total knee joint replacement education manual

A partner for lifelong health

Total Knee Joint Replacement Education Manual

Please bring this booklet with you to:⚫ Everyofficevisitwithyourdoctor

⚫ Yourjointreplacementclass

⚫ Thehospitalwhenyouareadmitted

⚫ Everyfollow-upvisitwithyourdoctor

⚫ Yourphysicaltherapyappointments

2|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual

3 Appointments for your total knee joint replacement surgery

4 Your questions

5-7 Phone numbers and LMH Health maps

8 Our commitment to you

9 Notes

10-16 Preparing for surgery (what you need to do)

17 Notes

18-23 Surgery and hospitalization

24-27 Recovery after discharge

28-30 Frequently asked questions

31 Notes

Contents

LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|3

Appointments for Your Total Knee Joint Replacement Surgery

Medical clearance:

Date:��

Time:��

Doctor:��

Other necessary clearances:

��

��

Pre-admission phone call:

Date:��

Time:��

Joint replacement class:

Date:��

Time:��

ClasswilltakeplaceatLMHHealth.Reporttothemainlobbyonthewestsidenearadmissions.Bringalistofyourmedications,allergiesandquestions,aswellasthisbookandyourcompassionatecoach.

Surgery:

Date:��

Time:��

Post-operative surgeon office visit:

Date:��

Time:��

Doctor:��


Questions


LMHHealthsurgerydepartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-505-6480OrthoKansas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-843-9125Surgerypre-admissionnurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-505-6268OrthoKansasschedulers:(foranindividualscheduler’sphonenumber,seetheirbusinesscard). . . . . . . . . 785-843-9125OrthoKansasnursenavigator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-838-7815Primarycarephysician. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��

Important Phone Numbers and Maps

Patient Parking

4 T H ST R E E T

3 R D ST R E E T3 R D ST R E E T

2 n d ST R E E T2 n d ST R E E T

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AS

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4th Street Health Plaza

Lawrence Memorial Hospital

Lawrence Health Plaza

EMERGENCY

225 Maine

CO

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TR

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316 Maine

320 Maine

ReservedParking

for 320 Maine

ReservedParking

for 316 Maine

C

A

B

D

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First floor

Patient Rooms 201-214



2 North

2 East

Lawrence GI Consultants 215

Lawrence Urology Specialists 205

Cardiopulmonary Services 2030• Anticoagulation Clinic• Echocardiology Services• Pulmonary Function Lab• EKG

Lawrence General Surgery 202Spencer Harrison, MD

Lawrence Pain Specialists 201

LMH Health System Pharmacy

Therapy& Wellness

Treatment & Procedure

Center

ICU Patient Rooms229-238


Chaplain

Chapel

Compliance Management

Cardiovascular Specialists of Lawrence 2050

Lawrence Pulmonary Specialists 2001Vascular Surgery Associates


LMH

Palliative Support Services 210

EMERGENCY


Volunteer ServicesRisk Management/Medical Sta� O�ceLab

Endoscopy Center


Ko�ee Korner

Gift Shop

SpecialProcedures

Imaging

Surgery

ExecutiveO�ces

Admissions/Patient Registration

Cotton O’Neil Clinic 110

Oncology/Hematology Center 105

Precision Cancer Care 120Radiation Oncology

Hospital Patient Accounts

D

Nursing Administration


Pain Management

DaVita Dialysis 100

Elevators to Lower Level and Floors 2 & 3

Elevators to 4th Floor

Workplace Wellness 1020Information Technology 1010

Mario’s Closet

WellCare Clinic 1015

Second floor



Quest Diagnostics 3000

Total Family Care 3200Lawrence Endocrinology 3201Plastic Surgery Specialists of Lawrence 3202Lawrence Neurology Specialists 3203Lawrence Spine Care 3204

Cardiac & Pulmonary Rehabilitation 310Diabetes Education

Rooftop Garden

Lawrence OB/GYN Specialists 300

Care Coordination/Social Services


Patient Rooms 317-321 Patient Rooms 338-348


Pediatric Rooms 322-328 Family Birthing Center

Maternity Preadmission Clinic

Perfect Fit

Patient Rooms

370-387

3 West

3 North


LMH

Lower level

Third floor

Fourth floor

DiningCourt

Community Outreach & Engagement

MedicalRecords(HIMS)

Education/Learning ServicesConference Room A

Conference Room D North

Conference Room D South

Human Resources Auditorium

CafeteriaDining

Facilities Management

Environmental Services

ReceivingLoading Dock

Materials Management/

Purchasing

SterileProcessing

Biomedical


4 North

Rehabilitation Rooms 418-426

Transitional Care Unit Rooms 401-417


Our Commitment to You

ThankyoufortrustingLMHHealthandOrthoKansaswithyourorthopedicsurgeryexperience.

Wearecommittedtobeingyourpartnerforlifelonghealthandassureyouthatourexperienced

teamofphysicians,nurses,therapistsandotherhealthcareprofessionalsarededicatedtoproviding

excellentorthopediccare.

Wewantyoutohaveapositiveexperiencefromthemomentyouscheduleyoursurgerythroughyour

recoveryprocess.Ourgoalistoassistyouingettingbacktoyournormalactivitylevelasquicklyas

possible.Wewanttoinvolveyouinyourtreatmenteachstepoftheway.

Theinformationinthisbookcanhelpyouunderstandthejointreplacementprocessandmakethe

preparationandrecoveryforyourupcomingsurgeryeasier.Anytimeyouhavequestions,pleaseask

yourdoctor,nursesoranyoneinvolvedinyourcare.

WethankyouforchoosingLMHHealthandOrthoKansas.Wevalueyourtrustinusandarecommitted

tohelpingyouachieveaspeedyrecovery.

Introduction to a new lifeJointreplacementisanelectiveoperation,meaningthatitisachoiceyoumakeafterconsultingwith

yourorthopedicsurgeon.Thedecisiontoproceedcanbedifficulttomakeandshouldnotbetaken

lightly.Jointreplacementisconsideredamajoroperation,andrecoverycanbepainfulandchallenging.

Thegoalsofthissurgeryincluderelieffrompain,improvedmobilityandrestoredfunction–allof

whichcanprovideyouwithanewoutlookonlife.

Theinformationinthisbookcanguideyouthroughtheprocessbyexplaininggeneralandspecific

medicalandsurgicalrisks,andbyansweringquestionsrelatedtopre-andpost-operativecareandthe

healingprocess.

Youareapartnerinthisprocesswithyourcareteam.Youplayalargeroleinshapingtheoutcome

ofyoursurgery.Supportfromyourfamilyandfriendsisalsoimportant.Eachsurgicalexperienceis

unique.Ourmainfocusisyoursafetyandwell-being.Pleasedonothesitatetoaskquestions.

Individualshavethecapacitytohealthemselvestoonedegreeoranother.Thisvariesanddependson

multiplefactorssuchasnutrition,weight,exerciseandleveloffitness,smokinganduseofalcoholas

wellasoverallgeneralhealth.

Attitudeiseverything!Themostimportantfactorsinasuccessfulrecoveryareyouroverallattitude,

motivationandefforts.Apositive,can-doattitudeandwillingnesstoworkhardwillgreatlyincrease

yourpotentialforasuccessfuljointreplacementandrenewedoutlookonlife.

Thank you for choosingLMH Health and OrthoKansasas your healthcare providers.


Notes


Preparing for Surgery

Verify insurance benefits and coverageItisimportanttoverifybenefitsandcoverageandobtainauthorizationwhennecessarypriortoyour

surgery.Youwillreceivestatementsforchargesfrommultipleentitiesincluding,butnotlimitedto:

LMHHealthPhysicianBilling,LMHHealth,radiologyandanesthesia.

OrthoKansaswillprovideyouwithawrittenestimateofthechargesthatourofficewillsubmitto

yourinsuranceifyouhaveanon-Medicareinsuranceplan.Thesechargesincludeallcareprovided

byOrthoKansasdoctorsandphysicianassistantsforwhatisknownastheglobalperiod.Thisperiod

startsonthedayofyoursurgeryandcontinuesforasetnumberofdaysaftersurgery.Youwillbe

requestedtopayanyout-of-pocketcostspriortoschedulingyoursurgery.Ourfinancialcounselorwill

reviewthesecostswithyou.

IfyouhaveMedicarewithasupplementalplan,youwillnotneedtomeetwiththeOrthoKansas

financialcounselor.However,ifyouhaveMedicarewithnosupplementalplan,youwillberequestedto

payanyexpectedout-of-pocketexpensespriortoschedulingsurgery.Ifyouhavequestions,youcan

contacttheOrthoKansasfinancialcounselorat785-838-7854.


Obtain medical clearance for your surgeryYouwillneedtohaveacompletephysicalexam

conductedbyyourprimarycarephysician

approximatelyonemonthbeforeyoursurgery

toassessyourgeneralhealthandruleoutany

conditionsthatcouldinterferewithyoursurgery.

Youalsomayberequiredtoobtainclearance

fromanyspecialistyouseesuchasacardiologist

(heartdoctor)orpulmonologist(lungdoctor).

Itisimportanttohavetheseexamsandall

testingdoneinatimelymannertoavoidlast-

minutedelaysorcancellations.Severaltests,

includingabloodtest,anelectrocardiogram

(EKG)andaurinetestwillbeperformedto

helpyourphysiciandetermineyourabilityto

undergosurgerysafely.Youshouldreviewyour

medicationswithyourphysiciantodetermineif

thereareanythatyouwillneedtostoptaking

priortosurgery.

Thefollowingmedicationsshouldbestopped

sevendayspriortosurgery.Theseareknown

asanti-inflammatories.Ifyoufeelthatstopping

thesewillcauseundueincreasedpain,pleasetalk

withyoursurgeon.

⚫ Celebrex

⚫ Voltaren(diclofenac)

⚫ Mobic(meloxicam)

⚫ Relafen(nabumetone)

⚫ Aleve(naproxen)

⚫ Naproxyn,Motrin/Advil(ibuprofen)

⚫ Feldene(piroxicam)

⚫ Clinoril(sulindac)

⚫ Lodine(etodolac)

⚫ Toradol(ketorolactromethamine)

⚫ Indocin(indomethacin)

Ifyoutakemedicationssuchasaspirin,Coumadin

(warfarin),Jantoven,Plavix,Effient,Brilinta,

Pradaxa,Xarelto,Eliquis,anyanti-coagulantor

anti-plateletmedication,youneedtocheckwith

yourprimaryphysicianorcardiologistabout

whentostopthismedicationpriortosurgery.

Thiswillberesumedaftersurgerywhenyour

surgeondecidesitissafetodoso.

Ifyoutakemedicationsthatsuppressyour

immunesystemsuchas:Humira,Remicade,

Enbrel,Methotrexate,orOtezla,youmayneed

todiscontinueuseweekspriortosurgery.

Yoursurgeonwilldiscussthiswithyouandyour

prescribingprovider.

MedicationsforweightlosssuchasPhentermine

andContraveneedtobestoppedtwoweeks

priortosurgery.Pleasediscusswithyour

prescribingprovider.

PleasenotifytheOrthoKansasnursenavigatorof

anymedicationchangespriortosurgery.


Additional activitiesYouwillmeetandvisitwiththenursenavigator

whenyouscheduleyoursurgery.Heorshewill

helpguideyouthroughthisprocess.

Identifysomeoneasyourcompassionatecoach.

Thismaybeafamilymemberorclosefriendwho

willbeavailablebeforeandaftersurgerytohelp

youprepareforandrecoverfromyoursurgery.

Heorsheshouldattendthejointreplacement

classwithyouandattendatleastonephysical

therapysessionwithyouduringyourstayat

LMHHealth.Thispersonwillhelpwithyour

day-to-dayneedsandprogressafterdischarge

fromthehospitalandwilllikelyberequiredto

transportyoutofollow-updoctorvisitsandto

therapyappointments.Itisbestifthispersoncan

staywithyouforthefirstoneortwoweeksafter

surgery.

Attendjointreplacementclasswithyour

compassionatecoach.Don’tforgettobring

thisbook!

Stopsmokingpriortosurgery.Youwillnotbe

abletosmokewhileatthehospital.Smoking

reducescirculationtotissueandmakeshealing

moredifficult.Itreducesthesizeofbloodvessels

anddecreasestheamountofoxygencirculated

intheblood.Itcanincreasetheriskofbloodclots

whichisoneofthebiggestpost-operativerisks

associatedwithtotaljointreplacementsurgery.

Bloodclotscanleadtoheartorlungdamageand

increasetheriskofstroke.Ifyouwanthelpwith

smokingcessation,pleaseaskusaboutavailable

resources.

Preventinfections,especiallyintheteeth,skin

andurinarytract.Reportanysymptomstoyour

primaryphysician.Althoughrare,aninfection

canoccuraroundyourreplacedjointifbacteriais

allowedintothebloodstream.Toreducetherisk:

⚫ Haveacompletedentalexamnocloserthan

twoweekspriortoyoursurgerydatetobe

suretherearenopotentialproblems.

⚫ Avoidtreatmentofsignificantdentaldiseases

foratleastamonthpriortosurgery.Wealso

recommendavoidinganyelectivedentalwork

forthreemonthsaftersurgery.

⚫ Notifyyourprimaryphysicianifyoudevelop

anyurinarysymptomssuchasburningwith

urination,achangeinurinaryfrequencyor

bloodinurine.

⚫ Notifyyourprimaryphysicianifyoudevelop

anyskininfectionsorirritationonyour

operativeleg,orifyoudevelopchronic

swellingofthatleg.

ConsidercompletingaLivingWillandDurable

PowerofAttorney.Thisissimplyaprecaution.

Ifalreadydone,besuretotakeacopytothe

medicalrecordsdepartmentonthelowerlevel

ofLMHHealthorbringitwithyouthedayof

surgery.

Contactyourpreferredphysicaltherapylocation

andletthemknowyourdateofsurgeryand

whattypeofsurgeryyouwillhave.Ifyouintend

togotooutpatienttherapyimmediatelyafter

discharge,plantostartthisthreeorfourdays

aftersurgery.Ifyouwillbehavinghomehealth

therapy,plantostartoutpatienttherapy15-20

daysaftersurgery.


Notes

Joint replacement classReviewthisbookpriortothedateofyourjoint

replacementclass,andbringitwithyoutoyour

scheduledclass.Usethespaceonthispageto

writedownanyquestionsthatcometomindand

wewilladdresstheminclass.

RepresentativesfromseveralLMHHealth

departmentswillbeapartoftheclass

experience.Theseincludesocialwork,pharmacy,

physicaltherapy,nursing,andothers.Itisvery

importantforyourcompassionatecoachto

attendthisclasswithyou.Theclasswilltake

approximatelytwototwoandahalfhours.

Bringyourmedicationlisttoreviewwitha

pharmacyrepresentative.Yourlistshouldinclude

allknownallergiesandintolerances.


Pre-op instructionsArepresentativefromtheLMHHealthsurgerydepartmentwillcontactyoubytelephonepriortoyour

surgerydate.Youwillbegivenfinalpre-opinstructionsregardingwhentostoptakingmedicationsthe

daybeforesurgery. You will be instructed not to take anything by mouth after midnight the night before surgery.Thisincludesfluids,gum,candy,tobaccoandalcohol.Youalsowillbeinstructedwhat

timetoarriveatthehospitalthedayofsurgery.Inrareinstances,yourarrivaltimemayneedtobe

changedduetoachangeinthesurgeryschedule.Ifthishappens,youwillbenotifiedofyournewtime.

Itisimportanttobecarefulwithyourlegsinthedayspriortosurgery.Cuts,scrapesandscratcheson

youroperativelegcouldposeaninfectionrisksopleasenotifyyoursurgeonifthisoccurs.Youmaybe

askedtogotothesurgeon’sofficetohavethisevaluated.

Avoidusingnailpolishonyourfingernailsandtoenailsunlessitisclearpolish.

Practiceorreviewbreathingexercises.Theseexerciseswillbeimportantaftersurgerytokeepyour

lungsclearandreduceyourriskofinfection.Youwillreceiveanincentivespirometeraftersurgeryfor

useinthehospitalandathome,butpracticingdeepbreathingandforcedcoughingbeforesurgerywill

behelpful.Practicinginadvancewithoutthespirometerwillstrengthenthemusclesofyourabdomen

andchest.

For deep breathing:⚫ Breatheinthroughyournoseasdeeplyasyoucan.

⚫ Holdyourbreathfor5-10seconds.

⚫ Breatheoutasifyouwereblowingoutacandle.Trytobreatheoutfor10-20seconds.

⚫ Takeabreakbetweenbreathsthenrepeatthisexercise5-10times.

Coughing:⚫ Takeinaslow,deepbreaththroughyournose,fillinglungscompletely.

⚫ Breatheoutthroughyourmouthandconcentrateonemptyingyourlungscompletely.

⚫ Repeatbreathingin,butthistimeholdyourbreathandthencoughhard.Whenyoucough,focuson

emptyingyourlungs.

⚫ Repeatthesesteps3-5times.


Preparing your homeTherearemanythingsyoucandobeforesurgery

toprepareyourselfandyourhomeforasafe

recovery.

Safety⚫ Putitemsyouuseoftenoncountersor

shelvesthatareeasytoreach.

⚫ Makesurestairrailingsaresecure.

⚫ Beawareofallfloorhazardssuchaspets,

powercordsandunevensurfaces.

⚫ Removeallthrowrugsfromyourwalkingor

standingpath.

⚫ Installnightlightsinbathrooms,bedrooms

andhallways.

⚫ Haveanon-slipmatinyourshower.

⚫ Havesupportlinedup,especiallyifyoulive

alone.Ifyouhaveconcernsaboutreturning

homeafterdischarge,pleasediscussthese

withthenursenavigator.

Comfort⚫ Shopahead.Freezemealsforuseafter

surgery.Considerstockinguponfoodsand

beveragesthatwillbeeasytoeatordrink

whenyourappetiteispoor,oryouhavenausea

orbowelproblems.

⚫ Checkchairandbedheightbysittingonthem.

Yourhipsshouldbehigherthanyourknees

whenseated.

⚫ Checktoiletheight.Addaseatriserifitis

toolow.

⚫ Arrangeforcareofpetsandcollectionofmail.

⚫ Cleanyourhouse.

⚫ Dolaundryandputitaway.

⚫ Putcleanlinensonyourbedandinthe

bathroom.

⚫ Haveyardworkdoneasneeded.

What to bring to the hospital⚫ Personalhygieneitems(toothbrush,

toothpaste,deodorant,batteryoperated

razor,comb,etc.)

⚫ Loose-fittingclothes(sweats,shorts,t-shirts,

bathrobe)

⚫ Slipperswithnon-sticksoles,flatshoesor

tennisshoes

⚫ Walkerorcrutchesifavailable,orborrow/

purchaseaftersurgery

⚫ Casesforglasses,dentures,hearingaidsand

extrabatteries

⚫ CopyofyourAdvanceDirectives

(ifyouhaveone)

⚫ Thishandbook

⚫ YourphotoIDandinsurancecard

⚫ AformofpaymentforMedstoBedsshould

youdecidetousethisservice

What to leave at home⚫ Homemedications,exceptinhalers(checkwith

thehospitalpharmacistformoreinformation)

⚫ Valuablesincludingmoneyandjewelry

Stop smoking⚫ Decidetoquit.

⚫ Choosethedate.

⚫ Talkwithyourprimarydoctoraboutsmoking

cessationresourcesandmedications.

⚫ Limittheareawhereyousmoke;don’tsmoke

athome.

⚫ Throwawaycigarettesandashtrays.

⚫ Don’tputyourselfinsituationswhereothers

smoke.

⚫ Rewardyourselfforeachdaywithout

cigarettes.

⚫ Staypositive.

⚫ Takeitonedayatatime.Youmightslip,but

ifyoudo,getbacktoyourdecisiontoquit.


Further preparationHandicap parking placard Youmaywanttoobtainahandicapparkingpermitforthemonthsfollowingsurgery.Thiswillallow

youeasieraccesstoyourdoctor’soffice,therapyclinicsandshopping.Callyoursurgeon’snurseor

clinicalassistanttorequestanapplication.Oncecompleted,takeittoyourlocalcountytreasurer’s

office.

Therapy preparationItisimportanttobeasflexibleandasstrongaspossiblebeforehavingkneesurgery.Manypatients

witharthritistendtolimithowmuchtheyusetheirpainfulleg.Withlessuse,musclesbecomeweaker

whichleadstoaslowerandmorechallengingrecovery.Startingatherapy/exerciseprogrambefore

surgerycanmakeyourrecoveryfasterandeasier.Exercisesareincludedwiththishandbookthatalso

canbeusedafteryoursurgery.Starttheexerciseswithbothlegsaboutsixweeksbeforesurgery.

Performtheexercisestwiceadayfor15-20minutesforbestresults.Ifyouareable,youalsoshould

performlightenduranceactivitiestobenefityourheartandlungs.Trywalkingorcyclingfor

10-15minuteseachday.Poolexerciseisagoodalternativeifwalkingorcyclingistoopainful.

Tohelpyourphysicaltherapistbetterprepareyoutoreturnhomeaftersurgery,pleaseanswerthe

questionsbelowpriortoyoursurgery.

1. Doyouhavemainflooraccesstoyourbed,bathandtoilet?

2. Whichsideofthebeddoyougetinandoutof?

3. Whatistheheightofthetopofyourbedmattressfromthefloor?

4. Whatisyourtub/showerdesign?

5. Haveyoubeenfittocrutchesorawalker?

6. Howmanystairsdoyouhavetoclimbtogetintoyourhouse?

7. Doyouhaverailingsonyourstairs?Onwhichsidearetherailings?


Notes


Surgery and Hospitalization

The day of surgeryRemembernottoeatordrinkanythingafter

midnight.

ArriveattheLMHHealtheastentrance(Maine

Street)promptlyatyourdesignatedtime.

Ifthereisachangetoyourarrivaltimeyouwill

benotifiedbyamemberofthehospitalstaff.

Ifyouhaveanylast-minuteissuesthatwill

preventyoufromarrivingatyourscheduled

time,pleasecontactthesurgerydepartment

at785-505-6482.

Anursewillcompleteyouradmissionactivities

andanyadditionalnecessarypreparation.

Thenursewillaskyouwhich,ifany,medications

youtooktodayandthelasttimeyouateor

drankanything.

Youwillchangeintoahospitalgown.Special

supportstockings(TEDhose)andcompression

deviceswillbeputonyourlowerlegstohelp

preventbloodclots.Arepresentativefromthe

laboratorywilldrawyourbloodtocheckyour

bloodtype.Shouldyouneedabloodtransfusion,

compatiblebloodwillbeavailable.

Youwillbeaskedtosignasurgicalconsentwhich

detailsyoursurgicalprocedure.

AnIVwillbestartedforadministrationoffluids

andmedications.Youwillreceiveatleastthree

dosesofantibioticsthroughyourIV.Besureto

mentionanyallergiesyouhavetomedications.

Ifyouhaveallergies,aspecialbraceletwillbe

placedonyourarmtoalertstaff.

Ananesthesiologistwillvisitwithyoupriorto

goingtotheoperatingroom.Heorshewill

considerwhichtypeofanesthesiawillbebest

foryou,takingintoaccountyourhealthhistory

andpreferences.Therearetwomaintypesof

anesthesiathatareused:

⚫ Generalanesthesiaproducestemporary

unconsciousness.

⚫ Spinalanesthesiainvolvestheinjectionofa

localanestheticprovidingnumbness,lossof

pain,orlossofsensationtothebody.Youalso

willreceiveadoseofmedicationthroughyour

IVthatwillrelaxyouandcreatewhatisknown

asconscioussedation.


Youalsomayreceiveanadductorblockwhichis

aone-timeinjectionintoyourthigh.Thiswillhelp

reducepainaftersurgery.

Yoursurgeonwillvisityoubeforeyouaretaken

intosurgery.Heorshewilltalkwithyouand

reviewtheplannedsurgery.Thesurgeonwill

signthecorrectsurgicalkneepriortosurgery,

toensureaccuracy.

Whenyougototheoperatingroom,yourfamily

willbedirectedtothesurgerywaitingroom.

Theywillbegiveninstructionsonhowtocheck

yourprogressandknowwhensurgery

iscomplete.

Somepeopleexperienceanxietypriortosurgery.

Weencourageyoutoaskquestionsandtalkwith

thesurgerystaffifyouhaveconcerns.

Therewillbemanypeopleintheoperatingroom.

Thesurgicalteamincludesananesthesiologist,

yoursurgeonandhisorherphysicianassistant,

nurses,andotherprofessionals.Theywillbe

movingaroundtheroombeforesurgerymaking

sureeverythingisreadyforyourprocedure.

Onceyouentertheoperatingroomandare

situatedontheoperatingtable,youwillbeasked

yournameandwhatsurgeryyouarehaving

done.

Youwillhavemonitoringdevicessuchasablood

pressurecuffandaheartmonitorplacedonyou.

Theanesthesiologistusesthesedevicesand

otherstomonitoryourconditionthroughoutthe

surgery.Heorshewillmanageyourvitalsigns

suchasheartrateandrhythm,bloodpressure,

temperatureandbreathing.Heorshealso

willmonitoryourIVfluidandneedforblood

replacementifnecessary.Medicationwillbe

giventohelpyoufeelmorecomfortable.

Onceyouareasleep,aurinarycathetermaybe

placedtohelpdrainyourbladder.

Theentiresurgerytakesapproximatelyoneand

ahalftotwohours.Oncecomplete,yoursurgeon

willvisitwithyourfamily.

After surgery – Post Anesthesia Care UnitFollowingsurgery,youwillbemovedtothePost

AnesthesiaCareUnit.Youwillbemonitoredby

physiciansandnursesforanadditionaloneto

twohours.Yourvitalsignsandpainlevelwillbe

monitored.Youmayhaveonevisitoratatimein

thisareaifyouwish.

Dependingonthetypeofanesthesiaused,you

mayexperiencenausea,drymouth,chillsorother

symptoms.

MedicationwillbegivenbymouthorbyIVto

helpcontrolyourpainandothersymptomsas

needed.

Yourkneewillbecoveredwithadressing.

Youalsowillhavecompressiondevicesaround

bothlowerlegsthatworkbysqueezingthe

calvestohelppreventbloodclots.

Whenyouareawake,yourvitalsignsare

stableandyourpainiscontrolled,youwillbe

transportedupstairstoyourroomon3West.

Continued on page 20


Pain controlMostoftheworstdiscomfortwilloccur12-24

hoursaftersurgery.Paincontrolisatoppriority

foryournursesandphysician.Youwillfrequently

beaskedquestionsthathelpstaffmonitorand

treatyourpain,butweencourageyoutolet

thestaffknowifyouarehavingpainoritisnot

well-controlledatanytime.AtLMHHealthwe

useanassessmentmethodcalledtheClinically

AlignedPainAssessment.Thismethodinvolvesa

conversationthatfocusesonthequalityofpain

andhowitaffectsyourabilitytocomfortably

performdailyactivities,ambulate,orcomplete

testsandtherapies.Youwillbeasked:

InregardtoCOMFORT,isyourpain…

⚫ Tolerable

⚫ Tolerablewithdiscomfort

⚫ Comfortablymanageable

⚫ Littleornopain

InregardtoFUNCTIONING,wouldyousay…

⚫ Ican’tdoanythingbecauseofthepain.

⚫ PainkeepsmefromdoingMOSTof

whatIneedtodo.

⚫ Icandomostthings,butpaingetsin

thewaysome.

⚫ IcandoeverythingthatIneedtodo.

InregardtoCHANGEINPAIN,isyourpain…

⚫ Gettingworse

⚫ Aboutthesame

⚫ Gettingbetter

InregardtoSLEEP,areyou…

⚫ Awakewithpainmostofthenight

⚫ Awakewithoccasionalpain

⚫ Sleepingnormally

Youalsomaybeaskedtorateyourpainona

scaleof0to10with0beingnopainand10being

theworst.

Itislikelyyouwillcontinuetoneedpain

medicationonceyouhavebeendischarged

fromthehospital.Youwillbegivenawritten

prescriptionforthispriortoleavingthehospital.

Youmaychoosetohaveitfilledatthehospital’s

pharmacythroughtheMedstoBedsprogram

beforedischarge.Opioidmedicationsmust

betakenasprescribedbecausetheycanhave

seriousconsequencesifnotusedcorrectly.

Yoursurgeonwillmanageyourpainmedication

followingdischargesoyouwillneedtocontact

hisorherofficetorequestrefills.Youwillwant

toplanaheadwhenyouarerunninglowon

medicationsinceyoursurgeonisofteninsurgery

andoutoftheoffice.Allowtwobusinessdays

forrefillstobewritten.You must pick up a written prescription in the office to take to your pharmacy.Theofficestaffisunabletophoneor

faxtheprescriptioninforyou.Afriendorrelative

onyourHIPAAlistmaypickupthewritten

prescriptionforyouifneeded.

3 WestYourstayon3Westisdesignedtogetyou

startedontheroadtorecoveryfromyourknee

surgery.

Anytimethereisashiftchange,thenurseswill

cometoyourbedsideanddiscussyourplan

ofcarewhichincludesyourhealthcareneeds

andtreatmentgoals.Yourinputinthisprocess

isencouraged.Youandyourcompassionate

coachmayusethistimetoaskquestionsorraise

concernswithyournurses.Youareapartnerin

thisprocessandshouldunderstandyourplanof

care.Pleasebeawarethatyoumaybeawakened

duringthenightforthenursetomonitoryour

condition.Thestaffwillmakeeveryattempt

toperformthesenecessaryinterruptionsinan

efficientmanner.

Surgery and Hospitalization continued from page 19


Yoursafetyisofthehighestconcerntothestaff.

Youwillwearabraceletthatwillbescanned

priortoreceivinganymedicationtobesureyou

receivetherightmedication.Anadditionalred

braceletindicatesanyallergiestomedications

orproductsthatcontainlatexoradhesives.

Youalsowillhaveayellowbraceletthatindicates

youmightbeaFallRisk,meaningyourriskof

fallingisgreaterduetomedication,equipment

orhealthconditions.Pleaseuseyourcalllightto

letthestaffknowifyouneedassistanceorhave

otherneeds.

Yournursewillcheckyourvitalsignsand

conditionfrequently.Besuretolethimor

herknowifyouhavequestionsorconcerns.

Yourcompassionatecoachalsocanbe

helpfulincommunicatingwiththestaffsince

themedicationstocontrolpainmaymake

youdrowsy.Thosemedications,alongwith

anesthesia,cancausenauseaand/orvomiting.

Yournursecangiveyoumedicationforthisif

needed.Anothercommonproblemaftersurgery

isconstipation,forwhichmedicationswillbe

recommended.

Onceyourpainiswell-controlledwithoral

medicationsandyouaretoleratingoralfluids,

yourIVwillbediscontinued.Initially,youwillbe

givenclearliquidstodrink,andyourdietwill

beadvancedastolerated.Youmaynothave

muchappetiteaftersurgery,butyouwillbe

encouragedtoeatanddrink.Goodnutrition

isimportantforgoodhealing.Mealtimesat

LMHHealthareflexibleandarepresentative

fromdiningserviceswillcometoyourroomto

takeyourorderoffofamenuwhichcorresponds

withthedietyourphysicianhasordered.

Anincentivespirometerwillbeatyourbedside.

Youwillbeencouragedtouseitfrequently,much

likeyourpre-operativebreathingexercises.Thisis

tohelpdecreaseyourriskofpneumonia.

Youwillbeencouragedtodofootandankle

movementssoonaftersurgeryandthroughout

yourhospitalstay.

Continue to wear your TED hose (compression stockings) until your first post-op appointment at your surgeon’s office. Besuretohavethese

onwhenyouaredischargedfromthehospital.

Theyhelpminimizetheriskofbloodclotsand

reduceswelling.Removethestockingstoshower.

Youwillbeencouragedtouseacommodeor

standtourinate.Ifyouareunabletourinate,a

cathetermaybeplacedtemporarilytoempty

yourbladder.Difficultyinurinatingisnot

uncommonaftersurgery.Ifyouhaveaurinary

catheterinplacefromsurgery,itwillberemoved

shortlyaftersurgery.

Icepacksonyourkneeandcompressiondevices

onyourlowerlegswillhelpreduceswelling,

whichhelpslessenyourpain.

Intheeveningonthesamedayasyoursurgery

youwilllikelybeassistedtositontheedge

ofyourbed,andpossiblytostandattheside

ofyourbed.Youalsomaybeginwalkingwith

assistancethedayofsurgery.Thismayseemlike

adifficulttask,butitisthefirststeptowardyour

recovery.

Weencourageyoutohavevisitorsduringyour

hospitalstay,butkeepinmindthatyoualsoneed

timetorest.Youmayneedyourcompassionate

coachtolimithowmanypeoplevisitatatime,

andremindvisitorshowlongtheymaystay.

3WesthasadesignatedQuiet Time from 3:30 to 5 p.m. Thisisagoodtimetorestandrecover

fromtheday.Ourstaffwilltrynottodisturb

youduringthistime,butyouareencouragedto

notifythemusingthecalllightifneeded.

Planningforyourdischargewillbeginafter

surgery.Ateamofprofessionalsfrom

LMHHealthwillworkwithyouandyour

physician(s)todeterminethetimingand

conditionsofyourdischargefrom3West.

Thisteamincludesphysicalandoccupational

therapists,socialworkers,nurses,andpharmacy

staff.Somepatientsareabletoleavethehospital

3 West continued on page 22


afteroneortwodays,butsomestayuntilthe

thirddayaftersurgery.Priortosurgery,you

maywanttoconsiderwhatyouroptionsare

afterdischarge.Themajorityofpeoplegohome

withacaregiver,butsomepeoplemayneedto

transfertoarehaborskilledfacility.LMHHealth

hassuchafacilityonthe4thfloorandthereare

otheroptionsinthecommunity.Asocialworker

canhelpyouexploreyouroptions.Socialwork

willvisitwithyouandyourcareteamtohelp

makewhateverarrangementsareneeded.Donot

hesitatetoaskforinformation.

After surgery, while you are in the hospitalYourgoalforthesedaysistopreparephysically

andmentallytoleavethehospitalandcontinue

yourrehabilitation.

Laboratorypersonnelwilldrawyourblood

themorningaftersurgerytocheckyourblood

counts.Resultsofthesetestswillletthedoctor

knowifyoumayhaveaninfectionorifyou

havebecomeanemic.Anemiaishavingalow

redbloodcellcountwhichcancausefatigue,

weaknessandpaleskin.Itisnotuncommonfor

thistooccuraftertotaljointreplacementsurgery.

Ifyourredbloodcellcountgoestoolow,your

doctormayorderabloodtransfusion.Redblood

cellscarryoxygentovitalorgansincludingthe

brain,soit’simportanttomakesureyoumaintain

ahealthylevel.

Yoursurgeonand/orphysicianassistant

willcheckonyoudaily,usuallyearlyinthe

morning.Thisisagoodtimetoaskquestions

orcommunicateconcernswithyourphysician.

Askyournursewhattimeyoucanexpectyour

surgeonorphysicianassistantifyouwantto

arrangetohaveyourcompassionatecoach

presentduringthesevisits.

3 West continued from page 21

Surgery and Hospitalization

Youwillbeencouragedtochangefromahospital

gownintoyourown,loose-fittingclothes.You

mayweartheseforthedurationofyourstay.

Itwillbemorecomfortabletobeinyourown

clothes,especiallywhenworkingwithphysical

therapyoutsideofyourroom.Youwillcontinue

towearyourTEDhoseatalltimesexceptwhile

bathing.

Ourgoalisthatyouambulateshortlyafteryou

arrivetoyourroomon3Westaftersurgery.

Youwillbeencouragedtositinachairforyour

mealsratherthanstayinginbed.Youalsowill

beencouragedtogetuptousethebathroom

orcommodeforyourtoiletingneeds.Astaff

memberwillassistyouwithyourdailyhygiene.

Atsomepoint,onceyouareable,youwillbe

encouragedtotakeashower.Instructionsabout

howtokeepyourwounddrywillbeprovided.

Alwaysrequestassistancewhengettingoutof

bed.Astaffmemberwillneedtobepresentto

helpwithtransferstoachairortoescortyouto

thebathroom.Youwillbeunstableonyourfeet

andatahigherriskforfalls,especiallyinthefirst

severaldaysaftersurgery.

Medicationwillbegiventoyoutopreventblood

clots.Thismedicationwillbegiveneitherorally

orbyinjection,dependingonyourphysician’s

preferencesandyourhealthhistory.Thiswillbe

continuedafterdischargeandyouwillbegiven

instructionsfortakingthismediationathome.

Physicaltherapywillbeginrightaway.Therapy

staffwillworkwithyouonyourkneeexercises

andtransfersfromthebedtoachair.Theyalso

willhelpyoulearntouseyourwalkerorcrutches.

Yourcompassionatecoachisencouragedto

bepresentforatleastonetherapysessionto

learnyourroutinesoheorshecanassistyouat

home.Youwillbeexpectedtoexerciseatleast

twiceadayathome.Thegoalistogradually

increaseyourknee’srangeofmotionandthe


distanceyouareabletowalk.Thesemayseem

likeimpossibletasksinthedaysimmediately

followingsurgery,butarekeyforasuccessful

recovery.Itisexpectedthatbyyourtwo-week

post-opappointmentatOrthoKansasyouare

abletobendyourkneeatleast90degrees.

Youalsomayhaveanoccupationaltherapist

workwithyouonactivitiesofdailylivingsuch

asdressing,bathing,usingadaptiveequipment,

etc.Adaptiveequipmentsuchasgrabberscan

bepurchasedthroughMedstoBeds.Therapy

alsowillmakesureyourassistivedevicessuch

asawalker,caneandcrutchesfitappropriately.

Theywillaskquestionsaboutyourhome

environmenttolearnaboutanyphysical

challengesyoumightfacesuchasstairsinside

andoutsidethehouse.

Usuallyontheseconddayaftersurgery,the

bulkydressingonyourkneewillberemoved

andreplacedwithasmallerdressing.Youwill

beinstructedonwhattypeofdressingsyou

willneedtopurchase,aswellashowoften

youwillneedtochangeyourdressing.Your

compassionatecoachwillneedtobeinstructed

onthisaswell.

Discharge from LMH HealthYourdischargefromLMHHealthwilloccurwhen

yourhealthcareteamdeterminesitissafeforyou

toleave3West.Dependingonyourcontinuing

careneeds,youroptionsafterdischargeinclude:

⚫ Homewithcompassionatecoach

⚫ Homewithoutpatienttherapy

⚫ Homewithhomecarenurseand/ortherapy

⚫ Transfertoskilledorrehabfacility

Mostpeoplegodirectlyhomeafterleaving

3Westaslongastheyhavetheabilitytowalk

safelywithawalker,transferinandoutofbed

safelywithoutassistance,andnavigatestairs.

TherearequalifyingfactorssetbyMedicareand

otherinsurancesthathavetobemetinorder

foranypatienttobetransferredtoaskilledor

rehabfacility.Asocialworkerwillexplainthese

qualifyingfactorstoyou.

Ifyouplantohavehomehealththerapy,post-

dischargetherapyorderswillbesenttothe

homehealthagencyofyourchoice.Otherwise,

theorderswillbesenttotheoutpatientphysical

therapylocationofyourchoice.Ifyouknowprior

tosurgerythatyourplanistogotoanoutpatient

therapyfacility,youwillwanttocontactthem

afewweeksbeforesurgerytosetyourfirst

appointments.Thesefacilitiescanbeverybusy

andtheremaybeawaitbeforeyoucangetin

toseeatherapist.Planningaheadmayhelpyou

avoiddelaysinreceivingtherapyaftersurgery.

LMHHealthhasseveraloutpatienttherapy

locationsinandaroundLawrence,oryoumay

considerotheroptions.

Priortodischarge,yournursewillreviewwritten

careinstructionswithyouandgiveyouacopy

totakehome.Theseinstructionswillinclude

informationaboutwoundcare,dressingchanges

andhowtoprotectyourincisionduringashower.

Yoursurgeonwillgiveyouaprescriptionfor

painmedicationandpossiblyabloodthinner.

LMHHealthhasapharmacyconvenientlylocated

onsite.WiththeMedstoBedsprogram,you

areabletohaveyourprescription(s)filledatthe

hospitalpharmacyanddelivereddirectlytoyour

roompriortodischarge.Yourcompassionate

coachwillneedtoarrangetohaveyourwallet

availablesoyoucanpayforyourmedication.

Thebenefitsofthisprogramareexplainedinthe

FrequentlyAskedQuestionssectionofthisbook.

Besuretotakeallofyourpurchasedassistive

devicesandequipmentwithyouwhenyouleave.

Theseincludeyourwalkerorcrutches,TEDhose,

incentivespirometerandcoldtherapymachine.

Anddon’tforgetthisbook!

Ifgoinghome,youwillneedtoarrangefor

someonetopickyouup.Ifyouaretransferring

toaskilledorrehabfacility,transportationwillbe

arranged.Yourdischargewillusuallytakeplace

between11a.m.and3p.m.


Recovery After Discharge

Complications after joint replacement surgeryTwomaincomplicationsthatcanoccuraftertotal

jointreplacementsurgeryareinfectionaround

thenewjointandbloodclots,oftenreferredtoas

DVT(deepveinthrombosis).

Infection:Signsofinfectioninclude:

⚫ Feverwithatemperaturegreaterthan

101degrees

⚫ Chillsorshaking

⚫ Increasedredness,swellingorpainaround

theincision

⚫ Changeincolor,amountorodorofdrainage

⚫ Increasedjointpain

Youshouldnotifyyoursurgeonifyoudevelop

anyofthesesignsofinfection,oryouhave

anyconcernsaboutyourincision.

Blood clots:Signsofabloodclotinclude:

⚫ Increasedpain,tenderness,warmthorredness

intheleg(notdirectlyaroundtheknee)

⚫ Swellingortightnessinthecalforankle

Notifyyoursurgeonimmediatelyifyoudevelop

anyofthesesymptoms.Anultrasoundmaybe

donetoevaluateforbloodclots.Ifclotsdevelop,

medicationcanbeusedtotreatthem.

Anundiagnosedbloodclotinthelegcantravel

tothelungsandbecomeapulmonaryembolism.

Signsofthisinclude:

⚫ Suddendifficultybreathing,rapidbreathingor

feelingshortofbreath

⚫ Chestorbackpain

⚫ Coughingupblood

⚫ Sweating

⚫ Changeinmentalstatus(confusion)

Notifyyoursurgeonorgotothenearest

EmergencyRoomimmediatelyasthisisa

medicalemergency.Apulmonaryembolism

canbefatalifnottreatedquickly.


RecoveryThenextseveralweekswillbeveryimportant

inthesuccessfulrecoveryfromyourtotalknee

replacementsurgery.Theseweekscanbe

difficultduetothechallengesofadaptingto

beingathomeandworkingthroughphysical

therapy.Yourgoalwillbetoregainuseofyour

kneeandreturntoanactivelifestylethatyou

mayhavebeenmissingpriortosurgery.Be

realisticaboutyourgoalsafterrecovery.Ifyou

coulddocertainactivitiespriortoyourknee

becomingarthriticandpainful,thereisagood

chanceyoucangetbacktothoseactivitiesas

longastheydonotplacetoomuchstresson

yournewjoint.However,ifyouwerelimitedby

otherhealthconditionspriortosurgery,youmay

continuetohavethesesameissues,butwithout

thekneeproblem.

Physical therapyYouwillcontinuewithphysicaltherapyeitherat

homewithahomehealthphysicaltherapistorat

anoutpatientfacility.Thearrangementsforthis

willbemadepriortoyouleavingthehospital.

Youshouldexpecttoworkwithatherapistthree

tofivetimesaweekafterthefirstfewweeks

aftersurgery.Inaddition,youwillbetaughta

homeexerciseprogramwithexercisesthat

youwillbeexpectedtoperformtwiceaday.

Yourtherapistwillhelpsetgoalsforfunctionand

activity.Thetherapistwilltakeintoconsideration

yourlevelofactivitypriortosurgeryandyour

goalsforaftersurgery.Youwillcontinuewith

therapyuntilyourgoalshavebeenmetoryou

demonstratetheabilitytoworkonyourown.

Insomecases,yourinsurancemayhavealimit

onhowmanytherapysessionstheywillcover

aftersurgery.

Incision careKeepyourincisioncoveredanddryuntilyou

seeyoursurgeonatyourpost-opappointment.

Beforeleavingthehospitalyouwillbetaught

howtochangeyourdressing.Mostpatientswill

gohomewithanAquaceldressing.Thistype

ofdressingischangedeverysevendaysunless

therearecircumstancesthatmakeitnecessaryto

changeitsooner.Somepatientsgohomewitha

Tegadermdressing.Tegadermdressingsshould

bechangedeveryotherdayunlessyouare

instructedtodootherwise.Ifyouhaveincreased

drainage,youmayneedtochangethedressing

moreoften.IftheTegadermdressinggetswet,

youwillneedtoremoveitandreplaceitwitha

dryone.Bothtypescanbepurchasedatthe

LMHHealthPharmacythroughMedstoBeds.

Besureyourhandsarecleanbeforechanging

yourdressing.Whilethedressingisoff,checkfor

anychangesintheappearanceoftheincision.

Ifthereareanysignsofinfection,notifyyour

surgeon.Donotapplyanylotions,ointments

orcreamsonordirectlyaroundyourincision.

Youwillbegivenadditionalwoundcare

instructionsatyourfirstpost-opappointment

whenyouhaveyourstaplesremoved.

ShoweringPriortoyourfirstpost-opappointmentwith

yoursurgeon,youmayshoweraslongasyou

protectyourincisionfromgettingwet.Tegaderm

dressingswillkeepmoistureout,butitisalways

goodtoreinforcethis.Aquaceldressingsare

waterproof.Besuretheyareintactandno

moisturegetsinsidethedressing.Donotsoakin

atuborsimilaruntilyouaretoldyouarecleared

todoso.Itmaybeweeksaftersurgerybefore

youwillbeallowedtosoakyourkneeinatub

orpool.Youwillreceiveinstructionsregarding

showeringandbathingwhenyouhaveyour

staplesorsuturesremovedatyourappointment

withyoursurgeon.



SwellingSwellingiscommonaftertotaljointreplacement,

generallyonlyintheoperativeleg.Areasmost

likelytobecomeswollenarethefoot,ankle,knee

andthigh.Useofcompressionstockings(TED

hose)canhelpavoidthis.Continuetousecold

therapy.Thisalsowillhelpreducetheamountof

swellinginyourknee.Swellinginthekneecan

maketherapymoredifficult,soworktoreduce

thisbyelevatingthelegswhenlyingdownor

whenseated.Donotallowyourlegstohang

lowerthanyourwaistforextendedperiodsof

time.Movingaroundfrequentlyalsowillhelp

reduceswellingbyincreasingbloodcirculation

inthelegs.

Bruising or redness on operative legYoumaynoticebruisinganywhereontheleg

fromyourhipdowntoyourfeet.Thisisnot

uncommonafterkneereplacement.Theupper

legcanbebruisedbecauseofthetourniquet

thatwasplacedduringsurgerytoreduceblood

loss.Lowerlegbruisingcanbearesultofinternal

jointbleedingthatcanoccurduringorafter

surgery.Bruisingaroundthereplacedkneeisalso

common.

DietSomelossofappetiteiscommonforseveral

weeksaftersurgery.Abalanceddietisimportant

topromotepropertissuehealingandrestore

musclestrength.Besureyouconsumeplentyof

proteinasthisisespeciallyimportantinhealing.

Asyoubegintobemoreactive,yourappetite

shouldimprove.Besureyouaredrinkingplenty

offluids.Hydrationwillhelpavoidconstipation

whichiscommonaftersurgery.Constipationcan

occurbecauseofdecreasedactivityandopioid

painmedicationuse.

Pain controlContinuetotakeyourpainmedication(s)as needed and as prescribedtokeepyourpain

undercontrolforthefirstfewweeks.Keepin

mindthatrecoveryfromkneereplacement

surgeryispainful,andmedicationmaynot

eliminateallofyourpain.Donotexceed

recommendedorprescribeddosesofyour

medication.Somemedications,iftakentoooften

orintoohighadose,cancauseover-sedation

orotherwiseputyourhealthatrisk.Donot

exceed3,000mgofTylenolina24-hourperiod.

Ifyouareprescribedapainmedicationthat

containsTylenol,staywithinthatdosinglimit.

Refillrequestsforcontrolledmedicationsmust

becalledintoyoursurgeon’sofficeandyouwill

needtopickupthewrittenprescriptionthere.

Overtime,yoursurgeonwillencourageyouto

tobackoffofstrongopioidpainmedicationand

beginusingover-the-countermedications.Most

peopleareabletoreduceoreliminatetheneed

forprescriptionpainmedicationwithinfourtosix

weeksaftersurgery.Ifyouhavequestionsabout

whatover-the-countermedicationsyoucantake,

contactyoursurgeon’soffice.

Besidesmedication,thereareotherwaystohelp

minimizethepainanddiscomfortfromyour

surgery.Continuetousecoldtherapyonyour

kneetohelpreduceswelling.Youalsoshould

elevateyourlegwhenlyingorsittingtoaid

inreducingswelling.Youshouldgetup,walk

andchangeposition.Althoughyourexercises

andtherapycanbepainful,theyalsocanaid

inreducingswellingbyincreasingcirculation.

Expectyournewkneetofeelstiffaftersittingor

lyingforextendedperiodsoftime.Youwillbe

encouragedtomovearoundfrequentlytoavoid

this.

Recovery After Discharge

Continued from page 25


TravelingDonottravelalongdistance(overonehour)by

vehicleorairplaneuntilclearedbyyoursurgeon.

Thisrestrictionusuallylastseighttotwelveweeks

aftersurgery.Failuretofollowthisrestriction

increasesyourriskforbloodclots.Ifyouare

travelingbycar,besuretostopeveryhourto

getoutandstretchyourlegs,otherwiseyoucan

becomestiffandsore.Iftravelingbyairplane,

trytostandandstretchperiodicallyaswellas

dosomelowerlegstretchesorexerciseswhile

seated.

Yournewjointwilllikelyactivatemetaldetectors

thatareusedinsecuritychecksatairportsand

insomebuildings.Youwillreceiveacardatyour

surgeon’sofficethatyoucancarryinyourwallet

toshowtosecuritypersonnel.Accommodations

willbemadetoscreenyouforclearance.

Dental workForaperiodofatleasttwoyearsafteryourtotal

jointreplacement,youwillberequiredtotake

asingledoseofantibioticspriortoanydental

procedures.Theseincludecleanings,periodontal

procedures,fillings,etc.Yoursurgeon’sofficewill

prescribetheappropriatemedicationforyouto

take.Youneedtowaitthreemonthsaftersurgery

beforehavinganyelectivedentalworkdone.

Althoughtheriskisverysmall,yoursurgeon

wantstominimizetheriskofanyinfectioninyour

newkneeasaresultofbacteriafromyourmouth.

Activity after knee replacementExerciseisthekeytosuccessfulrecovery

followingjointreplacementsurgery.Oncecleared

byyoursurgeonintheweeksaftersurgery,you

shouldbeabletoresumemostnormalactivities.

Atfirst,someactivitiesmaybealittlepainful,but

overtimeyouwillfindyourselfparticipatingmore

intheactivitiesyouenjoy.

Startbackintoactivitygradually.Slowlyincrease

youractivityinyourhomebywalkingaround

thehouseandresuminghouseholdchores.

Eventually,youshouldbeabletoreturnto

walkingoutsideorgoingtoagym.Besureto

usecautiontoavoidfallsandinjuries.Swimming

isanexcellentformofexercisethathelps

strengthenyourlegswhileyouarerecovering.

Otheractivitiesthatyoumightconsiderinclude

golf,lighthiking,recreationalbikingonpaved

surfaces,dancing,bowlingandgardening.

Plantoexerciseatleastthreetofourtimesa

weekfor20to30minutesatatime.

Donotrunorparticipateinhigh-impactactivities.

Avoidactivitiesthatrequirealotofstops,starts,

turnsandtwistingmotions.Donotparticipatein

contactsportsthatincreaseriskofinjurytoyour

knee.Specificactivitiestoavoidincludevigorous

hiking,jogging,snowskiing,tennis,repetitive

aerobicstairclimbing,repetitiveweightliftingof

40poundsormore,football,basketball,baseball,

highimpactaerobics,racquetballanddeep

squats,tonameseveral.Theseactivitiesincrease

riskofinjuryorearlywearingoftheartificialjoint.

Sexual activityItisnotuncommonforyouoryourpartnerto

experienceanxietyaboutengaginginsexual

activityaftertotaljointreplacement.Thepainful

jointmayhavelimitedyourabilitytoenjoy

sexualactivitypriortosurgery.Thejointsurgery

willalleviateasignificantamountofthatpain

andjointstiffnessandallowyoutoresumethis

activitymorecomfortably.Itisgenerallysafeto

resumesexualactivityaboutfourtosixweeks

aftersurgery.Thejointrecoveryprocessmay

requireyoutotakeamorepassive“bottom

position”initially,butovertime,youshould

beabletotakeamoreactiveroleinsexual

intercourse.Ifyouhavequestions,youcanalways

checkwithyoursurgeon,nurseorphysical

therapist.


Frequently Asked Questions

What is osteoarthritis and why does it make my knee hurt?Osteoarthritisisthemostcommonformof

arthritis.Itiscausedbythewearingdownofjoint

cartilage,thetough,smoothtissuethatcovers

theendsofboneswherejointsarelocated.

Jointcartilagecushionstheboneduring

movementandallowsmotionwithminimal

friction.Asthecartilagewearsdownovertime

itexposestheendsoftheboneswhichleadsto

painfulbone-on-bonecontact,swellingandloss

ofmotioninthejoint.

What is a total knee replacement?Thetermtotalkneereplacementissomewhat

misleading.Thekneeisnotreplaced,butrather

animplantisusedtore-capthewornendsofthe

bone.Thisisdonebyremovingthewornsurfaces

oftheboneandimplantingmetalsurfaceswith

aplasticspacerinbetween.Thiscreatesanew,

smoothcushionandafunctionaljointthatcan

reduceoreliminatepain.

How long and where will my scar be?Surgicalscarswillvaryinlength,butyour

surgeonmakesitassmallaspossible.Itwill

startjustaboveyourkneeandextenddown

themiddleofyourkneetojustbelowtheknee.

Astimegoesby,thisscarwillfadeandbecome

muchlessnoticeable.Somepeoplenotice

numbnessaroundthescarwhichmaydecrease

overtimeormaybepermanent.

What is the recovery time after my knee surgery?Everyonehealsfromsurgeryatadifferentpace.

Peoplehavedifferentlevelsofpaintolerance

anddifferentlevelsofmotivation,andbothare

factorsthataffecthowsoonanindividualis

abletoworktowardrecovery.Youshouldplan

touseanassistivedevicesuchasawalker,cane

orcrutchesforamonthortwoaftersurgery.

Physicaltherapywillhelpyougetbacknormal

useofyourknee.Bythreemonthsaftersurgery

mostpeoplehaveregainedfulluseoftheirknee

andareabletoresumemostnormalactivities.


How long will I be on pain medication and why do I have to pick up a written prescription from my surgeon’s office?Mostpeopleareabletodecreaseoreliminate

theuseofnarcoticpainmedicationbyaround

fourtosixweeks.Refillswillbeatthediscretion

ofyoursurgeonandbasedonyourprogress

withtherapyandthelengthoftimethathas

passedsincesurgery.Thestrongnarcoticpain

medicationthatyoureceivedatthehospital

willgraduallybereplacedwithlowerdose

painmedications,andeventuallyyouwillbe

encouragedtouseonlyover-the-counter

medicationssuchasTylenoland/oranti-

inflammatories.Narcoticpainmedicationsare

rigidlycontrolledbytheDrugEnforcement

Agencyandpertheirguidelines,onlywritten,

signedprescriptionscanbeacceptedatthe

pharmacy.TheDEAmonitorsallcontrolled

substanceprescriptionswrittenbydoctorsas

wellasprescriptionsfilledbyindividuals.

How long will my new knee last and can a second replacement be done?Allimplantshavealimitedlifedependingonan

individual’sage,weight,activitylevelandmedical

conditions(s).Theimplantisamedicaldeviceand

issubjecttowearthatmayleadtomechanical

failureovertime.Thereisnoguaranteethat

yourimplantwilllastforanyspecifiedlengthof

time.However,mosttotalkneeimplantslastat

least15to20years.Animplantcanbereplaced,

althoughthesurgeryisalittlemorecomplicated.

How often will I need to see the surgeon after surgery?Youwillhaveaseriesofappointmentsduringthe

threetosixmonthsaftersurgery.Expecttosee

yoursurgeontwoweeksaftersurgeryandagain

atdifferentintervalsduringthattimeperiod.

Youalsowillfollowupwithyoursurgeonatyour

one-yearanniversaryofyoursurgery.Afterthat,

expecttofollowupeverythreetofiveyears

aftersurgerytobesureeverythingisgoingwell.

Youshouldnotifyyoursurgeonanytimeyou

haveconcernsorquestionsaboutyourknee.

When will I be able to return to work after surgery?Thatanswerdependsalotonwhattypeofwork

youdo.Ifyouworkatasedentaryjob,youmay

bereadytoreturntoworkinfourtosixweeks,

althoughtheremaybelimitationsinplaceand

youmayonlybeabletoworkparttimeforafew

weeks.Ifyouhaveajobthatismorephysically

demanding,itmaybeuptothreemonthsbefore

youcanreturntofullduty.

Can I drink alcohol during my recovery?Aslongasyouaretakingnarcoticpain

mediation,youshouldavoidanyalcohol

consumption.Bothhaveasedatingeffectand

cansuppressthecentralnervoussystem.Alcohol

alsocandecreaseyourabilitytowalksafely

andincreaseyourriskoffalling.Youshould

avoidalcoholifyoutakecertainprescription

medicationssuchaswarfarin.Checkwithyour

primarycaredoctorifyouhaveanyquestions

aboutthis.

Is it normal to feel depressed after surgery?Itisnotuncommontohavenewsymptomsof

depression(orworseningsymptomsifyouhadit

priortosurgery)afterjointreplacementsurgery.

Thismaybeduetoavarietyoffactorssuchas

limitedmobility,discomfort,temporarylossof

independence,lackofsleep,feelinghomebound

andmedicationsideeffects.Thesefeelings

shoulddiminishasyoubegintoresumeregular

activities.Ifthesymptomspersist,checkwith

yourprimarycarephysician.

Is it normal to have insomnia after surgery, and what can I do about it?Insomniaisverycommonaftertotaljoint

replacementsurgery.Patientsoftenreportthis

asoneoftheirchiefcomplaintsduringtheir

recovery.Thiscanresultfrompain,toomuch

napping,anxiety,oranynumberofreasons.

Yoursurgeonwillnotprescribesleepmedication



What are the benefits of using Meds to Beds?Youwillbeabletopurchaseprescription

medications,assistivedevicesandmedical

equipmentsuchasdressingsoricepacksdirectly

fromtheLMHHealthpharmacy.

⚫ Yourprescriptionsareconveniently

deliveredtoyou.

⚫ Youcanavoidanadditionalstopatthe

pharmacyonyourwayhome.

⚫ Apharmacistorpharmacyinternwillmeet

withyoupersonallytoprovideone-on-one

dischargemedicationeducationandanswer

medicationquestionstoyoursatisfaction.

⚫ Remainingrefillswillbetransferredtoyour

pharmacyofchoiceandmedicationchanges

communicatedtoyourpharmacist.

⚫ Anupdatedmedicationlistwillbesenttoyour

primarycareprovider.

How long after surgery do I need to wear compression stockings (TED hose)? Youshouldcontinuetowearyourcompression

stockingsuntilyourtwo-weekpost-op

appointment.

How soon after surgery can I drive? Youcanusuallyresumedrivingtwotofour

weeksaftersurgery.Beforedrivingyouwillneed

tobeoffopioidpainmedication,havegood

legcontrol,andbefullyweightbearing.Your

surgeonwilldiscussyourprogressanddriving

potentialatyourtwo-weekpost-opvisit.

Frequently Asked Questions

foryoubecausethesedatingeffectofthat

withyournarcoticpainmedicationcanbea

dangerouscombination.Therearenatural,

over-the-counteroptionssuchasmelatonin

thatyoumightconsidertrying.

Is it normal for my leg with the joint replacement to feel longer now? Inmostcases,thelengthofyourlegwillnotbe

differentaftersurgery.However,insomecases

thelegislengthenedasaresultofstraightening

akneethatwaspreviouslybowed.Itmayfeel

awkwardatfirst,butmostpeoplebecome

accustomedtothedifference.Inrareinstances,a

shoeliftmaybenecessaryontheoppositeleg.

How do I get the cold therapy unit and how long will I need it?Whenyouschedulesurgeryyouwillbegiven

informationaboutwhotocontactandhowto

makearrangementstohavethecoldtherapy

machineavailablepriortosurgery.Youwillhave

thisinplaceimmediatelyaftersurgeryandwill

useitaslongasyoufeelitiseffectiveforyou.

Itismosteffectiveifyouuseitatleastthree

timesadayfor10-15minutesatatime.You

shouldexpecttouseitforatleastseveralweeks

aftersurgerytohelpkeepswellingundercontrol

andminimizepain.Ifyoudon’twanttopurchase

thecoldtherapymachine,youcanpurchaseor

makeyourowncoldpacks.

Who do I call after surgery if I have questions?ContactthenursenavigatoratOrthoKansasif

youhavequestionsorconcerns.Ifyoubelieve

youarehavingamedicalemergency,however,

youshouldcontact911orgodirectlytothe

EmergencyRoom.

Continued from page 29


Notes


©2020TheLawrenceMemorialHospitalDBALMHHealth.Allrightsreserved.LMHHealthprovidescarethatissensitivetocultural,racial,religiousandotherdifferencesanddoesnotdiscriminateonthebasis

ofrace,religion,age,ethnicity,culture,language,socio-economicstatus,sex,sexualorientation,genderidentityorexpression,nationalorigin,physicalormentaldisability,orsourceofpayment,norinrelationtoemploymentpractices.

8/2020

total knee joint replacement education manual

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