Overview

• Objectives• Your Joints• What is Total Joint Replacement?• Preparing for a Total Joint Replacement• Surgery Day• Postoperative and Recovery• Discharge

Objectives

• Gain valuable information on what to expect before, during and after surgery

• Decrease your anxiety about the unknown and ease any worries you may have

• Get answers to your questions and concerns

Your Joints

The Knee JointFormed at the meeting of 2 major leg bones, the femur and the tibia

Femur: Thigh Bone

Tibia: Shin bone

Patella: Knee Cap

Cartilage: Elastic tissue to cushion

Ligaments: Connect bone to bone

Tendons: Connect muscle to bone

The Hip Joint(ball and socket joint)

Ball

Femur: thigh bone•Femoral Head•Femoral Neck

Socket•Acetabulum- (cup-like)

The Shoulder Joint(ball and socket joint)

Ball: Upper Arm•Humerus

Socket•Glennoid Fossa(dish-shaped portion of the outer scapula)

What Causes the Pain?

• Arthritis

• Degenerative Joint Disease

• Affects the cartilage or lining on the ends of the bones

• Cartilage becomes worn so movement is not smooth within that joint, and the grinding is painful (bone-on-bone)

• Pain, stiffness and loss of function are common

What is Total Joint Replacement?

Total Knee Replacement• Replaces parts of the tibia and femur where they meet

• Replaced with artificial parts called “Prosthesis”

Uni-Compartmental Knee

• Also known as “partial knee replacement”

• Candidates include patients with osteoarthritis in only one part of the knee

Total Hip Replacement• Incision made in the side of the

thigh

• Removal of the neck of the femur (thighbone) and insertion of a stem deep inside the bone to connect with the pelvic socket and liner

Hip Resurfacing• End of the thigh bone (femur)

is capped with a metal covering, much like the capping of a tooth

• This fits neatly into a metal cup that sits in the hip socket

Total Shoulder Replacement• The ball (humeral head) and socket (glenoid bone) are

replaced with metal and plastic components to alleviate pain and improve function

Preparing for Total Joint

Replacement

Preparing your Home

• Arrange for special equipment needed• Remove throw rugs and other tripping hazards• Move medications, phone, remote control within reach• Widen pathways for using a walker• If living alone, arrangements need to be made for someone to

assist you or to go to a Skilled Nursing Facility for a short period of time.

Pre-Surgical Nurse Contact

• You will speak with the pre-test nurse prior to your pre-surgical testing appointment.

• The information needed is:– List of physicians you see on a regular basis– List of allergies and your reactions to them– List of your surgical/medical history

Pre-Surgical Testing Appointment• This visit may last 1 hour

• Medical tests performed (EKG, chest x-ray, blood test, urine sample)

• Medical/surgical history will be reviewed

• List of medications that you need to stop taking and which you need to take the morning of surgery will be provided

• Hibiclens Soap will be given with instructions

• Assessment by an anesthesiologist

Anesthesia • General or Spinal anesthesia is required to be administered

before your hip or knee surgery– A femoral block for Total Knee Replacements

• General anesthesia is required to be administered before your shoulder surgery– An Inter-scalene Block

• You will meet your anesthesiologist prior to surgery in the preoperative testing process and in the preoperative holding area

• Your anesthesiologist will review your history and discuss the best option for you

Day before surgery

• Do not shave legs the day before or day of surgery for knee or hip replacement

• Shower with the Hibiclens Soap the night before and the morning of surgery

• Do not eat or drink after midnight, including water, candy or gum

Surgery Day

Day of Surgery• Take any morning medications that you were instructed to

take, sip of water only• Arrive at the hospital 1.5 hours before your scheduled surgery

time• At Progress West: Go to the 2nd floor- you will be escorted to

your room and registered bedside• At Barnes-Jewish St. Peters: Go to the hospital’s Main Entrance

(A) and register in Admitting. You will be escorted to the preoperative area.

Day of Surgery (cont.)

• What to bring to the hospital: – Copies of Advance Directives– Loose comfortable clothing, enough for 4 days– Flat, supportive walking shoes that are non-slip with an

enclosed heel– CPAP, if applicable

Day of Surgery (cont.)• What to expect:

– To be admitted to the hospital by the registration clerk

– To meet a member of the anesthesia team to review earlier choices and assess for any changes

– To be given a mild sedative

– That family and friends will be directed to the surgical waiting area

Day of Surgery: Preoperative• The staff will prepare you for surgery

• You will change into a hospital gown

• A name band will be verified and applied

• An IV will be started (using Lidocaine)

• Your medical/surgical history will be reviewed

• Your completed “Patient Home Medication List” will be reviewed and recorded

Day of Surgery: Preoperative• You will meet your Surgical Team

• The surgeon, with your assistance, marks the operative leg

• The anesthesiologist will review your choices

• Prophylactic antibiotic will be administered

• Relaxing medication will be administered

Day of Surgery: Operating Room

• Anesthesia will be administered

• Catheter will be inserted

• Length of time for surgery is approximately 1 to 2 hours

Post Surgery and Recovery

Day of Surgery:Post Anesthesia Care Unit

• Close monitoring until you are fully awake• You will wake up with the following:

– Oxygen in nose– Blood pressure cuff on arm– Pulse oximeter on finger– Catheter in bladder– Surgical bandage on incision

• Your surgeon will speak to family and friends in the surgical waiting area

Post Surgery• You will be transported in your bed to your private room from

the PACU• Your nurse and tech will:

– Monitor vital signs closely– Manage your pain

• You will receive a clear liquid meal tray progressing to an approved diet

• During the night you may still have:– Oxygen in your nose– IV fluids – Catheter in your bladder (this will be removed the next

day)

Progressing toward Recovery:Pain Management

• Patients may have a Patient Controlled Analgesia device called a PCA

• Knee replacement patients may have a femoral block

• Shoulder replacement patients may have and inter-scalene block

Progressing toward Recovery:Pain Management

• Tell your doctor what pain medications have worked in the past

• Request pain relief when you begin to feel discomfort

• To help the doctors and nurses better relieve your pain, report whether the pain relief measures are adequate

• Ice packs will be in place to assist in decreasing swelling and relieve pain

Your Hospital Stay

• Your stay will be several days

• All rooms are private

• Wifi is available throughout the hospital

• Dining on call at PW (you choose when and what you eat according to the diet allowed by your doctor)

Recovery in the hospital

• In-room Physical Therapy

• Pain medications administered by IV and then by mouth

• Coughing and deep breathing is important

• Foot pumps and/or mechanical pumps may be used to prevent blood clots

Common ComplicationsNausea• First meal will be clear liquids• Medication can be given if needed

Constipation• Daily stool softener administered• Laxative can be given if needed

Swelling• Ice Therapy

Serious ComplicationsSurgical sight infection

– Occurs in fewer than 2% of patientsHeart attack or stroke

– Occur even less frequentlyChronic illnesses

– May increase potential for complications– Can prolong recovery

Blood clots– Most common complication – Blood thinners will be started

Damage to nerves or blood vessels around the site of surgery– A rare occurrence

Discharge

Discharge Planning

• Depending on your physical and clinical status you will be discharged home three days after your surgery.

• Your progress and readiness for discharge will be assessed daily.

• Your case manager– Visits with you the day after surgery– Assists with the discharge plan– Makes arrangements for needed medical equipment

Day of Discharge• We will be sure that you have the proper equipment for your home.

• Your nurse will review discharge instructions with you and your care partner or family member.

• Your instructions will include your first postoperative appointment with your surgeon in 7 to 10 days.

• If you have not progressed to the point where you can safely return home, inpatient rehabilitation may be recommended. This allows for further work with therapists and 24-hour support.

Home CareNO baths, only showers, until the incision is thoroughly healed.

It is important to eat a balanced diet at this time!

Exercise is critical.– Home health visits will be scheduled until you have reached a

point where you can go to outpatient physical therapy.

Driving is usually approved about 4-6 weeks after surgery.

After Total Joint Replacement

• More than 90 percent of patients report a dramatic reduction in pain.

• Full range of motion is not expected, particularly in patients with limited motion before surgery. – About 115 degrees

• Avoid high impact activities.

Post surgery Activity Levels

• Dangerous– Jogging or running– Contact sports– High impact aerobics

• Exceeds recommendations– Vigorous walking – Skiing– Tennis– Lifting 50 lbs or more

• Expected– Recreational walking – Golf– Light hiking– Ballroom dancing– Normal stair climbing

Your success is very important to us. We strive to provide an excellent patient

experience.

Please let us know if there is anything that we can do to improve your care.

Any Questions??