Remember to bring this booklet to the hospital on the day of your surgery

Remember to bring this booklet to the hospital on the day of your surgery

Total Knee Replacement Index page BEFORE SURGERY What is a total knee replacement? 3 Why have this operation? 3 How can I get ready for this surgery? 3 Personal and Medical Information to bring to the hospital 5 Pack a hospital bag 5 Last minute preparations 6 AFTER ADMISSION What is done during the surgery? 7 Who is part of the Rehabilitation Team? 8 What to expect during the hospital stay 9 Pain Management 10 Discharge Goals 10 Getting Ready for discharge 10 Discharge Status (sheet) 11 Follow up therapy? AFTER DISCHARGE Care of the incision 12 Helpful Hints 13 About Home Exercises 14 Exercises for Movement 16 Exercises for Strength 16 Walking 16 Frequently asked Questions 17 2

BEFORE SURGERY What is a total knee replacement? It is an operation in which the problem knee joint is removed and an artificial joint (called a prosthesis) is inserted. Why have this operation? To stop or reduce knee pain To improve walking ability To increase leg strength over time (because you will be able to use your leg more) To improve your ability to do daily tasks To improve ease of movement Because other treatments have not worked How can I get ready for this surgery? If you smoke, cut down or quit If you drink, don t have any alcohol for at least 48 hours before surgery Be sure that you are aware of any medication that you should take the morning before the surgery, and that your Doctor knows of any regular medication that you are already taking. Narcotics and other drugs can have an affect on surgery If you cook, consider freezing meals ahead, or stock up on ready made foods Remove any throw rugs that you might trip on. Look for any other obstacles that might hinder easy movement in your home. Tape down electrical cords, and remove any clutter 3

Install night lights in your bedroom and hallways Keep a flashlight handy in your bedroom Consider the items you use regularly in your kitchen and home in general. Make sure they are within easy reach, (between the waist and shoulder level) If you sleep upstairs arrange things so that you only have to go up once a day Arrange for someone to take you home Consider arranging for someone to help you with day-to-day activities for the first few days at home If you know someone who has had the surgery, talk to them Equipment that may be needed at home after surgery: 1. Walker or crutches (Label your own equipment if bringing it to the hospital.) 2. Raised toilet seat* 3. Reacher* 4. Long handled shoe horn* 5. Bath aides* 6. Sock aid* *used to avoid too much knee bending after the surgery PLEASE NOTE: Except for crutches or walker, we do not encourage patients to bring their personal equipment to the hospital 4

Personal and Medical Information to bring to the hospital 1. Prepare a list of all the doctors you currently see and your reasons for seeing them 2. List your medical conditions and all previous operations 3. List all current medications, including vitamin and mineral supplements, ointments, and any over the counter drugs 4. List any allergies or adverse reactions you have had to drugs, food or anesthesia in the past 5. Note any dietary restrictions 6. Bring a copy of any legal arrangements you ve made, such as a living will, advanced directives, or power of attorney Pack a hospital bag Comfortable, low heeled walking shoes with non-skid soles or running shoes (Do not use sandals, open heeled shoes, or slippers) Knee length robe Underwear and shorts T-shirt or shirt Any medications that you would regularly take Copies of your OHIP insurance card, and, if you have them, any medical directives Personal items such as hair brush, toothbrush, toothpaste, razor, deodorant, denture case, eyeglass case, contact lens case Something to read Leave your cash, credit cards, and jewelry at home 5

Last minute preparations Use the following checklist: Take a shower or bath the night before surgery. It helps prevent infection. Do not shave the area of the surgery. If this is needed, the doctor or nurse will take care of it. Do not wear any makeup, lipstick or nail polish. Do not eat or drink anything after midnight the night before surgery. This will help prevent any nausea from the anesthetic Have your hospital bag ready. 6

AFTER ADMISSION What is done during the surgery? You will have an IV (intravenous) started and will be taken to the operating room. You will be given anesthesia. Depending on the kind best suited to you, you will either be asleep for the surgery or will be numb from the waist down. An incision will be made along the side or front of your knee, and the damaged parts of your knee will be removed. They will be replaced with the new knee components (prosthesis.) A tube, (called a drain,) may be put in to help drain any fluid or blood from the new joint. The incision will be closed up with either staples or stitches. You may need a blood transfusion during the operation. After surgery you will be taken to the recovery room. Your condition will be watched carefully, and you will be given pain medication. You will then be returned to your room. 7

Who is part of the Rehabilitation Team? You: Your strength, mobility, and independence can only be successfully regained if you are an active participant in your postoperative rehabilitation program. Orthopaedic surgeon: Performs the surgery, facilitates treatment planning, checks your progress and provides follow-up care. Nurse: Monitors your progress as you recover, provides your medication, and provides information regarding your recovery. Physiotherapist: Designs a therapeutic exercise program that includes leg exercises, walking and climbing stairs. Occupational Therapist: Teaches you the skills of daily living that you need to manage when you return home. Social Worker / Discharge Planner: Reviews community supports at home and any alternative discharge arrangements 8

What to expect during the hospital stay During your stay in hospital you will learn how to gradually resume your everyday self-care activities. You may need to have a small catheter put in your bladder if you have trouble urinating. The goal is to be ready for discharge in 6 days. The team will also assist you regarding pain management. About Pain Management: The experience of pain is different for everyone. Nursing staff and physicians will be working with you to control discomfort in order to allow you to practice your exercises and resume activity again. The doctor will prescribe medication for you to take as needed for discomfort. Your input is very important. Nursing staff will be asking you to rate your pain on a scale of 0-5. Your pain will be rated prior to administration of the pain medication and within 1 hour after pain medication has been administered. This is done to evaluate the effectiveness of the pain medication. A 0 would be no pain and a 5 would be the worst pain you have ever experienced. Rating your pain helps staff to determine if the medication is working well for you. Make a point of taking your pain medication before your physiotherapy sessions and evaluating your pain before physical activities such as transfers from bed to chair. 9

Good pain control is important for your recovery. Here is what the pain scale looks like. Developed by Windsor Essex County Palliative Care Committee Faces provided by Palliative Pain Research Team St. Joseph s Health Centre, Sarnia, On. Face 0 - No Pain: content, pleasant, calm Face 1 - Mild Pain: If unable to verbalize client/caregiver to choose Face that best reflects pain Discharge Goals: Get in and out of bed independently Walk independently using crutches or walker for support Able to bend knee to 90 degrees by yourself Walk up and down stairs Able to modify activities of daily living Getting Ready for discharge If in-home services (nursing, homemaker, or physiotherapist,) are required, a Coordinator from CCAC (Community Care Access Center,) will visit you near the end of your stay in hospital to discuss these arrangements. Arrangements will be made for equipment to either be picked up (by a friend or family member) or delivered to your home. Follow up therapy? Your Physiotherapist in the hospital will arrange for Outpatient Physiotherapy or Home Care Physiotherapy (Arranged through CCAC) 10

Discharge Status Report Please share the following information with your Physiotherapist. It will tell them how you were doing at the end of your time in Hospital. Range of Motion Strength Ambulation (walking) You may put weight through your affected leg. Stairs Other Physiotherapist Signature: Physiotherapist Name: (Please Print) 11

AFTER DISCHARGE Care of the incision Keep the area clean and dry Help the healing process by eating a well balanced diet including foods high in protein and vitamins Drink fluids, (about 6-8 glasses per day) Watch for signs of infection like: 1. increasing pain 2. increasing swelling, redness, or warmth 3. foul drainage from the incision IF THERE ARE SIGNS OF INFECTION OR IF THE INCISION BEGINS TO OPEN, SEEK MEDICAL ATTENTION IMMEDIATELY AS ANOTHER PRECAUTION, YOU SHOULD BE PRESCRIBED ANTIBIOTICS BY YOUR DENTIST PRIOR TO HAVING DENTAL WORK DONE, IN ORDER TO AVOID KNEE JOINT INFECTION. 12

Helpful Hints Avoid forced knee movements like squatting. ie Use a mop to scrub the floor instead of going on your knees Take small steps to turn instead of pivoting on one leg Sit on a chair with armrests and avoid low or soft couches, which require too much knee bend. Do not carry items while using a walker or crutches. Use pockets, a knapsack or attach a pouch to the walker. Dressing: 1. Put clothing on the operated side first, using assistive devices if needed. 2. When undressing, complete the non-operated side first. Tub/toilet use: 1. A raised toilet seat may be more comfortable when you are first home, and a tub bench or chair may increase safety. Getting In and Out of a car: The ideal spot for you during a car ride is in the front seat, passenger side. Regular, larger vehicles are better than sports cars. Do keep in mind that vans are roomy, but may require the use of a step stool, so you do not bend too much at the knees. Make sure that you go slowly and move in several small steps instead of just one. 1. Make sure the front seat of the car is pushed all the way back. 2. Use a cushion or pillow to raise the seat height up initially for comfort 3. The car should be parked at least 2 feet from the curb. 4. Back up to the car with the walker 13

5. Lower yourself slowly to the seat; move your legs into the car slowly, one at a time 6. Reverse the process to get out of the car Climbing Stairs: 1. Go up steps, leading with the non-operated leg first, followed by the operated leg 2. Go down steps, leading with the operated leg followed by the non-operated leg About Home Exercises When you continue to walk frequently and exercise, you will ensure the best possible outcome after your total knee replacement. Walking distance and exercise tolerance should increase Flexibility and strength should gradually improve Exercises should become easier with practice Pain should slowly subside Discontinue exercises and consult your physiotherapist if you notice: Increased difficulty walking Increased difficulty doing exercises Physiotherapist name Phone number: 254-5577, extension 52260 14

WINDSOR REGIONAL HOSPITAL EXERCISE PROGRAM AFTER TOTAL KNEE REPLACEMENT Your Physiotherapist will teach you the program, beginning in the hospital. You will continue it at home. Exercises should be performed times each, and times daily. Before and after each session apply ice to your knee for 15 minutes. Applying ICE Use either crushed ice (placed in a damp towel), or a bag of frozen vegetables and place over the knee. During this time your knee should be supported and elevated to allow the swelling to drain away. Precautions: If stitches are still in place, do not wet the incision. Use a plastic wrap like saran wrap over the dressing. Do not allow ice to come in direct contact with your skin, as it may cause a burn. 15

Exercises for Movement 1) Lying on your back, slide the heel of you leg up the bed, bringing the knee up toward your chest. Bend the knee as far as you can tolerate. 2) Sitting on the side of bed, or in a chair, bend your knee as far as you can, then place unaffected leg over the affected leg and gently push down. Exercises for Strength 1) Lying on your back, press the back of your knee into the bed, tightening the muscle on the front of your thigh. Hold 5 seconds, relax and repeat. 2) Lying on your back, place a rolled towel under the knee. Raise your heel off the bed as far as you can and straighten your leg resting on the roll. Hold 5 seconds, relax slowly and repeat. 3) Lying on your back, keeping the knee straight, pull foot up, tighten muscle lifting the leg off the bed approximately 12 inches. Hold 5 seconds, relax and repeat. Walking Continue to use crutches or walker until your physician or physiotherapist advises you otherwise. 16

FAQs (Frequently asked questions) 1. When can I drive? >Avoid driving until after your follow-up appointment with your doctor >Drive only when instructed by your doctor 2. How much weight can I put on my surgical leg? >You may continue to put weight through your leg. After discharge your Physiotherapist will tell you when you are able to increase your weight bearing. 3. When can I return to work? Most people are able to return to their work in approximately 3-5 months unless otherwise instructed by their physician 4. Can I travel by plane in the future? Yes, once you can get around more easily. Keep in mind, your new joint will result in beeping as you go through customs. HERE ARE MY OWN QUESTIONS TO ASK: 1. 2. 3. 17