bon secours orthopaedic institute at memorial regional...

Bon Secours Orthopaedic Institute at

Memorial Regional Medical Center

A PATIENT HANDBOOK

MISSION

Bon Secours Orthopaedic Institute at Memorial Regional Medical Center Page 1

Mission Statement

of the Bon Secours Health System:

Our mission is to bring compassion to healthcare and to

be good help to those in need, especially those who are

poor and dying.

As a system of caregivers, we commit ourselves to help

bring people and communities to health and wholeness

as part of the healing ministry of Jesus Christ and the

Catholic Church.

We are proud that in today’s competitive healthcare environment, the Sisters of

Bon Secours and those who work for the Bon Secours Health System view the

delivery of quality healthcare as their primary goal.

WELCOME

Page 2 Bon Secours Orthopaedic Institute at Memorial Regional Medical Center



We welcome you with great pleasure to the Bon Secours Orthopaedic Institute at Memorial

Regional Medical Center. We understand that you and your doctor have decided that a joint

replacement is needed to decrease pain and improve function in your joint. Together we will

work toward one common goal: improving the quality of life through increased mobility.

This handbook is designed to help you understand what will happen before surgery, on the

day of surgery, during your hospital stay, and after discharge.

We are pleased you have chosen Bon Secours Memorial Regional Medical Center for your

care. Our goal is to provide you with world class healthcare that will return you to a more

active, higher quality of life. And remember, most of all, as your healthcare team we are

here to accompany you every step of the way.

Your Healthcare Team with



TABLE OF CONTENTS

Mission Statement 1

Welcome 2

Table of Contents 3

About Us 4

Your Healthcare Team 5-6

Understanding Your Surgery 7-10

Preparing for Surgery 11-22

Your Surgery 23-27

Hospital Stay 28-56

Anterior Total Hip Exercises 34-36

Posterior Total Hip Precautions & Exercises 37-44

Getting IN/OUT of Vehicle 45

Total Knee Precautions & Exercises 46-51

Exercise Logs 52-53

Instructions for UP/DOWN stairs 54

Discharge 55-56

Recovering at Home 57-62

Living with Your Joint Replacement 63-66

ADDITIONAL INFORMATION SECTION 67 Commonly Asked Questions 68

Common Complaints After Joint Replacement Surgery 69

Key Telephone Numbers 70

Maps and Directions 71

Note Pages 72-73

Content Page/s


ABOUT US

About Bon Secours Memorial Regional Medical Center


is a 225 private bed acute care

facility, offering the full spectrum

of healthcare services for patients,

including Acute and Critical Care,

Ambulatory and Surgical Services,

and a 24-hour Emergency Room.

Other key services available at


and Hanover Medical Park include

Orthopaedics, Cardiology and

Diagnostic Treatment Centers,

Physical Rehabilitation, Radiation

Therapy, Urology, and Physician

Practices.

Our Orthopaedic Institute at

Memorial Regional Medical

Center performs over 600 joint

replacements per year and anticipates

substantial growth in years to come.

Our Orthopaedic Team is committed

to providing world class healthcare.


“Joint surgery

changed my life!”

—Shirley Cadden,

joint replacement

surgery patient

YOUR HEALTHCARE TEAM

Getting to Know Your Healthcare Team

We take a team approach to your healthcare at the Bon Secours Orthopaedic Institute at

Memorial Regional Medical Center. In the weeks before your surgery, at the hospital

and when you return home, you will come in contact with many members of your

healthcare team, including:

Orthopaedic Surgeon: Your orthopaedist is the doctor who performs the actual joint replacement

surgery and is responsible for your overall health during your hospital stay and following your

surgery.

Anesthesiologist: Your anesthesiologist is the doctor who administers anesthesia during your

surgery and monitors your vital signs during your surgery.

Nurse Anesthetist: Your nurse anesthetist is a nurse trained in anesthesia and who works closely

with your anesthesiologist in the delivery of anesthesia.

Primary Care Physician: Your primary care physician, or family practitioner, takes care of your

general health. He or she may perform your preoperative medical evaluation to be sure that it is safe

to proceed with surgery and to determine that any preoperative medical conditions you have are

stable and in the best possible condition for a successful recovery.

Hospitalist: Your hospitalist is a medical doctor who may be asked to assist in the general medical

needs while you are hospitalized.

Orthopaedic Patient Educator: Your orthopaedic patient educator is a registered nurse specializing

in joint replacement care. He or she will educate you prior to surgery and follow you during your

hospital stay.

Orthopaedic Nurse Manager: Your nurse manager is a registered nurse who manages the staff and

care of your unit. He or she provides professional support and clinical education for nurses and oth-

er members of the healthcare team.

Nurse: Before and during your hospital stay, you will meet a number of nurses who perform different

jobs. Some nurses attend to your daily healthcare needs in the hospital, others assist surgeons in the

operating room, while others work in hospital admissions and, in some cases, visit patients at home.

Nurses are among the most visible healthcare professionals in the hospital.


YOUR HEALTHCARE TEAM (continued)

Occupational Therapist: Your occupational therapist is trained to teach you how to perform the

activities of daily living, such as dressing and bathing after your surgery.

Nutritionist: Your nutritionist is specially trained in meeting your dietary needs while you are in the

hospital and helping you maintain a healthy diet. The Classic Cuisine Program is available to meet

your dietary needs.

Hospital Chaplain: The hospital chaplain is trained to meet your spiritual needs and those of your

family, regardless of religious denomination.


Care Manager: Your care manager is a registered nurse or social worker who will be coordinating

your hospital care and discharge.

Dietary and Environmental Services: These are the friendly people who bring your meals to you

and clean your room.

Patient Representative: If you have questions or concerns regarding your care, this person will be

there to assist you. Please feel free to contact him or her.

Physical Therapist: Your physical therapist is trained to assist you in regaining strength and motion in

your new joint. A physical therapist will work with you during your hospital stay on exercises and

walking and, if needed, for the first few weeks after you return home to help you be as independent and

mobile as possible.

Nurse Practitioner: Your nurse practitioner is a liaison between you and your physician while you are

in the hospital. He or she will follow you throughout your hospital stay and will assist in managing

your daily care and discharge planning.

Physician Assistant: Your physician assistant will act as a liaison between you and your physician in

the absence of the nurse practitioner. He or she will follow you during your hospital stay.

UNDERSTANDING YOUR SURGERY

What Are the Causes of Serious Hip and Knee Problems?

Problems with major joints like the hip and knee are most frequently the result of arthritis.

Osteoarthritis. Osteoarthritis is the most common form of arthritis. It is most often related to wear

and tear that has been placed on the joints over the years. Its onset is usually after age 50. Factors that

predispose this condition include family history, obesity, previous surgery to the joint where a large

piece of cartilage was removed, or previous fractures in the area of the joint.

Rheumatoid Arthritis. Rheumatoid Arthritis is one of the more common kinds of inflammatory

arthritis. It is a chronic inflammatory disorder affecting the joints of the body that are lined with a

membrane called synovium. These joints include the hips, knees, shoulders, elbows, wrists, hands, and

feet. Rheumatoid arthritis is likely to be of autoimmune origin, which means that the body produces

cells that irritate the synovium in the joint, leading to destruction of the cartilage. This form of arthritis

occurs in all age groups. It is characterized by stiffness, joint swelling, laxity of the ligaments, pain,

and decreased range of motion.

Avascular Necrosis. Avascular Necrosis involves loss of the blood supply to the bone, which results

in collapse of the joint and arthritis. Most forms have no specific cause but excess alcohol intake and

long term steroids have been implicated.




What is Total Knee Replacement Surgery?

The knee joint is composed of three parts: the end of the

femur (thigh bone), the top of the tibia (shin bone), and the

patella (knee cap). In a normal knee, these three bones are

covered with smooth cartilage that cushions the bones and

enables them to move easily. In the arthritic knee, the

cartilage layers are destroyed resulting in bone rubbing

against bone which causes pain, muscle weakness, and

limited motion.

Total knee replacement surgery involves the removal of the

arthritic, roughened bone in the knee joint and replacing it

with a new surface. Metal parts are cemented onto the bones

and a plastic liner is inserted between them. The kneecap is

also resurfaced with a plastic liner. When in place, these

components move together to allow near normal motion of

the knee joint. Bow legged or knock kneed deformities can

usually be corrected by the new alignment.

At right, (top) x-ray of a patient’s knee

before joint replacement surgery and

(bottom) after the components are in

place.


What is Total Hip Replacement

Surgery?

Your hip joint is composed of two parts: the round head of

the femur (the ball) and the acetabulum (the cup or socket in

your pelvis). In a normal hip joint, these two bones are coat-

ed with smooth cartilage that allows them to move against

each other without friction or pain. In an arthritic hip, the car-

tilage layers are destroyed and bone rubs against bone, caus-

ing pain and limited motion.

Hip replacement surgery replaces your arthritic hip joint with

an artificial joint composed of a ball component and a socket

component. The metal or ceramic ball is attached to a stem

that fits firmly inside your thigh bone. This component can be

cemented or non-cemented depending on your age and the

condition of your bone. A plastic or metal liner with an outer

metal shell is secured into the socket of your pelvis. As our

techniques have evolved, many restrictions have been

eliminated or changed. Hip dislocation with normal activities

of daily living is a very rare occurrence. Your orthopaedic

surgeon will choose the type of prosthesis that best meets

your individual needs.

Joint replacement patient X-ray,

showing hip prosthesis in place




Why Should I Have Joint Replacement Surgery?

Joint replacement is considered when there is progressive loss of joint function accompanied by pain that

can not be controlled by medications, injections, walking aids, weight loss, or lifestyle modifications.

Your overall health should be good enough that you and your doctor think that surgery can be performed

safely.

What Results Can You Expect from a Joint Replacement?

The goal of a total joint replacement is to relieve pain,

correct deformities, and help return patients to former

activities. Total joint replacements usually last 10-20

years with success depending on age, weight, and

activity level.

What Activities Can I Return to After Joint Replacement?

In time, and as allowed by your surgeon, hiking, walking,

swimming, cycling, golf, fishing, hunting, dancing, and

low impact aerobics are some of the activities you may

enjoy after joint replacement. You may also use exercise

equipment such as a treadmill, stair climber, elliptical glider

or light lower extremity weights.

You should avoid jogging or activities that require

running or jumping, such as basketball, football, baseball,

racquetball, handball, squash, or high impact aerobics. You

should also avoid heavy lifting.

“Hip replacement turned my life

around. No more cane!”

—Van Noble, joint replacement

surgery patient

Are There Risks With Joint Replacement Sur-

gery?

Joint replacement is considered to be major surgery. It is

important that you are aware of potential risks and complica-

tions. These include problems from anesthesia, infection,

surgical bleeding, blood clots, damage to nerves or blood

vessels, dislocation with hip replacement, and very rarely,

death. Although these complications are rare, they are possi-

ble. Every precaution is taken by your healthcare team to

avoid these complications. Over time, an artificial joint may

become loose or wear out and could require further surgery

and repair.

PREPARING FOR SURGERY


Your path to recovery begins with the preoperative steps that take place weeks before your surgery.

You can improve your results when you take charge of your care and complete all of these steps.

Each step is listed below, along with specific instructions for you to follow.

1. Physical Exam by Medical Doctor or Health Practitioner

2. Preoperative Education Class

3. Preparing Your Home

4. Surgery Center Preoperative Visit

5. Exercise

6. Medications Before Surgery

7. Diet and Nutrition

Healthy Eating

Iron and Vitamin Supplements

Reminders

8. Preventing Infections

Visiting Your Dentist



1 Physical Exam by Healthcare Practitioner

Before undergoing surgery, you will need to be checked for any medical problems that could put

you at risk during or after your surgery. This should be done 3 to 4 weeks before your date of sur-

gery to allow for any special tests and/or treatments that need to be done preoperatively. Your sur-

geon or another healthcare provider will perform this exam.

2 Preoperative Education Class

To fully prepare for your surgery, your orthopaedic surgeon requires that you attend our preopera-

tive teaching class at Memorial Regional Medical Center. This class will enable you and your fam-

ily to participate in your care and gain a better understanding of the postoperative recovery period

and exercise program. You will find if you are better informed, you are better prepared. This is

key to better results. Preoperative education classes are held on Tuesdays from 10:00 am until 12

noon. Contact the Patient Education Coordinator to schedule your class at 804-7646700. Addi-

tional classes may be available.

3 Preparing Your Home

Some suggestions for home preparation are as follows:

Choose your bed. In general, the bed you have at home will be suitable to sleep in af-

ter your surgery.

Prepare your bathroom. An elevated toilet seat will make it safer and easier to get on

and off the commode in the first few months after your surgery. Having arms on the

elevated seat is helpful. You may want to have handrails professionally installed in

your tub and shower as well as adjacent to your toilet for safety. This is not a require-

ment and your therapist will make suggestions as to placement and location of hand

rails.

Select a chair from your home with a high back, arms, and a firm seat cushion for

your use only.

Arrange furniture so that it is clear of cords and clutter that could get in the way of

moving freely in your home with crutches or a walker.

Be sure that all stairways are secure and have hand rails.

Accident proof your home by removing throw rugs from around the house and tack

down loose carpets.

Be aware of all floor hazards such as pets, small objects, and uneven surfaces.

Schedule your physical examination

3-4 weeks before your surgery



Equipment You May Need for Home

To ensure safe recovery, you may need to use some special

equipment.

Walker or Crutches. If you do not have either, it can

be ordered for you while you are in the hospital.

Raised Toilet Seat. Needed following hip replacement

or bilateral knee replacement. It is optional if you are

having a single knee replacement.

Other equipment you may need for bathing and dressing:

Reacher. Allows you to reach items from the floor.

Long-handled Shoe Horn. Helps you guide your foot

into your shoe.

Sock Aid. Helps put on support stockings without bend-

ing.

Dressing Stick. Aids you in putting on and taking off

clothing.

Long-Handled Sponge. Assists you in washing your

lower legs and feet.

Elastic Shoe Laces. Allows you to keep your shoes tied

and slip in and out of them.

Grab Bars. When professionally installed, helps you

safely climb in and out of the shower.

Hand-held Shower Head. Lets you control the spray of

water.

Shower Bench. Allows you to sit while showering.

Non-skid Tub Mats. Prevents you from falling.



4 Surgery Center Preoperative Visit

This visit is generally done 7-14 days before your surgery. At this visit you will have preadmission testing

performed, if it has not been completed previously. Testing consists of lab work (blood and urine testing),

EKG and, if needed, a chest Xray. You will be interviewed by a nurse about your medical/surgical history,

medications, and allergies. You will receive a skin preparation kit and information sheet for preparing the skin

before your surgery. As part of your preopertive testing, we will be running a blood test called the Hemoglobin

A1c (HgbA1c). This test is used to diagnose diabetes, as well as to determine long-term blood sugar (glucose)

control for those who already have diabetes. It is an average of blood glucose levels over the past three

months. If elevated you will be notified to see staff in the Diabetic Treatment Center before surgery to work

on better blood sugar control.

ALL PATIENTS: Having high blood sugars going into surgery increases the risk of complications such

as infection. If your blood sugar is extremely elevated, it may delay your surgery. Please also note that if

after surgery your blood sugar is not in target range, you will receive insulin injections to help bring it down

(even if you have always been on pills for your diabetes, or if your diabetes has been diet-controlled).

Another laboratory screening is the MRSA (Methicillin Resistant Staphlococcus Aureus) bacterial screening

test. MRSA is a bacterial organism that can potentially cause an infection. We need to identify this organism

before surgery. We will obtain the screening with a nasal swab to identify the bacteria. If your results are

positive your surgeon will prescribe an antibiotic regimen to begin before your surgery. This does not mean

that you have a MRSA infection, it means that you are a carrier of the bacteria (as many people are).

When preparing for your surgery center

preoperative visit, please bring with you:

All of your medications, eye drops, and inhalers.

Place the actual containers in a large plastic bag to bring

with you. Include any herbal, recreational, and overthe

counter medications. Please do not substitute with a list

of medicines.

A list of previous surgeries, including dates and

information on any previous problems with

anesthesia.

Bring all of your medications,

eye drops, and inhalers with

you to your preoperative visit.

Place the actual containers in a

plastic bag; do not substitute

with a list of medications.

5 Exercise

Exercise is the key to recovery! Your exercise program begins before your surgery and continues while

you are in the hospital and when you return home. New exercises will be added as your condition improves.

See pages 32-54 for your pre & postoperative exercises.



6

7

Medications Before Surgery

Diet and Nutrition

Medications to Stop

To minimize the risk of blood loss during surgery, ask your physician if you must avoid or stop taking

medicines that contain aspirin, anti-inflammatories, blood thinners, arthritis, and any over-the-counter

medications 5 days prior to your surgery.

Ask your physician if you should stop taking the following medications:

Antiinflammatories, such as Advil, Aspirin, Aleve, Motrin, Naprosyn, Relafen, Celebrex,

Vioxx, Bextra, Mobic, and Ibuprofen.

Blood Thinners, such as Coumadin or Plavix, Xarelto, and Pradaxa

Omega 3 and herbal supplements

NOTE: Pain medication such as Tylenol, Tylenol extra strength, Tylenol with Codeine, Vicodin,

Hydrocodone, Percocet, Oxycodone or Darvocet do not have to be stopped before your surgery.

On the morning of your surgery, take only the medicines (with a small sip of water) that you have been

instructed to take by the pre-admission testing nurse or your physician .

Healthy Eating

To achieve good nutrition we recommend planning ahead and building a healthy plate of food.

Healthy food choices like vegetables, fruits, whole grains, low-fat dairy products, and lean protein foods

contain the nutrients you need without too many calories.

The My Plate Planner shows you how to plan your meals accordingly. You may find more helpful

resources from this website: http://www.choosemyplate.gov/

http://www.choosemyplate.gov/



7 Diet and Nutrition (Continued)



Diet and Nutrition (Continued) 7

SAMPLE MEAL PLAN

Below is a day of healthy meals that you can use as an

example for food choices and appropriate portions.

Breakfast

1/2 cup cooked oatmeal with

3/4 cup blueberries and

1 cup skim milk

1 slice light wheat toast with

1 tablespoon peanut butter

Lunch

3 ounces grilled chicken breast on

2 slices rye bread with

1 tablespoon of light mayonaise

Lettuce and tomato salad with

1 tablespoon light salad dressing

1 small apple (approximately 4 ounces)

1 can diet soft drink

Dinner

3 ounces baked pork tenderloin

1 cup brown rice

1 cup green beans with

2 teaspoons margarine

Evening Snack

6 ounces artificially sweetened yogurt with

1 1/4 cup strawberries and

1 tablespoon walnuts, chopped

(Approximately 175mg carbohydrates)

Bon Secours Orthopaedic Institute at Memorial Regional Medical Center


Iron and Vitamin Supplements

Iron is an essential mineral that plays an important role in a variety of body functions. Iron carries

oxygen and carbon dioxide within your red blood cells to other body tissues. It is also necessary

for the production of energy and the support of your immune system.

When taking an iron supplement, you should:

Take your supplement on an empty stomach with an 8 ounce glass of water or juice.

Add foods to your diet that are rich in iron, such as lean meat, poultry, fish, liver, spinach,

raisins, carrots, turnip greens, and whole wheat bread.

Include Vitamin C rich foods such as strawberries, orange juice, cantaloupe, green peppers,

tomatoes, potatoes, and broccoli with each meal. These foods help the body absorb iron.

Refrain from drinking coffee and tea with meals as they hinder the absorption of iron. Instead,

drink these beverages between meals.

If you use calcium or zinc supplements, take them separately from your iron supplement.

Reminders

Stop Smoking. Smoking increases your risk of lung complications during and after sur-

gery. It can also increase the risk of infection and slow healing. Let your doctor know

before surgery if help is needed in order to stop smoking.

Limit Alcohol. Limit your alcohol intake to one glass of wine or beer or cocktail per day

or less starting about 57 days prior to surgery. After surgery, check with your doctor be-

fore resuming alcohol consumption. Notify your doctor if this is difficult for you.

Diet and Nutrition (Continued) 7



8 Preventing Infections

It is important that you have no active infections at the time of your joint replacement. Infections can

enter the body through various pathways, but most commonly through the mouth, skin, and urinary tract.

It is important that any problems in these areas be treated before your surgery. You will be asked to prepare

the skin with a body wipe the night before and the morning of surgery. (See page 21 “Cleansing Your Skin

Before Surgery”)

Do not have a manicure or pedicure 5 days before your surgery.

Do not shave your legs 2 days before your surgery.

Avoid any cuts, scraps, or abrasions before your surgery which can be portals for infection.

Visiting Your Dentist

Bacteria can easily enter your blood stream through the mouth during dental procedures and cause

widespread infection. To minimize this problem:

Schedule a dental checkup in the weeks before your surgery if you haven’t had one recently.

Continue to brush and floss your teeth regularly.

Remember to attend to any infected teeth or gums 2-4 weeks before your surgery.

Whew! We realize that after the primary care doctor preoperative

visit, orthopaedic surgeon preoperative visit, dentist, and

preoperative surgery center visit you will be tired of all

the running around. We apologize for any inconvenience

it will cause you, please note that all these phases are

done to insure that you have a safe, smooth operation and

postoperative recovery.



We are excited about all of the newer surgical techniques and prostheses that are in use at our hospital. Per-

haps the most significant advancement is what we do before you ever get to the hospital on the day of sur-

gery. Proper preoperative preparation is of paramount importance in maximizing your postoperative results.

Your full and active participation is required in the pre and postoperative period to insure that you get an ex-

cellent outcome. Our team at Memorial Regional Medical Center is here to assist you in the steps to achieve

this goal. You are the main driver of your care.

Take ownership of your new hip/knee replacement.

Essentials for your first day/night before surgery:

Items to Pack: Undergarments

Slippers with backs and rubberized sole or walking sneakers/shoes with Velcro closures

Socks

Eyeglasses (if applicable)

Make-up, hand mirror (if desired)

CPAP machine settings, tubing, and machine (if applicable)

Driver’s license or photo ID, insurance card, Medicare/Medicaid card

Copy of your Advance Directive

Important telephone numbers, including person responsible for bringing you home

This handbook

Your walker (if applicable)

Do Not: Do NOT eat or drink anything after the time you were instructed. Ice, gum, and mints are not allowed.

Do NOT bring valuables—no jewelry, credit cards, checkbook, or cash greater than $10.00.

Do NOT bring your own medications.

Do: Shower/Cleanse your skin prior to coming for your surgery as directed.

Sleep on freshly laundered pajamas/nightgowns/clothing the night before.

Sleep on freshly laundered linens.



Cleansing Your Skin Before Surgery

READ ALL THE INFORMATION AND DIRECTIONS COMPLETELY BEFORE BEGINNING

THE SKIN CLEANSING.

Stop shaving 48 hours prior to your surgery. The only area of your body you could shave within 48

hours of surgery is your face.

Your surgery team at Memorial Regional Medical Center requests that you cleanse your skin the night

before surgery, by taking a complete shower or bath.

Avoid excessive rubbing of the skin during showering/bathing to prevent injury to the skin.

Gently dry your skin with a clean towel. It is best not to apply any lotions, creams, or moisturizers

to the skin after bathing.

It is important to put on clean pajamas or a clean gown afterwards. Clean linen should be placed on the

bed.

On the day of your surgery, your surgery team will cleanse your skin again when you arrive in the

Pre-op Holding area. A special antiseptic cloth will be used containing Chlorhexidine Gluconate

(CHG). This antiseptic will reduce the risk of infection at the surgical site. Please let the nurse know if

you are allergic to this product.

Sign below indicating you completed your skin cleansing.

Give this sheet to your nurse on the day of surgery.

__________________________________________________________________________________

Date Time Patient’s/Representative’s Signature

Verified skin prep completed prior to surgery.

_________________________________________________________________________________

Date Time Nurse’s Signature

YOUR SURGERY


After weeks of preparation, you are ready for surgery. This

chapter includes the following material related to your day of

surgery:

1. Day of Surgery

Leaving for the hospital

Reporting to the hospital

2. Preoperative Preparation Area

3. Family Waiting Area

4. Anesthesia

5. The Surgery


YOUR SURGERY

Leaving for the Hospital

Before leaving for the hospital you should:

Bring this handbook.

Be sure you have done your preoperative skin cleansing. Remember no shaving.

Do not eat or drink on the day of surgery.

Brush your teeth but do not swallow the water when you rinse.

Take medications as instructed by your physician or preadmission testing nurse with a small sip of water.

Do not bring your own medications to the hospital.

Wear proper clothing. Wear clothes that are loose fitting and easily removed. (Avoid back zippers and

pantyhose).

Leave jewelry and valuables at home. You may wear your wedding band if it cannot be removed. Remove

all body piercings.

Avoid using perfumes, deodorants, shaving creams or any scented lotions.

Do not wear makeup or nail polish (except clear).

Bring a case with your name on it to hold your eyeglasses, contact lenses, hearing aids, dentures, and any

other items necessary for your hospital stay.

Bring a robe, slippers, walking shoes, and a jogging suit.

Bring your walker or crutches to be checked by the therapist.

Bring your signed skin preparation sheet (page 21 of this handbook).

Bring your CPAP machine and all accessories.

Reporting to the Hospital

You may be asked to arrive approximately two hours before your scheduled surgery.

Report to the Surgery Center located on the ground floor of the hospital. Enter the hospital complex from the

Meadowbridge Road entrance (See map on page 71). Take the first right and look for Surgery Center sign just

past the Emergency Room entrance on the left. Parking is available in this area.

You may want a friend or family member to accompany you.

1 Surgery Day


YOUR SURGERY

Once you arrive at the hospital, you will enter the Surgery Center where you will receive your hospital

identification bracelet and be escorted to the Operating Room Holding Area. Your clothes will be placed

in a plastic bag and labeled with your name. If you wear dentures, eye glasses or contact lenses, you will

need to remove them at this time.

In final preparation before surgery, the admitting nurse will recheck all of your medical records and

conduct a brief physical examination that includes taking your vital signs (pulse, heart rate, and blood

pressure). You will be asked to empty your bladder. An intravenous line will be started. Your surgeon

will see you to confirm the side to be operated on and may make a mark on that side. You may also

discuss any final questions you have with your surgeon at this time.

Once your final preparation is complete, your family members can visit you in the Holding Area until it

is time for your surgery. They will then be invited to go to the Surgical Waiting Area.

Your family members should

register with the volunteer in charge

of the waiting area so the physician

can locate them after your surgery.

2

3 Surgical Waiting Area

We have a wonderful group of volunteers who staff our Surgical Waiting Area. It is extremely

important that those waiting, register with the volunteers in charge of the waiting area so that the

physician can locate them after your surgery. After surgery, the physician will discuss the results

of your operation with family members and others waiting. Once you have been assigned a

room, your family can go to your room and wait for you there. Please remember that while the

average operative time for joint replacement is 30 minutes to 2 hours, additional time is spent in

post-anesthesia recovery (1 to 3 hours) and in getting you from one location to another. This

means it may be 4 to 6 hours before you are in your room where your family can see you.

Preoperative Preparation Area


YOUR SURGERY

4 Anesthesia

The different anesthesia options will be discussed with you by the anesthesiologist prior to your surgery.

They will be able to advise you on the anesthetic plan most appropriate for you.

Options include:

1. General Anesthesia:

You are given medications that will keep you asleep for your operation.

These medications produce complete loss of consciousness and perception of pain during surgery.

You will wake up quickly when surgery is over.

2. Combined General and Intraspinal Duramorph (Spinal Anesthesia):

This is the same as above with the addition of an injection into a space in your lower back

surrounding your spinal cord, through which medicine is infused for postoperative pain management.

This allows you to wake up more comfortably and this last for several hours.

The needle and tubing will be removed immediately after injection.

This is the typical method used at Memorial Regional Medical Center.

3. Epidural Anesthesia with Sedation:

This method is not frequently used.

You will receive local anesthetics (numbing medicine) and pain medication through a thin tube

(catheter) placed in the epidural space in your lower back. The tube will remain in for 24 hours.

Local anesthesia blocks the nerves that give you feeling in your legs and hips.

Medications are given with your intravenous fluids before and during your surgery to keep you

sedated and comfortable.

4. Spinal Block:

The anesthesia is injected into the fluid surrounding the spinal cord in the lower part of your back.

This produces a rapid numbing effect that can last for hours, depending on the drug used. Sometimes

spinal anesthesia is not an option if you have had previous extensive back surgery or some other

medical condition.

Regardless of the type of anesthesia you receive, you will be monitored

at a level appropriate for your condition.


5

Our skilled surgeons and operating

room staff begin one of the more than

600 joint replacement surgeries

completed at Bon Secours


each year.

The Surgery

Going Into Surgery

You will go into the operating room where your hip or knee will be prepared for surgery. The

average length of time for the surgery can be 30 minutes to 2 hours. A dose of the appropriate

antibiotic will be given prior to your surgical incision.

In the Recovery Area

After your surgery is completed, you will be wheeled into the post-anesthetic care unit (PACU)

or recovery room. In the PACU:

Nurses will check your blood pressure, pulse, and breathing.

You will receive medications for pain, as needed and a dose of the appropriate antibiotic.

Nurses will check your bandages and encourage you to take deep breaths and to move your ankles

and feet.

You may have an oxygen tube in your nose, a catheter in your bladder, a small drain tube from your

operative site, and an intravenous line for fluids.

Usually after 1 or 2 hours you will be ready to be moved from the PACU to your hospital room. From

this step forward, you begin your postsurgical recovery. Please inform your family that the length of

time in the recovery room may vary.

YOUR SURGERY

HOSPITAL STAY


The average length of stay in the hospital after a hip or knee replacement is 2 to 3 days. Everyone is different,

however, and your doctor and care team (not your insurance company) will determine when you are ready to

leave. During your hospital stay, you will receive care from your healthcare team at the Bon Secours

Orthopaedic Institute at Memorial Regional Medical Center. This team will prepare you for your discharge

and return home. This section includes information on your hospital stay and your discharge from the hospital.

Our team will assess you after surgery in order to achieve the goal of returning you home with your family.

1. Post-Surgical Care Intravenous Fluids, Antibiotics

Dressings

Drainage Tubes

Bladder Catheter

Support Stockings (TEDS), Sequential/Compression devices, Foot Pumps

Oxygen

Anticoagulant

Blood Transfusions (if needed)

2. Pain Medications and Pain Management Spinal Pain Medicine

Pain Pills

Intravenous Pain Management

Intra-articular Pain Management

PCA Pump

Pain Scale

3. General Postoperative Schedule

4. Post-Surgical Exercises and Activities Total Hip Care

Total Knee Care

5. Discharge Planning Options

6. Discharge from the Hospital

The Drive Home

7. Recovering at Home

8. Living with your Joint Replacement

9. Additional Information

HOSPITAL STAY


1 Post-Surgical Care

From the post-anesthesia care unit, you will be transferred to your hospital room in the Orthopaedic Institute.

You may wake up feeling groggy and will see the surgical dressings and tubes that were applied during or im-

mediately after surgery. They are a normal part of postsurgical care.

Intravenous Fluids, Antibiotics

You will be provided with fluids and electrolytes through an intravenous tube. It will be removed on the

first postoperative day if you are drinking fluids and your blood count is stable. Antibiotics are also given

intravenously to prevent infection.

Dressings

A compressive dressing will be placed over your wound after surgery. The dressing will be changed on

the first postoperative day and daily thereafter.

Drainage Tubes

A drainage tube may be inserted into your hip or knee during surgery. This tube collects bloody drainage after

surgery. It will be removed on the first postoperative day.

Bladder Catheter

You may have a catheter inserted into your bladder during your surgery to empty your bladder. The urine drains

into a bag. The catheter will be removed within 24 hours after it is inserted into the bladder.

Support Stockings (TEDS), Sequential Compression Devices, Foot Pumps

After hip and knee surgery, sequential compression devices or foot pumps and elastic stockings will be placed

on both your legs to help your blood circulate and to prevent blood clots. You may continue to wear your elas-

tic stockings for 4 to 6 weeks after surgery.

Oxygen

After surgery you may receive oxygen through a tube under your nose. A monitor will be placed on your

finger to measure the amount of oxygen in your blood.

Anticoagulation (Blood Thinner)

To prevent blood clots from developing in your legs which can potentially move to your lungs and cause harm,

you will be given a type of medicine for anticoagulation. You may be given Coumadin, low molecular weight

Heparin (Lovenox), Aspirin, or other anticoagulants which will be prescribed by your surgeon.

Blood Transfusions

During or after a total hip or knee replacement, you may need a blood transfusion. Bon Secours Memorial

Regional Medical Center stocks blood and blood products from the Virginia Blood Services. While there are

risks associated with transfusion of banked blood, these are very low. See Statistics on next page.


HOSPITAL STAY

Risk Statistics of Bank Blood (per unit):

AIDS—1 in 2,000,000

Hepatitis C—1 in 205,000

Hepatitis B—1 in 2,000,000

Call Virginia Blood Services at (804) 359-5100 if you have any further questions

regarding blood transfusions.

2 Pain Medications and Pain Management

Spinal Pain Management If you received a spinal injection it will usually last 24-36 hours. It will control your pain from the waist down. Pain Pills On the day of surgery you can begin taking pain pills to manage discomfort. The medications are ordered by your surgeon to be given to you “as needed”. This means that you will need to ask the nurses for your pain medications when you start to have pain. We encourage you to take them before you exercise. Intravenous Pain Management You will have intravenous pain medication available if your pain is not managed by the pain pills. Again, you must ask your nurse for your pain medications when you start having pain.

0 1 2 3 4 5 6 7 8 9 10 no

pain

worst pain you

can imagine

Intra-articular Pain Management In an effort to decrease the need for postoperative narcotics and to manage pain, some surgeons will inject a numbing medication mixed with pain medication directly into the joint space before closing the wound. This method has fewer side effects. If you need additional pain management, you will need to ask the nurse for your pain medication when you start having pain. PCA Pump Another means used to manage pain after surgery is with a patient controlled analgesia pump (PCA). This pump allows you to give yourself pain medication by pressing a button. The button signals the pump to deliver the medication to you through an intravenous tube. The pump is set to limit the amount of medicine dispensed and the frequency so you cannot get too much. This is used when other methods fail.

Pain Scale While you are in the hospital, you will be asked to rate the intensity of pain you are experiencing through the use of a pain scale. A pain scale is a line numbered from 0 to 10, with each number representing a degree of pain. A sample of the pain scale can be seen below.


HOSPITAL STAY

3 General Postoperative Schedule

Day of Surgery

Tubes in place (oxygen, intravenous, bladder catheter, wound drainage catheter, epidural catheter).

More frequent vital sign checks.

Begin ankle pumps; coughing and deep breathing; turning in bed.

Sit at bedside with assistance.

Out of bed (first session of physical therapy).

1 Day After Surgery—Postoperative Day # 1

Physical therapy sessions twice on this day. You will take steps in your room and further if desired.

Bladder catheter and drains removed.

Possible blood transfusion if needed.

Oxygen as tolerated.

Occupational therapy visit.

Care management visit.

Dressing change.

2 Days After Surgery—Postoperative Day # 2

Dressing change.

Physical therapy sessions once or twice today.

Stair climbing training.

Care management visit to finalized discharge plan.

Discharge home.

3 Days After Surgery—Postoperative Day # 3 (if not already discharged)

Further gait training with physical therapist that includes instruction in stair climbing and getting on and off the commode safely.

Discharged to next level of care, i.e. home or appropriate rehabilitation facility.


HOSPITAL STAY

4 PostSurgical Exercises and Activities

Coughing and Deep Breathing Exercises

Coughing and deep breathing help prevent lung congestion after surgery.

To cough, take a deep breath in and cough forcefully from your abdomen.

To deep breathe, inhale as deeply as you can and hold while counting to 10. Now exhale all the air.

Repeat this exercise 5 times. Another part of your deep breathing exercise involves the use of a small

plastic device called an incentive spirometer. The spirometer helps you fully expand your lungs.

You will be asked to use your spirometer about 10 times every hour that you are awake.

Ankle Pumps

Immediately after your surgery, you will be encouraged to do ankle pumps every hour. This is done by

moving your ankles up and down and wiggling your toes. Ankle pumps help increase the circulation in

your lower legs.

Turning in Bed

Turning in bed helps prevent skin breakdown, lung congestion, and blood clots.

Hip Replacement: The nurses will assist you to turn to your non-surgical side. To protect your hip

from dislocation and if you have hip precautions your nurse will instruct you to put pillows be-

tween your legs to keep them apart. If your surgeon prescribes hip precautions, to prevent disloca-

tion, you must follow these precautions for the next three months. If you do not have hip precau-

tions, you may move anyway you want to get comfortable.

Knee Replacement: A towel roll will be placed under your ankle for a few minutes during the day

to help straighten your leg. You should not place the towel or pillow directly under your knee

while lying on your back to avoid contractures. Otherwise, you may move your knee any way that

you want to get comfortable.

Ambulation

You may begin walking the day of your surgery. A physical therapist will teach you how to transfer out of

bed and how much weight you can place on your new joint using a walker to move to a chair. You will sit

up for about an hour. Each day, the distance you walk will be increased. You will learn how to walk to the

bathroom, through the hallway, and how to climb stairs.


HOSPITAL STAY

Physical Therapy Exercises

You may be out of bed or take a few steps on the day of your surgery. Participating in physical therapy

strongly influences your recovery. While you are in the hospital, you will receive physical therapy twice

a day. The exercises you learned in the weeks before your surgery will be resumed by physical therapy the

morning after surgery. In the days following, you should progress to more advanced exercises and walking

with the assistance of crutches or a walker. Your therapist will determine which of these is best for you.

Occupational Therapy

These exercises will help you regain your independence in performing everyday activities such as

dressing, bathing, toileting, etc. Your occupational therapist will help you determine your need for

adaptive and durable medical equipment.


HOSPITAL STAY

Anterior Total Hip Exercises

On the following pages, you will find exercises you may be instructed to

do before your surgery and during your recovery. Your physician and

physical therapist will advise you on which exercises are appropriate

for you and the number of repetitions needed.

1. Bend ankles up and down,

alternating feet.

You should do this exercise:

Before surgery

In the hospital

At home

2. Slowly tighten muscles on

thigh of straight leg while

counting aloud to 10.


Before surgery

In the hospital

At home

3. Squeeze buttocks muscles as

tightly as possible while

counting aloud to 10.


Before surgery

In the hospital

At home

4. Push heel into bed and hold

while counting to 10.


Before surgery

In the hospital

At home


HOSPITAL STAY


5. Slide one leg out to the side.

Keep knee cap pointing toward

ceiling. Gently bring leg back to

pillow.


Before surgery

At home

6. Slide foot toward buttocks

until it is flat on the bed.

Make sure you lie flat in bed.


Before surgery

In the hospital

At home

7. Step your leg forward to touch your heel

to the ground, then step your leg back,

touching your toe to the ground.


In the hospital

At home

8. Using a counter or sturdy surface for

balance, keep legs shoulder width

apart and toes pointed outward. Kick

leg out and back to side, keeping

knee straight. Do not lean.


In the hospital

At home


HOSPITAL STAY


9. Take alternating steps.


In the hospital

At home

10. Gently rise up on toes and roll back on

heels.


In the hospital

At home

11. Using a stair or stool, step up then down

with same leg 5 times. Repeat using

other leg to complete set of 10 step-ups.


At home

12. Practice standing up. Return to sitting

position.


In the hospital

At home


HOSPITAL STAY

1. Bend ankles up and down, alternating

feet.


Before surgery

In the hospital

At home

2. Slowly tighten muscles on thigh of

straight leg while counting aloud to 10.


Before surgery

In the hospital

At home

3. Squeeze buttocks muscles as tightly as

possible while counting aloud to 10.


Before surgery

In the hospital

At home

4. Push heel into bed and hold while

counting to 10.


Before surgery

In the hospital

At home

Posterior Total Hip Precautions & Exercises

On the following pages, you will find exercises you may be instructed

to do before your surgery and during your recovery. Your physician

and physical therapist will advise you on which exercises are appro-

priate for you and the number of repetitions needed.



5. Stand or sit with pillow between legs,

gently turn legs and feet out.


Before Surgery

In the hospital

At home

6. Slide one leg out to the side. Keep knee

cap pointing toward ceiling.

Gently bring leg back to pillow.


Before surgery

At home

7. Slide foot toward buttocks until it is flat

on the bed. Make sure you lie flat in

bed.


Before surgery

In the hospital

At home


balance, keep legs shoulder width apart

and toes pointed forward. Slowly ex-

tend one leg back, keeping knee

straight. Do not lean forward.


In the hospital

At home

HOSPITAL STAY



9. Step your leg forward to touch your heel

to the ground, then step your leg back,

touching your toe to the ground.


In the hospital

At home


balance, keep legs shoulder width

apart and toes pointed outward. Kick

leg out and back to side, keeping

knee straight. Do not lean.


In the hospital

At home



In the hospital

At home


heels.


In the hospital

At home

HOSPITAL STAY



13. Using a stair or stool, step up then down

with same leg 5 times. Repeat using

other leg to complete set of 10 step-ups.


At home

14. Practice standing up. Return to sitting

position.


In the hospital

At home

Afte

r reco

very

from

surg

ery

HOSPITAL STAY



The purpose of these instructions is to prevent you from having a dislocation

of your new total hip. Even though your new hip will function like a normal

hip joint, it is different from your old hip in that it can be dislocated.

Any total hip replacement, no matter how stable, can be dislocated with everyday activities

if put in an awkward enough position. This is for life!

For the safety of your new hip you should adhere to the following precautions, particularly during the

first three months after surgery. While these precautions can be relaxed after this period, you should

attempt to adhere to them with your general living habits thereafter.

DO NOT flex or force your

hip over 90 degrees. This

happens by bringing your

knee too close to your chest

or by bending forward and

bringing your chest too

close to your knee.

DO NOT reach forward to

the floor from a sitting po-

sition. If you drop some-

thing on the floor while

you are seated, use your

pickup stick.

HOSPITAL STAY



DO NOT sit on low chairs

or toilets. This may force

the hip to bend beyond 90

degrees.

DO NOT turn your knee inward while sitting or

lying down. Imagine a line drawn on the hip,

through your knee and to your foot. Your foot

should not be outside of that line. When you are

sitting and looking down at your knee, you should

not see your foot outside of your knee. Your foot

should always be in alignment with your knee or to

the inside of your knee when sitting.

DO NOT pivot or twist on

the operated leg. Forcing

your operated leg inward

should be avoided.

DO NOT cross your legs.

This means do not drape

one knee over the other.

When sitting, you may

cross your ankles.

HOSPITAL STAY



DO sit with hips higher

than knees.

DO use an elevated commode seat.

DO use a pillow between

your legs when sleeping,

especially when you turn

on the non-operative side

to rest.

HOSPITAL STAY



Most hip dislocations will occur during the following activities:

Getting on and off the

commode. Getting up and down out of a

low chair or sofa.

Attempting to dry feet or apply lotion

which can cause flexing over too far. Stooping suddently to pick up

an object off of the ground.

Getting in and out of a car. Those with total hip replacement on the left are at higher risk of

dislocation when getting out of the driver’s side, while those with right hip replacement are

more at risk getting out on the passenger side.

Getting in and out of bed.

Falling suddenly or changing positions that causes the hip to be over-flexed.

HOSPITAL STAY

Again, it is very important to follow your hip precautions when performing these activities.


Anterior & Posterior Total Hip Precautions & Exercises

HOSPITAL STAY

Instructions for Transfer In/Out of a Car Using a Walker

Avoid traveling in cars with deep buckets or low seats. You

may need to sit on a pillow to raise the height of the seat.

1. Back up to car. Tuck head down

and place hand on back of car

seat for support while sitting

down.

2. Use only unaffected leg to push

up and back onto seat. Caregiv-

er should assist as needed.

3. Slowly swivel around. Use

slick pillow cover and wear

smooth clothing to make this

easier.

4. Place pillow between knees.

Fasten seatbelt and keep back

reclined.


Total Knee Precautions & Exercises

HOSPITAL STAY

1. DO NOT sit on low chairs. A

chair with arms will allow you

to get up and down easier.

2. DO NOT sit longer than 45

minutes at a time as this may

make muscles around your

knee stiffen.

3. DO stay active. When your physical therapist says you are ready, you should take

daily walks, increasing your distance as your strength improves.


HOSPITAL STAY

DO push yourself to gain maximum motion of your

knee during the first 6 to 8 weeks after surgery. Work

very hard on this and do not be afraid to push through a

moderate amount of pain to accomplish this.

For the exercise above:

1. Sit in your chair with toe against wall.

2. Scoot to the edge of the chair and hold for a few seconds.



HOSPITAL STAY

On the following pages, you will find exercises you may be instructed to

do before your surgery and during your recovery. Your physician and

physical therapist will advise you on which exercises are appropriate

for you and the number of repetitions needed.

1. Bend ankles up and down, alternating

feet.


Before surgery

In the hospital

At home 2. Tighten calf muscle or tighten back of

leg and push heel into bed. Hold while

counting to 10.


Before surgery

In the hospital

At home

3. Slowly tighten muscles on thigh of

straight leg while counting aloud to 10.


Before surgery

In the hospital

At home

4. Place a rolled towel under leg. Straight-

en knee and leg. Hold 5 seconds.


Before surgery

In the hospital

At home



HOSPITAL STAY

5. Bend knee and pull heel toward buttocks.

Hold 5 seconds. Return. Repeat with

other knee.


Before surgery

In the hospital

At home

6. Keeping feet on floor, slide foot of

operated leg back, bending knee.


Before surgery

In the hospital

At home

7. Prop your foot on a foot stool or on a

chair for 5-15 minutes. You should

feel a stretch behind your knee.


In the hospital

At home


heels.


In the hospital

At home



HOSPITAL STAY



In the hospital

At home

10. Step up with surgery leg. Return.


At home

11. Holding a chair for balance, slowly bend

knees. Keep both feet on the floor.


In the hospital

At home



HOSPITAL STAY

12. With operated leg on top and bottom leg

bent, lift the top leg up towards the ceil-

ing. Keep knee pointing straight ahead

and leg in line with body. Slowly lower.


At home

13. Try to lift operated leg keeping knee as

straight as possible. Do not lift or turn

hips.


At home

14. Bend knee, bringing heel towards but-

tocks. Hold, then straighten. Can use the

non-operated leg to push the operated leg.


At home



HOSPITAL STAY Exercise Log


HOSPITAL STAY

Going Down:

1. If using a cane, place cane

down a step.

2. Move weaker leg down first.

3. Follow with other leg to same

step.

1

2

3

Instructions for Going Up and

Down Stairs Using a Cane 1

2

Going up:

1. Step up with stronger leg

first.

2. Move cane and weaker leg up

to same step.

“Up with the

GOOD FOOT;

Down with the

BAD”


HOSPITAL STAY

5 Discharge Planning Options

It is important for you to know that your orthopaedic surgeon will not discharge you from the hospital until he

or she knows you can safely go to the next level of care. However, the options opened to you at discharge are

sometimes predicated on your type of insurance coverage and other factors. There are four basic options to

consider with regard to discharge.

Home with Home Healthcare

Our goal is to have you return home, continuing your physical therapy and care in a familiar, comfortable

environment. You should have someone stay with you or check in on you frequently for the first 7 to 10 days

after you return home. A nurse and therapist may visit you regularly after discharge from the hospital. The

physical therapist will continue to work with you on the exercises you learned in the hospital and may add new

exercises as well. A nurse will visit your home to draw blood samples if you are sent home on Coumadin. The

dosage will be adjusted by your doctor’s office twice a week as the blood samples are drawn and reported. Your

staples, if you are discharged home with them, will be removed by the nurse or physical therapist after 10 to 14

days, depending on your surgeon’s preference. The Home Health staff will provide instructions on the use of ice

packs and discuss the frequency of their visits.

Home with Relative or Friend Plus Home Healthcare

You will be cared for as described above, except you will stay in someone else’s home.

Skilled Nursing/Assisted Living Facility

For those who will require additional time with a less aggressive program to get back to independent living.

This requires insurance and your surgeon’s approval for admission. The goal is a short stay (5 to 10 days) and

then return home.

Inpatient Rehabilitation Facility

For those who require additional time and can tolerate a more intensive rehabilitation program (3 hours per day,

minimum). The goal is a short stay (5 to 10 days) and then return home. This option must be approved by your

doctor, the rehabilitation facility, and your insurance company.

Equipment You May Need for Home

Equipment you may need once you return home includes:

3in1 elevated commode or raised toilet seat with arms. This is recommended equipment for patients with

hip replacement or bilateral knee replacement; it is optional for patients with single knee replacement.

Walker or crutches (forearm or underarm). If you don’t have these, they can be ordered for you while you

are in the hospital.

Shower chair, bench or other assistive devices such as a long-handle reacher, sponge or shoehorn. These

items are optional. You will be informed about where to obtain these items.

A list of suppliers of durable medical goods and their locations is available if you need it at discharge.


HOSPITAL STAY

6 Discharge From the Hospital

When you are medically stable and walking with a walker or crutches, you will be ready to return home or,

in some cases, transfer to a rehabilitation facility. Your hospital stay will be approximately 2-3 days.

Prior to going home you will be given:

Prescription for pain medicine

Prescription for blood thinner

Written instructions from your surgeon

Elastic stockings (TEDs)

Home Health and Durable Medical Equipment information

Information on equipment arrangements if necessary

Discharge instructions

For additional information regarding discharge planning you may contact our Care Management

department at (804)764-6702 or our Joint Replacement Center at (804) 764-6036.

The Drive Home

You will need to have a friend or family member pick you up from the hospital on the day you are

discharged. Specific instructions for your drive home can be found below. Plan your discharge around

11:00 am.

Make sure that the friend or family member taking you home brings pillows for you to sit on in the car.

When getting into the car:

Move the front passenger seat back as far as possible.

Place the pillows on the car seat and recline the seat slightly, if possible.

If your drive home is long, stop to stand up and stretch after 45 minutes to 1 hour.

See page 45 for Instructions on Transferring In/Out of a Car.


RECOVERING AT HOME

Your recovery period at home may take 6 to 12 weeks. Each day you will be able to resume more and

more activities. Keep in mind, however, that recovery is a gradual process, and we all recover at our

own pace.

This section provides information about the following:

1. Medications

Anticoagulation

Pain Medications

Laxatives and Stool Softeners

2. Precautions

Blood Clots

Infections

3. Diet and Exercise

4. Everyday Activities

5. Restricted Activities

6. PostSurgery Follow-up

Physician Checkup


RECOVERING AT HOME

1 Medications

Anticoagulation (Blood Thinners)

These medicines are used after your surgery to prevent blood clots in your legs that could potentially

cause thrombophlebitis (blood clot in your leg that causes pain and swelling) or pulmonary embolus

(a blood clot that travels from your leg to your lung). Depending on the judgment of your doctor,

you will be on one of the following medications to prevent this.

Coumadin

Take Coumadin daily at 6:00 pm if prescribed by your doctor. Do not take any aspirin or anti-

inflammatory medicines while you are taking Coumadin. You may take regular or extra strength

Tylenol and pain medications ordered by your doctor unless you are currently taking a medication with

acetaminophen (Tylenol). If you experience any unusual bleeding, notify your physician immediately.

Your Coumadin dose will be adjusted twice a week to

prevent your blood from getting too thick or too

thin. You will have your blood drawn to monitor this

(usually on Monday and Thursday). In the first few

weeks at home, the home health nurse will come to

your house to draw blood. After that, you may need

to go to a laboratory twice a week to have this done.

Coumadin is usually taken for 4 to 6 weeks after your

surgery. Your doctor’s office will call you twice a week

on a specified day (usually Tuesday and Friday) to

adjust your Coumadin dosage. Do not take

Coumadin on these days until your doctor’s office

has called to adjust the dosage. If you have not

heard from your doctor’s office by 3:00 pm, call

your doctor for the adjusted dosage.

Do not take Coumadin on

Tuesdays or Fridays until

your Doctor’s office has

called to adjust the dosage.

If you have not heard from

your Doctor’s office by

3:00 pm, call your doctor.

Lovenox (Low Molecular Weight Heparin)

This medication is administered by subcutaneous injection once or twice a day as prescribed by your

doctor. As with Coumadin, if you experience any unusual bleeding, notify your physician immediately.

Aspirin

Take one coated aspirin in the morning and one in the evening with food, unless your doctor has

prescribed Coumadin or you are allergic.

Other Anticoagulants

A) Xarelto is taken by mouth once a day as prescribed by your physician. If you experience any

unusual bleeding, notify your physician immediately.


Hospital Stay RECOVERING AT HOME

Pain Medications

Take your prescribed pain medication every 3 to 4 hours if needed. You may need it frequently when you

first arrive home to manage your pain. Gradually, you should be able to increase the length of time between

pills or decrease the number of pills from 2 to 1.

Take pain medication 2030 minutes before the therapist arrives. This will help you to perform your

exercises with minimal pain. After exercising, you may want to apply ice to your incision for about 20

minutes to decrease swelling.

Laxatives and Stool Softeners

If you are experiencing problems with constipation, you may take any over-the-counter laxatives or stool

softeners, such as Milk of Magnesia, Dulcolax suppositories or pills, Miralax laxative, or Metamucil.

Another option would be to use a Fleets enema.

2 Precautions

Blood Clots

Blood clots can sometimes occur after joint replacement surgery. Taking Coumadin, low molecular

weight Heparin, Aspirin, or other blood thinners as prescribed by your doctor and wearing your support

stockings (TEDS) are important ways to decrease the possibility of clot formation. However, as a

precautionary measure, it is important to recognize the signs of blood clots.

Warning signs of blood clots in the leg:

Increased pain in the calf of your leg

Tenderness or redness

Increased swelling of the thigh, calf, ankle, or foot

If you experience any of these

warning signs, call your doctor

immediately.


warning signs, call 911 for

transport to an emergency room

Warning signs of blood clots in the lung:

Sudden increased shortness of breath

Sudden onset of chest pain

Localized chest pain with coughing or

when taking a deep breath




warning signs, call your doctor

immediately.

Infections

The most common causes of infection are from bacteria entering the blood stream through the

mouth, urinary tract, or skin. You should take antibiotics prior to dental work and abdominal or

urinary tract procedures.

Warning signs of infection include:

Persistent fever (oral temperature greater than

100.5 degrees)

Shaking or chills

Increased redness, tenderness, swelling, or drain-

age from incision

Increased pain during activity and at rest

3 Diet and Exercise

Diet

It is important to eat a well balanced diet when you return from the hospital. A healthy diet will supply

you with proper nutrition and help restore your strength. For food choices, follow the suggestions that are

provided under “Nutrition” in the Preoperative section of this handbook on pages 15-17. Remember, it is

normal to experience a loss of appetite for the first few days after surgery. If you find that your appetite is

slightly decreased for the first week or two, try eating five or six small meals spaced throughout the day.

Exercise

For the first few weeks after your surgery, you will be visited by a physical therapist at home. He or she will

help you perform the exercises you learned in the hospital as well as new exercises. Your physical therapist

will discuss the frequency of their visits, tell you which exercises you should do, and add exercises as

appropriate.

If any signs of chest pain, shortness of

breath or unusual heart beat,

DIAL 911.



4 Everyday Activities

Bathing

Follow your surgeon’s instructions regarding showering and bathing. If you have a tub shower,

you may want to use a shower bench or chair. You may find a handheld shower or long-handled

sponge to be helpful to wash your feet, back, and legs.

Walking

Take short walks about every two hours, increasing your distance each day. Always use your walker

or crutches and avoid overextension. Do not walk on uneven surfaces such as lawns or gravel.

Climbing Stairs

If you must climb stairs, go up the stairs using your good leg first. Go down stairs placing your bad

leg first (See page 54 for instructions on how to climb stairs using a cane.)

Sitting

Use chairs that have arms, backs, and firm seats. You need arms to help lift yourself out of the chair.

Be cautious about sitting on low stools, low chairs, or low toilets. To maintain good circulation,

pump your ankles up and down after sitting in one spot for more than 30 minutes.

Reaching

Use your long-handled adaptive equipment for reaching objects from the floor and for dressing.

Be cautious when bending over to pick up any objects.



5

6

Restricted Activities

Post-Surgery Follow-up

DO NOT do any of the following until you see

your doctor at your first postoperative appoint-

ment within 2 to 4 weeks after your surgery:

Return to work.

Drive a car.

Participate in sports.

Take a tub bath.

Physician Checkup

Your first postoperative visit will generally be 2 to 4 weeks

after your surgery. You should schedule your appointment

as soon as you return home from the hospital if this has

not already been scheduled by your doctor on your discharge

instructions.

Besides a thorough checkup, you will also receive a new set of

instructions for care and a list of activities that you can now en-

gage in. Your next visit will be determined by your surgeon and

the progress you have made in physical therapy.


Hospital Stay LIVING WITH JOINT REPLACEMENT

By having a hip or knee replacement, you join more than 1 million Americans who undergo

this surgery every year. More than 95% of them experience a dramatic reduction in pain and

renewed ability to participate and enjoy physical activity. Still, a replacement hip or knee is

not a normal hip or knee. This section discusses your lifestyle with your joint replacement.

1. Lifetime Activities

Recommended

NOT Recommended

AVOID Entirely

2. Medical and Dental Care

Medical Follow-up

Dental Visits

Metal Detectors

Infection Protection



1 Lifetime Activities

After three to six months, you will most likely be able to resume the

majority of activities that you were able to enjoy when you had a healthy

hip or knee. Still, there are some activities that your doctor prefers over

others, and some that your doctor will want you to avoid entirely.

Recommended

Swimming

Biking

Walking

Golf

Hunting

Low impact and water aerobics

Stair Climber

Dancing

Bowling

Fishing

Gardening

Elliptical Stepper/Nordic Track

Light lower extremity weights

Not Recommended

Basketball

Skiing

Weightlifting with weights that exceed 50 lbs.

Racquetball

Tennis (Doubles okay, NOT singles)

Softball

Squash

Baseball

Jogging or Running

Avoid Entirely

Contact sports

Jumping sports

High impact aerobics

CHECK WITH YOUR

PHYSICIAN REGARDING

ANY OF THESE

ACTIVITIES!



2 Medical Follow-up and Dental Care

Medical Follow-up

Your hip or knee should be evaluated at 5 year intervals for the rest of your life. Although

90% of replacements function well for more than 10 years, the implant may wear with increasing years

of use.

You may need to take antibiotics prior to urinary tract or abdominal surgery/procedures.

Dental Visits

Because infections commonly enter the body through the mouth, you must take certain precautions

before having dental work.

Tell your dentist that you have had joint replacement surgery.

Take an antibiotic, which will help prevent bacteria from entering your blood stream. Your surgeon or

your dentist may prescribe the antibiotic.

For dental work, antibiotics are recommended for two years following your surgery and for life if you

are diabetic or susceptible for infection.

Metal Detectors

Your new hip or knee may activate metal detectors used for security in airports and some buildings.

Tell the security agent about your joint replacement and carry the card confirming that you have an ar-

tificial joint. You will be scanned in airports with a scanning device as a security precaution.

ALL PATIENTS WILL BE ISSUED A JOINT REPLACE-

MENT IDENTIFICATION CARD AS A REMINDER TO

BE CAREFUL WITH INFECTION



Infection Protection

To protect yourself and your joint replacement, it is very important that you know how to

prevent infection. Your doctor will use special measures to prevent infection in your joint

replacement. When you arrive for your operation, your doctor will order an antibiotic medicine.

This medicine will be given to you before and a few doses after your operation. After you go

home, you must always remember that it is possible to develop an infection in your joint re-

placement. When germs enter your body, they can be carried through your body by the blood

stream and could settle in your joint replacement. If you need dental work or special procedures

i.e. urinary tract or abdominal surgery, you may need an antibiotic before the procedure.

A LIFETIME PRECAUTION TO STOP INFECTION

If you need dental work or a special procedure or surgery of any kind, you must

tell your dentist or doctor that a joint replacement is in place. An antibiotic will

be given to prevent any new infection from going to the new joint.


Hospital Stay ADDITIONAL INFORMATION SECTION

This section provides you with:

1. Commonly Asked Questions

2. Common Complaints

3. Important Phone & Resource Numbers

4. Map and Directions

5. Note pages



Commonly Asked Questions

Q: How long do I have to wear stockings (TEDS) and why?

A: They need to be worn for 46 weeks after surgery to prevent blood clots.

Q: How long do I need to maintain hip precautions?

A: If your doctor says that you have hip precautions they will be for approximately 3 months. However,

you should always avoid the dangerous combinations of flexion and internal rotation of the operated

leg, or hyper-extension and external rotation.

Q: When can I start driving?

A: About 46 weeks after surgery.

Q: How long do I have to keep doing the exercises?

A: Specific exercises should be done until you are pain free and walk without a limp; however, regular

exercise should be a lifetime commitment.

Q: How long will my prosthesis last?

A: An average of 10 to 20 years, depending on your age, weight, and activity level.

Q: When can I take a shower or tub bath?

A: See your Discharge Instruction sheet for specifics regarding a shower and tub bath.

Q: When can I start crossing my legs and sleep without a pillow between them after hip

replacement?

A: Consult your physician for instructions about crossing your legs and sleeping without a pillow after

your hip replacement.

Q: What should I do if my leg swells?

A: It is not unusual to have a moderate amount of swelling in the leg on the operated side. If the

swelling increases after you have returned home, contact your surgeon. You may need a test for

blood clots.



Common Complaints

COMMON SYMPTOM RECOMMENDED ACTION

Difficulty sleeping You may take Tylenol PM. Remember that some prescription

pain medications have acetaminophen in them. Do not take

more than 4,000 milligrams of acetaminophen (Tylenol) per

day.

Drink warm milk before bedtime.

Lack of appetite Eat small, frequent meals.

Drink Carnation Instant Breakfast or Ensure.

Constipation You may use Milk of Magnesia, Dulcolax tabs, Miralax, sup-

pository or a Fleets enema.

You may use a stool softener.

Swelling Apply an ice pack 20 minutes after exercise.

If swelling does not go down overnight, notify your physician.

Numbness along outer side of the knee incision This is normal. No action is needed.

Drainage from incision Change bandage daily.

Leave bandage off when the all drainage stops.

If drainage continues, notify your physician.

Clicking with knee bending Occasionally, you may feel soft clicking of metal and plastic.

This is normal. No action is needed.

Activate metal detector alarm Your knee or hip may activate metal detectors required for

security in airports. Tell the security agent about your joint

replacement.

Mood swings/feeling “blue” Mood swings are normal. These sad feelings should improve

with time. They tend to come from the combination of sur-

gery, anesthesia, pain, and emotional factors in about 20% of

patients. Call your physician if your emotional recovery is not

progressing.

Call your physician if any of these symptoms persist



Phone Numbers & Resource Numbers

Your Surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________

Your Family Physician . . . . . . . . . . . . . . . . . . . . . . . _____________________

Home Physical Therapy . . . . . . . . . . . . . . . . . . . . . . _____________________

Bon Secours Orthopaedic Institute at Memorial Regional

Medical Center . . . . . . . . . . . . . . . . (804)764-6036

Orthopaedic Institute Patient Rooms . . . . . . . . . . . . . (804)764-Room#

Orthopaedic Patient Educator . . . . . . . . . . . . . . . . . . (804)764-6700

Orthopaedic Nurse Manager . . . . . . . . . . . . . . . . . . . (804)764-6730

Care Management. . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6702

Bon Secours Memorial Regional Medical Center . . . . . . . (804)764-6000

Surgery Center and Waiting Area. . . . . . . . . . . . . . . . . (804)764-6913

Gift Shop. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6412

Nutritional Services. . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6067

Pastoral Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6125

Patient Representative. . . . . . . . . . . . . . . . . . . . . . . (804)764-6437

Virginia Blood Services . . . . . . . . . . . . . . . . . . . . . . (804)359-5100

OR . . . . . . . . (800)989-4438

Volunteer Services. . . . . . . . . . . . . . . . . . . . . . . . . (804)764-6044



Map & Directions



Notes

ADDITIONAL INFORMATION SECTION

Notes


8260 Atlee Road

Mechanicsville, VA 23116

(804) 764-6000 Created: August 2012 / DLT & ELG

bon secours orthopaedic institute at memorial regional...

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