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Bon Secours Orthopaedic Institute at
Memorial Regional Medical Center
A PATIENT HANDBOOK
MISSION
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 1
Mission Statement
of the Bon Secours Health System:
Our mission is to bring compassion to healthcare and to
be good help to those in need, especially those who are
poor and dying.
As a system of caregivers, we commit ourselves to help
bring people and communities to health and wholeness
as part of the healing ministry of Jesus Christ and the
Catholic Church.
We are proud that in today’s competitive healthcare environment, the Sisters of
Bon Secours and those who work for the Bon Secours Health System view the
delivery of quality healthcare as their primary goal.
WELCOME
Page 2 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Bon Secours Orthopaedic Institute at
Memorial Regional Medical Center
We welcome you with great pleasure to the Bon Secours Orthopaedic Institute at Memorial
Regional Medical Center. We understand that you and your doctor have decided that a joint
replacement is needed to decrease pain and improve function in your joint. Together we will
work toward one common goal: improving the quality of life through increased mobility.
This handbook is designed to help you understand what will happen before surgery, on the
day of surgery, during your hospital stay, and after discharge.
We are pleased you have chosen Bon Secours Memorial Regional Medical Center for your
care. Our goal is to provide you with world class healthcare that will return you to a more
active, higher quality of life. And remember, most of all, as your healthcare team we are
here to accompany you every step of the way.
Your Healthcare Team with
Bon Secours Orthopaedic Institute at
Memorial Regional Medical Center
TABLE OF CONTENTS
Mission Statement 1
Welcome 2
Table of Contents 3
About Us 4
Your Healthcare Team 5-6
Understanding Your Surgery 7-10
Preparing for Surgery 11-22
Your Surgery 23-27
Hospital Stay 28-56
Anterior Total Hip Exercises 34-36
Posterior Total Hip Precautions & Exercises 37-44
Getting IN/OUT of Vehicle 45
Total Knee Precautions & Exercises 46-51
Exercise Logs 52-53
Instructions for UP/DOWN stairs 54
Discharge 55-56
Recovering at Home 57-62
Living with Your Joint Replacement 63-66
ADDITIONAL INFORMATION SECTION 67 Commonly Asked Questions 68
Common Complaints After Joint Replacement Surgery 69
Key Telephone Numbers 70
Maps and Directions 71
Note Pages 72-73
Content Page/s
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 3
ABOUT US
About Bon Secours Memorial Regional Medical Center
Memorial Regional Medical Center
is a 225 private bed acute care
facility, offering the full spectrum
of healthcare services for patients,
including Acute and Critical Care,
Ambulatory and Surgical Services,
and a 24-hour Emergency Room.
Other key services available at
Memorial Regional Medical Center
and Hanover Medical Park include
Orthopaedics, Cardiology and
Diagnostic Treatment Centers,
Physical Rehabilitation, Radiation
Therapy, Urology, and Physician
Practices.
Our Orthopaedic Institute at
Memorial Regional Medical
Center performs over 600 joint
replacements per year and anticipates
substantial growth in years to come.
Our Orthopaedic Team is committed
to providing world class healthcare.
Page 4 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
“Joint surgery
changed my life!”
—Shirley Cadden,
joint replacement
surgery patient
YOUR HEALTHCARE TEAM
Getting to Know Your Healthcare Team
We take a team approach to your healthcare at the Bon Secours Orthopaedic Institute at
Memorial Regional Medical Center. In the weeks before your surgery, at the hospital
and when you return home, you will come in contact with many members of your
healthcare team, including:
Orthopaedic Surgeon: Your orthopaedist is the doctor who performs the actual joint replacement
surgery and is responsible for your overall health during your hospital stay and following your
surgery.
Anesthesiologist: Your anesthesiologist is the doctor who administers anesthesia during your
surgery and monitors your vital signs during your surgery.
Nurse Anesthetist: Your nurse anesthetist is a nurse trained in anesthesia and who works closely
with your anesthesiologist in the delivery of anesthesia.
Primary Care Physician: Your primary care physician, or family practitioner, takes care of your
general health. He or she may perform your preoperative medical evaluation to be sure that it is safe
to proceed with surgery and to determine that any preoperative medical conditions you have are
stable and in the best possible condition for a successful recovery.
Hospitalist: Your hospitalist is a medical doctor who may be asked to assist in the general medical
needs while you are hospitalized.
Orthopaedic Patient Educator: Your orthopaedic patient educator is a registered nurse specializing
in joint replacement care. He or she will educate you prior to surgery and follow you during your
hospital stay.
Orthopaedic Nurse Manager: Your nurse manager is a registered nurse who manages the staff and
care of your unit. He or she provides professional support and clinical education for nurses and oth-
er members of the healthcare team.
Nurse: Before and during your hospital stay, you will meet a number of nurses who perform different
jobs. Some nurses attend to your daily healthcare needs in the hospital, others assist surgeons in the
operating room, while others work in hospital admissions and, in some cases, visit patients at home.
Nurses are among the most visible healthcare professionals in the hospital.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 5
YOUR HEALTHCARE TEAM (continued)
Occupational Therapist: Your occupational therapist is trained to teach you how to perform the
activities of daily living, such as dressing and bathing after your surgery.
Nutritionist: Your nutritionist is specially trained in meeting your dietary needs while you are in the
hospital and helping you maintain a healthy diet. The Classic Cuisine Program is available to meet
your dietary needs.
Hospital Chaplain: The hospital chaplain is trained to meet your spiritual needs and those of your
family, regardless of religious denomination.
Page 6 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Care Manager: Your care manager is a registered nurse or social worker who will be coordinating
your hospital care and discharge.
Dietary and Environmental Services: These are the friendly people who bring your meals to you
and clean your room.
Patient Representative: If you have questions or concerns regarding your care, this person will be
there to assist you. Please feel free to contact him or her.
Physical Therapist: Your physical therapist is trained to assist you in regaining strength and motion in
your new joint. A physical therapist will work with you during your hospital stay on exercises and
walking and, if needed, for the first few weeks after you return home to help you be as independent and
mobile as possible.
Nurse Practitioner: Your nurse practitioner is a liaison between you and your physician while you are
in the hospital. He or she will follow you throughout your hospital stay and will assist in managing
your daily care and discharge planning.
Physician Assistant: Your physician assistant will act as a liaison between you and your physician in
the absence of the nurse practitioner. He or she will follow you during your hospital stay.
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. 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 where a large
piece of cartilage was removed, or previous fractures in the area of the joint.
Rheumatoid Arthritis. Rheumatoid Arthritis is one of the more common kinds of inflammatory
arthritis. It is a chronic inflammatory disorder affecting the joints of the body that are lined with a
membrane called synovium. These joints include the hips, knees, shoulders, elbows, wrists, hands, and
feet. Rheumatoid arthritis is likely to be of autoimmune origin, which means that the body produces
cells that irritate the synovium in the joint, leading to destruction of the cartilage. This form of arthritis
occurs in all age groups. It is characterized by stiffness, joint swelling, laxity of the ligaments, pain,
and decreased range of motion.
Avascular Necrosis. Avascular Necrosis involves loss of the blood supply to the bone, which results
in collapse of the joint and arthritis. Most forms have no specific cause but excess alcohol intake and
long term steroids have been implicated.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 7
UNDERSTANDING YOUR SURGERY
Page 8 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
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 smooth cartilage that cushions the bones and
enables them to move easily. In the arthritic knee, the
cartilage layers are destroyed resulting in bone rubbing
against bone which causes pain, muscle weakness, and
limited motion.
Total knee replacement surgery involves the removal of the
arthritic, roughened bone in the knee joint and replacing it
with a new surface. Metal parts are cemented onto the bones
and a plastic liner is inserted between them. The kneecap is
also resurfaced with a plastic liner. When in place, these
components move together to allow near normal motion of
the knee joint. Bow legged or knock kneed deformities can
usually be corrected by the new alignment.
At right, (top) x-ray of a patient’s knee
before joint replacement surgery and
(bottom) after the components are in
place.
UNDERSTANDING YOUR SURGERY
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 or socket in
your pelvis). In a normal hip joint, these two bones are coat-
ed with smooth cartilage that allows them to move against
each other without friction or pain. In an arthritic hip, the car-
tilage layers are destroyed and bone rubs against bone, caus-
ing pain and limited motion.
Hip replacement surgery replaces your arthritic hip joint with
an artificial joint composed of a ball component and a socket
component. The metal or ceramic ball is attached to a stem
that fits firmly inside your thigh bone. This component can be
cemented or non-cemented depending on your age and the
condition of your bone. A plastic or metal liner with an outer
metal shell is secured into the socket of your pelvis. As our
techniques have evolved, many restrictions have been
eliminated or changed. Hip dislocation with normal activities
of daily living is a very rare occurrence. Your orthopaedic
surgeon will choose the type of prosthesis that best meets
your individual needs.
Joint replacement patient X-ray,
showing hip prosthesis in place
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 9
UNDERSTANDING YOUR SURGERY
Page 10 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Why Should I Have Joint Replacement Surgery?
Joint replacement is considered when there is progressive loss of joint function accompanied by pain that
can not be controlled by medications, injections, walking aids, weight loss, or lifestyle modifications.
Your overall health should be good enough that you and your doctor think that surgery can be performed
safely.
What Results Can You Expect from a Joint Replacement?
The goal of a total joint replacement is to relieve pain,
correct deformities, and help return patients to former
activities. Total joint replacements usually last 10-20
years with success depending on age, weight, and
activity level.
What Activities Can I Return to After Joint Replacement?
In time, and as allowed by your surgeon, hiking, walking,
swimming, cycling, golf, fishing, hunting, dancing, and
low impact aerobics are some of the activities you may
enjoy after joint replacement. You may also use exercise
equipment such as a treadmill, stair climber, elliptical glider
or light lower extremity weights.
You should avoid jogging or activities that require
running or jumping, such as basketball, football, baseball,
racquetball, handball, squash, or high impact aerobics. You
should also avoid heavy lifting.
“Hip replacement turned my life
around. No more cane!”
—Van Noble, joint replacement
surgery patient
Are There Risks With Joint Replacement Sur-
gery?
Joint replacement is considered to be major surgery. It is
important that you are aware of potential risks and complica-
tions. These include problems from anesthesia, infection,
surgical bleeding, blood clots, damage to nerves or blood
vessels, dislocation with hip replacement, and very rarely,
death. Although these complications are rare, they are possi-
ble. Every precaution is taken by your healthcare team to
avoid these complications. Over time, an artificial joint may
become loose or wear out and could require further surgery
and repair.
PREPARING FOR SURGERY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 11
Your path to recovery begins with the preoperative steps that take place weeks before your surgery.
You can improve your results when you take charge of your care and complete all of these steps.
Each step is listed below, along with specific instructions for you to follow.
1. Physical Exam by Medical Doctor or Health Practitioner
2. Preoperative Education Class
3. Preparing Your Home
4. Surgery Center Preoperative Visit
5. Exercise
6. Medications Before Surgery
7. Diet and Nutrition
Healthy Eating
Iron and Vitamin Supplements
Reminders
8. Preventing Infections
Visiting Your Dentist
PREPARING FOR SURGERY
Page 12 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
1 Physical Exam by Healthcare Practitioner
Before undergoing surgery, you will need to be checked for any medical problems that could put
you at risk during or after your surgery. This should be done 3 to 4 weeks before your date of sur-
gery to allow for any special tests and/or treatments that need to be done preoperatively. Your sur-
geon or another healthcare provider will perform this exam.
2 Preoperative Education Class
To fully prepare for your surgery, your orthopaedic surgeon requires that you attend our preopera-
tive teaching class at Memorial Regional Medical Center. This class will enable you and your fam-
ily to participate in your care and gain a better understanding of the postoperative recovery period
and exercise program. You will find if you are better informed, you are better prepared. This is
key to better results. Preoperative education classes are held on Tuesdays from 10:00 am until 12
noon. Contact the Patient Education Coordinator to schedule your class at 804-7646700. Addi-
tional classes may be available.
3 Preparing Your Home
Some suggestions for home preparation are as follows:
Choose your bed. In general, the bed you have at home will be suitable to sleep in af-
ter your surgery.
Prepare your bathroom. An elevated toilet seat will make it safer and easier to get on
and off the commode in the first few months after your surgery. Having arms on the
elevated seat is helpful. You may want to have handrails professionally installed in
your tub and shower as well as adjacent to your toilet for safety. This is not a require-
ment and your therapist will make suggestions as to placement and location of hand
rails.
Select a chair from your home with a high back, arms, and a firm seat cushion for
your use only.
Arrange furniture so that it is clear of cords and clutter that could get in the way of
moving freely in your home with crutches or a walker.
Be sure that all stairways are secure and have hand rails.
Accident proof your home by removing throw rugs from around the house and tack
down loose carpets.
Be aware of all floor hazards such as pets, small objects, and uneven surfaces.
Schedule your physical examination
3-4 weeks before your surgery
PREPARING FOR SURGERY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 13
Equipment You May Need for Home
To ensure safe recovery, you may need to use some special
equipment.
Walker or Crutches. If you do not have either, it can
be ordered for you while you are in the hospital.
Raised Toilet Seat. Needed following hip replacement
or bilateral knee replacement. It is optional if you are
having a single knee replacement.
Other equipment you may need for bathing and dressing:
Reacher. Allows you to reach items from the floor.
Long-handled Shoe Horn. Helps you guide your foot
into your shoe.
Sock Aid. Helps put on support stockings without bend-
ing.
Dressing Stick. Aids you in putting on and taking off
clothing.
Long-Handled Sponge. Assists you in washing your
lower legs and feet.
Elastic Shoe Laces. Allows you to keep your shoes tied
and slip in and out of them.
Grab Bars. When professionally installed, helps you
safely climb in and out of the shower.
Hand-held Shower Head. Lets you control the spray of
water.
Shower Bench. Allows you to sit while showering.
Non-skid Tub Mats. Prevents you from falling.
PREPARING FOR SURGERY
Page 14 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
4 Surgery Center Preoperative Visit
This visit is generally done 7-14 days before your surgery. At this visit you will have preadmission testing
performed, if it has not been completed previously. Testing consists of lab work (blood and urine testing),
EKG and, if needed, a chest Xray. You will be interviewed by a nurse about your medical/surgical history,
medications, and allergies. You will receive a skin preparation kit and information sheet for preparing the skin
before your surgery. As part of your preopertive testing, we will be running a blood test called the Hemoglobin
A1c (HgbA1c). This test is used to diagnose diabetes, as well as to determine long-term blood sugar (glucose)
control for those who already have diabetes. It is an average of blood glucose levels over the past three
months. If elevated you will be notified to see staff in the Diabetic Treatment Center before surgery to work
on better blood sugar control.
ALL PATIENTS: Having high blood sugars going into surgery increases the risk of complications such
as infection. If your blood sugar is extremely elevated, it may delay your surgery. Please also note that if
after surgery your blood sugar is not in target range, you will receive insulin injections to help bring it down
(even if you have always been on pills for your diabetes, or if your diabetes has been diet-controlled).
Another laboratory screening is the MRSA (Methicillin Resistant Staphlococcus Aureus) bacterial screening
test. MRSA is a bacterial organism that can potentially cause an infection. We need to identify this organism
before surgery. We will obtain the screening with a nasal swab to identify the bacteria. If your results are
positive your surgeon will prescribe an antibiotic regimen to begin before your surgery. This does not mean
that you have a MRSA infection, it means that you are a carrier of the bacteria (as many people are).
When preparing for your surgery center
preoperative visit, please bring with you:
All of your medications, eye drops, and inhalers.
Place the actual containers in a large plastic bag to bring
with you. Include any herbal, recreational, and overthe
counter medications. Please do not substitute with a list
of medicines.
A list of previous surgeries, including dates and
information on any previous problems with
anesthesia.
Bring all of your medications,
eye drops, and inhalers with
you to your preoperative visit.
Place the actual containers in a
plastic bag; do not substitute
with a list of medications.
5 Exercise
Exercise is the key to recovery! Your exercise program begins before your surgery and continues while
you are in the hospital and when you return home. New exercises will be added as your condition improves.
See pages 32-54 for your pre & postoperative exercises.
PREPARING FOR SURGERY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 15
6
7
Medications Before Surgery
Diet and Nutrition
Medications to Stop
To minimize the risk of blood loss during surgery, ask your physician if you must avoid or stop taking
medicines that contain aspirin, anti-inflammatories, blood thinners, arthritis, and any over-the-counter
medications 5 days prior to your surgery.
Ask your physician if you should stop taking the following medications:
Antiinflammatories, such as Advil, Aspirin, Aleve, Motrin, Naprosyn, Relafen, Celebrex,
Vioxx, Bextra, Mobic, and Ibuprofen.
Blood Thinners, such as Coumadin or Plavix, Xarelto, and Pradaxa
Omega 3 and herbal supplements
NOTE: Pain medication such as Tylenol, Tylenol extra strength, Tylenol with Codeine, Vicodin,
Hydrocodone, Percocet, Oxycodone or Darvocet do not have to be stopped before your surgery.
On the morning of your surgery, take only the medicines (with a small sip of water) that you have been
instructed to take by the pre-admission testing nurse or your physician .
Healthy Eating
To achieve good nutrition we recommend planning ahead and building a healthy plate of food.
Healthy food choices like vegetables, fruits, whole grains, low-fat dairy products, and lean protein foods
contain the nutrients you need without too many calories.
The My Plate Planner shows you how to plan your meals accordingly. You may find more helpful
resources from this website: http://www.choosemyplate.gov/
PREPARING FOR SURGERY
Page 16 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
7 Diet and Nutrition (Continued)
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 17
PREPARING FOR SURGERY
Diet and Nutrition (Continued) 7
SAMPLE MEAL PLAN
Below is a day of healthy meals that you can use as an
example for food choices and appropriate portions.
Breakfast
1/2 cup cooked oatmeal with
3/4 cup blueberries and
1 cup skim milk
1 slice light wheat toast with
1 tablespoon peanut butter
Lunch
3 ounces grilled chicken breast on
2 slices rye bread with
1 tablespoon of light mayonaise
Lettuce and tomato salad with
1 tablespoon light salad dressing
1 small apple (approximately 4 ounces)
1 can diet soft drink
Dinner
3 ounces baked pork tenderloin
1 cup brown rice
1 cup green beans with
2 teaspoons margarine
Evening Snack
6 ounces artificially sweetened yogurt with
1 1/4 cup strawberries and
1 tablespoon walnuts, chopped
(Approximately 175mg carbohydrates)
Page 18 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
PREPARING FOR SURGERY
Iron and Vitamin Supplements
Iron is an essential mineral that plays an important role in a variety of body functions. Iron carries
oxygen and carbon dioxide within your red blood cells to other body tissues. It is also necessary
for the production of energy and the support of your immune system.
When taking an iron supplement, you should:
Take your supplement on an empty stomach with an 8 ounce glass of water or juice.
Add foods to your diet that are rich in iron, such as lean meat, poultry, fish, liver, spinach,
raisins, carrots, turnip greens, and whole wheat bread.
Include Vitamin C rich foods such as strawberries, orange juice, cantaloupe, green peppers,
tomatoes, potatoes, and broccoli 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.
Reminders
Stop Smoking. Smoking increases your risk of lung complications during and after sur-
gery. It can also increase the risk of infection and slow healing. Let your doctor know
before surgery if help is needed in order to stop smoking.
Limit Alcohol. Limit your alcohol intake to one glass of wine or beer or cocktail per day
or less starting about 57 days prior to surgery. After surgery, check with your doctor be-
fore resuming alcohol consumption. Notify your doctor if this is difficult for you.
Diet and Nutrition (Continued) 7
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 19
PREPARING FOR SURGERY
8 Preventing Infections
It is important that you have no active infections at the time of your joint replacement. Infections can
enter the body through various pathways, but most commonly through the mouth, skin, and urinary tract.
It is important that any problems in these areas be treated before your surgery. You will be asked to prepare
the skin with a body wipe the night before and the morning of surgery. (See page 21 “Cleansing Your Skin
Before Surgery”)
Do not have a manicure or pedicure 5 days before your surgery.
Do not shave your legs 2 days before your surgery.
Avoid any cuts, scraps, or abrasions before your surgery which can be portals for infection.
Visiting Your Dentist
Bacteria can easily enter your blood stream through the mouth during dental procedures and cause
widespread infection. To minimize this problem:
Schedule a dental checkup in the weeks before your surgery if you haven’t had one recently.
Continue to brush and floss your teeth regularly.
Remember to attend to any infected teeth or gums 2-4 weeks before your surgery.
Whew! We realize that after the primary care doctor preoperative
visit, orthopaedic surgeon preoperative visit, dentist, and
preoperative surgery center visit you will be tired of all
the running around. We apologize for any inconvenience
it will cause you, please note that all these phases are
done to insure that you have a safe, smooth operation and
postoperative recovery.
Page 20 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
PREPARING FOR SURGERY
We are excited about all of the newer surgical techniques and prostheses that are in use at our hospital. Per-
haps the most significant advancement is what we do before you ever get to the hospital on the day of sur-
gery. Proper preoperative preparation is of paramount importance in maximizing your postoperative results.
Your full and active participation is required in the pre and postoperative period to insure that you get an ex-
cellent outcome. Our team at Memorial Regional Medical Center is here to assist you in the steps to achieve
this goal. You are the main driver of your care.
Take ownership of your new hip/knee replacement.
Essentials for your first day/night before surgery:
Items to Pack: Undergarments
Slippers with backs and rubberized sole or walking sneakers/shoes with Velcro closures
Socks
Eyeglasses (if applicable)
Make-up, hand mirror (if desired)
CPAP machine settings, tubing, and machine (if applicable)
Driver’s license or photo ID, insurance card, Medicare/Medicaid card
Copy of your Advance Directive
Important telephone numbers, including person responsible for bringing you home
This handbook
Your walker (if applicable)
Do Not: Do NOT eat or drink anything after the time you were instructed. Ice, gum, and mints are not allowed.
Do NOT bring valuables—no jewelry, credit cards, checkbook, or cash greater than $10.00.
Do NOT bring your own medications.
Do: Shower/Cleanse your skin prior to coming for your surgery as directed.
Sleep on freshly laundered pajamas/nightgowns/clothing the night before.
Sleep on freshly laundered linens.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 21
PREPARING FOR SURGERY
Cleansing Your Skin Before Surgery
READ ALL THE INFORMATION AND DIRECTIONS COMPLETELY BEFORE BEGINNING
THE SKIN CLEANSING.
Stop shaving 48 hours prior to your surgery. The only area of your body you could shave within 48
hours of surgery is your face.
Your surgery team at Memorial Regional Medical Center requests that you cleanse your skin the night
before surgery, by taking a complete shower or bath.
Avoid excessive rubbing of the skin during showering/bathing to prevent injury to the skin.
Gently dry your skin with a clean towel. It is best not to apply any lotions, creams, or moisturizers
to the skin after bathing.
It is important to put on clean pajamas or a clean gown afterwards. Clean linen should be placed on the
bed.
On the day of your surgery, your surgery team will cleanse your skin again when you arrive in the
Pre-op Holding area. A special antiseptic cloth will be used containing Chlorhexidine Gluconate
(CHG). This antiseptic will reduce the risk of infection at the surgical site. Please let the nurse know if
you are allergic to this product.
Sign below indicating you completed your skin cleansing.
Give this sheet to your nurse on the day of surgery.
__________________________________________________________________________________
Date Time Patient’s/Representative’s Signature
Verified skin prep completed prior to surgery.
_________________________________________________________________________________
Date Time Nurse’s Signature
Page 22 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
PREPARING FOR SURGERY
YOUR SURGERY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 23
After weeks of preparation, you are ready for surgery. This
chapter includes the following material related to your day of
surgery:
1. Day of Surgery
Leaving for the hospital
Reporting to the hospital
2. Preoperative Preparation Area
3. Family Waiting Area
4. Anesthesia
5. The Surgery
Page 24 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
YOUR SURGERY
Leaving for the Hospital
Before leaving for the hospital you should:
Bring this handbook.
Be sure you have done your preoperative skin cleansing. Remember no shaving.
Do not eat or drink on the day of surgery.
Brush your teeth but do not swallow the water when you rinse.
Take medications as instructed by your physician or preadmission testing nurse with a small sip of water.
Do not bring your own medications to the hospital.
Wear proper clothing. Wear clothes that are loose fitting and easily removed. (Avoid back zippers and
pantyhose).
Leave jewelry and valuables at home. You may wear your wedding band if it cannot be removed. Remove
all body piercings.
Avoid using perfumes, deodorants, shaving creams or any scented lotions.
Do not wear makeup or nail polish (except clear).
Bring a case with your name on it to hold your eyeglasses, contact lenses, hearing aids, dentures, and any
other items necessary for your hospital stay.
Bring a robe, slippers, walking shoes, and a jogging suit.
Bring your walker or crutches to be checked by the therapist.
Bring your signed skin preparation sheet (page 21 of this handbook).
Bring your CPAP machine and all accessories.
Reporting to the Hospital
You may be asked to arrive approximately two hours before your scheduled surgery.
Report to the Surgery Center located on the ground floor of the hospital. Enter the hospital complex from the
Meadowbridge Road entrance (See map on page 71). Take the first right and look for Surgery Center sign just
past the Emergency Room entrance on the left. Parking is available in this area.
You may want a friend or family member to accompany you.
1 Surgery Day
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 25
YOUR SURGERY
Once you arrive at the hospital, you will enter the Surgery Center where you will receive your hospital
identification bracelet and be escorted to the Operating Room Holding Area. Your clothes will be placed
in a plastic bag and labeled with your name. If you wear dentures, eye glasses or contact lenses, you will
need to remove them at this time.
In final preparation before surgery, the admitting nurse will recheck all of your medical records and
conduct a brief physical examination that includes taking your vital signs (pulse, heart rate, and blood
pressure). You will be asked to empty your bladder. An intravenous line will be started. Your surgeon
will see you to confirm the side to be operated on and may make a mark on that side. You may also
discuss any final questions you have with your surgeon at this time.
Once your final preparation is complete, your family members can visit you in the Holding Area until it
is time for your surgery. They will then be invited to go to the Surgical Waiting Area.
Your family members should
register with the volunteer in charge
of the waiting area so the physician
can locate them after your surgery.
2
3 Surgical Waiting Area
We have a wonderful group of volunteers who staff our Surgical Waiting Area. It is extremely
important that those waiting, register with the volunteers in charge of the waiting area so that the
physician can locate them after your surgery. After surgery, the physician will discuss the results
of your operation with family members and others waiting. Once you have been assigned a
room, your family can go to your room and wait for you there. Please remember that while the
average operative time for joint replacement is 30 minutes to 2 hours, additional time is spent in
post-anesthesia recovery (1 to 3 hours) and in getting you from one location to another. This
means it may be 4 to 6 hours before you are in your room where your family can see you.
Preoperative Preparation Area
Page 26 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
YOUR SURGERY
4 Anesthesia
The different anesthesia options will be discussed with you by the anesthesiologist prior to your surgery.
They will be able to advise you on the anesthetic plan most appropriate for you.
Options include:
1. General Anesthesia:
You are given medications that will keep you asleep for your operation.
These medications produce complete loss of consciousness and perception of pain during surgery.
You will wake up quickly when surgery is over.
2. Combined General and Intraspinal Duramorph (Spinal Anesthesia):
This is the same as above with the addition of an injection into a space in your lower back
surrounding your spinal cord, through which medicine is infused for postoperative pain management.
This allows you to wake up more comfortably and this last for several hours.
The needle and tubing will be removed immediately after injection.
This is the typical method used at Memorial Regional Medical Center.
3. Epidural Anesthesia with Sedation:
This method is not frequently used.
You will receive local anesthetics (numbing medicine) and pain medication through a thin tube
(catheter) placed in the epidural space in your lower back. The tube will remain in for 24 hours.
Local anesthesia blocks the nerves that give you feeling in your legs and hips.
Medications are given with your intravenous fluids before and during your surgery to keep you
sedated and comfortable.
4. Spinal Block:
The anesthesia is injected into the fluid surrounding the spinal cord in the lower part of your back.
This produces a rapid numbing effect that can last for hours, depending on the drug used. Sometimes
spinal anesthesia is not an option if you have had previous extensive back surgery or some other
medical condition.
Regardless of the type of anesthesia you receive, you will be monitored
at a level appropriate for your condition.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 27
5
Our skilled surgeons and operating
room staff begin one of the more than
600 joint replacement surgeries
completed at Bon Secours
Memorial Regional Medical Center
each year.
The Surgery
Going Into Surgery
You will go into the operating room where your hip or knee will be prepared for surgery. The
average length of time for the surgery can be 30 minutes to 2 hours. A dose of the appropriate
antibiotic will be given prior to your surgical incision.
In the Recovery Area
After your surgery is completed, you will be wheeled into the post-anesthetic care unit (PACU)
or recovery room. In the PACU:
Nurses will check your blood pressure, pulse, and breathing.
You will receive medications for pain, as needed and a dose of the appropriate antibiotic.
Nurses will check your bandages and encourage you to take deep breaths and to move your ankles
and feet.
You may have an oxygen tube in your nose, a catheter in your bladder, a small drain tube from your
operative site, and an intravenous line for fluids.
Usually after 1 or 2 hours you will be ready to be moved from the PACU to your hospital room. From
this step forward, you begin your postsurgical recovery. Please inform your family that the length of
time in the recovery room may vary.
YOUR SURGERY
HOSPITAL STAY
Page 28 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
The average length of stay in the hospital after a hip or knee replacement is 2 to 3 days. Everyone is different,
however, and your doctor and care team (not your insurance company) will determine when you are ready to
leave. During your hospital stay, you will receive care from your healthcare team at the Bon Secours
Orthopaedic Institute at Memorial Regional Medical Center. This team will prepare you for your discharge
and return home. This section includes information on your hospital stay and your discharge from the hospital.
Our team will assess you after surgery in order to achieve the goal of returning you home with your family.
1. Post-Surgical Care Intravenous Fluids, Antibiotics
Dressings
Drainage Tubes
Bladder Catheter
Support Stockings (TEDS), Sequential/Compression devices, Foot Pumps
Oxygen
Anticoagulant
Blood Transfusions (if needed)
2. Pain Medications and Pain Management Spinal Pain Medicine
Pain Pills
Intravenous Pain Management
Intra-articular Pain Management
PCA Pump
Pain Scale
3. General Postoperative Schedule
4. Post-Surgical Exercises and Activities Total Hip Care
Total Knee Care
5. Discharge Planning Options
6. Discharge from the Hospital
The Drive Home
7. Recovering at Home
8. Living with your Joint Replacement
9. Additional Information
HOSPITAL STAY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 29
1 Post-Surgical Care
From the post-anesthesia care unit, you will be transferred to your hospital room in the Orthopaedic Institute.
You may wake up feeling groggy and will see the surgical dressings and tubes that were applied during or im-
mediately after surgery. They are a normal part of postsurgical care.
Intravenous Fluids, Antibiotics
You will be provided with fluids and electrolytes through an intravenous tube. It will be removed on the
first postoperative day if you are drinking fluids and your blood count is stable. Antibiotics are also given
intravenously to prevent infection.
Dressings
A compressive dressing will be placed over your wound after surgery. The dressing will be changed on
the first postoperative day and daily thereafter.
Drainage Tubes
A drainage tube may be inserted into your hip or knee during surgery. This tube collects bloody drainage after
surgery. It will be removed on the first postoperative day.
Bladder Catheter
You may have a catheter inserted into your bladder during your surgery to empty your bladder. The urine drains
into a bag. The catheter will be removed within 24 hours after it is inserted into the bladder.
Support Stockings (TEDS), Sequential Compression Devices, Foot Pumps
After hip and knee surgery, sequential compression devices or foot pumps and elastic stockings will be placed
on both your legs to help your blood circulate and to prevent blood clots. You may continue to wear your elas-
tic stockings for 4 to 6 weeks after surgery.
Oxygen
After surgery you may receive oxygen through a tube under your nose. A monitor will be placed on your
finger to measure the amount of oxygen in your blood.
Anticoagulation (Blood Thinner)
To prevent blood clots from developing in your legs which can potentially move to your lungs and cause harm,
you will be given a type of medicine for anticoagulation. You may be given Coumadin, low molecular weight
Heparin (Lovenox), Aspirin, or other anticoagulants which will be prescribed by your surgeon.
Blood Transfusions
During or after a total hip or knee replacement, you may need a blood transfusion. Bon Secours Memorial
Regional Medical Center stocks blood and blood products from the Virginia Blood Services. While there are
risks associated with transfusion of banked blood, these are very low. See Statistics on next page.
Page 30 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
Risk Statistics of Bank Blood (per unit):
AIDS—1 in 2,000,000
Hepatitis C—1 in 205,000
Hepatitis B—1 in 2,000,000
Call Virginia Blood Services at (804) 359-5100 if you have any further questions
regarding blood transfusions.
2 Pain Medications and Pain Management
Spinal Pain Management If you received a spinal injection it will usually last 24-36 hours. It will control your pain from the waist down. Pain Pills On the day of surgery you can begin taking pain pills to manage discomfort. The medications are ordered by your surgeon to be given to you “as needed”. This means that you will need to ask the nurses for your pain medications when you start to have pain. We encourage you to take them before you exercise. Intravenous Pain Management You will have intravenous pain medication available if your pain is not managed by the pain pills. Again, you must ask your nurse for your pain medications when you start having pain.
0 1 2 3 4 5 6 7 8 9 10 no
pain
worst pain you
can imagine
Intra-articular Pain Management In an effort to decrease the need for postoperative narcotics and to manage pain, some surgeons will inject a numbing medication mixed with pain medication directly into the joint space before closing the wound. This method has fewer side effects. If you need additional pain management, you will need to ask the nurse for your pain medication when you start having pain. PCA Pump Another means used to manage pain after surgery is with a patient controlled analgesia pump (PCA). This pump allows you to give yourself pain medication by pressing a button. The button signals the pump to deliver the medication to you through an intravenous tube. The pump is set to limit the amount of medicine dispensed and the frequency so you cannot get too much. This is used when other methods fail.
Pain Scale While you are in the hospital, you will 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 0 to 10, with each number representing a degree of pain. A sample of the pain scale can be seen below.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 31
HOSPITAL STAY
3 General Postoperative Schedule
Day of Surgery
Tubes in place (oxygen, intravenous, bladder catheter, wound drainage catheter, epidural catheter).
More frequent vital sign checks.
Begin ankle pumps; coughing and deep breathing; turning in bed.
Sit at bedside with assistance.
Out of bed (first session of physical therapy).
1 Day After Surgery—Postoperative Day # 1
Physical therapy sessions twice on this day. You will take steps in your room and further if desired.
Bladder catheter and drains removed.
Possible blood transfusion if needed.
Oxygen as tolerated.
Occupational therapy visit.
Care management visit.
Dressing change.
2 Days After Surgery—Postoperative Day # 2
Dressing change.
Physical therapy sessions once or twice today.
Stair climbing training.
Care management visit to finalized discharge plan.
Discharge home.
3 Days After Surgery—Postoperative Day # 3 (if not already discharged)
Further gait training with physical therapist that includes instruction in stair climbing and getting on and off the commode safely.
Discharged to next level of care, i.e. home or appropriate rehabilitation facility.
Page 32 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
4 PostSurgical 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 deep breathe, inhale as deeply as you can and hold while counting to 10. Now exhale all the air.
Repeat this exercise 5 times. Another part of your deep breathing exercise involves the use of a small
plastic device called an incentive spirometer. The spirometer helps you fully expand your lungs.
You will be asked to use your spirometer about 10 times every hour that you are awake.
Ankle Pumps
Immediately after your surgery, you will be encouraged to do ankle pumps every hour. This is done by
moving your ankles up and down and wiggling your toes. Ankle pumps help increase the circulation in
your lower legs.
Turning in Bed
Turning in bed helps prevent skin breakdown, lung congestion, and blood clots.
Hip Replacement: The nurses will assist you to turn to your non-surgical side. To protect your hip
from dislocation and if you have hip precautions your nurse will instruct you to put pillows be-
tween your legs to keep them apart. If your surgeon prescribes hip precautions, to prevent disloca-
tion, you must follow these precautions for the next three months. If you do not have hip precau-
tions, you may move anyway you want to get comfortable.
Knee Replacement: A towel roll will be placed under your ankle for a few minutes during the day
to help straighten your leg. You should not place the towel or pillow directly under your knee
while lying on your back to avoid contractures. Otherwise, you may move your knee any way that
you want to get comfortable.
Ambulation
You may begin walking the day of your surgery. A physical therapist will teach you how to transfer out of
bed and how much weight you can place on your new joint using a walker to move to a chair. You will sit
up for about an hour. Each day, the distance you walk will be increased. You will learn how to walk to the
bathroom, through the hallway, and how to climb stairs.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 33
HOSPITAL STAY
Physical Therapy Exercises
You may be out of bed or take a few steps on the day of your surgery. Participating in physical therapy
strongly influences your recovery. While you are in the hospital, you will receive physical therapy twice
a day. The exercises you learned in the weeks before your surgery will be resumed by physical therapy the
morning after surgery. In the days following, you should progress to more advanced exercises and walking
with the assistance of crutches or a walker. Your therapist will determine which of these is best for you.
Occupational Therapy
These exercises will help you regain your independence in performing everyday activities such as
dressing, bathing, toileting, etc. Your occupational therapist will help you determine your need for
adaptive and durable medical equipment.
Page 34 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
Anterior Total Hip Exercises
On the following pages, you will find exercises you may be instructed to
do before your surgery and during your recovery. Your physician and
physical therapist will advise you on which exercises are appropriate
for you and the number of repetitions needed.
1. Bend ankles up and down,
alternating feet.
You should do this exercise:
Before surgery
In the hospital
At home
2. Slowly tighten muscles on
thigh of straight leg while
counting aloud to 10.
You should do this exercise:
Before surgery
In the hospital
At home
3. Squeeze buttocks muscles as
tightly as possible while
counting aloud to 10.
You should do this exercise:
Before surgery
In the hospital
At home
4. Push heel into bed and hold
while counting to 10.
You should do this exercise:
Before surgery
In the hospital
At home
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 35
HOSPITAL STAY
Anterior Total Hip Exercises
5. Slide one leg out to the side.
Keep knee cap pointing toward
ceiling. Gently bring leg back to
pillow.
You should do this exercise:
Before surgery
At home
6. Slide foot toward buttocks
until it is flat on the bed.
Make sure you lie flat in bed.
You should do this exercise:
Before surgery
In the hospital
At home
7. Step your leg forward to touch your heel
to the ground, then step your leg back,
touching your toe to the ground.
You should do this exercise:
In the hospital
At home
8. Using a counter or sturdy surface for
balance, keep legs shoulder width
apart and toes pointed outward. Kick
leg out and back to side, keeping
knee straight. Do not lean.
You should do this exercise:
In the hospital
At home
Page 36 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
Anterior Total Hip Exercises
9. Take alternating steps.
You should do this exercise:
In the hospital
At home
10. Gently rise up on toes and roll back on
heels.
You should do this exercise:
In the hospital
At home
11. Using a stair or stool, step up then down
with same leg 5 times. Repeat using
other leg to complete set of 10 step-ups.
You should do this exercise:
At home
12. Practice standing up. Return to sitting
position.
You should do this exercise:
In the hospital
At home
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 37
HOSPITAL STAY
1. Bend ankles up and down, alternating
feet.
You should do this exercise:
Before surgery
In the hospital
At home
2. Slowly tighten muscles on thigh of
straight leg while counting aloud to 10.
You should do this exercise:
Before surgery
In the hospital
At home
3. Squeeze buttocks muscles as tightly as
possible while counting aloud to 10.
You should do this exercise:
Before surgery
In the hospital
At home
4. Push heel into bed and hold while
counting to 10.
You should do this exercise:
Before surgery
In the hospital
At home
Posterior Total Hip Precautions & Exercises
On the following pages, you will find exercises you may be instructed
to do before your surgery and during your recovery. Your physician
and physical therapist will advise you on which exercises are appro-
priate for you and the number of repetitions needed.
Page 38 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Posterior Total Hip Precautions & Exercises
5. Stand or sit with pillow between legs,
gently turn legs and feet out.
You should do this exercise:
Before Surgery
In the hospital
At home
6. Slide one leg out to the side. Keep knee
cap pointing toward ceiling.
Gently bring leg back to pillow.
You should do this exercise:
Before surgery
At home
7. Slide foot toward buttocks until it is flat
on the bed. Make sure you lie flat in
bed.
You should do this exercise:
Before surgery
In the hospital
At home
8. Using a counter or sturdy surface for
balance, keep legs shoulder width apart
and toes pointed forward. Slowly ex-
tend one leg back, keeping knee
straight. Do not lean forward.
You should do this exercise:
In the hospital
At home
HOSPITAL STAY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 39
Posterior Total Hip Precautions & Exercises
9. Step your leg forward to touch your heel
to the ground, then step your leg back,
touching your toe to the ground.
You should do this exercise:
In the hospital
At home
10. Using a counter or sturdy surface for
balance, keep legs shoulder width
apart and toes pointed outward. Kick
leg out and back to side, keeping
knee straight. Do not lean.
You should do this exercise:
In the hospital
At home
11. Take alternating steps.
You should do this exercise:
In the hospital
At home
12. Gently rise up on toes and roll back on
heels.
You should do this exercise:
In the hospital
At home
HOSPITAL STAY
Page 40 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Posterior Total Hip Precautions & Exercises
13. Using a stair or stool, step up then down
with same leg 5 times. Repeat using
other leg to complete set of 10 step-ups.
You should do this exercise:
At home
14. Practice standing up. Return to sitting
position.
You should do this exercise:
In the hospital
At home
Afte
r reco
very
from
surg
ery
HOSPITAL STAY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 41
Posterior Total Hip Precautions & Exercises
The purpose of these instructions is to prevent you from having a dislocation
of your new total hip. Even though your new hip will function like a normal
hip joint, it is different from your old hip in that it can be dislocated.
Any total hip replacement, no matter how stable, can be dislocated with everyday activities
if put in an awkward enough position. This is for life!
For the safety of your new hip you should adhere to the following precautions, particularly during the
first three months after surgery. While these precautions can be relaxed after this period, you should
attempt to adhere to them with your general living habits thereafter.
DO NOT flex or force your
hip over 90 degrees. This
happens by bringing your
knee too close to your chest
or by bending forward and
bringing your chest too
close to your knee.
DO NOT reach forward to
the floor from a sitting po-
sition. If you drop some-
thing on the floor while
you are seated, use your
pickup stick.
HOSPITAL STAY
Page 42 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Posterior Total Hip Precautions & Exercises
DO NOT sit on low chairs
or toilets. This may force
the hip to bend beyond 90
degrees.
DO NOT turn your knee inward while sitting or
lying down. Imagine a line drawn on the hip,
through your knee and to your foot. Your foot
should not be outside of that line. When you are
sitting and looking down at your knee, you should
not see your foot outside of your knee. Your foot
should always be in alignment with your knee or to
the inside of your knee when sitting.
DO NOT pivot or twist on
the operated leg. Forcing
your operated leg inward
should be avoided.
DO NOT cross your legs.
This means do not drape
one knee over the other.
When sitting, you may
cross your ankles.
HOSPITAL STAY
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 43
Posterior Total Hip Precautions & Exercises
DO sit with hips higher
than knees.
DO use an elevated commode seat.
DO use a pillow between
your legs when sleeping,
especially when you turn
on the non-operative side
to rest.
HOSPITAL STAY
Page 44 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Posterior Total Hip Precautions & Exercises
Most hip dislocations will occur during the following activities:
Getting on and off the
commode. Getting up and down out of a
low chair or sofa.
Attempting to dry feet or apply lotion
which can cause flexing over too far. Stooping suddently to pick up
an object off of the ground.
Getting in and out of a car. Those with total hip replacement on the left are at higher risk of
dislocation when getting out of the driver’s side, while those with right hip replacement are
more at risk getting out on the passenger side.
Getting in and out of bed.
Falling suddenly or changing positions that causes the hip to be over-flexed.
HOSPITAL STAY
Again, it is very important to follow your hip precautions when performing these activities.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 45
Anterior & Posterior Total Hip Precautions & Exercises
HOSPITAL STAY
Instructions for Transfer In/Out of a Car Using a Walker
Avoid traveling in cars with deep buckets or low seats. You
may need to sit on a pillow to raise the height of the seat.
1. Back up to car. Tuck head down
and place hand on back of car
seat for support while sitting
down.
2. Use only unaffected leg to push
up and back onto seat. Caregiv-
er should assist as needed.
3. Slowly swivel around. Use
slick pillow cover and wear
smooth clothing to make this
easier.
4. Place pillow between knees.
Fasten seatbelt and keep back
reclined.
Page 46 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Total Knee Precautions & Exercises
HOSPITAL STAY
1. DO NOT sit on low chairs. A
chair with arms will allow you
to get up and down easier.
2. DO NOT sit longer than 45
minutes at a time as this may
make muscles around your
knee stiffen.
3. DO stay active. When your physical therapist says you are ready, you should take
daily walks, increasing your distance as your strength improves.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 47
HOSPITAL STAY
DO push yourself to gain maximum motion of your
knee during the first 6 to 8 weeks after surgery. Work
very hard on this and do not be afraid to push through a
moderate amount of pain to accomplish this.
For the exercise above:
1. Sit in your chair with toe against wall.
2. Scoot to the edge of the chair and hold for a few seconds.
Total Knee Precautions & Exercises
Page 48 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
On the following pages, you will find exercises you may be instructed to
do before your surgery and during your recovery. Your physician and
physical therapist will advise you on which exercises are appropriate
for you and the number of repetitions needed.
1. Bend ankles up and down, alternating
feet.
You should do this exercise:
Before surgery
In the hospital
At home 2. Tighten calf muscle or tighten back of
leg and push heel into bed. Hold while
counting to 10.
You should do this exercise:
Before surgery
In the hospital
At home
3. Slowly tighten muscles on thigh of
straight leg while counting aloud to 10.
You should do this exercise:
Before surgery
In the hospital
At home
4. Place a rolled towel under leg. Straight-
en knee and leg. Hold 5 seconds.
You should do this exercise:
Before surgery
In the hospital
At home
Total Knee Precautions & Exercises
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 49
HOSPITAL STAY
5. Bend knee and pull heel toward buttocks.
Hold 5 seconds. Return. Repeat with
other knee.
You should do this exercise:
Before surgery
In the hospital
At home
6. Keeping feet on floor, slide foot of
operated leg back, bending knee.
You should do this exercise:
Before surgery
In the hospital
At home
7. Prop your foot on a foot stool or on a
chair for 5-15 minutes. You should
feel a stretch behind your knee.
You should do this exercise:
In the hospital
At home
8. Gently rise up on toes and roll back on
heels.
You should do this exercise:
In the hospital
At home
Total Knee Precautions & Exercises
Page 50 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
9. Take alternating steps.
You should do this exercise:
In the hospital
At home
10. Step up with surgery leg. Return.
You should do this exercise:
At home
11. Holding a chair for balance, slowly bend
knees. Keep both feet on the floor.
You should do this exercise:
In the hospital
At home
Total Knee Precautions & Exercises
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 51
HOSPITAL STAY
12. With operated leg on top and bottom leg
bent, lift the top leg up towards the ceil-
ing. Keep knee pointing straight ahead
and leg in line with body. Slowly lower.
You should do this exercise:
At home
13. Try to lift operated leg keeping knee as
straight as possible. Do not lift or turn
hips.
You should do this exercise:
At home
14. Bend knee, bringing heel towards but-
tocks. Hold, then straighten. Can use the
non-operated leg to push the operated leg.
You should do this exercise:
At home
Total Knee Precautions & Exercises
Page 52 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY Exercise Log
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 53
HOSPITAL STAY Exercise Log
Page 54 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
Going Down:
1. If using a cane, place cane
down a step.
2. Move weaker leg down first.
3. Follow with other leg to same
step.
1
2
3
Instructions for Going Up and
Down Stairs Using a Cane 1
2
Going up:
1. Step up with stronger leg
first.
2. Move cane and weaker leg up
to same step.
“Up with the
GOOD FOOT;
Down with the
BAD”
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 55
HOSPITAL STAY
5 Discharge Planning Options
It is important for you to know that your orthopaedic surgeon will not discharge you from the hospital until he
or she knows you can safely go to the next level of care. However, the options opened to you at discharge are
sometimes predicated on your type of insurance coverage and other factors. There are four basic options to
consider with regard to discharge.
Home with Home Healthcare
Our goal is to have you return home, continuing your physical therapy and care in a familiar, comfortable
environment. You should have someone stay with you or check in on you frequently for the first 7 to 10 days
after you return home. A nurse and therapist may visit you regularly after discharge from the hospital. The
physical therapist will continue to work with you on the exercises you learned in the hospital and may add new
exercises as well. A nurse will visit your home to draw blood samples if you are sent home on Coumadin. The
dosage will be adjusted by your doctor’s office twice a week as the blood samples are drawn and reported. Your
staples, if you are discharged home with them, will be removed by the nurse or physical therapist after 10 to 14
days, depending on your surgeon’s preference. The Home Health staff will provide instructions on the use of ice
packs and discuss the frequency of their visits.
Home with Relative or Friend Plus Home Healthcare
You will be cared for as described above, except you will stay in someone else’s home.
Skilled Nursing/Assisted Living Facility
For those who will require additional time with a less aggressive program to get back to independent living.
This requires insurance and your surgeon’s approval for admission. The goal is a short stay (5 to 10 days) and
then return home.
Inpatient Rehabilitation Facility
For those who require additional time and can tolerate a more intensive rehabilitation program (3 hours per day,
minimum). The goal is a short stay (5 to 10 days) and then return home. This option must be approved by your
doctor, the rehabilitation facility, and your insurance company.
Equipment You May Need for Home
Equipment you may need once you return home includes:
3in1 elevated commode or raised toilet seat with arms. This is recommended equipment for patients with
hip replacement or bilateral knee replacement; it is optional for patients with single knee replacement.
Walker or crutches (forearm or underarm). If you don’t have these, they can be ordered for you while you
are in the hospital.
Shower chair, bench or other assistive devices such as a long-handle reacher, sponge or shoehorn. These
items are optional. You will be informed about where to obtain these items.
A list of suppliers of durable medical goods and their locations is available if you need it at discharge.
Page 56 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
HOSPITAL STAY
6 Discharge From the Hospital
When you are medically stable and walking with a walker or crutches, you will be ready to return home or,
in some cases, transfer to a rehabilitation facility. Your hospital stay will be approximately 2-3 days.
Prior to going home you will be given:
Prescription for pain medicine
Prescription for blood thinner
Written instructions from your surgeon
Elastic stockings (TEDs)
Home Health and Durable Medical Equipment information
Information on equipment arrangements if necessary
Discharge instructions
For additional information regarding discharge planning you may contact our Care Management
department at (804)764-6702 or our Joint Replacement Center at (804) 764-6036.
The Drive Home
You will need to have a friend or family member pick you up from the hospital on the day you are
discharged. Specific instructions for your drive home can be found below. Plan your discharge around
11:00 am.
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 45 minutes to 1 hour.
See page 45 for Instructions on Transferring In/Out of a Car.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 57
RECOVERING AT HOME
Your recovery period at home may take 6 to 12 weeks. Each day you will be able to resume more and
more activities. Keep in mind, however, that recovery is a gradual process, and we all recover at our
own pace.
This section provides information about the following:
1. Medications
Anticoagulation
Pain Medications
Laxatives and Stool Softeners
2. Precautions
Blood Clots
Infections
3. Diet and Exercise
4. Everyday Activities
5. Restricted Activities
6. PostSurgery Follow-up
Physician Checkup
Page 58 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
RECOVERING AT HOME
1 Medications
Anticoagulation (Blood Thinners)
These medicines are used after your surgery to prevent blood clots in your legs that could potentially
cause thrombophlebitis (blood clot in your leg that causes pain and swelling) or pulmonary embolus
(a blood clot that travels from your leg to your lung). Depending on the judgment of your doctor,
you will be on one of the following medications to prevent this.
Coumadin
Take Coumadin daily at 6:00 pm if prescribed by your doctor. Do not take any aspirin or anti-
inflammatory medicines while you are taking Coumadin. You may take regular or extra strength
Tylenol and pain medications ordered by your doctor unless you are currently taking a medication with
acetaminophen (Tylenol). If you experience any unusual bleeding, notify your physician immediately.
Your Coumadin dose will be adjusted twice a week to
prevent your blood from getting too thick or too
thin. You will have your blood drawn to monitor this
(usually on Monday and Thursday). In the first few
weeks at home, the home health nurse will come to
your house to draw blood. After that, you may need
to go to a laboratory twice a week to have this done.
Coumadin is usually taken for 4 to 6 weeks after your
surgery. Your doctor’s office will call you twice a week
on a specified day (usually Tuesday and Friday) to
adjust your Coumadin dosage. Do not take
Coumadin on these days until your doctor’s office
has called to adjust the dosage. If you have not
heard from your doctor’s office by 3:00 pm, call
your doctor for the adjusted dosage.
Do not take Coumadin on
Tuesdays or Fridays until
your Doctor’s office has
called to adjust the dosage.
If you have not heard from
your Doctor’s office by
3:00 pm, call your doctor.
Lovenox (Low Molecular Weight Heparin)
This medication is administered by subcutaneous injection once or twice a day as prescribed by your
doctor. As with Coumadin, if you experience any unusual bleeding, notify your physician immediately.
Aspirin
Take one coated aspirin in the morning and one in the evening with food, unless your doctor has
prescribed Coumadin or you are allergic.
Other Anticoagulants
A) Xarelto is taken by mouth once a day as prescribed by your physician. If you experience any
unusual bleeding, notify your physician immediately.
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Hospital Stay RECOVERING AT HOME
Pain Medications
Take your prescribed pain medication every 3 to 4 hours if needed. You may need it frequently when you
first arrive home to manage your pain. Gradually, you should be able to increase the length of time between
pills or decrease the number of pills from 2 to 1.
Take pain medication 2030 minutes before the therapist arrives. This will help you to perform your
exercises with minimal pain. After exercising, you may want to apply ice to your incision for about 20
minutes to decrease swelling.
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, Miralax laxative, or Metamucil.
Another option would be to use a Fleets enema.
2 Precautions
Blood Clots
Blood clots can sometimes occur after joint replacement surgery. Taking Coumadin, low molecular
weight Heparin, Aspirin, or other blood thinners as prescribed by your doctor and wearing your support
stockings (TEDS) are important ways to decrease the possibility of clot formation. However, as a
precautionary measure, it is important to recognize the signs of blood clots.
Warning signs of blood clots in the leg:
Increased pain in the calf of your leg
Tenderness or redness
Increased swelling of the thigh, calf, ankle, or foot
If you experience any of these
warning signs, call your doctor
immediately.
If you experience any of these
warning signs, call 911 for
transport to an emergency room
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
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Hospital Stay RECOVERING AT HOME
If you experience any of these
warning signs, call your doctor
immediately.
Infections
The most common causes of infection are from bacteria entering the blood stream through the
mouth, urinary tract, or skin. You should take antibiotics prior to dental work and abdominal or
urinary tract procedures.
Warning signs of infection include:
Persistent fever (oral temperature greater than
100.5 degrees)
Shaking or chills
Increased redness, tenderness, swelling, or drain-
age from incision
Increased pain during activity and at rest
3 Diet and Exercise
Diet
It is important to eat a well balanced diet when you return from the hospital. A healthy diet will supply
you with proper nutrition and help restore your strength. For food choices, follow the suggestions that are
provided under “Nutrition” in the Preoperative section of this handbook on pages 15-17. Remember, it is
normal to experience a loss of appetite for the first few days after surgery. If you find that your appetite is
slightly decreased for the first week or two, try eating five or six small meals spaced throughout the day.
Exercise
For the first few weeks after your surgery, you will be visited by a physical therapist at home. He or she will
help you perform the exercises you learned in the hospital as well as new exercises. Your physical therapist
will discuss the frequency of their visits, tell you which exercises you should do, and add exercises as
appropriate.
If any signs of chest pain, shortness of
breath or unusual heart beat,
DIAL 911.
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Hospital Stay RECOVERING AT HOME
4 Everyday Activities
Bathing
Follow your surgeon’s instructions regarding showering and bathing. If you have a tub shower,
you may want to use a shower bench or chair. You may find a handheld shower or long-handled
sponge to be helpful to wash your feet, back, and legs.
Walking
Take short walks about every two hours, increasing your distance each day. Always use your walker
or crutches and avoid overextension. Do not walk on uneven surfaces such as lawns or gravel.
Climbing Stairs
If you must climb stairs, go up the stairs using your good leg first. Go down stairs placing your bad
leg first (See page 54 for instructions on how to climb stairs using a cane.)
Sitting
Use chairs that have arms, backs, and firm seats. You need arms to help lift yourself out of the chair.
Be cautious about sitting on low stools, low chairs, or low toilets. To maintain good circulation,
pump your ankles up and down after sitting in one spot for more than 30 minutes.
Reaching
Use your long-handled adaptive equipment for reaching objects from the floor and for dressing.
Be cautious when bending over to pick up any objects.
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Hospital Stay RECOVERING AT HOME
5
6
Restricted Activities
Post-Surgery Follow-up
DO NOT do any of the following until you see
your doctor at your first postoperative appoint-
ment within 2 to 4 weeks after your surgery:
Return to work.
Drive a car.
Participate in sports.
Take a tub bath.
Physician Checkup
Your first postoperative visit will generally be 2 to 4 weeks
after your surgery. You should schedule your appointment
as soon as you return home from the hospital if this has
not already been scheduled by your doctor on your discharge
instructions.
Besides a thorough checkup, you will also receive a new set of
instructions for care and a list of activities that you can now en-
gage in. Your next visit will be determined by your surgeon and
the progress you have made in physical therapy.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 63
Hospital Stay LIVING WITH JOINT REPLACEMENT
By having a hip or knee replacement, you join more than 1 million Americans who undergo
this surgery every year. More than 95% of them experience a dramatic reduction in pain and
renewed ability to participate and enjoy physical activity. Still, a replacement hip or knee is
not a normal hip or knee. This section discusses your lifestyle with your joint replacement.
1. Lifetime Activities
Recommended
NOT Recommended
AVOID Entirely
2. Medical and Dental Care
Medical Follow-up
Dental Visits
Metal Detectors
Infection Protection
Page 64 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Hospital Stay LIVING WITH JOINT REPLACEMENT
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
Biking
Walking
Golf
Hunting
Low impact and water aerobics
Stair Climber
Dancing
Bowling
Fishing
Gardening
Elliptical Stepper/Nordic Track
Light lower extremity weights
Not Recommended
Basketball
Skiing
Weightlifting with weights that exceed 50 lbs.
Racquetball
Tennis (Doubles okay, NOT singles)
Softball
Squash
Baseball
Jogging or Running
Avoid Entirely
Contact sports
Jumping sports
High impact aerobics
CHECK WITH YOUR
PHYSICIAN REGARDING
ANY OF THESE
ACTIVITIES!
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Hospital Stay LIVING WITH JOINT REPLACEMENT
2 Medical Follow-up and Dental Care
Medical Follow-up
Your hip or knee should be evaluated at 5 year intervals for the rest of your life. Although
90% of replacements function well for more than 10 years, the implant may wear with increasing years
of use.
You may need to take antibiotics prior to urinary tract or abdominal surgery/procedures.
Dental Visits
Because infections commonly enter the body through the mouth, you must take certain precautions
before having dental work.
Tell your dentist that you have had joint replacement surgery.
Take an antibiotic, which will help prevent bacteria from entering your blood stream. Your surgeon or
your dentist may prescribe the antibiotic.
For dental work, antibiotics are recommended for two years following your surgery and for life if you
are diabetic or susceptible for infection.
Metal Detectors
Your new hip or knee may activate metal detectors used for security in airports and some buildings.
Tell the security agent about your joint replacement and carry the card confirming that you have an ar-
tificial joint. You will be scanned in airports with a scanning device as a security precaution.
ALL PATIENTS WILL BE ISSUED A JOINT REPLACE-
MENT IDENTIFICATION CARD AS A REMINDER TO
BE CAREFUL WITH INFECTION
Page 66 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Hospital Stay LIVING WITH JOINT REPLACEMENT
Infection Protection
To protect yourself and your joint replacement, it is very important that you know how to
prevent infection. Your doctor will use special measures to prevent infection in your joint
replacement. When you arrive for your operation, your doctor will order an antibiotic medicine.
This medicine will be given to you before and a few doses after your operation. After you go
home, you must always remember that it is possible to develop an infection in your joint re-
placement. When germs enter your body, they can be carried through your body by the blood
stream and could settle in your joint replacement. If you need dental work or special procedures
i.e. urinary tract or abdominal surgery, you may need an antibiotic before the procedure.
A LIFETIME PRECAUTION TO STOP INFECTION
If you need dental work or a special procedure or surgery of any kind, you must
tell your dentist or doctor that a joint replacement is in place. An antibiotic will
be given to prevent any new infection from going to the new joint.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 67
Hospital Stay ADDITIONAL INFORMATION SECTION
This section provides you with:
1. Commonly Asked Questions
2. Common Complaints
3. Important Phone & Resource Numbers
4. Map and Directions
5. Note pages
Page 68 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Hospital Stay ADDITIONAL INFORMATION SECTION
Commonly Asked Questions
Q: How long do I have to wear stockings (TEDS) and why?
A: They need to be worn for 46 weeks after surgery to prevent blood clots.
Q: How long do I need to maintain hip precautions?
A: If your doctor says that you have hip precautions they will be for approximately 3 months. However,
you should always avoid the dangerous combinations of flexion and internal rotation of the operated
leg, or hyper-extension and external rotation.
Q: When can I start driving?
A: About 46 weeks after surgery.
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 prosthesis last?
A: An average of 10 to 20 years, depending on your age, weight, and activity level.
Q: When can I take a shower or tub bath?
A: See your Discharge Instruction sheet for specifics regarding a shower and tub bath.
Q: When can I start crossing my legs and sleep without a pillow between them after hip
replacement?
A: Consult your physician for instructions about crossing your legs and sleeping without a pillow after
your hip replacement.
Q: What should I do if my leg swells?
A: It is not unusual to have a moderate amount of swelling in the leg on the operated side. If the
swelling increases after you have returned home, contact your surgeon. You may need a test for
blood clots.
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 69
Hospital Stay ADDITIONAL INFORMATION SECTION
Common Complaints
COMMON SYMPTOM RECOMMENDED ACTION
Difficulty sleeping You may take Tylenol PM. Remember that some prescription
pain medications have acetaminophen in them. Do not take
more than 4,000 milligrams of acetaminophen (Tylenol) per
day.
Drink warm milk before bedtime.
Lack of appetite Eat small, frequent meals.
Drink Carnation Instant Breakfast or Ensure.
Constipation You may use Milk of Magnesia, Dulcolax tabs, Miralax, sup-
pository or a Fleets enema.
You may use a stool softener.
Swelling Apply an ice pack 20 minutes after exercise.
If swelling does not go down overnight, notify your physician.
Numbness along outer side of the knee incision This is normal. No action is needed.
Drainage from incision Change bandage daily.
Leave bandage off when the all drainage stops.
If drainage continues, notify your physician.
Clicking with knee bending Occasionally, you may feel soft clicking of metal and plastic.
This is normal. No action is needed.
Activate metal detector alarm Your knee or hip may activate metal detectors required for
security in airports. Tell the security agent about your joint
replacement.
Mood swings/feeling “blue” Mood swings are normal. These sad feelings should improve
with time. They tend to come from the combination of sur-
gery, anesthesia, pain, and emotional factors in about 20% of
patients. Call your physician if your emotional recovery is not
progressing.
Call your physician if any of these symptoms persist
Page 70 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Hospital Stay ADDITIONAL INFORMATION SECTION
Phone Numbers & Resource Numbers
Your Surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________
Your Family Physician . . . . . . . . . . . . . . . . . . . . . . . _____________________
Home Physical Therapy . . . . . . . . . . . . . . . . . . . . . . _____________________
Bon Secours Orthopaedic Institute at Memorial Regional
Medical Center . . . . . . . . . . . . . . . . (804)764-6036
Orthopaedic Institute Patient Rooms . . . . . . . . . . . . . (804)764-Room#
Orthopaedic Patient Educator . . . . . . . . . . . . . . . . . . (804)764-6700
Orthopaedic Nurse Manager . . . . . . . . . . . . . . . . . . . (804)764-6730
Care Management. . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6702
Bon Secours Memorial Regional Medical Center . . . . . . . (804)764-6000
Surgery Center and Waiting Area. . . . . . . . . . . . . . . . . (804)764-6913
Gift Shop. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6412
Nutritional Services. . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6067
Pastoral Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6125
Patient Representative. . . . . . . . . . . . . . . . . . . . . . . (804)764-6437
Virginia Blood Services . . . . . . . . . . . . . . . . . . . . . . (804)359-5100
OR . . . . . . . . (800)989-4438
Volunteer Services. . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6044
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 71
Hospital Stay ADDITIONAL INFORMATION SECTION
Map & Directions
Page 72 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center
Hospital Stay ADDITIONAL INFORMATION SECTION
Notes
ADDITIONAL INFORMATION SECTION
Notes
Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 73
8260 Atlee Road
Mechanicsville, VA 23116
(804) 764-6000 Created: August 2012 / DLT & ELG
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