JOINT CENTERHIP AND KNEE JOINT REPLACEMENT GUIDE

CONTENTS

JOINT REPLACEMENT SURGERY 1

LEADING UP TO YOUR SURGERY 3

THE DAY OF SURGERY 5

GOING INTO SURGERY 6

PAIN MANAGEMENT 7

POSTOPERATIVE CARE AND RECOVERY 9

WHAT TO EXPECT DAY BY DAY 10

REHABILITATION 11

GOING HOME 12

WHAT YOU NEED TO KNOW GOING FORWARD 13

LIFELONG PROTECTION AGAINST INFECTION 15

SURGERY INFORMATION

TOTAL HIP REPLACEMENT SURGERY 16

WHAT TO EXPECT THE FIRST THREE DAYS AFTER TOTAL HIP REPLACEMENT SURGERY 17

TOTAL KNEE REPLACEMENT SURGERY 23

WHAT TO EXPECT THE FIRST THREE DAYS AFTER TOTAL KNEE REPLACEMENT SURGERY 25

Joint Replacement Surgery 1

JOINT REPLACEMENT SURGERY

Houston Methodist Sugar Land HospitalJOINT CENTER

Thank you for choosing Houston Methodist Sugar Land Hospital for your joint replacement surgery. We value the trust you have placed in our organization. Our team of highly trained, experienced and compassionate professionals looks forward to helping you get back in the game of life!

Getting You Back in the Game: JOINT REPLACEMENT SURGERY

Houston Methodist Sugar Land Hospital Joint Replacement Program specializes in helping patients recover from joint replacement surgery. Our specialty trained staff, state-of-the-art facilities and advanced diagnostic and treatment techniques all contribute to optimal outcomes for our patients.

We believe that joint replacement surgery and recovery is a team effort, which is why we encourage you to be involved in every aspect of your care. Our dedicated team of physicians, nurses, nutritionists, pharmacists, and therapists will assist you throughout each step of the program. Virtually every detail—from preoperative teaching to postoperative exercising—will be considered and reviewed with you.

At Houston Methodist Sugar Land Hospital, we use new surgical techniques and improved analgesic methods that allow for a speedy recovery. This rapid recovery process allows you to return to most normal activities, including driving, walking distances and daily living, in just six-to-eight weeks.

You Make the Call: IS JOINT REPLACEMENT SURGERY RIGHT FOR YOU?

Joint replacement surgery is recommended for individuals who have joint damage that

interferes with the quality of their daily lives. If you are no longer able to participate in your favorite activities, joint replacement surgery may be the right choice for you.

Discuss any questions or concerns you have with your surgeon. You may be required to visit your primary care physician to receive surgical clearance.

RISKS AND COMPLICATIONS ASSOCIATED WITH JOINT REPLACEMENT SURGERY

Although Houston Methodist Sugar Land Hospital exercises extensive safety precautions, there are risks associated with any surgical procedure.

The risks of joint replacement surgery may include, but are not limited to

• Blood clots in the legs (deep vein thrombosis or DVT).

• Blood clots that break loose and travel to the lungs (pulmonary emboli).

• Dislocation or loosening of the artificial joint.

• Extra bone growth that can cause stiffness.

• Infection that requires removal of the artificial joint.

• Pneumonia.

LEGAL DOCUMENTS

Medical Power of Attorney and Advance Directives are important documents that give you control over what happens to you in the event of unexpected illness, injury or accident.

These documents are recommended for all adults

• Medical Power of Attorney – allows you to appoint another person to make health care decisions on your behalf if you are not able to make them for yourself.

• Advance Directives – helps you communicate your wishes about future medical treatment in the event you become unable to make your wishes known because of illness or injury.

You can download these forms from our website under the “For Patients” page.

WE’RE ON YOUR TEAM!

If you have any questions or concerns regarding your care, please let your doctor or nurse know, or contact the joint coordinator by calling 281.275.0685

2Joint Replacement Surgery

For more information visit: houstonmethodist.org/sugarland

Leading Up To Your Surgery3

LEADING UP TO YOUR SURGERY

Pregame Warm Up:LEADING UP TO YOUR SURGERYJust as an athlete prepares for a big game, it is important that you prepare for your joint replacement surgery. The better prepared you are, the more rapidly you’ll return to normal activity.

Discuss the following with your surgeon prior to your procedure

• What you can expect from joint replacement surgery.

• Questions or concerns you have about the procedure.

• Medications

• Provide a complete list of your current medications, including dosages and frequency (include over-the-counter medications such as aspirin or ibuprofen, as well as diet pills, herbal supplements and teas).

• Ask your doctor about taking any medications prior to surgery.

• Prescriptions for a walker, crutches or other medical equipment you may need after surgery.

To be best prepared, prior to surgery you should also

• Find one or more relatives or friends who will assist you during your recovery as your “coach.”

• Prepare your house for your recovery (refer to the home safety tips on page 13).

• Schedule your follow-up visits.

• Make sure you have any equipment you’ll need during your recovery.

PREPARING FOR SURGERY

Follow the instructions below the day before surgery

• DO NOT

• Eat or drink after midnight the night before surgery (including water, hard candy and gum).

• Use alcohol or sedatives 24 hours before surgery.

• Smoke after midnight the day before surgery.

• Shave the operative area.

PREPARING FOR SURGERY continued

The following medications may be taken with a SIP of water the morning of surgery

• Blood pressure/heart medications.

• Stomach/antireflux medication.

• Seizure medication.

The following medications should NOT be taken the morning of surgery

• Oral or injectable glucose medication.

• Diuretics (water pills).

WHAT TO BRING TO THE HOSPITAL

Please remember to bring

• Three changes of loose, comfortable clothing and a light bathrobe (loose clothing fits best over bandages); shorts are better than pants to prevent tripping.

• Walking shoes or sneakers with traction and laces – avoid shoes with no back.

• Personal toiletries.

• Eyeglasses – we are not responsible for lost or misplaced glasses.

• Dentures – a container will be provided.

• List of medications – it’s important that you list all of your current medications including dosages and frequency.

• History of any previous surgeries.

• List of any phone numbers you may need.

• Walker and/or crutches and other medical equipment you may need after surgery.

DO NOT bring valuables, jewelry or medications from home unless advised by your physician.

4Leading Up To Your Surgery

For more information call: 281.275.0685

Make sure you have packed three changes of loose clothing and walking shoes with traction.

Notify your doctor immediately if you develop any symptoms of illness prior to your surgery. Symptoms may include cough, fever, upset stomach or skin rash.

The Day of Surgery 5

THE DAY OF SURGERY

Stepping Up to the Plate:THE DAY OF SURGERY

Once you arrive

• Please report to the front reception desk on the first floor of the Main Pavilion. (refer to the map on inside back cover).

• After registration, you will be directed to the surgery desk on the second floor of the Main Pavilion.

• You’ll be escorted to your room and asked to change into a hospital gown and to place all nonvaluable items into a bag provided for you.

• A nurse from the Day Surgery Unit will complete preparations including

• Starting an intravenous (IV) line.

• Placing a Foley urinary catheter (to monitor the function of your kidneys, hydration level and urine output during surgery).

• Monitoring additional vitals such as blood pressure, respiration and pulse.

Before your surgery, your operating room nurse will introduce herself/himself, check your identification band and ask you a few questions. Your surgeon will also visit with you to answer any questions you have before you receive your anesthetic.

Anesthesia services are provided by a care team overseen by board-certified anesthesiologists. The team includes certified nurse anesthetists with special training in providing anesthesia care. Your anesthesiologist will speak with you before surgery and answer any questions you may have. Be sure to talk to your anesthesiologist about any medications you are currently taking, including over-the-counter drugs.

You can learn what to expect during total hip replacement surgery on page 16 and during total knee replacement surgery on page 23.

IMMEDIATE POSTANESTHESIA PHASE

After your procedure, you’ll be taken to the recovery room. Specialized nurses with advanced education and training will monitor your progress through the immediate postanesthesia phase.

To provide privacy for all patients, decrease the risk of infection and enhance the healing process, visitation in the recovery room is limited. During your stay in recovery, your family may wait in the designated area. A patient liaison will keep your family informed of your condition.

When you return to your room, the nurse will check your blood pressure, pulse, respirations and bandages. Your IV will remain in place until your physician determines that it’s no longer needed. Visitors are welcome once you are transferred to your inpatient room.

6Going Into Surgery

Patients must arrive at Houston Methodist Sugar Land Hospital at least two hours before their scheduled surgery time.

Prior to surgery, be sure to advise us of your medical history, including any allergies, previous complications with anesthesia and any medical issues you may have.

Patients must arrive at Houston Methodist Sugar Land Hospital at least two hours before their scheduled surgery time.

For more information call:281.275.0685.

GOING INTO SURGERY

Before Your Procedure:GOING INTO SURGERY

1ST BASE

Unrelieved pain after surgery can be harmful, making it difficult to take a deep breath, or to move and walk. This can result in complications and a longer hospital stay. That’s why pain management immediately following your procedure is so important.

WHAT YOU CAN EXPECT

We are dedicated to keeping you as comfortable as possible during your hospital stay.

As a patient, you can expect

• Quick and respectful response to your pain.

• Assessment of your response to pain medication given.

• Detailed information about pain relief measures.

• Availability of pain relief specialists and/or anesthesiologist.

COMMON PAIN MANAGEMENT THERAPIES

The most common types of pain management therapy include

• IV PCA (Patient Controlled Anesthesia) This system delivers medication (usually narcotics) through a peripheral intravenous catheter when you push the PCA button. You’ll have a safe hourly limit and safe time intervals between doses. You know best when you are hurting and when it’s necessary to self-administer a dosage.

• Regional blocks – This system is a pressurized pump filled with local anesthetic that delivers continuous medication through a tiny catheter. The regional block provides local anesthetic to the nerve directly associated with the joint for temporary control of pain. This is often used in combination with PCA therapy for total knee replacement.

• Epidurals – This is a form of regional analgesia involving injection of medication through a catheter. The injection can cause both loss of sensation (anesthesia) and a loss of pain (analgesia) by blocking the transmission of signals through nerves in or near the spinal cord. This is commonly used in total hip replacement.

You may also be prescribed oral pain medication, which is administered on a schedule and/or as needed.

Pain Management7

PAIN MANAGEMENT

Calling in the Relief:PAIN MANAGEMENT

As most athletes know, sometimes pain is just part of the game. When you have joint replacement surgery, your chronic arthritic pain is gone, but you may experience initial postsurgical pain.

8Pain Management

For more information visit: houstonmethodist.org/sugarland

PATIENT RESPONSIBILITIES REGARDING PAIN MANAGEMENT

We can manage your pain most effectively if you report

• When the pain began.

• Where you feel pain.

• How the pain feels using the pain scale (shown below).

• If the pain is constant, or if it comes and goes.

• What, if anything, makes the pain feel better.

• What, if anything, makes the pain feel worse.

• How much pain, if any, your medicine is taking away.

• How many hours of relief you get from your medication.

Remember, you will not be completely free of pain, but our staff will work to effectively manage your pain at a comfortable level.

PAIN SCALEPlease use the pain scale below throughout your hospital stay

to describe your pain levels to your health care professionals.

No Hurt Hurts Little Hurts Little Hurts Even Hurts Whole Hurts Worst Bit More More Lot

0 2 4 6 8 10No Pain Moderate Pain Worst Pain

After Your Procedure:POSTOPERATIVE CARE AND RECOVERY

You may not be running the bases yet, but after the procedure you can expect to be moving toward a successful recovery—all before you even leave the hospital. Your team of physical therapists will evaluate and assist you in taking a postoperative walk—as soon as the morning after your surgery.

On your first day after surgery, you will feel much stronger. In addition to walking and attending group physical therapy, you will work with an occupational therapist to create a care plan that maximizes your independence with functional activity.

Other important aspects that will be monitored during your hospital stay include

• Eating – When you can eat after surgery depends on how alert you are, how you feel and your physician’s orders. Because of the anesthesia used during surgery, your digestive system will be a little slow in digesting food for a day or two. Your care team will start your diet with clear liquids, such as jello, broth, apple juice, coffee, tea and water. As soon as you are able to pass gas and tolerate a clear diet, you may move on to solid food.

• Neurovascular circulation – Your legs will be checked frequently for the first 48 hours to make sure that you have good blood flow and that you are able to move your legs well. You will be asked to do several small foot and leg exercises to improve circulation and help prevent blood clots from forming.

• Exercising your lungs – Anesthesia can often cause a sore throat and shallow breathing. You will be asked to cough and breathe deeply at least every two hours to move secretions.Your doctor will order an incentive spirometer (pictured here)—a medical device used to improve the functioning of your lungs—to be used throughout the day. Your nurse or respiratory therapist will instruct you on how to use it.

• Postoperative dressing – You will have dressings that are usually changed the day after surgery.

• Urination – A urinary catheter may be used and removed on the second day after surgery. After removal, you’ll be encouraged to use the bedside commode or walk to the bathroom with assistance.

Under no circumstances should you get up by yourself since you could fall without assistance.

10What To Expect Day By DayPostoperative Care and Recovery9

POSTOPERATIVE CARE AND RECOVERY

PREVENTING POSTOPERATIVE COMPLICATIONS

Safety measures are in place to help prevent postoperative complications, such as

• Circulation issues – You’ll wear elastic stockings and use a mechanical compression device to prevent circulation problems. You’ll also be asked to perform specific exercises to promote circulation and to strengthen your muscles.

• Blood clots – You’ll be prescribed an anticoagulant (blood thinner) to prevent your blood from clotting and causing phlebitis or deep vein thrombosis (DVT)—a possible risk after total joint replacement surgery. Some commonly used anticoagulants include enoxaparin (Lovenox®), rivaroxaban (Xarelto®), and warfarin (Coumadin®). Your physician will prescribe the anticoagulant that is best for you.

The Playbook:WHAT TO EXPECT DAYBY DAYYour game plan will vary depending on the type of joint replacement procedure you undergo. For the best possible outcome, it’s important to follow the playbook as set out by your team of physicians, nurses and physical therapists. You will find detailed information about what you can expect during your first three days after total hip replacement surgery on page 16 and total knee replacement surgery on page 23.

WHAT TO EXPECT DAY BY DAY

2ND BASE

Rehabilitation 11

REHABILITATION

Getting Back on Your Feet:REHABILITATION

Your rehabilitation care includes

• Therapy sessions – During your hospital stay, you’ll work with your physical therapist twice a day to improve the range of motion and strength of your legs.

• Coaching – It’s imperative that you bring someone—a relative or a friend—with you to the Joint Center to be your “coach.” Your coach will be with you throughout the day in the hospital and can stay the night if necessary. While in the hospital, your coach will assist you each day with your therapy—from getting you out of bed in the morning, to getting you back in bed in the evening. This experience will be invaluable for you—and your coach—when you continue your therapy together at home.

• Continuous passive motion – For total knee replacement patients, the continuous passive motion machine will be used between therapy sessions to assist you in achieving your functional goals. This machine will exercise your knee while you lie in bed to help improve your recovery time.

• Joint Center gym – The Joint Center has a gym that offers a positive atmosphere with recliners specifically designed for your therapy.

Your care team will support you in beginning to walk by

• Assisting you to sit with your feet over the side of the bed.

• Helping you stand with the use of a walker and assist you to a chair.

• Encouraging you to increase your walking distance throughout the day.

You’ve been working hard to round the bases and now you’re almost home! If you’ve been hitting it out of the park with your recovery efforts, you’ll be discharged from the hospital at this point. However, your care doesn’t end once you’ve made it safely to home plate; your surgeon may recommend that you continue to work with a physical therapist to achieve and maintain optimum joint function.

Several items will be reviewed with you before you leave the hospital to ensure your complete recovery.

SURGICAL SITE CARE

Although rare, it is possible for infections to occur after surgery. Check the surgical site daily for symptoms of infection, which may include

• Increased swelling and redness.

• Increased pain.

• Any amount of yellow, green or foul-smelling drainage.

• Oral temperature greater than 100.4 F.

Notify your surgeon IMMEDIATELY if you have any of the above symptoms.

Your nurse will give you specific instructions at the time of discharge. DO NOT peel off your sterile strips from the incision as they will fall off on their own within three-to-six days.

PAIN MANAGEMENT AT HOME

Before you leave the hospital, your doctor will give you prescriptions for pain medication and an anticoagulant (blood thinner). Take your medication as prescribed. If you are experiencing side effects, or if your pain medication does not work, call your physician.

12Going Home

To stay in the game, you’ve got to keep your newly improved body warmed up and ready to play. Physical therapy is an essential part of your care. You’ll begin physical therapy the day after surgery and continue with it after you return home.

Walking is a critical aspect for a successful recovery; in fact, getting back on your feet is the most important thing you will do.

GOING HOME

Getting Ready for Discharge:GOING HOME

3RD BASE

HOMEPLATE

What You Need To Know Going Forward13

WHAT YOU NEED TO KNOW GOING FORWARD

Post Game Review:WHAT YOU NEED TO KNOW GOING FORWARDYou may feel like an All-Star now that you’ve successfully completed your joint replacement procedure, but you still need to take it easy for a while. To ease the transition from hospital to home, be sure to arrange for someone to assist you with your daily needs.

HOME SAFETY

During the first few weeks at home, you’ll need to adapt what you learned at the hospital to your own setting.

Rooms and hallways

• Declutter.

• Have good lighting.

• Install handrails on stairs.

• Remove cords and rugs.

• Make certain your bed height is 18 inches or more to ensure your hips are above your knees when you sit on the edge.

Bathroom

• Check toilet seat to make sure it is the adequate height.

• Install grab-bars by toilet and bathtub.

• Ensure bathtub seat/bench is the appropriate height and secured well.

• Adhere safety strips to bathtub or shower floor.

• Use a handheld shower head, if available.

Other tips

• Place good lighting and nonslip treads on outside steps or ramp.

• Sit in a firm chair with arms (add two firm pillows to a low chair to provide proper height).

• Store items within easy reach, not in high or low cabinets.

• Prepare favorite meals ahead of time.

• For safety, be mindful of grandchildren and small pets.

•

•

•

•

•

DRIVIING

Consult with your physician before driving. Typically, patients may begin driving within four-to-six weeks post surgery.

BATHING/SHOWERING

Please remember your hip/knee precautions while bathing (refer to pages 19 and 27). Your nurse will give you instructions regarding bathing at home at the time of your discharge.

WATER EXERCISES/SWIMMING

Swimming and other water related exercises are NOT permitted without consent from your surgeon.

HEALTHY EATING

Due to anesthesia, pain medications and low levels of activity, constipation will likely occur.

To minimize constipation

• Drink plenty of water—at least eight glasses (8 oz) of water per day.

• Add fiber to your diet by eating at least five servings of fruit and vegetables and three-to-four servings of whole grains.

• Eat yogurt with live cultures.

• Take an over-the-counter stool softener, laxative or fiber supplement, if needed.

MY PLATE

“My Plate” is a resource provided by the U.S. Department of Agriculture that outlines what to eat each day. It’s not a rigid prescription, but rather a general guide that lets you choose a healthful diet that’s right for you.

My Plate’s healthy diet

• Emphasizes fruits, vegetables, whole grains and fat-free or low-fat milk and milk products.

• Includes lean meats, poultry, fish, beans, eggs, and nuts.

• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

14What You Need To Know Going Forward

For more information call: 281.275.0685

A key factor to a successful recovery is your personal motivation and involvement in continuing your physical therapy program.

Please be sure to schedule your follow-up visits prior to your surgery.

To learn more about My Plate, visit www.ChooseMyPlate.gov.

To prevent future infections, be sure to let your physician know that you have an artificial joint when receiving any of the following procedures to determine if an antibiotic regimen is necessary

• Colonoscopy/endoscopy.

• Cystoscopy.

• Dermatologic procedures (requiring cutting into the skin).

• Podiatry procedures (requiring cutting into the skin).

• Routine dental cleaning or any dental procedures, including root canals.

• Skin biopsy.

It is NOT necessary to take antibiotics for the following

• Cataract surgery.

• Gynecologic exams.

• Injections or blood work.

• Pedicures/manicures.

If you have a prosthetic device, such as an artificial joint, you should

• Carefully protect against infection and take antibiotics before any dental work or invasive procedure.

• Always tell your healthcare provider about your prosthetic joint.

• Carry a medical identification card indicating that you have a prosthetic device.

Lifelong Protection Against Infection15

LIFELONG PROTECTION AGAINST INFECTION

Be a Hall of Famer:LIFELONG PROTECTION AGAINST INFECTION

Although uncommon, an artificial joint can become infected from a bacterial infection in another part of the body, such as pneumonia, urinary tract infection, staph infections, food poisoning, etc. Contact your physician immediately if you think you have a bacterial infection. Routine colds, cuts and bruises do not require treatment with antibiotics.

16Total Hip Replacement Surgery

TOTAL HIP REPLACEMENT SURGERY

What You Need to Know:TOTAL HIP REPLACEMENT SURGERYWHAT IS TOTAL HIP REPLACEMENT? Total hip replacement surgery—also called hip hemiarthroplasty, hip arthroplasty and total hip replacement—is performed to replace all or part of a damaged hip joint with an artificial device (prosthesis).

The hip is a “ball and socket” joint. The head of the thigh bone (“ball”) fits in the pelvic bone (“socket”). When the joint is damaged, it does not function properly, often causing pain and limited mobility.

Total hip replacement uses an artificial joint that consists of three parts

• Cup – replaces your hip socket.

• Metal or ceramic ball – replaces the fractured head of your thigh bone (femur).

• Metal stem – attaches to the shaft of your femur bone to add stability to the artificial joint.

Hemiarthroplasty replaces only the head of the femur with a prosthetic device.

ABOUT THE SURGERY

Total hip replacement surgery starts with the removal of the head of the femur (Fig. 1). Next, the new socket is implanted, after which the metal stem is inserted into the femur (Fig. 2). The artificial components are fixed in place, sometimes with special bone cement (Fig. 3–4).

SURGERY INFORMATION

Total Hip Replacement Surgery 16

Total Knee Replacement Surgery 23

Metal or Ceramic

Ball

Metal Stem

Cup

What To Expect17

WHAT TO EXPECT

The Playbook:WHAT TO EXPECT THE FIRST THREE DAYS AFTER TOTAL HIP REPLACEMENT SURGERY

18What To Expect

For more information visit: houstonmethodist.org/sugarland

DAY ONE DAY TWO DAY THREE

ACTIVITY

• Physical therapy twice a day• Care team will assist with:

• Getting out of bed and walking with your walker

• Getting out of bed and in a chair for meals

• Activities of daily living

• Physical therapy twice a day • Care team will assist with:

• Performing hip exercises

• Using your walker

• Physical therapy once in the morning• You should be able to:

• Get out of bed independently

• Walk with a walker or crutches

• Be independent with your exercise program at home

MEDICATION

• Pain medications given through an IV catheter (PCA) and epidural

• Antibiotics given to prevent infection• Blood thinners given and antiembolism

stockings used to prevent blood clots• Stool softener given to prevent

constipation

• Pain will be managed through oral medications only

• Continue with blood thinners, antiembolism stockings and stool softener

• Continue oral pain medications• Review medications that will be taken at

home (included with discharge instructions)

DO NOT drink alcoholic beverages while on pain medication.

BREATHING EXERCISES

• Deep breathing exercises and using the incentive spirometer every hour while awake to prevent fevers and pneumonia

• Same as day one • Same as day one, except every two hours

DIET

• Begin with clear liquids; advance to a regular diet

• Regular diet (Please note that drinking several glasses of water and eating plenty of fruits and vegetables each day will help prevent constipation.)

• Same as day two

SELFCARE• Feed yourself• Wash your face and upper body• Ask for assistance to wash your legs

• Walk to the bathroom with assistance • Dress and bathe yourself with minimal assistance

During the first three days following your total hip replacement surgery, we’ll work together to help you achieve certain goals that guide you toward a speedy recovery.

While there may be exceptions, most patients can expect the first three days after surgery to look like the chart below:

What To Expect19

WHAT TO EXPECT

PLANNING YOUR DISCHARGE

Beginning the second day after surgery, we’ll start working with you to plan your discharge from the hospital.

• Your case worker will meet with you and your coach to discuss discharge plans.

• Your physical therapist and nurse will help you identify what equipment you’ll need at home, and your case manager will arrange for you to get the equipment needed.

• Your physical therapist will advise you on how to get in and out of a car and how to climb stairs using a walker or crutches.

• You’ll be given instruction on how to administer self-injected anticoagulation therapy, if needed.

UPON DISCHARGE

• You’ll be given written and verbal discharge instructions.

• Your nurse will review

• Instructions for your care at home, including caring for your incision.

• Signs of an infection or blood clot.

• The importance of good nutrition.

• Your doctor may suggest home care services, such as home health or physical therapy.

TOTAL HIP REPLACEMENT PRECAUTIONS

Follow hip precautions at all times to prevent dislocation.

Immediately following surgery, you should take the following precautions to avoid injury

• Do not bend past 60-or-90 degrees.

• Do not twist or cross your legs.

Other specific instructions include

Lying down

• While in bed, lie on your back and keep a pillow between your thighs to prevent your knees from touching.

Getting up

• Move to the edge of the bed or chair before standing and keep your recovering leg in front of the other when getting up.

Walking

• Continue using your walker until your physician instructs you to stop.

• Wear shoes with good traction.

• Take short walks every hour; be sure to take small steps when turning.

• Maintain your weight-bearing status as indicated by your surgeon orders (the amount of weight you are allowed to safely put on your surgery leg).

Sitting

• Sit in firm chairs that are higher than knee height that have a straight back and armrests.

Toileting

• Use a raised toilet seat and avoid twisting while flushing or grabbing toilet paper.

Bathing

• If discharged with staples in place, DO NOT shower unless otherwise advised by your surgeon. Once sutures are removed, you may shower, but do not bathe in a tub until you receive permission from your surgeon.

• You may use a walk-in shower, a tub seat or bench, or take a sponge bath. DO NOT sit in the bottom of a standard bathtub.

• Remember, do not bend or reach for the knobs to wash your legs and feet.

• Make sure you dry the surgical site gently, but completely.

Dressing

• Ask your coach to assist you in getting dressed or use long-handled equipment.

• Always place clothing on recovering side first and remain seated when pulling clothing over feet.

• While dressing, remember not to bend over, raise or cross your legs.

Riding in a car

• Driving is not permitted until instructed by your doctor.

• Enter car from a flat surface (a curb or step could be a falling hazard).

• If possible, do not take long car rides. If a long car ride is unavoidable, get out of the car and walk around every two hours.

• Cars with deep bucket seats or low seats are not recommended; however, if this is your only option, use a pillow to raise the height of the seat.

Household chores

• Ask someone to assist in household chores during your recovery.

• Do not bend to pick up objects from the floor; use a long-handled reaching tool.

• Do not vacuum or sweep.

• Use a rolling cart to transport items.

• To help you avoid bending, place commonly used items above knee level.

• Sit while preparing food.

20What To Expect

For more information call: 281.275.0685

Your physical therapist and nurse will help you identify what equipment you’ll need at home, as well as arrange for you to get the equipment needed.

ANKLE PUMPS

Perform this exercise 10 times every hour while awake to promote circulation.

1. Slowly point and flex your foot.

QUAD SETS

1. Press the back of your knee toward the bed and tighten your thigh muscle.

GLUTEAL SQUEEZE

1. Lie on your back and tighten your buttocks muscle for 10 seconds.

SHORT ARC QUADS

1. Place a small towel behind your knee so that it is NOT touching the bed.

2. Flex your thigh muscle to lift your ankle off the bed. Hold fully straightened for 5-to-10 seconds. Then, slowly lower your heel back down to the bed.

What To Expect21

WHAT TO EXPECT

HIP EXERCISES

22What To Expect

For more information visit: houstonmethodist.org/sugarland

HEEL SLIDES

1. Lie on your back and bend your knee by sliding your heel back toward your buttocks.

2. Do not bend your hip more than 90 degrees, but try to increase the bend in your knee a little more with each repetition.

3. Hold your knee in maximally bent position for 5-to-10 seconds and then straighten.

4. Repeat until your legs feel fatigued or until you can completely bend your knee.

HIP ABDUCTION

1. Lie on your back and tighten your thigh muscles.

2. Lock your knee and move the recovering leg outward and then back inward.

STAIR CLIMBING

If needed, you will practice stair climbing.

1. Step up with non-recovering leg.

2. Step down with recovering leg.

The benefits of exercise after a total hip replacement surgery are endless.

Speak with your surgeon and physical therapist about the best postoperative activities for you.

HIP EXERCISES CONTINUED

Total Knee Replacement Surgery23

TOTAL KNEE REPLACEMENT SURGERY

24Total Knee Replacement Surgery

What You Need to Know:TOTAL KNEE REPLACEMENT SURGERY

WHAT IS TOTAL KNEE REPLACEMENT? Total knee replacement surgery—also known as knee arthroplasty—is performed to remove a damaged knee joint and replace it with an artificial joint (prosthesis). The goal of an artificial knee joint is to replicate your knee’s natural ability to roll and glide as it bends.

There is a wide variety of prosthetic designs that take into account your age, weight, activity level and overall health. You and your doctor will choose the artificial joint design that works best for you.

ABOUT THE SURGERY

Total knee replacement surgery is performed using general anesthesia. The surgeon makes a cut over the knee, moves the kneecap (patella) out of the way, and cuts the ends of the thigh bone (femur) and shin (tibia) to fit the prosthesis. The prosthesis is fixed onto the ends of the femur, tibia and undersurface of the patella, sometimes with the use of bone cement.

For more information call: 281.275.0685

The goal of an artificial knee joint is to replicate your knee’s natural ability to roll and glide as it bends.

What To Expect25

WHAT TO EXPECT

The Playbook:WHAT TO EXPECT THE FIRST THREE DAYS AFTER TOTAL KNEE REPLACEMENT SURGERY

26What To Expect

For more information visit: houstonmethodist.org/sugarland

DAY ONE DAY TWO DAY THREE

ACTIVITY

• Physical therapy twice a day• Care team will assist with:

• Getting out of bed and walking with your walker

• Getting out of bed and in a chair for meals

• Activities of daily living

• Physical therapy twice a day • Care team will assist with:

• Performing knee exercises

• Using your walker

• Physical therapy once in the morning• You should be able to:

• Get out of bed independently

• Walk with a walker or crutches

• Be independent with your exercise program at home

MEDICATION

• Pain medications given through an IV catheter (PCA) and epidural

• Antibiotics given to prevent infection• Blood thinners given and antiembolism

stockings used to prevent blood clots• Stool softener given to prevent

constipation

• Pain will be managed through oral medications only

• Continue with blood thinners, antiembolism stockings and stool softener

• Continue oral pain medications• Review medications that will be taken at

home (included with discharge instructions)

DO NOT drink alcoholic beverages while on pain medication.

BREATHING EXERCISES

• Deep breathing exercises and using the incentive spirometer every hour while awake to prevent fevers and pneumonia

• Same as day one • Same as day one, except every two hours

DIET

• Begin with clear liquids; advance to a regular diet

• Regular diet (Please note that drinking several glasses of water and eating plenty of fruits and vegetables each day will help prevent constipation.)

• Same as day two

SELFCARE• Feed yourself• Wash your face and upper body• Ask for assistance to wash your legs

• Walk to the bathroom with assistance • Dress and bathe yourself with minimal assistance

During the first three days following your total knee replacement surgery, we’ll work together to help you achieve certain goals that guide you toward a speedy recovery.

While there may be exceptions, most patients can expect the first three days after surgery to look like the chart below:

What To Expect27

WHAT TO EXPECT

PLANNING YOUR DISCHARGE

Beginning the second day after surgery, we’ll start working with you to plan your discharge from the hospital.

• Your case worker will meet with you and your coach to discuss discharge plans.

• Your physical therapist and nurse will help you identify what equipment you’ll need at home, and your case manager will arrange for you to get the equipment needed.

• Your physical therapist will advise you on how to get in and out of a car and how to climb stairs using a walker or crutches.

• You’ll be given instruction on how to administer self-injected anticoagulation therapy, if needed.

UPON DISCHARGE

• You’ll be given written and verbal discharge instructions.

• Your nurse will review

• Instructions for your care at home, including caring for your incision.

• Signs of an infection or blood clot.

• The importance of good nutrition.

• Your doctor may suggest home care services, such as home health or physical therapy.

TOTAL KNEE REPLACEMENT PRECAUTIONS

Certain body positions and activities can cause knee dislocation. Prevention of dislocation includes the following

• DO NOT stand, bend knees and twist at the same time.

• DO NOT put more weight on your affected leg than instructed.

KNEE EXERCISES

ANKLE PUMPS

Perform this exercise 10 times every hour while awake to promote circulation.

1. Slowly point and flex your foot.

QUAD SETS

1. Press the back of your knee toward the bed and tighten your thigh muscle.

HEEL SLIDES

1. Lie on your back and bend your knee by sliding your heel back toward your buttocks.

2. Do not bend your hip more than 90 degrees, but try to increase the bend in your knee a little more with each repetition.

3. Hold your knee in maximally bent position for 5-to-10 seconds and then straighten.

4. Repeat until your legs feel fatigued or until you can completely bend your knee.

HEEL SLIDES IN CHAIR

1. Sit in your chair and make sure the foot of your recovering leg is as close to you as possible.

2. Scoot toward the edge of the chair without moving your feet.

3. Stretch for a full 10 seconds and repeat 10 times.

28What To Expect

For more information call: 281.275.0685

What To Expect29

WHAT TO EXPECT

KNEE EXERCISES CONTINUEDSTRAIGHT LEG RAISES

1. Lie on your back and bend your non-recovering knee.

2. Raise your recovering leg, keeping your knee straight.

3. Repeat 20 times.

STAIR CLIMBINGIf needed, you will practice stair climbing.

1. Step up with non-recovering leg.

2. Step down with recovering leg.

The benefits of exercise after a total knee replacement surgery are endless.

Speak with your surgeon and physical therapist about the best postoperative activities for you.

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