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EVARTS JOINT CENTER at Highland Hospital

Total Joint ReplacementA Guide for Patients and Families

New Hope for Greater Mobility and Pain Free Living.

V i s i t J o i n t . u r m c . e d u t o l e a r n m o r e .

Please bring this guide to the hospital.

Mission: Commitment to excellence in health care, with patients and their families at the heart of all we do.

EVARTS JOINT CENTER at Highland Hospital Joint.urmc.edu

Table of Contents

Introduction 4

Before Your Surgery 8

Your Hospital Stay 12

Your Recovery 14

Life After Surgery 26

4E V A R T S J O I N T C E N T E R a t H i g h l a n d H o s p i t a l

Welcome to the Evarts Joint Center

The mission of the Evarts Joint Center is to help you live pain-free with greater mobility and independence.

UR Medicine’s Highland Hospital has created a state-of-the-art center for joint care combining the research and educational resources of an academic medical center with the clinical expertise, efficiency and compassionate care of a community hospital. We offer a full range of services related to joint care, from arthritis and osteoporosis counseling to joint replacement and fracture treatment.

Highland Hospital has special new operating rooms for total joint replacements as well as a recovery unit consisting of rooms designed for comfort, quiet and privacy.

For more information about the Evarts Joint Center, including details about surgical procedures, what to expect during your stay and additional resources, please visit: joint.urmc.edu.

Remember: This guide provides general information on the joint replacement process. Your physician, nurse, or therapist may add to or change the recommendations. Always use their recommendations first and be sure to ask questions if any information or instructions are unclear. Keep this Total Joint Replacement Guide as a handy reference for at least the first year after your surgery.

Introduction

Your Joint Replacement ProcessTreatment TeamThe Evarts Joint Center at Highland Hospital provides a comprehensive course of treatment. Your team includes the region’s most experienced orthopaedic surgeons, anesthesiologists, internists/geriatricians, physicians’ assistants, nurse practitioners, orthopaedic nursing staff, physical therapists, social workers and occupational therapists specializing in total joint care. Orthopaedic Surgeon Performs your surgery and directs your medical care during your hospital stay. Anesthesiologist Meets with you immediately before your surgery to evaluate your general health and discuss anesthetic options.Physician Assistant (PA)/Nurse Practitioner (NP)/Orthopaedic Resident Functions as an extension of the surgeon and assists during surgery and helps monitor your recovery. Geriatric Physicians Highland Hospital Geriatrics Group (HHGG) is a group of physicians who specialize in the medical care of older patients in a hospital. Available to assist surgeons in managing complex medical problems of seniors.

Nurse The primary point of contact between you, your family and the rest of your health care team. Monitors and tracks vital signs, monitors pain control, administers medication, performs procedures such as IV placement and phlebotomy, and tracks your progress. Patient Care Technician (PCT) Assists nurses with your daily care. Takes vital signs, helps with hygiene routine, and assists you getting in/out of bed/chair. Social Worker (SW) Coordinates your discharge plan to home or to a short term rehabilitation facility. Home Care Coordinator (HCC) Arranges for services and equipment as needed in your home. Respiratory Therapist (RT) Monitors your oxygen needs and instructs you how to use an incentive spirometer. Occupational Therapist (OT) Evaluates and assists you to complete “activities of daily living” (ADL) such as bathing, dressing, and personal hygiene while maintaining your joint precautions. Teaches you how to use dressing and bathing equipment needed to achieve independence. (see the “Your Recovery” chapter beiginning on page 14.)

Physical Therapist (PT)

Evaluates and assists you with bed mobility, transfers, walking, stair climbing and exercises while maintaining your joint precautions. (see the “Your Recovery” and “Life After Surgery” chapters on page 14 and page 26.)

Dietician Technician: Provides you with appropriate menu options while you are in the hospital. Unit Secretary Answers your call bell and informs your nurse, PCT, or other health care professional to assist you. Environmental Services Aide Cleans your room daily during your hospital stay.

IntroductionV i s i t J o i n t . u r m c . e d u t o a c c e s s v a l u a b l e r e s o u r c e s .5


Hip Replacement ProceduresHip HealthIn order to understand what a total hip replacement is, it is necessary to understand how a healthy hip works. The hip is a ball and socket joint. The “ball” is at the top of your femur (thigh bone) and the “socket” is at the bottom of your pelvis. There is cartilage that covers the head of the femur. This allows the ball to move easily and smoothly in the socket. With the help of the muscles surrounding the hip, you are able to walk easily and without pain. An unhealthy or painful hip usually results from a wearing away of the cartilage. Without the cartilage present, there is no protection between the bony surfaces of the ball and socket. These two bony surfaces become rough and begin grinding against each other. This causes pain that results in stiffness and discomfort during movement.

What is a Total Hip Replacement?If your surgeon recommends a total hip replacement, he or she will choose the best artificial hip (prosthesis) for you. This prosthesis has four components: • A cup that replaces your hip socket. • A liner which fits into the cup.

• A ball that will replace the head of the thigh bone.

• A stem that is attached in the shaft of the thigh bone to

add stability to the prosthesis.

The components can be made from materials such as titanium, metal alloys, high grade plastics, and ceramics and are secured by several methods. The cup and stem are usually uncemented titanium implants that are secured within the bone as a “press-fit” with special surfaces that allow bone to bond directly to the implant. Fixation with cement is sometimes used in special situations. The ball is either metal or ceramic, and the liner is either polyethylene or ceramic.

Approaches to Hip ReplacementYour surgeon will make a small incision near the hip joint and will then go between the muscles, tendons, and capsule to expose the joint. Next, the head of the thigh bone (femur) is removed and the socket (acetabulum) is prepared for the cup and liner component of your prosthesis. The hollow canal inside the femur is then prepared so the femoral stem component of your implant can be fitted into position. Next, the ball component is secured on the end of the femoral stem and then fitted back into the socket. Finally, all surrounding tissues are repaired back to the normal position. Your surgeon will consult with you regarding the approach they will use during your surgery. All surgical approaches are utilized at the Evarts Joint Center in order to take advantage of individual surgeon expertise and the specific needs of each patient. You will receive specific instructions from your surgeon regarding the best approach for you to ensure a safe and fast recovery.

Mini-Posterior ApproachThe mini-posterior approach involves accessing

the hip joint via an incision made along the side of the hip. The surgeon enters the hip through muscles in the back of the joint. This approach allows excellent visualization of the joint and proper placement of the implants. It has a long history of successful outcomes and is the most widely used approach in the USA. This incision has grown smaller over the years and soft tissue dissection is minimized.

Anterior ApproachThe anterior approach involves accessing the hip joint via an incision more in the front of the hip and between the muscles in this area. During this procedure a special table is used to position the leg for surgery along with x-ray imaging to visualize the hip. For some patients, this approach may allow more movement immediately after surgery without bending precautions that follow the mini-posterior approach. The incision length is similar between all approaches.

Lateral ApproachesThis approach accesses the hip joint between the anterior and posterior muscle intervals.

Hip ResurfacingHip resurfacing is a type of hip replacement that places a metal cap over your natural hip ball and a metal liner inside the hip socket. It is a metal-against-metal articulation. This method is occasionally used for younger male patients. The long term results of this procedure are yet to be determined. Ask your surgeon if you have questions.

Introduction

Knee Replacement ProceduresKnee HealthIn order to understand what a total knee replacement is, it is necessary to understand how a healthy knee works. The knee is the largest joint in the body. It is classified as a hinge joint and works very much like a common hinge. Your knee is made up of three bones: the femur (thigh bone), the tibia (lower leg bone), and the patella (knee cap). Your knee joint connects the femur to the tibia, and on top of this rests the patella. The patella protects the knee joint and slides in a groove found in your femur when you bend your knee. The muscles around the knee are responsible for supporting and moving your knee. It is extremely important to rebuild and strengthen these muscles before and after surgery. Unfortunately, as a result of years of working, arthritis or trauma, a knee can become painful and less functional. Arthritis is the wearing away of normally smooth surfaces within the joint and subsequent pain caused by abnormal mechanics and inflammation.

What is a Total Knee Replacement? Knee replacement is a surgical procedure to resurface a damaged knee. Metal and plastic parts are used to cap the ends of the bones that form the knee joint along with the kneecap. An artificial knee will function very much like your original knee. Generally speaking, your surgeon will replace the bottom part of the femur and the top of the tibia. In most cases, your surgeon will also decide that your patella needs to be replaced.

Surgical ApproachThe knee joint is usually accessed through an incision directly over the front of the knee. An effort is made to minimize soft tissue disruption as much as possible.

Introduction

V i s i t J o i n t . u r m c . e d u to view our videos on both hip and knee surgery. Read our patient stories and learn what to expect.

V i s i t J o i n t . u r m c . e d u t o a c c e s s v a l u a b l e r e s o u r c e s .7


Before Your SurgeryUse this checklist to ensure you have properly completed each step prior to your surgery.

STEP 1Know your surgery date. (Once the decision is made, the surgeon’s office will inform you of your surgical date.)

STEP 2Complete paperwork sent from your surgeon. Your surgeon will make the arrangements for surgery. A mailing from your surgeon’s office will include: • A letter with your surgeon’s instructions to

prepare for your surgery. • Information about Highland Hospital’s pre-

surgical screening appointment. • Information about anesthesia. • A two page surgical pre-admission form. Please answer all questions on front and back. Bring the completed form with you to your pre-surgical screening appointment.

STEP 3Start your exercises. It is important to be familiar with the exercises that you will do after surgery to speed your recovery. Your doctor will let you know if you should omit any exercise. In the Life After Surgery section you will find an exercise sheet associated with your joint replacement. Perform each exercise ten times, twice a day.

STEP 4Attend a pre-surgical education class. The Evarts Joint Center conducts a pre-surgical education class for patients who will be having total joint replacement surgery. The presenters include an orthopaedic nurse, an occupational therapist, a physical therapist, and a social worker. During the class a social worker will get you started on your discharge planning paperwork. If you do not attend the class a social worker will call you.

STEP 5Go to pre-surgical screening appointment. • Our prescreening scheduler will call you

to schedule a pre-surgical screening appointment. Prior to your pre-surgical screening appointment please visit joint.urmc.edu to learn more about your Anesthesia care. Please have the following information available to review with the nurse: surgeon’s name; date and type of surgery; health history -- including past surgeries; pharmacy phone numbers; medication names, dosages, how often you are taking them and actual time of day. This includes vitamins and over-the-counter medications.

• Bring with you: insurance cards, health care proxy or living will (if you have one), and your 2 page surgical pre-admission form. If you do not have a Health Care Proxy form we can provide one, if desired.

• When you arrive you will meet with the secretary who will review and verify your information.

• Services provided at the pre-surgical screening department are: a) Blood work b) EKG c) Health history screening d) Pre-surgical education and instructions

Before Your Surgery

Call 585-784-2966 to register today.

V i s i t J o i n t . u r m c . e d uto choose your rehabilitation location.

Pre-Surgical Screening is located on the main floor (Floor 2) of the hospital. Enter the hospital through the main lobby and proceed straight down the main hallway. Turn left near the end of the hallway and continue, Pre-Surgical Screening will be on the right.

STEP 6Stop all anti-inflammatory medications.Do not take ASA/Anti-inflammatory medications (Advil, Motrin, Naproxen, Aleve) 10 days prior to your surgical date per your preoperative instruction sheet. If you have any questions or concerns regarding these medications, contact your surgeon.

STEP 7Prepare your home. Prepare your home for your return from the hospital. Pick up throw rugs and tack down loose carpeting. Remove electrical cords and other obstructions from walkways. Install night lights in bathrooms and hallways.

Before Your SurgeryV i s i t J o i n t . u r m c . e d u t o a c c e s s v a l u a b l e r e s o u r c e s .9


STEP 8Pack for your hospital stay. • Insurance cards • Copy of advanced directive. • Your Total Joint Replacement Guide. • List of medication changes, if any, since your

pre-surgical visit. • Personal hygiene items. • Loose fitting pajama pants or shorts with

elastic waistbands, loose underwear, shirts, a pair of shoes (walking/gym shoes with or without laces).

• Cell phone, if desired. • Credit card to pay for medications upon

discharge. • Do not bring valuable jewelry or large

amounts of cash.

STEP 9Follow the preoperative instructions. Please read and carefully follow the preoperative instructions for any medication changes. The instruction sheet has a section on medications with specific instructions for the day of surgery.

STEP 10Know your arrival time for surgery. • On the day before surgery, you must call

(585) 341.6707 between 2 p.m. and 4 p.m. to verify your arrival time.

• If your surgery is on a Monday, call the Friday before your surgery. If your surgery is the day after a holiday, call on the last working day before the holiday.

• Even if you have already been given a surgery time, you must call in advance to confirm your surgery time, because schedule changes do occur.

STEP 11Do Not Eat anything after midnight before your surgery.Preparing for your surgery is important. To avoid complications or cancellations of your surgery you must: • Not eat anything after midnight before your

surgery. • Review and follow the surgical instructions

given to you by the nurse, specifically related to eating, drinking and medications.

• Remember not to chew gum or eat mints on the day of your surgery.

Before Your Surgery

• Watch videos on what to expect.

• Review helpful answers to frequently asked questions.

• Find out more about the role of anesthesia in your procedure.

• Choose your preferred Nursing home(s) or rehabilitation center for after surgery recovery if necessary. • Refer to checklist on what to look for

• Learn more about adaptive equipment you may want to purchase in advance of your surgery.

Helpful Resources

V i s i t J o i n t . u r m c . e d u for more information on the following:



Your Hospital Stay Day of SurgeryBefore SurgeryOn the day of your surgery please report to the Same Day Surgery Unit waiting room located on the first floor of the hospital. Enter the hospital through the main lobby, proceed to the Blue Elevators and take them down to the first floor (Floor 1). Follow signs to the Surgery Center. Please arrive on time and check in with the receptionist.

Please bring your insurance card and any completed paperwork sent to you. We will keep you informed regarding your surgery time, but sometimes delays are unavoidable. Your surgeon and the anesthesiologist will see you before surgery.Your family or companion may wait with you before surgery and then will be directed to the main lobby. Your surgeon will call the main lobby to speak with them after your surgery is over. Your family or companion will keep your belongings while you are in surgery and can bring your suitcase/personal items to your room after your surgery. Please be advised that two visitors per patient are allowed to sit with you and no children under the age of 12 are allowed in the department.

Your Hospital Stay

MainLobby

Blue Elevators


After surgery After surgery you will be transferred from PACU (Post-Anesthesia Care Unit) to your hospital room in a bed. Your family will be notified when you have arrived in your room. • Your nurse will assess your condition

and your individualized care plan will be reviewed. Your needs will be monitored through hourly rounding by a nurse or patient care technician.

• Your pain level will be monitored and your pain medication adjusted as needed.

• You will be able to have ice chips and a liquid diet until your nurse assesses that you are ready for solid food.

• It’s important to begin ankle pumps, 20 repetitions, every hour that you are alert.

• Your surgeon and anesthesiologist will visit you.

• You will sit on the edge of the bed, stand and walk, if medically able.

• A social worker will review your discharge plans.

A typical hospital stay after joint replacement surgery is 2 – 3 days. During this time:After your surgery there is a greater potential to fall when you move. We will assist you to move from your bed, chair and while you walk. There is a call bell by each bed to be used to call for assistance. • Your daily individualized care plan will be reviewed by your nurse. • Your needs will be met by your nurse and your patient care technician through hourly rounding. • You will be visited by your surgeon or his/her resident, physician’s assistant or nurse practitioner. • Your anesthesiologist may visit you. • Your patient care technician will assist you to sponge bathe. • Oxygen will be discontinued, IV fluids will be stopped and your urinary catheter will be removed. • You will wear white supportive stockings during the day. • An ice pack should be on your joint as directed throughout the day. • You will be sitting in an appropriate chair for at least two hours, twice during the day. • A physical therapist will evaluate you and assist you to move and walk and provide physical

therapy sessions during your stay. • An occupational therapist will teach you how to bathe, dress and toilet while maintaining your

joint precautions. • The dressing on your joint will be changed. • A dietician technician will help you with menu choices. • An environmental services aide will clean your room every day.Before You are Discharged • When cleared by your surgeon, your nurse will review your discharge instructions. • If you are going to a skilled nursing facility directly from the hospital, a social worker will confirm

your discharge plans. • A home care coordinator may visit you and, if going home directly from the hospital,

a physical therapist will provide a therapy session.

Your Hospital Stay


Your RecoveryYour Discharge PlanIt’s important for you to have a safe discharge plan either directly home or to a short-term rehabilitation unit, if needed and as approved by your insurance plan. The following benchmarks are the goals for a safe home discharge plan following a total joint replacement. With good pain management, you will be independent and able to maintain the joint precautions while performing the following: • Getting in and out of bed • Moving from sitting to standing • Walking with a walker or other assistive

device • Accessing the needed areas of the home with

adequate endurance • Going up and down the number of stairs

needed to access home • Dressing • Personal Hygiene • Home exercise programIt is important to have family and friends available to assist you for a safe home discharge plan. If you live alone, it is a good idea to have a family member or friend stay overnight upon discharge. Someone responsible will need to drive you home.

TransportationTransportation home is arranged by the patient which is usually by car. Transportation to a rehab facility is usually arranged by the social worker and is at the patient’s expense.Home Discharge Plan A social worker will refer you to a home care agency of your choice: Visiting Nurse Service (VNS); Home Care of Rochester (HCR); or Lifetime Care (LTC). Other agencies cover areas outside of Monroe County. Please note that your insurance plan may dictate which agency you choose. Services Arranged by Your Home Care AgencyNursing: A nurse will visit you as ordered by your surgeon for further pain management and to reinforce how you can prevent complications from your surgery. Physical Therapy: A physical therapist will visit you in your home and assist you to develop a customized exercise and walking program to achieve the outlined goals in section “Maintaining and Improving Mobility”. Occupational Therapy: An occupational therapist may visit you once or twice to continue instruction on using your adaptive equipment, evaluate your bathroom and kitchen for safe use, and suggest additional equipment as needed. The therapist may also work on your homemaking skills needed to be independent. Lab Work: If ordered by your surgeon, a lab technician will come to your home for a blood draw.

Meal Assistance: If needed, you may arrange Meals on Wheels® or Dining Car®. Home Care Coordinator from your chosen home care agency will visit with you in the hospital to arrange services and delivery of needed equipment for home use.

Short-Term Rehabilitation Discharge PlanIt may be necessary to go to a short-term rehabilitation facility to recover following your surgery before returning home independently.* Short-term rehabilitation is offered at a skilled nursing facility (SNF) where you will receive nursing, physical therapy and occupational therapy. A social worker will assist you to select a rehabilitation facility. Visit Joint.urmc.edu to reeview the Nursing Home List for area facilities. If time allows prior to your surgery, you may contact facilities to ask questions or to schedule a tour. A sample check list of questions to ask can also be found at joint.urmc.edu. When you attend the pre-surgical education class, you will be asked to provide 7-10 choices of rehabilitation facilities. * You must have a safe home discharge plan in place prior to surgery. Please note that your insurance plan will dictate whether or not a skilled nursing facility is an option for you. This option may be age dependent. If your insurance company determines that you are functionally independent, safe to discharge to home and does not provide coverage for your discharge to a skilled nursing facility, you will be responsible for the costs/fees as determined by the skilled nursing facility.

Your Recovery


Caring for Yourself at HomeSit in an appropriate chair to maintain your joint precautions • A stable chair with a back and arm rests. • If the seat is too low, a firm pillow may

increase the height of the seat of the chair enough for ease in maintaining your joint precautions.

• Avoid overstuffed chairs or sofas, chairs that swivel or have wheels and rocking chairs.

Keep tools close and within reach for ease of use including: • Walker/crutches • Reacher to retrieve items from the floor or

beyond your arm’s length reach. • Cell phone or cordless phone • Prescribed medication and water within

reach • Pad of paper and pencil • Wear compression stockings during the day

and remove at night for 4 to 6 weeks.

Keep home safe for walking with a walker • Keep home well lit, including night lights, a

bedside light, and entryway lights. • Have family/friends move unnecessary

furniture to provide a wide pathway. • They should also remove scatter rugs and

hallway runners and tape down the edges of large area rugs.

• If you have pets, arrange for care as necessary.

• Keep electrical cords and phone cords out of the way.

• Have family/friends keep kitchen and bathroom floors dry, cleaning up spills quickly.

Practice care in the bathroom • Use a raised toilet seat or “3 in 1” commode

for 3 months after surgery. • Use safety bars or a shower chair in the bath

that your OT has recommended • Use non-slip mats inside and outside the

bathtub/shower. Remember that the floor may be wet.

• Use the recommended technique for toileting (wipe yourself while standing with support of a walker or grab bar).

Caring for your incision Always wash your hands before incision care. Keep your incision clean and dry and covered with a light dressing if you have any drainage. Ask your surgeon if you have staples or sutures and if you may take a brief shower. If so, do not scrub your incision - just pat the area dry.

Your Recovery

Special Hip CareDepending on the surgical approach used by your surgeon, you may need to maintain certain joint temporary precautions to avoid dislocation of your new hip. These include:

Do not lean forward or bend your hip greater than 90°Avoid extreme positions with your hip


Inspect Your Incision for the Following: • Increase in redness around the incision • Presence of drainage • Drainage develops an odorContact your surgeon if any of the above changes occur or if you have a fever which exceeds 101 degrees Fahrenheit (101°F).

Controlling Discomfort • Use ice for pain control. Place ice pack

on your joint for 30 minutes at a time as needed. You can use it before and after your exercise/walking program.

• Change your positions frequently at least every two hours.

• Take your pain medication as prescribed by your surgeon prior to physical therapy sessions.

• Gradually wean yourself from prescription medication to Tylenol® You may take two, extra-strength Tylenol up to four times per day in place of your prescription medication.

Temporary Changes • Your appetite may be poor. Drink plenty of

fluids such as water, juice, milk, and light soups to keep from getting dehydrated. Your desire for solid food will return.

• You may have difficulty sleeping, this is not abnormal. Don’t sleep or nap too much during the day.

• Your energy level will be decreased for the first month.

• Pain medication contains narcotics, which promote constipation. Try eating more fruits such as prunes, or use stool softeners or laxatives such as milk of magnesia if absolutely necessary.

Your Recovery

Look for Blood Clots in LegsHow Blood Clots FormSurgery may cause the blood to slow and coagulate in the veins of your legs, creating a blood clot. This is why you take blood thinners after surgery. If a clot occurs despite these measures, you may need different treatment or be admitted to the hospital to receive intravenous blood thinners. Prompt treatment

usually prevents the more serious complication of pulmonary embolus.

Signs of Blood Clots in Legs • Swelling in thigh, calf or ankle that does not go down when elevated (especially overnight). • Sudden increase in pain, tenderness, redness or warmth in calf. • New calf pain with ankle pumps.Prevention of Blood Clots • Foot and ankle pumps. • Walking. • Compression Stockings: You will be asked to wear special white stockings. These stockings

are used to help compress the veins in your legs. This helps to keep swelling down and reduces the chance of blood clots. Wear the stockings during the day and remove at night.

• If swelling in the operative leg is bothersome, elevate the leg for short periods throughout the day. It’s best to lie down and raise the leg above heart level.

• Take blood thinners as directed.

Your Recovery

Managing Your Daily RoutinesThe follow techniques are recommended by your occupation therapist.

Getting DressedSlacks and Underwear • Using a dressing stick or reacher, catch the waist of the underwear or slacks. • Lower the item to the floor. • Slip the clothing over your surgical leg first, then the non-surgical leg. • Pull the clothing to your thighs; do not reach below the knees to grab clothing. • Stand with the assistance of a walker and pull up the clothing to the waist. Socks and StockingsUse sock aid as follows: • Slide your sock or stocking onto the sock aid making sure the heel is at the back of the aide and

the toe is straight and tight on the end. • The top of the sock should not come over the upper edge of the sock aid. • Hold onto the cords, drop the sock aid out in front of surgical leg, and slide your toes into the

opened sock. • Point your toes and slowly pull on the cords to pull the sock up. Shoes • Slip-on shoes are easier to put on than tie-up shoes. Elastic shoe laces can replace shoe laces in

sneakers to allow the shoes to slip on easily without needing to be tied. • Use the reacher to grab the shoe by the tongue and place your toes in shoe. • With the aid of a long handled shoehorn, push your heel into the shoe.


18E V A R T S J O I N T C E N T E R a t H i g h l a n d H o s p i t a lYour Recovery

Moving AroundIt is important to use the correct technique when sitting down and standing up. Raising the level of the toilet seat and choosing appropriately sized chairs will help to minimize pain and help to maintain joint precautions during the process of moving from a standing to sitting position.

Sitting Down • Back up with the walker until you feel the chair behind your legs. • Position the back legs of the walker against the chair. • Slide your surgical foot forward on the floor toward the front legs of the walker. • Lower yourself slowly to the chair using your arms.

Standing up • Position the back legs of the walker against the chair. • Slide your surgical foot forward on the floor toward the front legs of the walker. • Push up from the chair with both hands to begin standing up. • Continue standing to achieve the upright position. • Use the walker or crutches to support your weight and maintain your balance. • Slide your surgical foot backward toward the chair to be even with your other foot. • Stand with weight on both legs as directed by your physical therapist.

Your Recovery

WalkingYour physical therapist will tell you exactly how much weight you are allowed to put on your surgical leg as ordered by your surgeon. Your allowed weight may range from “touchdown” (barely touching your foot to the floor), to “partial” (less than 50% of your weight), or “as tolerated” (as much as is comfortable). Weight bearing as tolerated is the most common protocol.

Walking with a walker • Always keep your walker in front of you. • Lift your walker and place it approximately an arm length in front of you. Be sure to place all four

legs down flat before walking. • Place your surgical leg approximately one-half the distance between you and the walker. • Place your non-surgical leg next to or past the surgical leg near the front of the walker. Note: If you are using crutches, your weight should be supported on your hands, not under your arms.



Getting Into and Out of a Vehicle The vehicle needs to sit high enough and have a wide enough door swing to maintain your surgeon’s joint precautions. Practice the vehicle transfer before your surgery to select the appropriate vehicle. Remember that you will not be able to drive for at least six weeks or until approved by your surgeon.

Front seat, passenger side • Open the passenger door and roll down the window. • Move the passenger seat back as far as it will go in its track and recline the seat to at least 45°

angle for ease of getting into the vehicle. • Approach the vehicle and back up to the seat until you feel the seat behind your legs. • Follow the steps for “Sitting Down.” • Reach back for the vehicle frame/dashboard/window/seat with your hands and lower yourself to

the seat. • Move your hips and knees further onto the passenger seat and toward the center of the vehicle. • Lean back, and with assistance, position your hips and knees so that you face the windshield. • With assistance, gently position one leg at a time into the vehicle. • By leaning backward onto the reclined seat, you will be able to bend your knees to clear the door

jam with your legs while maintaining joint precautions. • Once in the vehicle, adjust the seat for comfort. • Reverse this process to get out of the vehicle.

Your Recovery

Back Seat: • Plan to enter the car to allow your surgical leg to rest flat on the back seat. • Open the vehicle door and back up to the vehicle with your walker until you feel

the seat behind your legs. • Follow the steps for “Sitting Down.” • Back into the vehicle by pushing through your hands and non-surgical leg to unweight the hips

and knees to scoot across the seat until your surgical leg is resting flat on the back of the seat. • Remember to keep your hands behind your hips to maintain joint precautions. • The non-surgical leg can rest in the well of the vehicle. • Reverse this process to get out of the vehicle.



Getting Into and Out of BedThe bed needs to be high enough to follow your surgeon’s joint precautions. Bed heights greater than or equal to 23 inches from the ground would be appropriate in most cases. Bed risers can be used to increase the height of your bed. Getting Into Bed • Get into bed towards your non-surgical side. • Begin by following steps for “Sitting Down.” • Move toward the center of the bed by pushing down on the bed with your hands and

pushing off the floor with your non-surgical foot to unweight your new joint. • Carefully reposition your hips and knees so that you are facing the foot of the bed. • Lift your non-surgical leg onto the bed. • Lift your surgical leg onto the bed with the help of folded bed sheet or a leg lifter. • Position your hips towards the center of the bed by pushing down on the bed with your hands and

pushing off the bed with your non-surgical foot to unweight your hips. • Recline backward with support on one bent elbow and then onto the other bent elbow. • Relax one elbow and then the other to lie flat on the bed.

Your Recovery

Getting Out of Bed • Get out of bed towards the surgical side. • Push up onto your elbows from a flat position. • Straighten your elbows one at a time to position yourself in long sitting. • Move toward the edge of the bed by pushing down on the bed with your hands and

pushing off the bed with your non-surgical foot to unweight your hips. • Carefully reposition your hips and knees so that you are facing the edge of the bed. • Lower your surgical leg to the floor with the help of a folded bed sheet or a leg lifter. • Lower your non-surgical leg to the floor. • Reposition your hips so that you are sitting squarely on the edge of the bed. • Continue by following steps for “Standing Up.”

Bed Positioning Lying on your back • Safest position. • Keep a pillow between your legs to maintain joint precautions. Side lying • As dictated by comfort. • Place pillows between legs to maintain joint precautions.



Going Up and Down Stairs You will be instructed on how to stair climb to minimize pain and promote stability following your joint replacement.

Going up the stairs with a cane and one hand railing • Approach the stairs with a walker. • Put one hand on the railing and move the walker to the side. • Position the cane on the floor next to your foot. • Step up with your non-surgical leg while supporting your weight and maintaining balance

with the assistance of the cane and the railing. • Step up with your surgical leg. • Bring the cane up to the step. • Repeat.

Going down stairs with a cane and one hand railing • Approach the stairs with a walker. • Put one hand on the railing and move the walker to the side. • Position the cane next to your foot. • Place the cane on the stair below you. • Move hand down the hand railing even with cane. • Step down with your surgical leg. • Step down with your non-surgical leg while supporting your weight and

maintaining balance with the assistance of the cane and the railing. • Repeat.

Your Recovery

Adaptive Equipment you may want to purchase in advance of your surgery.

Crutches Cane Dressing Reacher Dressing Stick Long Handled Bath Sponge

Leg Lifter Elastic Shoe LacesLong-handled Shoe Horn Elastic Shoe Laces

Raised Toilet Seat 3 in 1 Commodes

Walker Walker with Wheels Wheel Chair


26E V A R T S J O I N T C E N T E R a t H i g h l a n d H o s p i t a lLife After Surgery

Life After SurgeryProgressing to IndependenceWeeks 1-2Your goals for this period of time are to: • Recall and demonstrate joint precautions,

if applicable. • Independently get in and out of bed and

independently get up and out of a chair. • Independently walk with a walker or crutches

and walk at least 150 ft, three times a day. • Independently climb and descend a flight of

stairs once a day. • Improve strength by 10%. • Perform a car transfer with assistance

of one person. • Control pain with the use of ice packs. • Manage swelling and decrease risk of a DVT

by wearing compression stockings during the day.

• Perform toileting and personal hygiene skills and dress independently.

• Shower when approved by surgeon with assistance from one person.

Week 2-4Your goals for this period of time are to: • Recall and demonstrate joint precautions,

if applicable. • Achieve your “1 to 2 week goals”. • Walk at least ¼ mile

(or as much as comfortable). • Climb and descend a flight of stairs more

than once daily. • Complete your daily home exercise program. • Improve strength by 25%. • Perform a car transfer independently. • Control pain with the use of ice packs. • Manage swelling and decrease the risk

of DVT by wearing compression stockings during the day.

• Independently shower and dress. • Resume light home-making tasks. • For Total Knee Replacements - Achieve

at least 90 degrees of flexion, if you had this amount of flexion preoperatively.

Week 4-6Your goals for this period of time are to: • Recall and demonstrate joint precautions, if

applicable. • Achieve your “2 to 4 week goals”. • Walk with a cane or crutch without limping. • Walk at least ½ mile, three times per week. • Climb and descend stairs in a normal fashion

if comfortable. • Complete your daily home exercise program. • Improve strength by 50%. • Control pain with the use of ice packs. • Discontinue use of compression stockings as

advised by your surgeon. • Drive a car with your surgeon’s approval.

Total Knee Replacement: Right knee at 6 weeks, Left knee when comfortable.

• Resume homemaking tasks.

Week 6-12Your goals for this period of time are to: • Achieve your previous goals. • Walk without a cane or crutch support

without limping. • Walk approximately 1 mile,

three times a week. • Improve strength by 75%. • Resume all activities after 12 weeks with

your surgeon’s approval. • Achieve normal ambulation.

Life After SurgeryV i s i t J o i n t . u r m c . e d u t o a c c e s s v a l u a b l e r e s o u r c e s .27

28E V A R T S J O I N T C E N T E R a t H i g h l a n d H o s p i t a lLife After Surgery

What to Do for Exercise • Recommended exercise classes • Regular 1 to 3 mile walks • Home treadmill (without an incline) • Stationary bike with proper seat elevation • Nordic Track or elliptical glider • Regular exercise at a fitness center as

directed and approved by your surgeon • Resume low impact sports such as golf,

bowling, walking, gardening, dancing, cross country skiing, snowshoeing, etc.

What NOT to Do for Exercise • Do not run or engage in high impact

activities • Ask your surgeon if you have questions

about other activities

E V A R T S J O I N T C E N T E R a t H i g h l a n d H o s p i t a l

Helpful Resources

V i s i t J o i n t . u r m c . e d u for more information on the following:

• Watch videos on what to expect.

• Review helpful answers to frequently asked questions.

• Find out more about the role of anesthesia in your procedure.

• Choose your preferred nursing home(s) or rehabilitation center for after surgery recovery if necessary. • Refer to checklist on what to look for

• Learn more about adaptive equipment you may want to purchase or rent in advance of your surgery.

585-784-2966

EVARTS JOINT CENTER at Highland Hospital

1000 South Avenue Rochester, NY 14620

585.784.2966 joint.urmc.edu

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