wsc uni knee/ total knee replacments · control your discomfort u most outpatients receive an...

WSC UNI KNEE/ TOTAL KNEE REPLACMENTS

Westminster Surgery Center

u Thank you for choosing the Westminster Surgery Center to help restore your quality of living with your new prosthetic joint.

u The surgery aims to relieve pain, restore independence and return you to work and other daily activities.

u Knee Replacement patients recover quickly. Patients are able to walk the day of surgery.

u We believe that you play a key role in a successful recovery.

u Our goal is to educate you and give you the necessary information needed for a safe and successful surgical outcome.

What To Do Before Surgeryu Obtain medical clearance

u Clearance from your specialist if required ( i.e. Cardiac Clearance )

u Obtain a walker or crutches prior to your pre-op physical therapy visit

u Pre-op phone call– Before your surgery, a registered nurse from the Westminster Surgery Center will call you to review past medical history and medications. Pre op instructions will also be given during this phone call.

u You must Attend Pre-op Physical therapy session- This session will review how to walk with a walker/crutches, how to go up and down stairs, as well as exercises. Call either PIVOT or Med Star physical therapy to set up this appointment.

u PIVOT 410-876-5600u Medstarr410-751-7930u Prior to surgery, you should have scheduled your first post-

operative outpatient physical therapy appointment to begin on or about post-operative day 2 or 3.

Preparing Your Home Prior To Surgery

u Remove any and all lose rugs through out house to avoid falling

u Make sure all wires and cords are out of the way to reduce tripping

u Have chairs that have arm rest to aid in helping you get in and out of chairs.

u Have adequate lighting for hallways bedrooms, and bathrooms

u You may need a bedside commode if bathroom is on alternate floor .

u Safety rails in shower/tub or around toilet are helpful

u DO NOT carry items in you hands when using walker or crutches.

u Use pockets of jackets/sweater, walker bag/tray or utility cart to carry items (i.e. cell phone, drink, remote, icepack )

u Arrange your kitchen and bathroom for easy access to frequently used items. Place items on middle shelf or on counter

u Use lighter containers when necessary (i.e. 1/2gallon milk )

u When reaching for items support your self on stable surface (i.e. countertops, dressers or door jams )

What To Do The Night Before Surgery

u Please take two tablets of 500mg Tylenol by mouth the NIGHT BEFORE surgery. Do Not take if you have an allergy to Tylenol or are at an increase risk of liver damage.

u NPO After midnight– This means no eating or drinking after midnight, NOT EVEN WATER, unless otherwise instructed to do so.

u Medication with a sip of water- You will receive instructions about which medications ( if any ) to take the morning of your surgery with a small sip of water.

u Pre-op skin preparation- you will be given instruction on cleaning your skin before surgery to help reduce the chance of infection. There will be an additional surgical site preparation done in the operating room

u Do not wear any makeup, lotions, powder, contact lenses or jewelry. Remove all rings and piercings.

What To Bring Day Of Surgery

u Loose comfortable clothing

u Supportive shoes that have a back on them

u Bring insurance card, photo ID and any copayment required by your insurance company

u Crutches /walker

u Cpap/bipap machine if you have one

u You will also need a responsible adult/Driver with you in the surgery center the entire time of procedure.

u Someone to care for you for the first 24 hrs. after anesthesia

Control Your Discomfort u Most outpatients receive an

intraoperative injection of long acting anesthetic (Exparel) into the tissues surrounding the knee, which is usually quite effective for the prevention of postoperative pain for approximately 48-72 hours.

u You may resume whichever anti-inflammatory medication (e.g. Meloxicam, Celebrex, and Naprosyn) you may have been taking prior to surgery, or you may take over the counter Ibuprofen to supplement the narcotic pain medicine.

u You may use the narcotic pain medicine prescribed or use milder over the counter medication if sufficient.

u Take your pain medication 30 mins. prior to physical therapy.

u Change your position every 45 mins through the day to help prevent bed sore or pressure ulcers.

u In addition to elevation of the leg, ice is effective for swelling and should be used frequently for several weeks after surgery. It should not be applied directly onto unprotected skin.

Body Changes

u Your appetite may be poor at first but should gradually improve over the next few days after surgery.

u Drink plenty of fluids to keep from getting dehydrated.

u Pain medication contains narcotics which may cause constipation. Use over the counter stool softeners or laxatives daily as directed

u Your energy level may be decreased for about the first month

Care For Yourself At Home

when you go home there are a variety of things you need to know for a safe and speedy recovery

Signs of Infection

q Increased swelling or redness at the incision site

q Change in color, amount, odor of drainage

q Increased pain in knee that pain medication does not cover

q Fever greater then 101 F

q Notify your Surgeon’s Office if you have any of the above symptoms

Preventing blood clots

q Blood thinning medication may be given after surgery to help prevent blood clots after surgery.

q Sequential compression devices/ SCD’s will be given to you on the day of you procedure . These will go home with you . Theses SCD’s are sleeves that wrap around each calf and inflate with air. This helps prevent blood cots.

q Foot and ankle pump Exercises

q Walking

Please note everyone will get a copy of their surgeons specific discharge instructions to go home with on the day of surgery

Recognizing And Preventing Potential Complications

Deep Vein Thrombophlebitis or DVT – is a blood clot in a deep vein in the body, usually in the legs

Signs of a DVT

u may include swelling in thigh, calf, ankle that does not go down with elevation

u pain/tenderness in calf

u Note blood clots can form in either leg

Pulmonary Embolus or PE - blood clot in the lungs.

Signs of a PE

u Sudden Chest pain

u Difficult and /or rapid breathing

u Shortness of breath

u Sweating

u Confusion

These are an emergency and you should call 911 or go to the nearest Emergency Room if suspected.

Care For Yourself At Home

Walking:

u Postoperatively, walking is encouraged early and often, at least every 2 hours during the day.

u You may bear full weight on the operative leg immediately and as tolerated.

u You may progress from a walker or crutches to a single crutch or cane as soon as you are safe and comfortable doing so.

u Most patients use crutches or a walker for 7-10 days before progressing to a cane.

Exercise:

u Frequent (3-5x/day) range of motion exercises will help prevent swelling and stiffness and promote a rapid recovery. The operative leg should be elevated with support under the foot to encourage full knee extension and prevent swellingwhen resting.

u There should NEVER be a pillow under the knee while resting.

Walkingu In addition to your exercise

program, you must leave time for walking. Walking helps build your strength and endurance.

u Walk around your home three to five times each day. Trips to the bathroom or kitchen are not enough. Progress to walking outside and in the community.

u Important: Talk with your therapist about how far you should walk each day so you don't overdo it.

Home Exercisesu A regular exercise program will strengthen the weakened muscles. Your

success with rehabilitation largely depends on your commitment to follow the exercise program developed by your surgeon and therapists.

u Ideally, you should exercise three to five times a day, every day, after surgery.

u Complete each exercise 10 times. If you are comfortable with the exercise, increase the repetitions by five times each week, until you reach 20 repetitions:

u week one: 10 repetitions

u week two: 15 repetitions

u week three: 20 repetitions

u Follow specific directions given to you by your surgeon or therapist

u For the most comfort, do your exercises lying down. Your bed is an excellent place to do your exercises.

Ankle Dorsiflexion - Plantarflexionu Standing, hold onto a firm surface. (Steady chair or

countertop )

u Raise up on toes.

u Go Back on to heels

u Bend both your ankles up, pulling your toes toward you, then bend both your ankles down, pointing your toes

away from you. u In addition, rotate each foot clockwise

and counterclockwise, keeping your toes pointed toward the ceiling.

Ankle Pumps

Thigh squeezes (quadriceps sets)

Place a rolled up towel under ankle and then tighten the muscles on the front of your thigh by pushing the back of your knee down into the bed. Hold for 5 seconds and relax. Repeat with opposite leg.

Heel slides (hip and knee flexion)Bend your hip and knee by sliding your heel up toward your buttocks while keeping your heel on the bed. Slide your heel back down to the starting position. Keep your kneecap pointed up toward the ceiling during the exercise. You may want to use a plastic bag under your heel to help it slide easier. Repeat with opposite leg

Leg slides (abduction/adduction)Slide your leg out to the side, keeping your kneecap pointed up toward the ceiling. Slide your leg back to return to the starting position. You may want to use a plastic bag under your heel to help it slide easier. Repeat with opposite leg.

Lying kicks (short arc quadriceps)Lie on your back with rolled blanket under your knee. Straighten your knee. Hold for 5 seconds. Slowly lower your leg down and relax. The back of your knee should stay in contact with the blanket during the exercise. Repeat with opposite leg.

Straight leg raisesBend one of your legs with your foot flat on the bed. Raise your opposite leg up (about 12 inches), keeping your knee straight. Hold briefly. Progress to holding for 5 seconds. Slowly lower your leg down and relax. Repeat with opposite leg.

Hamstring sets (heel digs)Bend your surgical knee slightly and tighten the muscle on the back of your thigh by digging your heel into the bed. Hold for 5 seconds.

Prolonged knee stretch Sit on a chair. Bend your knee back as much as you can. Scoot your body forward on the chair to increase the stretch. Hold for 30 to 60 seconds.

Sitting kicks (long arc quads) Sit in a sturdy chair. Lift your foot, straightening your knee as much as possible. Try to keep your knees level, as if you were holding a tray on your lap. Hold for 5 seconds. Slowly lower your leg down and relax. Return to the starting position and repeat with opposite leg.

Knee straightening stretch

Work on straightening your surgical knee for 10 minutes. Sit on a sturdy chair with your heel up on another chair, or a footstool, in front of you. You should feel a stretch on the back of your knee. You can do thigh squeezes while you sit in this position to increase the stretch.

Knee dangling/swinging

Sit on a bed so that your feet will not touch the floor. Allow your knees to bend. Swing your surgical leg back and forth so that you feel a gentle rebounding sensation. Do this for 2 to 3 minutes.

Range of Motion – Strengthening Exercises Ankle Pumps reps times/Day

Thigh Squeeze reps times/Day

Heel slide reps times/Day

Leg Slides reps times/Day

Lying Kicks reps times/Day

Straight Leg Raises

reps times/Day

Hamstring Set reps times/Day

Prolonged KneeStretch

reps times/Day

Sitting Kicks reps times/Day

Knee StraighteningStretch

reps times/Day

Knee dangling /swinging

reps times/Day

Ankle Pumps reps times/Day

Thigh Squeeze reps times/Day

Heel slide reps times/Day

Leg Slides reps times/Day

Lying Kicks reps times/Day

Straight Leg Raises

reps times/Day

Hamstring Set reps times/Day

Prolonged KneeStretch

reps times/Day

Sitting Kicks reps times/Day

Knee StraighteningStretch

reps times/Day

Knee dangling /swinging

reps times/Day

Range of Motion – Strengthening Exercises

wsc uni knee/ total knee replacments · control your discomfort u most outpatients receive an...

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