The Center For Bone and Joint Care

A Patient Guide to Total Joint Replacement “Moving you forward in life.”

IN PARTNERSHIP WITH

Day Kimball Hospital is Designated as a

for Knee and Hip Replacement

RESULTS. TOTAL HEALTH AND WELL BEING. 4

SECTION I: PREPARING FOR YOUR SURGERY

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SECTION II: YOUR HOSPITAL STAY

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SECTION III: POST-OPERATIVE DAILY LIVING

17 SECTION IV: YOUR POST HOSPITAL RECOVERY 18

SECTION V: POST-OPERATIVE GUIDELINES FOR HIP AND KNEE REPLACEMENT

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SECTION VI: EXERCISES FOR POST-OPERATIVE HIP AND KNEE REPLACEMENT

SECTION VII: POST-OPERATIVE GUIDELINES AND EXERCISES 28

FOR HIP REPLACEMENT SECTION VIII: POST-OPERATIVE GUIDELINES AND EXERCISES 32

FOR KNEE REPLACEMENT

NOTE: DESIGNATION AS BLUE DISTINCTION CENTERS® MEANS THESE FACILITIES’ OVERALL EXPERIENCE AND AGGREGATE DATA MET OBJECTIVE CRITERIA ESTABLISHED IN COLLABORATION WITH EXPERT CLINICIANS’ AND LEADING PROFESSIONAL ORGANIZATIONS’ RECOMMENDATIONS. INDIVIDUAL OUTCOMES MAY VARY. TO FIND OUT WHICH SERVICES ARE COVERED UNDER YOUR POLICY AT ANY FACILITIES, PLEASE CALL YOUR LOCAL BLUE CROSS AND/OR BLUE SHIELD PLAN; AND CALL YOUR PROVIDER BEFORE MAKING AN APPOINTMENT, TO VERIFY THE MOST CURRENT INFORMATION ON ITS NETWORK PARTICIPATION AND BLUE DISTINCTION STATUS. NEITHER BLUE CROSS AND BLUE SHIELD ASSOCIATION NOR ANY OF ITS LICENSEES ARE RESPONSIBLE FOR ANY DAMAGES, LOSSES, OR NON-COVERED CHARGES THAT MAY RESULT FROM USING BLUE DISTINCTION OR OTHER PROVIDER FINDER INFORMATION OR RECEIVING CARE FROM A BLUE DISTINCTION OR OTHER PROVIDER.

SOURCES 1. “NAON Patient Education Series: Total Knee Replacement”, 2009, National Association of Orthopaedic Nurses, Chicago, IL 2. “NAON Patient Education Series: Total Hip Replacement”, 2009, National Association of Orthopaedic Nurses, Chicago, IL 3. “Patient Education Booklet: Total Joint Replacement”, 2009, American Academy of Orthopedic Surgeons, Rosemont, IL 4. “Your Pathway to Recovery: A Patient’s Guide to Total Hip Replacement”. Volume 1, 6th Edition, 2010, Hospital For Special Surgery, NY, NY 5. “Your Pathway to Recovery: A Patient’s Guide to Total Knee Replacement”. Volume 1, 6th Edition, 2010, Hospital For Special Surgery, NY, NY

WELCOME Dear Joint Replacement Patient,

Congratulations on making this life-changing decision, and thank you for selecting Day Kimball Hospital and The Center for Bone & Joint Care for your total joint care. We know that choosing the right care is important, and we are proud of our excellent patient outcomes for total joint replacements.

Day Kimball is very proud of the fact that every year nearly 200 residents of Northeast Connecticut trust our outstanding team to provide quality, state-of-the art medical care and excellent service in order to achieve the best possible outcome from your total joint surgery. You’ve made a great choice!

Recently, Day Kimball Hospital was named a Blue Distinction Center for Knee and Hip ReplacementÂŽ from Anthem Blue Cross and Blue Shield for demonstrating outstanding quality of care and patient results in knee and hip replacement surgeries.

Now that you have decided to move forward with surgery and have selected the top-flight professionals at The Center for Bone & Joint Care, it is time for the real planning to begin.

Research has shown that the more informed you are about your surgery, the more active you are in participating in the process, the more likely that you will positively impact your recovery and achieve the results you want and expect.

We believe Day Kimball Hospital deserves to hold the respected Blue Distinction Center designation because we stand out from the rest in the areas that matter to patients—quality care, treatment expertise and patient results.

Anthem Blue Cross and Blue Shield awards this designation based on rigorous clinical criteria, developed with input from expert physicians and medical organizations in knee and hip replacements. The goal of Blue Distinction is to recognize medical facilities that provide exceptional quality healthcare services while meeting the best industry standards for quality and performance for a specific area of specialty care.

Several weeks before the actual date of surgery, you and your healthcare providers will start to prepare. Part of this preparation will include keeping important appointments. Preparation will also include attending important informational sessions and making some adjustments at home, in your diet, and in your daily routine. Being prepared is a critical component of achieving a positive outcome. Following these important steps will help ensure that your surgery is successful.

SECTION I: PREPARING FOR YOUR SURGERY and your hospital stay. You will see a PRE-ADMISSION TESTING AT demonstration of your Constant Passive DAY KIMBALL HOSPITAL Motion (CPM) machine and discuss your plan • During Pre-Admission Testing, you will undergo for care after you leave the hospital. You will a thorough physical examination and a series also have a chance to ask questions. At the of tests, such as x-rays and blood work. You end of the session, you will be familiar with will also meet with an anesthesiology staff the total joint experience. We encourage you member to discuss the type of anesthesia to bring family members, a coach, or a guest that is best for you. to this program.

• Day Kimball’s Pre-Admission Testing office • The Joint Academy usually takes place on the will call you to schedule an appointment. third Thursday of every month at 2 pm at the • If you have any questions or if you haven’t Day Kimball Hospital Field Conference Room, heard from the Pre-Admission Testing office located across from the Laboratory. two weeks prior to surgery call 860-963-6419.

• The date of your Joint Academy Program • The date for your Pre-Admission Testing is: Class is:______________________________________ _______________________________________________________________ MEDICAL EVALUATION WITH YOUR PRIMARY CARE PHYSICIAN • Your primary care doctor must provide approval for you to undergo surgery. Your orthopedic surgeons’ office will help you to schedule your medical evaluation two to three weeks prior to surgery.

• This examination by your primary care physician, in combination with Pre-Admission Testing, is necessary to review your overall health and identify any medical conditions that could interfere with your surgery or recovery.

• The date for your evaluation with your Primary Care Physician is:___________________________ THE JOINT ACADEMY OF NORTHEAST CONNECTICUT • The “Joint Academy” is an important one-hour educational program presented by healthcare team members from Day Kimball Hospital and The Center for Bone and Joint Care.

• At this hands-on educational group session you will receive information about your surgery

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PREPARING YOUR BODY FOR SURGERY It is important that you be in the best possible physical condition for your surgery. A few important steps will help make the road to recovery smoother.

Physical Therapy: Whenever possible your

doctor will order a physical therapy evaluation prior to surgery in order to instruct you on the proper use of crutches and/or a walker and to determine what, if anything, can be done to improve your body strength prior to surgery. This evaluation will identify exercises that will increase your strength and endurance.

Perform these exercises as often as prescribed by your Physical Therapist:

• Special exercises to increase your upper body strength for when you use a walker or crutches in the early days following surgery.

• Exercises that strengthen your legs in order to reduce recovery time.

• Instruction in the correct use of a walker or crutches.

• Aerobic conditioning to increase stamina.

• Your choice of Physical Therapy Centers is: ________________________________________

Stop Smoking: This is a good idea anytime but

especially before major surgery. If you smoke, stopping now will help reduce the risk of postoperative lung problems and improve healing.

Check with your surgeon or your personal physician if you are using medication to help you quit smoking such as a nicotine patch or gum. Please be aware that smoking is prohibited anywhere in the hospital and on the hospital campus.

Watch Your Weight: If you are overweight,

losing weight will help to reduce the stress on your new joint. Even small increments of weight loss can make a big difference. For every pound you lose you reduce the stress on your knee by four pounds.

Have A Dental Exam: Although infections in joint

replacements are not common, an infection can occur if bacteria enters the blood stream somewhere else in your body. Dental work can increase this risk. Therefore, you should arrange to have dental procedures such as extractions and periodontal work completed before surgery.

Stop Taking Certain Medications: Some

medications and dietary supplements can increase risk during joint replacement surgery.

Be certain to tell your surgeon all the medications that you are taking, including over-the-counter medications and dietary supplements, because some of these may increase bleeding during surgery. Your surgeon or your personal physician can advise you which medications to stop taking before your surgery. Please be honest about your drug and alcohol use. It is important for your surgical team to know as it can impact your anesthesia and pain management. Examples of

medications and supplements you should stop taking are: • NSAIDS like Motrin, Aleve, etc.

• Aspirin • Fish oils • Herbal supplements such as ginseng, gingko biloba, garlic pills, and vitamin E.

Start taking Iron and Folic Acid for at least four weeks prior to surgery. This will boost the minerals

needed for new blood production by your body.

A stool softener (example: Metamucil Colace) should be taken with the iron supplement twice each day.

KEEPING A LIST OF MEDICATIONS You should always keep a list of the medications you take with you for your doctor or surgeon to review. On the day of your surgery please make note of what medications you have taken before coming to the hospital.

HEALTHCARE PROVIDERS PHONE NUMBERS Name

Number

Your Surgeon Your Primary Care Doctor Your Physical Therapist Your Home Care Agency

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PREPARING YOUR HOME BEFORE SURGERY Before your surgery, you or a family member should make sure that your home is ready for your return. Making a few adjustments in advance will make your home safer and more comfortable upon your arrival back home. Consider the following small changes that will make your transition easier.

HOME SAFETY • Scan your kitchen and other rooms in your home. Look high and low. Place items that you use daily at arm level so you don’t have to bend or reach up to find them.

• Rearrange furniture to give yourself enough room to maneuver with a walker or crutches.

• Scan the floor and look for items that might be a tripping hazard. Remove loose carpets and rearrange electrical cords in the areas where you will be walking.

COMFORT Set up a “command center” in your home, with the phone, television remote control, radio, facial tissues, wastebasket, water pitcher and glass, reading materials and medications within reach of where you will sit and sleep.

• Get a good chair. You will want a chair that is firm, has a seat high enough to allow your knees to remain lower than your hips, and has armrests to help you get up. Place this chair in the room where you plan to spend the most time.

• Find a footstool and place it near your chair.

This will be useful for keeping your surgical leg straight out in front of you when you sit.

CLOTHING • Plan to wear a “big-pocket” shirt, soft shoulder bag, or “fanny pack” to help you carry things around.

• Wear comfortable loose fitting clothing that won’t rub or restrict movement on or about your incision.

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PLANNING AHEAD FOR YOUR DISCHARGE Whether or not you will require “rehab” following your surgery depends on several factors, including your general state of health. Many patients can be safely discharged directly home, but only under certain circumstances.

If you and your doctor determine that you will be discharged directly home, now is the time to evaluate your needs for at-home care after leaving the hospital. Most joint replacement patients who choose to go directly home upon discharge from the hospital will probably need help at home for the first few weeks, including assistance in preparing meals and transportation.

If you and your surgeon determine that you need to be discharged to a rehabilitation facility after you leave the hospital you must contact the rehab facility of your choice as soon as possible BEFORE surgery in order to make a reservation.

HERE ARE SOME LOCAL OPTIONS: • Westview Nursing & Rehab in Dayville – 860-774-8574 • Matulaitis Nursing Home in Putnam – 860-928-7976 • Villa Maria Nursing & Rehabilitation in Plainfield – 860-564-3387 • Other:_______________________________________ Be sure to consider what your insurance will pay for and know what benefits are available to you. Different insurance providers have different rules for determining the medical necessity of rehabilitation and most do not provide payment for your transportation home or to the rehab facility.

Whether you will be discharged to home or go to a rehabilitation facility, a Nurse Case Manager from Day Kimball Hospital will call you at home approximately one week prior to surgery to review your plan for discharge.

THE DAY BEFORE AND THE DAY OF SURGERY In the 48 hours before your surgery, there are some specific steps you must take. It is important that you follow these simple steps: Pre-Op Call: You must call the hospital the day

before surgery between 12 noon and 3 p.m. to confirm the time you must be at the hospital on the day of surgery. PLEASE CALL 860-963-6350 TO CONFIRM. Food and Drink: There are several restrictions

regarding food and fluid intake that you need to follow before surgery.

• Plan to eat a light meal the evening before your surgery.

• DO NOT eat or drink anything of substance after midnight the night before surgery.

• You CAN take a small sip of water with your necessary medications the morning of surgery.

• You CAN brush your teeth and rinse your mouth, but do not swallow the water.

• Avoid alcohol and smoking 48 hours prior to surgery.

Skin Care: To help prevent surgical site

infections you must clean your skin at the surgical area before surgery with a Hibiclens cleaner (Chlorhexidine). This can be purchased at your local pharmacy. Take a shower the night before, or if possible, the morning of surgery before you leave for the hospital. Wash the area at and near your surgical site thoroughly during your shower. If you are having a knee replacement wash your entire leg that you are having surgery on. If you are having a hip replacement wash your buttock and hip area from the groin to the middle of the back down to the knee on the leg that you are having surgery on. DO NOT shave the area and DO NOT use ointments or creams or hair removing agents. Rinse and dry off as you would normally.

WHAT TO BRING AND WHAT NOT TO BRING TO THE HOSPITAL Bring to Hospital

• • • •

• • • • • • •

Toiletries (toothbrush, comb etc.).

Your cane or crutches.

Eyeglasses (but not contact lenses).

Dentures and/or hearing aid. These should be stored in a container and kept in your bedside table when not in use after surgery.

A list of your medications – including the ones you have stopped taking at your surgeons request.

Bring your CPAP or BIPAP if you use this device for Sleep Apnea.

Important telephone numbers.

A small amount of cash.

A book, magazine, or items to pass the time.

Comfortable clothing – pajama’s or shorts, non-skid slippers.

THIS BOOKLET.

Do Not Bring

• Any medications unless asked by your surgeon.

• Valuables such as jewelry, large amounts of cash, credit cards, expensive watches, etc. The hospital respects your property rights but cannot guarantee security for your personal property.

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SURGERY PREPARATION CHECKLIST The Night Before Your Surgery:

Shower and wash the entire leg that will have surgery with Hibiclens soap (may be done day of surgery if time permits).

Nothing to eat or drink after midnight.

REVIEW THIS ENTIRE GUIDE. Get a good night’s rest.

The Day of Your Surgery:

Take routine medications with only a sip of water (as instructed by your doctor).

Brush your teeth and rinse without swallowing water.

Wear comfortable clothing.

Leave valuables at home or with a family member.

SECTION II: YOUR HOSPITAL STAY YOUR ARRIVAL AT THE HOSPITAL ON YOUR DAY OF SURGERY Your big day has arrived and our team is ready to make sure that you are comfortable and well informed throughout the entire process. Let’s walk through the process once you arrive at the hospital.

• You need to enter the hospital at the rear entrance behind the Pediatric Center and stop at the Registration desk to check in and make sure that your registration and insurance information is on file and correct.

• You will be directed to the Ambulatory Care Unit (ACU) where you will check in with the receptionist and a member of the healthcare team will bring you to your room in order to change into a hospital gown. Your own clothing and personal belongings will be safely stored.

• A member of the ACU team will review your chart, take your vital signs, and start an IV that will be used to administer fluids and medication. You will remain in this bed until you are transported up to the Operating Room.

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Family members can remain with you in this room until you leave for the Operating Room.

• At this time, you will be asked to fill out an operative consent form, review it, and sign it along with your surgeon. If you have already completed this form your surgeon will review it with you again. Next, your anesthesiologist will review with you the type of anesthesia that will be used for your surgery, and you will be asked to sign a consent form specifically for the anesthesia.

This is a good time to make sure that the surgeon knows who you have designated to be your advocate after surgery. This is the person that the doctors will speak with once the surgery is over. Surgery can take from two to three hours to complete depending upon the complexity of your problem. With your permission, the doctor will contact this person to let them know how everything went and what to expect next. Make sure that the doctor knows how to reach your advocate. Your family member can remain in the waiting area in ACU or they can choose to leave

the hospital and return once the surgery is over.

Just be sure that the ACU and the surgeon know how to contact this person.

When your operating room is ready you will be transported to the Pre-Op Holding Area by a member of the nursing staff. Finally, your surgeon will conduct all required safety checks, such as marking the area of your body where the surgery will take place.

WHAT TO EXPECT AFTER SURGERY Following surgery you will leave the operating room and spend time in the Post-Anesthesia Care Unit. Here, the anesthesia staff and nurses will monitor your vital signs – temperature, blood pressure, etc. As the anesthesia wears off and you become more responsive, the nurses will manage your pain and monitor other symptoms while you are in the Post-Anesthesia Care Unit.

Once you are stable, you will be transferred to your bed on the Medical-Surgical Unit. When you return to your regular hospital room on the day of surgery you will be tired and sleep most of the time. This is typical and should be expected.

You will have a large bandage over the surgical site, and you will have an intravenous catheter in your arm to provide fluids and administer medications. You may have a urinary catheter to keep your bladder empty of urine. There may also be a drain in your surgical site that will be removed the first day after surgery. Your care team will monitor your progress throughout your hospital stay to ensure your safe and efficient recovery. They will continue to check your vital signs and change the dressings that cover your incision.

PAIN MANAGEMENT Pain is often the biggest concern for patients when considering joint replacement surgery.

Managing your pain is also important to us, and we will work with you to keep your pain after surgery to a minimal level by using medications, ice, and therapy. The first two days after surgery tend to be the most difficult – after that the pain will decrease significantly. The exact type of medication used to control your pain will be determined by your surgeon and is based on

your medical history and any adverse side effects you may have had in the past. Your doctor will make sure that you know what pain medication and remediation is available to you.

One of the most important steps in controlling pain is keeping your doctor and nurses aware of your pain. Speaking up about how you feel is critical. Changes can be made if the pain is not being managed well.

BREATHING EXERCISES AND PHYSICAL THERAPY The day after your operation, your nurses, physical therapists, and other caregivers will start you on a course of treatment that will begin your recovery and life with your new knee or hip. Getting out of bed is an important step to a quick recovery.

Breathing exercises are an important part of your recovery. While lying in bed after your surgery, you will need to do breathing exercises on your own. You will be given a device known as an Incentive Spirometer. The nurse will instruct you on how to use this device. You will be expected to use this at least 10 times every hour while you are awake. This will help you to fully expand your lungs by breathing deeply and will prevent fluid collection, pneumonia and, fevers.

From the first day after surgery, you will be expected to be out of bed at least 3 times each day. The nursing staff or therapist will help you.

DO NOT get out of bed by yourself.

On the morning following your surgery a physical therapist will assist you to a standing position, and using a walker, you will begin to walk on your new knee or hip. In most cases you will be allowed to put all your weight on your leg – this is called weight bearing as tolerated. Sometimes, because of the nature of your surgery, your surgeon may decide that you should place only a part of your weight on your leg – this is called partial weight bearing. As time passes you will be able to increase the amount of weight that you place on your operated side.

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Your surgeon will work closely with your physical therapist to determine a personal physical therapy regimen that is just right for you. Your therapy program will have the therapist helping you with motion, strength, getting out of bed, and walking.

Your therapist will review exercises that you will also do in bed on your own. Your therapist will also work with you on special techniques for dressing, bathing, and climbing stairs. Therapy is a critical part of getting better – make sure to take full advantage of the time you have with your therapists.

By about the third day after surgery you will be walking with greater confidence. You should also be ready for discharge. Most patients are surprised at how independent they become, and how quickly.

If you have had a total hip replacement there are some restrictions with motion that you need to be aware of to prevent dislocations. These motion restrictions will be for life but are most important during the first two months after surgery.

The therapist will review these with you regularly:

1.

2.

3.

4.

No hip flexion greater than 90 degrees.

No leg adduction past midline.

No internal rotation of your leg.

Use abduction pillow between legs while in bed for two months.

PREVENTING BLOOD CLOTS Every joint replacement patient has a risk of developing deep vein thrombosis, also known as a blood clot. You will be asked to participate in decreasing the risk of this complication. A few simple but important steps will help reduce this serious risk.

• Wear compression stockings. These stocking will be provided to you and will help to keep the swelling down. Plan to use compression stockings on both legs for about one month after surgery.

• Utilize a calf squeezing leg wrap. This will also be provided to you. Use it while you are in bed.

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• Take prescribed medications, such as Warfarin or Lovenox. These medications will continue after you leave the hospital. Patients who receive Lovenox will need to learn how to give self injections or recruit a family member or friend to help. Those who are prescribed Warfarin, will need to have blood drawn regularly at the hospital to check for proper blood levels.

• Exercise. Doing the assigned exercises and movements will help to prevent blood clots. This is why being active early while still in the hospital is so important. Make sure that you do all of the activities assigned to you by your therapist.

BOWEL AND BLADDER Bowel: Pain medications and iron supplements used after joint replacement surgery make most people constipated. To help alleviate this side effect, you will receive a stool softener, which should be taken two times a day, and also a laxative. If you have not had a bowel movement by early evening the day after the surgery your nurse will administer an enema. Preventing constipation is important and, if needed, an enema will be given each day to initiate a bowel movement. Constipation can be a problem while you are taking pain medication and while you are physically less active – especially after you are discharged from the hospital. Drinking fluids, taking a stool softener and exercising will also help to prevent constipation.

Bladder: You may have a catheter to keep your

bladder empty. This will be removed as soon as possible. Some patients may still have a difficult time urinating on their own. Be sure to tell your nurse if you have a difficult time urinating.

Reinserting a catheter is only used as a last option as this procedure also carries a risk of infection.

QUICK CHECKLIST OF ACTIVITIES WHILE YOU ARE IN THE HOSPITAL

1st Day After Surgery

2nd Day After Surgery

3rd Day After Surgery

Your Doctor or Nurse Practitioner will…

Remove drain if you have one

Change your dressing and wear compression stockings

Check your incision and review discharge instructions

You will be out of bed…

3 times a day with assistance of a nurse or therapist

3 times a day with assistance of a nurse or therapist

3 times a day with assistance of a nurse or therapist

Your Physical Therapist will work with you…

2 times a day to review and perform exercises in bed

2 times a day to walk as far as is safe and to review and perform exercises in bed

1-2 times a day to walk as far as is safe and to review and perform exercises in bed

Bowel and Bladder...

Tell nurse if no bowel movement or difficulty voiding

Tell nurse if no bowel movement or difficulty voiding

Tell nurse if no bowel movement or difficulty voiding

YOU will perform breathing exercises...

Using incentive spirometry 10 times per hour

Using incentive spirometry 10 times per hour

Using incentive spirometry 10 times per hour

Lovenox injections...

YOU must learn to give injections or teach family member

YOU must learn to give injections or teach family member

YOU must learn to give injections or teach family member

Discharge Plan...

Review your discharge plan with Case Manager

Confirm discharge plan with Case Manager

Arrange for a ride home or to rehabilitation facility

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SECTION III: POST-OPERATIVE DAILY LIVING SAFETY AND AVOIDING FALLS A fall can be dangerous at anytime, but especially after a joint replacement. The following suggestions may help you prevent falls and injury.

• Remove throw rugs from floors.

• Notice and avoid hazards at floor level, such as pets, toys, and uneven surfaces.

• Install and/or use good lighting, keep a flashlight nearby, and install nightlights in hallways.

• Remove electrical cords from any area where you may walk.

• Wear solid shoes and slippers. Make sure both have good traction soles and backs.

• Use chairs with arms to help you get up and down.

• Avoid dizziness by getting up slowly from chairs and bed.

• Do not lift heavy objects for at least 3 months and discuss with your doctor when you can resume this activity.

• Recognize your temporary limitations and do not act impulsively.

• Do not sit in the same position for long periods of time, including in the car. Move every one or two hours to prevent stiffness.

• Keep all of your doctor appointments.

WHILE IN BED Hip:

• Use a pillow or foam wedge between your legs when on your back or side.

• Do not cross your legs.

• Do not lie on your affected hip unless approved by your surgeon.

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Knee:

• Use a pillow between your knees when on your side.

• Bend your unaffected leg to help push yourself to a new position.

AMBULATION You will be fitted with a walker, crutches, or cane by your physical therapist.

If you use a walker:

1. Stand up straight with the walker a few inches in front of you.

2. Place each hand on the handgrips of the walker.

3. Take a step into the walker with your affected leg.

4. Lean on the walker to give balance and support.

5. Take a step with your unaffected leg.

6. Move the walker forward one step.

7. Repeat the above.

If you use crutches:

There are specific ways to use crutches in the case of a joint replacement. Your physical therapist will instruct you on proper usage for your specific needs.

If you use a cane:

1. Stand up straight with the cane held by your hand on the unaffected side.

2. Move the cane forward one step.

3. Move your affected leg forward.

4. Move your unaffected leg forward.

5. Repeat the above.

TRANSFERS

Getting into bed:

1. Back up to the bed until you feel it behind your legs. Place yourself halfway between the foot and head of the bed. Slide your affected leg out in front of you before sitting down.

2. Reach back with both hands and sit down on the edge of the bed. Scoot back toward the center of the mattress. Slick sheets, slick pajamas, or sitting on a plastic bag may make scooting easier.

3. Move the walker out of your way. Keep it close by.

4. Scoot your hips around to face the foot of the bed.

5. Lift the close leg into bed while scooting around.

6. Lift the other leg into bed. Do NOT cross your legs to help the affected leg into bed.

Keep your legs at least 6 inches apart.

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

8. Place a pillow between your knees (for hip replacement).

Getting out of bed:

1. Move your hips to the edge of the bed while leaning on your elbows.

2. Sit up while lowering your unaffected leg to the floor.

3. Scoot to the edge of the bed while using your hands behind you.

4. Use both hands to push off from the bed.

5. Slide the affected leg out in front of you before standing up.

6. Get balanced before reaching for the walker.

CHAIRS AND TOILETS Hip:

Sit in chairs with high, firm seats in order to keep your hips above your knees. Avoid low sofas or chairs. An extra cushion or pillow may be needed on the seat of a low chair if there is no other choice for sitting. Avoid crossing the affected leg over the

other leg. Always keep your knees about 6 inches apart. It’s safer to keep both feet on the floor or on a stool.

Knee:

Sit in chairs with firm seats for ease of movement.

An extra cushion or pillow may be needed on the seat of a low chair if there is no other choice for sitting. It is safer to keep both feet on the floor or on a stool.

For either hip or knee replacement, a raised toilet seat or a three-in-one bedside commode will be needed over your toilet for about 12 weeks after surgery. Ask your surgeon if precautions need to be followed beyond 12 weeks. Such equipment is no longer needed once you can get up and down from the toilet safely on your own.

Sitting on a chair or toilet:

1. Take small steps and turn until your legs are against the toilet/chair.

2. Slide the affected leg out in front of you before sitting down.

3. When using a commode with armrests, reach back for both armrests and lower yourself onto the toilet. If using a raised toilet seat without armrests, keep one hand on the middle of the walker/crutch/cane while reaching back for the toilet seat with the other hand.

Getting up from a chair or toilet:

1. Slide the affected leg out in front of you before standing up.

2. When using a commode with armrests, push yourself up from the armrests. If using a raised toilet seat without armrests, keep one hand on the middle of the walker/crutch/ cane and push off from the toilet seat with the other hand.

3. Gain your balance and place your hands on the walker/crutches.

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TUB/SHOWER You cannot get down into a tub until your surgeon tells you otherwise. You can safely sit on a bench/chair or stand in a shower. Be sure the tub bench/chair is high enough to keep your hips above your knees. Assure all needed items are within reach prior to your shower.

Use a rubber mat or non-skid adhesive on the floor of the tub or shower. Do not shower until your staples/ sutures are removed unless approved by your surgeon. The instructions below can also be followed for a shower stall.

Getting into the tub using a tub bench:

1. Place the tub bench in the tub. It should face the faucets.

2. Back up until you can feel the tub bench on the back of your legs. Be sure you are fully centered against the tub bench.

3. Slide your affected leg out in front of you before sitting down.

4. Keep one hand on the middle of the walker/ crutch/cane while reaching back for the tub bench with the other hand.

5. Slowly lower yourself onto the tub bench without leaning forward.

6. Move the walker out of your way. Keep it close by.

7. Lift your legs over the edge of the tub as you scoot yourself around. Do not bend more than 90 degrees.

8. Scoot yourself to the center of the bench.

Getting out of the tub using a tub bench:

1. Scoot yourself around as you lift your legs over the edge of the tub. Do not bend more than 90 degrees in the case of a hip replacement. Be sure your legs do not cross.

2. Scoot yourself to the edge of the tub bench.

3. Place one hand on the middle of the walker/ crutch/cane. Push up with the other hand on the back of the tub bench. Do not bend forward.

4. Gain your balance and place your hands on the walker/crutches.

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Getting into a vehicle:

1. Push the seat all the way back. Recline the back of the seat at least halfway.

2. Place a plastic trash bag on the seat to help you turn frontward more easily.

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

4. Slide your affected leg out in front of you.

5. Reach back for the back of the seat with one hand and the dashboard with the other hand.

6. Lower yourself down without bending more than 90 degrees. Be sure to lower your head to avoid hitting it on the doorframe. Scoot backward toward the other seat.

7. Turn frontward, leaning back as you lift one leg at a time onto the floorboard of the vehicle.

8. Center yourself on the seat.

9. Bring the seat back to a comfortable position.

Put on your seatbelt.

Getting out of the vehicle:

1. Push the seat all the way back. Recline the back of the seat at least halfway.

2. Scoot yourself sideways and backward as you lift one leg at a time out of the vehicle and onto the ground. Lean back as you do so.

3. Slide your affected leg out in front of you.

4. Push yourself up with one hand on the dashboard and the other on the back of the seat. Do not bend more than 90째 in the case of a hip replacement. Be sure to lower your head to avoid hitting it on the doorframe.

5. Gain your balance and place your hands on the walker/crutches/cane.

STAIRS General rule of thumb: Go up with your unaffected leg and down with your affected leg.

Going Up Stairs NOTE: Your therapist should give you detailed

instructions on how to go up and down stairs with your walker, crutches, or cane. Below are general reminders related to stairs.

1. Face the stairs. Hold the handrail with one hand.

2. Hold the walker, crutches, or cane with the other hand on the step above you.

3. Step up with the unaffected leg.

4. Step up with the affected leg.

5. Move the walker, crutches, or cane up one step.

6. Repeat the above until you’ve reached your target.

Going Down Stairs

1. Face the stairs. Hold the handrail with one hand.

2. Hold the walker, crutches, or cane with the other hand on one step below you.

3. Step down with your affected leg.

4. Step down with your unaffected leg.

5. Move the walker, crutches, or cane down one step.

6. Repeat the above until you’ve reached your target.

DRESSING

Putting on pants and underwear by yourself:

1. Be sure all needed items are within easy reach.

2. Slide your affected leg out in front of you.

3. Sit down on a supportive surface to maintain your balance.

4. Use a reacher or dressing stick to grasp the clothing. Place your affected leg in first, followed by your unaffected leg. The reacher or dressing stick can be used to guide the waistband over your feet and knees.

5. Pull your pants up to your thighs. The case of a hip replacement, without bending past 90°.

6. Stand with the walker in front of you. Pull your pants up the rest of the way without bending forward.

Taking off pants, underwear, or socks by yourself:

1. Be sure all needed items are within easy reach.

2. Back up to a chair or bed.

3. Unfasten your pants and allow them to fall to the floor. Push your underwear off your hips.

4. Slide your affected leg out in front of you.

Lower yourself down to a chair or bed.

5. Use a reacher or dressing stick to grasp the clothing.

6. Remove your unaffected leg first, followed by your affected leg.

Putting on socks by yourself:

1. Be sure all needed items are within easy reach.

2. Slide your affected leg out in front of you.

3. Sit down on a supportive surface to maintain your balance.

4. Slide the sock fully onto the sock aid.

5. Bend your knee slightly.

6. While holding the cord with both hands, drop the sock aid in front of your foot.

7. Slide your foot into the sock aid.

8. Point your toes and straighten your knee.

9. Pull the sock on and keep pulling until the sock aid pulls out of the sock. Do not lean forward past 90 degrees if you have had a hip replacement.

Putting on shoes by yourself: NOTE: Shoes should have rubber soles. Do NOT

wear high heels or shoes without backs.

Wear one of the following: sturdy slip-on shoes, Velcro® closure shoes, or shoes with elastic shoelaces. Do not tie your own shoes since precautions could not be maintained.

1. Be sure all needed items are within easy reach.

2. Slide your affected leg out in front of you.

3. Sit down on a supportive surface to maintain your balance.

4. Use a long-handled shoehorn, dressing stick, or reacher to slide your shoe in front of your foot.

5. Place the shoehorn inside the shoe.

6. Lean back as you lift your leg to place your toes inside the shoe.

7. Step down into your shoe, sliding your heel downward against the shoehorn.

8. Fasten your shoe by using the reacher to close the Velcro® straps or pull elastic shoelaces tight.

Taking shoes off by yourself:

1. Be sure all needed items are within easy reach.

2. Slide your affected leg out in front of you.

3. Sit down on a supportive surface to maintain your balance.

4. Use a reacher to unfasten your Velcro® straps or elastic shoelaces.

5. Use a long-handled shoehorn, dressing stick, or reacher to slide your shoe off of your foot.

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LONG-TERM JOINT PROTECTION

Choose low-impact activities such as:

• • • • • • • • •

Regular walks in or outdoors.

Walking on treadmill.

Recommended exercise at a fitness center.

Swimming.

Bicycling.

Dancing.

Golfing.

Cross-country skiing.

Aquatics or Tai Chi program (many are sponsored by a local Arthritis Foundation chapter).

• Joints in Motion class (sponsored by a local chapter of the Arthritis Foundation).

• Walk with Ease program (sponsored by a local chapter of the Arthritis Foundation).

• Upper extremity strengthening exercises.

Avoid high-impact activities such as:

• • • • • • • •

Downhill or water skiing.

Jogging or running.

High impact aerobics.

Jumping activities.

Tennis or racquetball.

Football.

Baseball.

Lifting more than 25 lbs. over and over.

Household Tips:

• Maintain clear walkways.

• Do not get down on your knees to scrub floors.

Use a mop or long-handled brush.

• Keep often used cooking or working supplies where they can be easily reached.

• Plan ahead by gathering all cooking or working supplies at one time to work on a project.

• Use a high stool or use cushions to provide a better working height.

• Plan rest periods in-between periods of activity.

• Pace yourself; attempting to do too much at one time can leave you exhausted for the rest of the day.

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• Note your highest energy time of day to tackle a heavier activity.

• Break down a heavy activity into smaller, more manageable ones.

• Push or pull items instead of carrying them.

• Ask for help when you need it.

• Learn to work smarter, not harder.

Note: Many other tips for joint protection,

work simplification, energy conservation, and equipment are available from an Occupational Therapist or the Arthritis Foundation. Check your local phone book for an Arthritis Foundation chapter near you.

Making changes in your diet, such as avoiding foods with vitamin K, will be important. Foods that are rich in vitamin K include the following. More about diet can be found on page 17.

• • • • • • • • • • • • • • • •

Broccoli Cauliflower Brussels sprouts Liver Green beans Garbanzo beans Lentils Soybeans Soybean oil Spinach Kale Lettuce Turnip Greens Cabbage Onions

SECTION IV: YOUR POST HOSPITAL RECOVERY RECOVERY STARTS DAY ONE Your post-hospital recovery begins the day you are discharged from the hospital and transferred to home or to a rehabilitation facility. For the first four to six weeks following surgery most of our patients require and receive some form of therapy – either in an inpatient rehabilitation facility, home care therapy, or in an outpatient therapy setting or a combination of these. Regular exercise is an important part of restoring your normal joint motion and strength, and plays a key role in returning you to your normal everyday activities (see attached exercise program specific to your joint replacement surgery). Your surgeon and your therapist will develop a plan that is best for you.

Your total recovery period is about one year, and you will have many follow-up visits with your doctor and your therapists. Remember to ask lots of questions along the way and to stay on track with your exercise and diet regimen.

CARE OF YOUR SURGICAL INCISION Your surgical incision will be closed using sutures or staples. These will be removed in your surgeon’s office in about two weeks after your surgery.

Taking appropriate care of your wound helps to prevent infection. You can help by following these simple steps: • Keep the area clean and dry. A dressing will be applied to the incision in the hospital and should be changed as necessary. How to do this and how often will be explained to you before you go home or before you leave the rehabilitation facility. If you are not sure how to do this ask your doctor or nurse.

• Watch for changes. Immediately notify your doctor if the wound appears more red and warm or begins to drain liquid. Remember that some swelling is expected for the first three to six months after surgery.

RESUMING YOUR NORMAL ACTIVITIES, MONITORING HEALTH, AND DIET Most joint replacement patients experience a dramatic reduction in joint pain and a significant improvement in ability to participate in the activities of daily living within 2-3 weeks after surgery. Be aware however that recovery takes time. Expect to feel a bit more tired than usual for the first few weeks. Joint replacement surgery is a major event, so allow yourself plenty of time to regain your strength and self-confidence. Stay active – just don’t overdo it!

It is also important to monitor your own health on a daily basis to ensure that your recovery is continuing as planned. You are the best to notice changes in your body and to inform doctors if needed.

• Take your temperature twice daily until your first office visit after surgery and notify your doctor is it exceeds 100.5 degrees.

• Take all of your medications as directed.

• Notify your doctor immediately if you notice tenderness, redness, or pain in your calf, chest pain, and/or shortness of breath. These all could be signs of a blood clot.

• Because you have an artificial joint it is especially important to prevent bacteria from entering your bloodstream that could ultimately end up in your joint implant. Take antibiotics whenever there is a possibility of a bacterial infection, such as when you have dental work, and always remember to tell your dentist that you have had a joint replacement surgery.

By the time you come home from the hospital or rehabilitation facility you should be eating a normal diet. Your physician may recommend that you continue to take iron and vitamin supplements.

Continue to drink plenty of fluids and avoid excessive intake of vitamin K if you are taking blood thinning medication such as Coumadin or Lovenox.

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SECTION V: POST-OPERATIVE GUIDELINES FOR HIP AND KNEE REPLACEMENT PREVENTING BLOOD CLOTS AND REDUCING SWELLING With a joint replacement, as with other major surgeries, it is important to take a few simple steps to prevent blood clots. Blood clots are dangerous, as they can move to other parts of the body, such as the lung, and cause life-threatening complications. Your doctor will assess your risk of blood clots and talk with you about your specific needs. To reduce the risk of blood clots and swelling, he or she may ask you to: • Wear snug stockings at home.

• Elevate your affected leg above heart level for short periods throughout the day.

• Lay flat for short periods throughout the day.

• Take a prescribed anticoagulant medication as directed.

• Complete a regimen of exercises.

• Walk.

CONTACT YOUR SURGEON RIGHT AWAY IF YOU EXPERIENCE ANY OF THE FOLLOWING: • Pain or excessive tenderness in your leg or calf.

• Redness of your calf.

• Swelling in your foot, ankle, calf, or thigh.

CALL 911 IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: • Shortness of breath.

• Chest pain.

• Coughing up blood.

• Unexplained anxiety, especially with breathing.

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CONTACT YOUR SURGEON RIGHT AWAY IF YOU NOTE: • New onset of severe hip or groin pain.

• Turning in or out of your leg that is new.

• Unable to walk or put weight on your leg.

• Increased numbness or tingling of the leg.

• Change in length of the leg.

• A bulge felt over the hip.

If you fall contact your surgeon immediately.

PREVENTING INFECTION The most important thing you can do to prevent infection is to wash your hands thoroughly or use an alcohol-based hand cleanser frequently and before changing the dressing over your incision.

Unless your surgeon has indicated otherwise, do not let your incision or dressing get wet.

Support your body’s ability to fight infection by eating a healthy diet and drinking plenty of water and healthy fluids. Your doctor will discuss with you any possible need to take antibiotics if you undergo any dental work or medical procedures.

Contact your primary care physician if you think you may have an infection elsewhere.

CALL YOUR DOCTOR IMMEDIATELY IF YOU NOTICE: • Increased redness, heat, or swelling around incision.

• Excessive or foul smelling drainage coming from incision.

• Increased pain in the joint replaced.

• Persistent fever greater than 100° F or chills.

PROMOTING WEIGHT LOSS Reaching and maintaining an ideal body weight is one way to help accelerate recovery and mobility, as a lower weight will put less stress on your new joint. You can promote weight loss with an exercise program. Or speak to a dietician, who can provide a healthy weight-loss program.

EXERCISES FOR YOUR JOINT REPLACEMENT One of the most important ways you can help speed your recovery and increase mobility after your hip replacement is to complete your

exercises and to challenge your self a little bit each day. This booklet will help you strengthen and improve the muscles around your new hip or knee. Typically, you will complete 10 to 15 repetitions of each exercise 2 to 3 times each day. While you will be focusing on the leg with the hip or knee replacement, you might want to do the exercises with both legs. Follow all of the precautions outlined here and explained to you by your physical therapist, and remember to breathe in deep, regular breaths.

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SECTION VI: EXERCISES FOR POST-OPERATIVE HIP AND KNEE REPLACEMENT THE FOLLOWING LEG EXERCISES WILL HELP BUILD MUSCLE AND IMPROVE MOBILITY AROUND YOUR NEW JOINT. UNLESS NOTED OTHERWISE, COMPLETE 10 TO 12 REPETITIONS OF EACH EXERCISE 2 TO 3 TIMES PER DAY.

TIGHTE

N

HAM SETS While lying on your back in bed, keep your affected leg bent and the other leg straight. Tighten the muscle on the back of your affected leg. Push the heel down into the bed with the affected leg. Hold for 5 seconds.

20

QUAD SETS While lying on your back in bed, press your knee into the mattress and tighten your muscle on the top of your thigh.

Hold for a count of 5-10 seconds.

TI

G

HT

EN

GLUTEAL SETS While lying on your back in bed, squeeze your buttock muscles together and hold for a count of 5-10 seconds.

TIGHTE

N

HEEL SLIDES While lying on your back in bed, bend your knee and slide your heel to your buttock. Slide it back out straight. Tie a plastic bag around your foot if it makes the foot easier to slide.

STRAIGHT

SLIDE

STRAIGHT LEG RAISES While lying on your back in bed, tighten your thigh muscles and lift the leg up several inches off the bed.

Keep your knee straight and toes pointed up. Hold the leg up for 5-10 seconds and then lower it back onto the bed. Do not continue if this hurts your low back.

21

LYING KNEE EXTENSION Lie on your back in bed. Place a towel roll or ball under the lower part of your thigh. Lift your foot and straighten your knee. Do not raise your thigh off the roll or ball.

STRAIGHT

ANKLE PUMPS While sitting in a chair or lying on your back in bed, straighten your knee and slowly push your foot forward and backward. Repeat 20 times with both ankles, every hour while awake.

22

STRAIGHT

SITTING KNEE EXTENSION While sitting in a chair with your back against the chair back, straighten your knee and hold for a count of 5-10 seconds. Lower your leg back down to the floor.

HEEL RAISES While standing up, hold on to the back of a chair. Raise up on your toes.

TOE RAISES While standing up, hold on to the back of a chair. Lean body weight onto your heels.

Toes should be off the ground. Slowly lower toes back to the ground. * Ask your therapist when you are ready to start this exercise

OW

SL

STANDING KNEE FLEXION While standing up, hold on to the back of a chair. Bend your knee back behind you. Slowly lower it back to the ground.

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KNEE RAISES While standing up, hold on to the back of a chair. Raise one knee at a time as if marching in place. Do not lift your knee higher than your waist. Hold your knee up for 2-3 seconds. Slowly lower it back to the ground.

SLOW STANDING HIP ABDUCTION/ADDUCTION While standing up, hold on to the back of a chair.

Move one leg out to the side. Keep hip, knee, and foot pointed straight forward. Slowly lower it back down to the ground. * Ask your therapist when you are ready to start this exercise

ST

RA

IGH

T

SL O W

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STANDING HIP EXTENSIONS While standing up, hold on to the back of a chair. Bring your leg backward as far as you can. Keep your knee straight.

MINI SQUATS While standing up, place your back against a wall. Slide down the wall until your knees are bent at 30-45째. Slowly raise up to the straight position. * Ask your therapist when you are ready to start this exercise

SLOW

WRIST FLEXION/EXTENSION Sit in a chair with feet flat on the floor. Hold a soup can or bottle of water in your hand. Place arm on the armrest of the chair. Extend wrist up. Bend wrist down.

FOREARM ROTATION Sit in a chair with feet flat on the floor. Hold a soup can or bottle of water in your hand. Place your arm on the armrest of the chair.

Rotate the forearm downward so that the soup can or bottle faces the floor. Rotate the forearm upward so that the soup can or bottle of water faces the ceiling.

25

ELBOW FLEXION Sit in a chair with feet flat on the floor.

Hold a soup can or bottle of water in your hand. Place your arm on the armrest of the chair. Bend your elbow, bringing your hand toward your shoulder. Lower your hand back onto armrest.

ELBOW EXTENSION Sit in a chair with feet flat on the floor. Hold a soup can or bottle of water in your hand. Place your arm on the armrest of the chair. Lift your elbow up toward your head. Bring your hand down toward your ear.

Lift up toward the ceiling.

SHOULDER FLEXION Sit in a chair with feet flat on the floor.

Hold a soup can or bottle of water in each hand. Start with your hands on your legs. Reach your arms toward the ceiling with the elbows straight. Lower your arms to your legs.

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SHOULDER ABDUCTION Sit in a chair with feet flat on the floor. Hold a soup can or bottle of water in each hand. Start with your arms out to the sides, even with your shoulders. Keeping your elbows straight, reach for the ceiling from the sides of your body. Lower arms back toward the sides of the body.

ARM CHAIR PUSH-UPS Sit in a chair with feet flat on the floor. Place hands on the armrests.

Straighten your arms while raising your buttocks off the chair.

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SECTION VII: POST-OPERATIVE GUIDELINES AND EXERCISES FOR HIP REPLACEMENT PREVENTING DISLOCATION Your therapist will work closely with you and teach you precautions about your hip replacement.

It is important to keep these precautions in mind as you do the exercises that will help you strengthen the muscles and adjust to your new hip. Follow these precautions until your surgeon indicates that changes in the following activities, depicted and numbered below are safe:

1

28

4

1. Do NOT bend forward more than 90 degrees.

2. Do NOT lift your knee higher than your affected hip.

3. Do NOT bring legs together or cross 4.

5.

6.

7.

your legs.

Do NOT turn your affected leg inward.

Do NOT twist your body when standing.

Do NOT reach across your affected leg.

Do NOT put more weight on your affected leg than instructed.

2

5

3a

6

3b

7

Setting milestones will help you keep track of your improvement and help keep you motivated to move to the next level.

BY THE END OF WEEK TWO, YOU SHOULD BE ABLE TO: • Walk at least 300-500 feet with your walker, crutches, or cane as instructed.

• Go up and go down 12-14 steps with a rail, one foot at a time, once per day.

• Bend your hip 60 degrees.

• Straighten your hip completely by lying flat for 30 minutes several times per day.

• Shower and dress by yourself.

• Gradually resume light home duties with help as needed.

BY THE END OF WEEK FOUR YOU SHOULD BE ABLE TO: • Complete any remaining goals from week 1-2.

• Wean from a walker or crutches to one crutch or a cane, as instructed by your doctor or therapist.

• Walk at least the distance of 4 blocks.

• Go up and go down 12-14 steps with a rail, one foot at a time, more than once per day.

• Bend your hip to 90 degrees unless told otherwise.

• Resume all light home duties with help as needed.

BY THE END OF WEEK SIX YOU SHOULD BE ABLE TO: • Complete any remaining goals from weeks 1-4.

• Walk with a crutch or cane to complete the distance of 4-8 blocks.

• Go up and down stairs – with a rail – from one foot to another in a normal fashion.

• Bend your hip to 90 degrees.

• Drive a car at 6 weeks if approved by your surgeon.

• Resume all light home duties by yourself.

• Return to light work duties if approved by your surgeon.

BY THE END OF WEEK TWELVE YOU SHOULD BE ABLE TO: • Complete any remaining goals from weeks 1-6 • Walk without a cane or crutch without a limp the distance of 8-16 blocks • Go up and down stairs with a rail • Resume all home duties and low impact activities

29

THE FOLLOWING LEG EXERCISES WILL HELP BUILD MUSCLE AND IMPROVE MOBILITY AROUND YOUR NEW JOINT. UNLESS NOTED OTHERWISE, COMPLETE 10 TO 12 REPETITIONS OF EACH EXERCISE 2 TO 3 TIMES PER DAY.

LYING HIP ABDUCTION/ADDUCTION While lying on your back in the middle of the bed, slide affected leg out to the side as far as you can. Keep your knee straight and toes pointed up. Slide it back to the center. Tie a plastic bag around your foot if it makes the foot easier to slide.

30

STRAIGHT

SL

ID

E

SIDE LYING HIP ABDUCTION Place two pillows between your knees and turn to your unaffected side. Tighten the thigh muscle of your affected leg. Lift the leg 8-10 inches up from the pillow.

SINGLE LEG STEP-UP While standing on the bottom step, hold on to the stair rail. Slowly lower one leg to the floor. Body weight should be supported by the leg on the floor. Slowly straighten the leg on the step. Body weight should be supported by the leg on the step. * Ask your therapist when you are ready to start this exercise

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SECTION VIII: POST-OPERATIVE GUIDELINES AND EXERCISES FOR KNEE REPLACEMENT PREVENTING DISLOCATION Your therapist will work closely with you and teach you precautions about your knee replacement. It is important to keep these precautions in mind as you do the exercises that will help you strengthen the muscles and adjust to your new knee. Follow these precautions until your surgeon indicates that changes in the following activities are safe: • Do NOT stand, bend knees, and twist at

the same time (see below) • Do NOT put more weight on your affected leg than instructed (see below)

CONTACT YOUR SURGEON RIGHT AWAY IF YOU NOTE: • New onset of severe knee pain • Turning in or out of your leg that is new • Unable to walk or put weight on your leg • Increased numbness or tingling of the leg • Change in length of the leg • Apparent deformity of the knee Contact your surgeon right away if you happen to fall.

Do NOT stand, bend knees, and twist at the same time

32

EXERCISES FOR YOUR KNEE REPLACEMENT One of the most important ways you can help speed your recovery and increase your mobility after your knee replacement is to complete your exercises and to challenge yourself a little bit each day. The exercises you will learn with your therapist and outlined in this booklet will help you strengthen and improve the muscles around your new knee and will help you gain mobility in your knee. Typically, you will perform your exercises 10 to 15 times, 2 to 3 times each day. While you will be focusing on the leg with the hip replacement, you might want to do the exercises with both legs.

Follow all of the precautions, and remember to breathe in deep, regular breaths.

Setting milestones will help you keep track of your improvement and help keep you motivated to move to the next level.

BY THE END OF WEEK TWO, YOU SHOULD BE ABLE TO: • Walk at least 300-500 feet with your walker, crutches, or cane as instructed.

• Go up and go down 12-14 steps with a rail, one foot at a time, once per day.

• Bend your knee 90 to 105 degrees.

• Straighten your knee completely by lying flat for 30 minutes several times per day, place a towel under your ankle.

• Shower and dress by yourself.

• Gradually resume light home duties with help as needed.

BY THE END OF WEEK FOUR YOU SHOULD BE ABLE TO: • Complete any remaining goals from week 1-2.

• Wean from a walker or crutches to one crutch or a cane, as instructed by your doctor or therpist.

• Walk at least the distance of 4 blocks.

• Go up and go down 12-14 steps with a rail, one foot at a time, more than once per day.

• Bend your knee 90 to 105 degrees.

• Straighten your knee by placing your foot on a stool for half an hour several times a day.

• Resume light home duties with help as needed.

BY THE END OF WEEK SIX YOU SHOULD BE ABLE TO: • Complete any remaining goals from weeks 1-4.

• Walk with a crutch or cane to complete the distance of 4-8 blocks.

• Go up and down stairs with a rail from one foot at a time to regular way.

• Bend your hip to 90 degrees.

• Drive a car at 6 weeks if approved by your surgeon.

• Resume all light home duties by yourself.

• Return to light work duties if approved by your surgeon.

BY THE END OF WEEK TWELVE YOU SHOULD BE ABLE TO: • Complete any remaining goals from weeks 1-6.

• Walk without a cane or crutch without a limp the distance of 8-16 blocks.

• Go up and down stairs with a rail.

• Bend your knee 90 to 105 degrees.

• Straighten your knee by placing your foot on a stool for half an hour several times a day.

• Resume light home duties with help as needed.

• Resume all work duties and low impact activities.

Do NOT put more weight on your affected leg than instructed.

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THE FOLLOWING LEG EXERCISES WILL HELP BUILD MUSCLE AND IMPROVE MOBILITY AROUND YOUR NEW JOINT. UNLESS NOTED OTHERWISE, COMPLETE 10 TO 12 REPETITIONS OF EACH EXERCISE 2 TO 3 TIMES PER DAY.

DOWNWARD KNEECAP PUSH With thumbs on upper border of kneecap, gently push kneecap toward foot.

UPWARD KNEECAP PULL With thumbs on lower border of kneecap, gently pull kneecap toward hip.

34

SITTING KNEE EXTENSION WITH STOOL While sitting in a chair, place the foot of your affected leg on top of another chair seat or stool. Press your knee down and hold for 30 seconds. Repeat 10 times, 2-3 times per day.

SITTING KNEE FLEXION While sitting in a chair, scoot a little forward. Place a belt or towel under your foot while holding the edges in your hands. Bend your knee as far as you can with the belt/towel. Scoot forward a little more to feel more of a stretch at your knee. Hold for 30 seconds.

SLIDE

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