Joint  Replacement  101

Ohio  Valley  Medical  Center  and  East  Ohio  Regional  Hospital  Pre-­‐surgical  Class  for  Total  Joint  Replacements

“Ohio  Valley  Medical  Center

 and   East  Ohio  Regional  Hospital

are  both      certified  by  the  Joint  Commission  as  

“Center’s  for  Excellence”   in  total  hip  and  total  knee  replacement  

surgery”

“Gold  Seal  of  Approval”

Agenda

• General  information  • Preparing  for  surgery  • Understanding  your  surgery  • Hospital  expectations  • Rehabilitation  • Recovery  at  home

Our  Goal…

To  get  you  back  to  the  activities  and  lifestyle  you  are  used  to  and  to  do  so  as  quickly  and  safely  as  possible.

Preparing  for  your  Surgery

                             Plan  Ahead  Make  sure  you  have  someone  to  help  you  get  home  from  the  hospital  and    during  the  first  week  at  home.  

Have  ready-­‐to-­‐eat  or  reheatable    meals  ready  if  you  do  not  have  a    full-­‐time  caregiver.

Preparing  for  your  Surgery

Preparing  Your  Home

Preparing  for  your  Surgery                                                                            Preparing  Your  Home

Preparing  for  your  Surgery

•  Eat  a  healthy  diet  •  Increase  your  protein  intake  •  Maintain  a  normal  glucose        level  

In  the  weeks  leading  up  to  your  surgery…

Preparing  for  your  Surgery

• It  may  also  be  a  good  idea  to  discuss  beginning  a  fitness  program  with  your  physician  in  the  weeks  leading  up  to  your  surgery.      

• You  will  need  to  get  your  physician’s  approval  before  starting  any  fitness  program.  

• You  may  then  resume  your  fitness  program  following  completion  of  your  post-­‐surgical  rehabilitation.  

“Surgical  Clearance”  Must  be  obtained  before  surgery        

Preparing  for  your  Surgery

Preparing  for  your  Surgery

Medication  Management  

•Please  discuss  your  medication  regimen  with  your  doctor  or  pharmacist  prior  to  your  surgery  •Our  Preoperative  Nurses  will  let  you  know  which  medications  to  take  on  the  day  of  surgery

Preparing  for  your  Surgery

                                                           Labs  •Blood  work  must  be  completed.  •Chest  x-­‐ray  and  EKG  are  required  prior  to  surgical  procedures  and  will  be  ordered  by  you  physician

Preparing  for  your  SurgeryWhat  to  bring  to  the  hospital  

 

Preparing  for  your  SurgeryWhat  NOT  to  bring  to  the  hospital    

Preparing  for  your  Surgery

Communication  

Notify  your  surgeon  if  there  is  any  change  in  your  condition  (illness,  injury,  etc.)  in  the  days  before  surgery.    

Preparing  for  your  SurgeryThe  Night  Before  Surgery  

•Do  not  eat  of  drink  anything  after  midnight  including  water,  chewing  gum  or  mints/candy  unless  you  are  instructed  to  take  any  medications  with  a  sip  of  water.  •You  may  brush  your  teeth  or  rinse  your  mouth  as  frequently  as  you  wish,  but  spit  and  do  not  swallow.    •Please  refrain  from  smoking,  smokeless  tobacco  and  alcohol  for  24  hours  prior  to  surgery.

Expectations

Day  of  Surgery  •Report  to  the  main  Registration  Desk  in  the  front  lobby  of  the  hospital.  •You  will  be  registered  and  an  identification  wristband  will  be  placed  on  your  wrist.  •Surgery  times  are  subject  to  change  and  you  will  be  notified  if  there  has  to  be  a  change.  •Please  do  not  wear  contact  lenses  on  your  surgery  day;  you  may  wear  your  glasses.

ExpectationsHolding  Room  

•Introduction  to  nursing  staff  •Height  and  Weight  •Change  into  surgical  gown  •Confirmation  of  identity,  surgery  and  surgical  site  •Prepare  for  surgery  •Coordinated  review  of  medical/surgical  history

Expectations

                                                                     Anesthesia  •You  will  have  the  chance  to  meet  your  anesthesiologist  and  he  or  she  will  explain  how  your  anesthesia  will  work.  •An  antibiotic  will  be  administered  by  the  anesthesiologist.  •Medication  to  relax  you  will  be  given  prior  to  going  into  surgery.

Understanding  Your  Surgery• Total  Hip  Replacement

• Total  Knee  Replacement

Understanding  Your  Surgery

Healthy  Knee

Understanding  Your  Surgery

Total  Knee  Replacement

Preparing  for  Surgery

Total  Hip  Replacement

Preparing  for  Surgery

Total  Hip  Replacement

Day  of  Surgery

ExpectationsPost  Anesthesia  Care  Unit  (PACU)  

You  will  awaken  with:  •An  oxygen  mask  on  your  face  •Blood  pressure  cuff  on  your  arm  •Pulse  oximeter  on  your  finger  •An    IV  in  your  arm  •A  surgical  dressing  covering  the  incision  •Compression  stockings  on  your  legs  (TED  Hose)  •Sequential  compression  device  (SCD)  •You  may  have  a  catheter  in  your  bladder  •You  may  have  a  drain  from  your  incision  •You  may  have  a  nerve  block  in  your  inner  thigh

ExpectationsPost  Anesthesia  Care  Unit  (PACU)  •You  will  receive  pain  medication  and  possibly  some  additional  medications  as  they  are  needed  •Your  family  will  be  notified  that  surgery  is  complete  and  the  doctor  will  answer  any  of  their  questions  •You  will  remain  in  the  PACU  until  your  vital  signs  are  stable  and  you  are  awake  (about  1  hour).    At  that  point  you  will  be  transferred  to  the  nursing  unit.

Expectations

Orthopedic  Unit  Our  nursing  team  will:  •Orient  you  with  your  room  and      the  orthopedic  unit  •Check  vital  signs  and  circulation  •Assess  your  surgical  site  •Help  you  manage  your    pain  •Manage  your  care  to  expedite    recovery

Expectations          Pain  Management  

We  want  to  manage  your  pain  well  so  you  can:  ➢Move  with  less  difficulty  ➢Get  in  and  out  of  bed  ➢Participate  in  therapy  ➢Rest  soundly  and  comfortably  

✓It  is  YOUR  RESPONSIBILITY  to  request  pain  medication.  ✓Do  not  wait  until  your  pain  is  bad  before  requesting  pain  medication.  ✓We  also  use  a  Cryocuff,  which  is  similar  to  a  cold  pack,  to  help  manage  pain.

     Cryocuff

Preventing  ComplicationsCoordinated  Effort  

Our  team  will  work    hard  to  manage      ➢Nausea  and  constipation  by  medication  

And  to  prevent:  ➢Pneumonia  ➢Blood  Clots  ➢Infection  ➢Falls  ➢Knee  contracture  ➢Hip  Dislocation

Rehabilitation

Goals  ✓Get  in  and  out  of  bed  independently  ✓Get  on  and  off  a  chair  and  toilet  safely  ✓Walk  safely  with  an  assistive  device  (e.g.  walker,  cane)  ✓Dress  yourself  with  minimal  assistance  ✓Go  up  and  down  stairs  safely  ✓Return  home  after  surgery

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Posterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Posterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Posterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Anterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Anterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Hip  Replacement  –  Anterior  Approach

RehabilitationJoint  Specific  Goals  

Total  Knee  Replacement  ➢NEVER  put  a  pillow  under  your  knee  ➢Fully  straighten  your  knee  ➢Bend  your  knee  to  90  degrees

RehabilitationWhat  to  Expect  

➢Physical  Therapy          2  times  per  day  ➢Occupational  Therapy          1  time  per  day  ➢Out  of  bed  for  all  meals

RehabilitationPhysical  Therapy  

•Functional  Goals  • Moving  in  bed  • Getting  in/out  of  bed  • Sitting  down  and  Standing  up          from  toilet  or  chair  • Walking  • Stair  climbing  

•Range  of  Motion  (ROM)  •Strengthening  •Decrease  pain,  stiffness  and  swelling

Rehabilitation

Continuous  Passive  Motion  machine  (CPM)

RehabilitationOccupational  Therapy  

•Getting  dressed  and  undresses  •Toileting  •Bathing  (practice)  •Grooming  •Use  of  adaptive  Equipment  •Safety

Hospital  DischargeGoing  Home  

➢It  is  our  goal  to  get  you  back  home  within  2  to  3  days  after  your  surgery  ➢What  if  you’re  not  ready?  • Skilled  Nursing  Facility  • In-­‐patient  Rehab  

Care  Manager  will  coordinate  care

Recovery  at  HomeHome  Health  

Registered  Nurse:  •Inspect  surgical  incision  and  change  dressing  •Pain  and  medication  management  •Ongoing  physical  assessment  •Draw  blood  (if  needed)  •Available  24/7  Physical  Therapist:  •Progress  strengthening,  range  of  motion  and  walking  •Ensure  safety  and  mobility  throughout  home  environment  •Promote  safe  return  to  community  (out  of  home)  Occupational  Therapy:  •Progress  performance  of  activities  of  daily  living  (e.g.,  getting  dressed,  bathing,  toileting)  •Assess  home  safety

Recovery  at  HomeWound  Care  and  Preventing  Infections  

➢Keep  the  incision  clean  and  dry  • No  showering  until  the  physician  says  so!  • Wash  your  hands  with  soap  and  water  or  use  a  hand  

sanitizer  before  and  after  changing  your  dressing.  

➢Check  your  surgical  site  daily  for  these  signs  of  infection:  

• Redness,  tenderness,  swelling  in  the  tissue  surrounding  the  incision  

• Leg  that  is  warm  to  the  touch  or  persistent  fever  (101  degrees  orally)  

• Drainage  that  looks  like  “pus”  or  smells  “bad”  or  discharge  that  has  changed  in  color  or  odor  

• Increased  pain  with  both  activity  and  at  rest  that  is  not  controlled  by  pain  medications  

➢Notify  your  home  health  nurse  if  you  develop  any  of  these  signs  ➢Eating  healthy  foods  will  also  aid  in  the  healing  of  your  incision

Recovery  at  Home

Medications  ➢A  list  of  the  medications  that  you  will  be  taking  at  home  will  be  given  to  you  prior  to  discharge  with  instructions.  ➢Continue  your  medications  at  home  as  prescribed  by  your  surgeon  and  primary  care  physician.  ➢If  your  pain  medication  is  not  effective  in  relieving  your  pain,  or  you  experience  unpleasant  side  effects,  do  not  hesitate  to  call  your  home  health  nurse  or  surgeon.

Recovery  at  HomeBlood  Clot  Prevention  

➢If  the  white  stockings  (TEDS)  are  provided  at  discharge,  wear  them  until  your  follow-­‐up  appointment  with  the  doctor;  but  remove  them  once  a  day  to  bathe  and  inspect  your  skin  for  breakdown.  ➢Continue  your  exercises,  the  foot  pump  exercises  can  be  done  anytime  and  should  be  done  often.  ➢Be  mobile,  do  not  sit  for  long  periods  of  time  (greater  than  1-­‐2  hours).

Recovery  at  Home    Blood  Clot  Warning  Signs  

➢Increase  pain  in  the  calf,  ankle  or  foot  ➢Increased  swelling  in  the  calf,  ankle  or  foot  ➢Tenderness  or  redness  above  or  below  the  knee  ➢The  area  is  warm  to  the  touch  

Notify  your  home  health  nurse  or    surgeon  immediately  if  you  develop    any  of  these  signs!

Our  Goal

To  get  you  back  to  the  activities  and  lifestyle  you  are  used  to  and  to  do  so  as  quickly  and  safely  as  possible.

From  all  of  us  here  at  Ohio  Valley  Medical  Center  and  East  Ohio  Regional  Hospital  thank  you,  for  choosing  us.

Ohio  Valley  Medical  Center and  

East  Ohio  Regional  Hospital

“Where  Caring  is  a  Way  of  Life!”