before, during and after hip and knee replacement...
TRANSCRIPT
Before, During and After Hip and Knee Replacement Surgery A PATIENT’S GUIDE
OAS S
Acknowledgments
We would also like to thank the joint replacement clients who participated in the revision process of this booklet.
Your feedback and suggestions will be of great help to people who are preparing for joint replacement surgery.
This revised booklet is based on information produced
over the years by a variety of organizations. We would
like to acknowledge the contributions made by:
TheArthritisSociety,BC&YukonDivision
TheMaryPackArthritisProgram
HipHipHooray
BCOrthopedicAssociation
CanadianOrthopedicFoundation
This edition of the booklet was developed by OASIS
(OsteoArthritis Service Integration System) at
Vancouver Coastal Health in partnership with staff at:
VancouverIslandHealthAuthority
NorthernHealthAuthority
InteriorHealthAuthority
FraserHealthAuthority
ProvidenceHealthCare
OAS S
ContentsHip Surgery•HipAnatomy ...................................... 7•HipReplacementSurgery .................... 8•JointComponentsandAttachment ..... 9•HipPrecautions ................................. 10
Knee Surgery•KneeAnatomy .................................. 15 •KneeReplacementSurgery ................ 16•JointComponentsandAttachment ... 16•KneePrecautions ............................... 18
Before Surgery •HomeSet-Up ................................... 23•Exercise ............................................ 28•Nutrition ......................................... 29•WeightManagement ......................... 30•Pre-OperativeEducation ................... 31•Pre-AdmissionClinic ........................ 31•FinalChecklistBeforeSurgery ........... 32
During Your Hospital Stay•Dayofsurgery ................................... 35•Lengthofstay .................................... 37 •Rehabilitation ................................... 38•PainControl ...................................... 39•PreventingBloodClots ...................... 41•GoingHome ..................................... 41
After Surgery•RecoveryAtHome ............................ 45 •ReturningtoWork ............................ 53•Complications ................................... 54
Resources .............................................. 61
Index ....................................................... 62
Youareabouttohavehiporkneereplacement
surgery.Patientswhoarepreparedforsurgery
andwhotakepartintheircarecanrecoverin
lesstimeandwithlesspain.Thisbookletwill
giveyouthegeneralinformationyouneed
togetyourself,yourfamilyandyourhome
readyforsurgery.Readthisbookletwithcare
andbringittothehospitalwhenyougofor
surgery.Wehopethatyoufindthisbookleta
usefulreferenceguidebefore,duringandafter
yourjointreplacementsurgery.
*IMPORTANT: If your surgeon or health care team gives you
different advice than what has been provided in this booklet,
please follow the specific directions you receive.
Do you still have questions about joint replacement surgery?
Would you like to talk to someone who has gone through the surgery?
Ifso,Ortho Connectisforyou!ItisaprogramthroughtheCanadianOrthopedicFoundationthatwillconnectyouwithavolunteerwhohasgonethroughasimilarsurgicaltreatment. Youwillbeabletoaskthevolunteerquestionsaboutwhattoexpectthroughthisexperienceandgetusefultipsonhowtocope.
Moreinformationisavailableat: www.canorth.org(clickon“patientresources”) orphone1-800-461-3639 [email protected]
4 | Before, During & After Hip and Knee Replacement Surgery
Hip SurgeryIn this section, you will learn about:
2 Hip Anatomy
2 Hip Disease
2 Total Hip Replacement Surgery
2 Hip Resurfacing Surgery
2 Hip Revision Surgery
2 Artificial Joint Components
2 Joint Attachment (Fixation)
2 HIP PRECAUTIONS
Before, During & After Hip and Knee Replacement Surgery | 7
Hip Anatomy
Thehipjointisaballandsocketjoint–that’swhyyoucanmoveyourhipinmanydirections.Theballistheroundheadofthethighbone(femur).Itmovesinthesocketofyourpelvis(acetabulum).Musclesandligamentssupportandstrengthenthejoint.
Hip Disease
ThemostcommonreasonforjointreplacementsurgeryisOSTEOARTHRITIS.Osteoarthritisresultsinthebreakdownofcartilageontheendsofthebones.Itusuallyappearsinjointsthatcarryyourbodyweight,suchashipsandknees.Osteoarthritiscancausejointpainandstiffness.Advancedjointdamagecanberepairedthroughjointreplacementsurgery.
Otherdiseaseconditionsmayalsoleadtodamageofthejoint,requiringjointreplacementsurgery.Theseincludeconditionssuchasrheumatoidarthritis,boneinfectionoralackofbloodsupplytothebone.Talktoyourdoctorifyouhavequestionsaboutyourjointhealth.
Joint Damage
Normal Hip Joint
Femur
Pelvis
Osteoarthritic Hip Joint
WornCartilage
BoneSpurs
Acetabulum
Cartilage
8 | Before, During & After Hip and Knee Replacement Surgery
Total Hip Replacement
Intotalhipreplacementsurgery,thesurgeonreplacesthediseasedjointwithanartificialjoint(prosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthehipjoint.Thentheheadofthethighboneisreplacedwithanartificialballandstem.Thepelvicsocketissmoothedandlinedwithaprostheticcup.Thenthejointisputbacktogetherwiththeballfittedintothecup.Oncethenewjointisinplace,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).Thissurgerytakesabouttwohours.
Today,manypatientswhohavehipreplacementsurgerycanmovetheirjointmoreeasily,havelesspainandareabletowalkmorecomfortablyforupto25yearsaftersurgery.
Hip Resurfacing
Hipresurfacingisatypeofhipreplacementsurgerythatmaybesuggestedbyyoursurgeonbasedonanumberoffactorsincludingthedegreeofdamagetoyourjointandyouroverallhealth.
Inthissurgery,thesurgeonreplacesthediseasedjointwithaspecialformofartificialjoint(resurfacingprosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthehipjoint.Thenthedamagedcartilageandsomepartsofthebonesurfaceareremovedfromtheheadofthethighbone(femur)andthehipsocket(acetabulum).Aball-shapedcapisplacedovertheheadofthethighbone.Thehipsocketissmoothedandlinedwithamoldedshell.Oncethejointisputbacktogether,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).
Prostheticcup
Head
Stem
Femur
Pelvis
Artificial Hip Joint
Resurfacingprosthesis
Resurfaced Hip Joint
Before, During & After Hip and Knee Replacement Surgery | 9
Hip Revision (Repeat)
Somepeoplewhohavehadahipreplacementmayneedanothersurgerybecause:
•Thejointhasdislocated
•Thejointislooseorwornout
•Therehasbeenbonelossoraninfectioninthejoint
Thesesurgeriescanbemorecomplexandyoumayneedmorerehabilitationaftersurgery.Youmaynotbeabletocarryasmuchweightonyournewjointwhileyourecover.
Joint Components (Prosthetics)
Artificialjointcomponentsmaybemadeofmedical-grademetal,plastic,ceramicorsomecombinationofthesematerials.Yoursurgeonwilldeterminethetypeofjointtobeused,matchingyourindividualneedswithasuitabletypeofmaterial.
Joint Attachment (Fixation)
Thetypeoffixationusedtosecuretheartificialjointinyourbodywilldependonavarietyoffactorsincludingyourage,diseasetypeandbonequality.
CEMENTED:Theartificialjointpiecesaresecuredtothebonewithaquick-hardeningadhesive.
CEMENTLESS: Theartificialjointpiecesarecloselyfittedintothebones.Thesepiecesarecoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.
HYBRID: Inthistypeofsurgery,onepieceoftheartificialjointisattachedwithcementwhiletheotherpieceiscoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.
10 | Before, During & After Hip and Knee Replacement Surgery
Hip Precautions
After Hip Surgery, you will need to follow HIP PRECAUTIONS for 3 MONTHS
unless otherwise advised by your surgeon.Theseactivityrestrictionswillhelpyourjointtohealandreducetheriskofhipdislocation.See“Complications”sectionformoreinformation,page54. Shaded leg is the surgical leg.
DO NOT bend your hip past 90 degrees DO NOT cross your legs at the ankles or knees
DO NOT twist your body or legs
AdditionalNotesforHipSurgeryandPrecautions:
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
45°
90°
Before, During & After Hip and Knee Replacement Surgery | 11
Things you CAN DO after hip surgery:
DO sit on a raised chair or use a high-density foam cushion to increase
surface heights. Use a raised toilet seat.(seepage49forhowtosit)
DO use long-handled aids, such as a shoehorn and reacher, to help you dress
and pick up items.
DO sleep with pillows between your legs for the first 3 months after surgery. Youmayrequireassistanceplacingthepillowsorchoosetouseanextra-longpillow.
90°
Shoe Horn
Reacher
12 | Before, During & After Hip and Knee Replacement Surgery
Knee SurgeryIn this section, you will learn about:
2 Knee Anatomy
2 Knee Disease
2 Total Knee Replacement Surgery
2 Bilateral Knee Replacement Surgery
2 Unicompartmental Knee Replacement Surgery
2 Artificial Joint Components
2 Joint Attachment (Fixation)
2 KNEE PRECAUTIONS
Before, During & After Hip and Knee Replacement Surgery | 15
Knee Anatomy
Thekneejointiswherethethighbone(femur)meetstheshinbone(tibia).Thekneeisahingejointthatallowsyoutobendandstraightenyourleg.
Knee Disease
Themostcommonreasonforjointreplacementsurgeryis OSTEOARTHRITIS.Osteoarthritisresultsinthebreak-downofcartilageontheendsofthebones.Itusuallyappearsinthejointsthatcarryyourbodyweight,suchashipsandknees.Osteoarthritiscancausejointpainandstiffnessthatmayrequirejointreplacementsurgery.
Otherdiseaseconditionsmayalsodamagethejoint,requiringjointreplacementsurgery.Theseincluderheumatoidarthritisoraninjurytothejoint.Talktoyourdoctorifyouhavequestionsaboutyourjointhealth.
Total Knee Replacement
Intotalkneereplacementsurgery,thesurgeonreplacesthediseasedjointwithanartificialjoint(prosthesis).First,thesurgeonmakesanincisionandmovesthemusclesandligamentsawayfromthekneejoint.Thenthedamagedbonesarereshapedtofittheartificialjoint.Theendsofthethighboneandshinbonearecoveredwithmetalshells,separatedbyaplasticliner.Ifthekneecap(patella)isdamaged,itmaybelinedwithaplasticdisc.Oncethenewjointisinplace,themusclesandligamentsarerepaired.Yourskinisclosedwithsuturesorstaples(staplesaremetalclipsthatholdyourskintogetherwhiletheincisionheals).Thissurgerytakesabouttwohours.
Today,manypatientswhohavekneereplacementsurgerycanmovetheirjointbetter,havelesspainandareabletowalkmorecomfortablyforupto25yearsaftersurgery.
Normal Knee Joint
Patella
Cartilage
Femur
Tibia
Ligament
Osteoarthritic Knee Joint
Artificial Knee Joint
WornCartilage
Femurprosthetic
PlasticLiner
Tibialprosthetic
PatellarButton
16 | Before, During & After Hip and Knee Replacement Surgery
Bilateral (Both) Knee Replacement
Insomecases,asurgeonmaydecidethatbothkneesneedtobereplacedatthesametime.Thisdependsonanumberoffactorsincludingyouroverallhealth,jointdamageandlifestyle.Thesurgerywillbethesameasatotalkneereplacement.Yourhospitalstaymaybelongerandyoumayneedmorerehabilitationaftersurgerytohelpyougetbacktoyourdailyactivities.
Unicompartmental (Partial) Knee Replacement
Ifyouonlyhavebonedamageononesideofyourknee,yoursurgeonmaydecidethatyouareasuitablecandidateforpartialkneereplacementsurgery.Aswithtotalkneereplacementsurgery,thesurgeonreshapesthedamagedpartsofthebonetofittheartificialjoint(prosthesis).Manypeoplewhohavethiskindofjointreplacementsurgeryrecovermorequicklythanpeoplewhohavetotalkneereplacementsurgery.Peoplewhohavepartialkneereplacementsurgeryareoftensenthomefromthehospitalthedayaftersurgery.
Knee Revision (Repeat)
Somepeoplewhohavehadakneereplacementneedanothersurgery.Thiscanbebecause:
•Yournewjointislooseorwornout•YouhadbonelossoraninfectioninthejointThesesurgeriescanbemorecomplexandyoumayneedmorerehabilitation.Comparedtoyourfirstsurgery,youmaynotbeabletocarryasmuchweightonyournewjointwhileyourecover.
Joint Components (Prosthetics)
Artificialkneejointcomponentsaremadeofmedical-grademetalandplastic.Therecanbedifferencesintheanatomyofmen’skneesandwomen’sknees.Yoursurgeonmaychoosea“gender-specific”kneejointforyou,dependingontheshape ofyourknee.
Partial Knee Joint
Before, During & After Hip and Knee Replacement Surgery | 17
Joint Attachment (Fixation)
Theartificialjointcanbesecuredindifferentways:
CEMENTED: Theartificialjointpiecesaresecuredtothebonewithaquick-hardeningadhesivematerial.
CEMENTLESS:Theartificialjointpiecesarecloselyfittedintothebones.Thesepiecesarecoveredinaroughmaterialthatencouragesbonegrowth.Bonegrowthintotheartificialjointcanprovideadditionallong-termjointstability.Somepartsoftheartificialjointmaybescrewedinplacetokeepthejointstable.
HYBRID: Acombinationofthesemethods.
18 | Before, During & After Hip and Knee Replacement Surgery
Knee Precautions
After Knee Surgery, you will need to follow Knee precautions for 3 months or
until advised by your surgeon.Theseactivityrestrictionswillhelpyourjointtohealandreducestiffnessinthenewjoint.See“Complications”sectionformoreinformation,page54.Shaded leg is the surgical leg.
DO NOT put a pillow behind your knee. Your knee may become stiff if you keep it bent.
DO NOT kneel on your new knee joint
DO NOT do deep squats (squatting down to the floor.)
AdditionalNotesforKneeSurgeryandPrecautions:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Before, During & After Hip and Knee Replacement Surgery | 19
Things that you CAN DO after knee surgery:
DO sit on a raised chair or use a cushion.Itwillbeeasiertogetonandoffhighersurfacesaftersurgery.Considerusingaraisedtoiletseat.
DO use long-handled aids, like a shoehorn and reacher, to help you get
dressed or pick up items.
Shoe Horn
Reacher
20 | Before, During & After Hip and Knee Replacement Surgery
Before SurgeryIn this section, you will learn about:
2 Home Set-up
2 Equipment
2 Exercise
2 Nutrition
2 Weight Management
2 Pre-op Education
2 Pre-Admission Clinic
2 Final Checklist for Hospital
Before, During & After Hip and Knee Replacement Surgery | 23
Home Set-Up
ItisimportanttosetupyourhomeBEFOREjointsurgery.Thiswillallowyoutoeasilymovearoundyourhomewithawalkerorcrutchesaftersurgery,reducetheriskoffallsandmaintainyourhiporkneejointprecautions.
•Ensurehallwaysandroomsarefreeofclutterandtrippinghazards(egscatterrugs,footstools,etc.)
•Addnon-slipsurfacestooutsidestairsandwalkways
•Installstairrailingsormakesuretheexistingonesaresecure
•Setupafirmchairwitharmrests.Ifyouhavehadhipsurgery,seepage25formoreinformationonseatingheights.
•Ensuregoodlightinginhallwaysandotherwellusedareas
•Arrangeforextrahelpwithhouseholdtasksifneeded(i.e.vacuuming,laundry)
•Movefrequentlyusedhouseholditemstocounterheight(i.e.potsandpans).Considermovingitemsinthelowerpartsofthefridge/freezertoahighershelf.
•Stockyourfreezer/pantrywithhealthyfoodsandsnacks.Ifneeded,privatefood/mealdeliveryservicesareavailableinmanyareas.
•Keepanicepackinyourfreezerforpossiblejointswellingaftersurgery.Alternatively,youcanuseabagoffrozenpeas.
•Haveathermometerathometocheckyourtemperatureifneededaftersurgery.
Secure Stair Rails
24 | Before, During & After Hip and Knee Replacement Surgery
Bathroom
•Installaraisedtoiletseatwitharmrests/toiletsafetyframetoassistyoutositorstand
•Removeslidingdoorsfromyourbathtubandreplacewithashowercurtain
•Setupatubtransferbench(inthebathtub)orashowerchair(inashowerstall)
•Useanon-slipbathmatbothinsideandoutsidethebathtuborshower
•Installahand-heldshowerhoseinthebathtub
•Grabbarsinthebathtub/showerstallandbythetoiletareveryuseful.Removablegrabbarsareavailable.DoNOTusetowelsracksortoiletpaperholderstoassistyoutostandorsit.
Raised Toilet Seat
Tub Transfer Bench Removable Tub Clamp
Before, During & After Hip and Knee Replacement Surgery | 25
Seating After HIP SURGERY:
•As you are not able to bend your hip past 90 degrees for 3 months after
hip surgery, ALL surfaces that you sit on MUST be 2 inches above knee
height. Thisincludeschairs,bedsandtoilets.
•Useahigh-densityfoamcushionorbedblockstoincreasechairheight.Plantotakeyourfoamcushionwithyoutoadaptchairsoutsideofthehouse.
•Setupafirmchairwitharmrests(notarockingchair).
•Setupatablebesideyourchairforfrequentlyuseditemsasyou willnotbeabletobendforwardtothecoffeetable.
•Ifyourbedistoolow,addanothermattressorplacetheframeonbedblocks.
2”
BedblocksExtra matress
26 | Before, During & After Hip and Knee Replacement Surgery
Equipment List – Arrange up to 2 weeks before surgery.
* Items NOT available at the Red Cross may be purchased at local medical supply stores.
Hip Surgery
•Walker –q StandardORq 2-wheeled
•Crutches
•Highdensity(firm)foamcushion*(atleast4inchx16inchx18inch,neededforgoinghomeinthecar)
•Dressingequipment(longhandledreacher,longhandledshoehornandsockaid)
Knee Surgery
•Walker –q StandardORq 2-wheeled
•Crutches
•Dressingequipment(longhandledreacher,longhandledshoehornandsockaid)–OPTIONALbutrecommended
Equipment you MUST bring to HOSPITAL — unless otherwise told
Equipment for HOME
Hip Surgery Knee Surgery Theequipmentbelowisrequired Theequipmentbelowisrecommended
•4inchraisedtoiletseat(withorwithoutarmrests) ORcommodechairwithwheels
•26inchLonghandledreacher
•24inchLonghandledshoehorn
•Sockaid
•24inchlonghandledsponge*
•Non-slipbathmat*
•Elasticshoelaces*(otherwiseusesliponshoeswithanenclosedheel)
•Hand-heldshowerhose*
Bathing–useawalk-in shower: OR bathtub:
qShowerchair qTubtransferbenchOR
qRaisedshowerboard
qRemovabletubclamp ORinstalledgrabbars*
Before, During & After Hip and Knee Replacement Surgery | 27
Where to Get Equipment
Red Cross Loan Cupboards
•LocationsthroughoutBC
•Provides“free”equipmentfor3months(donationsgratefullyaccepted)
•REQUIRES a signed equipment request form.Thisformwillbeprovidedbythehospital,atyourpre-operativeeducationclassorthroughyourcommunitytherapist.Ifyoudonothavethisformlessthan1weekbeforesurgery,pleasecontactyourlocalhospital.
•BeawarethatTheRedCrosshasalimitedsupplyofequipmentandmaynothavealltheitemsyouneed.
Medical Supply Store
•Equipmentforrentand/orpurchase
•Maydelivertoyourhomeand/orinstall
•Costsmaybecoveredbyextendedhealthplans–checkyourplan
Government Agencies
•VeteransAffairsCanada(VAC)
Friends/Family
Checkwithfriendsandfamilywhomayhaveequipmentyoucanborrow
* Please ensure that equipment fits in your home and is in good working order before you have your surgery
Transportation Support
Sometransportationsupportservicesrequireapplicationformstobecompletedbyyouandyourdoctororhealthprofessional.Theseservicesincludetemporarydisabledparkingpasses(SPARCpass)andHandyDart.
For more information on the services listed above, see the Resources
section of this booklet, page 61.
28 | Before, During & After Hip and Knee Replacement Surgery
Exercise
Exercisingbeforesurgerywillhelpyouhaveafasterandeasierrecovery.Doactivitiesthatputlessstressonyourjoint.Try:
•exercisesinwater,suchasswimmingorwaterwalkingatacommunitypool
•cycling
•Nordicpolewalking
•gentlestretchingandstrengthening
•specificexercisessuggestedbyaphysiotherapist
•balanceexercises(valuableinpreventingfalls)
Theseactivitieswillmakeyourmusclesstrong,improveyourenduranceandhelpkeepyourjointmoving.Exercisingbeforesurgerywillalsohelpyoutobuildupyourconfidenceandknowledgeofhowtoexerciseaftersurgery.
* REMEMBER: After surgery, daily exercise will be part of your rehabilitation for many months.
Be sure to strengthen your arm muscles.Youwillneedstrongarmsafteryoursurgerytousewalkingaids,getinandoutofbedandgetonandoffachair.Ifpossible,dostrengtheningexercisesforatleast3weeksbeforesurgery.
For example: Push up through your arms while seated. Work up to 10
repetitions 2 times each day.
Ifthisexercisecausesyoudiscomfortorifyouarenewtoexerciseand/orhaveotherhealthconditions,always talk to your
family doctor before starting a new exercise program.Ifyoudon’tknowhowtogetstarted,talktoaphysiotherapist.
Before, During & After Hip and Knee Replacement Surgery | 29
Nutrition
Goodnutritionhelpsyoutorecoverfromsurgeryandreducestheriskofinfection.Importantnutrientsbeforeandaftersurgeryinclude:
Protein
Proteinpromoteshealingaftersurgery.Tomeetincreasedproteinneeds,trytoeatatleast3servingsfromeachofthesefoodgroupseveryday.Forexample:
Multivitamin
Whileabasicmultivitaminisrecommendedtopromotehealing,largedosesofanynutrientaregenerallynotrecommended.Ifyouhaveahistoryofanemia,talktoyourdoctor,pharmacistordietitianaboutsupplements.
Calcium and Vitamin D
CalciumandVitaminDareimportantforstrongbones.Adultsshouldhave2to3servingsofmilkorcalcium-fortifiedproductsaday.Aminimumof400IUVitaminDsupplementisrecommendedforallpeopleover50yearsold.Talktoyourdoctor,pharmacistordietitianaboutcurrentsupplementrecommendationsthatarerightforyou.
Fibre and Water
It’simportanttohavearegularbowelhabitbeforejointsurgerybecauseconstipationcanbeacomplication.Includefibreinyourdiet,suchaswholegrains,bran,fruitsandvegetables,beansandlentils.Spreadthefibrethroughoutthedayanddrinkatleast8glassesofwaterorotherlow-caloriefluidaday.
Formoreinformationaboutnutrition,seeCanada’sFoodGuide: www.healthcanada.gc.ca/foodguide
Meat and Alternatives
1 serving =
> 2-3 oz of meat, poultry or fish
> 2 eggs
> 3/4 cup beans
> 3/4 cup tofu
> 2 tablespoons peanut butter
Milk and Alternatives
1 serving =
> 1 cup milk or soy beverage
> 2 ounces cheese
> 3/4 cup yogurt
30 | Before, During & After Hip and Knee Replacement Surgery
Weight Management
Beingoverweightorunderweightcanaffectyourrecoveryfromsurgery.
Ifyouareoverweight,moderateweightlossisagoodstrategytoreducehipand/orkneepainandtoallowyoutodomoreactivities.Everyextrapoundyoucarryplaces3-6poundsofforceonyourkneesandhips.Ifyouaretryingtoloseweightbeforesurgery,aimforagraduallossofnomorethan1poundperweek.Avoidfaddietsastheymaycauseyoutobeundernourishedandprolongrecovery.
Beingunderweight canmakeitharderforyourbodytohealaftersurgery.Itisimportanttoeatwellbeforesurgery.
Talktoadietitianifyouareworriedaboutbeingoverweightorunderweightbeforesurgery.Tofindoutmoreinformationonnutritionorspecificnutrients:
Dial-a-Dietitian:604-732-9191 or
Toll Free in BC: 1-800-667-3438 Website:www.dialadietitian.org
DietitiansofCanadaWebsite:www.dietitians.ca
1 EXTRA POUND =
approximately
3-6 POUNDS OF FORCE
on your knees and hips
Before, During & After Hip and Knee Replacement Surgery | 31
Pre-Operative Education
WHEN? As far in advance as possible*
ThehospitalwillcalltoregisteryouforaPre-opJointReplacementClass.Atthissession,youwilllearnmoreaboutyoursurgery,whattoexpectwhileyouareinhospitalandwhatyouneedtoprepareathome.Itisagoodideatobringafamilymemberorsupportpersonwithyoutothissession.Formoreinformationonpreparingforsurgery,seeResourcesonpage61.*In some BC hospitals, your pre-op education
may be provided at your Pre-Admission Clinic visit.
Pre-Admission Clinic (PAC)
WHEN? A few days before your surgery
ThePre-AdmissionClinicwillcallyoutoscheduleanappointment.Thisappointmentmaylastafewhours.Thenursewilldiscussmanypointsincluding:
•whentostopeatinganddrinkingbeforesurgery
•medicinemanagementbeforeandaftersurgery.Some medicines
and supplements must be stopped 1-2 weeks before surgerytoavoidproblemswithbleedingorsleepiness.Talktoyoursurgeonifyouhavequestionsaboutyourmedicines.
•allergies
Bring ALL of your medicines/supplements to your Pre-Admission Clinic
appointment.
Youmayhavesometestsdoneincluding:
•Bloodwork
•X-ray
•ECG(electrocardiogram)
Youmayalsobescheduledtomeetwithananesthesiologist.Thisisamedicaldoctorwhoistrainedtogiveanestheticdrugsandmonitoryouthroughoutyoursurgery.Bring any questions about your anesthesia to your Pre-Admission Clinic appointment.
Your surgery may be cancelled if you have:anactiveinfectionanywhereinyourbody,askininfectionoverthejoint,acoldortheflu.Ifyouaresickbeforesurgery,call your surgeon.
32 | Before, During & After Hip and Knee Replacement Surgery
1 Day Before Surgery: A FINAL Checklist
Bynowyoushouldhavepickedupyourmedicalequipmentandsetupyourhome.Hereisafinalchecklistofthingsyouneedtodobeforecomingtothehospital:
qLabelallofyourequipmentwithyourname(walker,crutches,dressingequipment)–ifyouarebringingtheseitemstothehospital
qMakearrangementsfortransportationtoandfromthehospital
qMakearrangementsforsomeonetostaywithyouorbenearbyforatleastthefirst72hoursafteryouleavethehospital
qHaveabathorshowerusingregularsoapthenightbefore,orthemorningofyoursurgery(do not shaveyourlegsasanycutsorskinirritationmayresultinyoursurgerybeingcancelled)
qPackyourbagforthehospital.Bring:
mtoiletryitems(toothbrush,hairbrushetc.)
mloosefittingclothestoexerciseinandtowearhome
mcomfortable,closedtoeandheelshoes/slipperswithnon-slipsoles.Yourshoesshouldberoomysinceyouwillhavesomeswellinginyourfeet.
mifyouwearelasticsupportstockings,bringthemwithyou
meyeglassesandreadingmaterials
mhearingaids
mifneeded,creditcardinformationforitemssuchashospitalTVrental
DO NOT bring valuables to the hospital
During Your Hospital Stay
In this section, you will learn about:
2 Day of Surgery
2 Recovery Room
2 Length of Hospital Stay
2 Rehabilitation
2 Pain Control
2 Heparin Injections
2 Going Home
Before, During & After Hip and Knee Replacement Surgery | 35
Day of Surgery
Before Surgery:
•GototheAdmittingDeskinthehospital
•Bringallofyourmedicineswithyou,asdirectedbythe Pre-AdmissionClinic
•Askfriendsorfamilytobringyourlabelledequipmenttothehospitalwardunlessotherwiseinstructed
•Toprepareforsurgery,youwillchangeintoahospitalgownandanursewillstartanintravenousline(IV)inyourarm
During Surgery: Anesthesia
Eachhospitalmanagesyouranestheticdifferently.Manypeoplewhohavejointreplacementsurgeryhaveaspinal anesthetic.Thisislikethefreezingyougetatthedentist,exceptthisfreezinggoesintoyourbackandmakesyounumbfromthechestdownandstopsyoufromfeelingpain.Theanesthesiologistwillmakesureyouarecomfortablethroughoutthesurgery,givingyoumedicinethroughyourIVthatmakesyourelaxedandsleepy.Ifyouhaveaspinalanesthetic,youwillnotbeabletomoveyourlegsforupto4hoursaftersurgery.
Somepeoplereceivegeneral anesthetic.Thisisacombinationofdrugsthatwillmakeyouunconsciousduringthesurgery.
Bring any questions you have about anesthetic to your Pre-Admission Clinic appointment.
After Surgery: Recovery Room
•Youaremovedfromtheoperatingroomtotherecoveryroom
•Youmayhaveoxygenbymaskforashorttimeornasaloxygenovernight
•Thenursemonitorsyourvitalsigns,includingyourpulseandbloodpressure
•Youwillhavepainmedicineonaregularbasis.Tell your nurse if you
are in pain.
•Somepeoplemayhavecompressiondevicesplacedontheirlowerlegs.Compressiondevicesgentlysqueezeyourcalfmuscletohelpwithbloodcirculation.
•ThestayintheRecoveryRoomisusually1to3hours
36 | Before, During & After Hip and Knee Replacement Surgery
After Surgery: The Hospital Ward
•Onceyouaremedicallystable,youaretransferredtotheorthopaedicward
•Youwillbetoldhowmuchweightyoucanputonyournewjoint(weightbearingstatus).Thiscanvaryforeachindividual.Oftenpeoplearetoldtoweightbearastolerated,butyoumayhaveaweight-bearingrestrictionsuchaspartial, feather,ornon-weightbearingonyoursurgicalleg
•Thewardstaffhelpsyoutostandonyournewjointifallowedbyyoursurgeon
•Thenurseassessesyouforpainandnausea
•Youwilluseacommode/raisedtoiletseatduringthedayandabedpan/urinalatnight.Whenyouareable,youwillwalktothebathroom.Somepeoplewhohavespinalanestheticfinditdifficulttourinateandwillneedacatheter(atemporarytubeplacedinyourbladdertoemptyit).
•Youmayhavebloodwork
•Youmayhaveanintravenousline(IV)formedicine
•Afterkneesurgery,youmayhaveadrainonyourlegtocollectbloodfromyourknee
•Youaretaughtexercisestohelpreducecomplicationsaftersurgery,suchas:
>breathingdeeplyandcoughingeveryhourtokeepyourlungsclear
>pumpingyouranklestoimprovecirculationinyourlegs
•Mostpeoplewillbestartedonamedicinethathelpsreducetheriskofdevelopingabloodclotaftersurgery.See“PreventingBloodClots”formoreinformation,page41.
Before, During & After Hip and Knee Replacement Surgery | 37
Length of Hospital Stay Guidelines
Yourtimeinthehospitalisshort.Yourhealthcareteamwillworkwithyoutomakesureyouaremedicallystableandabletomanagedailytaskstogohome.Beforesurgery,itisimportanttomakearrangementstohavesomeonepickyouupfromthehospitalwhengoinghome.Dischargetimeisusuallyinthemorning.
Be aware that you may go home sooner than expected.
Ensure your travel arrangements are flexible.
Total Hip Replacement = 3 nights or LESS
(includesresurfacingandrevisionsurgery)
Total Knee Replacement = 3 nights or LESS
(includesrevisionsurgery)
Partial Knee Replacement = overnight
Bilateral (both) Knee Replacement = 5 nights or LESS
For example:IfyouhavesurgeryonMondayandarespending3nightsinthehospital,youwillprobablybesenthomeonThursdaymorning.
MondaySURGERYDAY
Tuesday
Wednesday
Thursday DISCHARGEHOME
38 | Before, During & After Hip and Knee Replacement Surgery
Rehabilitation
•Physical activity is a very important part of your recovery. Notonlydoesithelptoimprovethefunctionofyourjoint,butitalsohelpsclearyourlungs,reducestheriskofbloodclotsinyourlegs,reducespain,andstartsyourbowelsmoving.
•Thephysiotherapist(PT)willworkwithyouthroughoutyourstay.Yourphysiotherapistwillteachyouhowto:
>walkwithawalkerand/orcrutches
>doyourdailyexercises
>usethestairssafely
•Thephysiotherapistwillgiveyouexercisestodoinhospitalandathome.Theymayalsoreferyoutoaphysiotherapistinyourlocalcommunity.
•Theoccupationaltherapist(OT)willteachyouhowtododailyactivities,suchasdressingandbathing,whilefollowingprecautionsandprotectingyournewjoint.
Before, During & After Hip and Knee Replacement Surgery | 39
Pain Control
Pain Control After Surgery
•Yournursewillteachyouhowtousethepainscaletodescribeyourlevelofpain.“0”isnopainand“10”istheworstpossiblepain.
•It is our goal to keep your pain at “3-4” or below at all times.
•Generally,painmedicineisgivenasapilltakenbymouth.
•Ifyouhavehadageneralanaesthetic,youmayhaveapatientcontrolledanalgesia(PCA)pump.ThisiswhenacontrolledamountofpainmedicationispumpedintoyourIVtubewhenyoupushabutton.
•Acombinationofmedicineswilllikelybeusedtocontrolyourpainaftersurgery.Thisnormallywouldincludeacetaminophen(i.e.TylenolTM)pluspossiblyananti-imflammatory(i.e.NSAID)and/ornarcotic(i.e.morphine).Bytakingacombinationofthesemedicines,youmaybeabletoreducethesideeffectsofanyoneofthesemedicinesandhaveimprovedpaincontrol.Itisimportanttotalktoyourhealthcareteamtounderstandhowandwhentotakethesemedicinestobestcontrolyourpainandsymptoms.
•Somesideeffectsofpainmedicinecaninclude:nausea,vomiting,drowsiness,itchinessand/orconstipation.Tellyournurseifyouhaveanyofthesesymptoms.
Pain Assessment
0 1 2 3 4 5 6 7 8 109No Pain Mild Moderate Severe Very Severe Excruciating
40 | Before, During & After Hip and Knee Replacement Surgery
Pain Control at Home
Mostpeoplehavelessandlesspainoverthenext6to12weeks.Ifpainispreventingyoufromcaringforyourself,sleepingand/orexercising,talktoyourphysiotherapistordoctor.If your pain becomes
increasingly worse or if you have pain in a new part of your body, seek
medical attention immediately.(Seebackcoverofthisbookletforguidelines).
Herearesomewaystomanageyourpain:
•Takepain medicineasdirected.Itisnormaltohavesomeincreasedpainorsymptomsduringphysicalactivityorphysiotherapysessions.Itmaybehelpfultotakeadoseofpainmedicine1or2hoursbeforeengagingintheseactivitiesinthefirstweeksaftersurgery.ItisbettertotakemedicineBEFOREthepainissevere.
•Icecanreducepainandinflammation.Itisparticularlyusefulfor peoplewhohavehadkneereplacementsurgery.Placeanicepack wrappedinatowelonyourjointasdirectedbyyourphysiotherapist.
• Pace yourself.Donotpushyourself.Regularrestisanimportantpartofyourhealingprocess.
•Relax.Userelaxationtechniquessuchasbreathingexercisesorprogressivemusclerelaxation(progressivemusclerelaxationiswhenyoutightenandrelaxeachpartofyourbody,startingwiththetoesandworkinguptoyourneck).
•Distractyourself.Listentomusic,visitwithfriends,writeletters,watchTV.
•Think positively.Youwillbecomemoreandmorecomfortableasyourecoverfromyoursurgery.
Ice pack on knee joint
Before, During & After Hip and Knee Replacement Surgery | 41
Preventing Blood Clots
Afterhiporkneereplacementsurgery,youareatriskfordevelopingabloodclot(see“Complications”,page55).Manypeoplearegivenamedicineaftersurgerytoreducethisrisk.
•Themedicinemaybeapillthatyoutakeonceadayforamonthaftersurgery,OR
•Themedicinemaybeaninjectionthatistakenonceadayfor 10-35daysaftersurgery
•Yoursurgeonwilldecidewhichmedicineisrightforyou.Hospitalstaffwillbeavailabletoansweranyquestionsaboutthemedicineandhowtotakeit.
•Fillyourprescriptionatapharmacynearthehospital,incaseyourlocalpharmacydoesnotcarrythemedicine.
•Itisimportanttotakethemedicineexactlyasprescribed.
Going Home
Formostpeople,youwillbedischargedtoyour home,notarehabfacility.Beforeleavingthehospital,planappointmentswiththefollowingpeople:
Follow-Up Medical Appointments
•Theperson(e.g.GPorphysiotherapist)whowillremoveyourstaples,7-14daysaftersurgery
•Yoursurgeon,usuallyaround6weeksaftersurgery
•Yourphysiotherapist,usuallywithin1weekofdischarge(ifrecommendedbyyoursurgeon)
•Yourfamilydoctor,onceyouarebackonyourfeet,toreviewyourgeneralcondition
42 | Before, During & After Hip and Knee Replacement Surgery
After SurgeryIn this section, you will learn about:
2 Physiotherapy After Hospital
2 Transportation
2 Everyday Activities Guidelines
2 Wound Care
2 Sexual Activity
2 Returning to Work
2 Complications
2 Dental Work or Other Medical Procedures
Before, During & After Hip and Knee Replacement Surgery | 45
Recovery at Home
Physiotherapy After Hospital
Thehospitalphysiotherapistwillhelpyoutoarrangeaphysiotherapyappointmentforwhenyougethomefromhospital.Dependingonyourneeds,whereyouliveandlocalservices,yourappointmentmaybeataphysiotherapyclinic,out-patienthospitalcentre,rehabfacilityorhomehealthprogram.
Yourphysiotherapistwillgiveyouexercisestostretchandstrengthenyourlegsandimproveyourwalkingandbalance.Asyourecover,theexerciseswillgetharder.Doingtheexercisesassignedbyyourphysiotherapistwillhelpyoumoveyournewjointandenjoygreaterindependence.Itisimportanttocontinuewiththeexercisesforatleast1yearafteryoursurgery.
Talktoyourphysiotherapistifyouhavequestionsaboutyourexercisesorconcernsaboutyourprogress.
46 | Before, During & After Hip and Knee Replacement Surgery
Transportation
Therearemanydifferentwaystogetaroundaftersurgery.Herearesomeoptions:
•Friends/family
•Taxis
•Temporarydisabledparkingpass(SPARC)*
•HandyDART*(ifavailableinyourcommunity)—transitserviceforthosewhocannotusetheregularbusservice.HandyDARTwillpickyouupanddropyouoffatappointmentssuchasmedicalvisits.
•TravelAssistanceProgram(TAP)*–assistswithcostsforout-of-townmedicaltravel
Talk to your healthcare providers about completing the necessary forms for these services BEFORE surgery. See “Resources” page 61.
Air Travel
Youmayhavesomeextrachallengestravellingbyplaneaftersurgery.Besuretogiveyourselfextratimewhenflying.Yournewjointmay setoffmetaldetectorsattheairport.Ifyouareflyingwithin3monthsofhavinghipsurgery,bringyourhigh-densityfoamcushiontoraise theheightofyourseat.Whileontheplane,dofootpumpingexerciseseveryhourtohelpreducetheriskofclots.Ifflyinghomefromhospital,checkwithyouraircarrierifmedicaldocumentationisneeded.
Driving
Drivingisrestrictedafterkneeorhipsurgery.Thereareanumberoffactorsthatcanimpactyourabilitytosafelyreturntodriving.Theseincludeusingmobilityaidsandtakingprescriptionpainmedicines.Talktoyoursurgeonandphysiotherapistbeforedriving.Mostpeoplestarttodrivewithin12weeksaftersurgery.
Taxi
HandyDART
Personal vehicle
Before, During & After Hip and Knee Replacement Surgery | 47
Car Transfer
Itcanbechallengingtoprotectyourjointgettingintosomecars,particularlyfollowinghipsurgery.Talktoyouroccupationaltherapist ifyouhavequestionsaboutcartravel.Pleasepracticetheseinstructionsbeforeyoucometothehospital.
•Parkawayfromthesidewalkorcurbsoyouarenotsteppingdownfromthecurbtothecar.Ifyouhaveahightruckorsport-utilityvehicle,youmayneedtoparknearthecurbsothatyoudonothavetoclimbuptotheseat.
•Movetheseatasfarbackaspossible
•Reclinetheseat
•Placeyourhigh-densityfoamcushionontheseat.Ifitisawedgecushion,positionthethickendatthebackoftheseat.
•Backuptotheseatuntilyoufeelthebackoftheseatonyourlegs
•Extendyouroperatedleg
•Holdontothebackoftheseatandthecartostabilizeyourself
•Loweryourselftotheseat
•Slidebackandliftyourlegsintothecar.(Ifyouhavehadhipsurgery,doNOTbendmorethan90degrees).
•Apieceofplasticoralargegarbagebagoverthecushionmayhelpyoutoslideinmoreeasily
•Youcanalsotryadevicecalleda“Handybar”thatcanassistyouto getinandoutofaregularcar.Thiscanbepurchasedatmedicalsupplystores.
Shaded leg is the surgical leg.
48 | Before, During & After Hip and Knee Replacement Surgery
Everyday Activities Guidelines
Walking
Youcanexpecttousewalkingaids,suchasawalker,crutchesorcane,forupto3monthsorlongeraftersurgery.By4to6weeksafteryoursurgery,youshouldbewalkingwithmoreconfidence,havemorestrengthandbeabletowalklongerdistances.Regularphysiotherapyafteryoursurgerywillhelpyougetthemostoutofyournewjoint.Physicalactivitywillhelpyouhaveafasterrecoveryandwillgetyourbloodmoving.Thiswillalsoreduceyourriskofdevelopingabloodclot.
Stairs
Itisagoodideatopracticethestairswiththehospitalphysiotherapistsothatyouareabletomanagestairssafelyandindependently.Ifyouhavehadbothkneesreplaced(bilateral),yourphysiotherapistwillpracticeatechniquewithyouthatallowsyoutoalternateyoursurgicallegswhengoingupanddownthestairs.Shaded leg is the surgical leg.
Going UP the stairs:
•Useahandrailand/orcrutches,cane
•StepUPwithyourgood (non-operated)legfirst
•Followwithyouroperatedlegandcrutch,onestairatatime
Going DOWN the stairs:
•Usethehandrailoryourcrutches
•Placeyourcrutchonthestepbelow
•StepDOWNwithyouroperatedlegfirst
•Followwithyourgood(non-operated)leg,onestairatatime
Before, During & After Hip and Knee Replacement Surgery | 49
Getting Into Bed
•Sitatthesideofthebed.Itmaybeeasiertogetintobedonyourstrongerside.
•Slidebackacrossthebedusingyourarmsforsupport
•Ifnecessary,a1⁄2bedrailcanallowyoutogetinandoutofbedmoreeasily.A1⁄2bedrailconsistsofahandlewith2longmetalrodsthatareplacedbetweenthemattressandtheboxspring.A1⁄2bedrailcanbeobtainedthroughtheRedCrossormedicalsupplystores.
•Liftyouroperatedlegintobedorusea“leglifter”(thismaybethebeltfromyourhousecoatoracrutchturnedupsidedown,hookedoveryourfootsoyoucanhelpliftthelegusingyourarms)ifneeded
Getting Out of Bed
•Slideyourbodytotheedgeofthebed
•Useyourarmstopushyourselftoasittingposition.(Ifyouhavehadhipsurgery,donotpushyourselfuppast90degrees.Rememberyourhipprecautions!)
•Slideyouroperatedlegoffthebed
•Bringyourbodytoasittingpositionatthebedside
Sitting Down
•Useafirmchairwitharmrests
•Ifyouhavehadhipsurgerymeasurethechairheightagainstyourlegbeforeyousit.Thechairshouldbe2inchesaboveyourstandingkneeheight.Useahighdensityfoamcushionorbedblockstoincreasethechairheight.
•Backuptothechairuntilyoufeeltheedgebehindyourknees
•Moveyouroperatedlegforwardandreachbackforthearmrests
•Slowlyloweryourselfintothechair
50 | Before, During & After Hip and Knee Replacement Surgery
Getting Dressed
•Sitonaraisedchairorbed
•Dressyouroperatedlegfirstandundressitlast
•Useadaptiveaidslikealong-handledreacher,sockaidandshoehorntoreachthefootofyouroperatedlegandputonsocks,pants,shoes,etc.whileprotectingyournewjoint
•Whileyouareinhospital,youroccupationaltherapistwillshowyouhowtousetheseaidsandgiveyoutipsonhowtodresswhilemaintainingjointprecautions
Bathroom Safety
Fallscanhappenanywherebutaremostlikelyinthebathroom.Herearewaystoreducetherisk:
•Donotrush.Plantousethetoiletoften.Haveabedsidecommodeifneeded.
•Whenbathing,useabenchorchair,non-slipbathmats,grab-barsand/oraremovabletubclamp
•Makesuretheroutefromyourbedroomtothebathroomiswell-lit
•Wearsensible,non-slipshoesorslippers
•Ifyoufeeldizzyorunsteady,talktoyourfamilydoctor
Using the Toilet
•Usearaisedtoiletseatforthefirst3monthsafteryoursurgery
•Makesurethatthetoiletseathassecurearmrestsorthatyoucanusethecountertopushyourselfup.Youcanalsoinstallgrabbarstohelpyoustandorsit.DoNOTusetowelsracksortoiletpaperholderstohelpyoustandorsitdown.
•Toiletseatshouldbe2inchesabovestandingkneeheight
•Sitdownasyouwouldinachair(seepage49)
Raised Toilet Seat
Removable Tub Clamp
Before, During & After Hip and Knee Replacement Surgery | 51
Bathtub Transfer
•Useatubtransferbenchwithahand-heldshower(inabathtub)orshowerchair(inashowerstall)forthefirst3monthsaftersurgery.DoNOTtrytositonthebottomofthetub.
•Removeglassshowerdoorsonyourtubandreplacewithashowercurtain
•Placeanon-slipbathmatinsideandoutsidethetub
•Yourtransferbenchorshowerchairshouldbe2inchesaboveyourstandingkneeheight.Ifyouaretall,youmayneedbenchlegextensions.
•Sitdownasyouwouldinachair(seepage49).Slidebackasfarasyoucanontheseat.Thenliftyourlegsovertheedgeofthetub.Donotbendyourhippast90°ifyouhavehadhipsurgery.
•Uselong-handledaidstocleanyourfeetandotherhard-to-reachplaces
•Ahand-heldshowerhosewillallowyoutobathemoreeasily.Ifyouhavehadahipreplacement,youwillnotbeabletoreachforwardforthetapsduetohipprecautions.
•Somesurgeonswillwantyoutodosponge-bathsuntilyourstaplesareremovedinordertoavoidgettingthenewincisionwet
52 | Before, During & After Hip and Knee Replacement Surgery
Wound Care
Youwillhaveacut(incision)atthesiteofyoursurgery.Yournursewillteachyouhowtocareforyourincisionathome.Whileitisnormaltohavesomerednessandcleardrainagefromyourwound,watchforsignsofinfection(page56).Youdonotneedabandageunlessthereisdrainage.
Theedgesofyourskinmaybeheldtogetherwithsutures,staplesorsteri-strips.Staplesaremetalclipsthatholdtheedgesofyourskintogetherwhileyourskinheals.Yourstapleswillberemoved7to14daysaftersurgery.Ifyouhavesteri-strips,leavethemalone.Theywillfalloffontheirown.
Itisimportanttokeepyourincisiondryuntilitisfullyhealed.Youmayfinditusefultotapeaplasticbagorwaterproofdressingoveryourincisionwhileshoweringunlessotherwiseinstructedbyyoursurgeon.
Sexual Activity After Hip Replacement:
•Youmayreturntosexualactivitywhenyoufeelreadyandcomfortable;thisisoftenaround4to6weeksaftersurgery
•Youmustmaintainhipprecautionsfor3monthsduringalldailyactivities,includingsexualactivity
•Thinkabouthowyouwillmaintainyourhipprecautionsofnottwistingandnotbendingmorethan90degrees
•Youmayneedtoconsidertryingsomenewpositions.Talktoyourpartner.
•Ifyouhavequestionsorconcernsabouthowtoprotectyournewhipduringsexualactivity,talktoyouroccupationaltherapist,physiotherapistorsurgeon.
•Visitthewebsite:www.aboutjoints.comforillustrationsofsexualpositionsthatmaintainhipprecautions
Before, During & After Hip and Knee Replacement Surgery | 53
Returning to Work
Allowyourselftimetorecoverfromsurgeryandfocusonyourrehabilitationbeforereturningtowork.Somepeoplereturntosomeformofworkquicklyaftersurgerybutothersneedalongertimetohealandrecover.Thisdependsonfactorssuchashealthstatusandthetypeofworkyoudo.Talktoahealthcareprofessional,suchasanoccupationaltherapist,aboutwhatisrightforyou.
Work Environment Adaptations:
• Chair:Chooseastandardchairforsitting.Avoidchairswithwheels;theycanrollawayfromyouwhenyouaregettingup.Useyourhigh-densityfoamcushiontoincreasetheseatheightifnecessary.
•Desk:Positionyourphone,paperworkandcomputerclosetoyou.Ifyouhavehadahipreplacement,youshouldNOTbendforwardtoreachtheseitems.Thiswillbreakyourhipprecautions.
•Keyboard Tray:Ifyouhaveraisedyourchairandyourdeskistoolow, useaheight-adjustablekeyboardtraysothatyoucansitcomfortablywhiletyping.
•Schedule:Planlotsofstretchbreaks.Getupandmovearoundfrequently.Avoidsittinginthesamepositionformorethan45minutesatatime.
•Bathroom:Checktheheightofthetoiletsattheofficeandthelocationofgrabbars.
* Review your workstation before surgery so that you can make the necessary adjustments before you return to work *
Standardchair-nowheels
Hipanglegreaterthan90degrees;usehigh-densityfoamcusionifnecessary
Cleardeskspaceofclutter
54 | Before, During & After Hip and Knee Replacement Surgery
Complications
Aftersurgery,afewpeoplehavecomplicationsandneedmoremedicaltreatment.Herearesomepossiblecomplications:
•Constipation/bladderfunction
•Short-termconfusion
•Bloodclots
•Swelling
•Infection
•Anemia(lowbloodcount)
•Jointloosening
•Hipjointdislocation
Short Term Confusion
Asmallnumberofpeopledevelopshort-termconfusionaftersurgery.Thismayberelatedtoothermedicalconditionsorconditionssuchasalcoholwithdrawal.Forexample,ifyoudrinkalcoholdaily,considercuttingbackbeforesurgery.Ifyouareunabletocutbacktheamountofalcoholyoudrink,tellyournursesothatprecautionscanbetakentoavoidwithdrawalsymptoms.
Constipation / Bladder Function
Constipationcanbeaproblemaftersurgery.Achangeinyourdiet,lessactivityandpainmedicinemaymakeyourconstipationworse.Herearesomewaystostayregularatthehospitalandathome:
•Drinkatleast8glassesofwaterorlowcaloriefluidaday
•Eatfibre,suchasprunes,bran,beans,lentils,fruitandvegetables
•Movearoundasmuchasyoucan–doyourexercises!
Yournursemaygiveyoulaxativesand/orstoolsofteners.Youmayneedtokeeptakingthesemedicinesathome.Ifyouhaveconstipationathome,talktoyourfamilydoctororpharmacist.Constipationcanbeserioussodonotignoreyoursymptoms.
Somepatientshavedifficultyurinatingaftertheirjointsurgery.Pleasetalktoyournurserightawayifyouarehavingproblems.Youmayneedacatheter.
Before, During & After Hip and Knee Replacement Surgery | 55
Blood Clots
Asmallnumberofpeoplemaygetbloodclotsaftersurgery.Bloodclotsusuallydevelopinthedeepveinsinthelegs.Peoplewhohaveproblemswiththeircirculationand/orareinactivearemorelikelytodevelopabloodclot.
Toreducetheriskofbloodclots:
•Takethemedicineprescribedbyyoursurgeontopreventbloodclots
•Walkshortdistancesatleastonceanhour(exceptwhenyouaresleeping)
•Whenyouaresittingorinbed,pumpyouranklesandflexyourlegmuscles
Swelling
Itisnormaltohavesomeswellinginyourlegaftersurgeryandduringyourrecovery.Swellingmayincreaseasyoubecomemoreactive.Tohelpreduceswelling:
•Pointandflexyourfeethourlywhenawake
•Liedownflatandraiseyourlegs(maintainhiporkneeprecautions)byplacingpillowsunderthelengthofyourleg
•Doshortperiodsofactivity.Walkafewsteps.Rest.Repeat.
•Placeanicepackwrappedinatowelonyourjoint.Forsomekneeclients,a“cryocuff”maybeused.Thisisatypeoficepack/compressiondeviceforthelowerleg.Formoreinformation,talktoyourphysiotherapistaboutusingiceathome.
Tell your family doctor or surgeon immediately
if you have:
• Pain,aching,heatorrednessinyourcalfarea
• Increasingsevereswellinginyoursurgicalleg
Call 911 immediately if you have:
• Shortnessofbreath
• Suddenchestpain
56 | Before, During & After Hip and Knee Replacement Surgery
Infection
Lessthan1%ofpeoplehaveaninfectionaroundtheirnewjoint.An infectioninthebodycanreachthenewjointthroughthebloodstream.Peoplewhodevelopjointinfectionsneedantibioticsand,onrareoccasions,furthersurgery.Topreventinfectionorincisionproblems,itisimportanttokeeptheincisionanddressingsdry.Donottouchorpickattheincisionandmaintaingoodcleanlinessofthesurroundingskin.
Tell your doctor or surgeon if you have any of these signs of infection:
Incision Infection:
•Theareaaroundyourincisionisbecomingmoreredandtheredisspreading
•Newdrainage(green,yelloworfoulsmellingpus)fromthewoundsite.Itiscommonfornewsurgicalwoundstohavesomedrainageforthefirstfew(3-5)daysaftersurgerybutthiswillslowlystop andthewoundshouldstaydry.
•Thereisincreasedpainorswellingofwoundsiteandsurroundingarea
•Feverabove38°Cor101°F
•Callyoursurgeonifyouthinkyouhaveapossiblewoundinfection
Urinary Tract Infection:
•Painwhenyouurinate
•Frequentorurgentneedtourinate
•Foulsmellingurine
•Feverabove38°Cor101°F
Sore Throat/Chest Infection:
•Swollenneckglands,painwhenyouswallow
•Frequentcough,coughing-upyelloworgreenmucous, shortnessofbreath
•Feverabove38°Cor101°F
Before, During & After Hip and Knee Replacement Surgery | 57
Anemia (low blood count)
Ifyouhavesignsofanemia,seeyourfamilydoctor.Youmayneedanironsupplement.Thesignsofanemiaare:
•Feelingdizzyorfaint
•Feelingverytired
•Shortnessofbreath
•Rapidpulse
Joint Loosening
Overmanyyears,thebondbetweenthejointreplacementandyourbonemayloosen.Thiscancausepainandmakeitdifficultforyoutomoveyourartificialjoint.Toreducetheriskofthiscomplication,avoidhigh-impactphysicalactivities.Ifyounoticeincreasedpaininyourartificialjoint,talktoyourdoctorassoonaspossible.
Hip Joint Dislocation
Call 911ifyoursurgicallegissuddenlyextremelypainful,shortens,andthehipcannotbemoved.
Dental Work and Medical Procedures
Itisimportanttotellyourhealthcareprofessionalthatyouhavehadjointreplacementsurgerybeforehavingdentalworkormedicalprocedures(includingprocedureswiththebladder,prostate,lungorcolon).Youmaybeputonantibioticstopreventinfectionfrommovingthroughyourbloodstreamtoyournewjoint.Talktoyourdentistordoctoraboutwhatisrightforyou.
We hope you found the information in this booklet useful. We wish you a speedy recovery and many happy years with your new joint.
58 | Before, During & After Hip and Knee Replacement Surgery
Resources
Before, During & After Hip and Knee Replacement Surgery | 61
Resources
Arthritis & Surgery Information
OASISProgram; “OsteoarthritisServiceIntegrationSystem”VancouverCoastalHealthwww.vch.ca/oasis
Email:[email protected]:604-875-4257
TheArthritisSocietywww.arthritis.ca
Email:[email protected]: 1-800-321-1433
TheArthritisResource GuideforBCwww.argbc.ca
CanadianOrthopedicAssociationwww.coa-aco.org
CanadianOrthopedicFoundationwww.canorth.org/en/patienteducation
andOrthoConnectwww.canorth.org
“MyJointReplacement”informationwww.myjointreplacement.ca
SurgicalorOrthopedicInformationAmericanAcademyofOrthopaedicSurgeonshttp://orthoinfo.aaos.org
Equipment
VeteransAffairsCanadawww.vac-acc.gc.ca
TollFree: 1-866-522-2122
RedCrosswww.redcross.ca
TollFree: 1-800-565-8000 orchecklocallistingsforareaphonenumber
Health Professionals
HealthLinkBCPhone:8-1-1www.healthlink.ca
Non-emergencyhealthinformationprovidedbyanurse,pharmacistordietitian.
DietitiansofCanada www.dietitians.ca
PhysiotherapyAssociationofBritishColumbia(PABC)–tofindaphysiotherapistinyourareawww.bcphysio.org
Home Safety
HomeSafetyRenovations (lowincomeseniors)www.cmhc-schl.gc.ca.
Phone:1-800-639-3938
Transportation
HandyDARTwww.bctransit.ca
ProvidedbylocalbusservicesthroughoutBC–checkyourlocallistingsforphonenumbersInLowerMainland:Phone:604-575-6600
SPARC– disabledparkingpasswww.sparc.bc.ca
Phone:604-718-7744
TAP–TravelAssistanceProgramwww.health.gov.bc.ca/msp/
mtapp/tap_patient.html
Phone:1-800-465-4911
* Please note that phone numbers may change and you may need to use directory assistance.
62 | Before, During & After Hip and Knee Replacement Surgery
Indexacetabulum ...............................7,8airtravel .....................................46anemia ............................29,54,57anesthesia .............................31,35bathing ...........................24,38,50bed(gettinginandout) ..............49bedblocks ............................25,49bilateralknee replacement ....................16,37,48bloodclots ....36,38,41,48,54,55bloodthinner ..................36,41,55bothknees ............................16,48cartransfer ..................................47chestinfection ............................56complications ....................... 54-57constipation ....................29,39,54crutches ..............23,26,32,38,48daleparin ....................................41dayofsurgery .............................35deepbreathingandcoughing ......36Dial-a-Dietitian ....................30,61disabledparkingpass (SPARCpass)..................36,46,61discharge(hospital) .....................37dislocation(hip) ..............10,54,57dressing ..............11,26,32,38,50driving .......................................46education ....................................31emergencysituations ......55,56,57equipment ............................26,27exercise ...28,36,38,40,45,46,54fallsprevention ...............23,28,50femur .................................7,8,15follow-up ....................................41grabbars ..................24,26,50,53governmentagencies ............27,61hand-heldshowerhose ....24,26,51HandyDART ..................27,46,61heparin ...........................36,41,55highdensityfoamcushion ...11,25,
26,46,47,48,53hipprecautions ........10,11,12,49, .......................................51,52,53
hipreplacement ............................8hipresurfacing ..............................8hiprevision ..................................9homeset-up ................................23ice ..................................21,40,55incisioninfection ........................56infection .........................31,52,56injection .........................36,41,55intravenous ...........................35,36jointloosening ............................57kneeprecautions .........................18kneereplacement ..................15,16kneerevision ..............................16kneestiffness ........................15,18leglifter .....................................49lengthofhospitalstay ................37lighting ......................................23long-handledreacher ...........11,19,
26,50long-handledshoehorn ........11,19,
26,50loosening(joint) ...................54,57LowMolecularWeightHeparin(LMWH) ....................................41medicalappointments ................14medicalsupplystores ..................27medication .................................39nausea ...................................36,39nutrition .....................................29OASIS ........................................55occupationaltherapist ....38,47,49,
52,53officework ..................................53OrthoConnect ........................4,61osteoarthritis ..........................7,15pain .................7,8,15,30,35,36,
38,39,40,54,55,56,57painassessmentscale ..................39partialkneereplacement .............16physiotherapy .....38,40,41,45,48Pre-AdmissionClinic .................31pre-opchecklist ..........................32pre-opeducation .........................31
prosthesis ...............................8,15protein .......................................29railings .......................................23raisedtoiletseat .............11,19,24,
26,36,50recoveryroom .............................35RedCrossLoanCupboards .........27rehabilitation ..............................38resources .....................................61returningtowork .......................53revision ...................................9,16sexualactivity .............................52showerchair ...................24,26,51showering .................24,32,51,53sitting ........................................49sleep .....................................11,40sorethroat ..................................56SPARCpass ....................27,46,61spinalanesthetic ...................35,36stairs(goingup,down) ...............48staples ..................8,15,41,51,52steristrips ...................................52swelling ................................55,56TheArthritisSociety ..................61toilettransfer ..............................50transportation .......................27,46TravelAssistanceProgram(TAP) .............................................46,61tubclamp .......................24,26,50tubtransferbench ...........24,26,50underweight ...............................30urinarytractinfection .................56unicompartmentalkneereplacement ................................16urinating ........................36,54,55vitamins .....................................28walker ......................26,32,38,48walking ................................28,45weightbearingstatus .................36weightmanagement ...................30workenvironment ......................53woundcare .................................52woundinfection ..........................56
Whentoseekmedicalattention
OAS S
CALL 911 if you develop:
• Suddenseverepaininyoursurgicalleg
• Inabilitytomovethesurgicalleg
• Shorteningoftheleg
• Shortnessofbreath
• Chestpain
CALL your Surgeon if you develop:
• Rednessanddrainageatthe
incisionsite
• Fever
• SevereFatigue
• Dizziness
For more copies, go online at http://vch.eduhealth.ca or
email [email protected] and quote Catalogue No. FB.130.B393
© Vancouver Coastal Health, January 2011