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Before SurgeryBefore Surgery

Prepare Home ◦Remove rugs, railing for the stairs, bath bench, toilet seat riser, or grab bars.

Walker/Crutches/CaneMake sure to set up a ride home

after discharge and a caregiver for approximately 1 week.

Will receive two phone calls before surgery◦ Insurance confirmation - demographic

information◦ Nurse registration – to review medical history

and medications and confirm scheduled procedure Any patient on a blood thinner needs to speak with

their primary doctor and surgeon regarding use 1-2 weeks before surgery

Overnight bag◦ All labeled medications in the prescription

bottle (except pain medication), loose fitting shoes, and comfortable clothes

◦ CPAP if used for sleep apnea

Day of SurgeryNothing to eat or drink after

midnight including coffee, water, gum, hard candy, etc.

Shower as instructed the night before/morning of surgery.

Medications as instructed during pre-procedure phone call with nurse.

After SurgeryAfter Surgery Surgeon will speak with family

after the procedure. Expect to be in recovery for 1-2

hours after surgery. Wi-Fi is available within the

building

Overnight StayExpect to stay 1-3 days

◦ See joint recovery plan◦ Family allowed overnight; one visitor meal

provided per day

Equipment Reason

Ted hose (white socks) Prevent blood clots

Athrombics (leg massage) Prevent blood clots

Ice (polar cooler or packs) Decrease swelling/pain

Incentive spirometry (volurex)

Prevent respiratory complications

Continuous Passive Motion (CPM)

Assist with range of motion for Total Knees

PainGoal: Well Controlled Pain Levels

◦ Scale 0-10◦ Pain should be tolerable but not likely pain

free.◦ Be proactive, it is easier to control pain than

catch up to severe pain.

◦ An anesthesiologist will discuss pain control options

prior to surgery.

Common MedicationsNarcotics Additional

Pain Medications

Antibiotics

Morphine Dilaudid Tramadol Oxycodone Hydrocodone

◦Possible Side Effects

ConstipationNauseaItchingDrowsinessDizziness

Tylenol Gabapentin Celebrex Toradol Vistaril Valium Naropin Exparel

◦Side effects vary based on the medication given.

• Ancef• Clindamyci

n• Vancomyci

n• Keflex

• Possible Side Effects:

• Rash• Itching• Flushed

face

Common Medications Cont.

Blood Thinners

Nausea & Vomiting

Prevention

Stool Softners

&Laxatives

Fragmin then Aspirin Xarelto then AspirinCoumadinAspirin

◦Possible Side Effects:

Mild bleedingBruising

ZofranBenadrylScopolamine PatchDecadronReglanPhenergan

◦Possible Side Effects:

DrowsinessDizzinessConstipation

ColaceMiralaxSennaMilk of MagnesiumPrunes or Prune juice

◦Possible Side Effects:

AbdominalCrampingDiarrhea

Physical Therapy:Physical Therapy:

Therapy begins the day of or day after surgery, depending on your doctor. You are expected to participate in 2 sessions per day.

Total Knee Replacement

Patients who have had a total knee replacement will begin outpatient therapy within a few days of leaving the hospital.

◦If you are able to schedule your appointment before you come for surgery, you will have a better chance of getting the date and time you prefer.

◦A prescription for therapy (2-3 times a week) will be given to you prior to discharge.

Total Hip ReplacementTotal Hip ReplacementStandard Total Hip

◦Hip precautions – to be followed for 8 weeks unless your surgeon specifies otherwise.

Do not bend your hip into more than 90 degrees of flexion (right angle).

Do not cross your legs, either at the knee or the ankle.

Do not let your toes (hip) rotate inward.

Anterior Total Hip◦ No precautions to follow, unless

specified by your surgeon.

o Outpatient therapy will be ordered after your first follow up appointment if needed.

Post-Op ActivitiesPost-Op ActivitiesPlease consult your physician

with specific questions about returning to activities.

Driving – per physician guidelinesKneeling – 8 weeksDancing – 8 weeksBicycling – 4-8 weeksGolfing – 6-8 weeks

ExercisesExercisesQuad Sets – squeeze top of thigh,

pushing knee flat. Hold for 10 seconds. Repeat 20 times.

ExercisesExercisesHamstring sets – tighten muscles

on back of thigh, digging heel down and back. Hold 10 seconds. Repeat 20 times.

ExercisesExercisesHeel slide – bend knee as far as

you comfortably can. Hold 5 seconds. Repeat 20 times.

ExercisesExercisesShort arc quad – with a rolled

towel or coffee can under knee, tighten muscles on top of thigh and straighten knee. Hold 10 seconds. Repeat 20 times.

ExercisesExercisesStraight leg raise – keeping knee

straight, lift leg 6-8 inches off bed. Hold 5 seconds. Repeat 20 times.

ExercisesExercisesLong arc quad – from a seated

position, straighten knee. Hold 5 seconds. Repeat 20 times.

Arm ExercisesArm ExercisesChair push-upsBicep curlsShoulder raisesSide (lateral) shoulder raises

Frequently Asked Frequently Asked QuestionsQuestionsWhy do I have to start therapy so

soon?How often/how long will I have to

go to outpatient therapy after my knee replacement?

Do I still have to do my exercises at home after I start therapy?

Can I just do my exercises at home and skip outpatient therapy?

FAQ, continuedFAQ, continuedWhy do I need someone to stay

with me after I leave the hospital?

How long will I need a walker/crutches?

Will we practice the stairs?Will I see my doctor before I

leave?

Discharge PlanningDischarge PlanningA RN will speak with you either

the day of or day after surgery reguarding any needs or plans for at home.

Assist with ordering equipmentAssist with setting up Home

Health Care or Rehab services if needed.

Please don’t compare your surgery to anyone else’s or even to a

previous surgery that you’ve had.

Each surgery is unique and each person heals differently.

Visit www.sfsh.com for PowerpointClick on surgery/total joint academy