager and physical therapist can provide you with more information on these items.
18. Will I need physical therapy when I go home?
Yes. We will arrange your follow-up visits with physical therapy. You may go to an outpatient facility two to three times a week to assist in your rehabilitation. The length of time required for this type of therapy varies with each person.
19. How long until I can drive and get back to normal?
You may not drive until cleared by your doctor, which is usually six weeks. Getting back to normal will depend somewhat on your progress. Consult with your doctor or physical therapist for advice on your activity.
20. When will I be able to go back to work?
We recommend that most people take at least two months off from work, unless their jobs are quite sedentary and they can return to work with crutches.
21. When can I have sexual intercourse?
The time to resume sexual intercourse is usually between three to six weeks.
22. How often will I need to be seen by my doctor following the surgery?
Your first post-operative office visit will be at about one to two weeks after you go home. The frequency of follow-up visits will depend on your progress. Many people see their doctor at six weeks, 12 weeks, and then yearly or as directed.
23. Do you recommend any restrictions following this operation?
Yes. High-impact activities, such as running, singles tennis and basketball are not recommended. Injury- prone sports, such as downhill skiing are also dangerous for a joint replacement.
24. What physical or recreational activities may I participate in after my recovery?
You are encouraged to participate in low-impact activities such as walking, dancing, golfing, hiking, swimming, bowling and gardening.
25. Will I notice anything different about my joint?
Yes. You may have a small area of numbness to the outside of the scar, which may last a year or more and is not serious. Some people notice some clicking when they move their new joint. This is the result of the artificial surfaces coming together and it is not serious.