Knee / Hip Replacement Orientation Class

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1 THIS IS YOUR GUIDE FOR YOUR HIP OR KNEE REPLACEMENT PATIENT NAME DATE OF SURGERY Physicians Location Phone Christian H. Bean, MD Green Mountain Orthopaedic Surgery (802) Mahlon A. Bradley, MD Central Vermont Orthopaedics (802) Christopher Meriam, MD Green Mountain Orthopaedic Surgery (802) Knee / Hip Replacement Orientation Class For patients scheduled for knee or hip repacement, families and caregivers of knee/hip replacement patients, or anyone considering knee/hip replacement. Feel better prepared for surgery and recovery with help and information from Central Vermont Hospital's Nursing, Care Management, Nutrition and Rehab/Occupational Therapy staff. This class will include a videotape presentation to walk you through the knee/hip replacement process and time for questions and answers. Offered the 1st Thursday of each month, 2-3 pm, CVMC Boardroom, free of charge. January 8 February 5 March 5 April 2 May 7 June July 2 August 6 September 3 October 1 November 5 December 3 All are welcome, no need to register. If you have questions, please call

2 PLANNING FOR YOUR RETURN HOME AFTER SURGERY One of the keys to a smooth successful joint replacement is planning ahead for your needs following surgery. One of your first and foremost needs will be rehabilitation which can come from a variety of sources. You may receive physical therapy and occupational therapy from your local Visiting Nurse Association in your home. You might choose to come to Central Vermont Hospital for outpatient therapy, or you may need a short stay at a local rehabilitation facility. In order to decide which option is best for you, you will need to answer the following questions: o 1. Do you have a spouse or family member at home able to assist you after surgery? Who? o 2. How many hours a day is someone available to help? You may need someone with you 24 hours a day for possibly a week or more. o 3. What services do you have in place prior to surgery? Example: Visiting Nurses, Meals on Wheels, Lifeline, Project Independence, Medicaid Waiver, or private duty help? o 4. Can you have meals prepared ahead of time? o 5. Do you have any special needs? Examples: hearing or vision problems. o 6. Is your home equipped for your needs following surgery? Examples: bars in the shower, raised toilet seat, Lifeline. You may talk with the Physical Therapist before surgery to get an idea of what might be needed. o 7. Have you checked what costs associated with your surgery, including any follow up needs, skilled rehabilitation and prescription coverage, are covered by your insurance? o 8. If you are going home or to someone else s home following your hospital stay, how will you get there? Transportation should be arranged before coming to the hospital. If a short term stay in a rehabilitation facility is what you choose the Care Management Department at Central Vermont Hospital is available to help with finding a facility for you. To answer questions about the rehab facility option please contact Care Management at

3 HOME SAFETY 1. Remove throw rugs (loose or slippery scatter rugs). 2. Keep electrical cords out of the walkways. 3. Beware of wet or uneven floors. 4. Install railings along stairs 5. Beware of small pets. 6. Watch for small objects on the floor. 7. Store items within easy reach, so you do not need to stretch or bend. 8. Add firm pillows to low chairs to ensure knees are below the hips. (If you are having a hip replacement) 9. Beware of furniture that may move. i.e. rocking chairs, rolling desk chairs. 10. Install grab bars in shower.

4 PHYSICAL THERAPY TOTAL HIP PROTOCOL Pre-op: Post-op: Post-op: Instructions in gait with walker, exercise program, precautions Physical Therapy treatment is twice a day while in the hospital. Day 1: Initiate exercise program, precaution teaching and transfer training. May start walking with walker with Physical Therapy. Day 2 through discharge: Continue treatment outlined in Day 1. Start walking with a walker By discharge: You should be able to get in and out of bed with minimal assistance; in and out of a chair by yourself; and walking by yourself with walker or crutches. 4 weeks: You may progress to a cane with permission of your doctor. 6 weeks: You may eliminate the pillow between legs/knees in side lying and eliminate raised toilet seat with permission of your doctor.. DO S AND DON TS FOR TOTAL HIP REPLACEMENTS Do not force hip to bend beyond 90 degrees. Do not sit in too low a chair-keep knees slightly lower than hips. Do not lean forward while sitting in a chair. Do not reach for feet to put on socks or shoes on and off. Do not cross legs: keep pillow between knees for safety. When turning in bed, TURN ON TO OPERATED HIP ONLY. Do your exercises 2-3 times a day and increase repetitions gradually to 30.

5 HIP EXERCISES 1. Ankle Pumping, 1 set of 10. Increase ROM and circulation by first pointing your foot downward, then up, in a slow steady motion. Do 1 set of Quadriceps Set, 1 set of 10. This is an isometric exercise: there is no movement involved. Tighten the quadriceps muscles by pressing the back of your knee flat, tightening the kneecap (patella). Look for a visible contraction, especially on the inside of the thigh by the knee. Hold for 5 seconds. Release. Do 1 set of Gluteal Sets, 1 set of 10. While lying down on your back, tighten your buttock muscles. Hold tightly for 5 seconds. Do 1 set of Hip Flexion, Supine, 1 set of 10. Slowly bend your hip and knee. Hold for 5 seconds, then slowly lower your leg to the starting position. Do 1 set of Hamstring Sets, 1 set of 10. This is an isometric exercise, no movement should occur. Lie or sit with your knees bent over a towel roll. Pull your heel into the mattress, tightening the muscles on the back of your thigh. Hold for 5 seconds, then relax. Do 1 set of 10.

6 HIP EXERCISES - continued 6. Terminal Knee Extension, Supine, 1 set of 10. Lie on your back with a towel roll under your knee. Straighten you knee (still supported by the roll) and hold 5 seconds. Slowly return to the starting position. Do 1 set of Hip Abduction/Adduction, Supine, 1 set of 10. Lie on your back, with your knees straight and your toes pointing upward. Slowly move your leg out to the side as far as possible, then return to the starting position. Be sure to leave yourself enough room, and do not cross the midline of your body. Do 1 set of Rotation, 1 set of 10. While lying down on your back, with knees straight, gently roll knees toward each other then away from each other. Keep several inches between legs. Do 1 set of Hip Flexor Stretch, Supine, 1 set of 5. With operated leg out straight, bring unoperated knee to chest. Hold this position for 30 seconds. Return to the starting position. Repeat 3-5 times. Do 1 set of Knee Extension, Sitting, 1 set of 10. Sit upright in a chair with a towel roll under you knee. Straighten your knee, and hold for 5 seconds. Slowly return to the starting position. Do 1 set of Sitting Push-ups, 1 set of 10. Sit on the edge of a chair. Grasp the arms of the chair with your hands and straighten elbows, lifting your buttocks off the chair seat. Hold for 5 seconds. Relax. Do 1 set of 10.

7 PHYSICAL THERAPY TOTAL KNEE PROTOCOL Pre-op: Post-op: Post-op: and motion Instructions in gait with walker, exercise program, precautions and CPM (Continuous Passive Motion Machine). Physical therapy treatment is twice a day while in the hospital. Day 1: Start exercise program, CPM, transfer training and ice pack or cryocuff to decrease pain swelling. You will sit in a chair!/2 to 2 hours as tolerated, You may begin walking. Your knee will be measured daily. Day 2 through Discharge: Continue treatment outlined in Day 1. Walk with a walker or crutches. Weight bear as tolerated. Begin moving your knee cap. By discharge you should have knee motion of at least 10 to 80 degrees; be able to lift your leg straight off the bed and be independent with transfers, walking and climbing stairs. DO S AND DON TS FOR TOTAL KNEE REPLACEMENTS help 1: Continue your exercise program 2-3 times a day and increase to 30 repetitions 2: Never put pillows under your operated knee; use a pillow lengthwise under your calf and heel to straighten your knee. 3: When you are allowed to use a cane hold it in the hand OPPOSITE the operated knee

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9 table or couch

10 OCCUPATIONAL THERAPY The purpose of Occupational Therapy is to help you achieve a higher level of safe, independent function following your surgery. An Occupational Therapist will assist you as you rehabilitate from hip or knee surgery by providing the following services: Instruct you in how to be as independent as possible while maintaining correct precautions which are to be followed during your daily activities. Provide and practice with adaptive equipment that you may require to complete activities of daily living such as bathing, dressing, toileting and household tasks. Provide you with alternatives to maximize your safety and independence during the rehabilitation process. Ensure that your upper body strength and function are optimal. Provide education regarding posture and body mechanics. CONSIDERATIONS FOLLOWING SURGERY Remove all scatter rugs. Avoid low, soft chairs. Use a chair with arm rests. Organize the kitchen so that your most frequently used items are at counter height or slightly above to avoid over-reaching or stooping. Slide objects on counters instead of trying to carry them. A walker basket or tray is useful for transporting items when using a walker. Consider purchasing a reacher for completing dressing and household activities. If you use tie shoes, consider purchasing spyrolaces (Walmart, the Dollar Store) or elastic shoe laces. This eliminates the issue of bending to tie your shoes. A long handles shoe horn is an additional help. Use grab bars, not towel bars to enable safe transfers, especially in the bathroom. Consider using a raised toilet seat or placing a commode chair over the toilet. Arrange for help with groceries and laundry tasks.

11 PATIENT CARE MAP - Total Hip or Knee Replacement This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs. PRE - ADMISSION DISCHARGE PLANS EDUCATION (PREPARING FOR SURGERY) LAST-MINUTE REMINDER TREATMENTS MEDICATIONS TESTS ACTIVITIES OF DAILY LIVING FOOD/NUTRITION FAMILY Make sure everything is ready for your return home, including transportation. Please see packet. If you have further questions, call your doctor. Do not take any aspirin or aspirin products like Motrin or Darvon or herbs including for 2 weeks before surgery as this sometimes affects blood loss. Review your medication list with your physician to determine what medications should be stopped prior to surgery. Attend orientation class for hip and knee replacement. Pre-operative visit with anesthesia and surgical services A health care provider will perform a physical examination Please tell the physical therapist if you have questions about home safety. If you become sick or have a cold, please call your surgeon. Leave all valuables and medicine at home. However, bring a list of your current medicines, how much you take, and how often you take them. Take a shower or bath before coming to the hospital. On day of admission, remember to bring shoes, special braces, razor and toiletries you use at home. Do not wear any jewelry, makeup or nail polish on day of surgery. Do not eat or drink after midnight the night before your surgery. Reviewed by nursing at orientation class. Ask the anesthesiologist if you should take any of your medications with a sip of water on the day of surgery. There are several types of pain medications available. Your anesthesiologist will talk to you about them, please let us know if a particular pain pill has worked well for you. Blood work, chest x-ray, EKG Practice using walker or crutches and any special equipment. Study your precautions (dos & don ts) for hip replacement. Practice your exercise program. Review coughing and deep breathing Nutritional supplements/snacks if needed. Refer to packet given at pre-op orientation class. Your family may attend pre-op class and any other pre-op visits with you. Care management is available to assist you and your family.

12 PATIENT CARE MAP - Total Hip or Knee Replacement This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs. DAY OF ADMISSION/SURGERY DISCHARGE PLANS CONSULTANTS EDUCATION TREATMENTS Review of coughing and deep breathing Pain control and precautions will be discussed with you. Sequential compression device (lower leg compression/squeezing machine) will be used to help prevent blood clots. You may have an ice pack. A pillow will be between your legs to keep your hip in place (hip replacement only). NO pillow under knee for knee replacements. A nurse will check on you at least every hour You may have a catheter in your bladder to drain urine. You may have oxygen, IV, PCA (patient controlled analgesia) for pain control. You will need to practice deep breathing with an incentive spirometer. MEDICATIONS TESTS ACTIVITIES OF DAILY LIVING FOOD/NUTRITION FAMILY Pain relief medications. IV antibiotics. Medication for nausea may be needed. X-rays will be taken to check your new hip and may be taken of your knee. Nurses will help you turn, cough and deep breathe and help with your personal care. Do ankle pumps for circulation. Use trapeze bar to move about your bed (optional) You may be assisted out of bed the evening of surgery You will be able to have liquids after surgery and then your regular diet when you are able. A family member is welcome to wait in the waiting room while you are in surgery / recovery.

13 DISCHARGE PLANS CONSULTANTS EDUCATION TREATMENTS MEDICATIONS TESTS ACTIVITIES OF DAILY LIVING FOOD/NUTRITION FAMILY PATIENT CARE MAP - Total Hip Or Knee Replacement This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs. DAY ONE If you have concerns about going home, please talk to your nurse or physical therapist. A care coordinator from Care Management will visit you to discuss discharge plans. Physical therapy twice a day. Occupational therapy may be in to determine if you need equipment to help wirh dressing/bathing Follow-up visit from anesthesiologist. Nutrition visit. Instruction for hip or knee precautions (do s & don ts). You may receive a blood transfusion. Continue pillow between legs (for hip replacment only). You will start using your continuous passive motion machine (CPM) for knee replacement only. Continue sequential compression device, wound drain and ice. IV fluids stop if eating/drinking well. Indwelling (urine) catheter will be removed. Continue incentive spirometer, coughing and deep breathing Pain medicine will continue. You may be started on shots and/or pills to prevent blood clots. IV antibiotics may be stopped. You will take your normal medicine. Stool softeners and medication to prevent constipation will be provided. The lab will draw blood samples everyday to check your blood count and to measure how quickly your blood clots. You will get out of bed today. It may be difficult but will improve each time and is necessary to prevent complications. Remember to cough and deep breathe on your own. Continue your exercise program. Use trapeze bar to assist in turning and getting in/out of bed. Resume your normal diet with between meal snacks. Drink plenty of liquids to prevent constipation. Your family members may discuss any concerns and potential discharge needs after discharge with nurses and care coordinator.

14 DISCHARGE PLANS EDUCATION TREATMENTS MEDICATIONS TESTS ACTIVITIES OF DAILY LIVING FOOD/NUTRITION FAMILY PATIENT CARE MAP - Total Hip Or Knee Replacement This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs. DAY TWO Continue to think of ways in which you may need help at home and discuss them with your nurse, physical therapist, or care coordinator. Finish plans for transportation home. Continue education mentioned on Day One. Nurse will review possible complications to watch for at home. Physical therapist will teach home exercise program and use of walker/crutches. Occupational therapist will instruct in and you may practice use of special equipment needed to dress and bathe. Continue sequential compression device, wound drain and ice. CPM for total knee replacement. Continue pillow between legs for hip replacements. Follow precautions (dos & don ts). Wound drain will be removed. Dressing may be changed. Continue incentive spirometer. Pain medications will continue. Continue to discuss pain control with your caregivers You may continue shots and/or oral medications to help prevent blood clots and medication to prevent constipation. Lab work as on day 1. For total knee replacement: leg x-rays. Walk to bathroom with walker/crutches with therapist or nurse. Get out of bed to chair for meals Continue to cough and deep breathe. Continue exercise program. If constipation becomes a concern please let your nurse know Continue to use trapeze. Practice lower body dressing with special equipment, if needed. Your normal diet. Nutrition education offered for those on therapeutic diets It may be helpful to have a family member attend your physical and occupational therapy seesion to help you at home.

15 DISCHARGE PLANS CONSULTANTS EDUCATION TREATMENTS MEDICATIONS TESTS ACTIVITIES OF DAILY LIVING FOOD/NUTRITION FAMILY PATIENT CARE MAP - Total Hip Or Knee Replacement This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs. DAY THREE You will be assisted in getting necessary equipment for home use. Plan on discharge today unless there is a medical reason to stay Arrangements for home care will be made, if needed. Instructions about: equipment for personal care. home exercise program. stair climbing, if ready. possible food/drug interactions wound care Continue sequential compression device as needed and ice as needed. CPM Continue pillow between legs for hip replacements. Follow precautions (do s & don ts). Your dressing (bandage) may be removed. Please ask for pain pills as needed (especially prior to therapy). You may continue shots and/or oral medications to help prevent blood clots and stool softner. Lab work. Exercise with physical therapist and on your own as instructed. Continue practicing lower body dressing techniques, if needed. Walk in hall using your walker/crutches with therapist or nurse. Continue to use trapeze. Your normal diet. Nutrition education offered for those on therapeutic diets Discharge medication list and medication instructions Signs and symptoms of wound infection and other complications and when to call your health care provider Follow up appointments with health care provider Finalize discussion of any services and care that may be needed This is a daily guide designed for the average course of treatment. Your care may vary to meet your specific health needs.

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