joint brochure revised 7 2016 1 - Home Page | Pain is relieved, deformity corrected, and patients...

Welcome

NMMC Joint Replacement Center

Introduction

Welcome to “Charting Your Course to Wellness,” a comprehensive patient guide to assist you in preparing foryour joint replacement surgery.

The thought of undergoing surgery can be unsettling. Most of us actually share concerns related to surgery. As your health care team, we want to assure you that the process of surgery is not one that you face alone. In fact, you are now a member of a team that includes your family, doctors, nurses and other health care professionals. Together, we will work toward one common goal: improving the quality of your life throughincreased mobility.

When you turn to the first section of this guide, you take the first step in your Course to Wellness. It is acourse comprised of multiple steps that begins weeks before your surgery and continues well beyond yourrecovery. With your active participation, and our support, you should find this course surprisingly smooth. And remember, your health care team is here to assist you every step of the way.

Sincerely,

Your Health Care TeamNMMC Joint Replacement Center

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joint brochure revised 7 2016_1 7/26/2016 8:20 AM

Our Mission

The Mission of NMMC’s Joint Replacement Center

To improve the health and well-being of our patients by providing compassionate, quality care

through our comprehensive Joint Replacement Center.

NMMC is a 2006 and 2012 recipient of the prestigious Malcolm BaldrigeNational Quality Award for innovative practices, commitment to excellenceand outstanding results.

At North Mississippi Medical Center our patients are our No. 1 priority. We view the delivery of quality health care as our primary goal.

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Charting Your Course to Wellness


Table of Contents


About the Joint Replacement Center ......................................................................................5

Your Health Care Team ............................................................................................................6

Understanding Your Surgery ....................................................................................................7

Preparing for Surgery..............................................................................................................11

Your Surgery ............................................................................................................................24

Joint Replacement Center Stay ..............................................................................................28

Discharge Plan ........................................................................................................................34

Recovering at Home ................................................................................................................36

Living with Your Joint Replacement ......................................................................................43

Exercises ..................................................................................................................................46

Exercise Log ............................................................................................................................49

Commonly Asked Questions ................................................................................................51

Common Complaints After Joint Replacement Surgery ......................................................52

Phone Numbers and Directions ............................................................................................53

NMMC’s Hospital Directions..................................................................................................54

NMMC’s Entrance and Parking Directions ............................................................................56

United Blood Services Map ..................................................................................................57

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Acknowledgments

Acknowledgments

The NMMC Joint Replacement Center would like to acknowledge the following for theirassistance with this project:

• Joint Replacement Center at Bon Secours St. Mary’s Hospital for all their gracious support and encouragement

• Sundown Studio, Bruce Bigelow

• Orthopaedic Advantage, Marcia Friesen

• Joint Replacement Center Implementation Team

• NMMC Orthopedic Surgeons

• NMMC Marketing Department

© 2007 North Mississippi Medical Center Joint Replacement CenterRevised July 2016

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About Us


About The Joint Replacement Center...

We are pleased that you have selected the NMMC Joint

Replacement Center for your surgery. In selecting our

Center you have chosen a facility that…

• Successfully performs about 1,000 joint replacements per year.

• Features a special unit dedicated to the care of hip and knee replacement patients.

• Has a unique, innovative approach to treatment and patient education that centers on family involvement and group interaction.

• Is part of a 650-bed regional referral center that holds the distinction of being the largest hospital in Mississippi and the largest non-metropolitan hospital in America. The medical center serves more than 650,000 people in 24 counties in north Mississippi, northwest Alabama and portions of Tennessee.

• Was the only health care organization to receive the Malcolm Baldrige National Quality Award in 2006 and 2012, because of its innovative practices, commitment to excellence and outstanding results. This organization is among America’s best and is considered by many as a role model for any organization striving for world-class performance.

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Your Health Care Team

Your Health Care Team

We take a team approach to your health care at the NMMC Joint Replacement Center.

Members of your health care team include:

• Orthopaedic Surgeon: Your orthopaedist is the surgeon who performs the actu al joint replacement surgery.

• Anesthesiologist: Your anesthesiologist administers and oversees administration of anesthesia during your surgery. He or she also oversees pain control while you are in the Post-Anesthesia Care Unit (PACU) recovery area.

• Primary Care Physician: Your primary care physician, or family practitioner, takes care of your general health.

• Nurse: Before, during and after your Joint Replacement Center stay, you will meet a number of nurses who perform different jobs. Nurses are among the most visible health care professionals in the hospital.

• Physical Therapist: Your physical therapist will assist you in regaining strength and motion in your new joint.

• Occupational Therapist: Your occupational therapist will teach you how to perform the activities of daily living, such as dressing and bathing after your surgery.

• Dietitian: A dietitian will help you meet your dietary needs while in the hospital.

• Hospital Chaplain: The hospital chaplains at NMMC are available to meet your spiritual needs and those of your family, regardless of religious denomination.

• Discharge Planning: Your discharge planner is in charge of coordinating your hospital discharge.

• Coach: Your coach is a spouse, family member or friend that you designate to help you through your recovery. Your coach’s role is to provide you support and encouragement. We request your coach’s presenceat the daily exercise classes after surgery.

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Understanding Your Surgery


What Are the Causes of Serious Hip and Knee Problems?

Problems with major joints like the hip and knee are most frequently the result of arthritis.

• Osteoarthritis is the most common form of arthritis. It is most often related to wear and tear that has been placed on the joints over the years. Its onset is usually after age 50. Factors that predispose this condition include family history, obesity, previous surgery to the joint or previous fractures in the area of the joint.

• Rheumatoid arthritis is one of the more common kinds of inflammatory arthritis. It is a chronic inflammatorydisorder affecting the joints of the body which are lined with a membrane called synovium. These joints include the hip, knee, shoulder, elbow, wrist, hands and feet. Rheumatoid arthritis is likely autoimmune in origin, which means the body produces cells that irritate the synovium in the joint leading to destruction of the cartilage. This form of arthritis may occur in any age group. It is characterized by stiffness, joint swelling, laxity of the ligaments, pain, and decreased range of motion.

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A damaged hip A good hip

A damaged knee A good knee



What is Total Knee Replacement Surgery?

The knee joint is composed of three parts: the end of the femur (thigh bone), the top of the tibia (shin bone),and the patella (knee cap). In a normal knee, these three bones are covered with a smooth cartilage that cush-ions the bones and enables them to move easily. In the arthritic knee, the cartilage layers are destroyed resultingin bone rubbing against bone, which causes pain, muscle weakness and limited motion. Total knee replacementsurgery involves the resurfacing of the knee joint. Metal components are attached to the ends of the bones anda plastic liner is inserted between them. The knee cap is resurfaced with a plastic liner, or sometimes replaced.When in place, these components move together to allow normal motion of the knee joint. Bow leg or knockknee deformity can usually be corrected by the new alignment.

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Damaged knee Knee implants Knee preparedfor implants

Completed totalknee replacement




What is Total Hip Replacement Surgery?

Your hip joint is composed of two parts: the round head of the femur (the ball) and the acetabulum (the cup orsocket in your pelvis). In a normal hip joint these two bones are coated with smooth articular cartilage thatallows them to move against each other without friction or pain. In an arthritic hip, the cartilage layers aredestroyed, and bone rubs against bone causing pain and limiting motion.

Hip replacement surgery replaces your arthritic hip joint with an artificial joint composed of a ball componentand a socket component. The metal ball is attached to a stem that fits into your thighbone. This component canbe cemented or non-cemented depending on your age and the condition of your bone. A socket with an outermetal socket is secured into your pelvis. A combination of a cemented ball and a non-cemented socket also maybe used. Your orthopaedic surgeon will choose the type of prosthesis that best meets your individual needs.Once in place, the artificial ball and socket function in essentially the same manner as your natural hip.

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Damaged hip Hip implants Hip preparedfor implants

Completed hipreplacement



Risks of Joint Replacement Surgery

Joint replacement is considered to be major surgery. It is important that you are aware of potential risks andcomplications. These include problems from anesthesia, infection, surgical bleeding, blood clots, damage tonerves or blood vessels, dislocation of the hip replacement, a loose component of the implant, and very rarely,death. Although these complications are rare, they are possible. Every precaution is taken by your health careteam to avoid these complications. You, as the patient, will also take part in efforts to prevent any complicationsafter surgery.

What Results Can You Expect from a Joint Replacement?

Generally, total joint replacement is successful. Pain is relieved, deformity corrected, and patients resume formeractivities and enjoy an active lifestyle. Long-term success rates vary from 10 to 20 years, depending on age,weight and activity level. Adjustments in leg length may be needed during the joint replacement surgery.

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Preparing For Surgery


Steps in Preparing for Surgery

1. Blood donation• Autologous (“your own blood”)

2. Physical exam by medical doctor or health practitioner (if ordered)

3. Dental exam (if you have not had one in the past year)

4. Designation of your coach

5. Pre-Anesthesia Admissions Testing (PAAT)

6. Pre-operative classes• Class preparations• Exercise

7. Diet and nutrition• Healthy eating• Iron and vitamin supplements

8. Medications before surgery• Other medication notes

9. Preventing infections• Cleansing skin

10. Discharge planning• Outpatient therapy services• Home Health services• Rehabilitation facilities• Equipment needed for home• Transportation needs

11. Making your home a safe environment• Meal planning• Accident proofing• Help at home

12. Packing for the Joint Replacement Center

13. Countdown to surgery checklist

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1. Blood Donation

During or after total hip or knee replacement surgery, you may need a blood transfusion. NMMC stocks bloodand blood products from United Blood Services and has them available for you should you need them.However, as an alternative, your surgeon may choose to have you donate your own blood (this is called anautologous blood donation).

The Autologous DonationShould your surgeon ask you to donate your own blood for later use, you may be asked to do one or more ofthe following:

• Schedule an appointment with United Blood Services, if it has not already been scheduled by your surgeon’s office.

• Eat foods that are rich in iron such as lean meats, liver, spinach, raisins, carrots, turnip greens and whole wheat bread. (See section on Diet and Nutrition, page 16)

• Drink plenty of fluids prior to and following donation.

• Have a family member or friend drive you to and from the blood bank.

Call United Blood Services at (662) 842-8871 if you have any further questions regarding blood donation.See Appendix, Area Maps on page 57 for location.

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2. Possible Physical Exam by Medical Doctor

3. Dental Exam

4. Your “Coach”

5. Pre-Anesthesia Admissions Testing (PAAT)

Before undergoing surgery, you may need to be evaluated by your primary care physician or at the time of Pre-Anesthesia Admission Testing to assess your overall health and identify medical conditions that may interferewith your surgery or recovery.

Although infections after joint replacement are not common, an infection can occur if bacteria enter the blood-stream. Therefore, dental procedures such as extractions and periodontal work should be completed at leastfour weeks before your joint replacement surgery.

Schedule a dental check-up at least four weeks before your surgery if you haven’t had one within the last year. Continue to brush and floss your teeth regularly.

Your family has a very important role in your recovery. Identify a family member or friend who can support andencourage you through recovery and rehabilitation. We strongly encourage you to bring your coach to yourpreoperative education class.

This is usually on the day that you attend your pre-operative education class (either before or after class). You will be registered in our computer system and interviewed by a nurse about your medical/surgical history, medications and allergies. Based on your medical history and lab work, other diagnostic tests may be orderedby your physician.

Bring these to your PAAT appointment:

• All bottles of medications you currently take, including dosages.• A list of food or medicine allergies.• A list of previous surgeries, including dates and information on any previous problems with anesthesia.• A copy of your Living Will or Advance Medical Directive if you have one.

Your nose may be swabbed to test for MRSA (methicillin-resistant staphylococcus aureus), a type of bacteriathat is resistant to some common antibiotics and can cause infection. These bacteria normally live on the skinor in the nose. Staph on the surface of the skin does not cause problems. However, if it enters the body througha cut or break in the skin, an infection can occur. If you test positive for carrying MRSA, additional measureswill be taken to prevent surgical infection.

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6. Your Pre-Operative Education ClassIt is important that you are prepared for your surgery and recovery. Your orthopaedic surgeon would like you toattend our pre- operative class, which will enable you to plan for and participate in your care. The educationprovided in class will move you toward more positive outcomes. Your surgeon’s office will schedule your classdate. Be sure to bring your coach to your pre-operative education class.

Class Preparation

To make sure you are prepared for class, you will need to bring:

• This patient guide.

• Your coach, a family member or caregiver who will be assisting you at home after surgery.

• Pen for note-taking.

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Exercise is key to your recovery!

If your physician orders a physical therapy visit in your home prior to or after surgery, please be flexible in scheduling this appointment. The physical therapistwill perform a safety assessment in your home, discuss exercises, etc. You may wantto have your coach or caregiver present during the visit.

One of the goals of therapy is to introduce you and your coach to your exercise program. Your exercise program begins before surgery and continues throughoutyour Joint Replacement Center stay and recovery period. It is normal to experiencesome muscle soreness with exercises.

Illustrations of all your exercises are included in the back of the patient guide onthe pages labeled “Exercises.”

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Pre-OperativeExercises

Perform two to threesets of 10 repetitions

two to three timesa day.

See exercises section.



7. Diet and Nutrition

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Healthy Eating

Good nutrition is an important factor in healing. Eating well and maintaining a healthy weight also helps eliminate unwanted stress to your joints and may reduce the risk of heart disease, high blood pressure, diabetesand cancer. To achieve good nutrition, we recommend a balanced diet of a variety of foods each day from theillustration below.

Drink more liquids four to five days before surgery to prevent dehydration, unless your fluid intake is limited byother medical conditions.

After surgery, you will return to your regular diet unless ordered otherwise by your physician. Eating 5-6 smallmeals each day may help with poor appetite.




7. Diet and Nutrition

Iron and Vitamin Supplements

Iron is an essential mineral that plays an important role in a variety of body functions. Iron carries oxygen andcarbon dioxide within your red blood cells to other body tissues. It is also necessary for the production of energy and in the support of your immune system.

If your doctor orders an iron supplement:

• Take your iron supplement with food or a snack.

• Add foods to your diet that are rich in iron, such as lean meat, poultry, fish, greens, dried fruit and iron-enriched cereals.

• Include Vitamin C-rich foods such as strawberries, orange juice, cantaloupe, green peppers, tomatoes and potatoes with each meal. These foods help the body absorb iron.

• Refrain from drinking coffee and tea with meals as they hinder the absorption of iron. Instead, drink these beverages between meals.

• If you use calcium or zinc supplements, take them separately from your iron supplement.

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8. Medications Before Surgery

To decrease the risk of blood loss during surgery, you may be asked to stop taking medicines that contain aspirin, anti-inflammatories, blood thinners andarthritis medications five days before surgery. A discussion with your physicianmay be necessary to determine whether some blood thinners will be stoppedprior to surgery. This depends on your past history (ex: blood clots).

NOTE: You may take Extra-Strength Tylenol for pain (if you are not allergic).If the Tylenol does not relieve your pain, call your surgeon.

Other Medication Notes

• If you currently take Coumadin for another health condition, please check with your physician about whether you need to stop taking this medication before your surgery.

• On the morning of your surgery, take only the medicines you have been instructed to take. You may take these with a small sip of water.

Additional health tips for the weeks before your surgery

• Stop smoking and chewing tobacco. Smoking increases your risk of lung complications during and after surgery. Stopping smoking will improve your healing. If you are interested in an NMMC class on smoking cessation, please call (662) 377-3000 and ask to set up a smoking cessation appointment/class.

• Limit alcohol. Restrict your alcohol intake starting about five to seven daysprior to surgery. After surgery, check with your doctor before resuming alcohol intake.

• You should not have anything to eat or drink after midnight on the night before your surgery.

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Five days prior tosurgery, stop

taking aspirin, anti-inflammatories

and arthritis medications(Motrin, Advil etc…)

if ordered byyour physician.

Take Coumadin at5 p.m. the day

before your surgery,if ordered by

your physician.


You should not have anything to eat or

drink after midnighton the night before

your surgery.




9. Preventing Infections

Infections can enter the body through various pathways, but most commonly through the

mouth and the skin.

Cleansing Your Skin

• Two weeks before your surgery: Shower or bathe daily with an antibacterial soap to decrease bacteria on your skin.

• The evening before your surgery: Wash your knee or hip twice for approximately two minutes each time. Make sure to rinse the soap off your skin.

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Wash your knee or hipwith antibacterial soap

two times onthe evening priorto your surgery.



10. Discharge Planning

Our goal is to allow you to recover at home safely and comfortably.

Equipment You May Need for Home

• Walker with wheels. We prefer that you use one that does not have a seat. (See below for examples)• Bedside commode or elevated toilet seat with arms. This is often necessary for patients with posterior

hip replacement or bilateral knee replacement. It is optional for anterior hip replacement or single knee replacement.

• Shower chair or bench. • Hip Kit will be necessary for posterior hip replacement

These items are optional and usually not paid for by insurance companies.

To obtain this equipment:

• Our discharge planner will order a walker for you while you are in the Joint Replacement Center.• Purchase commode seats, shower chairs or assistive devices from a medical supply store or local

pharmacy.

This equipment is rarely paid for by your insurance company.

Transportation NeedsYou will need to have a friend or family member pick you up from the Joint Replacement Center on the day you are discharged.

If you require additional help or services, our discharge planner will assist you while in the Joint ReplacementCenter. Our Discharge Planning Department can be reached by calling (662) 377-3158.

See Discharge Plan tab for information on outpatient therapy, Home Health and rehabilitation facilities.

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11. Making Your Home a Safe Environment

Meal Planning• Prepare and freeze or purchase small portion meals for times you may be alone.

Accident Proofing Your Home• Remove scatter/throw rugs from around the house. These can cause a fall.• Make sure stairways are secure and have hand railings.• Tuck away long phone and lamp cords. Use a hand-held portable phone, if you have one. • Arrange furniture so that you can easily move about your house with a walker.• A hand-held shower nozzle, non-skid tub mats and grab bars for the tub or shower may help prevent

falls.• If needed, arrange a place for pets that may run “under foot.”• Designate a chair from your home with a back, a firm seat cushion and arms as “your chair” after you

return home. DO NOT use chairs with wheels.• If possible, prepare a sleeping area downstairs for the first week or two at home.

Help at HomeIt is a good idea to have your coach or family member help you the first few days at home.

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Tubbench

Bathroom should beaccessible for

a walker

You may need a grab bar near toilet and shower

Prepare adownstairs bedroom

Handrail forstairway

Clear pathways andbe alert for pets

Remove rugsand electrical cords



12. Packing for the Joint Replacement Center

You will be admitted to the Joint Replacement Center after your surgery. Hospital gowns are not worn, so besure to bring enough comfortable clothing for two to four days.

Items to include in your bag are:

■■ Comfortable clothing such as loose fitting T-shirts or blouses, elastic waist gym shorts or lounge wear. If you normally wear dresses or skirts, please bring shorts to wear underneath.

■■ Tennis shoes or flat rubber sole shoes with closed in heel (no backless shoes, please)■■ Personal hygiene toiletries■■ Eyeglass, contact lens and denture cases■■ Hearing aids with batteries, ear drops, eye drops, nasal sprays or inhalers

Also bring:

■■ Your CPAP machine, equipment and supplies (if used)■■ Blood donation card (if your physician has asked you to donate blood)■■ Current medication list with dosages■■ Information on any allergies to food or medicines■■ Living Will/Advanced Medical Directive■■ A copy of your insurance cards■■ This patient guide■■ Family members who chose to stay with the patient should bring a sweater or jogging outfit. The patient’s

room temperature may be kept lower than at home.

Additionally:

■■ Do not bring jewelry, credit cards or large sums of cash■■ Label your things with your name.

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13. Countdown to Surgery Checklist

4 weeks■■ Schedule your blood donation Date: ___________■■ Schedule your pre-operative physical exam by your medical doctor Date: ___________■■ Have a dental exam more than four weeks before surgery Date: ___________■■ Select coach to assist you through the entire process

2 weeks■■ Begin showering daily with antibacterial soap ■■ Attend pre-operative education class and complete your

pre-admissions testing Date: ___________■■ Start pre-operative exercise program at home■■ Begin preparing your home for your return

5 days■■ Stop taking arthritis medications and aspirin

(Discuss with physician) Date: ___________■■ Stop alcohol intake and tobacco use■■ Don’t shave or wax legs from this point until after

discharge from the Joint Replacement Center

Day before surgery■■ Take Coumadin at 5 p.m. (if prescribed)■■ Wash your knee or hip with antibacterial soap

two times on the evening prior to your surgery■■ Pack for the Joint Replacement Center■■ Avoid eating and drinking after midnight

Day of surgery Date: _____________■■ Take medications with a small sip of water

(Only the ones you have been instructed to take)■■ Report to the hospital’s Short Stay Surgery Holding area on

the 2nd floor of NMMC’s East Tower Time:_____________

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Your Surgery

After weeks of preparation, you are ready for surgery. This section includes the following

material related to your day of surgery:

1. Day of surgery

• Before leaving for the hospital

• Reporting to the hospital

2. Before surgery

• Short Stay Surgery Holding

• Anesthesia

3. Your surgery

• Going into surgery

• The Post-Anesthesia Care Unit (PACU) recovery area

Your Surgery24


1. Day of SurgeryBefore leaving for the hospital:

• You may shower.

• Brush your teeth, but do not swallow the water.

• Take medications as instructed with a small sip of water as soon as you get up.

• You may wear your wedding band if it cannot be removed.

• Avoid using perfumes, deodorants, shaving creams or any scented lotions.

• Do not wear make-up or nail polish.

• Bring a case with your name on it to hold your eyeglasses, contact lenses, hearing aids and dentures.

Reporting to the Joint Replacement Center

• You will be given an arrival time for the day of surgery when you come to your PAAT (Pre-AnesthesiaAdmission Testing) visit.

• Report to the Short Stay Surgery reception desk located on the 2nd floor of NMMC’s East Tower.

• You should have a friend or family member to accompany you.

Short Stay Surgery HoldingTo prepare for surgery, you will be escorted to Short Stay Surgery’s holding area (the pre-operative preparationarea). You will receive your hospital identification bracelet and be asked to change into a hospital gown. Pleaseempty your bladder before going to surgery.

An admitting nurse will review your medical information and conduct a brief physical examination thatincludes taking your vital signs (pulse and heart rate). An intravenous line will be started. Your surgeon willverify and mark your surgical site.

A family member may remain with you in Short Stay Surgery Holding until you go into the operating room.Someone from Short Stay Surgery Holding will advise your family of your Joint Replacement Center room number, where they may wait for your arrival from the Post-Anesthesia Care Unit (PACU) recovery area.

Remember, it may be six to eight hours, or more, from the time you arrive at the hospital, until you are admitted to your room on the Joint Replacement Center Unit.


2. Before Surgery

Your Surgery 25


Your Surgery

Anesthesia

General Facts:

• A member of your anesthesia team will see you before surgery.

• Please inform the anesthesia provider if you have ever had any problems with anesthesia in the past.

• Please inform staff of any medication changes since you provided your medical history.

• After surgery you may have a small tube under your nose providing you with oxygen.

General Anesthesia:

• General anesthesia is used to put you to sleep for your operation.

Femoral Nerve Block:

• To help control pain after knee replacement surgery, you may receive an injection of local anesthetic that targets the major nerve that gives feeling for your knee. This injection is done before surgery, after you are sedated. The effects of the medication usually last 18-20 hours. You will still receive additional pain medication through your IV after surgery. The local anesthetic may make your leg temporarily weak.

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Your Surgery


3. Your Surgery

Going Into Surgery

After leaving the holding area you will go into the operating room. The average length of time for the surgery isone to two hours. Revision surgery may require more time. Double the time for having both knees or hipsreplaced.

In the Post-Anesthesia Care Unit (PACU)

After your surgery is completed, you will be taken to the recovery room.

In the PACU:

• Nursing staff will check your bandage and vital signs (blood pressure, pulse and breathing).

• Nurses will place ice bags on your affected hip or knee.

• You may receive medications as needed for pain.

• While in the PACU, you may also receive oxygen by a mask or small tube placed under your nose.

When you leave the PACU, you will be moved to your room in the Joint Replacement Center. Your familyshould expect a call notifying them you are on your way to your assigned room.

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Our skilled surgeons and operating room staff performabout 1,000 joint replacement surgeries at NMMC per year.



Joint Replacement Center Stay

1. Post-surgical care• Intravenous fluids, antibiotics• Dressings• Ice• Drainage tubes• Support stockings (TEDS)• Oxygen• Blood thinners• Blood transfusions

2. Pain medications and pain control• Pain pills• Pain scale

3. Joint Replacement Center Typical Day• Day of surgery• Daily schedule• Hourly activities

4. Group exercises and activities• Coughing and deep breathing• Physical therapy exercises• Activities for hip replacement patients• Activities for knee replacement patients

5. Discharge goals

Joint Replacement Center Stay28


1. Post-Surgical Care

Intravenous Fluids, AntibioticsYou will be provided with fluids through an intravenous (IV) tube. It may be removed the day after surgery if you are drinking fluids. Antibiotics are also given intravenously to prevent infection.

DressingsThe surgical dressing will be changed prior to discharge. You will be given instructions at discharge regarding dressing changes at home.

IceIce may be applied to your affected knee or hip to help with pain and swelling.

Drainage TubesA drainage tube may be inserted into your hip or knee during surgery. This tube collects bloody drainage after surgery. It is usually removed by the second post-operative day.

If needed, you may have a catheter inserted into your bladder during surgery to empty your bladder. Normally, one is not inserted.

Support Stockings (TEDS)After hip and knee surgery, elastic stockings may be placed on both legs to decrease risk of blood clots. You should continue to wear your stockings for about four to six weeks after surgery.

OxygenAfter surgery you may receive oxygen through a small tube under your nose. Periodically, a monitor will be placed on your finger to measure the amount of oxygen in your blood.

AnticoagulationYou may be given blood thinner (anticoagulant) or aspirin, which will be started while in the hospital, to help prevent blood clots.

Blood TransfusionsIf you are lightheaded, dizzy, or if your blood count is low, your surgeon may want you to receive a blood transfusion.


Joint Replacement Center Stay 29



2. Pain Medications and Pain Control

Pain PillsPatients must request pain medications, but nurses will follow physician’s orders regarding appropriate dose and timing.

Pain ScaleWhile you are in the Joint Replacement Center, you may be asked to rate the intensity of pain you are experiencing through the use of a pain scale. A pain scale is a line numbered from one to 10, with each number representing the amount of pain you’re feeling. Our pain scales examples are listed below.

The Pain Intensity Scale

Verbal Numeric Pain Scale

0 1-3 4-6 7-9 10No Mild Moderate Severe Worst Pain

Pain Pain Pain Pain ever had



3. JRC Typical Day

Day of Surgery

• You may get out of bed with physical therapy or nursing depending on arrival time to 4 South post-surgery.

• Knee patients:• Patients with knee immobilizers will remain in place until post-op day one.• Some patients will be set up to a continuous passive motion machine after surgery.

Daily Schedule

7-7:30 a.m. Breakfast

7:30-9 a.m. Occupational therapy (assists with dressing and transfers to recliner in room)OT may assist with car transfer and tub/shower transfer if able

8-10:30 a.m. Physical therapy (assists with walking and stair training)

10:30-11:30 a.m. Group exercise class – please have your coach attend

11:30 a.m. Lunch. You will remain sitting in your recliner during lunch.

1-2:30 p.m. OT (assists with car transfer and tub/shower transfer) PT (assists with walking and stair training)

2:30-3:30 p.m. Group exercise class – please have your coach attend

3:30 p.m. Return to room

• If your doctor has ordered continuous passive motion you will be set up for two hours.

• You may ask for assistance back to bed when you are ready.

*All times are subject to change.

Hourly Activities

• Ankle pumps• Incentive spirometry/deep breathing exercises


Continuous passive motion (CPM) machine




4. Group Exercises and Activities

Coughing and Deep Breathing Exercises

Coughing and deep breathing help prevent lung congestion after surgery.

• To cough, take a deep breath in and cough forcefully from your abdomen, to force air from your lungs.

• Another deep breathing exercise involves the use of a small plastic device called an incentive spirometer. The spirometer helps you fully expand your lungs.

Physical Therapy Exercises

Progress during your recovery is a direct result of participation in physical therapy while you are in the JointReplacement Center. You will be expected to walk and participate in group physical therapy sessions two timesa day. Coaches are strongly encouraged to attend.

Occupational Therapy

An occupational therapist will assess your ability and assist in performing daily activities such as bathing, dressing, shower/tub and car transfers.

One of our goals is that you achieve optimum safety and independence.

Deep breathing using an incentive spirometer 10 times every hour while awake



5. Discharge Goals

You will be able to go home safely when you can independently:

Hip Goals■■ Get in and out of bed ■■ Get up and down from chair and toilet■■ Get in and out of shower by yourself■■ Walk with walker on level surface for 250 feet■■ Be able to go up and down stairs if you have them at home or where you will be recovering■■ Understand all the hip precautions (for posterior incisions)■■ Get dressed with hip precautions (for posterior incisions)■■ Get in and out of your car■■ Perform hip exercise program independently

Hip precautions do not apply to patients having an anterior approach

Knee Goals■■ Get in and out of bed ■■ Get up and down from chair and toilet■■ Get in and out of shower by yourself■■ Extend your knee to zero degrees■■ Bend your knee to 90 degrees■■ Walk with walker on level surface for 250 feet■■ Be able to go up and down stairs if you have them at home or where you will be recovering■■ Get dressed■■ Get in and out of your car■■ Perform knee exercise program independently





Discharge Plan

Before you leave the Joint Replacement CenterYou will be ready to safely return to your home when you meet your discharge goals. Your doctor (not yourinsurance company) will determine when you are ready to leave.

Before going home you will be given:

• A prescription for pain medicine• A prescription for blood thinner (if ordered)• Written instructions from your surgeon• Support stockings (TEDs) (if ordered)• An appointment for your follow-up visit with your physician

The Drive HomePlease make sure that the friend or family member taking you home brings pillows for you to sit on in the car.

When getting into the car:

• Move the front passenger seat back as far as possible.• Place the pillows on the car seat and recline the seat slightly, if possible.• If your drive home is long, stop to stand up and stretch after 30 minutes.• You should avoid riding home in a compact car, sports car, truck or any vehicle with raised

suspension.

Discharge Plan34


Outpatient Physical Therapy

Home Health Care

Transfer to Rehabilitation or Skilled Nursing Facility

Patient Satisfaction Surveys

When you are discharged from the hospital, you may need to continue physical therapy on an outpatient basis.

Your discharge planner will set up an outpatient evaluation for you prior to discharge.

A number of home health services may be arranged to help you after you return home:

• A physical therapist will progress your walking and exercises.• If you have staples in your incision, they may be removed at home by the physical therapist or a home

health nurse, if not removed at your post-operative physician visit.• A home health nurse may also assist you with wound care and administration of injectable medications.

Your doctor may decide that you need additional assistance with your recovery. In this event you may transferto a skilled nursing facility for a short period of time before going home. Your discharge planner will assist youwith arranging the transfer and will answer any questions.

After discharge, you may receive a patient satisfaction survey in the mail. If you receive a survey, please complete it and mail it back to us. This is an important way we measure our goal of providing excellent care. We hope your experience will be a very good one.


Discharge Plan 35



Recovering at Home

Your recovery period at home may take six to 12 weeks. Keep in mind, however, that recovery

is a gradual process. Remember by six weeks, scar tissue begins to develop. It is important to exercise

daily as instructed in class, using this book as your guide.

This section provides information about the following:

1. Medications• Anti-coagulants (blood thinners)• Aspirin• Pain medications• Laxatives and stool softeners

2. Precautions• Blood clots• Infections/wound care

3. Special equipment• Hip Kit• Walker with wheels (not one with a seat)

4. Activities• Bathing• Walking• Climbing Stairs• Sitting• Standing and Reaching• Driving• Returning to Work• Sports• Hip Do’s and Don’ts• Knee Do’s and Don’ts

5. Post-surgery follow-up• Physician checkup

Recovering at Home36


1. Medications

Take your medications as prescribed.

Anticoagulants (Blood Thinners)

Your physician may prescribe an anticoagulant (blood thinner) medication or aspirin for you at discharge. You will receive instructions before leaving the Joint Replacement Center on the proper use of the medicationthat your physician selects. If you have any suspected or obvious bleeding such as nose bleed, red-colored urineor black, tarry bowel movements, call your doctor before your next scheduled dose of anti-coagulant (bloodthinner).

Pain Medications

Take your pain medication as prescribed by your physician.

At home, you may take pain medications 20-30 minutes before the therapist arrives, if prescribed. This will help you to perform your exercises with minimal pain.

Laxatives and Stool Softeners

If you are experiencing problems with constipation, you may take any over-the-counter laxatives or stool softeners, such as Milk of Magnesia, Dulcolax suppositories or pills, Colace stool softener, a Fleets enema orMetamucil.

Ice

Applying an ice pack for 15 minutes after exercise may decrease pain and swelling.


Recovering at Home 37



2. Precautions

3. Special Equipment

Blood Clots

Blood clots can sometimes occur after joint replacement surgery. Taking blood thinners,aspirins, performing ankle pump exercises and wearing your support stockings (TEDs),when prescribed by your doctor, are ways to decrease the possibility of clot formation.

Warning signs of blood clots in the leg:

• Tenderness, redness, increased pain or swelling in the calf, thigh, ankle or foot

Warning signs of blood clots in the lung:

• Sudden increased shortness of breath• Sudden onset of chest pain• Localized chest pain with coughing, or when taking a deep breath

Infections/Wound CareKeep your incision clean and dry and check it daily. The most common causes of infection are from bacteriaentering the bloodstream through the mouth, urinary tract or skin. You may be instructed to change yourdressing at home, so do not wear false fingernails, nail tips or nail polish. These can be potential sources ofinfection. Practice good hand hygiene before changing dressing. Do not allow pets near your incision. Avoidshaving your legs until after surgery. Check with your doctor if you have any questions. Be sure to tell yourdentist and other health care providers you have had joint replacement surgery.

Warning signs of infection include:

• Persistent fever (oral temperature greater than 100 degrees)• Shaking or chills• Increased redness, tenderness, swelling or drainage from incision• Increased or unusual pain during activity and at rest

Ask your occupational therapist about special equipment to help you do routine activities at home.

These may include:

• Dressing sticks• Long shoe horns • Elastic shoe laces• Reacher • Long handled sponge• Soap on a Rope • Raised commode seat• Bathtub benches and handrails• Sock aid

If you experience

any of these

warning signs,

call your doctor

immediately

• Hip Kit contents:Dressing sticks, reacher, long shoe horn, long handled sponge, sock aid and elastic shoe strings

Recovering at Home38



4. Activities

Everyday Activities

• Bathing: You will be instructed at discharge about when you may shower and take a tub bath. A shower bench or chair may make it easier and more comfortable for you. Position yourself to avoid direct spray of water on your incision.

• Walking: Always use your walker and avoid over-exertion. DO NOT walk on uneven surfaces such as lawns or gravel. You may put your weight on your affected leg as instructed by your doctor or therapist.

• Climbing Stairs: If you must climb stairs, go up using your good leg first; come down with your affected leg first.

• Sitting: Use chairs that have arms, backs and firm seats. Do not use chairs with wheels. You need the arms to help lift yourself out of the chair. To maintain good circulation, do ankle pumps after sitting or lying in one spot for more than 30 minutes.

Restricted Activities

Until you see your doctor for your first post-operative checkup, DO NOT attempt any of the following:

• Return to work• Drive a car• Participate in sports• Engage in sex• Take a tub bath

Recovering at Home 39


Recovering at Home

Dos and Don’ts For Hips

Dos and Don’ts for Anterior Hips:• DO NOT sit in a chair that does not have arms.• DO NOT sit longer than 30 minutes at a time without moving your leg.• DO stay active. Walk at least four times a day, increasing your distance as your strength improves. • DO carefully follow your doctor’s orders on how much weight you can put on your affected leg.

Dos and Don’ts for Posterior Hips:• DO NOT bend hip beyond 90 degrees. This includes reaching forward to the floor from a sitting position and

sitting in a low chair or toilet. • DO NOT cross your legs. Imagine a line drawn down the middle of your body (from the tip of your nose to

the space between your two feet). You should not bring your affected hip across that line.• DO NOT pivot or twist on the affected leg. Forcing your affected leg inward or outward should be avoided.• DO NOT sit in a chair that does not have arms. • DO use an elevated commode seat.• DO use Hip Kit items for dressing and other activities as needed.• DO use a pillow or abduction wedge between your legs when sleeping, especially when you turn onto the

non-affected side to rest.

40


* There are different approaches to total hip jointreplacement. Your surgeon will determine the most appropriate approach for you.


Recovering at Home


Dos and Don’ts For Knees

• DO NOT sit in a low chair or a chair that does not have arms.

• DO NOT sit longer than 30 minutes without moving your leg.

• DO NOT rest with a pillow under your knees.

• DO NOT twist your knee for six to eight weeks.

• DO NOT cross your legs or knees.

• DO push to gain maximum motion of your knee during the first six to eight weeks.

• DO stay active. Walk at least four times a day, increasing your distance as your strength improves.

• DO carefully follow your doctor’s orders on how much weight you can put on your affected leg.

41


Recovering at Home

5. Post-Surgery Follow-up

Your first post-operative visit with your orthopaedic surgeon will be anywhere from one to six weeks. You willbe given the date and time of your appointment before being discharged from the Joint Replacement Center. If you need to call your surgeon before these scheduled visits, please do so.

42



Living With Your Joint Replacement



By having a hip or knee replacement, you join an average of 450,000 Americans who undergo this surgeryevery year. This section discusses your life-style after your joint replacement.

1. Lifetime activities

• Recommended

• Not recommended

• Avoid entirely

2. Medical and dental follow-up

3. Magnetic resonance imaging

4. Metal detectors

43



1. Lifetime Activities

After three to six months, you will most likely be able to resume the majority of activities that you were able to enjoy when you had a healthy hip or knee. Still, there are some activities that your doctor prefers over others,and some that your doctor will want you to avoid entirely.

Recommended:

• Swimming • Dancing• Biking • Nordic Track• Walking • Bowling• Golf • Fishing• Tennis (social doubles) • Gardening• Low impact aerobics and/or water aerobics • Elliptical stepper

Not Recommended

• Basketball• Skiing• Weight-lifting with weights that exceed 50 lbs.• Racquetball

Avoid Entirely

• Jogging or running• Contact sports• Jumping sports• High impact aerobics

44

Check withyour physician

prior tobeginning

these activities





2. Medical and Dental Care Follow-up

3. Magnetic Resonance Imaging (MRI)

4. Metal Detectors

After the first year, your hip or knee should be evaluated every one to two years for the rest of your life.Although more than 90 percent of replacements function well for more than 10-20 years, the implant maybegin to wear with increasing years of use. For this reason, your surgeon may order an X-ray when necessary to determine if your replacement shows any wear.

Preventing Infection

Because infections commonly enter the body through the mouth, you must take certain precautions before having dental work.

• Tell your dentist and other health care providers you have had joint replacement surgery.

• Your medical doctor, surgeon or dentist may prescribe an antibiotic prior to some procedures(always take as directed).

If you are to have an MRI or other medical procedures, tell the doctor you have an artificial joint.

Your new hip or knee may activate metal detectors used for security in airports and some buildings. Please show this card to any security agent to confirm you have had total knee or total hip replacement.

Sample of a joint replacement surgery card(You should get a card that looks like this at discharge.)

45



Exercises for Hips & KneesOn the following pages, you will find exercises you may be instructed to do before surgery and during recovery.Your physician and physical therapist will advise you on which exercises are appropriate for you and the num-ber of repetitions needed. These should be done on a bed or chair. Do not attempt to do these exercises on thefloor. You may exercise both legs, but if energy or time is limited, please exercise surgical leg.

2-3 sets of 10 • 2-3 times per day

Bend ankles up and down, alternating feet.

You should do this exercise:• Before surgery• In the hospital• At home

Slowly tighten and relax muscles on thigh of straight leg.


Bend knee and pull heel toward buttocks, hold three seconds, return and repeat.


Squeeze buttocks muscles tightly and relax.


Figure 1. Ankle Pumps Figure 2. Quadriceps Set

Figure 3. Gluteal Set Figure 4. Heel Slides

Slide one leg out to the side. Keep kneecap pointing toward ceiling. Gently bring leg back to pillow.


Figure 5. Supine Abductions

Exercises46



Practice standing up and returning to the sitting position.


Figure 6 . Sit to Stand

Tighten the muscles on the front of your surgical leg while keeping the knee locked, lift leg 18 inches from the surface.


Figure 7. Straight Leg Raises

Sit, both feet flat. Lift knee toward ceiling.


Figure 8. Flexion Lift: Sitting (Active)

Sit with feet flat. Straighten knee.


Figure 9. Extension: Sitting (Active)

Do not use ankle weights with these exercises.

Prop your foot on a stool or chair for approximately 5 minutes, you should feel a stretch behind your knee.


Figure 10. Passive Knee Extensions(knee only)

Exercises 47


Start with arm at side. Holding band, raise arm forward and up. Keep elbowstraight. Hold 2 seconds.Use resistance band.

Figure 11. Flexion Unilateral (Band)

Start with arm slightlyforward. Holding band, pull backward, past hip, keeping elbow straight. Do not swing arm. Hold 2 seconds.Use resistance band.

Figure 12. Extension (Band)

Holding band, raise arm outand up. Keep elbow straight.Do not shrug shouldersHold 2 seconds.Use resistance band.

Figure 13. Abduction (Band)

Hold band with elbow bent.Straighten elbow.Hold 5 seconds.Use resistance band.

Figure 14. Extension (Band)

Lock wheelchair brakes.Lean forward slightly. Pushdown on armrests or wheels to raise buttocksfrom sitting position.Hold 5 seconds.*Place feet on floor if chair

chair beings to tip forward.

Figure 15. Depression Raise(Wheelchair)

With arms slightly wider than shoulders, gently leanbody to wall. Push bodyaway from wall by straightening elbows.Hold 5 seconds.

Figure 16. Extension/Chest Press (Wall)


Exercises48



Exercise LogWeek 1

Figure Sets Reps per/day Exercise date / / / / / / / 1 2-3 10 2-3 Ankle pumps

2 2-3 10 2-3 Quadriceps set

3 2-3 10 2-3 Gluteal sets

4 2-3 10 2-3 Heel slides

5 2-3 10 2-3 Supine abductions

6 2-3 10 2-3 Sit to stand

7 2-3 10 2-3 Straight leg raises

8 2-3 10 2-3 Flexion lift: sitting

9 2-3 10 2-3 Extension: sitting

10 2-3 10 2-3 Passive knee extensions

11 3 10 1 Shoulder Flexion

12 3 10 1 Shoulder Extension

13 3 10 1 Shoulder Abduction

14 3 10 1 Elbow Extension

15 3 10 1 Shoulder Depression Raise

16 3 10 1 Elbow Extension/Wall Press

Perform two to three repetitions of 10 for each exercisetwo to three times each day.

Week 2

















Exercise Log 49



Exercise LogWeek 3

















Perform two to three repetitions of 10 for each exercisetwo to three times each day.

Week 4

















Exercise Log50


Commonly Asked Questions


Commonly Asked Questions

Q: Why do I have to wear support stockings (TEDs) and how long will I have to wear them? A: Support stockings may need to be worn for four to six weeks after surgery to prevent blood clots. Make sure

that they are properly in place and not rolling down on your legs.

Q: How long do I need to maintain hip precautions?A: Until advised by your surgeon.

Q: When can I start driving?A: When cleared by your physician.

Q: How long do I have to keep doing the exercises?A: Specific exercises should be done until you are pain free and walk without a limp; however, regular exercise

should be a lifetime commitment.

Q: How long will my new prosthesis last?A: This varies from 10 to 20 years, depending on your age, weight and activity level.

Q: When can I take a shower?A: You will be instructed at discharge.

Q: When can I start crossing my legs and sleep without a pillow between them after hip replacement?A: When cleared by your physician.

Q: What should I do if my foot swells?A: If swelling does not go down overnight, contact your surgeon. You may need to have a test for blood clots.

Q: How long do I need to use my walker?A: Continue to use your walker until you feel stable.

51


Common Complaints after Joint Replacement

Common Complaints

Common Symptom Recommended Action

Difficulty sleeping • You may take Tylenol PM.• Drink warm milk before bedtime.• Avoid intense exercising two hours before bedtime.

Lack of appetite • Eat small, frequent meals.• Drink Carnation Instant Breakfast or Ensure.

Constipation • You may use a laxative like Milk of Magnesia, Dulcolax tabs, suppository or a Fleets enema.

• Use a stool softener such as Colace.

Swelling • Apply an ice pack for 15 minutes immediately following exercise;some degree of swelling may persist over several months.

Numbness along incision • This is normal.

Drainage from incision • Change bandage as instructed.• If drainage continues, notify your physician.

Clicking with knee bending • Occasionally you may feel soft clicking of metal and plastic, which may be normal. If concerned, call your physician.

Activate alarm in airports • Your knee or hip may activate metal detectors required for security in airports.

• Carry your joint replacement confirmation card with you.

Mood swings/feeling “blue” • Mood swings are normal. These sad feelings should improve with time.• Call your physician if your emotional recovery is not progressing.

Call your physician if any of these symptoms persist.

52



Key Telephone Numbers


Key Telephone Numbers

Surgeon’s Office .................................................... ___________________

NMMC ..................................................................(662) 377-3000

Joint Replacement Center’s Clinical Director..........(662) 377-3550

Discharge Planning ................................................(662) 377-3158

Short Stay Surgery ................................................(662) 377-2300

Outpatient Physical Therapy..................................(662) 377-7215

Gift & Floral Shop ................................................(662) 377-4194

Inpatient Physical Therapy ....................................(662) 377-3248

Food & Nutrition Services ....................................(662) 377-3018

Pastoral Care..........................................................(662) 377-3439

Ambassador Services..............................................(662) 377-3246

Pre-Anesthesia Admission Testing..........................(662) 377-4295

United Blood Services............................................(662) 842-8871

53



Directions

• East - From Memphis International Airport, Memphis, TN (97 miles) (Estimated drive time: 1 hour, 45 minutes) Exit Memphis International Airport South-East and bear left onto Sanderson Drive, turn right onto Runway Road and turn right onto Swinnea Road. Turn left on E. Shelby Drive proceed for 3.7 miles and bear right onto US-78 and drive 91 miles. Exit McCullough Blvd. and proceed 5.1 miles and take ramp (right) onto Gloster Street. Keep straight (south) on Gloster Street for 1 mile. Turn right on Garfield Street and left into Visitor Parking.

• West - From Birmingham, AL (141 miles) (Estimated drive time: 2 hours, 30 minutes) Exit 159, 1-20 via ramp at sign reading “Exit 123 US-78 Arkadelphia Rd to Jasper” and go West for .3 miles and bear right on US-78, AL-4 and go northwest 41 miles. Continue on ramp at sign reading “US-78 W/AL-118W” and go west for .6 miles and continue on US-78, AL-4 and go west for 31 miles. Turn left on ramp and go west for 200 feet and continue on US-78 going west for 61 miles. Exit US-78 via ramp at sign reading “Exit 86A US-45 S to Tupelo” and go east for .2 miles. Continue on US-45 and go south for 1.3 miles. Exit US-45 via ramp at sign reading “McCullough Blvd.” and go south for 1,000 feet. Turn right on McCullough Blvd. and go west for .6 miles. Exit McCullough Blvd. via ramp to Gloster Street and go south for 2.2 miles.

• North - From Jackson, TN (108 miles) (Estimated drive time: 2 hours, 15 minutes) On US-45, TN-5 go south for 40 miles bear right and go east for 300 feet. Turn right on US-45 and go south for 64 miles. Exit US-45 via ramp at sign reading “McCullough Blvd.” and go south for 1,000 feet. Turn right on McCullough Blvd. and go west for .6 miles. Exit McCullough Blvd. via ramp to Gloster Street and go south for 2.2 miles.

• South - From Jackson, MS (187 miles) (Estimated drive time: 2 hours, 30 minutes) On 1-55 go north for 86 miles. Exit 1-55 via ramp at sign reading “Exit 185 US-82 to Winona/Greenwood” and go northeast for .3 miles. Continue on US-82 and go east for 40 miles and bear right on ramp and go southeast for .2 miles. Turn left on Natchez Trace Parkway and for northeast for 56 miles. Turn right on ramp at sign reading “MS-6” and go northeast for .3 miles. Turn right on W. Main Street, MS-6 and go east for 2.3 miles. Turn right on MS-145 (S. Gloster Street) and go south for 1.0 miles.

Maps & Directions54


NMMC Campus Map


Maps & Directions 55



Entrance & Parking Directions

Please park in the East Tower parking directly across from the East Tower Outpatient Entrance.

Elevator

Restroom

Vending

Cafe

Entrance

1) South Lobby2) Volunteer Services3) Gift Shop4) Radiology5) Emergency Department6) Rapid Admit Unit7) Outpatient Imaging8) Outpatient Services

Ground Floors Main Hospital and East Tower

Entrance

East Tower Entrance

Maps & Directions56


United Blood Services

4326 South Eason Boulevard • Tupelo, MS 38801 • (662) 842-8871

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Maps & Directions 57



Notes

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joint brochure revised 7 2016 1 - Home Page | Pain is relieved, deformity corrected, and patients...

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Transcript of joint brochure revised 7 2016 1 - Home Page | Pain is relieved, deformity corrected, and patients...