ANTERIOR HIP REPLACEMENT WWW.ORTHOWISCONSIN.COM

ANTERIOR HIP REPLACEMENT WWW.ORTHOWISCONSIN.COM

The Orthopaedic Surgery Center Welcome Thank you for choosing The Orthopaedic Surgery Center for your medical and surgical needs. It is our goal and privilege to get you back to your daily activities as pain free as possible. Our experienced team is fully committed to providing you with the best coordinated care when having joint replacement surgery. To achieve this, our dedicated team of professionals has planned a complete, cutting-edge approach to your evaluation, treatment, and rehabilitation needs. As you embark on a road to a better you, The Orthopaedic Surgery Center staff will be with you every step of the way. From the moment you check into our state of the art facility to your rehabilitation process, our goal is to make sure you have an exceptional experience. To achieve the best results possible, The Orthopaedic Surgery Center believes you should have information regarding your surgery at your fingertips. This guide is designed to provide you with tips, answer any questions, and give you a detailed explanation on pre and post-operative care regarding your joint replacement surgery. We look forward to joining you on the road to a better you. Throughout your journey with us, you will receive expert individualized care from our team of orthopedic surgeons, nurses, and therapists, all of whom are here to serve you before, during, and after your surgery.

The Orthopaedic Surgery Center W238 N1610 Busse Road, Waukesha, WI 53188 262.522.8888 General Information Your Road to Recovery Staff Pre-Surgical Checklist Advance Directives: Exercise Your Rights Frequently Asked Questions (FAQ s) Your Procedure Pre-Operative Planning Your 23 Hour Stay & Discharge Welcome to The Orthopaedic Surgery Center Video at www.orthowisconsin.com under The Orthopaedic Surgery Center Tab. Exercises Post-Operative Rehabilitation Exercises Rehabilitation Exercise Video at www.orthowisconsin.com under The Orthopaedic Surgery Center Tab.

Your Road to Recovery Team An excellent prepared team of Healthcare professionals will be monitoring your care before, during, and after your procedure. The Orthopaedic Surgery Center Staff has been hand selected to provide you with the best care while you are on your journey to a better you. Orthopedic Surgeon: The surgeon of your choice will be performing your surgery and managing your care. Along with his team, he will be working with the nurses and post-operative care team to ensure that you are healing properly. Primary Medical Doctor: Your primary doctor needs to be consulted after your surgery is scheduled. They will oversee any lab work and perform a physical about 2 weeks before your surgery. Anesthesiologist: The anesthesiologist is in charge of administering the anesthesia at your surgery. They will continue to monitor you and be available to work with your surgeon on any pain management that may be needed for you during surgery. Nursing Staff: The excellent nursing staff at The Orthopaedic Center of Wisconsin includes Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CNA). They will work with you to make sure that you have the best experience possible before and after your surgery. They will be frequently monitoring your comfort and progress.

Pre-Surgical Checklist We advise our patients to plan ahead by preparing your home for after your surgery. This will make your recovery easier and less stressful. Please use these suggestions as a guide in preparing your home. General Living: Remove any rugs that may be covering your floors. Move all electrical cords, magazines, pet toys, etc. from all walking areas. Arrange your furniture (please ask for assistance if unable to do so) to allow for extra walking room. Place a pillow or folded blanket on chairs that you may be using to make sitting and getting up easier. Place a comfortable chair with armrests and back support in the areas you may be sitting. Install night-lights in the hallways so that you have lit pathways throughout your home. Arrange for a family member or friend to help share the responsibilities of any pets. Bedroom: Consider relocating to a lower level bedroom if possible if your bedroom is on the second floor of your home. Clear away unnecessary items from around your bed. Arrange the clothes you wish to wear once you return home, making sure they are easy to put on. Wash your laundry and change your bed linens so they are fresh for you when you return home from your procedure. Kitchen: Purchase ice packs to have on hand that are re-freezable. Do any grocery shopping prior to your surgery so you are prepared. Consider purchasing frozen dinner or food items that are easy to prepare. Place any utensils, pots, pans, and dishes to an appropriate counter height that is easily reachable. Bathroom: Install a night-light in the bathroom for easily visibility. Place towels and washcloths in an easy to reach area. Consider installing a shower chair or stool if needed. Install a non-skid bathtub shower mat. Clear as much space as possible and remove clutter.

Pre-surgical Checklist (cont.) Outdoors: If possible have a friend or service cut your grass or shovel your snow. Check your walkway to make sure you have an unobstructed pathway to get to your front door. Use handrails where needed. Additional Suggestions: Ask a relative or friend to be available to help you with your transportation needs. This might include transportation to your doctor's appointments, errands, etc. Pre-pack a bag to take with you to The Orthopaedic Surgery Center which might include: Toothbrush and toothpaste. Deodorant. Comfortable clothing that are easy for you to put on and take off. Comfortable shoes that have non-skid bottoms. Bring all current daily medications in their original bottle they were prescribed to you by the pharmacy to the surgery center. In addition, remember to bring your Lovenox injections (blood thinner), if your physician has prescribed. The nurses will teach you how to administer these injections for your return home. Current photo ID. Insurance Cards.

Advanced Directives ~Exercise Your Rights~ You have the right to choose what health care you want to receive, but a loved one who makes decisions for you should know your wishes should you become unable to speak for yourself. Consider making your wishes known legally in a document called an "Advance Directive." Wisconsin Law recognizes the following forms as Advanced Directives: Wisconsin Declaration to Physicians (Wisconsin Living Will ): This document informs your physician and the Surgery Center that, if your condition becomes terminal and death is close at hand, or if you fall into unconsciousness with no hope of recovery, that you wish to have life support procedures withheld so that you may die naturally. This Living Will only takes effect when your personal physician and another physician determine that you meet the criteria that you have chosen. Health Care Power of Attorney: This is a legal way for you to appoint someone to speak for you and to be your health care agent. This person can make decisions on your health care should the need arise. You are giving permission for this person to work with your physicians to make the right choices for you. Again, this only takes effect when two physicians or a physician and psychologist agree in writing that you are no longer capable of making these decisions for yourself. Your physician and The Orthopaedic Surgery Center staff wants to follow your wishes regarding your health care. When you are admitted to The Orthopaedic Surgery Center, your nurse will ask you (or a family member) if you have completed one of these documents. If you have, we will ask for a copy. Since December 1, 1991, Federal Law requires that all hospitals and surgical centers provide adult patients (over the age of 18 years) with information about Advanced Directives. The law also requires that we ask all adult patients whether or not they have Advanced Directives. The law is meant to make sure that your health care wishes are honored if you are unable to make decisions for yourself. Be assured that the care you receive will not be affected by whether or not you have these Directives. However, if you refuse treatments or request those that your physician or The Orthopaedic Surgery Center feels are not in keeping with our philosophy or ethics of care, your physician will discuss options with you. If you have any questions or concerns please contact The Orthopaedic Surgery Center at: 262.522.8888

FAQ's: Frequently Asked Questions ~Anterior Hip Replacement~ Should I exercise before surgery? You can exercise only if you can do it comfortably. How long will I be in The Orthopaedic Surgery Center? You will be hospitalized overnight in one of our 23 care suites. In these suites, there is a pull out couch available if you have a guest staying with you after surgery. There are several goals you must reach before being discharged. Please see our discharge section of this handout for more information. Who will be performing the surgery? Your orthopedic surgeon will do the surgery, while an assistant is also on hand to help. Will I need to contact my insurance company prior to the surgery? The nursing staff at Orthopaedic Associates of Wisconsin will contact your insurance company to pre-authorize your surgery. It is the patient s responsibility to contact their insurance company regarding the following items: Deductibles Length of Stay Need for second opinion Need for pre-authorization Any exclusions Should I take my daily medications before coming to The Orthopaedic Surgery Center? It is very important to consult your physician at least 2 weeks prior to your procedure regarding any medications or supplements you may need to stop prior to your procedure. Will I need therapy after discharge? Yes, you may need to attend physical or occupational therapy 2-3 times per week. Please discuss this with your physician as each patient's individual situation varies. Will I have pain after my surgery? There will most likely be post-operative pain, but our staff will make every effort to keep you comfortable with appropriate medication. Please refer to the pain management portion of this guide.

FAQ's: Frequently Asked Questions ~Anterior Hip Replacement~ Will I need a walker, crutches or cane? Depending on your surgery, yes. The medical staff will determine which type of assistive device(s) you may need and will instruct you on proper fit and use. If you have these devices at home already, spend some time before surgery practicing getting around with them. Will I need help at home after surgery? Yes, for the first several days or weeks it is likely that you will need assistance. If possible, arrange for family and friends to be available. Please refer to our pre-surgical checklist included in this handout How long until I can go back to work? Please consult with your orthopedic surgeon to discuss the possible length of time you will need to be off work. The decision will depend on the type of work that you do. Remember to contact your company's Human Resources department about disability coverage and medical leave. How soon after surgery will I need to be seen by my physician following my surgery? 7 to 14 days after discharge you will be seen for your first postoperative office visit, located at Orthopaedic Associates of Wisconsin. What extracurricular activities can I participate in? Once you have fully recovered, low impact activities such as golf, tennis, swimming, biking and walking are encouraged. Please discuss this with your physician before proceeding.

Pre-Operative Planning Once you have decided upon having surgery, various members of our staff will each take part in your pre-operative planning ensuring a positive experience. You may call your orthopaedic surgeons office staff at any time prior to surgery with any questions or concerns. The Surgeon's Office Staff: Assess and plan for your specific care needs, for example anesthesia and medical clearance for surgery. The staff will assist you in getting answers to your insurance questions. Act as your liaison throughout your course of treatment. Verify any of your appointments you may need scheduled for tests or additional medical care. The Orthopaedic Surgery Center: Will contact you to obtain a health history, personal and insurance information. Assess your needs at home including caregiver availability. Coordinate pre-operative testing and scheduling if necessary. Please feel free to use this checklist to ensure that all information and tasks have been completed prior to surgery. As stated previously, if you have any questions or concerns do not hesitate to contact your orthopaedic surgeon and their support staff. Has The Orthopaedic Surgery Center phoned you? Have you completed all laboratory testing requested by your physician? Have you started your Pre-Operative exercises? Have you watched Welcome to The Orthopaedic Surgery Center Video and Post-Operative Exercise Video? Have you prepared your home for your return from The Orthopaedic Surgery Center? Have you packed a bag to take with you the day of your surgery? Do you have your post-operative appointment with your physician scheduled as well as initial physical or occupational therapy session (this will be specific to procedure).

Your 23 Hour Stay at The Orthopaedic Surgery Center Your stay at The Orthopaedic Surgery Center has been carefully planned to allow you to recover from your surgery and return home within 23 hours. In order to help ease any anxiety you may feel going into surgery, we have outlined what will occur during your stay at The Orthopaedic Surgery Center. Day of Surgery: You will check in. Soon after a pre-operative nurse will come and bring you and your family back to our private suites. Here your nurse will have you change and get you comfortable. They will then take your vitals and answer any questions you may have. Soon after your surgeon will stop in and review the procedure with you and your family. Your surgeon will then make sure all of your questions and/or concerns are answered and they will mark the surgical site with their initials. Once the physician is finished, the anesthesiologist will come in and discuss their plan of care for the procedure you are having. Next, your surgical nurse will come in and again review the procedure with you and check the surgical site for the physician s initials and answer any remaining questions you or your family may have. At this time your surgical nurse will take you back to the operating room and your family will be taken back out to the waiting area where they can enjoy the amenities we have to offer while they wait for your procedure to be completed. Once your procedure is complete you will be taken back to your private suite where our skilled nurses will be monitoring you and care for you until you are discharged. During this time your surgeon will bring your family members back to our private consultation room where they will discuss how your procedure went. After approximately 30 minutes your family members will be allowed to come back to your suite. During the afternoon and evening of the day of surgery you will be asked to stand and walk with the help of The Orthopedic Surgery Center staff. Although this may seem difficult at first it will get easier each time. This is necessary to be able to get you home the next day functioning in your home environment First Day After Surgery: Your IV will be removed and your pain medication will be administered by mouth. You will be asked to stand and take short walks. Your nurse will review post-operative exercises as motion/activity will begin right away as you work towards a quick and safe recovery. These exercises are located in this booklet as well as on video on our website at www.orthowisconsin.com under The Orthopaedic Surgery Center tab. Once our medical staff feels you are ready to go home they will review all necessary documents and you will be discharged.

Things to note as you return home from surgery: Your 23 Hour Stay at The Orthopaedic Surgery Center (cont.) A moderate amount of pain is normal. Take your pain medications as prescribed by your physician. Do NOT take aspirin, ibuprofen or other pain relievers unless specifically approved by your physician. Your appetite may be poor for a few days. Remember that pain medications can cause constipation, so it is very important that you drink 6-8 glasses of water each day. In addition, eat grains, vegetables and fruits. Your appetite will return. You may have difficulty sleeping at night. Do not sleep or nap too much during the day as this will interrupt your sleep patterns. Many people will find sleeping in a recliner is more comfortable than a bed. Your energy levels may be less in the first month, however this will improve as you decrease pain medications and your body continues to heal. Follow instructions on wound care from the nurses/physicians. If at any time you have concerns on your wound please call your physician. You may have been put on an anticoagulant (blood thinner). Medicines such as Lovenox or Aspirin to help prevent blood clots. Follow your surgeon s directions carefully. Apply ice to the incision area for 15 minutes, 4 times a day to help lessen any discomfort. DO NOT use a heating pad. Do not shower until given permission by your surgeon. Notify your surgeon if there is any increased swelling or redness at your incision site, change in the amount of drainage on your bandages, increased pain, fever over 102 degrees, nausea or night sweats. This could possibly signify infection and should be treated as soon as possible. Note: Some swelling and bruising, even down to your ankle is normal. Severe symptoms including chest pain, difficulty breathing or shortness of breath, sweating and confusion could indicate that a blood clot has traveled to your lungs (pulmonary embolism). This is an emergency medical condition. Call 911 immediately. The Physicians and Staff would like to thank you for choosing Orthopaedic Associates of Wisconsin and The Orthopaedic Surgery Center for your health care needs. We hope that we have exceeded your expectations and wish you a safe and quick Road to Recovery.

ANTERIOR HIP REPLACEMENT POST OP EXERCISES ANKLE PUMPS Perform either sitting or lying down. Pump your ankles up and down. Push your foot down towards the floor as far as you can and then pull up as far as you can. Repeat 20 times. Do with both ankles. QUAD SETS Roll up a small towel and place behind your knee. While lying down, tighten your thigh muscle while pushing your knee down into the towel. Hold for 5 seconds and release. Repeat 10-20 times. HEEL SLIDES Lie on your back. Slide heel of affected leg up towards your buttocks as far as you can. Slowly straighten leg back towards the table as you slide heel away. Repeat 10-20 times.

ANTERIOR HIP REPLACEMENT POST OP EXERCISES GLUTEAL SQUEEZE Lie on your back. Squeeze your buttocks together. Hold for 5 seconds and relax. Repeat 10-20 times. SHORT ARC QUAD (SAQ) Lie on your back. Place a rolled towel under your knee. Lift your heel up with a straight leg. Keep knee on the rolled towel. Hold for 5 seconds and relax. Repeat 10-20 times. STRAIGHT LEG RAISE Lie on your back. Bend unaffected knee, keep foot on ground. Tighten your thigh muscle (i.e. like Quad Set). Raise leg up 6-10 inches, keeping leg straight. Hold 3 seconds and slowly lower leg back to the ground while keeping thigh muscle tight. Repeat 10-20 times.

ANTERIOR HIP REPLACEMENT POST OP EXERCISES BRIDGING SITTING KNEE EXTENSION Sit on chair with back supported. Raise foot up off ground straightening leg without upper leg coming off chair. Hold 2-3 seconds and relax slowly lowering foot to ground. Repeat 10-20 times. SITTING KNEE FLEXION Lie on your back with your knee bend and feet flat on the ground. Tighten your buttocks and push through your heels raising your hips off the ground. Hold 5 seconds and slowly lower down. Repeat 10-20 times. Sit on chair with back supported. Pull foot back and under chair, bending knee as far as possible. Hold 2-3 seconds and relax slowly returning to the front. Repeat 10-20 times. If affected leg needs assistance use unaffected leg to provide gentle pressure to front of lower leg - pushing leg back while bending knee.

ANTERIOR HIP REPLACEMENT POST OP EXERCISES SINGLE LEG BALANCE Balance on your surgical leg (knee slightly bent). Standing tall, using a sturdy chair or table for balance work on balancing for 10 seconds working up to 1 minute. Repeat 2-3 times. HIP KICKS Balance on your surgical leg (knee slightly bent). Standing tall, keep your non-surgical leg straight and gently lift your leg up and to the FRONT (A), BACK (B) and SIDE (C). Use a sturdy chair or table for balance if need be. Repeat each direction 10-20 times. Repeat balancing on non-surgical leg. A B C