Total Knee Replacement

Transcription

1 Total Knee Replacement 1 DOC NO OR00076 (02/09/11) ES

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3 We want you to know as much as possible about your knee surgery. This information helps explain the total knee operation, recovery, and rehabilitation. The knee is a complex, hinged joint that allows you to squat, kneel, sit and bend. Three bony parts make up the knee: The shin bone (tibia), the thigh bone (femur), and the knee cap (patella). A total knee replacement is a surgical procedure that replaces your knee with an artificial joint (prosthesis). You can only walk easily and without pain when the bones are smooth and cushioned by healthy cartilage. Fluid in the joint helps lubricate the cartilage. Strong muscles and ligaments are also needed for joint stability. Femur Articular Cartilage Tibia Fibula Normal knee joint, Diseased knee joint, showing healthy articular cartilage. showing worn cartilage. Conditions such as arthritis, old fractures, abnormal stress and aging may damage the joint and cause rough areas to develop. This creates pain and stiffness when moving the knee. This could even result in the knee giving out during normal activities. 3

4 A total knee replacement is an effective way to relieve the pain and restore movement in damaged knees. The replacement involves resurfacing the bones of the knee joint. There are three bony surfaces that can become rough and painful: the femur, tibia, and patella (knee cap). Depending on your condition, one, two, or all three of these surfaces may be replaced. The type of surgery you have depends on your age, the amount of damage to your knee, and your medical history. This surgery improves mobility and function, but does not guarantee a normal healthy knee. Femoral Component Tibial Component Artificial Knee (Prosthesis) 4

5 Getting Ready for Surgery Please refer to the exercise section of this document for a list of exercises to perform before surgery. They can help speed your recovery. Before surgery, your doctor may order: Visits with other doctors Blood and urine tests X-rays Electrocardiogram (EKG) Helpful Tips Don t bring jewelry, money, or other valuables to the hospital. Don t wear eye makeup or lipstick the day of surgery. You may wear your eyeglasses (no contact lenses) on the day of surgery. Please bring a case for them. When packing for your stay, bring a knee-length robe that opens in the front, walking shoes with low heels and slippers with non-skid soles. It is also a good idea to bring a regular set of clothes and shoes to allow you to practice dressing. Please bring a complete list of all medications that you are currently taking, including any herbal remedies. o The medication list should include the name of the medication, the dosage of the medication, how often you take the medication and why you are taking the medication. If you bring any medication from home, it must be in the original container. You may bring personal hygiene items (hairbrush, toothbrush, toothpaste, etc.) 5

6 Who Provides Your Care Listed below are members of the health care team who will guide you through surgery and rehabilitation. Nurses Monitor your condition throughout your stay Provide information and treatments needed for your recovery Organize and coordinate your care Answer questions or concerns Discharge Planners Assist with planning for your release from the hospital Answer questions about insurance coverage Provide counseling about possible lifestyle changes You can also discuss: Who can help you at home after your discharge from the hospital Discharge options, including home health care or rehabilitation center Meals-on-Wheels program Home delivery of groceries and medicines Insurance coverage Equipment needs Advance directives, such as living will and durable power of attorney Temporary disabled parking permits Referrals to other community resources Occupational Therapists (OT) Evaluate your ability to do your normal activities safely at home Teach you strategies and use of adaptive equipment to maximize your independence for self-care (i.e. dressing, bathing, toileting) Teach you strategies to assist with following your knee precautions during all daily activities, including home maintenance and community activities. Provide guidelines for home safety, transition to home, and modifying your environment for maximum independence Physical Therapy (PT) Evaluate your mobility and strength Teach you how to get out of bed, climb stairs, and get in and out of the car Teach you how to walk with crutches or walker Give you exercises to increase your strength and improve your knee s range of motion Educate you on continuous passive motion (CPM) machine controls and usage 6

7 The Day of Surgery When you arrive at the hospital, you are escorted to the surgery area to prepare for the operation. One or two family members may come with you. Your knee is scrubbed with a special soap. An IV is started in your arm. Fluid and medicines are given through the IV. The doctor who gives you anesthesia visits and answers any questions. Medicine is given to help you relax. You may feel hot, dizzy, or drowsy. This is normal. Operating rooms are cool. Heated blankets are provided for your comfort. Surgery Surgery usually lasts one to three hours, but varies with each person. While you are in surgery, your family may relax in the surgery waiting room. After surgery, you are taken to the Recovery Room for 30 to 60 minutes. The doctor informs your family about your condition. While resting in this area: Your blood pressure, breathing, and other vital signs are watched closely. Medicines for pain and nausea are available if you need them. Your family may see you once you are transferred from the Recovery Room to your room on the Surgical Unit. Care After Surgery (Surgical Unit) During the first 24 hours after the operation, a nurse checks your breathing, pulse, and blood pressure frequently, and changes your body position as needed. You are asked to move your feet and legs often to help blood flow in your legs. Staff help you get out of bed, stand, and /or take a few steps the day after surgery. Your family may help with your personal hygiene needs if desired. An ice bag is placed on your knee dressing to relieve pain and prevent swelling and bleeding. A tube (urinary catheter) may be inserted into your bladder to drain urine. It is usually removed in 2-3 days. You may need supplemental oxygen for 1 to 2 days after surgery. Breathing exercises are important in the first few days after surgery. You are asked to cough, breathe deeply, and perform other lung exercises to prevent fluid from collecting in your lungs. Gas pains and constipation are common after surgery. Increasing your physical activity, eating a high-fiber diet, and drinking plenty of fluids help prevent these problems. If you need a laxative during your hospital stay, please tell your nurse. 7

8 Pain Relief It is common to have some pain after surgery. Pain is not eliminated completely, but can be reduced to a slight to moderate level. Our goal is to make your stay and recovery as comfortable as possible. Everyone experiences pain differently. We ask you to decide what your pain goal is. We use a pain scale to help describe your pain. This helps us determine the proper type and amount of pain medicine to use. Your doctor may prescribe pain medicine given by mouth, injection through your IV, through a tube placed in your back (epidural), or a spinal medication. Pain is controlled best when you take medication before the pain becomes severe. Be sure to tell your nurse when you are having pain. It is important to stay on top of your pain. It is advised to take your pain medication early in the morning so it will be easier to get out of bed and move around. Helping Circulation Good circulation is important to promote healing. There are several things that are done to help prevent circulation problems in your legs. These may include: TED hose. You will be fitted with thigh-high support hose called TEDs. These help prevent blood clots from forming in your legs. Tell the nurse if you have any tight or burning areas beneath the hose. Blood thinning medicine may be ordered to help prevent blood clots; it may be given to you daily. Venous pumps. They have fabric booties that fit over your feet and massage them by inflating and deflating. This helps prevent blood clots. Pumping your feet up and down is an easy exercise to help increase blood flow. Recovery and Rehabilitation You begin an exercise program the day after surgery, unless otherwise ordered by your doctor. You may feel weak or dizzy at first. This is normal. There may be some pain when you first start to move. Let your therapist know if the pain is too severe. Remember to take your pain medication and stay on top of your pain. 8

9 The doctor decides how much weight you can put on your operated leg. It is important to follow these restrictions to allow proper healing of your new knee. Day 1 Blood is drawn in the early morning for testing. The nurse monitors how well your pain medicine is working, and makes adjustments as necessary. You are asked to cough and take deep breaths often to help keep your lungs clear. You will also have a machine called an Incentive Spirometer that will help you in taking those deep breaths. At least twice during the day the physical therapist teaches you how to get out of bed and helps you walk a few steps. You also learn some exercises. The case manager may visit to discuss your progress. Bed baths are given until your staples come out. Continuous Passive Motion Machine (cpm) may be started today. Day 2 Blood is drawn early in the morning for testing. The physical therapist is usually back twice today. The therapist assists with exercises and walking in your room and down the hall. The occupational therapist (OT) visits to assess current function and review precautions to follow when you use your new knee. The therapist also discusses what type of equipment might be helpful at home. If you have a urinary catheter, it is removed today. You are asked to drink plenty of fluids. This helps you urinate. Day 3 Blood is drawn early in the morning for testing. The physical therapist helps you exercise and walk. You may practice climbing stairs. Nurses monitor your progress and coordinate any discharge needs you may have. A case manager visits with you regarding your discharge needs. The occupational therapist may be back today to review use of equipment. Day 4 For many, this is the day to go home. If you are not quite ready to go home, you may be discharged to rehab or a skilled nursing facility for a short time. Blood is drawn early in the morning for testing. The physical therapist continues your exercise program and discusses ideas for making your home safer when use a walker or crutches. Some people may receive home visits by a therapist. Most people go home with prescriptions for pain pills and blood thinning medication (2-4 week supply). Your nurse discusses your discharge, including follow-up appointments and blood tests, if needed. Any questions or concerns you have about your recovery at home are answered. 9

10 Continuous Passive Motion Machine (CPM) Your doctor may order the use of a Continuous Passive Motion Machine. It keeps your knee joint in a very slow, continual motion. This increases circulation and prevents your knee from becoming stiff. The CPM is started 1 to 2 days after surgery. The amount of time you use the CPM can vary from as little as 6 hours to 23 hours a day, as determined by your doctor. You may have to sleep in the CPM. Let the nurse know if you get tired of being on your back. In the machine, your leg rests on a fleece support to prevent skin irritation and bruising. The nurse checks your upper thigh and heel often for irritated areas. Let the nurse know if the CPM burns or hurts your leg. You will take a CPM machine home when you are discharged from the hospital to be used for a length of time specified by your physician. CPM Instructions Use CPM 1-2 hours, 3 or more times a day for a total of 6 hours. Make sure that your foot is firmly against the footplate to allow for proper alignment. Place the strap around your thigh to maintain optimal positioning while the machine is in motion. Increase the flexion (bending) degrees as tolerated. It is okay to turn the machine down if it surpasses your maximum pain tolerance. Your therapist will instruct you on proper usage of the CPM controls. 10

11 Exercises Exercises are performed 3 to 4 times per day. Begin by repeating each exercise listed below 5 to 10 times; work up to 3 sets of 10. Exercises may be added to meet your individual needs. Your therapist works with you starting the day after surgery. Therapists recommend that you start these exercises 2 to 3 weeks before surgery. The two-arm exercises make it easier to learn to walk with crutches or a walker. If any exercise is painful, please stop. Do all exercises slowly in a controlled manner. Stop doing any exercise if it causes sharp pain. If you stop an exercise, tell your therapist on your next visit. Breathe normally during all exercises. DO NOT HOLD YOUR BREATH. Triceps Lie on back, knees bent. Hold arms with elbows pointing to the ceiling. Slowly straighten and bend elbows. This can be done with or without a weight (substitute a soup can for the weight if you don t have one). Chair pushup Sit straight in a chair with hands on the armrests. Straighten your arms, raising your bottom off the chair. Slowly lower yourself back to the chair. 11

12 Ankle Pumps Lying on your back, point toes up and down. Hip Abduction Straight leg raise Lying on your back, bring leg out to the side. Lying on your back, lift your leg up and down keeping the knee straight. Heel Slide Short Arc Quad Lying on your back, slide foot towards your bottom. Lying on your back, put a folded pillow under your knee and lift your foot up and down. 12

13 Quadriceps Extension Stretch Push the back of your knee into the mat and hold for 5 seconds. Hold this stretch for 5-10 minutes. Seated Extension Stretch Seated Knee Flexion Put your foot up on a stool or chair. Hold this stretch for 5-10 minutes. Sit in a chair and bend your knee by sliding your foot on the floor. Long Arc Quad Mini-squats Sit in a chair and lift your foot up and down. Hold onto the counter. Have feet shoulder width apart and bend knees. 13

14 Precautions Do not put pillows under your knees when you are lying down. Do not twist your knee when standing. Avoid sitting for prolonged periods. Guidelines 1. Follow the exercise program as instructed. 2. Do all exercises slowly in a controlled manner. 3. Stop doing any exercise if it causes sharp pain. 4. Breath normally during exercises. Do not hold your breath. 5. Walk the distance you can tolerate each day. 6. Do not become overly tired. 7. Do not strain your knee by excessive stooping and bending. Some stretching pains are normal when you exercise. 8. Always use crutches or a walker until instructed otherwise. 9. Follow your doctor s order for the amount of weight you may put on your leg. 10. Call your doctor if you notice signs of redness, swelling, or increased pain in your knee or leg. 11. When walking, move the crutches or walker first. Step forward with your operated leg while supporting yourself with your arms. Then step through with your good leg. 12. When going up stairs, remember to step up with your good leg first. When going downstairs, take your first step with your operated leg. Remember up with the good (leg), down with the bad (leg). Lying Do not put pillows directly under your knee. You may put a pillow under your foot or calf. Transfers Scoot to the edge of the bed or chair before standing. Keep your surgical leg in front of the other when getting up from a chair or bed. Push up from the chair or surface in which you are sitting and reach back before sitting down. Sitting Sit in a firm, straight-back chair with arm rests. Use caution and avoid sitting on soft chairs, rocking chairs, sofas, or stools. Avoid sitting for long periods. Change your position frequently to avoid developing stiffness in your knee. 14

15 How to go up and sown a curb or steps Square up with the curb or step Place the walker completely on the ground Put your surgical bad leg down first Put your non-surgical good leg down second Square up with the curb or step Place walker completely up on the curb or step Put your non-surgical good leg up first Put your surgical bad leg up second Hold onto the handrail Turn your walker sideways Go down with the bad leg and up with the good leg Move the walker up or down after each step 15

16 Car Transfer Move front passenger seat as far back as possible Square up with the front passenger seat Reach back for the dashboard and seat Slowly lower yourself down into the car Scoot your bottom back into the car You can bend your surgical knee Reverse to get out of the car Riding in a car DO NOT drive until your physician medically releases you to do so. Avoid long car rides. Get up and walk around every hour. Avoid cars with deep bucket seats or low seats. Sit on a pillow to raise the seat height. Walking Continue to use your walker, crutches, or cane until your physician or therapist instructs you otherwise. Wear well-fitting shoes with non-skid soles. Get up and move around every hour. Take short, frequent walks. Be careful on uneven ground or wet surfaces. Ice and Elevating Instructions Lie down several times throughout the day with the leg elevated higher than your heart (foot higher than knee, knee higher than hip) for minutes. Apply ice to affected knee for minutes while it is elevated. Do not ice more often than every 2 hours. Ice following every exercise session. 16

17 Planning Your Discharge The discharge planner meets with you to plan your discharge. Safety issues, equipment, and the physical layout of your home are discussed. Suggestions are made to make your recovery easier and safer. Several discharge options are reviewed. The final decision takes into account your doctor s recommendations, your individual needs, ability to tolerate physical activity, and insurance coverage. Portneuf Medical Center Rehab The Rehab unit is located on the PMC west campus. The staff works with you to restore strength, endurance, and skills needed to resume everyday activities. Most patients stay 4-10 days on the Rehab unit. Physical, occupational, and other therapies are part of your daily routine. Nursing care is provided 24 hours a day, encouraging patient independence. At discharge from the Rehab Unit, you may be referred for home or outpatient therapy services. Your health care team helps with necessary arrangements or equipment needs. Skilled Nursing Facility (SNF) A SNF is usually located in a nursing home or long-term care facility. It provides ongoing nursing care and rehab therapies that you need to complete your recovery. The typical length of stay is 2-3 weeks. Nurses monitor your recovery. Physical and occupational therapy are provided. The discharge planner arranges for any special equipment and/or home care you may need at discharge. Home Health Care Home health care may be ordered for those patients who are homebound but do not require intensive medical or rehabilitive care. The discharge planner discusses preferences and makes appropriate referrals. Home care nurses monitor your recovery, including pain management, home safety, and medicines. They also consider whether you need additional help with your self-care routines. A physical therapist checks your progress and helps with your exercise program. An occupational therapist is available to evaluate your home and your ability to do daily activities. The goal of home health is to help you reach a higher level of independence that is safe while your knee heals. The number of home visits varies based on individual needs. Your doctor may order additional outpatient therapy sessions after discharge from home health care if needed. 17

18 Adaptive Equipment Adaptive equipment may be necessary to create a safe home environment. Ask your therapist for more information. Adaptive dressing equipment may make dressing easier. Speak with your occupational therapist for more information. 18

19 Home Equipment At home, you may need the following equipment: Walker/crutches Tub transfer bench Toilet riser/commode chair Grab bars in bathroom and/or shower The discharge planner discusses equipment needs with you and helps make arrangements to get the necessary items. Information is provided on local loan closets, equipment companies, and insurance coverage for medical equipment. Many people borrow equipment from friends or family. Home Safety You can make your recovery safer by becoming aware of hazards in the home. We offer the following home safety tips: Move electrical cords out of the way. Remove throw rugs. Add firm pillows to low chairs Store items within easy reach Use a cart to move items Watch for small pets or objects on the floor Install rails along stairs if needed. To avoid injuring yourself, always think before you move Call your doctor if you have any of these symptoms: Temperature greater than 101 degrees Shortness of breath or chest pain Redness, swelling, or warmth at the incision Foul-smelling drainage from incision Trouble maintaining range-of-motion Extreme pain Any change in muscle weakness, numbness, tingling. Swelling, pain, or redness in lower leg, or sharp pain in your calf when you pull your toes up toward your head. Remember to wear elastic stockings and remove them twice a day for 15 to 30 minutes while resting. 19

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