1

What To Expect For Your Total Joint Replacement

• Preparing for Surgery• What to expect on the Day of Surgery and During

Your Hospital Stay• Nursing Care and Pain Management• Physical & Occupational Therapy• What Happens After Discharge?

– Patient Care Coordination (PaCC)

Class Outline

• Complete a pre-surgical medical clearance with your Primary Care Provider, following the guidelines provided in your mailed surgery packet– If you also see a specialist, such as a cardiologist or

pulmonologist, they may also need to clear you for surgery

• Depending on medical history, you may also need to complete a visit at GUH Pre-Surgical Department– They will call you approx 2 weeks prior to surgery to

conduct a phone screening– If you do not hear from them by 2 weeks prior, please call

202-444-2746

Preparing for Surgery

• Ask about which medication you should stop prior to surgery, and which medication you should still take the day of surgery (with a small sip of water)

• Otherwise, no food or drink after midnight the day of surgery

• Follow instructions for use of Hibiclens skin cleanser the night before and morning of surgery• Can be purchased at GUH pharmacy on Ground PHC

or any local CVS, Rite Aide, Walgreens, etc

Preparing for Surgery

• Report to Registration, 1st floor of Main Building– Use Entrance #2– Bring ID and insurance cards

• You will be escorted to Surgery Center, Ground Floor CCC Building

• Surgical Holding Area• Operating Room

– Surgery is approx 1.5 - 2 hours• Recovery Room (PACU)• Family Waiting Area, 2nd floor

CCC building

Day of Surgery

• Regional Anesthesia (preferred)– Spinal or Epidural Anesthesia– Plus…Deep IV sedation– Pros: gentler recovery, less bleeding during surgery, lower

incidence of postoperative blood clots, possibly less pain afterwards

• General Anesthesia– May be necessary if taking blood thinners, have had prior

back surgery, or if spinal/epidural does not work• Discuss the choices with your anesthesiologist• In either case you will be asleep during surgery

Anesthesia Options

• Oxygen for breathing support• IV in your arm• Bandage on hip or knee• Knee immobilizer (knee replacement)• Abduction pillow (hip replacement)• Elastic stockings and/or

compression stockings• Foley catheter in place to drain your urine

Immediately After Surgery…Waking Up in the PACU

• Nursing assessment and monitoring– Vitals signs checked every 4hrs first night

• Call Don’t Fall!• Breathing exercises

– Incentive Spirometer

• Blood clot prevention – Continued use of elastic and/or compression stockings while in bed

• Ice packs– Knee patients only

• Continuous Passive Motion (CPM)– Knee patients only, your surgeon may or may not order this for you

Transfer to the Nursing Unit

• Rate your pain on a scale of 0-10– 0 is no pain at all– 10 is the most pain you can imagine– Don’t wait till a “10” to ask for pain medication!

• Pain medication:– Oral Pain Pills

• Long acting– IV Medication

• Short acting• For breakthrough pain• You can not be discharged home or to a rehab center while taking IV Pain Medication

Pain Management

• What are they?• Why do you need to take them after surgery?• How often and when will you take them?• If you are already taking an anticoagulant, be

sure to check with your surgeon for any instructions on stopping or changing before surgery.

Anticoagulants

May 1, 2023

11

At Home• You may take a shower and get your incision site wet, pat with clean

towel to dry• Do NOT:

– Submerge the site in water• No baths, No hot tubs, No whirlpools, No swimming

– Apply any lotions or creams

• Contact us for any fever > 101 degrees, increasing redness or pain in calf, drainage from the wound

• Wash hands thoroughly before re-dressing or touching the site in any way – post-op infection is the number one reason for re-admission!

• If your surgeon used staples or sutures to close the surgery site, these will be removed at your first follow up visit

May 1, 2023

12

What Does My New Knee or Hip Look Like?

GUH surgeons use either DuPuy or Zimmer products. Ask your surgeon’s office for specific details of your replacement.

GUH does not perform metal on metal replacements

• Role of Physical Therapy (PT)

• Role of Occupational Therapy(OT)

Physical & Occupational Therapy

• Toiletries– Toothbrush, denture care, glasses, contacts, etc

• Clothing– Undergarments, sweat pants, gym shorts, T-shirt, nightgown

• Clothing should be loose fitting • Avoid: jeans and flip-flops• You will receive hospital traction socks, you may bring shoes if you prefer• Please pack lightly!

• Family and Friends– Encouraged to observe therapy sessions to learn how to assist you

properly at home

What to Bring to the Hospital

• Average Length of Stay– For both hip and knee patients average stay is 2 nights

• Day of Surgery– Our goal is to get you OUT OF BED SAME DAY– You will either have your full PT evaluation that evening, or your

nurse will help you to get out of bed and to the chair

• Post-Operative Day 1-2– You will be seen by PT twice each day– You will be seen by OT once each day, until you no longer need

their services

Physical and Occupational Therapy Plan

• Physical Therapy• Strengthening exercises, walking, stairs, group sessions• For knee patients, goal is 90 degree bend by time of

discharge• Recommend the safest assistive device for walking

• Occupational Therapy• Daily Activities: transferring to toilet, dressing• Recommend adaptive equipment

Physical and Occupational Therapy Plan

• Do not cross your legs• No bending forward at the hip• Do not rotate your leg inward• Weight bearing as tolerated

Posterior Hip Precautions(to be followed for approx 6 wks post surgery)

• There are no movement restrictions except for avoiding a figure of four position with the operated hip.

• You may cross your ankles• Weight bearing as tolerated

Anterior Hip Precautions(to be followed for approx 6wks post surgery)

Adaptive Equipment

Adaptive and Ambulatory Equipment

3 in 1 Commode * CaneWalker

* Many insurances do not cover Commodes. If you are tall, or have low toilets, considering purchasing this ahead of time at home improvement stores, medical supply stores, or thrift stores

Raised Toilet Seat

• Pages 13-18 in your Guidebook• Do as many as you can, without pain, before surgery• Your therapist will give you specific ones to do after

Exercises

• Two important exercises:

– Seated knee extension (quad mobilization):

– Seated hip flexion (hip flexor mobilization):

Anterior Total Hip Replacement Exercises

Your Patient Care Coordinator (PaCC) will assist with discharge planning from the hospital and help you make arrangements for rehabilitation

services.

Patient Care Coordination(PaCC)

• Outpatient Services– Traveling to physical therapy appointments 2-3 times/wk– More equipment with broader range of exercises

• Home Health Care– Physical therapist comes to your home 2-3 times/wk

• If you are not safe to discharge home, your PaCC will discuss other options with you during your care plan.

Our goal is for you to safely discharge HOME from the hospital!

Rehabilitation Options(Not all options are covered by all insurances)

May 1, 2023

25

What Factors Affect the Rehabilitation Option that is Right

for Me?• Your insurance coverage• The recommendation of your surgeon and

therapists• Level of activity and independence prior to

surgery• Existing medical conditions

Prepare BEFORE Surgery:

• Attend Total Joint Replacement Class• Read the Surgery Guide and other materials provided by

your surgeon’s office• Think of homecare agencies and outpatient physical

therapy facilities that you or others have used in the past• Get recommendations and visit facilities

• If you have commercial insurance, call ahead to check which facilities are in-network

• You will speak with your PaCC prior to surgery for an individualized Care Plan Meeting

• Your PaCC will be in communication with your medical team and therapists to determine appropriate discharge plan

• Your PaCC will meet with you in your room to review your discharge plan and discuss your preferences

• Your PaCC will make all necessary arrangements for transfer to your next location, whether that be home or a rehabilitation facility.

During Your Stay at Hospital

• Your PaCC remains available to address any questions or

problems and facilitate transitions to the next level of care.

• For many patients, rehabilitation will involve outpatient services at some point, regardless of where you go after your hospital stay

– Identifying a location early and getting appointments pre-scheduled avoids a lapse in therapy!

– You must obtain a prescription for physical therapy and bring to your first appointment

• First follow-up appointment with your surgeon’s office approx 2 weeks after surgery

After Your Discharge from Hospital

• 2-4 wks before your doctor will recommend driving

• Proper vehicles for transportation: Avoid anything too compact or too low to ground

• Up to 6wks before your doctor will recommend flying

TransportationPlan for TRANSPORTATION home from the hospital, and for all outpatient appointments.

• Raise the height of chairs and beds if necessary• 3 in 1 commode or raised toilet seat if necessary• Remove throw rugs and cords from walkways• Ensure adequate lighting; nightlights are a good idea!• Have footwear available that is easy to slip on but also

provides protection for your toes and heel• Make arrangements for care of young children and pets• Do laundry and stock up on groceries prior to surgery• Ask for help when you need it !!!

Preparing Your Home for Discharge

Thank you!

Questions?