before, during and after hip and knee replacement...

Before, During and After Hip and Knee Replacement Surgery A PATIENT’S GUIDE

OAS S

Acknowledgments

We would also like to thank the joint replacement clients who participated in the revision process of this booklet.

Your feedback and suggestions will be of great help to people who are preparing for joint replacement surgery.

This revised booklet is based on information produced

over the years by a variety of organizations. We would

like to acknowledge the contributions made by:

TheArthritisSociety,BC&YukonDivision

TheMaryPackArthritisProgram

HipHipHooray

BCOrthopedicAssociation

CanadianOrthopedicFoundation

This edition of the booklet was developed by OASIS

(OsteoArthritis Service Integration System) at

Vancouver Coastal Health in partnership with staff at:

VancouverIslandHealthAuthority

NorthernHealthAuthority

InteriorHealthAuthority

FraserHealthAuthority

ProvidenceHealthCare

OAS S

ContentsHip Surgery•HipAnatomy ...................................... 7•HipReplacementSurgery .................... 8•JointComponentsandAttachment ..... 9•HipPrecautions ................................. 10

Knee Surgery•KneeAnatomy .................................. 15 •KneeReplacementSurgery ................ 16•JointComponentsandAttachment ... 16•KneePrecautions ............................... 18

Before Surgery •HomeSet-Up ................................... 23•Exercise ............................................ 28•Nutrition ......................................... 29•WeightManagement ......................... 30•Pre-OperativeEducation ................... 31•Pre-AdmissionClinic ........................ 31•FinalChecklistBeforeSurgery ........... 32

During Your Hospital Stay•Dayofsurgery ................................... 35•Lengthofstay .................................... 37 •Rehabilitation ................................... 38•PainControl ...................................... 39•PreventingBloodClots ...................... 41•GoingHome ..................................... 41

After Surgery•RecoveryAtHome ............................ 45 •ReturningtoWork ............................ 53•Complications ................................... 54

Resources .............................................. 61

Index ....................................................... 62

Youareabouttohavehiporkneereplacement

surgery.Patientswhoarepreparedforsurgery

andwhotakepartintheircarecanrecoverin

lesstimeandwithlesspain.Thisbookletwill

giveyouthegeneralinformationyouneed

togetyourself,yourfamilyandyourhome

readyforsurgery.Readthisbookletwithcare

andbringittothehospitalwhenyougofor

surgery.Wehopethatyoufindthisbookleta

usefulreferenceguidebefore,duringandafter

yourjointreplacementsurgery.

*IMPORTANT: If your surgeon or health care team gives you

different advice than what has been provided in this booklet,

please follow the specific directions you receive.

Do you still have questions about joint replacement surgery?

Would you like to talk to someone who has gone through the surgery?

Ifso,Ortho Connectisforyou!ItisaprogramthroughtheCanadianOrthopedicFoundationthatwillconnectyouwithavolunteerwhohasgonethroughasimilarsurgicaltreatment. Youwillbeabletoaskthevolunteerquestionsaboutwhattoexpectthroughthisexperienceandgetusefultipsonhowtocope.

Moreinformationisavailableat: www.canorth.org(clickon“patientresources”) orphone1-800-461-3639 [email protected]

4 | Before, During & After Hip and Knee Replacement Surgery

Hip SurgeryIn this section, you will learn about:

2 Hip Anatomy

2 Hip Disease

2 Total Hip Replacement Surgery

2 Hip Resurfacing Surgery

2 Hip Revision Surgery

2 Artificial Joint Components

2 Joint Attachment (Fixation)

2 HIP PRECAUTIONS

Before, During & After Hip and Knee Replacement Surgery | 7

Hip Anatomy

Thehipjointisaballandsocketjoint–that’swhyyoucanmoveyourhipinmanydirections.Theballistheroundheadofthethighbone(femur).Itmovesinthesocketofyourpelvis(acetabulum).Musclesandligamentssupportandstrengthenthejoint.

Hip Disease

ThemostcommonreasonforjointreplacementsurgeryisOSTEOARTHRITIS.Osteoarthritisresultsinthebreakdownofcartilageontheendsofthebones.Itusuallyappearsinjointsthatcarryyourbodyweight,suchashipsandknees.Osteoarthritiscancausejointpainandstiffness.Advancedjointdamagecanberepairedthroughjointreplacementsurgery.

Otherdiseaseconditionsmayalsoleadtodamageofthejoint,requiringjointreplacementsurgery.Theseincludeconditionssuchasrheumatoidarthritis,boneinfectionoralackofbloodsupplytothebone.Talktoyourdoctorifyouhavequestionsaboutyourjointhealth.

Joint Damage

Normal Hip Joint

Femur

Pelvis

Osteoarthritic Hip Joint

WornCartilage

BoneSpurs

Acetabulum

Cartilage


Total Hip Replacement

Intotalhipreplacementsurgery,thesurgeonreplacesthediseasedjointwithanartificialjoint(prosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthehipjoint.Thentheheadofthethighboneisreplacedwithanartificialballandstem.Thepelvicsocketissmoothedandlinedwithaprostheticcup.Thenthejointisputbacktogetherwiththeballfittedintothecup.Oncethenewjointisinplace,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).Thissurgerytakesabouttwohours.

Today,manypatientswhohavehipreplacementsurgerycanmovetheirjointmoreeasily,havelesspainandareabletowalkmorecomfortablyforupto25yearsaftersurgery.

Hip Resurfacing

Hipresurfacingisatypeofhipreplacementsurgerythatmaybesuggestedbyyoursurgeonbasedonanumberoffactorsincludingthedegreeofdamagetoyourjointandyouroverallhealth.

Inthissurgery,thesurgeonreplacesthediseasedjointwithaspecialformofartificialjoint(resurfacingprosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthehipjoint.Thenthedamagedcartilageandsomepartsofthebonesurfaceareremovedfromtheheadofthethighbone(femur)andthehipsocket(acetabulum).Aball-shapedcapisplacedovertheheadofthethighbone.Thehipsocketissmoothedandlinedwithamoldedshell.Oncethejointisputbacktogether,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).

Prostheticcup

Head

Stem

Femur

Pelvis

Artificial Hip Joint

Resurfacingprosthesis

Resurfaced Hip Joint


Hip Revision (Repeat)

Somepeoplewhohavehadahipreplacementmayneedanothersurgerybecause:

•Thejointhasdislocated

•Thejointislooseorwornout

•Therehasbeenbonelossoraninfectioninthejoint

Thesesurgeriescanbemorecomplexandyoumayneedmorerehabilitationaftersurgery.Youmaynotbeabletocarryasmuchweightonyournewjointwhileyourecover.

Joint Components (Prosthetics)

Artificialjointcomponentsmaybemadeofmedical-grademetal,plastic,ceramicorsomecombinationofthesematerials.Yoursurgeonwilldeterminethetypeofjointtobeused,matchingyourindividualneedswithasuitabletypeofmaterial.

Joint Attachment (Fixation)

Thetypeoffixationusedtosecuretheartificialjointinyourbodywilldependonavarietyoffactorsincludingyourage,diseasetypeandbonequality.

CEMENTED:Theartificialjointpiecesaresecuredtothebonewithaquick-hardeningadhesive.

CEMENTLESS: Theartificialjointpiecesarecloselyfittedintothebones.Thesepiecesarecoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.

HYBRID: Inthistypeofsurgery,onepieceoftheartificialjointisattachedwithcementwhiletheotherpieceiscoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.


Hip Precautions

After Hip Surgery, you will need to follow HIP PRECAUTIONS for 3 MONTHS

unless otherwise advised by your surgeon.Theseactivityrestrictionswillhelpyourjointtohealandreducetheriskofhipdislocation.See“Complications”sectionformoreinformation,page54. Shaded leg is the surgical leg.

DO NOT bend your hip past 90 degrees DO NOT cross your legs at the ankles or knees

DO NOT twist your body or legs

AdditionalNotesforHipSurgeryandPrecautions:

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

______________________________

45°

90°


Things you CAN DO after hip surgery:

DO sit on a raised chair or use a high-density foam cushion to increase

surface heights. Use a raised toilet seat.(seepage49forhowtosit)

DO use long-handled aids, such as a shoehorn and reacher, to help you dress

and pick up items.

DO sleep with pillows between your legs for the first 3 months after surgery. Youmayrequireassistanceplacingthepillowsorchoosetouseanextra-longpillow.

90°

Shoe Horn

Reacher

Knee SurgeryIn this section, you will learn about:

2 Knee Anatomy

2 Knee Disease

2 Total Knee Replacement Surgery

2 Bilateral Knee Replacement Surgery

2 Unicompartmental Knee Replacement Surgery

2 Artificial Joint Components

2 Joint Attachment (Fixation)

2 KNEE PRECAUTIONS


Knee Anatomy

Thekneejointiswherethethighbone(femur)meetstheshinbone(tibia).Thekneeisahingejointthatallowsyoutobendandstraightenyourleg.

Knee Disease

Themostcommonreasonforjointreplacementsurgeryis OSTEOARTHRITIS.Osteoarthritisresultsinthebreak-downofcartilageontheendsofthebones.Itusuallyappearsinthejointsthatcarryyourbodyweight,suchashipsandknees.Osteoarthritiscancausejointpainandstiffnessthatmayrequirejointreplacementsurgery.

Otherdiseaseconditionsmayalsodamagethejoint,requiringjointreplacementsurgery.Theseincluderheumatoidarthritisoraninjurytothejoint.Talktoyourdoctorifyouhavequestionsaboutyourjointhealth.

Total Knee Replacement

Intotalkneereplacementsurgery,thesurgeonreplacesthediseasedjointwithanartificialjoint(prosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthekneejoint.Thenthedamagedbonesarereshapedtofittheartificialjoint.Theendsofthethighboneandshinbonearecoveredwithmetalshells,separatedbyaplasticliner.Ifthekneecap(patella)isdamaged,itmaybelinedwithaplasticdisc.Oncethenewjointisinplace,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).Thissurgerytakesabouttwohours.

Today,manypatientswhohavekneereplacementsurgerycanmovetheirjointbetter,havelesspainandareabletowalkmorecomfortablyforupto25yearsaftersurgery.

Normal Knee Joint

Patella

Cartilage

Femur

Tibia

Ligament

Osteoarthritic Knee Joint

Artificial Knee Joint

WornCartilage

Femurprosthetic

PlasticLiner

Tibialprosthetic

PatellarButton


Bilateral (Both) Knee Replacement

Insomecases,asurgeonmaydecidethatbothkneesneedtobereplacedatthesametime.Thisdependsonanumberoffactorsincludingyouroverallhealth,jointdamageandlifestyle.Thesurgerywillbethesameasatotalkneereplacement.Yourhospitalstaymaybelongerandyoumayneedmorerehabilitationaftersurgerytohelpyougetbacktoyourdailyactivities.

Unicompartmental (Partial) Knee Replacement

Ifyouonlyhavebonedamageononesideofyourknee,yoursurgeonmaydecidethatyouareasuitablecandidateforpartialkneereplacementsurgery.Aswithtotalkneereplacementsurgery,thesurgeonreshapesthedamagedpartsofthebonetofittheartificialjoint(prosthesis).Manypeoplewhohavethiskindofjointreplacementsurgeryrecovermorequicklythanpeoplewhohavetotalkneereplacementsurgery.Peoplewhohavepartialkneereplacementsurgeryareoftensenthomefromthehospitalthedayaftersurgery.

Knee Revision (Repeat)

Somepeoplewhohavehadakneereplacementneedanothersurgery.Thiscanbebecause:

•Yournewjointislooseorwornout•YouhadbonelossoraninfectioninthejointThesesurgeriescanbemorecomplexandyoumayneedmorerehabilitation.Comparedtoyourfirstsurgery,youmaynotbeabletocarryasmuchweightonyournewjointwhileyourecover.

Joint Components (Prosthetics)

Artificialkneejointcomponentsaremadeofmedical-grademetalandplastic.Therecanbedifferencesintheanatomyofmen’skneesandwomen’sknees.Yoursurgeonmaychoosea“gender-specific”kneejointforyou,dependingontheshape ofyourknee.

Partial Knee Joint


Joint Attachment (Fixation)

Theartificialjointcanbesecuredindifferentways:

CEMENTED: Theartificialjointpiecesaresecuredtothebonewithaquick-hardeningadhesivematerial.

CEMENTLESS:Theartificialjointpiecesarecloselyfittedintothebones.Thesepiecesarecoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.

HYBRID: Acombinationofthesemethods.


Knee Precautions

After Knee Surgery, you will need to follow Knee precautions for 3 months or

until advised by your surgeon.Theseactivityrestrictionswillhelpyourjointtohealandreducestiffnessinthenewjoint.See“Complications”sectionformoreinformation,page54.Shaded leg is the surgical leg.

DO NOT put a pillow behind your knee. Your knee may become stiff if you keep it bent.

DO NOT kneel on your new knee joint

DO NOT do deep squats (squatting down to the floor.)

AdditionalNotesforKneeSurgeryandPrecautions:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Things that you CAN DO after knee surgery:

DO sit on a raised chair or use a cushion.Itwillbeeasiertogetonandoffhighersurfacesaftersurgery.Considerusingaraisedtoiletseat.

DO use long-handled aids, like a shoehorn and reacher, to help you get

dressed or pick up items.

Shoe Horn

Reacher

Before SurgeryIn this section, you will learn about:

2 Home Set-up

2 Equipment

2 Exercise

2 Nutrition

2 Weight Management

2 Pre-op Education

2 Pre-Admission Clinic

2 Final Checklist for Hospital


Home Set-Up

ItisimportanttosetupyourhomeBEFOREjointsurgery.Thiswillallowyoutoeasilymovearoundyourhomewithawalkerorcrutchesaftersurgery,reducetheriskoffallsandmaintainyourhiporkneejointprecautions.

•Ensurehallwaysandroomsarefreeofclutterandtrippinghazards(egscatterrugs,footstools,etc.)

•Addnon-slipsurfacestooutsidestairsandwalkways

•Installstairrailingsormakesuretheexistingonesaresecure

•Setupafirmchairwitharmrests.Ifyouhavehadhipsurgery,seepage25formoreinformationonseatingheights.

•Ensuregoodlightinginhallwaysandotherwellusedareas

•Arrangeforextrahelpwithhouseholdtasksifneeded(i.e.vacuuming,laundry)

•Movefrequentlyusedhouseholditemstocounterheight(i.e.potsandpans).Considermovingitemsinthelowerpartsofthefridge/freezertoahighershelf.

•Stockyourfreezer/pantrywithhealthyfoodsandsnacks.Ifneeded,privatefood/mealdeliveryservicesareavailableinmanyareas.

•Keepanicepackinyourfreezerforpossiblejointswellingaftersurgery.Alternatively,youcanuseabagoffrozenpeas.

•Haveathermometerathometocheckyourtemperatureifneededaftersurgery.

Secure Stair Rails


Bathroom

•Installaraisedtoiletseatwitharmrests/toiletsafetyframetoassistyoutositorstand

•Removeslidingdoorsfromyourbathtubandreplacewithashowercurtain

•Setupatubtransferbench(inthebathtub)orashowerchair(inashowerstall)

•Useanon-slipbathmatbothinsideandoutsidethebathtuborshower

•Installahand-heldshowerhoseinthebathtub

•Grabbarsinthebathtub/showerstallandbythetoiletareveryuseful.Removablegrabbarsareavailable.DoNOTusetowelsracksortoiletpaperholderstoassistyoutostandorsit.

Raised Toilet Seat

Tub Transfer Bench Removable Tub Clamp


Seating After HIP SURGERY:

•As you are not able to bend your hip past 90 degrees for 3 months after

hip surgery, ALL surfaces that you sit on MUST be 2 inches above knee

height. Thisincludeschairs,bedsandtoilets.

•Useahigh-densityfoamcushionorbedblockstoincreasechairheight.Plantotakeyourfoamcushionwithyoutoadaptchairsoutsideofthehouse.

•Setupafirmchairwitharmrests(notarockingchair).

•Setupatablebesideyourchairforfrequentlyuseditemsasyou willnotbeabletobendforwardtothecoffeetable.

•Ifyourbedistoolow,addanothermattressorplacetheframeonbedblocks.

2”

BedblocksExtra matress


Equipment List – Arrange up to 2 weeks before surgery.

* Items NOT available at the Red Cross may be purchased at local medical supply stores.

Hip Surgery

•Walker –q StandardORq 2-wheeled

•Crutches

•Highdensity(firm)foamcushion*(atleast4inchx16inchx18inch,neededforgoinghomeinthecar)

•Dressingequipment(longhandledreacher,longhandledshoehornandsockaid)

Knee Surgery

•Walker –q StandardORq 2-wheeled

•Crutches

•Dressingequipment(longhandledreacher,longhandledshoehornandsockaid)–OPTIONALbutrecommended

Equipment you MUST bring to HOSPITAL — unless otherwise told

Equipment for HOME

Hip Surgery Knee Surgery Theequipmentbelowisrequired Theequipmentbelowisrecommended

•4inchraisedtoiletseat(withorwithoutarmrests) ORcommodechairwithwheels

•26inchLonghandledreacher

•24inchLonghandledshoehorn

•Sockaid

•24inchlonghandledsponge*

•Non-slipbathmat*

•Elasticshoelaces*(otherwiseusesliponshoeswithanenclosedheel)

•Hand-heldshowerhose*

Bathing–useawalk-in shower: OR bathtub:

qShowerchair qTubtransferbenchOR

qRaisedshowerboard

qRemovabletubclamp ORinstalledgrabbars*


Where to Get Equipment

Red Cross Loan Cupboards

•LocationsthroughoutBC

•Provides“free”equipmentfor3months(donationsgratefullyaccepted)

•REQUIRES a signed equipment request form.Thisformwillbeprovidedbythehospital,atyourpre-operativeeducationclassorthroughyourcommunitytherapist.Ifyoudonothavethisformlessthan1weekbeforesurgery,pleasecontactyourlocalhospital.

•BeawarethatTheRedCrosshasalimitedsupplyofequipmentandmaynothavealltheitemsyouneed.

Medical Supply Store

•Equipmentforrentand/orpurchase

•Maydelivertoyourhomeand/orinstall

•Costsmaybecoveredbyextendedhealthplans–checkyourplan

Government Agencies

•VeteransAffairsCanada(VAC)

Friends/Family

Checkwithfriendsandfamilywhomayhaveequipmentyoucanborrow

* Please ensure that equipment fits in your home and is in good working order before you have your surgery

Transportation Support

Sometransportationsupportservicesrequireapplicationformstobecompletedbyyouandyourdoctororhealthprofessional.Theseservicesincludetemporarydisabledparkingpasses(SPARCpass)andHandyDart.

For more information on the services listed above, see the Resources

section of this booklet, page 61.


Exercise

Exercisingbeforesurgerywillhelpyouhaveafasterandeasierrecovery.Doactivitiesthatputlessstressonyourjoint.Try:

•exercisesinwater,suchasswimmingorwaterwalkingatacommunitypool

•cycling

•Nordicpolewalking

•gentlestretchingandstrengthening

•specificexercisessuggestedbyaphysiotherapist

•balanceexercises(valuableinpreventingfalls)

Theseactivitieswillmakeyourmusclesstrong,improveyourenduranceandhelpkeepyourjointmoving.Exercisingbeforesurgerywillalsohelpyoutobuildupyourconfidenceandknowledgeofhowtoexerciseaftersurgery.

* REMEMBER: After surgery, daily exercise will be part of your rehabilitation for many months.

Be sure to strengthen your arm muscles.Youwillneedstrongarmsafteryoursurgerytousewalkingaids,getinandoutofbedandgetonandoffachair.Ifpossible,dostrengtheningexercisesforatleast3weeksbeforesurgery.

For example: Push up through your arms while seated. Work up to 10

repetitions 2 times each day.

Ifthisexercisecausesyoudiscomfortorifyouarenewtoexerciseand/orhaveotherhealthconditions,always talk to your

family doctor before starting a new exercise program.Ifyoudon’tknowhowtogetstarted,talktoaphysiotherapist.


Nutrition

Goodnutritionhelpsyoutorecoverfromsurgeryandreducestheriskofinfection.Importantnutrientsbeforeandaftersurgeryinclude:

Protein

Proteinpromoteshealingaftersurgery.Tomeetincreasedproteinneeds,trytoeatatleast3servingsfromeachofthesefoodgroupseveryday.Forexample:

Multivitamin

Whileabasicmultivitaminisrecommendedtopromotehealing,largedosesofanynutrientaregenerallynotrecommended.Ifyouhaveahistoryofanemia,talktoyourdoctor,pharmacistordietitianaboutsupplements.

Calcium and Vitamin D

CalciumandVitaminDareimportantforstrongbones.Adultsshouldhave2to3servingsofmilkorcalcium-fortifiedproductsaday.Aminimumof400IUVitaminDsupplementisrecommendedforallpeopleover50yearsold.Talktoyourdoctor,pharmacistordietitianaboutcurrentsupplementrecommendationsthatarerightforyou.

Fibre and Water

It’simportanttohavearegularbowelhabitbeforejointsurgerybecauseconstipationcanbeacomplication.Includefibreinyourdiet,suchaswholegrains,bran,fruitsandvegetables,beansandlentils.Spreadthefibrethroughoutthedayanddrinkatleast8glassesofwaterorotherlow-caloriefluidaday.

Formoreinformationaboutnutrition,seeCanada’sFoodGuide: www.healthcanada.gc.ca/foodguide

Meat and Alternatives

1 serving =

> 2-3 oz of meat, poultry or fish

> 2 eggs

> 3/4 cup beans

> 3/4 cup tofu

> 2 tablespoons peanut butter

Milk and Alternatives

1 serving =

> 1 cup milk or soy beverage

> 2 ounces cheese

> 3/4 cup yogurt


Weight Management

Beingoverweightorunderweightcanaffectyourrecoveryfromsurgery.

Ifyouareoverweight,moderateweightlossisagoodstrategytoreducehipand/orkneepainandtoallowyoutodomoreactivities.Everyextrapoundyoucarryplaces3-6poundsofforceonyourkneesandhips.Ifyouaretryingtoloseweightbeforesurgery,aimforagraduallossofnomorethan1poundperweek.Avoidfaddietsastheymaycauseyoutobeundernourishedandprolongrecovery.

Beingunderweight canmakeitharderforyourbodytohealaftersurgery.Itisimportanttoeatwellbeforesurgery.

Talktoadietitianifyouareworriedaboutbeingoverweightorunderweightbeforesurgery.Tofindoutmoreinformationonnutritionorspecificnutrients:

Dial-a-Dietitian:604-732-9191 or

Toll Free in BC: 1-800-667-3438 Website:www.dialadietitian.org

DietitiansofCanadaWebsite:www.dietitians.ca

1 EXTRA POUND =

approximately

3-6 POUNDS OF FORCE

on your knees and hips


Pre-Operative Education

WHEN? As far in advance as possible*

ThehospitalwillcalltoregisteryouforaPre-opJointReplacementClass.Atthissession,youwilllearnmoreaboutyoursurgery,whattoexpectwhileyouareinhospitalandwhatyouneedtoprepareathome.Itisagoodideatobringafamilymemberorsupportpersonwithyoutothissession.Formoreinformationonpreparingforsurgery,seeResourcesonpage61.*In some BC hospitals, your pre-op education

may be provided at your Pre-Admission Clinic visit.

Pre-Admission Clinic (PAC)

WHEN? A few days before your surgery

ThePre-AdmissionClinicwillcallyoutoscheduleanappointment.Thisappointmentmaylastafewhours.Thenursewilldiscussmanypointsincluding:

•whentostopeatinganddrinkingbeforesurgery

•medicinemanagementbeforeandaftersurgery.Some medicines

and supplements must be stopped 1-2 weeks before surgerytoavoidproblemswithbleedingorsleepiness.Talktoyoursurgeonifyouhavequestionsaboutyourmedicines.

•allergies

Bring ALL of your medicines/supplements to your Pre-Admission Clinic

appointment.

Youmayhavesometestsdoneincluding:

•Bloodwork

•X-ray

•ECG(electrocardiogram)

Youmayalsobescheduledtomeetwithananesthesiologist.Thisisamedicaldoctorwhoistrainedtogiveanestheticdrugsandmonitoryouthroughoutyoursurgery.Bring any questions about your anesthesia to your Pre-Admission Clinic appointment.

Your surgery may be cancelled if you have:anactiveinfectionanywhereinyourbody,askininfectionoverthejoint,acoldortheflu.Ifyouaresickbeforesurgery,call your surgeon.


1 Day Before Surgery: A FINAL Checklist

Bynowyoushouldhavepickedupyourmedicalequipmentandsetupyourhome.Hereisafinalchecklistofthingsyouneedtodobeforecomingtothehospital:

qLabelallofyourequipmentwithyourname(walker,crutches,dressingequipment)–ifyouarebringingtheseitemstothehospital

qMakearrangementsfortransportationtoandfromthehospital

qMakearrangementsforsomeonetostaywithyouorbenearbyforatleastthefirst72hoursafteryouleavethehospital

qHaveabathorshowerusingregularsoapthenightbefore,orthemorningofyoursurgery(do not shaveyourlegsasanycutsorskinirritationmayresultinyoursurgerybeingcancelled)

qPackyourbagforthehospital.Bring:

mtoiletryitems(toothbrush,hairbrushetc.)

mloosefittingclothestoexerciseinandtowearhome

mcomfortable,closedtoeandheelshoes/slipperswithnon-slipsoles.Yourshoesshouldberoomysinceyouwillhavesomeswellinginyourfeet.

mifyouwearelasticsupportstockings,bringthemwithyou

meyeglassesandreadingmaterials

mhearingaids

mifneeded,creditcardinformationforitemssuchashospitalTVrental

DO NOT bring valuables to the hospital

During Your Hospital Stay

In this section, you will learn about:

2 Day of Surgery

2 Recovery Room

2 Length of Hospital Stay

2 Rehabilitation

2 Pain Control

2 Heparin Injections

2 Going Home


Day of Surgery

Before Surgery:

•GototheAdmittingDeskinthehospital

•Bringallofyourmedicineswithyou,asdirectedbythe Pre-AdmissionClinic

•Askfriendsorfamilytobringyourlabelledequipmenttothehospitalwardunlessotherwiseinstructed

•Toprepareforsurgery,youwillchangeintoahospitalgownandanursewillstartanintravenousline(IV)inyourarm

During Surgery: Anesthesia

Eachhospitalmanagesyouranestheticdifferently.Manypeoplewhohavejointreplacementsurgeryhaveaspinal anesthetic.Thisislikethefreezingyougetatthedentist,exceptthisfreezinggoesintoyourbackandmakesyounumbfromthechestdownandstopsyoufromfeelingpain.Theanesthesiologistwillmakesureyouarecomfortablethroughoutthesurgery,givingyoumedicinethroughyourIVthatmakesyourelaxedandsleepy.Ifyouhaveaspinalanesthetic,youwillnotbeabletomoveyourlegsforupto4hoursaftersurgery.

Somepeoplereceivegeneral anesthetic.Thisisacombinationofdrugsthatwillmakeyouunconsciousduringthesurgery.

Bring any questions you have about anesthetic to your Pre-Admission Clinic appointment.

After Surgery: Recovery Room

•Youaremovedfromtheoperatingroomtotherecoveryroom

•Youmayhaveoxygenbymaskforashorttimeornasaloxygenovernight

•Thenursemonitorsyourvitalsigns,includingyourpulseandbloodpressure

•Youwillhavepainmedicineonaregularbasis.Tell your nurse if you

are in pain.

•Somepeoplemayhavecompressiondevicesplacedontheirlowerlegs.Compressiondevicesgentlysqueezeyourcalfmuscletohelpwithbloodcirculation.

•ThestayintheRecoveryRoomisusually1to3hours


After Surgery: The Hospital Ward

•Onceyouaremedicallystable,youaretransferredtotheorthopaedicward

•Youwillbetoldhowmuchweightyoucanputonyournewjoint(weightbearingstatus).Thiscanvaryforeachindividual.Oftenpeoplearetoldtoweightbearastolerated,butyoumayhaveaweight-bearingrestrictionsuchaspartial, feather,ornon-weightbearingonyoursurgicalleg

•Thewardstaffhelpsyoutostandonyournewjointifallowedbyyoursurgeon

•Thenurseassessesyouforpainandnausea

•Youwilluseacommode/raisedtoiletseatduringthedayandabedpan/urinalatnight.Whenyouareable,youwillwalktothebathroom.Somepeoplewhohavespinalanestheticfinditdifficulttourinateandwillneedacatheter(atemporarytubeplacedinyourbladdertoemptyit).

•Youmayhavebloodwork

•Youmayhaveanintravenousline(IV)formedicine

•Afterkneesurgery,youmayhaveadrainonyourlegtocollectbloodfromyourknee

•Youaretaughtexercisestohelpreducecomplicationsaftersurgery,suchas:

>breathingdeeplyandcoughingeveryhourtokeepyourlungsclear

>pumpingyouranklestoimprovecirculationinyourlegs

•Mostpeoplewillbestartedonamedicinethathelpsreducetheriskofdevelopingabloodclotaftersurgery.See“PreventingBloodClots”formoreinformation,page41.


Length of Hospital Stay Guidelines

Yourtimeinthehospitalisshort.Yourhealthcareteamwillworkwithyoutomakesureyouaremedicallystableandabletomanagedailytaskstogohome.Beforesurgery,itisimportanttomakearrangementstohavesomeonepickyouupfromthehospitalwhengoinghome.Dischargetimeisusuallyinthemorning.

Be aware that you may go home sooner than expected.

Ensure your travel arrangements are flexible.

Total Hip Replacement = 3 nights or LESS

(includesresurfacingandrevisionsurgery)

Total Knee Replacement = 3 nights or LESS

(includesrevisionsurgery)

Partial Knee Replacement = overnight

Bilateral (both) Knee Replacement = 5 nights or LESS

For example:IfyouhavesurgeryonMondayandarespending3nightsinthehospital,youwillprobablybesenthomeonThursdaymorning.

MondaySURGERYDAY

Tuesday

Wednesday

Thursday DISCHARGEHOME


Rehabilitation

•Physical activity is a very important part of your recovery. Notonlydoesithelptoimprovethefunctionofyourjoint,butitalsohelpsclearyourlungs,reducestheriskofbloodclotsinyourlegs,reducespain,andstartsyourbowelsmoving.

•Thephysiotherapist(PT)willworkwithyouthroughoutyourstay.Yourphysiotherapistwillteachyouhowto:

>walkwithawalkerand/orcrutches

>doyourdailyexercises

>usethestairssafely

•Thephysiotherapistwillgiveyouexercisestodoinhospitalandathome.Theymayalsoreferyoutoaphysiotherapistinyourlocalcommunity.

•Theoccupationaltherapist(OT)willteachyouhowtododailyactivities,suchasdressingandbathing,whilefollowingprecautionsandprotectingyournewjoint.


Pain Control

Pain Control After Surgery

•Yournursewillteachyouhowtousethepainscaletodescribeyourlevelofpain.“0”isnopainand“10”istheworstpossiblepain.

•It is our goal to keep your pain at “3-4” or below at all times.

•Generally,painmedicineisgivenasapilltakenbymouth.

•Ifyouhavehadageneralanaesthetic,youmayhaveapatientcontrolledanalgesia(PCA)pump.ThisiswhenacontrolledamountofpainmedicationispumpedintoyourIVtubewhenyoupushabutton.

•Acombinationofmedicineswilllikelybeusedtocontrolyourpainaftersurgery.Thisnormallywouldincludeacetaminophen(i.e.TylenolTM)pluspossiblyananti-imflammatory(i.e.NSAID)and/ornarcotic(i.e.morphine).Bytakingacombinationofthesemedicines,youmaybeabletoreducethesideeffectsofanyoneofthesemedicinesandhaveimprovedpaincontrol.Itisimportanttotalktoyourhealthcareteamtounderstandhowandwhentotakethesemedicinestobestcontrolyourpainandsymptoms.

•Somesideeffectsofpainmedicinecaninclude:nausea,vomiting,drowsiness,itchinessand/orconstipation.Tellyournurseifyouhaveanyofthesesymptoms.

Pain Assessment

0 1 2 3 4 5 6 7 8 109No Pain Mild Moderate Severe Very Severe Excruciating


Pain Control at Home

Mostpeoplehavelessandlesspainoverthenext6to12weeks.Ifpainispreventingyoufromcaringforyourself,sleepingand/orexercising,talktoyourphysiotherapistordoctor.If your pain becomes

increasingly worse or if you have pain in a new part of your body, seek

medical attention immediately.(Seebackcoverofthisbookletforguidelines).

Herearesomewaystomanageyourpain:

•Takepain medicineasdirected.Itisnormaltohavesomeincreasedpainorsymptomsduringphysicalactivityorphysiotherapysessions.Itmaybehelpfultotakeadoseofpainmedicine1or2hoursbeforeengagingintheseactivitiesinthefirstweeksaftersurgery.ItisbettertotakemedicineBEFOREthepainissevere.

•Icecanreducepainandinflammation.Itisparticularlyusefulfor peoplewhohavehadkneereplacementsurgery.Placeanicepack wrappedinatowelonyourjointasdirectedbyyourphysiotherapist.

• Pace yourself.Donotpushyourself.Regularrestisanimportantpartofyourhealingprocess.

•Relax.Userelaxationtechniquessuchasbreathingexercisesorprogressivemusclerelaxation(progressivemusclerelaxationiswhenyoutightenandrelaxeachpartofyourbody,startingwiththetoesandworkinguptoyourneck).

•Distractyourself.Listentomusic,visitwithfriends,writeletters,watchTV.

•Think positively.Youwillbecomemoreandmorecomfortableasyourecoverfromyoursurgery.

Ice pack on knee joint


Preventing Blood Clots

Afterhiporkneereplacementsurgery,youareatriskfordevelopingabloodclot(see“Complications”,page55).Manypeoplearegivenamedicineaftersurgerytoreducethisrisk.

•Themedicinemaybeapillthatyoutakeonceadayforamonthaftersurgery,OR

•Themedicinemaybeaninjectionthatistakenonceadayfor 10-35daysaftersurgery

•Yoursurgeonwilldecidewhichmedicineisrightforyou.Hospitalstaffwillbeavailabletoansweranyquestionsaboutthemedicineandhowtotakeit.

•Fillyourprescriptionatapharmacynearthehospital,incaseyourlocalpharmacydoesnotcarrythemedicine.

•Itisimportanttotakethemedicineexactlyasprescribed.

Going Home

Formostpeople,youwillbedischargedtoyour home,notarehabfacility.Beforeleavingthehospital,planappointmentswiththefollowingpeople:

Follow-Up Medical Appointments

•Theperson(e.g.GPorphysiotherapist)whowillremoveyourstaples,7-14daysaftersurgery

•Yoursurgeon,usuallyaround6weeksaftersurgery

•Yourphysiotherapist,usuallywithin1weekofdischarge(ifrecommendedbyyoursurgeon)

•Yourfamilydoctor,onceyouarebackonyourfeet,toreviewyourgeneralcondition

After SurgeryIn this section, you will learn about:

2 Physiotherapy After Hospital

2 Transportation

2 Everyday Activities Guidelines

2 Wound Care

2 Sexual Activity

2 Returning to Work

2 Complications

2 Dental Work or Other Medical Procedures


Recovery at Home

Physiotherapy After Hospital

Thehospitalphysiotherapistwillhelpyoutoarrangeaphysiotherapyappointmentforwhenyougethomefromhospital.Dependingonyourneeds,whereyouliveandlocalservices,yourappointmentmaybeataphysiotherapyclinic,out-patienthospitalcentre,rehabfacilityorhomehealthprogram.

Yourphysiotherapistwillgiveyouexercisestostretchandstrengthenyourlegsandimproveyourwalkingandbalance.Asyourecover,theexerciseswillgetharder.Doingtheexercisesassignedbyyourphysiotherapistwillhelpyoumoveyournewjointandenjoygreaterindependence.Itisimportanttocontinuewiththeexercisesforatleast1yearafteryoursurgery.

Talktoyourphysiotherapistifyouhavequestionsaboutyourexercisesorconcernsaboutyourprogress.


Transportation

Therearemanydifferentwaystogetaroundaftersurgery.Herearesomeoptions:

•Friends/family

•Taxis

•Temporarydisabledparkingpass(SPARC)*

•HandyDART*(ifavailableinyourcommunity)—transitserviceforthosewhocannotusetheregularbusservice.HandyDARTwillpickyouupanddropyouoffatappointmentssuchasmedicalvisits.

•TravelAssistanceProgram(TAP)*–assistswithcostsforout-of-townmedicaltravel

Talk to your healthcare providers about completing the necessary forms for these services BEFORE surgery. See “Resources” page 61.

Air Travel

Youmayhavesomeextrachallengestravellingbyplaneaftersurgery.Besuretogiveyourselfextratimewhenflying.Yournewjointmay setoffmetaldetectorsattheairport.Ifyouareflyingwithin3monthsofhavinghipsurgery,bringyourhigh-densityfoamcushiontoraise theheightofyourseat.Whileontheplane,dofootpumpingexerciseseveryhourtohelpreducetheriskofclots.Ifflyinghomefromhospital,checkwithyouraircarrierifmedicaldocumentationisneeded.

Driving

Drivingisrestrictedafterkneeorhipsurgery.Thereareanumberoffactorsthatcanimpactyourabilitytosafelyreturntodriving.Theseincludeusingmobilityaidsandtakingprescriptionpainmedicines.Talktoyoursurgeonandphysiotherapistbeforedriving.Mostpeoplestarttodrivewithin12weeksaftersurgery.

Taxi

HandyDART

Personal vehicle


Car Transfer

Itcanbechallengingtoprotectyourjointgettingintosomecars,particularlyfollowinghipsurgery.Talktoyouroccupationaltherapist ifyouhavequestionsaboutcartravel.Pleasepracticetheseinstructionsbeforeyoucometothehospital.

•Parkawayfromthesidewalkorcurbsoyouarenotsteppingdownfromthecurbtothecar.Ifyouhaveahightruckorsport-utilityvehicle,youmayneedtoparknearthecurbsothatyoudonothavetoclimbuptotheseat.

•Movetheseatasfarbackaspossible

•Reclinetheseat

•Placeyourhigh-densityfoamcushionontheseat.Ifitisawedgecushion,positionthethickendatthebackoftheseat.

•Backuptotheseatuntilyoufeelthebackoftheseatonyourlegs

•Extendyouroperatedleg

•Holdontothebackoftheseatandthecartostabilizeyourself

•Loweryourselftotheseat

•Slidebackandliftyourlegsintothecar.(Ifyouhavehadhipsurgery,doNOTbendmorethan90degrees).

•Apieceofplasticoralargegarbagebagoverthecushionmayhelpyoutoslideinmoreeasily

•Youcanalsotryadevicecalleda“Handybar”thatcanassistyouto getinandoutofaregularcar.Thiscanbepurchasedatmedicalsupplystores.

Shaded leg is the surgical leg.


Everyday Activities Guidelines

Walking

Youcanexpecttousewalkingaids,suchasawalker,crutchesorcane,forupto3monthsorlongeraftersurgery.By4to6weeksafteryoursurgery,youshouldbewalkingwithmoreconfidence,havemorestrengthandbeabletowalklongerdistances.Regularphysiotherapyafteryoursurgerywillhelpyougetthemostoutofyournewjoint.Physicalactivitywillhelpyouhaveafasterrecoveryandwillgetyourbloodmoving.Thiswillalsoreduceyourriskofdevelopingabloodclot.

Stairs

Itisagoodideatopracticethestairswiththehospitalphysiotherapistsothatyouareabletomanagestairssafelyandindependently.Ifyouhavehadbothkneesreplaced(bilateral),yourphysiotherapistwillpracticeatechniquewithyouthatallowsyoutoalternateyoursurgicallegswhengoingupanddownthestairs.Shaded leg is the surgical leg.

Going UP the stairs:

•Useahandrailand/orcrutches,cane

•StepUPwithyourgood (non-operated)legfirst

•Followwithyouroperatedlegandcrutch,onestairatatime

Going DOWN the stairs:

•Usethehandrailoryourcrutches

•Placeyourcrutchonthestepbelow

•StepDOWNwithyouroperatedlegfirst

•Followwithyourgood(non-operated)leg,onestairatatime


Getting Into Bed

•Sitatthesideofthebed.Itmaybeeasiertogetintobedonyourstrongerside.

•Slidebackacrossthebedusingyourarmsforsupport

•Ifnecessary,a1⁄2bedrailcanallowyoutogetinandoutofbedmoreeasily.A1⁄2bedrailconsistsofahandlewith2longmetalrodsthatareplacedbetweenthemattressandtheboxspring.A1⁄2bedrailcanbeobtainedthroughtheRedCrossormedicalsupplystores.

•Liftyouroperatedlegintobedorusea“leglifter”(thismaybethebeltfromyourhousecoatoracrutchturnedupsidedown,hookedoveryourfootsoyoucanhelpliftthelegusingyourarms)ifneeded

Getting Out of Bed

•Slideyourbodytotheedgeofthebed

•Useyourarmstopushyourselftoasittingposition.(Ifyouhavehadhipsurgery,donotpushyourselfuppast90degrees.Rememberyourhipprecautions!)

•Slideyouroperatedlegoffthebed

•Bringyourbodytoasittingpositionatthebedside

Sitting Down

•Useafirmchairwitharmrests

•Ifyouhavehadhipsurgerymeasurethechairheightagainstyourlegbeforeyousit.Thechairshouldbe2inchesaboveyourstandingkneeheight.Useahighdensityfoamcushionorbedblockstoincreasethechairheight.

•Backuptothechairuntilyoufeeltheedgebehindyourknees

•Moveyouroperatedlegforwardandreachbackforthearmrests

•Slowlyloweryourselfintothechair


Getting Dressed

•Sitonaraisedchairorbed

•Dressyouroperatedlegfirstandundressitlast

•Useadaptiveaidslikealong-handledreacher,sockaidandshoehorntoreachthefootofyouroperatedlegandputonsocks,pants,shoes,etc.whileprotectingyournewjoint

•Whileyouareinhospital,youroccupationaltherapistwillshowyouhowtousetheseaidsandgiveyoutipsonhowtodresswhilemaintainingjointprecautions

Bathroom Safety

Fallscanhappenanywherebutaremostlikelyinthebathroom.Herearewaystoreducetherisk:

•Donotrush.Plantousethetoiletoften.Haveabedsidecommodeifneeded.

•Whenbathing,useabenchorchair,non-slipbathmats,grab-barsand/oraremovabletubclamp

•Makesuretheroutefromyourbedroomtothebathroomiswell-lit

•Wearsensible,non-slipshoesorslippers

•Ifyoufeeldizzyorunsteady,talktoyourfamilydoctor

Using the Toilet

•Usearaisedtoiletseatforthefirst3monthsafteryoursurgery

•Makesurethatthetoiletseathassecurearmrestsorthatyoucanusethecountertopushyourselfup.Youcanalsoinstallgrabbarstohelpyoustandorsit.DoNOTusetowelsracksortoiletpaperholderstohelpyoustandorsitdown.

•Toiletseatshouldbe2inchesabovestandingkneeheight

•Sitdownasyouwouldinachair(seepage49)

Raised Toilet Seat

Removable Tub Clamp


Bathtub Transfer

•Useatubtransferbenchwithahand-heldshower(inabathtub)orshowerchair(inashowerstall)forthefirst3monthsaftersurgery.DoNOTtrytositonthebottomofthetub.

•Removeglassshowerdoorsonyourtubandreplacewithashowercurtain

•Placeanon-slipbathmatinsideandoutsidethetub

•Yourtransferbenchorshowerchairshouldbe2inchesaboveyourstandingkneeheight.Ifyouaretall,youmayneedbenchlegextensions.

•Sitdownasyouwouldinachair(seepage49).Slidebackasfarasyoucanontheseat.Thenliftyourlegsovertheedgeofthetub.Donotbendyourhippast90°ifyouhavehadhipsurgery.

•Uselong-handledaidstocleanyourfeetandotherhard-to-reachplaces

•Ahand-heldshowerhosewillallowyoutobathemoreeasily.Ifyouhavehadahipreplacement,youwillnotbeabletoreachforwardforthetapsduetohipprecautions.

•Somesurgeonswillwantyoutodosponge-bathsuntilyourstaplesareremovedinordertoavoidgettingthenewincisionwet


Wound Care

Youwillhaveacut(incision)atthesiteofyoursurgery.Yournursewillteachyouhowtocareforyourincisionathome.Whileitisnormaltohavesomerednessandcleardrainagefromyourwound,watchforsignsofinfection(page56).Youdonotneedabandageunlessthereisdrainage.

Theedgesofyourskinmaybeheldtogetherwithsutures,staplesorsteri-strips.Staplesaremetalclipsthatholdtheedgesofyourskintogetherwhileyourskinheals.Yourstapleswillberemoved7to14daysaftersurgery.Ifyouhavesteri-strips,leavethemalone.Theywillfalloffontheirown.

Itisimportanttokeepyourincisiondryuntilitisfullyhealed.Youmayfinditusefultotapeaplasticbagorwaterproofdressingoveryourincisionwhileshoweringunlessotherwiseinstructedbyyoursurgeon.

Sexual Activity After Hip Replacement:

•Youmayreturntosexualactivitywhenyoufeelreadyandcomfortable;thisisoftenaround4to6weeksaftersurgery

•Youmustmaintainhipprecautionsfor3monthsduringalldailyactivities,includingsexualactivity

•Thinkabouthowyouwillmaintainyourhipprecautionsofnottwistingandnotbendingmorethan90degrees

•Youmayneedtoconsidertryingsomenewpositions.Talktoyourpartner.

•Ifyouhavequestionsorconcernsabouthowtoprotectyournewhipduringsexualactivity,talktoyouroccupationaltherapist,physiotherapistorsurgeon.

•Visitthewebsite:www.aboutjoints.comforillustrationsofsexualpositionsthatmaintainhipprecautions


Returning to Work

Allowyourselftimetorecoverfromsurgeryandfocusonyourrehabilitationbeforereturningtowork.Somepeoplereturntosomeformofworkquicklyaftersurgerybutothersneedalongertimetohealandrecover.Thisdependsonfactorssuchashealthstatusandthetypeofworkyoudo.Talktoahealthcareprofessional,suchasanoccupationaltherapist,aboutwhatisrightforyou.

Work Environment Adaptations:

• Chair:Chooseastandardchairforsitting.Avoidchairswithwheels;theycanrollawayfromyouwhenyouaregettingup.Useyourhigh-densityfoamcushiontoincreasetheseatheightifnecessary.

•Desk:Positionyourphone,paperworkandcomputerclosetoyou.Ifyouhavehadahipreplacement,youshouldNOTbendforwardtoreachtheseitems.Thiswillbreakyourhipprecautions.

•Keyboard Tray:Ifyouhaveraisedyourchairandyourdeskistoolow, useaheight-adjustablekeyboardtraysothatyoucansitcomfortablywhiletyping.

•Schedule:Planlotsofstretchbreaks.Getupandmovearoundfrequently.Avoidsittinginthesamepositionformorethan45minutesatatime.

•Bathroom:Checktheheightofthetoiletsattheofficeandthelocationofgrabbars.

* Review your workstation before surgery so that you can make the necessary adjustments before you return to work *

Standardchair-nowheels

Hipanglegreaterthan90degrees;usehigh-densityfoamcusionifnecessary

Cleardeskspaceofclutter


Complications

Aftersurgery,afewpeoplehavecomplicationsandneedmoremedicaltreatment.Herearesomepossiblecomplications:

•Constipation/bladderfunction

•Short-termconfusion

•Bloodclots

•Swelling

•Infection

•Anemia(lowbloodcount)

•Jointloosening

•Hipjointdislocation

Short Term Confusion

Asmallnumberofpeopledevelopshort-termconfusionaftersurgery.Thismayberelatedtoothermedicalconditionsorconditionssuchasalcoholwithdrawal.Forexample,ifyoudrinkalcoholdaily,considercuttingbackbeforesurgery.Ifyouareunabletocutbacktheamountofalcoholyoudrink,tellyournursesothatprecautionscanbetakentoavoidwithdrawalsymptoms.

Constipation / Bladder Function

Constipationcanbeaproblemaftersurgery.Achangeinyourdiet,lessactivityandpainmedicinemaymakeyourconstipationworse.Herearesomewaystostayregularatthehospitalandathome:

•Drinkatleast8glassesofwaterorlowcaloriefluidaday

•Eatfibre,suchasprunes,bran,beans,lentils,fruitandvegetables

•Movearoundasmuchasyoucan–doyourexercises!

Yournursemaygiveyoulaxativesand/orstoolsofteners.Youmayneedtokeeptakingthesemedicinesathome.Ifyouhaveconstipationathome,talktoyourfamilydoctororpharmacist.Constipationcanbeserioussodonotignoreyoursymptoms.

Somepatientshavedifficultyurinatingaftertheirjointsurgery.Pleasetalktoyournurserightawayifyouarehavingproblems.Youmayneedacatheter.


Blood Clots

Asmallnumberofpeoplemaygetbloodclotsaftersurgery.Bloodclotsusuallydevelopinthedeepveinsinthelegs.Peoplewhohaveproblemswiththeircirculationand/orareinactivearemorelikelytodevelopabloodclot.

Toreducetheriskofbloodclots:

•Takethemedicineprescribedbyyoursurgeontopreventbloodclots

•Walkshortdistancesatleastonceanhour(exceptwhenyouaresleeping)

•Whenyouaresittingorinbed,pumpyouranklesandflexyourlegmuscles

Swelling

Itisnormaltohavesomeswellinginyourlegaftersurgeryandduringyourrecovery.Swellingmayincreaseasyoubecomemoreactive.Tohelpreduceswelling:

•Pointandflexyourfeethourlywhenawake

•Liedownflatandraiseyourlegs(maintainhiporkneeprecautions)byplacingpillowsunderthelengthofyourleg

•Doshortperiodsofactivity.Walkafewsteps.Rest.Repeat.

•Placeanicepackwrappedinatowelonyourjoint.Forsomekneeclients,a“cryocuff”maybeused.Thisisatypeoficepack/compressiondeviceforthelowerleg.Formoreinformation,talktoyourphysiotherapistaboutusingiceathome.

Tell your family doctor or surgeon immediately

if you have:

• Pain,aching,heatorrednessinyourcalfarea

• Increasingsevereswellinginyoursurgicalleg

Call 911 immediately if you have:

• Shortnessofbreath

• Suddenchestpain


Infection

Lessthan1%ofpeoplehaveaninfectionaroundtheirnewjoint.An infectioninthebodycanreachthenewjointthroughthebloodstream.Peoplewhodevelopjointinfectionsneedantibioticsand,onrareoccasions,furthersurgery.Topreventinfectionorincisionproblems,itisimportanttokeeptheincisionanddressingsdry.Donottouchorpickattheincisionandmaintaingoodcleanlinessofthesurroundingskin.

Tell your doctor or surgeon if you have any of these signs of infection:

Incision Infection:

•Theareaaroundyourincisionisbecomingmoreredandtheredisspreading

•Newdrainage(green,yelloworfoulsmellingpus)fromthewoundsite.Itiscommonfornewsurgicalwoundstohavesomedrainageforthefirstfew(3-5)daysaftersurgerybutthiswillslowlystop andthewoundshouldstaydry.

•Thereisincreasedpainorswellingofwoundsiteandsurroundingarea

•Feverabove38°Cor101°F

•Callyoursurgeonifyouthinkyouhaveapossiblewoundinfection

Urinary Tract Infection:

•Painwhenyouurinate

•Frequentorurgentneedtourinate

•Foulsmellingurine


Sore Throat/Chest Infection:

•Swollenneckglands,painwhenyouswallow

•Frequentcough,coughing-upyelloworgreenmucous, shortnessofbreath



Anemia (low blood count)

Ifyouhavesignsofanemia,seeyourfamilydoctor.Youmayneedanironsupplement.Thesignsofanemiaare:

•Feelingdizzyorfaint

•Feelingverytired

•Shortnessofbreath

•Rapidpulse

Joint Loosening

Overmanyyears,thebondbetweenthejointreplacementandyourbonemayloosen.Thiscancausepainandmakeitdifficultforyoutomoveyourartificialjoint.Toreducetheriskofthiscomplication,avoidhigh-impactphysicalactivities.Ifyounoticeincreasedpaininyourartificialjoint,talktoyourdoctorassoonaspossible.

Hip Joint Dislocation

Call 911ifyoursurgicallegissuddenlyextremelypainful,shortens,andthehipcannotbemoved.

Dental Work and Medical Procedures

Itisimportanttotellyourhealthcareprofessionalthatyouhavehadjointreplacementsurgerybeforehavingdentalworkormedicalprocedures(includingprocedureswiththebladder,prostate,lungorcolon).Youmaybeputonantibioticstopreventinfectionfrommovingthroughyourbloodstreamtoyournewjoint.Talktoyourdentistordoctoraboutwhatisrightforyou.

We hope you found the information in this booklet useful. We wish you a speedy recovery and many happy years with your new joint.

Resources


Resources

Arthritis & Surgery Information

OASISProgram; “OsteoarthritisServiceIntegrationSystem”VancouverCoastalHealthwww.vch.ca/oasis

Email:[email protected]:604-875-4257

TheArthritisSocietywww.arthritis.ca

Email:[email protected]: 1-800-321-1433

TheArthritisResource GuideforBCwww.argbc.ca

CanadianOrthopedicAssociationwww.coa-aco.org

CanadianOrthopedicFoundationwww.canorth.org/en/patienteducation

andOrthoConnectwww.canorth.org

“MyJointReplacement”informationwww.myjointreplacement.ca

SurgicalorOrthopedicInformationAmericanAcademyofOrthopaedicSurgeonshttp://orthoinfo.aaos.org

Equipment

VeteransAffairsCanadawww.vac-acc.gc.ca

TollFree: 1-866-522-2122

RedCrosswww.redcross.ca

TollFree: 1-800-565-8000 orchecklocallistingsforareaphonenumber

Health Professionals

HealthLinkBCPhone:8-1-1www.healthlink.ca

Non-emergencyhealthinformationprovidedbyanurse,pharmacistordietitian.

DietitiansofCanada www.dietitians.ca

PhysiotherapyAssociationofBritishColumbia(PABC)–tofindaphysiotherapistinyourareawww.bcphysio.org

Home Safety

HomeSafetyRenovations (lowincomeseniors)www.cmhc-schl.gc.ca.

Phone:1-800-639-3938

Transportation

HandyDARTwww.bctransit.ca

ProvidedbylocalbusservicesthroughoutBC–checkyourlocallistingsforphonenumbersInLowerMainland:Phone:604-575-6600

SPARC– disabledparkingpasswww.sparc.bc.ca

Phone:604-718-7744

TAP–TravelAssistanceProgramwww.health.gov.bc.ca/msp/

mtapp/tap_patient.html

Phone:1-800-465-4911

* Please note that phone numbers may change and you may need to use directory assistance.


Indexacetabulum ...............................7,8airtravel .....................................46anemia ............................29,54,57anesthesia .............................31,35bathing ...........................24,38,50bed(gettinginandout) ..............49bedblocks ............................25,49bilateralknee replacement ....................16,37,48bloodclots ....36,38,41,48,54,55bloodthinner ..................36,41,55bothknees ............................16,48cartransfer ..................................47chestinfection ............................56complications ....................... 54-57constipation ....................29,39,54crutches ..............23,26,32,38,48daleparin ....................................41dayofsurgery .............................35deepbreathingandcoughing ......36Dial-a-Dietitian ....................30,61disabledparkingpass (SPARCpass)..................36,46,61discharge(hospital) .....................37dislocation(hip) ..............10,54,57dressing ..............11,26,32,38,50driving .......................................46education ....................................31emergencysituations ......55,56,57equipment ............................26,27exercise ...28,36,38,40,45,46,54fallsprevention ...............23,28,50femur .................................7,8,15follow-up ....................................41grabbars ..................24,26,50,53governmentagencies ............27,61hand-heldshowerhose ....24,26,51HandyDART ..................27,46,61heparin ...........................36,41,55highdensityfoamcushion ...11,25,

26,46,47,48,53hipprecautions ........10,11,12,49, .......................................51,52,53

hipreplacement ............................8hipresurfacing ..............................8hiprevision ..................................9homeset-up ................................23ice ..................................21,40,55incisioninfection ........................56infection .........................31,52,56injection .........................36,41,55intravenous ...........................35,36jointloosening ............................57kneeprecautions .........................18kneereplacement ..................15,16kneerevision ..............................16kneestiffness ........................15,18leglifter .....................................49lengthofhospitalstay ................37lighting ......................................23long-handledreacher ...........11,19,

26,50long-handledshoehorn ........11,19,

26,50loosening(joint) ...................54,57LowMolecularWeightHeparin(LMWH) ....................................41medicalappointments ................14medicalsupplystores ..................27medication .................................39nausea ...................................36,39nutrition .....................................29OASIS ........................................55occupationaltherapist ....38,47,49,

52,53officework ..................................53OrthoConnect ........................4,61osteoarthritis ..........................7,15pain .................7,8,15,30,35,36,

38,39,40,54,55,56,57painassessmentscale ..................39partialkneereplacement .............16physiotherapy .....38,40,41,45,48Pre-AdmissionClinic .................31pre-opchecklist ..........................32pre-opeducation .........................31

prosthesis ...............................8,15protein .......................................29railings .......................................23raisedtoiletseat .............11,19,24,

26,36,50recoveryroom .............................35RedCrossLoanCupboards .........27rehabilitation ..............................38resources .....................................61returningtowork .......................53revision ...................................9,16sexualactivity .............................52showerchair ...................24,26,51showering .................24,32,51,53sitting ........................................49sleep .....................................11,40sorethroat ..................................56SPARCpass ....................27,46,61spinalanesthetic ...................35,36stairs(goingup,down) ...............48staples ..................8,15,41,51,52steristrips ...................................52swelling ................................55,56TheArthritisSociety ..................61toilettransfer ..............................50transportation .......................27,46TravelAssistanceProgram(TAP) .............................................46,61tubclamp .......................24,26,50tubtransferbench ...........24,26,50underweight ...............................30urinarytractinfection .................56unicompartmentalkneereplacement ................................16urinating ........................36,54,55vitamins .....................................28walker ......................26,32,38,48walking ................................28,45weightbearingstatus .................36weightmanagement ...................30workenvironment ......................53woundcare .................................52woundinfection ..........................56

Whentoseekmedicalattention

OAS S

CALL 911 if you develop:

• Suddenseverepaininyoursurgicalleg

• Inabilitytomovethesurgicalleg

• Shorteningoftheleg

• Shortnessofbreath

• Chestpain

CALL your Surgeon if you develop:

• Rednessanddrainageatthe

incisionsite

• Fever

• SevereFatigue

• Dizziness

For more copies, go online at http://vch.eduhealth.ca or

email [email protected] and quote Catalogue No. FB.130.B393

© Vancouver Coastal Health, January 2011

before, during and after hip and knee replacement...

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