Connecticut Joint Replacement Institute

Patient Handbook

Restoring

motion.

Renewing

vitality.

1

Welcome to the Connecticut Joint Replacement Institute (CJRI).

It is our pleasure to have you here at CJRI, where we are committed to ensuring the

best quality of care for our patients and their family members.

The CJRI Patient Handbook is a comprehensive guide that will:

• Prepare you for your surgery

• Walk you through your stay at CJRI

• Provide detailed exercises for you

• Give you helpful tips for your return home

Patient education classes are held every Monday at 9:30 a.m. at the Chawla Auditorium

at Saint Francis Hospital. To register, please call 1-877-783-7262.

You can also register on-line at www.stfranciscare.org/cjri, and click “Register for a

CJRI – Patient Education Class”.

Thank you for choosing CJRI, we look forward to helping you on your road to recovery!

Sincerely,

Stephanie Kelly, RN, BSN

Executive Director

skelly@stfranciscare.org

Patient Checklist

2

Schedule Medical Appointments

History and physical date: __/__/__

Lab Work

EKG

Other

Prepare for Recovery at Home

These tips will help you prepare your

home:

Remove scattered items, throw rugs,

loose wires and cords

Remove clutter

Place frequently used objects within

reach. Ensure that items are within

waist and shoulder level

Stock up on groceries and day-to-

day medical supplies

Cook and freeze meals in advance

so that you can have ready-made

meals handy

Consider modifying your bathroom to

include a shower chair, safety bars,

stair railings or raised toilet seat

Ensure you have pet care

Make alternate plans for indoor and

outdoor maintenance

Arrange for help for tasks such as

cooking, laundry, housework and

shopping

Provide good lighting throughout

your home by installing night lights in

the bathrooms, bedrooms and

hallways

Widen furniture paths to

accommodate a walker, cane or

crutches

After Discharge Care

Discuss options with your surgeon:

Home with home care service

and/or home with outpatient

rehabilitation

Explore insurance coverage/co-

pays

Patient Checklist

3

Essential Phone Numbers

Saint Francis:

(860) 714-4000

Patient Information:

(860) 714-4789

Patient Education Class:

(877) 783-7262

CJRI Reception - Admitting:

(860) 714-0447

Pre-Assessment Surgical Screening

Office:

(860) 714-4448

Pre-Registration:

(860) 714-5166 - Opt. 3

Nursing Station - 9th Floor:

(860) 714-0900

Nursing Station - 10th Floor:

(860) 714-1700

Integrative Medicine:

(860) 714-4450

Photo ID

Insurance and pharmacy cards

Stable walking shoes

CPAP Machine (if applicable)

Please Do Not Bring

Valuables including jewelry or cash

Night Before Surgery

Take a shower and follow surgeon’s

instructions

After Midnight

DO NOT EAT, SMOKE, CHEW

GUM

Take medications as instructed by

your nurse or physician

No perfume, aftershave, powder,

creams, make-up or nail polish.

Take medications as instructed.

May drink only Water or Gatorade

until the time you leave your home.

May drink one cup of black coffee.

No milk/cream or sugar.

Water, Gatorade or black coffee are

allowed, anything else will cause

your surgery to be cancelled.

Preparing for Surgery

4

Medications

Some prescription and non-prescription medications can have unwanted effects when

combined with medications or anesthesia you will receive during your hospitalization.

Your nurse or physician will instruct you on which of your routine medications you will

need to discontinue and which you may take the morning of surgery.

Herbal/Diet Products/MAO Inhibitors

All herbal and diet products must be stopped at least 2 weeks before your surgery.

Monoamine Oxidase (MAO) inhibitor drugs such as Nardil must be stopped 3 weeks

before surgery. Please see the doctor who prescribed the medication for instructions.

Blood Thinners

Blood thinners are medications that affect blood clotting. To minimize the risk of blood

loss during and after surgery, you will be asked to stop taking these medications.

Preventing Constipation

In the post-surgical period, constipation may occur. The factors that cause

constipation are:

1. Decreased Activity

2. Narcotics: Narcotics can decrease peristaltic activity in the gastrointestinal tract.

Intestinal peristalsis is the wave-like motion (motility), which takes place in the intestines

responsible for moving food material forward.

3. Anesthetic Agents: General anesthesia can cause constipation after surgery, because

most anesthetics also depress the central nervous system, which has a direct impact on

the intestine's motility.

4. Lack of Proper Nutrition: Pre-surgery, you will likely be asked to refrain from eating

and drinking for a period of time. No food or fluids, other than water, seeing as food or

fluids can disrupt the intestinal rhythm, and may create constipation after surgery when

normal eating is resumed. Furthermore, you might feel nauseated and have a decreased

appetite and not eager to eat as you normally would.

5

Dietary and lifestyle changes can help prevent constipation after a surgery or

lessen its duration.

1. Watch Your Diet

a. Drink plenty of water a few days before your surgery and post-surgery. A high

fiber diet helps you avoid being constipated before the surgery. You might also

want to consume prune juice or prunes after your surgery.

b. If you are not taking a fiber supplement, and think that you are not getting enough

fiber from foods, talk to your physician about adding a fiber supplement to your

diet. Remember to take the fiber supplements as directed.

c. Limit foods high in processed sugars and fats. These include hamburgers, French

fries, candy and cookies. Avoid foods that make you constipated, such as

processed foods, bananas, dairy products, rice, and white bread.

2. Move a Bit

a. Continue Walking and try to walk a little further every day.

b. Increase your physical activity within the parameters set by your surgeon.

3. Medications

a. Plan on taking a stool softener, and/or a fiber laxative

b. If over-the-counter laxatives aren't enough, consult your healthcare provider.

4. Additional Tips

a. Use the bathroom when you have the urge to instead of holding it in.

b. Try drinking hot liquids to kick-start a bowel movement.

c. Do not take medications without talking to your physician first.

d. Keep track of how often you have a bowel movement. If bowel movements

suddenly decrease, consult your caregiver about medications that prevent

constipation, and follow the directions of your healthcare provider.

PASS: Pre-Surgical Assessment, Screening and Surveillance

6

Pre surgical screening is an important part of your preparation for surgery. All patients

receive a telephone interview call 1-2 weeks prior to your date of surgery from one of

our nurses. Through this process we ensure that all medical issues are identified and

addressed.

You will be asked to provide the following information:

• Prescribed medications with dose and

frequency such as blood pressure, insulin,

inhalers, eye drops, etc.

• Over-the-counter (OTC), herbals, vitamins,

any supplements

• Allergies to medications, foods, dyes, latex

and environmental

• Surgical and medical history

• Name and phone number of your

pharmacy

• Name and phone number of your primary

care physician

• Name and phone number of any

specialists, i.e. cardiologist, urologist, etc.

.

PRO: Patient Reported Outcomes

7

Patient Reported Outcomes are a report of your health condition that comes directly

from you. Questions are sent to you before and after surgery via email. You will be

asked how you feel and what you are able to do. Your surgeon will receive the results of

your answers. Your preoperative answers are compared to your postoperative answers

to show your progress to your surgeon.

Patient Reported Outcomes:

Data is secure and protected.

Data is used for continuous quality improvement.

Invaluable resource that has helped us achieve some of the highest satisfaction

scores and lowest complication rates in the country.

You will receive emails from Your Care Steps/InVivoLink with your surgeon’s name and

a link to the questions:

Emails are sent within 1 month before surgery and 3, 6 and 12 months after

surgery.

If you do not have an email address, a member of the research staff will mail you

a survey to complete and mail back to us.

If you are attending the patient class, you will have the option of completing the

first survey.

The surveys take about 10 minutes to complete.

For more information or questions regarding the Patient Reported Outcomes, please

contact:

Gina Panek

ISO and Outcomes Manager,

860-714-4164 or gpanek@stfranciscare.org

8

Pre-Operative Surgical Suite

Before you are brought into surgery, you will be meeting with your Anesthesiologist and

Surgeon. Your family member or friend may remain with you for a portion of time up

until your surgery.

Recovery Room

After surgery, you will be brought into the Recovery Area where you will be monitored

while you recover from anesthesia. The average length of recovery is 2 to 4 hours.

Recovering in the Hospital

You will be transferred to your private room.

Our goal at CJRI is to provide superior patient care and customer service by attending

to the needs of our patients, their family members and friends. Our specialized team of

care providers will be working with you on your road to recovery.

For various reasons, such as distance, language barriers, comfort factor, etc., family

members may wish to stay in patient rooms. Please contact your nurse manager to

discuss this option

Sample Patient Day of Surgery Schedule (Times will vary)

Prep for Surgery 1 - 2 hours

Surgery

(Surgeon or physician assistant will contact family/friend

once surgery is completed.)

1 - 4 hours

PACU/Recovery 2 - 4 hours

Total Wait Time for Family/Friend 4 - 9 hours

Patient Safety and Fall Prevention

9

After a joint surgery, all patients are at a very high risk to fall

– no matter your age or physical ability.

Post-operatively ALL patients have muscle weakness to the affected leg. You may feel

better and think “I can stand on my own” but find you’re very unsteady. You will be

asked to sign a pledge stating that you are aware that you’re at risk to fall and promise

to give us a call anytime you need to get in or out of bed, a chair or the bathroom so we

can assist you. Our CALL...DON’T FALL program ensures that all patients receive

the assistance needed to prevent any injuries from falls. This is very important because

your body has not healed from the surgery and though you may feel as if you can walk

and be mobile on your own, you will need help.

Pain Management

10

Controlling Pain During Post-Op is Critical

Ask for pain relief while the pain is still tolerable.

The goal of pain management is to make you as comfortable as possible. Staying

ahead of the pain will make your recovery much more manageable so it is important to

ask for pain relief when pain begins and is still tolerable. This may include a

combination of nerve blocks, oral medications, injections, ice therapy, IV medications,

and integrative medicine.

Please use the system below to identify your pain level.

Post-Operative Preventative Measures

11

Blood Clot Prevention

There is a higher risk of blood clots after

surgery. Several steps will occur during

your hospital stay to prevent blood clots:

• Foot pumps - Foot pumps increase the

blood flow in your legs and help to

prevent blood clots from forming. They

also help reduce the chance of deep

venous thrombosis (DVT) and other

post-operative trauma and pain. Foot

pumps help reduce swelling in the leg,

foot, ankle, etc., and enhance arterial

blood flow.

• Mobility

• Medications:

> Injection

> Tablet (taken by mouth). Your doctor

will choose the best medication for you.

Blood thinners are typically continued

for 6 weeks after surgery. Listed below

is a brief description of each medicine

that prevents blood clots.

Lovenox (Enoxaprin) Injectable:

• Given as an injection into the skin in

the stomach once or twice a day.

• We will teach you how to self-

administer.

• Major side effect is bleeding. Contact

your surgeon’s office if you suspect

excess bleeding.

• Interacts with other medications.

Aspirin:

• Pills should be taken twice a day with

breakfast and dinner.

• May be started after your surgery

and/or after Lovenox is completed.

• Usual dose is 325 mg, enteric coated

to prevent stomach upset.

• Bleeding is the most common side

effect. Contact your surgeon’s office if

you suspect excess bleeding.

Coumadin (Warfarin Sodium):

Coumadin is occasionally used for

patients with high risk of blood clots or

who are on Coumadin prior to surgery.

If your doctor orders Coumadin for you,

we will discuss this medication with you

before you are discharged.

Avoid medication that may

thin your blood such as Advil,

Motrin, Ibuprofen, Aspirin,

Naproxen, and or Aleve. A

member of the clinical team

will discuss with you prior to

discharge.

Nutrition

12

To promote healing, eat balanced, nutritious meals, with adequate calories

and protein, to enable your body to replenish proteins depleted by surgery,

and to reduce the risk of complications such as infections or poor wound

healing.

The staff will work with you to determine when you can resume a regular diet. Please

make the staff aware of any special dietary needs you require.

The food plate outlines the dietary needs for healthy living and healing. The food plate

features four sections: vegetables, fruits, grains, lean protein and a side of dairy.

The sections of the plate vary in size depending on the recommended portion of each

food a person should eat. Half your plate should be filled with fruits and vegetables,

one-fourth with lean protein, poultry, or fish, and one-fourth with grains. To round out

your meal, add a glass of fat-free or low-fat milk and a serving of fruit for dessert. The

divided plate hopes to discourage super-big portions that can lead to weight gain.

The Food Plate Outlines:

Balancing Calories

Foods to Increase

o Make half your plate fruits and

vegetables

o Make at least half your grains whole grains

o Switch to fat-free or low-fat milk

Foods to Reduce

o Compare sodium in foods such as soup, bread, and frozen meals, and

choose the foods with lower numbers

o Drink water instead of sugary drinks

Integrative Medicine

13

Saint Francis Integrative Medicine focuses on assisting patients throughout

their healing process – spirit, mind and body – to relax, sleep better, and

expedite healing.

Prior to Surgery

“Prepare for Surgery, Heal Faster” classes are available pre-surgery. Studies show that

people, who prepare for an operation, use 23-50% less medication, have fewer

complications, recover sooner and reduce length of hospital stay. Please contact

Integrative Medicine at 860-714-4450 for more information. There is a cost associated

with this class.

Complimentary Relaxation Session in the Hospital

You can schedule a complimentary relaxation session while in the pre-operative area to

reduce anxiety and prepare you for your healing process. Contact Integrative Medicine

to schedule at 4-4450. Please allow 24-hour’s notice.

While on the inpatient unit we offer complimentary Integrative Medicine sessions. These

include reflexology, soft touch hand massage, or a gentle neck or back massage.

Bodywork can benefit blood pressure, circulation, and muscle tone as it boosts the

circulatory and immune systems. The touch of massage is an instinctive gesture of

comfort and relaxation

Meds2Go Discharge Medications Program

14

Meds2Go is through Arrow Pharmacy at Saint Francis Hospital and

Medical Center. You now have the option of having your medications

delivered to your room prior to discharge. This is an optional program,

offered solely for your convenience.

The benefits include:

Leave the Hospital with your prescriptions.

Pharmacists are available to answer any questions.

Arrow accepts most prescription insurance plans and will bill your insurance provider

directly. You will be responsible for any co-payments when the medications are

delivered or picked up. If your insurance does not cover your medication Arrow

Pharmacy will work with your care team to coordinate any insurance issues.

This service is available Monday through Friday, 9 a.m. to 5:30 p.m.

You can continue using Arrow Pharmacy for refills, or you can have your prescriptions

transferred to your local pharmacy.

Discharge Plan

15

It is very important to have a plan in place for when you leave the hospital.

When your CJRI healthcare team and surgeon feel you are ready, the team will work with you and your family to ensure a smooth transition to home.

You will have a dedicated nurse case manager who will assist you to:

Coordinate discharge planning with your family, surgeon, insurance provider and members of your CJRI healthcare team.

Ensure that care services are in place before you leave CJRI.

Overnight Accommodations

16

Hospitality Suites

The Hospitality Suites are designed to allow family members and loved ones to stay as close as possible to patients. The hospital offers a limited number of hotel-style hospitality suites. For more information or to request a hospitality suite, please contact the Admitted Department at 860-714-5166 from outside the hospital, or by dialing 4-5166 from your patient room.

The following hotel discounts have been offered to Saint Francis Hospital and Medical Center patients and their families.

Hotel Amenities Contact

Marriott Hartford Downtown

200 Columbus Blvd.

Hartford, CT 06103

Connected to the Connecticut

Convention Center. High-speed

internet access, spa and fitness

center is available.

(860) 249-8000

www.marriott.com/hotels/

travel/bdldt-hartford-marriott-

downtown

Marriott Residence Inn

942 Main Street

Hartford, CT 06103

Coffee in lobby, coffee/tea in-room,

local restaurant dinner delivery, full

American and hot breakfast, safe

deposit boxes at front desk.

(860) 524-5550

www.hartfordresidenceinn.com

Hilton Hartford Hotel

315 Trumbull Street

Hartford, CT 06103

ATM, complimentary beverage area,

coin laundry, local area transportation,

room service, fitness center.

*Use Corporate Code: N0220990

(860) 728-5151

www1.hilton.com/en_US/hi/

index.do

Radisson Hotel Hartford

50 Morgan Street

Hartford CT 06120

Free high-speed Internet access,

24-hour business center, seasonal

outdoor pool and complimentary

dash shuttle service to downtown.

(860) 549-2400

www.radisson.com/hartford-hotel-

ct-06120/usahart

Exercises for Hips & Knees

17

Rehabilitation after Hip Surgery

Ambulating is critical to a successful recovery. While rehabilitating at CJRI, you will

focus on walking, climbing stairs, getting in and out of bed, exercising, and precautions.

Walking

Walking is one of the best exercises to assist in your recovery from knee surgery. Your

first steps with the physical therapist will often be taken using a walker. As your motion,

muscle strength, and endurance improves your surgeon may allow you to walk with a

single cane or crutch. Your goal is to regain enough strength and flexibility to eventually

walk without the use of an assistive device.

Stair Climbing

The ability to go up and down stairs requires strength and flexibility. At first you will need a handrail for support and will only go up one step at a time. Always lead with your good knee and down with your operated knee.

Remember, “up with the good” and “down with the bad.”

Lying in Bed

When lying on your back, avoid placing a

pillow directly under your knee, as this

promotes tightness, making it difficult for

your knee to straighten. Instead, you

place a pillow underneath your lower leg

or ankle and elevate.

When lying on your side, place an extra

pillow between your knees and possibly

between your ankles, as well. This

provides the necessary support and

cushions your operated leg in a

comfortable position.

Exercises for Hips & Knees

18

Move your foot up and down as shown. May be performed lying down or sitting.

Lie with your leg extended.

Try to push your knee downward.

(You should feel the muscle in the

front of your thigh tighten).

Hold this position for 3-5 seconds.

Hip Surgery Exercise Program

The goals of your exercise program are to reduce pain and swelling with the hip joint;

increase flexibility of your hip joint; achieve full range of motion; and restore strength of

the muscles around the hip joint, improving overall endurance.

Remember: Do not hold your breath while exercising. Perform all exercises that require

you to lie down on your bed.

Hip Flexor Stretch

Ankle Pumps

Quad Sets

Lay flat down on your back with one

small pillow under your head. Relax in

this position by allowing your hip to fully

straighten. You will feel a stretch in the

front of your hip. Ice your hip while

stretching in this position for 5-15

minutes, as tolerated.

Exercises for Hips & Knees

19

Lie on your back with your legs straight. Bend your knee by sliding your foot

upwards until you feel a gentle stretch.

Sit in a chair with your knees bent. Lift your foot off the floor. Return to the starting

position and repeat.

Buttock Squeezes

Heel Slides

Knee Extensions (Kicks)

Lie on your back with legs straight.

Squeeze muscles of your buttocks

together.

Exercises for Hips & Knees

20

Sit in a chair that has armrests. Place your hands on the armrests of the chair and

push yourself upwards to stand using your legs to lift you up.

To sit back down: place your hands on the armrests of the chair and slowly lower

yourself to a seated position.

Lie on your back. Bend your one leg as shown. With you other leg straight, lift it in the air

(try not to let your leg bend as your raise it in the air). Return to the starting position and

repeat.

Stand with your feet flat on the floor, shoulder width apart. Ensure that you have a

secure surface to hold onto with both hands. Raise up on your toes. Return to the

starting position.

Sit to Stand

Straight Leg Raises

Heel Raises

Exercises for Hips & Knees

21

Stand with your feet flat on the floor, shoulder width apart. Ensure that you have a secure

surface to hold onto with both hands. Raise your leg up, letting the knee bend. Do not

bend past a 90-degree angle. Return to the starting position.

Stand with your feet flat on the floor, shoulder width apart. Ensure that you have a secure

surface to hold onto with both hands. Lift your leg straight out in front of you. Return to the

starting position.

Lying on your back, place your feet shoulder

width apart. Gently slide your operated leg

out to the side as shown. Return to the

starting position.

Standing Hip Flexion

Standing Leg Swing

Side Kick (In Bed)* Side Kick (Standing)*

Exercises for Knees Only

22

Pre-Surgery

Conditioning your body prior to undergoing joint surgery is an important step toward

improving your strength and contributing to a successful post-operative recovery.

Patients who exercise before joint replacement surgery have several advantages:

You will be stronger before surgery.

People with arthritis can still exercise. In fact, it has been shown that regular moderate-

level exercise does not exacerbate arthritic pain. An exercise program composed of

joint stretching, low-impact resistance training, and aerobic exercise increases joint

flexibility, combats fatigue, and supports weight management. All are beneficial in

building stronger muscles to support your joints.

You will have a faster recovery.

By adhering to an exercise training program before surgery, patients are more likely to

spend less time in the hospital, return directly home from the hospital, and reach their

goals sooner.

Always consult your Surgeon before beginning any exercise program.

Exercises for Knees Only

23

Lie on your back with your legs straight. Wrap a sheet around your foot as shown and

hold onto the ends with both hands. Bend your operated knee by sliding your foot

upwards. Gently pull knee up with the sheet until you feel a stretch.

Sit in a chair with your legs bent as shown. Place a towel under your operated leg.

Slide your foot back until you feel a gentle stretch. Hold this position for 15-30

seconds. Return to the starting position.

Knee Surgery Exercise Program

The goals of your exercise program are to reduce pain and swelling with the knee joint;

increase flexibility of your knee joint; achieve full range of motion; and restore strength

of the muscles around the knee joint, improving overall endurance.

Remember - Do not hold your breath when exercising. Perform all exercises that require

you to lie down on your bed.

Extension Stretch

Heel Slides (with Sheet)

Towel Slides

Lie on your back with a towel under

your ankle. Relax in this position by

allowing gravity to straighten your leg.

Ice your knee while stretching in this

position for 5-15 minutes, as tolerated.

Exercises for Knees Only

24

Sit in a chair with your knees bent. Lift your foot off the floor and straighten the knee

fully. Return to the starting position.

Stand with your feet flat on the floor, shoulder width apart. Ensure that you have a

secure surface to hold onto with both hands. Bend your knee behind you as far as

possible. Return to the starting position.

Sit with knee straight and a towel

looped around the foot. Gently pull on

the towel until you feel a stretch.

Knee Extensions (Kicks)

Standing Knee Bend

Calf Stretch

Shoulder Surgery

25

Shoulder Surgery

Tips for a Successful Shoulder Recovery

Making simple changes in your home before surgery can make your recovery period

easier and safer.

For the first several weeks after surgery, it will be hard to reach high shelves and

cupboards. Before your surgery, be sure to go through your home and place any items

you will need on lower shelves or even the countertops. Other arrangements that you

should make prior to surgery are:

Prepare microwavable meals

Stock up on nutritious ready-made meals

Remove scatter rugs

Reduce and/or eliminate clutter which can be a safety hazard

Organize your clothes closets and drawers for easier access

Wear loose fitting stretchable clothing with no/minimal fasteners

Consider shirts with button front or with large neck openings

When you come home from CJRI, you will need help for a few weeks with some daily

tasks like bathing, dressing, undressing, cooking, laundry and grocery shopping.

Do

Do wear your sling as instructed

Do ice as indicated by your surgeon

and/or therapist

Do follow the exercise program

prescribed for you

Do ask for assistance

Do any light housework/activity you

can do with one hand

Only use your non-surgical arm to

do all the work

Don’t

Do not use your operated arm to

push up in bed or from a chair

because this requires forceful

contraction of muscles

Do not lift anything – no lifting with

your operative arm for 6-8 weeks

Do not pull with your operative arm

Do not place your arm in any

extreme position, such as straight

out to the side or behind your body

Do not rotate your arm outward or

away from your body

Shoulder Surgery

26

Rehabilitation after Shoulder Surgery

Even though shoulder joint replacement is less common than knee or hip

replacement, it is just as successful in relieving joint pain. The key to your

recovery after surgery is managing pain and following your surgeon’s

specific instructions.

After surgery, your operated arm will be immobilized at your side with the use of a

specialized sling, known as an ultrasling, which has a supportive pillow. Based on the

surgical technique, you may begin gentle therapy on the first day post-operatively. Sling

immobilization is enforced during the early rehabilitation phase. However, your surgeon

may allow you to begin a specific and personalized exercise program. An occupational

therapist will instruct you on which exercises you may begin for your shoulder, elbow,

wrist and/or hand. Progression to more advanced exercises to improve strength and

flexibility will occur under the direction of your surgeon.

Most patients are ready to go home the second day following surgery. In the hospital,

our goal is to help promote function and protect your new shoulder from wear-and-tear

of daily activities. The occupational therapist will teach you how to manage your sling

(taking it off and putting it on) and perform modified bathing, dressing, undressing and

toileting since you will be using one arm for a while. If needed, physical therapy will also

work with you to ensure independence with transfers and ambulating.