i

YourReferenceGuideforTotalJointReplacementTheOutpatientSurgeryCenter

AaronSalyapongse,MD

ii

TableofContents GENERALINFORMATION..................................................................................................................................1WELCOME........................................................................................................................................................................................3PURPOSEOFTHENOTEBOOK.......................................................................................................................................................4USINGTHISNOTEBOOK................................................................................................................................................................4OVERVIEWOFTHEPROGRAMATTHEOUTPATIENTSURGERYCENTER.............................................................................4ROLEOFTHESURGERYSCHEDULER...........................................................................................................................................5 FREQUENTLYASKEDQUESTIONSSPECIFICTOTOTALHIPREPLACEMENTSURGERY.........................................7FREQUENTLYASKEDQUESTIONSSPECIFICTOTOTALKNEEREPLACEMENTSURGERY....................................11GENERALFREQUENTLYASKEDQUESTIONSSPECIFICTOTOTALJOINTREPLACEMENTSURGERY...................15 PRE-OPERATIVECHECKLIST.........................................................................................................................19OBTAINMEDICALANDANESTHESIACLEARANCE.................................................................................................................21OBTAINLABORATORYTESTS.....................................................................................................................................................21STARTPRE-OPERATIVEEXERCISES.........................................................................................................................................21REGISTER/ATTENDPRE-OPERATIVEINFORMATIONALCLASS...........................................................................................21

Read“AnesthesiaandYou”(Appendix)....................................................................................................................2110DAYSBEFORESURGERY.......................................................................................................................................................21

Pre-operativeVisittotheSurgeon..............................................................................................................................21StopMedicationsthatIncreaseBleeding.................................................................................................................22

DAYBEFORESURGERY................................................................................................................................................................22FindOutYourArrivalTimeattheSurgeryCenter..............................................................................................22TheNightBeforeSurgery...............................................................................................................................................22

DAYOFSURGERY..........................................................................................................................................................................22ArrivalTime..........................................................................................................................................................................22WhattoBringtoTheOutpatientSurgeryCenter................................................................................................22SpecialInstructions...........................................................................................................................................................23

DAYOFSURGERYEXPECTATIONS...............................................................................................................25WHATHAPPENSTHEDAYOFSURGERY..................................................................................................................................27RECOVERYROOMCARE..............................................................................................................................................................27IFYOUAREGOINGDIRECTLYHOME.......................................................................................................................................2823HOURSTAY:OVERNIGHTSTAY.........................................................................................................................................28POSTOPERATIVECARE....................................................................................................................................29CARINGFORYOURSELFATHOME.............................................................................................................................................31

Temperature.........................................................................................................................................................................31CONTROLLINGYOURDISCOMFORT..........................................................................................................................................31BODYCHANGES............................................................................................................................................................................32BLOODTHINNERS........................................................................................................................................................................32

Enoxaparin(Lovenox®)..................................................................................................................................................32Aspirin.....................................................................................................................................................................................33XARELTO®............................................................................................................................................................................33

CARINGFORYOURINCISION......................................................................................................................................................33DressingChangeProcedure(ifindicated)...............................................................................................................33

RECOGNIZINGANDPREVENTINGPOTENTIALCOMPLICATIONS..........................................................................................33Infections................................................................................................................................................................................33PreventionofInfection.....................................................................................................................................................33

iii

BloodClotsinLegs.............................................................................................................................................................33PreventionofBloodClots................................................................................................................................................34PulmonaryEmbolus..........................................................................................................................................................34PreventionofPulmonaryEmbolus.............................................................................................................................34

POSTOPERATIVEEXERCISES,GOALSANDACTIVITYGUIDELINES......................................................................................35ActivityGuidelines..............................................................................................................................................................35

ACTIVITIESOFDAILYLIVING........................................................................................................................37PRECAUTIONSANDHOMESAFETYTIPS..................................................................................................................................39

HowtoConserveYourEnergy......................................................................................................................................39HowtoPreventInfectionsPostRecovery................................................................................................................40WhattoDoforExercisePost-Recovery....................................................................................................................40

APPENDICES........................................................................................................................................................41EXERCISEYOURRIGHT(LIVINGWILL)...................................................................................................................................42

PutYourHealthCareDecisionsinWriting.............................................................................................................42WhatareAdvanceMedicalDirectives?.....................................................................................................................42TheDifferentTypesofAdvancedDirectives...........................................................................................................42

ANESTHESIAANDYOU................................................................................................................................................................43Whoaretheanesthesiologists?....................................................................................................................................43Whattypesofanesthesiaareavailable?..................................................................................................................43WillIhaveanysideeffects?............................................................................................................................................43Whatwillhappenbeforemysurgery?......................................................................................................................43Duringsurgery,whatdoesmyAnesthesiologistdo?...........................................................................................44WhatcanIexpectaftertheoperation?....................................................................................................................44MayIchooseanAnesthesiologist?..............................................................................................................................44

TECHNIQUESANDMETHODSOFRELAXATIONAFTERSURGERY.........................................................................................45RELAXATIONTECHNIQUES.........................................................................................................................................................45

MethodsofRelaxation......................................................................................................................................................45 NOTES......................................................................................................................................................................47

1

GENERALINFORMATION

3

Welcome ThankyouforchoosingDr.Salyapongseandhisteamforyourupcomingsurgery.Ourgoalistohelpreturnyoutoahigherleveloffunctionwithyournewprostheticjoint.We’veassembledthisnotebooktoprovideanintroductiontojointreplacementsurgery,aguideforpreparation,andareferenceforyourpost-operativerehabilitation.

IntheUnitedStates,over600,000peopleelecttohavetotaljointreplacementsurgeryeachyear.Itismostcommonlyrecommendedforpatientswhenpainintheirjointhasbecomesevere.Hipandkneediseasecanaffectindividualsranginginagefrom16to106:wehavetakencareofthemall.Althoughageisanimportantfactorindecidingwhenyoushouldconsidersurgery,it’snotthemostimportant.Whenyourlifehasbeenseverelyaffectedbyabadhiporknee,it’simportanttodiscusssurgerywithyourprimarycaredoctorandyoursurgeon;itmaybethebestoption.

Agoodindicatorthatyoumaybereadyforjointreplacementsurgeryiswhenpaininterruptsdailyactivities,suchaswalking,dressing,driving,sleeping,exercising,participatinginrecreationalactivities,andworking.Somepeoplemayevenhavepainsthatareseverewithrestorduringsleep;thissuggestsaseriousproblem.Somemayexperiencestiffnessinthejointthatlimitstheabilitytomoveorlifttheleg.Jointreplacementsurgeryaimstorelievethisjointpain,whilealsohelpingrestoreyourindependencesoyoumayreturntoworkandotherdailyactivities.

Totaljointreplacementpatientsrecoverquickly.Patientscanexpecttobeabletowalkthedayofsurgery.Generally,patientsareabletoreturntodrivingintwotofourweeks,danceinfourtosixweeks,andgolfinsixtotwelveweeks.

Dr.Salyapongseandhisteamhavedevelopedacomplete,plannedcourseoftreatment.Webelievethatyouplayakeyroleinmakingyourrecoveryasuccess.Ourgoalistoinvolveyouandyourfamilyinyourtreatmentfromstarttofinish.Thispatientnotebookwillgiveyouguidanceforasafeandsuccessfuloutcome.

Yourteamincludesphysicians,physicianassistants,patientcarecoordinators,nurses,nursingaides,andphysicaltherapiststrainedintotaljointcare.Specificdetails,frompre-operativeteachingtopost-operativeexercises,areconsideredandreviewedwithyouandyourfamily,orcoach.Ourteamofprofessionalswillhelptoplanyourtreatmentprogramandguideyouthroughtheentireprocess.

4

PurposeoftheNotebookTraining,education,continuityofcare,andapre-planneddischargeplanareessentialforoptimalresultsinjointsurgery.Communicationiscrucialforthisprocess.Thisnotebookservesasbothacommunicationandeducationaltoolforpatients,families,physicians,physicaltherapists,occupationaltherapists,andnurses.Ithasbeendevelopedtoeducateyousothatyouknow:

• Whattoexpecteverystepoftheway• Whatyouneedtodotoprepareforsurgery• Whatwillhappenthedayofsurgery• Howyourpost-oprecoveryathomewillprogress• Howtocareforyournewjointfortherestofyourlife

Remember,thisisjustaguide.Yourphysician,physicianassistant,nurse,ortherapistmayaddtoorchangemanyofthesesuggestions.Alwaysusetheirrecommendationsfirst.Don’thesitatetoaskquestionsifyouareunsureaboutanyinformation.Keepyournotebookasahandyguideforatleastthefirstyearafteryoursurgery.

UsingThisNotebookInstructionsforPatients:

• ReadSections1forgeneralinformation• UseSection2asachecklist.Markeachitemasyoucompleteeachtask.• Readsections3,4and5forsurgicalandpost-opinformation.• Bringyournotebookwithyoutoallphysicianvisits(surgeonandyourprimarycare

doctor),onthedayofsurgery,andkeepathomeforreference.

OverviewoftheProgramatTheOutpatientSurgeryCenterFeaturesoftheprograminclude:

• Nursesandtherapistswhospecializeinthecareofpatientshavinghipandkneesurgery

• Familyandfriendseducatedtoparticipateas“coaches”intherecoveryprocess.• Acompletepatientguideforyoutofollowfromsixweekspre-opuntilthreemonths

post-opandbeyond.• Coordinatedafter-careprogram.

Thisguidemayseemoverwhelmingonfirstreading.Pleasetakeitandreaditassuggested,onesectionatatime.

5

RoleoftheSurgicalSchedulerShortlyafteryouhavemadethedecisiontohavesurgery,yoursurgeon’sofficewillworkwithyouto:

• Setuppre-opappointments,surgicaldatesandtimes,andfollowupvisits• Actasalinkformanagementofyourpre-operativecarebetweenthedoctor’soffice,

TheOutpatientSurgeryCenter,yourprimarydoctor,andthetestingfacilities,ifneeded

• Answeranyquestionsanddirectyoutospecificresourceswithinthehealthcaresystemasneeded

YoumaycontacttheSurgicalSchedulerorPhysicianAssistant(seecontactlist)atanytimetoaskquestionsaboutyoursurgery.Amessagemaybelefttocallyoubackiftheyarenotavailable.

7

FrequentlyAskedQuestionsSpecifictoTotalHipReplacementSurgeryManypatientshaveaskedquestionsinregardstotheirtotalhipreplacements.Belowisalistofthemostcommonlyaskedquestionsalongwiththeiranswers.Thisnotebookgivesyouadditionalinformation.Ifthereareanyotherquestionsthatyouneedanswered,pleasecontactouroffice.Wewantyoutobefullyinformedaboutthisprocedure.

8

Whatisarthritisandwhydoesmyhiphurt?Inthehipjoint,thereisalayerofsmoothcartilageontheballoftheupperendofthethighbone(femur).Thereisanotherlayerwithinyourhipsocket,whichservesasacushion.Thisallowsforsmoothmotionofthehip.Arthritisisawearingawayofthissmoothcartilage.Thiscushionmayweardowntobone.Yourdiscomfort,swellingand/orstiffnessareduetoyourthighbonerubbingagainstyourhipsocket.Commonsymptomsofhiparthritisinclude:painsinthegroinorfrontpartofyourhip,troublebendingtoreachsocksandshoes,leglengthchanges,troublecrossinglegs,painsgoingupanddownstairs.

9

Whatisatotalhipreplacement?Atotalhipreplacementisanoperationthatremovesthearthriticballoftheupperthighbone(femur),aswellasthedamagedcartilagefromthehipsocket.Theballisthenreplacedwithametal(cobalt,chromiumalloy)orceramicball.Thisballisthenfixedsolidlyinsidethefemur.Thesocketisreplacedwithaplasticliner,whichisusuallyfixedinsideametalshell.Thiscreatesasmoothlyfunctioningjoint,reducingandsometimeseliminatingpain.Youcandiscussthesedifferenceswithyoursurgeontodeterminewhichimplantisbestforyou.

Whataretheresultsofatotalhipreplacement?Approximately95%percentofpatientshavegoodtoexcellentresultswithreliefofpainanddiscomfort.Patientssignificantlyincreaseactivityandmobilityaftertheirprocedure.WhenshouldIhavethistypeofsurgery?Yourorthopedicsurgeonwilldecideifyouareacandidateforthesurgery.Thisisbasedonyourhistory,exam,x-rays,MRI’sandresponsetoconservativetreatment.Thedecisionwillthenbeyours.Itisveryreasonabletoconsidersurgeryifyourhipcontinuestohurtdespitemedications,physicaltherapy,injections,andactivitymodification.AmItoooldforthissurgery?Ageisnotaproblemifyouareingoodhealthandhavethedesiretocontinuelivingaproductive,activelife.Youwillbeaskedtoseeyourprimarycarephysicianforhisorheropinionaboutyourgeneralhealthandreadinessforsurgery.Howlongwillmynewhiplast,andcanasecondreplacementbedone?Onaverage,theolderhipreplacementsfromthe80’sand90’shadalifespanofabout12-15years.Withrecentadvancesinthecomponentsandtechnology,thepotentialforthehipstolastformorethan17yearsisgood.Alotdependsonyouroverallhealth,weight,andactivitylevelafteryoursurgery.

10

Whatapproachwillmysurgeonuse?Dr.SalyapongseutilizestheAnteriorApproachfor>97%ofhispatients.It’scharacterizedbythelocationoftheincisionforyoursurgery.Inthisapproach,themusclesarepulledapart(ratherthancut)forexposure.Afteryoursurgicalprocedureisover,yourmusclesfallbackintotheirnaturalposition.Thishasbeenproventoprovideafasterrecoverythantraditionalapproachesandoftenlesspain.Youwillnothavetoworryaboutbending,twisting,orsleepingonyoursideaftersurgery.ThiswillallbeallowedwiththeAnteriorApproach.Howlongisrecovery?Thefirst2-3weeksisspentwalkingandtryingtodealwiththeswellingthatoccursimmediatelyaftersurgery.Justlikeanyothermusclepull,yourthighwillfeelsoreandstiff.That’stypical.From3weeksto3months,you’llbestrengtheningyourmusclesandtryingtoregainflexibility.Mostpeoplearewalkingwithoutassistivedeviceswithin2weeks,drivingin2-3weeks,andswimmingin6weeks.Mostpeoplearefullyindependentin3-4weeks,butwillstillbeworkingwiththerapyonmusclestrengtheningandflexibility.WillInoticeanythingdifferentaboutmyhip?Patientswithhipreplacementsthinkthatthenewjointfeelscompletelynatural.Werecommendalwaysavoidingextremepositionorhighimpactphysicalactivity(running,jumping,cuttingsports,kickboxing,etc).Inthefirstfewweeksaftersurgery,yournewhipmayfeellongerthanitwasbefore.Thisisduetothefactthatmostarthritichipshaveshortened.Aftersurgeryyourhiphasbeenrestoredtoitsoriginallengthandthismakesitfeellongerthanbefore.Mostpatientsgetusedtothisfeelinginashorttime.Whydohipreplacementsfail?Aslongasyouavoidrunning,jumpingandhighimpactactivity,thereispotentialforyourhiptolast15-20years(ormore).Failurecanoccuraftermajorinjuries(caraccidents,falls)wheretheforceisenoughtobreakyourbonesorbreakthehipreplacement.Theseepisodesareveryrare,butwecautionyounonetheless.Wearingoutoftheplasticcushionmayalsoresultintheneedforarevision,althoughnewerbearingsmaylastformorethan25years.Whatarethemajorrisks?Themainrisksofsurgerytoconsiderareinfection,dislocation,andbloodclots.Wetakegreatcareinpreparationforyoursurgery,duringyoursurgery,andformonthsaftertopreventthesecomplications.Seeourratesbelowcomparedtonationalaverage:

Dr.Salyapongse NationalAverageInfection 0.05% 1%Dislocation 0.2% 3-5%BloodClots 0.03% 1-2%

11

FrequentlyAskedQuestionsSpecifictoTotalKneeReplacementSurgeryPatientshaveaskedmanyquestionsabouttotalkneereplacements.Belowisalistofthemostcommonlyaskedquestionsalongwiththeanswers.Thisnotebookgivesyouadditionalinformation.Ifthereareanyotherquestionsthatyouneedanswered,contactouroffice.Wewantyoutobecompletelyinformedaboutthisprocedure.

KneeAnatomy

12

Whatisarthritisandwhydoesmykneehurt?Inthekneejointtherearethreelayersofsmoothcartilage.Thelayersareonthelowerendofthethighbone(femur),theupperendoftheshinbone(tibia)andtheundersurfaceofthekneecap(patella).Thiscartilageservesasacushion.Itallowsforsmoothmotionoftheknee.Arthritisisawearingawayofthissmoothcartilage.Thiscushioncanweardowntobone.Rubbingofboneagainstbonecausesdiscomfort,swellingandstiffness.

HealthyVsArthriticKnee

Whatisatotalkneereplacement?Atotalkneereplacementisacartilagereplacementwithanartificialsurface.Thekneeitselfisnotreplaced.However,anartificialsubstituteforthecartilageisinsertedontheendofthebones.Thisisdonewithametalalloyontheendofthefemurandtibiawithaplasticspacerbetweenthetwometalcomponentsandonthebackofthekneecap(patella).Thiscreatesanewsmoothcushionandafunctioningjointthatcansignificantlyreducepainsandswelling.Whatisapartialkneereplacement?Thekneeiscomprisedof3differentcompartments:inside(medial),outside(lateral)andfront(patellofemoral).Sometimesarthritisonlyaffectsoneoftheseareas.Patientswitharthritisinonlyonecompartmentmaybeacandidateforapartialkneereplacement.Onlytheaffectedareainthekneeisreplaced,leavingtheothertwocompartmentsuntouched.Usually,thisresultsinamorenaturalfeelaftersurgery.

13

MedialandLateralReplacements

PatellofemoralRepalcement

Whataretheresultsofatotalkneereplacement?90-95percentofpatientshavegoodtoexcellentresultswithreliefofdiscomfort.Patientssignificantlyincreaseactivityandmobility.Whatarethemajorrisks?Mostsurgeriesgowell,withoutanycomplications.Infectionandbloodclotsaretwodifferent,butserious,complications.Toavoidthesecomplications,weuseantibioticsandmedicationstothintheblood(bloodthinners).Therearealsospecialprecautionstakenintheoperatingroomtoreducetheriskofinfection.Thechancesofthishappeninginyourlifetimeareonepercentorless.Yourdoctorwilldiscusswaystoreducethisrisk.

14

ArthriticKneeVsReplacedKnee

15

GeneralQuestionsAfterTotalJointReplacementSurgeryShouldIexercisebeforethesurgery?Yes,youshouldeitherconsultanoutpatientphysicaltherapist,orfollowtheexerciseslistedinyournotebook.Exercisesshouldbeginassoonaspossible.HowlongwillIbeincapacitated?Youshouldbeabletowalkandbearweightusingawalkerorcrutcheswithinhoursaftersurgery.However,swellingandjointsorenesscanpersistforweekstomonths.Yourreturntonormalactivitiescantake3-6months.HowlongwillIbeatthesurgerycenter?Mosttotaljointreplacementpatientswillbedischargedfromthesurgerycenterwithin4-6hoursaftertheirprocedure.Somepatientsmaystayupto23hoursifneeded.WhatifIlivealone?Thebestoptionistoarrangetohaveafamilymemberorfriendstaywithyouforthefirst2-3daysafteryoursurgery.Wecanthenarrangeforahomephysicaltherapistand/oranursetocometoyourhome3-4timesperweektoassistwithyourrecovery.HowdoIarrangeforsurgery?Toschedulesurgery,contactDr.Salyapongse’sSurgeryScheduler.Theywillpencilinadateforyouandassistyouincompletingallpreoperativepreparationspriortoyoursurgery.Thiswillincludeeducation,avisitwithyourprimarydoctor(andanyotherspecialistsyoumayseeregularly),andapre-opvisitwithRobinMercerPA-CandDr.Salyapongse.Howlongdoesthesurgerytake?Weblockapproximatelytwototwoandahalfhoursforsurgery.Someofthistimeisusedbytheoperatingroomstafftoprepareyouforthesurgery.Theactualsurgicaltimerangesfrom45–90minutes.WillIrequiregeneralanesthesiaformysurgery?Youmayhaveageneralanesthetic,whichmanypeoplecall“beingputtosleep.”Somepatientsprefertohaveaspinalorepiduralanesthetic,whichnumbsyourlegsandmayallowforyoutostayawake.Thischoiceisbetweenyouandyouranesthesiologist.Formoreinformation,read“AnesthesiaandYou”inyournotebookappendix.Whatwillmypainbelikeaftermysurgery?Immediatelyaftersurgeryit’snormaltofeelachingandburningaroundyourincisionsite.Achinginyourjointisalsoverycommon.Pleasealertyournursehowsevereyourpainsare(onascaleof1–10).Forthefirst2daysaftersurgeryamildacheiscommon.Usually3daysaftersurgery,swellingstarts,andpeaksaround7days.Elevationofyourjointandicingwillhelp,butthiswillbethemostdifficultpartofyourrecovery.Afterthefirst2weeks,painandswellingshouldstarttosubside.

16

Whowillbeperformingthesurgery?Dr.Salyapongsewillperformallcriticalpartsofyoursurgery.ItisquitecommonforRobinMercerPA-Ctoperformthesurgicalclosureofyourskin.Mostpatientshaveabsorbablestitchesthatwillnotneedtoberemoved.WillIneedawalkerorcrutches?Asarule,werecommendthatyouuseawalkerorcrutches.Yourtherapistandsurgeonwillhelpyoudecideifyouneedanassistivedevice.Equipmentwillbeprovidedatdischarge,ifindicated.WillIneedsomeonewithmeALLthetimewhenIgohome?No.ThefirstfewdaysitwillbeVERYhelpfultohavesomeoneassistyouwithsomedailyactivities,suchaspreparingmeals,etc.TheTotalJointTeamwillarrangeforahomehealthnurseandphysicaltherapisttocometoyourhouse,ifneeded.Pleasetrytoarrangefamilyorfriendstobeavailabletohelp.Prepareahead.Beforeyoursurgery,youshouldconsiderhavingthefollowingactivitiescompletedtoreducetheneedforextrahelp:

• Finishyourlaundry• Cleanyourhouse• Removerugs(throwrugs)andanycordsthatmayinterferewithwalkerorcrutchuse• Makeyourbedwithcleanlinens• Cooksingleportionfrozenmeals(Refertopage31formoreinformation)

WillIneedphysicaltherapywhenIgohome?Asarule,youwillhavehomephysicaltherapyforthefirstweekorso.Therapyaftertotaljointreplacementusuallyconsistsofwalkingwithgeneralstretchingandmusclestrengthening.Manypatientscanachievethisathomewithouttheassistanceofaphysicaltherapist.Ifyouneedhomephysicaltherapy,thiswillbesetuppriortodischarge.WhenwillIbeabletoreturntowork?Returningtoworkisbasedoneachindividual’shealthanddemandoftheirjob.Ifyourjobinvolvesmoreofficetypework,youcanreturntoworkwithacaneorcrutchesearlierthansomeonewithamorestrenuousjob(sometimesasearlyas2-3weeks).Morephysicallydemandingjobsmayrequire2-3monthsofrehabbeforereturning.Aphysicaltherapistcanmakesuggestionsforjointprotectionandenergymanagementwhileatwork.HowoftenwillIneedtoseemydoctorfollowingthesurgery?Onetotwoweeksafterdischarge,youwillbeseenforyourfirstpost-operativeofficevisit.Thescheduleoffollow-upvisitswilldependonyourprogress.Manypatientsareseenatsixweeksandtwelveweeks.Yoursurgeonwillletyouknowwhatisrecommended,asitcandifferwitheachpatient.

17

WillIhaverestrictionsfollowingmysurgery?Yes.High-impactactivities,suchasrunning,singlestennis,andbasketballarenotsuggested.Injury-pronesportssuchasequestriananddownhillmogulskiingarealsodangerousforthenewjoint.Pleasecheckwithyourdoctorforpossiblerestrictions.Whatphysical/recreationalactivitiesmayIparticipateinaftermyrecovery?Youareencouragedtoparticipateinlowimpactactivitiessuchaswalking,dancing,golf,hiking,swimming,bowling,doublestennis,andgardening.WhencanIresumesexualactivity?Therearenotruemedicalrestrictionsforresumingsexualactivity.Youcanhaveintercoursewhenyourjointfeelscomfortableenough.WillIneedpost-operativeequipment?Forwalking,mostpatientsaremoststablewithawalkeraftersurgery.Youmaypurchaseaseatriseror3:1commodeifyoufeelitmaybemorecomfortable.Theseitemscanbepurchasedatamedicalsupplystoreoronline.Mostinsurancecompaniesdonotcoverthecostforthesetypesofequipment.Ifyouhavefurtherquestions,callyourinsuranceprovider.Ifyouhavenotpurchasedanice-coolingunit(forkneesurgery),thentrytobuy4-6flexibleicepackstouseforswellingandinflammation.WillIbeeligibleforatemporarydisabledplacard?Yes,youwillbeeligibleforatemporarydisabledplacardforabout8-12weekspostoperatively.HowlonguntilIcandriveaftersurgery?Drivingyourselfisdependentonwhichlegneededsurgery.Therightlegmayrequirealongerdelayinabilitytodrive.Ifyouhaveanautomatic,youcandrivewithin2-4weeks.Ifyoudriveastickshiftandhadsurgeryonyourleftlegthismaydelaydrivingtime.YoushouldNOTdrivewhileonnarcoticpainmedication.“Gettingbacktonormal”willdependonyourprogress.Youcandiscussamorespecifictimeframewithyoursurgeon.WillIneedaspecialcardforflying?Youmightreceiveacardfromyourdoctorthatstatesyouhavehadajointreplacement.Unfortunately,itisnotuncommontosetoffmetaldetectorswhengoingthroughsecurity.Thecarddoesnotserveasa“freepass”;theywilllikelywandyouformetal.Youshouldmentiontosecuritythatyouhavehadatotaljointreplacementandasktogothroughthefullbodyscannertoavoidfurtherdelays.

19

PRE-OPERATIVECHECKLIST

21

☐ ObtainMedicalandAnesthesiaClearanceWhenyouwerescheduledforsurgery,amedicalclearanceletterwillbesentdirectlytoyourprimarycarephysician’soffice.Theletterinformsyourprimarydoctorthatyouwillbeundergoingsurgeryforjointreplacementsoon.Basedonyourmedicalstatus,history,andcurrentlabwork/EKG,yourprimarydoctorwillsigntheletterand“clear”youforsurgery.

☐ ObtainLaboratoryTestsAtyourappointmentwithyourprimarycaredoctor,youwillreceiveinstructionsonobtaininglabworkinpreparationforsurgery.Followtheinstructionsinthisorder.

☐ StartPre-OperativeExercisesItisimportantthatyoubeginanexerciseprogrambeforesurgery.Seeexercisesonpage28.Manypatientswitharthritisfavortheirjointsandbecomeweaker.Thisslowstheirrecovery.Youmayalsobescheduledforphysicaltherapysessionsbeforeyoursurgery.Thiswillbediscussedbetweenyouandyoursurgeon. ☐ 4WeeksBeforeSurgery Dr.Salyapongselikesforyoutakeamulti-vitaminandironpills3-4weeksleadinguptosurgery.Thesesupplementsmaycauseyourstooltoturnblack.PleasestoptheuseofotherOTCsupplements(fishoil,gingko,vitaminE,“naturalherbs”,etc.)atthistime.Fishoilinparticularcancauseincreasedbleeding.Certainherbalsandothersupplementsmayinteractwithmedicationsyouwillreceiveaftersurgery.STOPSMOKING.Ifyouusetobacco,Dr.SalyapongsewilllikelyCANCELYOURSURGERY.Nicotinecanslowyourbody’snaturalhealingprocessandmayresultincatastrophicinfections.

Read“AnesthesiaandYou”(Appendix)TotalJointSurgeryrequirestheuseofeithergeneralanesthesiaorregionalanesthesia.Pleaseread“AnesthesiaandYou”(seeappendix).Ifyouhavequestions,pleasecontactouroffice.

1WeekBeforeSurgery

☐ Pre-operativeVisittotheSurgeonYoushouldhaveanappointmentinyoursurgeon’sofficeseventotendayspriortoyoursurgery.Thiswillserveasafinalcheckup.Pleasedonothesitatetoaskanyquestionsyoumighthave.

22

☐ StopMedicationsthatIncreaseBleedingStopallanti-inflammatorymedications7-10daysbeforesurgery.Examplesareaspirin,Motrin,Naproxen,VitaminE,etc.Thesemedicationsmaycauseincreasedbleeding.IfyouareonCoumadin,Xarelto,orPlavix,youwillneedspecialinstructionsbeforestoppingthemedication.Ourteamcanhelpansweranyquestionsyouhaveregardingtheseinstructions.YourPrimaryCarePhysician,Dr.Salyapongse,RobinMercerPA-Cwillhelpyouwiththisissue.Atourpre-operativevisit,wewillnotifyyouofmedicationsthatneedtobestoppedpriortosurgeryandthosethatshouldbecontinuedupuntilthedayofsurgery.Pleasebringacurrentlistofallprescriptionandover-the-countermedicationsyouarecurrentlytakingtoyourpre-opvisit.Youwillreviewthislistaspartofyourpre-operativevisit.

☐ DayBeforeSurgery

FindOutYourArrivalTimeattheSurgeryCenterYouwillbeaskedtocometothecentertwohoursbeforethesurgerytime.Thisgivesthenursingstafftimetoprepyouandanswerquestions.PhoneInterviewsYouwillreceiveacallfromanurseattheOutpatientSurgeryCenter.Thenursewillreviewanyspecialinstructionsrequiredforthedayofsurgery.Pleasehavealistofallcurrentmedicationsavailableduringthecall.Inaddition,youwillreceiveacallfromtheAnesthesiologistassignedtoyourcase.Theywillreviewyourhealthhistoryanddiscussanesthesiaoptions.Pleasedonotshaveyouroperativesiteforatleast24hourspriortosurgery.

TheNightBeforeSurgeryItisveryimportantthatyoudonoteatordrinkaftermidnight,NOTEVENWATER,unlessotherwiseinstructedtodoso.Thisincludeschewinggumandhardcandies.Surgerywillbecancellediftheseinstructionsarenotfollowed.

DayofSurgery

ArrivalTimeItisimportantthatyouarriveontimetothesurgerycenter.Itispossiblethatyoursurgerymaybemovedtoanearliertime.Ifyouarelate,itmaycreateaproblemwithstartingyoursurgeryontime.Beinglatecouldresultinmovingyoursurgerytoamuchlatertime,possiblyalaterdate.

WhattoweartoTheOutpatientSurgeryCenterYoushouldhavecomfortableloose-fittingclothing,suchas:shorts,t-shirts,sweats,well-fittedslippers,flatnon-skidshoesortennisshoes.

23

ImportantItemstoBringandLeaveatHomeDayofSurgery:

• BRING:o AcopyofyourAdvanceDirectiveso Yourinsurancecard,driver’slicenseorphotoI.D.o FrontWheelWalker(FWW)orcrutches

• LEAVE:o Cashandothervaluablesathomeo Alljewelryo Make-up

§ Allmake-upmustberemovedbeforeyourprocedure§ Youmaycontinuetowearnailpolish

25

DAYOFSURGERYEXPECTATIONS

27

WhatHappenstheDayofSurgeryArriveatTheOutpatientSurgeryCenterTWOhoursbeforeyoursurgerytime.Gotothemainentrance.Astaffmemberwillaccompanyyoutothepre-operativearea,whereyouwillbepreppedforyourprocedure.TherethenurseswillstartanIVandscrubyouroperativesite.Wewillaskuptotwofamilymemberstorejoinyouwhenthisiscomplete.Dr.Salyapongsewillspeakwithyouandyourfamily.HewillconfirmwhichSIDEisbeingoperatedonandsignhisnameonyourskin.Youroperatingroomnurseandyouranesthesiologistwillthentalkwithyouandescortyoutotheoperatingroom.AntibioticsandatypeofsedativesuchasVersedmaybegiventhroughyourIVbeforeenteringtheoperatingroom.OperatingRoomIntheoperatingroomyouwillhavecardiac,oxygenandbloodpressuremonitorsapplied,andyouwillbegivensomeoxygentohelpyoubreath.Onceanesthesiatakeseffectyouwillbepositionedontheoperatingroombedandyourskinwillbecleanedwithadisinfectantsolution.Steriledrapeswillbeappliedsothatonlytheareabeingoperatedonwillbeexposed.TheORstaffwillperforma“timeout,”whichistoverifythecorrectoperativesideandsite;onceconfirmed,thesurgeonwillbegintheprocedure.Oncethesurgeryiscompleteyouwillbetransferredtoagurneyandtakentotherecoveryroom.

RecoveryRoomCareYouwillbetakentoarecoveryareaaftersurgery.Duringthistime,paincontrolwillbemanaged.Yourvitalsigns(bloodpressure,heartrateandoxygensaturation)willbemonitored.Youwillbeverygroggyforthefirst2-3hoursaftersurgery;pleasemakesureallmovementsareslowanddeliberatetoavoidfalling/tripping.Youwillbereceivingpainmedication.ItisimportantthatyoutellthenursesifyouareNOTgettinggoodrelieffromthemedication.Ourgoalistomakeyouascomfortableaspossible,whilekeepingyousafe.Itisveryimportantthatyoubeginanklepumpexercisesonthisfirstday(locatedonpage28).Thiswillhelppreventbloodclotsfromforminginyourlegs.Youshouldalsobeginusingyourincentivespirometer.Anursewillinstructyouonhowtousethis.Mostofthediscomforttakesplacethefirst2weeksaftersurgery.Thephysicaltherapistmaycometovisitwithyoushortlyafterarrivingtotherecoveryarea.Otherwise,youwillwalkwiththenursepriortoyourdischarge.Thenurseswillmanagepain,possiblepost-operativenausea,andanyothersymptomsyoumayexperience.Mostpatientswillbedischargedabout6hoursaftersurgery.Readinessfordischargeisbasedonpaincontrol,abilitytourinate,andtoeat/drinksmallamountsoffood/liquids.Youwillalsoreceiveanincentivespirometer(encouragesyoutotakedeepbreaths)intherecoveryroomandshouldcontinuetousethisduringyour1stweekathome.

28

IfYouAreGoingDirectlyHomeAresponsibleadultwillneedtodriveyouhome.Youwillreceivewrittendischargeinstructionsaboutmedications,physicaltherapy,activity,etc.Wewillarrangeforanyequipmentaswellashomehealthservices,ifneeded.

23HourStay:OverNightStaySomepatientsmayneedtostayovernightdependingonresponsetoanesthesia.Ifyoustayovernight,youwillbetransitionedtoa“23hourstay”status.Anursewillbewithyouthroughoutthenighttomonitoryourrecovery,maintainpaincontrol,andassistwithwalking.Youwillthenbedischargedthefollowingmorning.

29

POSTOPERATIVECARE

IncentiveSpirometer FrontWheeledWalker(Reducestheriskofpneumonia)

SCD(sequentialcompressiondevice)Reducestheriskofbloodclots

31

CaringforYourselfatHomeTherearemanythingsyouneedtoknowforyoursafety,aspeedyrecoveryandyourcomfort.

• Itisrecommendedtoelevateyouroperativelegforshortperiodsduringtheday.Itisbesttoliedownandraisethelegaboveyourheart.

• Callyourdoctorifyounoticeincreasedpainorswellingineitherlegthatisnotgoingawaywithelevation.Swellingtendstopeakday5aftersurgery.

TemperatureTakeyourtemperatureifyoufeelwarmorsick.Ifyourtemperatureisabove101.5˚FandpersistsaftertakingTylenol,callyoursurgeon’sofficeforassistance.Itisquitenormaltohavefeversover101.5thefirst48hoursaftersurgery.It’susuallyduetoshallowbreathingduringyoursurgery.Takingafewslowdeepbreathsevery10-15minutesshouldhelp.Afeverlessthan101˚isnormalduringthefirstfewdaysafterTotalJointReplacementsurgery.Ifthetemperaturepersistsformorethan3days,besuretonotifyyoursurgeonandyourprimarycarephysician.

ControllingYourDiscomfort• Takeyourpainmedicationatleast30minutesbeforephysicaltherapy.• SlowlyreducetheamountofprescriptionpainmedicationandtransitiontoTylenol.

Youmaytaketwo;extra-strengthTylenolinsteadofyourprescriptionmedicationuptofourtimesdaily.PleasenotethatsomepainmedicationhasTylenolinitalready.ThemaximumamountofTylenolallowedin24hoursis4,000mg.Readthelabelscarefullysoyoudonotexceedthisamount.

• Changeyourpositionfrequently.Thiswillreducestiffness.• Useiceforpaincontrol.Applyingicetoyouraffectedjointwilldecreasediscomfort.

Anytimeyouarenotambulatingordoingexercisesyoushouldhaveiceappliedaroundyoursurgicalsite.Itisimportanttohaveabarrierbetweentheiceandyourskini.e.e.washcloth,towel,orpillowcase.Itisrecommendedtouseicebeforeandafteryourexerciseprogram.Ifyoudonothaveanicepack,abagoffrozenpeaswrappedinakitchentowelmakesanidealicepack.Alwayshavealayerofprotectionbetweentheiceandyourskintopreventaburn.

CRYO-THERAPY-ELECTRICICEMACHINES• IfyouhaveanelectricicetherapymachineitisrecommendedtouseitALLthetime

whenyouarenotwalkingordoingexercisesforthefirstseveralweeksaftersurgery.Again,youmustALWAYShavebarrierbetweenyourskinandthewrap.Aslongasyouhaveabarrierbetweentheiceandyourskin,theicewrapcanbeonatalltimes.Thiswillhelpreducepainandinflammation.

o QuickTIP:Freeze10-8ozwaterbottles,youcanusetheseasyouricecubesfortheelectricmachine.Pleaseremovealllabelsoffthebottlespriortouse.

32

BodyChanges• Yourappetitemaydecreaseaftersurgery.However,nutritionisveryimportant

duringyourrecovery.Yourbodyneedsmorecalories,protein,andcertainvitaminsandmineralstohelpyouhealandpreventinfection.

• Tryeatingmorefrequent,smallmealsandsnacks(beef,chicken,fish,soyproducts,peanutbutter,nuts,eggs,milk,cheese,yogurt,cottagecheese)

• Makesureyoueatfoodshighiniron(leanredmeats,fish,chicken,legumes,wholegrains,ironfortifiedbreadsandcereals)

• FocusonfoodshighinvitaminA(fortifieddairyproducts,tropicalfruits,carrots,wintersquash,sweetpotatoes,greenleafyvegetables)

• FocusonfoodshighinvitaminC(citrusfruitsandjuices,kiwifruit,strawberries,broccoli,bellpeppers)

• Considertakingamultivitaminwithmineralsupplement.Checkwithyourdoctorabouttakinganironsupplement,althoughthismaynotbeneeded.

• Drinkplentyoffluidstokeepfromgettingdehydrated.• Yourdesireforsolidfoodwillreturn.• Youmayhavedifficultysleeping,whichisnormal.Donotsleepornaptoomuch

duringtheday.Youmayfeelthatyourenergyislowbutstillhavetroublesleepingatnight.Thisisquitenormalandmaylastforonemonth.TrytakingaBenadryl(25mgtab)atnightforsleepaid.

• Itiscommonforyourenergyleveltobedecreasedforthefirstmonth.• Prescribedpainmedicationsmaycauseconstipation.Usestoolsoftenersor

laxatives,suchasSenokot-S,Miralax,orColace,onadailybasis.YoumayalsotakeMilkofMagnesiaifneeded.Thesecanallbepurchasedoverthecounteratalocalpharmacyorgrocerystore.

BloodThinnersDr.Salyapongsewillprescribeabloodthinner.Basedonyourhealthandmedicalhistory,youwillbeutilizingonefromthelistbelow.Ifyouhavequestionsaboutthetypeprescribed,pleasecontactDr.Salyapongse’soffice.

Enoxaparin(Lovenox®)Lovenoxorenoxaparinisananticoagulant(bloodthinner)thatisusedtohelppreventtheformationofbloodclots.Itisespeciallyusedforpatientsthathavejusthadtotaljointreplacementsurgery,suchasthekneeorhip.Itmustbeusedasasubcutaneous(undertheskin)injection.Yournursewillgiveyouinstructionsontheuseofthismedication.Youmayviewademonstrationvideoatthefollowinglink:www.lovenox.comLovenoxshouldbecontinuedforabout10-15daysafteryoursurgery.Followallinstructionsgiventoyoubyyourpharmacist.Ifquestionsariseafteryouareathome,pleasefeelfreetocalltheClinicalCoordinatorforOrthopedics.

33

XARELTO®XARELTO®isaprescriptionmedicineusedtoreduce the risk of forming a blood clotinthelegsandlungs,especiallyinthosewhohavejusthadhiporkneereplacementsurgery.Ifyouhadahipreplacementsurgeryyouwilltakexarelto10mgonceadayfor35daysfollowingsurgery.Ifyouhavekneereplacementsurgeryyouwillusuallytakethesamedosefor12days.Yoursurgeonwilldecidehowlongyoushouldtakethismedication.Donotstoporchangeyourdoseofxareltowithouttalkingtoyourprescribingdoctor. ASPIRIN®Aspirin is an over the counter medication sometimes prescribed as a blood thinner after surgery. Aspirin should be taken twice daily for 4-6 weeks depending on your surgeon’s preference. Enteric Coated Aspirin 325mg is the standard dose.

CaringforYourIncision

• Keepyourincisiondry(youMAYshowerwiththewaterproofbandageon)• Yourpost-operativebandagewillstayinplaceuntilseenatyourfollowupvisit,

usuallywithin7-14daysaftersurgery.• Youmayshowerwhenyouaredischarged,andeverydaythereafter,unless

instructedotherwise.Mostpatientswillhaveawaterresistantbandage.• Notifyyoursurgeonifthereisincreaseddrainage,redness,pain,odororheat

aroundtheincision.

RecognizingandPreventingPotentialComplications

InfectionsSignsandsymptomsofanInfection

• Spreadingrednessorwarmthatincisionsite• Increasingdrainagefromincisionsiteoverthefirst3-4daysaftersurgery• Persistentfevergreaterthan101.5°

PreventionofInfection• Takecareofyourincisionasexplained• Takepreventativeantibioticswhenhavingdentalwork.Antibioticsshouldbetaken

priortodentalproceduresforthefirstyearafteryoursurgery.• Notifyyourdentistthatyouhaveatotaljointreplacement;theycanprescribe

antibioticsbeforeeachvisit.

BloodClotsinLegsSurgerymaycausethebloodtoslowandthickenintheveinsofyourlegs,creatingabloodclot.Thisiswhyyouareprescribedbloodthinnersaftersurgery.Ifaclotoccurs,youmayneedtobeadmittedtothehospitalforIVbloodthinners.Earlytreatmentusuallypreventsthemoreseriouscomplicationofpulmonary(lung)embolus.

34

SignsofBloodClotsinLegs• Newswellinginthigh,calforanklethatdoesnotgodownwithelevation.

o Swellingaftersurgeryisnormal.IfyouhaveanunexpectedINCREASEincalf/legswellingand/orpain(thatisnotrelatedtoincreasedactivity)pleasecontactouroffice.

• Rednessandwarmthinalocalizedspot• Sharpandcontinuouspainortendernessincalf.• NOTE:bloodclotscanformineitherleg.

PreventionofBloodClots• Performfootandanklepumpexerciseswheneveryouaresittingorlyingaround.• Walkingseveraltimesaday• TakingyourbloodthinnersasdirectedsuchasAspirin,Lovenox,Xarelto.

PulmonaryEmbolusAnunrecognizedbloodclotcouldbreakawayfromtheveinandtraveltothelungs.ThisisanemergencyandyoushouldCALL911ifyouexperienceanyofthesignslistedbelow.SignsofaPulmonaryEmbolus:

• Suddenchestpain• Difficultyand/orrapidbreathing• Shortnessofbreath• Confusion

PreventionofPulmonaryEmbolus• Preventbloodclotsinlegs(seeabove)• Recognizeabloodclotandcallphysicianquickly

35

PostoperativeExercises,GoalsandActivityGuidelines

ActivityGuidelinesExercisingisimportanttoobtainthebestresultsfromtotaljointsurgery.Severalshortwalksthroughoutthedayarerecommended.Youmayreceiveexercisesfromyourhomehealththerapistorfromanoutpatienttherapist.Itisimportanttocontinuetheexercisesonthedaysyoudonothavephysicaltherapyappointments.Exercisesandactivitywillbecustomizedtofiteachpatient.Eachpatientwillprogressathisorherownrate.Trynottocompareyourselfwithotherpatients.PREOPERATIVEANDPOST-OPERATIVEEXERCISEPROGRAMAnklePumps

Anklepumpsshouldbedoneanytimeyouaresittinginachairorlyinginbed.Straightenyourlegandslowlypushyourfootforwardandbackward.Thisshouldbedonemultipletimesthroughouttheday.StraightLegRaises

Whilelyingonyourbackinbed,tightenyourthighmusclesandlifttheaffectedlegupseveralinchesoffthebed.Keepyourkneestraightandtoespointedup.Holdthelegupfor5–10secondsandthenloweritbackontothebed.Repeat10timeswitheachleg,2-3timesperday.Donotcontinueifthishurtsyourlowback.HamSets-(Post-OperativeKneeArthroplasty)

36

Whilelyingonyourbackinbed,keepyouraffectedlegbentandtheotherlegstraight.Tightenthemuscleonthebackofyouraffectedleg.Pushtheheeldownintothebedwiththeaffectedleg.Holdfor5seconds.Repeat10timeswithbothlegs,2–3timesperday.HeelSlides-(Post-OperativeKneeArthroplasty)

Whilelyingonyourbackinbed,bendyourkneeandslideyourheeltoyourbuttock.Slideitbackoutstraight.Youmayplaceaplasticbagunderyourfootifitiseasierthatway.Repeat10timeswiththeaffectedleg,2–3timesperday.SittingKneeExtensionwithStool-(Post-OperativeKneeArthroplasty)

Whilesittinginachair,placethefootofyouraffectedlegontopofanotherchairseatorstool.Pressyourkneedownandholdfor30seconds.Repeat10times,2–3timesperday.SittingKneeFlexion-(Post-OperativeKneeArthroplasty)

Whilesittinginachair,scootalittleforward.Placeabeltortowelunderyourfootwhileholdingtheedgesinyourhands.Bendyourkneeasfarasyoucanwiththebelt/towel.Scootforwardalittlemoretofeelmoreofastretchatyourknee.Holdfor30seconds.Repeat3-5timeswiththeaffectedleg,2–3timesperday.

37

ACTIVITIESOFDAILYLIVING

39

PrecautionsandHomeSafetyTips

HowtoConserveYourEnergy• KITCHEN

o DONOTgetdownonyourkneestoscrubfloors.Instead,tryusingamopandlonghandledbrushes.

o Pre-planmeals,orgathercookingsupplieswhenyouwanttoprepareameal.Itmaybeeasiertositwhilepreppingfood.

o Avoidrepetitivebendingandstretchingbyplacingfrequentlyusedcookingsuppliesandutensilswheretheycanbereachedeasily.

o Toprovideabetterworkingheight,useahighstoolorputcushionsonyourchairwhenpreparingmeals.

• BATHROOMo Useamoptocleanbathroomfloorsandthetub.DONOTgetdownonyour

kneestoclean.• SAFETYANDAVOIDINGFALLS

o Removethrowrugsfromthefloorandensureanyloosecarpetingistackeddown.Coverslipperysurfaceswithcarpetsthatarefirmlyanchoredtothefloororthathavenon-skidbacks.

o Beawareofyoursurroundings:pets,objectsonthefloor,orunevensurfacesinyourhome.Keepinmindyouwillbemuchwiderwhenwalkingwhileusingawalker.Youwillhavetoaccountforthisspacethroughoutyourhome.

o Useofnight-lightsinthebathrooms,bedroomsandhallwaysarehelpful.o Extensioncordsandtelephonecordsshouldberemovedfrompathways.DO

NOTrunwiresunderrugs,asthisisafirehazard.o DONOTwearopen-toedslippersorshoeswithoutbacks.Theydonot

provideadequatesupportandcanleadtoslipsandfalls.o Usechairswitharms,itismucheasiertogetupanddown.o Changepositionsslowly,suchas;goingfromlyingtosittingtostanding,to

reducefeelinglightheaded.o DONOTliftheavyobjectsforthefirstthreemonths,oruntilyourdoctorsays

itsissafe.o Alwaysusegoodjudgment.

• STAIRSANDGETTINGINANDOUTOFBED

o Youwillbeinstructedhowtouseawalkerorcrutchestogoupanddown

stairsifindicated.ThereareNOcontraindicationsafterjointreplacement.Aphysicaltherapistcanworkwithyouonthisaswell.Thephysicaltherapistwillalsoshowyoutipsongettinginandoutofbedtoputtheleastamountofstressonyouroperativeleg.

40

HowtoPreventInfectionsPostRecoveryAprostheticjointcouldpossiblyattractbacteriafromaninfectionlocatedinanotherpartofyourbody.Takingantibioticsonehourbeforehavingdentalworkwillhelppreventanycomplicationswithyourjoint.Itisrecommendedtotakeantibioticspriortodentalworkfor1yearfollowingyoursurgery.Post-opinfectionsareveryrare,butifyoushoulddevelopafeverofmorethan101.5°F,callyourdoctor.Theclosertheinjuryistoyourprosthesis,thebiggertheconcernis.Occasionally,antibioticsmaybeneeded.Surfacescratchesmaybetreatedwithtopicalantibioticointment.Notifyyourdoctoriftheareaispainfulorreddened.

WhattoDoforExercisePost-Recovery• ChooseaLowImpactActivity

o Recommendedexerciseclasseso Homeprogramasoutlinedinnotebooko Regularonetothreemilewalkso Hometreadmillo Stationarybikeo Regularexerciseatafitnesscentero Lowimpactsports—golf,bowling,walking,gardening,dancing,etc.

• WhatNottoDoo Donotrunorengageinhighimpactactivitieso Donotparticipateinhigh-riskactivitiessuchasdownhillskiing,etc.unless

youhavediscussedtheriskswithyourdoctor.o Avoidladdersandstepstools.

41

APPENDICES

42

ExerciseYourRight(LivingWill)

PutYourHealthCareDecisionsinWritingAlthoughitisextremelyraretoexperienceaseriousmedicalcondition,wehighlysuggestallpatientsundergoinganymedicaltreatmentshouldhaveanadvancemedicaldirectiveinplace.ItisthepolicyatTheOutpatientSurgeryCentertoplacepatient’swishesandindividualconsiderationsattheforefrontoftheircare.Werespectandupholdthosewishes.

WhatareAdvancedMedicalDirectives?AdvancedDirectivesareameansofcommunicatingtoallcaregiversthepatient’swishesregardinghealthcare.IfapatienthasaLivingWillorhasappointedahealthcareagent,andisnolongerabletoexpresshisorherwishes,TheOutpatientSurgeryCenteriscommittedtohonoringthewishesofthepatientastheyaredocumentedatthetimethepatientwasabletomakethatdecision.

TheDifferentTypesofAdvancedDirectivesLivingWillsThesearewritteninstructionsthatexplainyourwishesforhealthcareifyouhaveaterminalconditionorirreversiblecoma.AWillisusedwhenthepatientisunabletocommunicate.AppointmentofaHealthcareAgentThismaybereferredtoasaMedicalPowerofAttorney.Thisisadocumentthatletsyounameaperson(youragent)tomakemedicaldecisionsforyou,ifyoubecomeunabletodoso.HealthCareInstructionsTheseareyourspecificchoicesregardinguseoflifesustainingequipment,hydrationandnutritionanduseofpainmedications.Onadmissiontothesurgerycenter,youwillbeaskedifyouhaveanAdvancedDirective.Pleasebringcopiesofthedocumentstothesurgerycenterwithyou.TheDirectivecanbecomeapartofyourMedicalRecord.AdvancedDirectivesarenotarequirementforadmission.

43

AnesthesiaandYou

Whoaretheanesthesiologists?BoardCertifiedandBoardEligiblephysiciananesthesiologistsstaffTheOutpatientSurgeryCenter.EachmemberoftheanesthesiateamhasprivilegestopracticeatTheOutpatientSurgeryCenter.

Whattypesofanesthesiaareavailable?Decisionsregardingyouranesthesiaaremadetomeetyourpersonalneeds.Thetypesavailableforyouare:

• GENERALANESTHESIA,or“goingtosleep”,provideslossofconsciousness.Youranesthesiologistwillbemonitoringallofyourvitalsandbreathingclosely.

• REGIONALANESTHESIA,(e.g.nerveblocks),involvestheinjectionofalocalanesthetic.Thisprovidesnumbness,lossofpainorlossofsensationtoalargeregionofthebody.Regionalanestheticmethodsincludespinalblocks,epiduralblocks,andarmandlegblocks.Medicationscanbegiventomakeyoudrowsy.Theywillalsobluryourmemory.

Youandyourdoctorsmaydecidetouseacombinationofbothtypesofanesthetictechniques.AllanesthesiaprovidedinourcenterisadministeredbyMDanesthesiologists.

WillIhaveanysideeffects?Youranesthesiologistwilldiscusstherisksandbenefitsofthedifferentanestheticoptions.Theywilldiscussanycomplicationsorsideeffectsthatcanoccurwitheachtypeofanesthetic.Nauseaorvomitingmayoccurwithanesthesia.Withimprovedanestheticagentsandmethods,thereislessofaproblemtoday.Thesesideeffectscancontinuetooccurforsomepatients.Medicationstotreatnauseaandvomitingwillbegivenifneeded.Theamountofdiscomfortyouexperiencewilldependonseveralthings.Eachpatientcanreactdifferently.Yourdoctorsandnursescanhelprelievepainwithmedications.Yourdiscomfortshouldbetolerable,butdonotexpecttobetotallypain-free.Thestaffwillteachyouthepainscale(0-10)toassessyourpainlevel.Itisimportantnottocompareyourselfwithothers,eachindividualexperiencespaindifferently.Pleasenotifyyouranesthesiologistifyouhavehadanyproblemswithanesthesiainthepast.Pleasealertyouranesthesiologistifyou,orafirst-degreerelative,haveexperiencedMalignantHyperthermia.Thiswillaffectwhichtypesofanesthesiaaresafeandproperforyou.

Whatwillhappenbeforemysurgery?Youwillmeetyouranesthesiologistrightbeforeyoursurgery.Youranesthesiologistwillreviewallinformationneededtoevaluateyourgeneralhealth.Thiswillincludeyourmedicalhistory,laboratorytestresults,allergies,andcurrentmedications.

44

Asateam,youwilldeterminethetypeofanesthesiabestsuitedforyou.Heorshewillalsoansweranyotherquestionsyoumayhave.Youwillalsomeetyoursurgicalnurse.Intravenous(IV)fluidswillbestartedandpre-operativemedicationsmaybegiven.Monitoringdeviceswillbeattachedintheoperatingroom.Theseincludeabloodpressurecuff,EKG,andotherdevicesforyoursafety.Atthispoint,youwillbereadyforanesthesia.

Duringsurgery,whatdoesmyAnesthesiologistdo?Youranesthesiologistisresponsibleforyourcomfortandwellbeingbefore,duringandimmediatelyafteryoursurgery.Intheoperatingroom,heorshewillmanagevitalfunctions,includingheartrateandrhythm,bloodpressure,bodytemperatureandbreathing.

WhatcanIexpectaftertheoperation?Aftersurgery,youwillbetakentothePostAnesthesiaCareUnit(PACU).Speciallytrainednurseswillwatchyouclosely.Duringthisperiod,youmaybegivenextraoxygenandintravenousfluids.Youwilllikelybedehydratedfromnoteatingordrinkingpriortoyoursurgery.Yourbreathingandheartfunctionswillbewatchedclosely.Ananesthesiologistisavailabletoprovidecareasneededforyoursaferecovery.Manypeoplefeellightheadedafteranesthesia.Moveslowlywhenyoufirstgetup;dizzinessiscommon.

MayIchooseanAnesthesiologist?No.

45

TechniquesandMethodsofRelaxationafterSurgery

RelaxationTechniquesRelaxationisthelesseningoftension.Relaxationcanhelpyoucontrolanxiety.Ithelpsyouuseyourenergybetter.Tensepeoplesometimesfeelshortofbreath.Anxietyaboutfeelingshortofbreathactuallyincreasesshortnessofbreath!Relaxationactivitiescanreducetensionandanxiety.Itleavesmoreoxygenfordailyactivities.Relaxationisalearnedresponse.Ittakespractice.Inthebeginningyouneedtosetasidetimesduringthedaytopractice.Eventually,youwilllearntonoticethesignsthatyouaretense.Thatisyourtriggertobeginusingrelaxationactivities.Thiswillsaveyourenergyforchosenactivities.

MethodsofRelaxationDeepBreathing:Whilelyingonyourback,bendyourknees.Moveyourfeetabout8inchesapart.Keepyourtoesturnedoutslightly.

• Checkyourbodyfortension.• Placeonehandonyourstomach.Placetheotherhandonyourchest.• Breatheinslowlyanddeeplythroughyournoseintoyourstomach.Pushupyourhandas

muchasitfeelscomfortable.Yourchestshouldmoveonlyalittleandonlywithyourstomach.

• Whenyoufeelateasewiththatstep,smileslightlyandbreatheinthroughyournose.Breatheoutthroughyourmouth.Makeaquiet,relaxingwhooshingsoundlikethewindasyougentlyblowout.

• Continuedeepbreathingforaboutfivetotenminutesatatime.Dothisonceortwiceaday.Continueforacoupleofweeks.Thenyoucanincreasetheperiodtotwentyminutes.

• Attheendofthesession,taketimetocheckyourbodyfortension.Comparethetensionyoufeelattheendoftheexercisewiththatwhichyoufeltwhenyoubegan.

• Usethisexerciseanytimeyoufeeltensionoranxiety.BodyAwarenessThisexerciseallowsyoutoconcentrateondifferentbodyparts.Itwillbringongeneralrelaxation.Positionyourselfcomfortably.Closeyoureyes.Thinkofyourfacemuscles.Letthemtotallyrelax.Next,concentrateonyourneckandshouldermuscles.Relaxallyourmuscles.Movefromheadtotoe.Letallyourbodypartsbecomelooseandwarm.ImageryAllowpleasantthoughtsandimagestobringyouarelaxedstate.Closeyoureyes.Pictureapleasantsceneorafavoriteplace.Nowthinkaboutthesights,sounds,andsmellsofthepleasantsceneasyourelax.

46

AdditionalRelaxationTips• Usethesetipsanytimeyoufeeltenseduringtheday.Theymaybeveryhelpfultousebefore

youbeginataskorduringactivitiesthatcausetiredness.• Playsoothingmusic.• Thinkpleasantthoughts.• Takerestbreaksasneeded.• Yourlocationcanhelprelaxation.Turndownthelights.Closethedoorandbeina

quietplace.Wearloosecomfortableclothing.Trytokeepinterruptionsandnoisetoaminimum.

47

Notes

48

Notes