Baker Rehab Group HomeCare Rehab and Nursing LLC

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1 Baker Rehab Group HomeCare Rehab and Nursing LLC

2 Introduction So it s time for a joint replacement... Are you worried about the surgery? Are you wondering about the pre and post surgical process? Do you want to do everything you can to get a positive outcome? We can help! The therapists at Baker Rehab Group are experts in the rehabilitation process before and after joint replacement. This program is designed to educate you and your family about the joint replacement process from start to finish. Our therapists are highly experienced, professional, and friendly. And because the therapy services are provided in your home on a one on one basis, they might just become a part of your family as well. Knowledge is Power The need for joint replacement surgery usually results from severe arthritis, fracture, or other condition. There are nearly 800,000 hip and knee replacements performed each year in the United States. The vast majority of those patients experience excellent outcomes, with decreased pain and increased function leading to an improved quality of life. This program is a comprehensive look at your journey through the rehabilitative process from the moment you and your surgeon decide that a joint replacement is in your future. The Joint Venture Program was designed to complement your surgeon s protocols and assist in developing a specially tailored program to meet your unique needs and situation. You can relax... this is what we do best.

3 X-ray of total hip arthroplasty. X-ray of total knee arthroplasty.

4 Prehab Most people are familiar with the word rehab which usually occurs after a surgery or hospitalization. Prehab gets a jump on the rehabilitation process by offering physical and occupational therapy services 4-6 weeks before joint replacement surgery. Prehab services include: Strengthening, flexibility, and balance exercises Safety and home modifications Equipment recommendations and ordering Resources for transitional care or in-home care options And one great advantage of the prehab program is that you can request to have the same therapist work with you following your surgery as well. Continuity of care is a rare commodity in this current healthcare environment, and we believe that this is an important ingredient for success.

5 Pre-Operative Preparation Preparation is key! The physical and occupational therapist who visit your home prior to surgery will have many instructions and recommendations for you to consider before your big day. Physical Therapy Stair training Car transfers Entering and exiting the home Joint Venture exercise program (samples in the back of this booklet) Occupational Therapy Remove obstacles and hazards (throw rugs, clutter) Tub/shower transfer techniques Placement of grab bars Equipment needed for bathing, dressing, and toileting Appropriate lighting Tips to consider shopping, meal transportation for grocery preparation, and

6 Equipment

7 Post-operative Planning One of the most important ingredients for successful recovery is having a good discharge plan in place before you walk in the hospital door. In most cases, the hospitalization phase passes quickly, and last minute decisions regarding your care are usually not ideal. Things to consider: Who will be available to help me in the home? Who will run errands for me? Who will transport me to the doctor? Or to the lab? Or to therapy? Will my home be accessible if I cannot go up and down stairs? What places can I go to if I need extra assistance or more intensive therapy? What services can come into my home? Let s have that discussion and make some of those decisions now. Resources are provided in the back of this book.

8 Post-operative Care The post-operative care you receive in the hospital will vary in duration and approach depending on your individual needs. Most likely, you will begin some physical therapy immediately after surgery while you are still in the hospital. Hospital stays are getting shorter and shorter in the new healthcare realm, which can be both a good thing and a bad thing. The good news is you are home sooner. You are back in the comfort of your own house with your things all around you. Many people thrive and make quick progress once they are home, and your pre-op therapist can arrange to see you immediately. The more challenging part of shorter hospital stays is that you may still be quite weak or have pain that interferes with normal function. This may result in needing to go a sub-acute nursing facility or assisted living facility for a few days or weeks until you are strong enough to return home. Although joint replacement rehabilitation protocols are generally quite standard, the Joint Venture Program is designed to accommodate the specific rehabilitation protocols of each surgeon. Your therapist will communicate regularly with your

9 physician regarding your treatment plan, and all restrictions and guidelines will be strictly followed. Here are some standard guidelines commonly followed. These will vary depending on your surgeon s preferences:

10 Here are some standard guidelines that are commonly followed after joint replacement surgery. These will vary depending on your surgeon s preferences: Pain management The physician will send you home with the appropriate medication to moderate pain. It is important to follow the medication label as prescribed and, if possible, take the medication at least 30 minutes prior to physical therapy. In the beginning stages, it is recommended that you continue to take medications as prescribed because it is easier to prevent pain than it is to control it. Narcotics can also cause constipation, so a stool softener may be recommended. Discuss this with your health care provider if it is not prescribed. Wound care In most cases, staples will be used to close the surgical incision. The wound will need to be cleaned and dressed as instructed by the hospital staff. Follow-up wound care will be given by the physical therapist and/or nurse upon return home. The staples can be removed by the physician, physical therapist, or nurse usually about days following surgery, depending on the physician s instructions. Sometimes other closure options, such as glue, are also utilized. Your physician will decide which option is best for you. Blood Thinners In many cases, the patient will be on blood thinning medications. The effectiveness will need to be monitored, sometimes with blood draws. The physician may order your blood to be checked if you are on certain medications. Others do not require blood thinner monitoring.

11 Total Hip Replacement Precautions: The Don'ts Don't cross your legs at the knees for at least 8 weeks. Don't bring your knee up higher than your hip. Don't lean forward while sitting or as you sit down. Don't try to pick up something on the floor while you are sitting. Don't turn your feet excessively inward or outward when you bend down. Don't reach down to pull up blankets when lying in bed. Don't bend at the hip beyond 90. Don't stand pigeon-toed. Don't kneel on the knee of the unoperated leg (the good side). Don't use pain as a guide for what you may or may not do. The Dos Do keep the leg facing forward. Do keep the affected leg in front as you sit or stand. Do use a high kitchen or barstool in the kitchen. Do kneel on the knee on the operated leg (the bad side). Do use ice to reduce pain and swelling, but remember that ice will diminish sensation. Do not apply ice directly to the skin; use an ice pack or wrap it in a damp towel. Do apply heat before exercising to assist with range of motion. Use a heating pad or hot, damp towel for 15 to 20 minutes. Do cut back on your exercises if your muscles ache, but keep doing them.

12 *These are common restrictions used after total hip replacement surgery, but are not a substitute for your physician s specific guidelines. Anti-inflammatory Techniques Swelling and inflammation after surgery is normal, but management will significantly improve recovery. The acronym R.I.C.E. is a common reminder of how to manage the swelling. Rest Your body needs rest in order to recover. Ice Place an icepack over surgical area for min every 1-2 hours*

13 *A cryocuff/ice therapy system may be recommended with specific parameters. Time of ice use may vary Compression You may come home from the hospital with compression (TED) stockings- these help control swelling and prevent blood clots. Elevation Sometimes leaving your legs down causes fluid to build up in your lower extremities. Propping them up is a great way to use gravity to your advantage. Discuss this with your health care provider, if it is not prescribed. Possible Complications After Total Joint Replacement

14 Deep Vein Thrombosis o Signs and symptoms Calf edema Extreme pain and tenderness in calf Preventive measures Pulmonary Embolism o Signs and symptoms Anticoagulants, such as heparin, coumadin, and as- pirin Intermittent pneumatic compression boots Ankle exercises with plantar and dorsiflexion Routine position change Ambulation as soon as possible postoperatively Cough Chest discomfort Wheezing, dyspnea Tachycardia Fever Diaphoresis Confusion Anxiety or apprehension o Preventive measures Anticoagulants as for deep vein thrombosis (DVT) Provide adequate ventilation Incision and Wound Infection o Signs and symptoms Redness of incision and surrounding area Induration at incision site Edema beginning in area of prosthesis Temperature of more than 100 degrees Drainage, serous to purulent Difficulty with weight bearing Delayed wound healing time Persistent pain that is difficult to control o Preventative measures Use sterile technique Routinely evaluate operative site to identify early symptoms Monitor temperature Assess incision for discharge, edema, or redness Maintain prophylactic antibiotic therapy with dental or minor surgery procedures

15 Implant Failure or Joint Dislocation o Signs and symptoms Pain that is difficult to control Joint deformity Inability to freely weight bear on the operative joint Instability of the affected joint o Preventative measures Maintain proper body weight Maintain proper exercise and positioning techniques Reasons to Seek Medical Help Sometimes it is hard to really know what constitutes a serious or emergent situation. It is all right to seek answers to questions from your caregivers and no question should be left unanswered. Immediate contact with the physician is necessary if: There is excessive or increasing pain Temperature of 100 degrees or more Swelling increases around operative area and elevating does not help Drainage is noted from the incision site Calf pain, leg swelling, shortness of breath, or chest pain If chest pain or shortness of breath is of sudden onset, call 911.

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19 Exercise Log Activity Date Date Date Date Date Date Quad set Gluteal set Ankle pump Short arc quad Knee extension stretch Straight leg raise Hip abduction Sitting knee flexion stretch Sitting knee extension (long arc) Prone hip extension Prone knee flexion Sidelye hip abduction 626 Trail Ave, Frederick, MD Phone: Fax:

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