JOINT REPLACEMENT

GUIDEBOOK

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ABOUT DEKALB MEDICAL Founded in 1961, DeKalb Regional Health System, Inc., known as DeKalb Medical, is comprised of more than 800 physicians skilled in 55 medical specialties across three campuses and over 25 practices. The 627-bed system includes DeKalb Medical at North Decatur (451 beds), DeKalb Medical Long Term Acute Care at Downtown Decatur (76 beds), DeKalb Medical at Hillandale (100 beds), and DeKalb Medical Physicians Group and the DeKalb Medical Foundation.

VISIONIn partnership with the best physicians, employees and volunteers, DeKalb Medical will be the healthcare provider of choice by delivering a superior patient experience every time.

MISSIONTo earn our patients’ trust every day through uncompromising commitment to quality.

VALUES (I REACH!)Integrity | Respect | Excellence | Accountability | Compassion | Helping Hands

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TABLE OF CONTENTS Welcome What to Expect Preparing for Your SurgeryRange of Motion Before Your Surgery Day of Surgery Post-Surgical Recovery After Surgery Discharge

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WELCOMEThank you for choosing The Joint Solutions Center to help restoreyou to a higher quality of living with your new prosthetic joint.

If you have not already done so, please contact the joint care coordinator (404.501.5697) between 8 a.m. and 4:30 p.m.Monday through Friday to schedule your joint care class prior tosurgery.

Over 700,000 persons every year undergo total joint replacementsurgery. Primary candidates are individuals with chronic joint painfrom arthritis that interferes with daily activities, walking, exercise,leisure, recreation and work. Total joint replacement patientstypically recover quickly. Patients will be able to walk the first dayof surgery. Generally, patients are able to return to driving in twoto four weeks, dancing in four to six weeks and golfing in six to 12weeks.

The Joint Solutions Center has implemented a comprehensivepatient- and family-planned course of treatment. We believe thatyou play a key role in promoting a successful recovery. Our goal isto involve you in your treatment through each step of the program.This guide will give you the necessary information to promote amore successful surgical outcome.

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Your team includes physicians, physicians’ assistants, patient care technicians (PCT’s), nurses, physical and occupational therapists specializing in total joint care. Every detail, from before-surgery teaching to after-surgery exercising, is considered and reviewed with you. The Joint Care Coordinator will plan your individual treatment program and guide you through the surgical experience.

WHAT TO EXPECTThe Joint Solutions Center is unique. It is a dedicated center within DeKalb Medical. Patients have their surgery on Monday, Tuesday or Wednesday, and typically return home after a two-to-three-night stay in the hospital.

• You may wear your own clothes • Nurses and therapists specializing in the care of total joint replacement patients • Private rooms • Unlimited visiting hours for family and friends • Emphasis on group activities and individual care • Personal recovery coach – We encourage you to bring someone with you • Cooked-to-order menu every Wednesday in the Walker’s Café • Hourly rounding addressing The Four Ps – pain, potty, position and possession

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PREPARING FOR YOUR SURGERY

Enlist A Coach Find a family member or close friend to be your personal recovery coach. Every patient benefits from having a coach.

Your coach will serve in a support role to help build your confidence as you regain strength and stability in your new joint through therapy and exercise. A stronger and more stable joint means you will go home earlier, recover quicker and have a satisfactory outcome. Check With Your Physician You should have an appointment with your surgeon about two weeks before your surgery that serves as a final check-up and a time for you to ask questions. You will also be asked to stop or start taking certain medications prior to surgery including medications that may increase bleeding, such as aspirin, Advil, Naproxen, Celebrex, Plavix, or Coumadin.

Your surgeon may inform you to stop taking diabetic medications the day of surgery and will instruct you on which blood pressure and heart medications to take on the day of surgery. Prepare Your Home For Your Return Have your house ready for your arrival back home. Clean, do the laundry, and put it away. Put clean linens on the bed. Prepare meals and freeze them in single-serving containers. Cut the grass, tend to the garden and finish any other yard work. Pick up throw rugs and tack down loose carpeting.

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Remove electrical cords and other obstructions from walkways. Install night lights in bathrooms, bedrooms and hallways. Arrange to have someone collect your mail and take care of pets or family members if necessary. Exercise Start pre-op exercises as your doctor orders. It is important to be as fit as possible before undergoing a total joint replacement. Always consult your physician before starting the before-surgery exercise plan. Following the surgeon’s instructions will make your recovery time much faster.

Your physician and therapist have provided exercises for you to perform prior to surgery. Performing these exercises will help you during the after surgery period. You should be able to complete these exercises in 15–20 minutes and it is typically recommended that you do all of them twice a day.

Also, remember that you need to strengthen your entire body, not just your leg. It is very important that you strengthen your arms by doing chair push-ups (exercise #8 on page 9) because you will be relying on your arms to help you get in and out of bed, in and out of a chair, walk, and to do your exercises postoperatively. Exercise should not be painful. Please stop doing any movements that cause pain to your joint.

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RANGE OF MOTION & STRENGTHENING EXERCISES

1. ANKLE PUMPS Flex foot. Point toes. Repeat 20 times.

2. QUAD SETS (KNEE PUSHDOWNS) Lie on back with knee straight, press knee into mat, tightening muscles on front of thigh. Do NOT hold breath. Keep muscles tightened to count of five. Repeat 20 times.

3. GLUTEAL SETS (BOTTOM SQUEEZES) Squeeze bottom together. Do NOT hold breath. Keep muscles tightened to count of five. Repeat 20 times.

4. HIP ABDUCTION AND ADDUCTION — (STANDING)Standing at counter top or chair back, swing affected leg out to side away from body. Bring leg back toward body. Repeat 20 times.

5. HEEL SLIDES — (SLIDE HEELS UP AND DOWN) Lie on couch or bed. Slide heel toward your bottom, then slowly lower. Repeat 20 times.

6. SHORT ARC QUADS Lie on back, place towel roll under thigh. Lift foot, straightening knee. Do not raise thigh off roll. Hold to a count of five. Slowly lower. Repeat 20 times.

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7. KNEE EXTENSION — LONG ARC Sit with back against chair. Straighten knee. Hold to count of five. Lower leg. Repeat 20 times on each leg.

8. ARM CHAIR PUSH-UPS This exercise will help strengthen your arms for walking with crutches or a walker. Sit in an armchair. Place hands on armrests. Straighten arms, raising bottom up off chair seat if possible. Feet should be flat on floor. Repeat 20 times.

9. SEATED HAMSTRING STRETCH Sit on chair with leg extended. Lean forward until stretch is felt. Hold for 20–30 seconds. Keep back straight. Relax. Repeat five times.

10. STRAIGHT LEG RAISES Lie on back, unaffected knee bent, and foot flat. Lift opposite leg up 12 inches. Keep knee straight and toes pointed up. Relax. Repeat 20 times.

11. KNEE EXTENSION STRETCH Prop foot of involved leg up on chair. Place towel roll under ankle and ice pack over knee. Do for 10 minutes.

12. MINI SQUATS Holding on to a stable object, slightly bend knees and slowly straighten. Repeat 20 times.

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24 HOURS BEFORE YOUR SURGERY It is important you remember to:

• Not eat or drink after midnight• Take a very good shower• Bring this guidebook to the hospital• Bring a copy of advanced directives• Bring loose-fitting clothing• Bring any special equipment required for other medical conditions

DAY OF SURGERY

Please report to surgery one to two hours early. You will be prepared for surgery in the Surgery Admitting Area. This includes starting an IV and scrubbing the area for surgery. Your operating room nurse and anesthesiologist may interview you and they may escort you to the operating room where you will see your surgeon, if you have NOT seen him in the Surgery Admitting Area.

Following surgery, you will be taken to a recovery area where you will remain for one to two hours. During this time, pain control is typically established, your vital signs will be monitored, and an X-ray may be taken of your new joint. Your family waiting in the Surgery Admitting Area will be updated on your progress by the surgeon and afterwards you will be informed on the location of your family member on the Joint Solutions floor/unit. You will be taken to the Joint Solutions Center where highly trained staff in total joint care and orthopedics will care for you, and prepare you for discharge home or another level of care.

Most patients will get out of bed the day of surgery. It is very important that you begin ankle pumps on this first day. This will help prevent blood clots from forming in your legs. Your surgeon may choose to use a “Continuous Passive Motion” machine (CPM) to begin knee motion to help improve flexion.

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You should also begin using your Incentive Spirometer and doing the deep breathing exercises that you learned in class immediately after surgery 10 times every one hour.

Nursing staff will round on you minimally every hour to address any pain issues, bathroom breaks, positioning, and make certain all items are in your possession during the day and every two hours at bedtime to allow for a restful night.

Each day you will receive a copy of the “New Joint News,” a daily newsletter outlining the activities for the day.

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POST-SURGICAL RECOVERY

Potential Complications As you and your surgeon discussed before surgery, there are potential complications during and after the surgical procedure. They are:

• Blood Clots• Swelling• Infection – Please report any change in amount or drainage from incision site, increase in pain, or temperature greater than 100 degrees Fahrenheit.

Treatment & Preventative Measures Treatment and preventative measures for potential complications are:

• Ankle Pumps• Blood thinners• Hand washing

• Cover dressings • Early mobility• Fall precautions

DAILY SCHEDULE

DAY 1• 5:30 – 7:00 AM – Blood work; Out of bed and into recliner• 7:30 - 8:30 AM – Breakfast • 9:00 - 10:00 AM – Physical therapy (1 on 1 session) in room, walking in hallways• 11:45 - 12:45 PM – Lunch (in room)• 1:00 - 2:00 PM – Group therapy session• 2:00 - 3:00 PM – Group ADL class with occupational therapist• 3:00 - 5:00 PM – Relax in room or walk with a physical therapist• 4:30 - 5:30 PM – Dinner

*Nursing staff will be making hourly rounds as needed.

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DAY 2 • 5:30 – 7:00 AM – Blood work; Out of bed and into recliner• 7:30 - 8:30 AM – Breakfast • 9:00 - 10:00 AM – Group physical therapy• 11:45 - 12:45 PM – Special lunch in Walkers Café• 12:30 - 1:00 PM – Discharge class instructions during luncheon• 1:00 - 2:00 PM – Final group therapy session• 2:00 PM – Discharge from Joint Solutions Center to a more active and pain-free lifestyle!*

*Unless dictated by clinical presentation or physician/physical therapy suggestion**Nursing staff will be making hourly rounds and as needed

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DISCHARGE

Going Home Someone responsible needs to drive you home. You should receive written discharge instructions for medications, home or outpatient physical therapy, returning to prior activities of daily living, and how to change your dressings. We will make arrangements for any equipment needs during your hospitalization.

Going to a Sub-Acute Rehab Facility The decision to go home or to sub-acute rehab will be made collectively by you, the Joint Care Coordinator, your discharge planner, your surgeon, physical therapist, and your insurance company.

We will communicate to you prior to discharge if a family member or someone responsible needs to drive you to a subacute rehabilitation facility or the hospital can help you arrange for paid transportation. Either your primary care physician or a physician from sub-acute will be caring for you in consultation with your surgeon. Expect to stay three to five days, based upon your progress. Upon discharge home, instructions will be given to you by the sub-acute rehab staff.

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You’ll be able to track your progress on our Georgia Sightseers Tour as you walk our indoor circuit.

Enjoy the relaxing outside deck where you can take some time away from your bed and room, and breathe in the fresh air.

Every Wednesday, you’ll receive a cooked-to-order meal in the Walkers’ Cafe.