Joint Replacement 101. Ohio Valley Medical Center and East Ohio Regional Hospital Pre- surgical Class for Total Joint Replacements

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1 Joint Replacement 101 Ohio Valley Medical Center and East Ohio Regional Hospital Pre- surgical Class for Total Joint Replacements

2 Ohio Valley Medical Center and East Ohio Regional Hospital are both certified by the Joint Commission as Center s for Excellence in total hip and total knee replacement surgery Gold Seal of Approval

3 Agenda General information Preparing for surgery Understanding your surgery Hospital expectations Rehabilitation Recovery at home

4 Our Goal To get you back to the activities and lifestyle you are used to and to do so as quickly and safely as possible.

5 Preparing for your Surgery Make sure you have someone to help you get home from the hospital and during the first week at home. Plan Ahead Have ready- to- eat or reheatable meals ready if you do not have a full- time caregiver.

6 Preparing for your Surgery Preparing Your Home

7 Preparing for your Surgery Preparing Your Home

8 Preparing for your Surgery In the weeks leading up to your surgery Eat a healthy diet Increase your protein intake Maintain a normal glucose level

9 Preparing for your Surgery It may also be a good idea to discuss beginning a fitness program with your physician in the weeks leading up to your surgery. You will need to get your physician s approval before starting any fitness program. You may then resume your fitness program following completion of your post- surgical rehabilitation.

10 Preparing for your Surgery Surgical Clearance Must be obtained before surgery

11 Preparing for your Surgery Medication Management Please discuss your medication regimen with your doctor or pharmacist prior to your surgery Our Preoperative Nurses will let you know which medications to take on the day of surgery

12 Preparing for your Surgery Labs Blood work must be completed. Chest x- ray and EKG are required prior to surgical procedures and will be ordered by you physician

13 Preparing for your Surgery What to bring to the hospital

14 Preparing for your Surgery What NOT to bring to the hospital

15 Preparing for your Surgery Communication Notify your surgeon if there is any change in your condition (illness, injury, etc.) in the days before surgery.

16 Preparing for your Surgery The Night Before Surgery Do not eat of drink anything after midnight including water, chewing gum or mints/candy unless you are instructed to take any medications with a sip of water. You may brush your teeth or rinse your mouth as frequently as you wish, but spit and do not swallow. Please refrain from smoking, smokeless tobacco and alcohol for 24 hours prior to surgery.

17 Expectations Day of Surgery Report to the main Registration Desk in the front lobby of the hospital. You will be registered and an identification wristband will be placed on your wrist. Surgery times are subject to change and you will be notified if there has to be a change. Please do not wear contact lenses on your surgery day; you may wear your glasses.

18 Expectations Introduction to nursing staff Height and Weight Change into surgical gown Holding Room Confirmation of identity, surgery and surgical site Prepare for surgery Coordinated review of medical/surgical history

19 Expectations Anesthesia You will have the chance to meet your anesthesiologist and he or she will explain how your anesthesia will work. An antibiotic will be administered by the anesthesiologist. Medication to relax you will be given prior to going into surgery.

20 Understanding Your Surgery Total Hip Replacement Total Knee Replacement

21 Understanding Your Surgery Healthy Knee

22 Understanding Your Surgery Total Knee Replacement

23 Preparing for Surgery Total Hip Replacement

24 Preparing for Surgery Total Hip Replacement

25 Day of Surgery

26 Expectations Post Anesthesia Care Unit (PACU) You will awaken with: An oxygen mask on your face Blood pressure cuff on your arm Pulse oximeter on your finger An IV in your arm A surgical dressing covering the incision Compression stockings on your legs (TED Hose) Sequential compression device (SCD) You may have a catheter in your bladder You may have a drain from your incision You may have a nerve block in your inner thigh

27 Expectations Post Anesthesia Care Unit (PACU) You will receive pain medication and possibly some additional medications as they are needed Your family will be notified that surgery is complete and the doctor will answer any of their questions You will remain in the PACU until your vital signs are stable and you are awake (about 1 hour). At that point you will be transferred to the nursing unit.

28 Expectations Orthopedic Unit Our nursing team will: Orient you with your room and the orthopedic unit Check vital signs and circulation Assess your surgical site Help you manage your pain Manage your care to expedite recovery

29 Expectations Pain Management We want to manage your pain well so you can: Move with less difficulty Get in and out of bed Participate in therapy Rest soundly and comfortably It is YOUR RESPONSIBILITY to request pain medication. Do not wait until your pain is bad before requesting pain medication. We also use a Cryocuff, which is similar to a cold pack, to help manage pain. Cryocuff

30 Preventing Complications Coordinated Effort Our team will work hard to manage Nausea and constipation by medication And to prevent: Pneumonia Blood Clots Infection Falls Knee contracture Hip Dislocation

31 Rehabilitation Goals Get in and out of bed independently Get on and off a chair and toilet safely Walk safely with an assistive device (e.g. walker, cane) Dress yourself with minimal assistance Go up and down stairs safely Return home after surgery

32 Rehabilitation Joint Specific Goals Total Hip Replacement Posterior Approach

35 Rehabilitation Joint Specific Goals Total Hip Replacement Anterior Approach

38 Rehabilitation Total Knee Replacement NEVER put a pillow under your knee Fully straighten your knee Bend your knee to 90 degrees Joint Specific Goals

39 Rehabilitation Physical Therapy 2 times per day Occupational Therapy 1 time per day Out of bed for all meals What to Expect

40 Rehabilitation Functional Goals Moving in bed Getting in/out of bed Sitting down and Standing up from toilet or chair Walking Stair climbing Range of Motion (ROM) Strengthening Decrease pain, stiffness and swelling Physical Therapy

41 Rehabilitation Continuous Passive Motion machine (CPM)

42 Rehabilitation Getting dressed and undresses Toileting Bathing (practice) Grooming Use of adaptive Equipment Safety Occupational Therapy

43 Hospital Discharge Going Home It is our goal to get you back home within 2 to 3 days after your surgery What if you re not ready? Skilled Nursing Facility In- patient Rehab Care Manager will coordinate care

44 Recovery at Home Registered Nurse: Inspect surgical incision and change dressing Pain and medication management Ongoing physical assessment Draw blood (if needed) Available 24/7 Physical Therapist: Progress strengthening, range of motion and walking Ensure safety and mobility throughout home environment Promote safe return to community (out of home) Occupational Therapy: Home Health Progress performance of activities of daily living (e.g., getting dressed, bathing, toileting) Assess home safety

45 Recovery at Home Wound Care and Preventing Infections Keep the incision clean and dry No showering until the physician says so! Wash your hands with soap and water or use a hand sanitizer before and after changing your dressing. Check your surgical site daily for these signs of infection: Redness, tenderness, swelling in the tissue surrounding the incision Leg that is warm to the touch or persistent fever (101 degrees orally) Drainage that looks like pus or smells bad or discharge that has changed in color or odor Increased pain with both activity and at rest that is not controlled by pain medications Notify your home health nurse if you develop any of these signs Eating healthy foods will also aid in the healing of your incision

46 Recovery at Home Medications A list of the medications that you will be taking at home will be given to you prior to discharge with instructions. Continue your medications at home as prescribed by your surgeon and primary care physician. If your pain medication is not effective in relieving your pain, or you experience unpleasant side effects, do not hesitate to call your home health nurse or surgeon.

47 Recovery at Home Blood Clot Prevention If the white stockings (TEDS) are provided at discharge, wear them until your follow- up appointment with the doctor; but remove them once a day to bathe and inspect your skin for breakdown. Continue your exercises, the foot pump exercises can be done anytime and should be done often. Be mobile, do not sit for long periods of time (greater than 1-2 hours).

48 Recovery at Home Blood Clot Warning Signs Increase pain in the calf, ankle or foot Increased swelling in the calf, ankle or foot Tenderness or redness above or below the knee The area is warm to the touch Notify your home health nurse or surgeon immediately if you develop any of these signs!

49 Our Goal To get you back to the activities and lifestyle you are used to and to do so as quickly and safely as possible.

50 From all of us here at Ohio Valley Medical Center and East Ohio Regional Hospital thank you, for choosing us.

51 Ohio Valley Medical Center and East Ohio Regional Hospital Where Caring is a Way of Life!