Guidebook for Joint Replacement

General Information

1

guidebook

for Joint Replacement

General Table ofInformation Contents General Information Preparing for Surgery Your Hospital Stay Discharge Postoperative Care For the Long Haul Appendix

3 12 24 25 26 40 42

2

guidebook

for Joint Replacement

General Information Welcome Thank you for choosing Baptist Center for Joint Replacement to help restore you to a higher quality of living with a new prosthetic joint. According to the American Joint Replacement Registry, more than 7 million Americans have had a joint replacement surgery. Around 700,000 new joint replacements are performed annually in the United States. It is estimated that by 2030, over 30 million Americans will have had a prosthetic joint implanted.

Primary candidates are individuals with chronic joint pain from arthritis that interferes with daily activities like walking, exercise, leisure, recreation, and work. Joint replacement surgery aims to relieve pain, restore your independence, and return you to work and other daily activities. Advances in orthopedic surgery are allowing joint replacement patients to recover much more quickly. Better instruments, prosthetics, surgical techniques, and the use of precision robots are contributing to amazing patient outcomes. Typically, patients are up walking with physical therapy on the day of surgery, and are able to return to a high level of function in less than 12 weeks.

The Baptist Center for Joint Replacement has implemented a comprehensive, planned course of treatment that begins with preoperative education and sees you all the way through to your transition home after surgery. We firmly believe that as our patient, you play a key role in promoting a successful recovery. Our goal is to involve you in your treatment through each step of the program. This guidebook—in addition to your preoperative education session—will give you the necessary information to promote a more successful surgical outcome.

Besides your physician, the Joint Center team consists of nurses, nurse assistants, therapists, the Joint Coordinator and a dedicated case manager— all of whom are specialized in state-of-the-art joint replacement care. Every detail, from preoperative teaching to postoperative exercising, is considered and reviewed with you. The Joint Center Coordinator will aid in planning your individual treatment program and guide you through your joint replacement experience.

3

guidebook

for Joint Replacement

General Information The Purpose of the Joint Guidebook Preparation, focused education, continuity of care, and a preplanned discharge are crucial for optimum results after a joint replacement. Communication and education are essential to helping you achieve success after your surgery. This Guidebook is intended to be a means of communication and education for you, your coach, and other members of the healthcare team.

It is designed to provide you with important information so that you know:  What to expect every step of the way.  What you need to do and when you need to do it.  How to care for your new joint.

Remember, this book is only a guide. Your physician, nurse practitioner, physician’s assistant, nurse, or therapist may add to or change any of the recommendations. Always use their recommendations first and ask questions if you are unsure of any information. Keep your guidebook as a handy reference for at least the first year after your surgery.

4

guidebook

for Joint Replacement

General Information Overview of Baptist Center for Joint Replacement The Baptist Center for Joint Replacement offers a unique joint replacement experience. It is a dedicated center for orthopedic excellence within the Baptist Health System. With modern advancements in orthopedic surgery, the majority of patients are able to return home after a single night in the hospital. A joint replacement is considered to be an elective surgery and it’s expected that you will be discharged directly to your home or the home of a relative or friend after you leave the hospital. Unfortunately, insurance requirements determine eligibility for short-term rehab and this decision is based on how well you’re doing postoperatively. It is for these reasons that we cannot guarantee placement into a short-term rehab facility after your surgery. Of course you won’t be discharged until it’s deemed safe, but you should plan on going home after surgery and make preparations to have someone available to help you for at least a few days.

Features of the program include: • Nurses, therapists and patient-care technicians who specialize in the care of joint replacement patients • Private rooms • Emphasis on group activities as well as individual care • Family and friends participate as “coaches” in the recovery process • Group discharge teaching session with you and your coach • A Joint Center Coordinator who coordinates your care while you’re in the hospital and collaborates with a Social Worker for discharge planning • A comprehensive patient guidebook 55

guidebook

for Joint Replacement

General Information An Introduction to Joint Replacement Patients often have many questions about joint replacement. Below is a list of the most frequently asked questions along with their answers. If there are any other questions that you need answered, please contact your surgeon or the Joint Center Coordinator. We want you to be completely informed about your joint replacement surgery.

What is osteoarthritis and why does my hip or knee hurt?

Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction. Osteoarthritis, the most common form of arthritis, is a wear-and-tear condition that destroys joint cartilage. Sometimes as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. This can occur quickly over months or may take years to occur. Cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect only one joint or many joints.

What is a knee replacement?

A knee replacement is really a bone and cartilage replacement with an artificial surface. The knee itself is not replaced, as is commonly thought, but rather an implant is inserted on the bone ends. This is done with a metal alloy on the femur and plastic spacer on the tibia and patella (kneecap). This creates a new, smooth cushion and a functioning joint that can reduce or eliminate pain.

What is a hip replacement?

A hip replacement is an operation that removes the arthritic ball of the upper femur (thighbone) as well as damaged bone and cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic or metal liner that is usually fixed inside a metal shell to create a smoothly functioning joint.

66

guidebook

for Joint Replacement

General Information What are the results of joint replacement surgery?

Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient’s activity level, and the patient’s adherence to the doctor’s orders. New advances in orthopedics are contributing to significantly improved outcomes for patients undergoing a joint replacement. Many patients are able to go home after a single night in the hospital and are able to return to a high level of function in less than 12 weeks.

Am I too old for this surgery?

Age is generally not a factor if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.

How long will my new joint last and can a second replacement be done?

All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. The implanted joint’s longevity varies with each individual person. It is important to remember that an implant is a medical device that is subject to wear that may eventually lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time.

Why might I require a revision?

Just as your original joint wears out, a joint replacement can wear over time. The most common reason for revision is loosening of the artificial surface from the bone. Wearing of the plastic spacer may also result in the need for a new spacer. Your surgeon will explain the possible complications associated with joint replacement with you before your surgery. He or she wants you to understand every aspect of the surgery.

What are the major risks?

Most surgeries go well, without any complications. Infection, pneumonia, and blood clots are possible serious complications after joint replacement surgery. To avoid these complications, your surgeon will use antibiotics, incentive spirometry, and blood thinners. Surgeons also take special precautions in the operating room to reduce the risk of infections. We use a multifaceted approach to minimizing risk of complications.

Should I exercise before the surgery?

Yes, please read pages 12-15 for specific exercises you should start doing now.

77

guidebook

for Joint Replacement

General Information Will I need blood?

Current practices have greatly minimized blood loss associated with joint replacement.

Still, in some instances you might need blood afterward. If you are concerned about the possibility of needing blood after your surgery, be sure to discuss options with your surgeon beforehand. For more information, please read the Appendix “Blood Transfusions.” Baptist Health has options available in the event that your religious practices don’t allow for a blood transfusion. Please be sure to discuss available options with your surgeon prior to your surgery if this is the case for you.

How long will I be incapacitated?

You should expect to not be incapacitated for long at all. You will likely get out of bed on the day of your surgery and walk with a therapist. The next morning you will get up, sit in a chair or recliner, and will have your first group therapy session. The Joint Center emphasizes early and frequent mobilization as a key feature of our program.

How long will I be in the hospital?

Most patients will be hospitalized for a single night and will be doing well enough to go home the day after their surgery. However, there are several goals that must be achieved before discharge home. If you’re not meeting these goals you will be held for additional therapy. You might also be held for additional testing if your blood work needs to be rechecked.

What if I live alone?

A joint replacement is considered to be an elective surgery and it’s expected that you will be discharged directly to your home or to the home of a relative or friend after you leave the hospital. You should make plans to return home and receive help from a relative or friend. Insurance requirements determine eligibility for short-term rehab and this decision is based on how well you’re doing postoperatively. Social limitations like living alone or being the sole caregiver of a family member are not considered by your insurance as a qualifier for rehab placement. It is for these reasons that we cannot guarantee placement into a short-term rehab facility after your surgery unless you can afford to pay out of pocket for short term rehab. There is usually a $5,000 to $10,000 down payment and the fee is $350-$550 a day.

Will I need a second opinion prior to the surgery?

Your surgeon’s scheduler will contact your insurance company to pre-authorize your joint replacement surgery. If a second opinion is required, you will be notified.

88

guidebook

for Joint Replacement

General Information How long does the surgery take?

The hospital reserves approximately two to two-and-one-half hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery and for x-rays after your surgery.

Do I need to be put to sleep for this surgery?

You may have a general anesthetic, which most people call “being put to sleep.” Some patients prefer to have a spinal or epidural anesthetic, which numbs the legs only and does not require you to be asleep. The choice is between you, your surgeon, and the anesthesiologist. Please read the Appendix “Anesthesia” for more information.

Will the surgery be painful?

You should expect to have some discomfort following your surgery, but we will make every effort to keep you as comfortable as possible. Your surgeon will choose the best pain control methods to control your pain. While you’re asleep in the operating room, your surgeon will inject medication directly into your joint that will aid in your comfort.

Your doctor will also utilize a multimodal approach to promote comfort which may include opioids, acetaminophen, nonsteroidal analgesics, and muscle relaxers. Our goal is to use multiple techniques to control your pain in an effort to minimize the use of opioids. We want you to be comfortable but alert, and fully capable of participating in multiple group therapy sessions before you go home.

Who will be performing the surgery?

Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery.

How long—and where—will my scar be?

Surgical scars will vary in length and location, but most surgeons will make it as short as possible. If you have previous scar, your surgeon may be able to use the existing scar for your incision. There may be some lasting numbness around the scar, but much of the sensation can return over time.

Will I need a walker, crutches, or a cane?

Yes, for about six weeks we do recommend that you use a walker, a cane, or crutches.

The Joint Coordinator and your Case Manager can arrange for them if necessary.

99

guidebook

for Joint Replacement

General Information Where will I go after discharge from the hospital?

You should plan to go home or to the home of a relative or friend directly after discharge.

Insurance requirements determine eligibility for short-term rehab and this decision is based on how well you’re doing postoperatively. Social limitations like living alone or being the sole caregiver of a family member are not considered by your insurance as a qualifier for rehab placement. It is for these reasons that we cannot guarantee placement into a short-term rehab facility after your surgery unless you can afford to pay out of pocket for short term rehab. There is usually a $5,000 to $10,000 down payment and the fee is $350-$550 a day.

Will I need help at home?

Yes, for the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, cleaning, etc. Family or friends need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single portion frozen meals will help reduce the need for extra help.

Will I need physical therapy when I go home?

Yes, most patients will have in-home physical therapy ordered by their surgeon. Patients are encouraged to utilize outpatient physical therapy as soon as they are able to comfortably travel in an automobile. The length of time required for therapy varies with each patient.

How long until I can drive and get back to normal?

The ability to drive depends on whether surgery was on your right leg or your left leg and the type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right leg, your driving could be restricted as long as six weeks. Getting “back to normal” will depend somewhat on your progress. Consult with your surgeon or therapist for their advice on your activity. Always remember that you cannot drive while taking opioids for pain. You could be considered to be driving under the influence.

When will I be able to get back to work?

We recommend that most people take at least one month off from work, unless their jobs are quite sedentary and they can return to work with a walker or crutches. An occupational therapist can make recommendations for joint protection and energy conservation on the job.

10 10

guidebook

for Joint Replacement

General Information When can I have sexual intercourse?

This is a question that is asked quite often with any orthopedic surgery. The time to resume sexual intercourse should be discussed with your orthopedic physician and is nothing to be embarrassed about. If you’re more comfortable, he or she may be able to provide you with written information that you can review later.

How often will I need to be seen by my doctor following the surgery?

You will be seen for your first postoperative office visit ten to fourteen days after you are discharged. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, twelve weeks, and then every one or two years.

Are there any permanent restrictions following this surgery?

Yes, high-impact activities, such as running, tennis, and basketball are not recommended. Injury-prone sports such as downhill skiing are also restricted. Patients who’ve had a hip replacement will need to observe a set of prescribed precautions that help to minimize the risk for dislocation. These restrictions are typically in effect for three months after your surgery. Please be sure to observe your hip precautions until your surgeon tells you that you may discontinue them. You will receive your specific and customized set of hip precautions in writing as part of your discharge instructions.

What physical/recreational activities may I participate in after my recovery?

You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling, and gardening.

Should I try to lose weight before my joint replacement?

This is a common question and one that warrants discussion. Patients with a degenerated hip or knee often find physical activity painful. The accompanying immobility can lead to some weight gain over time. It is fine to try to lose some weight before your surgery, but your surgeon recommends achieving this by adjusting your diet and being as active as your degenerated joint will allow. Please don’t seek stimulants, appetite suppressants, or weight loss supplements as a means of losing weight prior to surgery. Typically when you discontinue these medications after surgery you’ll be gaining all of the weight back at the worst possible time. However, if you’re already taking these medications as part of your daily regimen, you can continue taking them.

Remember that adjusting your diet and being as active as you can comfortably tolerate are the best recommended options for weight loss.

11 11

guidebook

for Joint Replacement

Preparing for Surgery Role of the Joint Center Coordinator The Joint Center Coordinator is an intermediary between the nurses, physical and occupational therapists, and case manager while you’re in the hospital. The Joint Coordinator also educates you before and after surgery about the surgical process and provides you with important information geared toward helping you minimize risks for postoperative complications like blood clots, infection, and pneumonia.

The Joint Center Coordinator will: • • • • •

Help you schedule your preoperative education class.

Act as your liaison throughout the course of treatment—before your surgery, while you’re in the hospital, and all the way through discharge home.

Answer questions and direct you to specific resources within the hospital.

Coordinate your hospital care with Center for Joint Replacement team members.

Work closely with a case manager to guide you along the path to discharge, ensuring you have home care and any medical equipment before you go home.

You may call the Joint Center Coordinator at any time to ask questions or raise concerns about your surgery. The number to your Joint Center Coordinator is located on the back of this guidebook.

Pre-Register After your surgery has been scheduled, you will be called for pre-registration information. You will be asked to have the following information ready when you are contacted: • • • • • • • •

•

Patient’s full legal name, address, and phone number Marital status Social Security number Name of insurance holder, his/her address, phone number, work address, and work phone number Name of your insurance company, mailing address, policy and group numbers, and insurance card Your employer, address, phone number, and occupation Name, address, and phone number of nearest relative or friend Name, address, and phone number of someone to notify in case of emergency (this can be the same as the nearest relative or friend) Bring your insurance card, driver’s license or photo I.D., and any co-payment required by insurance company with you to the hospital 12 12

guidebook

for Joint Replacement

Preparing for Surgery Obtain Medical and Anesthesia Clearance Your safety is of the utmost concern to your orthopedic surgeon. It is for this reason that your surgeon may ask you to obtain clearance prior to your joint replacement surgery.

When you are scheduled for your surgery, you may be given a medical clearance form.

Please follow any instructions provided to you by your surgeon about preoperative clearance. The clearance form will need to be completed by your primary care physician.

If you see specialists—for your heart or kidneys, for example—you may be asked to have them complete a clearance form as well. When you make the appointment to see your primary care doctor or specialist, let them know it is for a preoperative medical clearance. Please note that clearance appointments are in addition to seeing your surgeon preoperatively.

Obtain Laboratory Tests When you were scheduled for surgery, you may have received a laboratory-testing order from your surgeon. Please be sure to follow the instructions provided to you by your surgeon about when and how to have this testing performed.

Billing for Services After your procedure, you will receive separate bills from the anesthesiologist, the hospital, radiology and pathology (if applicable), physical therapy and occupational therapy, and the surgical assistant. If your insurance carrier has specific requirements regarding participation status, please contact your carrier.

Start Preoperative Exercises Many patients with arthritis favor their joints due to the pain. This can weaken them, which interferes with postoperative recovery. It is important that you begin practicing the exercise program in this book before your surgery.

Register For Preoperative Class or Webinar Patients scheduled for joint surgery should watch a special webinar about what to expect; a link is available from your Joint Center Coordinator. On occasion, in-person classes may be available as well. Please call the Joint Center Coordinator at least 4 weeks prior to your surgery to access the webinar or schedule your preop class. The number to your joint coordinator is located on the back of this guidebook.

You will only need to attend one class. It is recommended that you bring a family member or friend to act as your “coach.” The coach’s role will be explained in class.

13 13

guidebook

for Joint Replacement

Preparing for Surgery Preoperative Exercises, Goals, and Activity Guidelines Exercising before Surgery It is important to be as fit as possible before undergoing joint replacement surgery.

These exercises can make your recovery faster. The exercises below are part of the Joint Center program, and your surgeon would like for you to start doing them now. You should be able to do them in 15–20 minutes and you should do all of them twice a day, even on your non-surgical side. Continue to exercise daily until the day of surgery.

Consider this a minimum amount of exercise prior to your surgery. Your therapist will provide you with a postoperative exercise sheet when you are discharged from the hospital. It will contain many of the same preoperative exercises from those listed below, but will be customized based on your needs and type of joint surgery you had.

Also, remember that you need to strengthen your entire body, not just your legs. It is very important that you strengthen your arms by doing chair push-ups (exercise #8) 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.

Stop doing any exercise that is too painful and contact your surgeon to inquire about a modification or alternative exercise option.

Joint Replacement Exercises (Before and After Surgery)

(See the following pages for descriptions.)

1. Ankle Pumps

20 reps.

2 times/day

2. Quad Sets (Knee Push-Downs)

20 reps.

2 times/day

3. Gluteal Sets (Bottom Squeezes)

20 reps.

2 times/day

4. Abduction and Adduction (Slide Heel Out and In)

20 reps.

2 times/day

5. Heel-slides (Slide Heel Up and Down)

20 reps.

2 times/day

6. Short Arc Quads

20 reps.

2 times/day

7. Long Arc Quads

20 reps.

2 times/day

8. Armchair Push-Ups

20 reps.

2 times/day

9. Straight Leg Raises (Knee Replacement Only)

20 reps

2 times/day

10 minutes

2 times/day

10. Knee Extension Stretch (Knee Replacement Only)

14 14

guidebook

for Joint Replacement

Preparing for Surgery Hip and Knee Exercises

Range of Motion and Strengthening Exercises

Ankle Pumps

Flex your foot. Point your toes. Repeat 20 times.

Quad Sets — (Knee Push-Downs)

Lie on your back, and press your non-bent knee into the mat, tightening the muscles on the front of your thigh. Do NOT hold your breath. Repeat 20 times.

15 15

guidebook

for Joint Replacement

Preparing for Surgery Gluteal Sets — (Bottom Squeezes)

Squeeze the muscles of your bottom together.

Remember to NOT hold breath. Repeat this 20 times.

Hip Abduction and Adduction (Slide Heels Out and In)

Lie on your back, and slide your leg out to the side. Keep your toes pointed up and your knees straight. Bring the leg back to the starting point. Repeat 20 times.

16 16

guidebook

for Joint Replacement

Preparing for Surgery Heel Slides — (Slide Heels Up and Down)

Lie on your couch or bed. Slide your heel toward your bottom. Repeat 20 times.

Short Arc Quads

Lie on your back, and place a towel roll under your thigh.

Lift your foot, straightening your knee. Do not raise your thigh off of the towel roll. Repeat 20 times.

17 17

guidebook

for Joint Replacement

Preparing for Surgery Long Arc Quads

Sit with your back against a chair. Straighten your knee. Repeat 20 times.

Armchair Push-Ups

This exercise helps to strengthen your arms for rising from a chair and walking with a walker. Sit in an armchair.

Place your hands on the armrests. Straighten your arms, lifting your bottom up off the chair seat. Keep your feet flat on the floor. Repeat 20 times.

18 18

guidebook

for Joint Replacement

Preparing for Surgery Knee Exercises Straight Leg Raises

KNEES ONLY: Lie on your back, with your unaffected leg bent at the knee, and your foot flat. Lift the opposite leg up 12 in. Keep your knee straight and your toes pointed up. Relax. Repeat 20 times.

Knee Extension Stretch

KNEES ONLY: Prop the foot of your operative leg up on a chair. Place a towel roll under your ankle and an ice pack over the knee. Place 5 lbs. of weight on top of knee (5 lb. bag of rice works well). Remain in this position for 10 min.

19 19

guidebook

for Joint Replacement

Preparing for Surgery Read “Anesthesia” (Appendix) Joint replacement surgery does require the use of either general anesthesia or regional anesthesia. Please review the appendix “Anesthesia” for information provided by our anesthesia department. If you have any questions or would like to request a particular anesthesiologist, please contact your surgeon’s office and notify the nurse at your PACE appointment.

Stop Smoking It is strongly advised that you stop smoking or using any form of tobacco at least 6 weeks before surgery. Nicotine impairs circulation to your healing joint and can significantly limit the healing of your bones. Your body’s ability to bring oxygen to the healing tissues and to carry away cellular debris and metabolic waste is an important part of the healing process.

*** Baptist Health is a tobacco-free environment. Smoking on campus, including vaping, is not permitted anywhere—not even in your car. This is in accordance with Florida state law and is enforced by security and the Jacksonville Sheriff’s Office. ***

20 20

guidebook

for Joint Replacement

Preparing for Surgery Preoperative Visit to Surgeon You should have an appointment in your surgeon’s office generally one to two weeks before your surgery.

This will serve as a final check-up and a time to ask any questions you may have. You’ll fill out some paperwork, sign a consent form, and meet with a PACE nurse in person or over the phone who will ask you several important questions.

Stop Medications that Increase Bleeding Five days before surgery, stop all anti-inflammatory medications such as aspirin, Motrin®, Naproxen, Vitamin E, etc. These medications may cause increased bleeding. If you are taking a blood thinner, you will need special instructions for stopping the medication. The PACE nurse will instruct you about what to do with your other medications.

Prepare Your Home for Your Return from the Hospital Have your home ready for your arrival after discharge.

Clean, do the laundry, and then 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. Be sure to pick up throw rugs and tack down any loose carpeting.

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 your pets or loved ones, if necessary.

21 21

guidebook

for Joint Replacement

Preparing for Surgery When to Arrive at the Hospital for Surgery If you don’t already know what time your procedure is scheduled for, call the hospital or your surgeon’s scheduler well in advance to ask. Typically, you will be directed to come to the hospital two to three hours before your surgery start time. This allows plenty of time for us to start your IV, prep your surgical site, and answer any remaining questions.

It is important that you arrive on time to the hospital. If you are late, it may create a problem with starting your surgery on time. In some cases, a late arrival could result in your surgery being moved to a later time or even cancelled and rescheduled. Occasionally surgery times are moved up at the last minute if there is a cancellation. This means your surgery could start earlier than what you were initially told.

When to Stop Eating and Drinking Unless you are told otherwise, do NOT eat anything after midnight on the day of your surgery. No chewing gum, candy mints, lozenges, or cigarettes are permitted. However, you can drink clear liquids until two hours before your scheduled arrival time for surgery. Please see Appendix “Surgery Strong” for important nutritional instructions on how to enhance your recovery.

What to Bring to the Hospital Personal hygiene items (toothbrush, deodorant, razor, etc.); hand-held mirror for use at the bedside; loose-fitting shorts or pants, tops; well-fitted flat shoes or tennis shoes. For safety reasons, DO NOT bring electrical items (fan, clock radio, etc.) You may bring battery-operated, rechargeable items like a cell phone, tablet, or electric razor and their respective charging cables. Please understand if your personal effects become lost or stolen, Baptist Health is not responsible for replacing them. You are responsible for maintaining awareness of your belongings while you are in the hospital.

You must bring the following to the hospital: • 2-wheeled rolling walker like the one pictured to the

right, if you already have one; please leave it in the car until after surgery • A copy of your advance directives (For more information, read the Appendix “Exercise your Right.”)

• Your insurance card, driver’s license or photo I.D., and any co-payment required by your insurance company

©performancehealth.com

22 22

guidebook

for Joint Replacement

Preparing for Surgery Special Instructions You will be instructed by your physician about medications, skin care, showering, etc.

• DO NOT take medication for diabetes on the day of surgery • Please leave jewelry, valuables, and large amounts of money at home.

Again, Baptist Health is not responsible for any lost or stolen items.

• Makeup must be removed before your procedure • Please remove any nail polish

23 23

guidebook

for Joint Replacement

Your Hospital Stay Day of Surgery — What to Expect In the pre-op holding area, patients are prepared for surgery. This includes starting an IV and scrubbing your operative site. Your operating room nurse as well as your anesthesiologist will ask you some important questions. Your surgeon will typically come visit you in preop holding. At the appropriate time, you will be escorted to the operating room where appropriate anesthesia will be achieved and the procedure will begin. 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 established, your vital signs are monitored, and an X-ray is taken of your new joint. You will then be taken to the Center for Joint Replacement where Joint Center staff will care for you. Only one or two very close family members or friends should visit you on the day of surgery. You will likely get out of bed on the day of surgery to walk with a therapist. It is also important that you begin ankle pumps on night of surgery. This will help prevent blood clots from forming in your legs. You should also begin using your Incentive Spirometer and doing the deep breathing exercises that you learned in class.

After Surgery — Day One On day one after surgery, you can expect your day to start early: • You will be helped out of bed and dressed in your own clothes. (If you’d like, bath wipes are available.)

• You’ll be seated in a bedside recliner in your room where breakfast will be served.

• Your surgeon, their physician’s assistant, or their nurse practitioner will visit you in the morning.

• Then, your first therapy session will take place. Your coach should be present as they are vital to your success.

• You will have a discharge teaching session where we will discuss some important topics to help prepare you for the transition home.

After Surgery — Day Two & Beyond If you are unable to go home on day one, you will experience the same regimen detailed above on day two. You will continue group therapy until you meet the criteria for safe discharge. If there are steps in your home, our therapists will practice them with you multiple times before you leave until you are comfortable and confident in your abilities to go up or down them once you are at home.

24 24

guidebook

for Joint Replacement

Discharge Going Home Someone responsible needs to drive you home. You will receive written discharge instructions concerning medications, physical therapy, activity, etc. If needed, you will receive equipment delivered to you at the hospital, or to your home. This usually happens before lunch on day one. Please understand that medical equipment is nonrefundable, so once you sign for it, be sure it goes home with you. Otherwise someone will have to retrieve it from the hospital or it will be discarded if left unclaimed. If your surgeon has ordered home health services like a physical therapist, the hospital will arrange for this before you go home in accordance with your choice. Rest assured that we will help coordinate all of your care to be sure you have everything you need for home.

If You are Going to a Sub-Acute Rehab Facility If you aren’t well enough to go home, or if there have been complications directly related to your surgery that are limiting your recovery, you might qualify for short-term rehabilitation at an intermediary facility prior to going home. These situations are rare and account for less than 2% of our patients each month. Please, do not count on going to short term rehab as your primary discharge plan as the eligibility criteria are quite strict. Almost all of our patients are doing so well that they don’t qualify.

Someone responsible needs to drive you to rehab, or the hospital can help you arrange for paid transportation. This is typically not covered by insurance. Your transfer papers will be completed by the nursing staff. Either your primary care physician or a physician from the sub-acute facility will be caring for you in consultation with your surgeon.

Expect to stay 3–5 days, based upon your progress. Upon discharge home, instructions will be given to you by the sub-acute rehab staff. Be sure to take this guidebook with you to the rehab facility so you may refer to it if needed.

Please remember that these short term rehab stays must be approved by your insurance company and will be approved or denied in accordance with the guidelines established

by Medicare or your insurance company. Although you may desire to go to rehab when you are discharged, your progress will be monitored by your insurance company while you are in the hospital. Upon evaluation of your progress, you will either meet the criteria to benefit from sub-acute rehab or your insurance company may recommend that you return home with other care arrangements. Therefore, it is important for you to make alternative plans preoperatively for care at home.

In the event sub-acute rehab is not approved by your insurance company, you can go to sub-acute rehab and pay privately. Please keep in mind that the majority of our patients do so well that they do not meet the guidelines to qualify for sub-acute rehab. Also keep in mind that insurance companies do not become involved in social issues, such as lack of caregiver, animals, etc. These are issues you will have to address before admission.

25 25

guidebook

for Joint Replacement

Postoperative Care Caring For Yourself at Home When you go home, there are a variety of things you need to know for your safety, for your recovery, and for your comfort.

Control Your Discomfort •

Take your pain medicine at least 45 minutes to 1 hour before physical therapy.

•

Gradually wean yourself from prescription medication with the assistance of your surgeon.

•

Change your position every 45 minutes throughout the day.

•

Use ice to help with pain control. Applying ice to your affected joint will decrease discomfort. You can use it before and after your exercise program. Remember to always use a barrier between your skin and the ice. Many patients find a pillowcase works well.

Body Changes •

Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Your desire for solid food will return.

•

You may have difficulty sleeping, which is normal. Do not sleep or nap too much during the day.

•

Your energy level will be decreased for at least the first month.

•

Pain medications that contain narcotics can promote constipation. Use stool softeners and laxatives, if necessary.

Blood Thinners You will be given a blood thinner to help avoid blood clots in your legs. You will need to take it for two to six weeks depending on your individual situation. Be sure to take your blood thinner exactly as directed by your surgeon. If you have bleeding from any place where you would not normally find blood (in the stool or urine, from the eyes or mouth, or a persistent nosebleed) or if you experience multiple, unexplained bruises please contact your surgeon’s office immediately for instructions. It is important that that this be addressed in a timely fashion.

26 26

guidebook

for Joint Replacement

Postoperative Care Stockings You will be asked to wear special stockings. These stockings are used to help compress the veins in your legs. This helps to keep swelling down and reduces the chance for blood clots.

• Elevate your legs throughout the day, lowering them

during meals. For knees, 10-12 inches of elevation of the postoperative leg is sufficient. For hips, having your legs parallel to the floor is fine.

•

Wear the stockings nearly continuously, removing for one to two hours twice a day. Please don’t leave them on all the time as this is not good for your skin.

Be sure to take them off twice a day for one to two hours as noted above.

•

Notify your physician if you notice increased pain, redness, or swelling in either leg.

•

Ask your surgeon when you can discontinue stockings. Usually, this will be done three weeks after surgery.

Caring For Your Incision •

Keep your incision dry unless your surgeon instructs otherwise. Your surgeon might use a type of wound closure or dressing that is water-resistant or repellent.

Do not assume that you can get your wound or dressing wet until your nurse or surgeon has clarified this for you.

•

Keep your incision covered with a dressing until your staples are removed, usually 10 –14 days. If your doctor uses glue or sutures, follow their instructions precisely when you go home. Your nurse will give you instructions in writing.

•

If a dressing change is required by your surgeon, you will be educated on how to do this before going home. We’ll send you home with enough dressings to last you until your follow-up with your surgeon.

•

Notify your surgeon if there is increased drainage, redness, pain, odor, or heat around the incision.

•

Take your temperature if you feel warm or sick. Call your surgeon if it exceeds 101° F. 27 27

guidebook

for Joint Replacement

Postoperative Care Recognizing & Preventing Potential Complications Signs of Infection • Worsening swelling and redness at incision site. Remember that some

redness and swelling is completely normal after a joint replacement and may gradually improve for up to three months. If you’re concerned, call your surgeon for instructions.

• Change in color, amount, odor of drainage • Increased pain in knee • Fever greater than 101° F Prevention of Infection • Take proper care of your incision as explained.

• Take prophylactic antibiotics when having dental work or other invasive

procedures.

• Notify your physician and dentist that you have a joint replacement.

Signs of Hip Dislocation after a Hip Replacement • • •

Severe pain Awkward rotation or shortening of your leg Being unable to walk, bear weight, or move your leg in a normal fashion

28 28

guidebook

for Joint Replacement

Postoperative Care Blood Clots Surgery may cause the blood to slow and stick together in the veins of your legs, creating a blood clot. This is why you need blood thinners after surgery. If a clot occurs despite these measures you may need to be admitted to the hospital to receive intravenous blood thinners.

Signs of blood clots in legs •

Swelling in thigh, calf, or ankle that does not go down with elevation and persists overnight • Pain, heat, and tenderness in calf, back of knee or groin area.

NOTE: blood clots can form in either leg Prevention of blood clots • • • •

Ankle pumps Limited walking Compression stockings Blood thinners

Embolism An unrecognized blood clot could break away from the vein and travel to the heart, brain, or lungs. This is called an embolism and is a medical emergency. You should immediately CALL 911 if you suspect you or your loved has an embolism.

Signs of an Embolism • • • • • • • •

Sudden chest pain Difficult and/or rapid breathing Shortness of breath Sweating Confusion Anxiety Feelings of approaching doom Stroke-like symptoms (weakness or numbness on one side, difficulty speaking or swallowing, etc.)

Preventing an Embolism • •

Prevent blood clot in legs Recognize a blood clot in the leg and call physician promptly

29 29

guidebook

for Joint Replacement

Postoperative Care Joint Replacement Postop Exercises & Goals Exercising is important to obtain the best results from joint surgery. Always consult your physician before starting a home exercise program. You may receive exercises from a physical therapist at an outpatient facility or at home. In either case, you need to participate in an ongoing home exercise program as well. These goals and guidelines are listed on the next few pages.

Weeks One and Two After one or two days you should be ready for discharge home from the hospital. During weeks one and two of your recovery typical two-week goals are to: • •

Continue with walker unless otherwise instructed.

Actively bend your joint: knees at least 90° and hips at least 60°.

• Straighten your knee or hip completely.

• Independently sponge bathe or shower (if permitted) and dress.

• Gradually resume homemaking tasks once your surgeon is ok with this.

• Do your therapy exercises twice a day, with or without the therapist.

Weeks Two to Four Weeks two to four will see you recovering to more independence. Even if you are receiving outpatient therapy you will need to be very faithful to your home exercise program to be able to achieve the best outcome. Your goals for the period are to: • • • • • • • • • •

Achieve one to two week goals.

Wean from full support to a cane or single crutch.

Walk at least one quarter mile.

Climb and descend a flight of stairs (12–14 steps).

Bend your joint: knees more than 90° and hips to 90°.

Straighten your knee or hip completely.

Independently shower and dress.

Resume homemaking tasks.

Do your therapy exercises twice a day with or without the therapist.

Begin driving if left knee or hip had surgery and you drive a vehicle with an automatic transmission. You will need permission from your surgeon.

30

guidebook

for Joint Replacement

Postoperative Care Weeks Four to Six Weeks four to six will see much more recovery to full independence. Your home exercise program will be even more important as you receive less supervised therapy. Your goals for this time period are to: • • • • • • • •

Achieve one to four week goals.

Walk with a cane or single crutch.

Walk one quarter to one half mile.

Begin progressing on stair from one foot at a time to regular stair climbing (foot over foot).

If knee, actively bend knee 110°.

If knee, straighten your knee completely.

Drive a car (either right or left side had surgery).

Continue with home exercise program twice a day.

Weeks Six to Twelve During weeks six to twelve you should be able to begin resuming all of your activities.

Your goals for this time period are to: • • • • • • • •

Achieve one to six week goals.

Walk with no cane or crutch and without a limp.

Climb and descend stairs in normal fashion (foot over foot).

Walk one half to one mile.

If knee, bend knee to 120°.

If knee, straighten knee completely.

Improve strength to 80%.

Resume activities including dancing, bowling, and golf.

Home Exercises after Joint Replacement Always consult your physician before starting a home exercise program. If you are recovering quickly, it is recommended that you supplement these exercises with others that your therapist recommends.

31

guidebook

for Joint Replacement

Postoperative Care Precautions and Home Safety Tips Do NOT pull up on the walker to stand!

Do NOT sit on a chair that is too LOW! Sit in a chair with arm rests when possible.

1. Scoot to the front edge of the chair.

2. Push up with both hands on the armrests. If sitting in a chair without armrest, place one hand on the walker while pushing off the side of the chair with the other.

3. Balance yourself before grabbing for the walker.

Proper Method

Improper Method

32

guidebook

for Joint Replacement

Postoperative Care Transfer – Bed

In

When getting into bed: 1. Back up to the bed until you feel it on the back of your legs (you need to be midway between the foot and the head of the bed).

2. Reaching back with both hands, sit down on the edge of the bed and then scoot back toward the center of the mattress.

3. Move your walker out of the way, but keep it within reach.

4. Scoot your hips around so that you are facing the foot of the bed.

5. Lift your leg into the bed while scooting around (if this is your surgical leg, you may use a cane, a rolled bed sheet, a belt, or your leg lifter to assist with lifting that leg into bed).

6. Keep scooting and lift your other leg into the bed.

7. Scoot your hips towards the center of the bed.

Out

When getting out of bed: 1. Scoot your hips to the edge of the bed.

2. Sit up while lowering your non-surgical leg to the floor.

3. If necessary, use a leg-lifter to lower your surgical leg to the floor.

4. Scoot to the edge of the bed.

5. Use both hands to push off the bed. If the bed is too low, place one hand in the center of the walker while pushing up off the bed with the other.

6. Balance yourself before grabbing for the walker.

33

guidebook

for Joint Replacement

Postoperative Care Transfer – Tub Getting into the tub using a bath seat: 1. Place the bath seat in the tub facing the faucets.

2. Back up to the tub until you can feel it at the back of your knees. Be sure you are in front of the bath seat.

3. Reach back with one hand for the bath seat. Keep the other hand in the center of the walker.

4. Slowly lower yourself onto the bath seat, keeping the surgical leg out straight.

5. Move the walker out of the way, but keep it within reach.

6. Lift your legs over the edge of the tub, using a leg lifter for the surgical leg, if necessary.

Hold onto back of shower seat.

NOTE: Although bath seats, grab bars, long-handled bath brushes, and handheld showers make bathing easier and safer, they are typically not covered by insurance.

NOTE: ALWAYS use a rubber mat or non-skid adhesive on the bottom of the tub or shower.

NOTE: To keep soap within easy reach, make a soap-on-a-rope by placing a bar of soap in the toe of an old pair of pantyhose and attach it to the bath seat.

Getting out of the tub using a bath seat: 1. Lift your legs over the outside of the tub.

2. Scoot to the edge of the bath seat.

3. Push up with one hand on the back of the bath seat while holding on to the center of the walker with the other hand.

4. Balance yourself before grabbing the walker.

34

guidebook

for Joint Replacement

Postoperative Care Transfer – Toilet Hips: You are required to use a raised toilet seat or a three-in-one bedside commode over your toilet for at least 12 weeks after surgery.

Knees: While it is still helpful for patients who’ve had a knee replacement to use a raised toilet seat or a three-in-one bedside commode over your toilet, it is not a requirement.

When sitting down on the toilet: 1. Take small steps and turn until your back is to the toilet. Never pivot.

2. Back up to the toilet until you feel it touch the back of your legs.

3. If using a commode with armrests, reach back for both armrests and lower yourself onto the toilet. If using a raised toilet seat without arm- rests, keep one hand on the walker while reaching back for the toilet seat with the other.

4. Slide your surgical leg out in front of you when sitting down.

When getting up from the toilet: 1. If using a commode with armrests, use the arm- rests to push up. If using a raised toilet seat without armrests, place one hand on the walker and push off the toilet seat with the other.

2. Slide operated leg out in front of you when standing up.

3. Balance yourself before grabbing the walker.

35

guidebook

for Joint Replacement

Postoperative Care Transfer – Automobile 1. Push the car seat all the way back; recline it if possible, but return it to the upright position for traveling.

2. Place a plastic trash bag on the seat of the car to help you slide and turn frontward.

3. Back up to the car until you feel it touch the back of your legs.

4. Reach back for the car seat and lower yourself down. Keep your operated leg straight out in front of you and duck your head so that you do not hit it on the doorframe.

5. Turn frontward, leaning back as you lift the operated leg into the car.

Walking 1. Move the walker forward.

2. With all four walker legs firmly on the ground, step forward with surgical leg.

Place the foot in the middle of the walker area. Do not move it past the front feet of the walker.

3. Step forward with the non-surgical leg.

4. NOTE: Take small steps. DO NOT take a step unless the 2 walker legs and 2 wheels are flat on the floor.

Stairclimbing 1. Ascend with non-surgical leg first (Up with the good).

2. Descend with the surgical leg first (Down with the bad).

36

guidebook

for Joint Replacement

Postoperative Care Personal Care Using a reacher or dressing aid: 1. Sit down.

2. Put your surgical leg in first and then your non-surgical leg. Use a reacher or dressing stick to guide the waist band over your foot.

3. Pull your pants up over your knees, within easy reach.

4. Stand with the walker in front of you to pull your pants up the rest of the way.

Taking off pants and underwear: 1. Back up to the chair or bed where you will be undressing.

2. Unfasten your pants and let them drop to the floor. Push your underwear down to your knees.

3. Lower yourself down, keeping your surgical leg out straight.

4. Take your non-surgical leg out first and then the surgical leg.

A reacher or dressing stick can help you remove your pants from your foot and off the floor.

37

guidebook

for Joint Replacement

Postoperative Care How to use a sock aid: 1. Slide the sock onto the sock aid.

2. Hold the cord and drop the sock aid in front of your foot. It is easier to do this if your knee is bent.

3. Slip your foot into the sock aid.

4. Straighten your knee, point your toe and pull the sock on. Keep pulling until the sock aid pulls out.

If using a long-handled shoehorn: 1. Use your reacher, dressing stick, or longhandled shoehorn to slide your shoe in front of your foot.

2. Place the shoehorn inside the shoe against the back of the heel. Have the curve of the shoehorn match the curve of your shoe.

3. Lean back, if necessary, as you lift your leg and place your toes in your shoe.

4. Step down into your shoe, sliding your heel down the shoehorn.

NOTE: Wear sturdy slip-on shoes, or shoes with Velcro closures or elastic shoe laces. DO NOT wear high-heeled shoes or shoes without backs.

38

guidebook

for Joint Replacement

Postoperative Care Around the House Saving energy and protecting your Joint Kitchen •

Do NOT get down on your knees to scrub floors. Use a mop and longhandled brushes.

• Plan ahead! Gather all your cooking supplies at one time. Then, sit to prepare your meal.

• Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.

• To provide a better working height, use a high stool, or put cushions on your chair when preparing meals.

Bathroom • •

Do NOT get down on your knees to scrub bathtub.

Use a mop or other long-handled brushes.

Safety and Avoiding Falls • • • • • • • •

Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.

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

Provide good lighting throughout your home. Install nightlights in the bathrooms, bedrooms, and hallways if more light is needed.

Keep extension cords and telephone cords out of pathways. Do NOT run wires under rugs, this is a fire hazard.

Do NOT wear open-toe slippers or shoes without backs. They do not provide adequate support and can lead to slips and falls.

Sit in chairs with armrests. It makes it easier to get up.

Rise slowly from either a sitting or lying position to avoid getting lightheaded.

Do not lift heavy objects for the first three months and then only with your surgeon’s permission.

39

guidebook

for Joint Replacement

For the Long Haul Do’s and Don’ts for the Rest of Your Life Whether you have reached all the recommended goals in three months or not, all joint patients need to have a regular exercise program to maintain their fitness and the health of the muscles around their joints. With both your orthopedic and primary care physicians’ permission, you should be on a regular exercise program three to four times per week lasting 20–30 minutes. High-impact activities such as running and singles tennis may put too much load on the joint and are not recommended. High-risk activities such as downhill skiing are likewise discouraged because of the risk of fractures around the prosthesis and damage to the prosthesis itself. Infections are always a potential problem, and you may need antibiotics for prevention before dental work and invasive procedures for at least two years.

What to Do in General •

Take antibiotics one hour before you have dental work or other invasive procedures.

•

Although the risks are very low for postoperative infections, it is important to realize that the risk remains. A prosthetic joint could possibly attract the bacteria from an infection located in another part of your body. If you should develop a fever of more than 101° or sustain an injury such as a deep cut or puncture wound you should clean it as best you can, put a sterile dressing or an adhesive bandage on it and notify your doctor. The closer the injury is to your prosthesis, the greater the concern. Occasionally, antibiotics may be needed.

Superficial scratches may be treated with topical antibiotic ointment. Notify your doctor if the area is painful or reddened.

•

Get an implant card from your surgeon that states you had a joint replacement. Carry the card with you, as you may set off security alarms at airports, malls, etc.

•

When traveling, stop and change positions hourly to prevent your joint from tightening.

•

See your surgeon yearly unless otherwise recommended. For more information, please read the Appendix “The Importance of Lifetime Follow-up Visits.”

40

guidebook

for Joint Replacement

For the Long Haul What to Do for Exercise Choose a Low Impact Activity •

Recommended exercise classes

•

Regular one to three mile walks

•

Home treadmill (for walking)

•

Stationary bike

•

Regular exercise at a fitness center

•

Low-impact sports such as golf, bowling, walking, gardening, dancing, etc.

What Not to Do •

Do not run or engage in highimpact activities

•

Do not participate in high-risk activities such as downhill skiing, etc.

41

guidebook

for Joint Replacement

Appendix Exercise Your Right Put Your Health Care Decisions in Writing It is our policy to place patients’ wishes and individual considerations at the forefront of their care and to respect and uphold those wishes.

What are Advance Medical Directives?

Advance Directives are a means of communicating to all caregivers the patient’s wishes regarding health care. If a patient has a Living Will or has appointed a Health Care Agent and is no longer able to express his or her wishes to the physician, family, or hospital staff, Baptist Health is committed to honoring the wishes of the patient as they are documented at the time the patient was able to make that determination.

There are different types of Advance Directives and you may wish to consult your attorney concerning the legal implications of each.

LIVING WILLS are written instructions that explain your wishes for health care if you have a terminal condition or irreversible coma and are unable to communicate.

APPOINTMENT OF A HEALTH CARE AGENT (sometimes called a Medical Power of Attorney) is a document that lets you name a person (your agent) to make medical decisions for you, if you become unable to do so.

HEALTH CARE INSTRUCTIONS are your specific choices regarding use of life sustaining equipment, hydration and nutrition, and use of pain medications.

On admission to the hospital you will be asked if you have an Advance Directive. If you do, please bring copies of the documents to the hospital with you so they can become a part of your Medical Record.

Advance Directives are not a requirement for hospital admission.

Consider visiting www.honoringchoicesfl.com for valuable information on advanced directives in Florida. Under the resources tab you will find fact sheets, advanced care planning information and forms, and links to additional resources.

42

guidebook

for Joint Replacement

Appendix Blood Transfusions Know your options What are the sources of blood? When a transfusion is needed, patients receive either blood they have donated for themselves, blood donated by a directed donor (a donor personally selected by you), or blood donated by the community. Being transfused with your own blood is generally the safest option, but some people are unable to provide their own blood and must rely on other blood sources.

Being your own blood donor The blood that offers you the most safety and the best match is the blood you donate for yourself. This is called autologous donation. If you are able to be your own blood donor, the blood collection process will probably begin about three weeks before your surgery.

However, the last donation must be made at least three days before surgery. Many patients anticipating surgery donate blood for themselves without problems. Your doctor will make the final decision, depending on your condition.

Benefits Your own blood provides the best match. Transfusion of your own blood eliminates the risk of getting a viral infection like hepatitis or HIV, from the transfusion. By giving blood to meet your own needs, you also help conserve the community blood supply for people who need blood in an emergency or who cannot be their own donors.

Possible risks Your blood iron level will decrease after donation. For this reason, your doctor may prescribe iron supplements.

Procedure During your pre-operative appointment, your surgeon may give you information on how to donate your own blood. This is usually done if postoperative anemia is a concern. Our surgery schedulers will then assist you in scheduling a blood collection time with the Florida–Georgia Blood Alliance. Your blood will be uniquely tagged especially for you and will be ready if you need it during or after surgery. Frequency of donation can be as often as every three days, but preferably one week apart.

Eat a light meal two to three hours before donation. Be prepared to give the blood bank personnel a general health history and list of medications. An infection may prevent you from being your own blood donor.

43

guidebook

for Joint Replacement

Appendix Blood Transfusions (continued) Maintain any iron therapy prescribed until your surgery. Your blood is reserved for you until its expiration date, at which time it is destroyed. Please call the blood bank if your surgery is rescheduled. There is a fee for the drawing and testing of the blood. This is charged regardless of whether or not your blood is transfused to you.

Choosing family or friends to donate blood When family or friends donate blood for you, the process is called a directed or designated donation. Although it is appealing to have people close to you give blood, directed donations are not statistically safer than the community blood supply. Blood types will not be performed prior to the donation unless the donor registers as an outpatient and pays a fee for the blood typing. Upon testing of donor units, donors, who are found to be incompatible with the patient, will be released into the general community supply. Because of the possibility of testing problems or mechanical failures, the hospital’s blood bank cannot absolutely guarantee that the directed donor blood will be available by the scheduled surgery date. Patients will be notified of this rare occurrence. Directed donor blood will automatically be released to other patients one week after the scheduled surgery date if it has not been used.

Benefits Directed donations may provide peace of mind for some patients because they personally know the person who donated the blood.

Possible risks The safety of any donation depends on the donor providing complete and factual answers to health screening questions. Sometimes friends or family may feel pressured into making a directed donation even though they know that their health history may make their blood unsafe. Even if a patient knows the donor personally, a directed donation may still transmit disease. You can be assured that the hospital’s blood bank will use the same thorough procedures for screening the donors and testing the blood that we normally use for the community blood supply. Donors are screened very carefully using a detailed health questionnaire. After the blood is collected, it is screened very carefully for any reason that would make it unacceptable for use. Any unacceptable units are discarded. There is a fee charged to the patient for the drawing and processing of directed donations. If your surgery date is postponed, you must notify the hospital’s blood bank.

44

guidebook

for Joint Replacement

Appendix Anesthesia Who are the anesthesiologists?

The Operating Room, Post Anesthesia Care Unit (PACU) and Intensive Care Units at Baptist Health are staffed by Board Certified and Board Eligible physician anesthesiologists. Each member of the service is an individual practitioner with privileges to practice at this hospital.

What types of anesthesia are available?

Decisions regarding your anesthesia are tailored to your personal needs. The types available for you are: • •

General Anesthesia which provides complete loss of consciousness.

Regional Anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain, or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, epidural blocks, and arm and leg blocks. Medications can be given to make you drowsy and blur your memory.

Will I have any side effects?

Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options as well as any complications or side effects that can occur with each type of anesthetic. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Although less of a problem today because of improved anesthetic agents and techniques, these side effects continue to occur for some patients.

Medications to treat nausea and vomiting will be given if needed. The amount of discomfort you experience will depend on several factors, especially the type of surgery.

Your doctors and nurses can relieve pain with medications. Your discomfort is usually minimal, but do not expect to be totally pain-free. The staff will teach you the pain scale (0–10) to assess your pain level.

What will happen before my surgery?

You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all the information needed to evaluate your general health.

This will include your medical history, laboratory test results, allergies, and current medications. With this information, the anesthesiologist will determine the type of anesthesia best suited for you. He or she will also answer any questions you may have.

45

guidebook

for Joint Replacement

Appendix Anesthesia (continued) You will also meet your surgical nurses. Intravenous (IV) fluids will be started and preoperative medications will be given. Once you are in the operating room, monitoring devices like a blood pressure cuff, EKG, and other devices will be attached to you for your safety. At this point, you will be ready for anesthesia.

During surgery, what does my anesthesiologist do?

Your anesthesiologist is responsible for your comfort and well-being before, during, and immediately after your surgical procedure. In the operating room, the anesthesiologist will manage vital functions, including heart rate and rhythm, blood pressure, body temperature, and breathing. The anesthesiologist is also responsible for fluid and blood replacement when necessary.

What can I expect after the operation?

After surgery, you will be taken to the Post Anesthesia Care Unit (PACU) where specially trained nurses will watch you closely. During this period, you may be given extra oxygen and your breathing and heart functions will be observed closely.

May I choose an anesthesiologist?

Although most patients are assigned an anesthesiologist, you may choose one based on personal preference or insurance considerations. If you have questions about your insurance coverage or medical plan participation by the anesthesiologist, please contact your insurance company for guidance. Requests for specific anesthesiologists should be submitted in advance through your surgeon’s office for coordination with the surgeon’s availability.

46

guidebook

for Joint Replacement

Appendix The Importance of Lifetime Follow-Up Visits Over the last several years, orthopedic surgeons have noticed that many people are not following up with their surgeons on a regular basis. The reason for this may be that they do not realize they are supposed to or they do not understand why it is important.

So, when should you follow up with your surgeon?

These are some general rules: • • •

Every year, unless instructed differently by your physician.

Anytime you have mild pain for more than a week.

Anytime you have moderate or severe pain.

There are two good reasons for routine follow-up visits with your orthopedic surgeon: 1. If you have a cemented knee, the integrity of the cement needs to be evaluated periodically. With time and stress, cement can sometimes crack. You probably would be unaware of this happening as it usually occurs slowly over a period of time. Seeing a crack in cement does not necessarily mean you need another surgery, but it does mean things need to be followed more closely. Why? Two things could happen. Your knee could become loose, leading to pain. Or, the cracked cement could cause a reaction in the bone called osteolysis, which can thin the bone and loosen your implanted joint. In both cases you might not know this for years. Orthopedists are continually learning more about how to deal with both of these problems. The sooner we know about potential problems, the better chance we have of avoiding more serious problems.

2. The second reason for follow-up is that the plastic liner in your knee can experience wear. Small liner particles can combine with white blood cells and may get in the bone leading to osteolysis, and similar consequences as detailed in number one above.

Replacing a worn liner early and grafting the bone can keep this from worsening.

X-rays taken at your follow-up visits can detect these problems. New X-rays can be compared with previous films to assess for changes. This can be done in your doctor’s office. Your surgeon is happy that most patients do so well that they do not think of them often. However, they enjoy seeing you and want to continue to provide you with the best care and advice. If you are unsure how long it has been or when your next visit should be scheduled, call your orthopedist. They will be delighted to hear from you.

47

guidebook

for Joint Replacement

Notes

48

guidebook

for Joint Replacement

Notes

49

guidebook

for Joint Replacement

Notes

50

guidebook

for Joint Replacement

Copyrighted Material © 2021 Baptist Health

Joint Concepts® and Biomet® are trademarks of Biomet, Inc. Motrin® and Band-Aid are registered trademarks of Johnson & Johnson. Tylenol® is a registered trademark of McNeal Consumer Brands. Betadine® is a registered trademark of Purdue Frederick, Co.

To contact your Joint Center Coordinator, call: Baptist Beaches

(904) 627-2132

Baptist Jacksonville (904) 202-2450 Baptist South

(904) 271-6634