Nurse Director 6-15-17.pdf · • Bike. If balance or the weather is challenging for you, use a...

Dear Valued Guest, Welcome and thank you for choosing Alpenglow Short Stay Assisted Living as your place of recovery! Alpenglow is designed to streamline the recovery process by alleviating some of the stressors of surgery, launching your physical therapy, providing education and inspiration, and teaching you daily living skills you'll need to continue your recovery at home.

The Alpenglow staff is a multidisciplinary team of highly skilled orthopedic professionals. We will assist you with activities of daily living and pain management — while empowering you to become an active partner in your recovery. After all, recovering from surgery is hard work. Your doctor will encourage you to start using your new knee almost immediately. Initial movement may be difficult and uncomfortable but it is crucial to an optimal recovery. We will give you support and encouragement but ultimately, you are the vital link in the successful outcome of your surgery. Please use this guide as a tool to help you through your pre- and post-surgical process. It contains important details regarding your surgical experience, post -op care, physical therapy activities and frequently asked questions and answers. Again, thank you for choosing Alpenglow Short Stay Assisted Living. We look forward to working with you soon on your way to achieving a pain free, independent and all around better quality of life! Sincerely, Christina Morgan, RN, BSN Nurse Director Alpenglow Short Stay Assisted Living

Important Numbers & Dates

3801 Lake Otis Parkway, Suite 300 907-562-2277

Fax: 907-563-3460 Surgeon: _________________________

Care Team Phone: _________________

Surgery Scheduler

Name: ___________________________

Phone: __________________________

3801 Lake Otis Parkway, Suite 100 907-563-1551

Fax: 907-563-1222

3801 Lake Otis Parkway, Suite 250

907-562-5080 Fax: 907-562-5081

OPA Physical Therapy Suite 210 907-341-5240

ALPENGLOW ACADEMY

Date: ____________ Time: ______________

ALPENGLOW IN-TAKE APPT.

Date: ____________ Time: ______________

PRE-OP PHYSICAL (at you primary care provider's office)

Date: ____________ Time: ______________

ADDITIONAL CLEARANCES (lab work, chest x-rays, etc. as needed)

Dt/Tm: ___________ @ _________________ Dt/Tm: ___________ @ _________________

PRE-OP WITH SURGEON @ OPA

Date: ____________ Time: ______________ PRE-REGISTER PRIOR TO SURGERY DATE

Visit AlpineSurgery.com, click the pink "Scheduled Patient PRE-REGISTRATION" button and complete your preregistration.

SURGERY @ ALPINE

Date: ________ Arrival Time: ___________

POST-OP APPOINTMENT(s) @ OPA

Date: ____________ Time: ______________ Date: ____________ Time: ______________

PHYSICAL THERAPY

Schedule with your therapist and keep up the good work!

Academy Overview By attending the Alpenglow Academy, you are taking a proactive approach to managing your health, which leads to a faster, more successful recovery process. The Academy is an opportunity for you to learn more about what will happen before and after surgery, familiarize yourself with the building and meet some of the staff that you will see while recovering. Please have your support person join you for this class. It should last 1-1.5 hours. After the class you will be asked to complete a questionnaire (as part of our commitment to continuous improvement). Academy Features:

• Education for you and your support person. • Led by nurses and therapists that you will encounter during your stay. • Education on exercises that may be done before and/or after surgery. • Information on how to use assistive devices and other medical equipment you may

need or find beneficial. • Guidance on joint protection. • Energy conservation strategies. • Instructions regarding your prescription medications. • Question and answer session.

This Academy binder will be your guide through every step of the surgery and recovery process. It is only a guide; be sure to follow your surgeon’s orders first and ask questions if you are unsure of any information. Bring this book with you to:

• Academy Class • Your Alpenglow Stay

Table of Contents Welcome

Important Numbers & Dates Academy Overview

A. Preparing for Surgery Overview .................................................................................................................. A1 Pre-op Exercises ....................................................................................................... A2 Long Term Prep Work ............................................................................................... A5 Dental work, Exercise, Smoking, Nutrition, Alcohol, Arranging for Help, Equipment

Near Surgery Day Prep .............................................................................................. A7 Illness, Medications, Diabetic Supplies, Preventing Infection

Preparing Your Home Checklist ............................................................................... A9 Night Before Surgery Checklist ................................................................................ A10 Day of Surgery Checklist ......................................................................................... A11 Day of Surgery Process ............................................................................................ A12

B. Your Alpenglow Stay Admission Details ..................................................................................................... B1 Early Activity ............................................................................................................. B1 Eating & Drinking ...................................................................................................... B1 Managing Pain, Cold Therapy, Nerve Block .............................................................. B2 Coughing & Deep Breathing ..................................................................................... B2 Constipation, Discharge ............................................................................................ B3

C. Post-Op Activities: Physical Therapy, Daily Activities & Exercises Post-op Therapy Progression ..................................................................................... C2 Therapy Do’s and Don'ts .......................................................................................... C3 Daily Activities .......................................................................................................... C4 Your Physical Therapy Plan & Additional Handouts ................................................ C21

D. Going Home Pain Management ..................................................................................................... D1 Showering/Bathing .................................................................................................... D2 Caring for Your Incision ............................................................................................ D2 CPM Use ................................................................................................................... D3 Decreasing Your Risks ............................................................................................... D4 For Lung Complications, Blood Clots & Infection

E. Resources Frequently Asked Questions ....................................................................................... E1 Helpful Links .............................................................................................................. E3 American Joint Replacement Registry Letter ............................................................... E4 Herbal Supplements to Avoid ..................................................................................... E5

A: Preparing for Surgery

Alpenglow Academy | Preparing for Surgery, Page A1

Preparing for Surgery: Overview One of the most important aspects of surgery is your prep work. Time and attention to the details outlined in this section helps ensure your safety, speeds your recovery and optimizes your surgical outcome. Your first task is scheduling pre-op appointments. See previous "Important Numbers & Dates" page. The pages that follow guide you through each phase of preparation in approximate chronological order — from long-term prep work like talking to your doctor about your medications and doing pre-op exercises to night-before instructions to post-op instructions. You'll learn more when you attend the Alpenglow Academy.

Essentials: The day before your operation, Alpine Surgery Center will contact you with your check in time. Do not eat or drink anything after midnight prior to your surgery. If your surgeon or anesthesiologist instructs you to take any medications prior to surgery, take with a small sip of water.

Preparing for surgery varies depending upon your surgeon and your individual needs. Always follow specific instructions from your doctor or nurse and do not hesitate to ask questions if you're ever unsure about anything.


Start and/or Maintain a Pre-Op Exercise Program

It is important to begin to exercise as soon as you know you are having surgery. Exercising will help to strengthen your arm, thigh, and hip muscles to help you recover more quickly after surgery. Cardiovascular conditioning (steady exercise for 10-20 minutes) will greatly help, too. Goals & Cautions Start slowly and if exercise causes pain, fatigue or shortness of breath, slow down or stop, and your surgeon’s office if you're concerned. Increase time or repetitions as your endurance and condition will allow. Work up to a 20-minute program. You should be able to carry on a conversation while exercising, but feel as though you are working fairly hard. General (Cardiovascular) Activities

• Walk, walk, walk! • Swim laps, walk or perform exercises in a (preferable warm) pool. • Bike. If balance or the weather is challenging for you, use a stationary bike.

Specific Exercises For all exercises, generally start with 10 repetitions and work up to 30 as you are able.

1. Chair Push Ups: Put your hands on the arms of the chair and push down in order to lift your body up.

2. Long Arc Quads: While sitting in a chair, slowly raise your foot until your knee is completely straight. Hold for 5 seconds.


3. Quad sets: Lie down on your back with your surgical leg straight out. Push the back of your knee into the bed, tightening up the top of your thigh. Hold for 5 seconds. 4. Straight Leg Raises: Lie down on your back with your good knee bent and foot flat on the ground. Lift the other leg up while keeping the knee straight. Raise your leg no higher than the height of the other leg’s knee.

5. Ankle Pumps: Point and flex your ankles.

6. Gluteal sets: Sitting or lying in bed, squeeze your buttocks together without using your thigh muscles. Hold for 5 seconds.

7. Hip abduction/adduction: Lie down on your back with your legs straight out. Slide your heel out to the side and back in (without lifting leg off bed).

8. Heel slides: Lie down on your bed with your legs straight out. Keeping your feet on the bed, slide the heel of your surgical leg toward your buttock, bending your knee.

9. Short Arc Quads: Lie in your bed with a small pillow/roll under both knees. Gently lift your heel off of the bed, straightening your knee. Do NOT raise thigh off of the pillow. Hold for 5 seconds.


10. Mini-squats: Stand in front of a countertop or other sturdy surface you can hold on to for balance and support. Very carefully, slightly bend your knees like you are going to squat down. Do not go down too far; stop if it becomes painful. Do not let your knees go past your toes. Hold 5 seconds, stand, repeat.

Seated Hamstring Stretch: Sit on firm couch or bed with one leg extended, other leg on floor. Keeping your back slightly arched, gently lean forward. You should feel a gentle pull in the back of your thigh. Hold for 20 seconds, relax, repeat. Perform 1 set of 4 repetitions, twice a day.


Long Term Prep Work Discuss Future Dental Work Discuss with your surgeon and/or dentist about the need for antibiotics prior to certain dental procedures in the future. Stop Smoking Smoking is not only harmful to your lungs, heart, and blood vessels, it also slows the healing process and places you at increased risk of complications during and after surgery. It is very important that you stop smoking. If you need help, speak to your doctor or call the American Lung Association for available smoking cessation programs. Also be aware that Alpenglow is a marijuana, smoke and tobacco-free campus. This includes e-cigarettes, vaporizers and other smoking alternatives. Look at Your Nutrition A well balanced diet, complete with lean protein, vegetables and six to eight glasses of water daily, is recommended before and after surgery. This will aid in healing and help to prevent constipation. Discuss Alcohol and Narcotic Usage If you drink, please discuss with your surgeon a good time to stop or taper consumption of alcohol prior to surgery. A general standard is 48 hours. If you use any other types of controlled substances, tell your doctor. Preoperative use of narcotics and other drugs can have an impact on your surgery and recovery. Arrange for Help It is important that you arrange for a friend or family member to be available to assist you for about two weeks after you are discharged from Alpenglow, until you can become more independent. You will need someone to assist you with meal preparation, light housekeeping, and personal care. You will also need to make arrangements for transportation for the next several weeks, as you will be restricted from driving. It is important that you make these arrangements before having surgery.


Get Equipment as Needed

Continuous Passive Motion Machine (CPM) Your surgeon may prescribe a CPM for you. This machine is used to passively extend and flex your knee to maintain range of motion and decrease stiffness. You will have specific orders from your surgeon regarding the settings and how long you will be on it. This machine will be ordered by your surgeon's office through a third party vendor. The vendor will contact you to set up an appointment to get you measured and oriented to the machine.

Cold Therapy Machine (Game Ready or Iceman) A Game Ready or Iceman may be used to aid in the healing process and decrease pain through ice application. If your surgeon decides that a Game Ready is required, it will be provided by a third party vendor. The vendor will contact you and make an appointment to get you oriented to this type of cold therapy machine. If your surgeon decides an Iceman is to be used this will be provided and applied at the end of your surgery at Alpine Surgery Center.

Assistive Devices Assistive mobility devices will be discussed with you upon your initial visit with the physical therapist after your surgery. During your sessions, you and your physical therapist will work together to figure out which mobility device is best for you (e.g., crutches or a walker). The physical therapist will fit the device to you and show you how to use it properly. Some insurance companies may cover the cost of the mobility devices. If you already have a walker or crutches, bring this device with you. You may also want to consider purchasing other assistive equipment such as a shower chair, tub transfer bench, or toilet riser. You can also borrow them from friends, family, or a loan closet.


Near Surgery Day Prep Illness If you develop any illness such as a cold, flu, temperature, skin rash or infection, or a “flare-up” of a health problem in the 10 days prior to your surgery, it is important that you notify your surgeon’s office immediately. Sometimes minor health problems can be quite serious when combined with the stress of surgery. Try not to damage, cut, or scratch the skin, especially on your operative leg. Animal scratches or bites, infection, etc., could result in your surgery being delayed. Medications Are you taking any blood thinning medications? If so, speak to your provider and/or Primary Care Physician as soon as possible about this and your upcoming surgery. You may need to stop these types of medications up to 14 days prior to your surgery – this should be done only with guidance from a provider. Two weeks before your surgery you may be required to discontinue or avoid aspirin or aspirin containing products (for example: Bufferin, Anacin, Excedrin, Fiorinal, Aspirin with Codeine, Darvon Compound, Soma Compound, all Alka Seltzer products, Pepto Bismol) and nonsteroidal anti-inflammatory medications (NSAIDs such as: Ibuprofen, Nuprin, Advil, Motrin, Aleve, Indocin, Naprosyn, and Relafen). Please talk to your surgeon if you are taking baby aspirin or Plavix for further instructions. You should also avoid natural and over-the-counter medications such as Ginkgo Biloba, Vitamin E, Feverfew, and Green Tea capsules. All of these can thin your blood, increasing the risk of blood loss during surgery. If you are on any of these medications for a medical condition, talk with your surgeon before discontinuing use. If taking any diet pills, discuss these medications as soon as possible with your doctor to avoid having to reschedule your surgery. Some of these medications should be discontinued a minimum of 14 days prior to surgery. Bring a complete list of ALL medications you take to your pre-op appointment. Be sure to include both prescription and over-the-counter medications and include the dose and frequency. If you need pain medications prior to surgery, please talk to your surgeon. At your pre-op appointment your surgeon may give you prescriptions for use after your surgery; fill these ahead of time and bring them with you to surgery in the original bottle. You will start using these once you arrive at Alpenglow. Your surgeon may recommend you take some medications the morning of surgery; if so, take them with only a small sip of water.


Diabetics If you are a diabetic you will need to bring your own glucometer (blood sugar machine) and diabetic supplies. You will continue to take diabetic medications as ordered unless otherwise instructed by your physician. Keep in mind that the stress from surgery can raise your blood sugar. Constipation You may normally have no problems with this in your daily life; however with surgery, a decline in mobility, and the use of narcotics, your risk for becoming constipated can increase. Please pay attention to your bowel movements prior to surgery and let your nursing staff know if you are experiencing problems. Be sure to drink plenty of water and include fiber in your diet to help prevent this problem. There are many over-the-counter remedies to treat constipation. We recommend you purchase bowel medications prior to surgery. Decreasing Your Risk for Infection Shower the morning of surgery. DO NOT SHAVE WITHIN THREE DAYS OF SURGERY. If you have been provided a medicated cleansing agent such as Chlorhexidine Gluconate use as directed. Steps to use Chlorhexidine Gluconate soap (not wipes):

1. Prior to showering, place clean linens on your bed – after using a medicated wash you should get into a clean bed.

2. Once in the shower, wash your hair and face normally, using your normal

products.

3. Apply a large amount of Chlorhexidine to a clean wet wash cloth. Wash your entire body (avoiding your head, face and genital areas).

4. Repeat these steps each time you shower using this product.

Stop use of cleansing agent if you develop irritation or problems.


Preparing Your Home Checklist For your safety, it's important modify your home environment prior to surgery.

Bedroom ! Place clean linens on your bed. ! Make sure that you have nightlights in all hallways and rooms. ! Keep a flashlight at bedside. ! Place a cordless phone within reach on nightstand. Bathroom ! Consider installing grab bars on walls of the shower, tub, and toilet. ! Move toilet paper so you can reach it from the toilet without bending or twisting. ! Explore purchasing a hand-held showerhead and a shower chair, which will allow you to sit

during showers, once allowed; a long handled sponge is useful, too. Living Space ! Remove or tape down all throw rugs or other objects on the floor, such as electrical or

telephone cords. These items could cause you to trip and fall. ! Have a firm chair that has armrests, a high seat and a straight back available for you to use. ! Enlist help to rearrange furniture, allowing clearance (at least 2 ft.) for your assistive device. ! Low chairs, swivel chairs, or rolling chairs are not safe for you to sit in after surgery. ! Place a list of emergency numbers by each telephone. ! Move commonly used items to waist level to avoid reaching up or down to get them. Wardrobe/Closet ! You will need low or flat, broad-heeled, non-skid shoes that are properly fitted and have a back

to them. ! Allow ease in dressing by wearing elastic waist or drawstring garments. ! Find some knee-length gowns/nightshirts and robes that won’t get in the way when you walk. ! Find an apron with pockets to hold things like a cell phone, tissues, TV remote, medications,

juice boxes, etc. ! Place frequently worn items in higher drawers (so you don't have to bend or stoop). ! Some adaptive equipment may prove helpful during your recovery: reacher, long handled shoe

horn, long handled bathing scrub sponge, elastic shoe laces, sock donner, and a dressing stick. Household chores ! Purchase over-the-counter stool softeners and/or laxative in preparation of post-operative

constipation. ! Arrange to have someone collect your mail and care for your pets. ! In inclement weather, arrange for someone to clear your walkways of ice and snow. ! Pre-clean your home. Have beds made with fresh linens. Have laundry washed, dried and put

away. ! Prepare meals and freeze in single-serving containers for easy meals after surgery.


Night Before Surgery Checklist

! Shower. Unless otherwise instructed by your doctor, wash and scrub yourself thoroughly, preferably with antibacterial soap, to minimize the risk of infection. Be sure to scrub under fingernails and toenails and remove any nail polish. DO NOT SHAVE.

! Do not eat or drink anything after midnight unless directed by your surgeon or Alpine staff. You will be contacted by someone from Alpine Surgery Center with instructions the day before your scheduled surgery day.

! Do NOT smoke at least after midnight.

! Any medications, including pain pills you are taking, should be taken the day of surgery ONLY if instructed by the staff, and with only a small sip of water, no later than four hours before your arrival time. If you have any questions, please call Alpine Surgery Center.


Day of Surgery Checklist Day of Surgery

! Shower. ! Wear something comfortable and easy to remove. ! Remove all jewelry prior to your arrival, including those in body piercings. Leave

these at home. ! Do not wear lotion, perfume or cologne. ! Brush your teeth — but do not drink or swallow any water.

Bring

! This Academy Binder. ! Pre-op Packet. ! Living Will and/or Advance Directives, if you have them. ! Current medical insurance card(s) and photo identification. ! If payment is required at Alpine Surgery Center, bring ONLY the amount of cash

necessary or a check or debit/credit card to cover these expenses. ! All prescription medications (including daily and as-needed medications) in their

original containers, with visible expiration dates. Including all pre-filled prescriptions that were given to you in your preoperative appointment.

! Personal hygiene items (toothbrush, toothpaste, deodorant, comb, brush, etc.) ! Glasses, contacts lenses with solution and case, hearing aids with extra batteries,

dentures and their containers. ! Comfortable, loose, easy-to-put-on clothing such as shorts with an elastic waist

band; ! Shoes with nonskid soles; ! Any assist devices (such as crutches or a front wheeled walker). ! If you have sleep apnea, bring your CPAP or BiPAP, including equipment and the

necessary water. ! If diabetic, bring your glucometer, test strips, lancets and any other necessary items. ! A responsible adult support person. (Please remember that space is limited and be

aware that all residents will have others with them.)

Do NOT ... • Bring weapons. • Wear any metal products (such as hair clips, bobby pins, jewelry) or nail polish. • Bring valuables such as large amounts of cash, jewelry, watches, nonessential

credit cards, and laptop computers. Cell phones are permitted, but it is recommended that they be kept with a friend or family member for safekeeping.


Day of Surgery Process Arrive on Time to Alpine Surgery Center Unlike at the hospital, all surgeries here are scheduled, so it is important to arrive on time. Your arrival time at the center will be approximately 1.5 hours before your scheduled surgery start time. This allows time for registration, evaluation and preparation for surgery. Alpine Surgery Center will call you the evening before your surgery with your check in time or the Friday before, if your surgery is on a Monday. Follow Instructions & Ask Questions Please follow all instructions you receive. Let us know if you might be pregnant, on blood thinning medications, or if at any time you do not understand what is happening. Check-in You will arrive to the Alpine Surgery Center, located on the 1st floor of the OPA building. Please be sure to arrive at the time given to you. This time takes into consideration all of the preparation needed before your actual surgery start time. Being late could delay your surgery and others. Pre-op You will be admitted by a pre-op nurse who will get you ready for surgery. To do this, he/she will start an intravenous line (IV) to give you fluids, administer any pre-surgery medications including antibiotics and/or pain medication, and review your health history and allergies. You will also meet your anesthesiologist who will discuss the medications that will be used during surgery. This is a good time to ask questions about what to expect during surgery and discuss pain management options for after surgery. (Pain management is also discussed in Section E). Recovery Room Once surgery is done, you will be taken into the recovery area where highly trained nurses monitor your recovery. The staff may apply Sequential Compression Devices (SCDs) to your lower legs to help with circulation. During your time in recovery you may have an X-ray taken of your surgical area. After you have met discharge criteria you will be discharged from Alpine Surgery Center.

YOU WILL WALK AS SOON AS POSSIBLE AFTER YOUR SURGERY

B: Your Alpenglow Stay

Alpenglow Academy |Your Stay at Alpenglow, Page B1

Your Alpenglow Stay Admission into Alpenglow Nursing staff will make you feel at home at Alpenglow. One guest, preferably your support person, is welcome to stay overnight in your room; the chair in the room folds into a sleeping surface. Alpenglow doors may be closed at times for security purposes; visitors will need to have a personal phone to call you or the front desk so staff can let them in. After your discharge from Alpine Surgery Center you may have an IV, drains and/or other equipment present. You will receive IV antibiotics for the first 24 hours following your surgery to decrease risk for infection. The IV may also be used to give pain medications or fluids as necessary. You will likely be wearing sequential compression devices on your lower legs or feet to decrease your risk for blood clots. You may have anti-embolism stockings on. Ice therapy will be used to help with inflammation and pain. Your length of stay at Alpenglow will be established by your surgeon. The goal is to help you get home as soon as you are able. The therapists will teach you exercises, instruct you on the use of assistive devices and help with range of motion. Early and Frequent Activity is Key to Recovery! You will be getting out of bed to WALK as soon as possible after your admission to Alpenglow. Residents are encouraged to WALK to the bathroom with assistance until they are able to do so safely on their own. You will most likely go to Physical Therapy the day of surgery. Your therapy will take place in a state-of-the-art rehabilitation suite that is located just down the hall from your room. You will be instructed on precautions, the proper way to move and perform activities of daily living, and a home exercise regimen. A customized therapy program will be developed for you by your Physical Therapist. The most important thing to remember is that MOVEMENT IS KEY. You should WALK multiple times each day. The more you WALK, the better. Eating and Drinking Your diet will be advanced as tolerated as soon as you are tolerating beverages and food; this means you will begin by taking small sips of water or clear liquids. If you do not experience any nausea, your intake will gradually be increased until you are able to tolerate solid foods. Meals are provided three times a day for Alpenglow residents. We will have snacks and juices available upon request.


Managing Your Pain Post-surgical pain is a complex response to tissue damaged during surgery; both bone and tissue are undergoing a healing process that will not be complete for several months after your operation. There are many avenues of pain relief including cold therapy, pain medications or alternative non-medical methods such as music therapy. After your surgery you should anticipate some pain. To help us minimize your pain (so you can get up and MOVE), we will ask you to rate the intensity of your pain through the use of a pain scale from 0-10 (0 is no pain, 10 is the most excruciating pain you have ever felt). Understand that a pain goal of 0 is not realistic but a score between 3-5 is an attainable and acceptable score for most patients. It is critical to stay ahead of your pain. We will work closely with you to manage your pain. When your pain is controlled, you recover faster (and WALK more). Careful pain management will allow you to eat, sleep, move, do your therapy, and begin doing normal activities. Management of your post-surgical pain is a high-priority. Don’t be afraid to ask for pain medication when you need it. Cold Therapy The application of ice to your surgical site is instrumental to your healing process. Ice therapy helps decrease bleeding, swelling and pain. Your surgeon may order ice application following your surgery, which may consist of ice packs or an ice machine. Be sure to intermittently utilize ice therapy, 20 minutes on followed by 20 minutes off. Also, keep a thin barrier between your skin and the cold therapy device. It can also be helpful to intermittently apply an ice pack to the back of your knee, if you do not have an ice machine that covers this area. Nerve Block A nerve block can be combined with surgical anesthesia after a total knee replacement. The nerve block will be applied before surgery. It may be referred to as your nerve block, pain ball or On Q ball. On Q is the brand that is used. A continuous nerve block generally lasts 3 to 5 days after your surgery and will be removed by you or your support person at home. You will have a dressing over where it goes into your thigh to keep it secured to your body. The block provides numbing medicine to the leg with a goal to decrease pain but keep mobility. Because mobility can be affected, your surgeon may instruct you to use a knee immobilizer when walking. Coughing and Deep Breathing You will be encouraged to take deep breaths and cough after your surgery 8-10 times an hour while awake. Deep breathing while walking and during therapy is also good for your lungs, as this will help keep secretions in your lungs from accumulating. When fluids accumulate it can lead to pneumonia. Your doctor may order an Incentive Spirometer device to assist you with your deep breathing exercises. If this has been ordered for you, you will receive instruction on it. You should continue to use it in the post-surgical period.


Constipation Constipation often occurs with pain medication, anesthesia and/or a decrease in activity. Moving (WALKING) as much as possible, staying hydrated and eating plenty of fiber can all be helpful in preventing constipation. If you have a history of trouble with constipation please let your nurse know. Prevention is always more pleasant than the treatment of constipation. You should take stool softeners while taking narcotics. You can use over-the-counter methods and drink prune juice. If you do not have a bowel movement by the second or third day, you may need a laxative, suppository, or enema to relieve your constipation. Discharge Your stay in Alpenglow will likely be within 24 to 48 hours, depending on the plan created for you by your surgeon. It is very important to have someone present for the review of discharge instructions. You will also need to have someone available to drive you home. You are not allowed to drive while taking narcotics. The need for continued outpatient physical therapy will be discussed prior to your discharge home. Ongoing need for therapy after discharge will be discussed with your clinic team at your post-operative appointments.

C: Post-Op Activities:

Physical Therapy, Daily Life & Exercises

Alpenglow Academy | Post-Op Activities, Page C1

Post-Op Activities: Physical Therapy, Daily Life & Exercises

Post-Op Therapy Progression .............................................................................. C2

Therapy Do's & Don'ts ........................................................................................ C3

Daily Activities

Lower Body Dressing ..................................................................................... C4

Getting Around Post-Op

Toilet Transfers ......................................................................................... C6

Chair Transfers .......................................................................................... C7

Car Transfers ............................................................................................. C8

Bed Transfer ........................................................................................... C10

Bed Positioning ............................................................................................ C12

Bathing Following Surgery ........................................................................... C13

Using Walkers

Safety Tips for Using a Wheeled Walker .................................................... 15

Walking Method (Front-wheeled Walkers) .............................................. C16

Managing Curbs ..................................................................................... C17

Using Crutches

Sitting Down & Standing Up ................................................................... C18

Walking .................................................................................................. C19

Maneuvering On Stairs ........................................................................... C20

Your Therapy and Home Exercise Program & Other Handouts .......................... C21


Post-Op Therapy Progression Your therapy progression may vary depending on the type of knee surgery you have had. If this is your first knee replacement, most likely you will be allowed to place as much weight as you can tolerate through your operated leg. Your nurse or physical therapist will be able to clarify this for you. If you have been prescribed a CPM, this could start the day of surgery or the day after surgery. Generally the CPM is used 3 times per day, 2 hours at a time, for 3 weeks.

• Day of surgery: Your Physical Therapist will see you for an initial evaluation to assess your pain, function, mobility, and home situation. You will be encouraged to wear your own comfortable clothing (e.g., loose fitting t-shirt and shorts). If you require any special equipment to help with dressing or bathing, your therapist will teach you how to use it. Getting up and walking with your nursing staff and therapists will be of the utmost importance to your recovery, and you should always use the assistive device, fit by your therapist, to ensure safe mobility. You may even begin going up and down stairs if you will have to manage them at home and are doing well enough today. In most cases your immediate post-op home exercise program will be very similar to your pre-operative exercise program, with your PT making adjustments as needed for your situation. You may require help to complete many of these exercises this soon after surgery. That is okay! It will get easier every day.

• Day 1 after surgery: Your nurses will continue to monitor your pain and dressings.

Depending on your surgical procedure and living situation, you may go home today. Until you are ready to return home, you should expect to receive therapy 1-2x/day to help with your mobility and function. Whether in your home or at Alpenglow, it is important that you get up to walk regularly, at least every two hours throughout the day, and continue your home exercise program.

• Day 2-7: Continue walking with your assistive device regularly throughout the day,

at least 300-500 feet at a time. Use a railing to climb or descend stairs. Gradually resume homemaking tasks, but don’t be afraid to ask for help when needed. Complete your home exercise program, issued by your therapist, twice a day. You should be able to actively bend your knee at least 60 degrees by the end of this week.

• Week 2-4: Your goals for this time period include: using a less supportive assistive

device, walking at least ¼ mile, climbing and descending a flight of stairs (12-14) more than once daily, bending your knee at least 90 degrees, independently showering and dressing, resuming homemaking tasks and completing your home


exercises twice daily. You should expect to be going to outpatient physical therapy 2 - 3 times per week to increase your mobility, range of motion and strength. Your physical therapist will also revise your home exercise program to be most appropriate for your needs.

• Week 4-6: Your visit frequency for PT may reduce to 1-2 times per week, requiring more vigilance on your part to comply with your home exercise program and thus help ensure a successful outcome. You should notice you are much more independent in all of your daily tasks and may be using only a cane for mobility at this time. You should walk ¼-½ mile every day and may start to climb stairs in a step-over-step manner. Your knee range of motion should be 110-120 degrees. Driving restrictions are usually lifted during this period.

• Week 6-12: Skilled physical therapy will most likely be completed, but you will be

continuing with the customized home exercise program your therapist created for you. You should be walking and negotiating stairs without an assistive device and able to increase your walking to ½-1 mile daily. You may resume all normal activities, as discussed with your surgeon. Depending on the type of knee replacement, general health and prior level of activity, exact timeframes for a safe return to more intense household activities and recreational activities or sports will differ among patients. Your surgeon, physician’s assistant, and physical therapist will work together to guide you.

Post-Op Therapy DOs and DON’Ts

DO • DO plan ahead! Gather all needed supplies at one time and sit to complete tasks

(i.e., grooming, cooking, etc.) • DO perform your home exercise program as directed twice daily. • DO get up and walk with your assistive device hourly. • DO rest your HEEL on a pillow when resting/sleeping. • DO dress operated side first and undress operated side last.

DON’T

• DON’T place a pillow under your knee for sleeping or resting! This slows the healing process and may prevent a full recovery.

• DON’T pull up on a walker when trying to stand.


Daily Life Activities

Lower Body Dressing After Surgery The use of a reacher, long-handled shoehorn and sock aid will help you get your lower body dressed without breaking any precautions you may have. Gather your underwear, pants, socks and shoes, reacher, long-handled shoehorn, sock aid, and walker or other assistive device. Place everything within easy reach. Choose clothes that fit loosely. Put on your socks, pants, and shoes before you stand to pull clothing over your hips. Wear rubber soled slip-on shoes or use elastic shoelaces. TIP: It is easiest to have your pants pulled above your knees before you stand to avoid a fall (putting you at risk for breaking your hip) or having to sit back down! And remember - if you have a weight-bearing precaution, when you go to stand to pull up or adjust your clothing, put only as much weight as your doctor allows on your surgical leg. Putting clothes on:

1. Lay out your skirt, pants, or underwear as you normally would. 2. Sit down. Use the reacher to pinch the waist of the garment. 3. Lower the garment to the floor. First, slip it over the surgical leg. Then slip it over

the other leg. (See picture below.) 4. Use the reacher to pull the garment up and over your knees. 5. Stand up with your walker in front of you, being sure to keep your balance. 6. Pull the garment up and over your hips and sit down, if needed, to secure the

garment.


Taking clothes off:

1. Stand up with your walker in front of you and a chair or bed right behind you. Be sure to have your balance before unzipping or unbuttoning your garment.

2. Push the garment down over your hips and knees, if possible. 3. Sit down safely. 4. Lower the garment to the floor and slide foot of your stronger leg out first. 5. Then use the reacher to pinch the waist of the garment and fully remove it from the

weaker leg. To put on socks or hosiery:

1. Place the sock aid into your sock or stocking. Make

sure the heel of your sock is at the back of the sock aid. For support hose, be sure to spread the hose over the sock aid evenly, without “bunching.”

2. Holding the sock aid by the straps with both hands, put the sock aid on the floor in front of the foot on your weaker or surgical leg.

3. Slide your foot into the sock aid, then pull on the straps to pull the sock onto your foot.

4. Keep pulling until sock is all the way up your leg and sock aid comes out. 5. Follow the same steps to put a sock on the other foot.

To remove socks or hose: Use your long-handled shoehorn, reacher, or dressing stick to push the sock down along the back of your leg and heel, then off your foot. Use your reacher to pick up your socks from the floor. To put on shoes:

1. Pinch the tongue of the shoe with your reacher and line it up with your toes. 2. Slide your foot into the shoe. (You may also want to use a long-handled shoehorn

to help slide your heel into your shoe.) Note: Adaptive equipment shown in these illustrations may not be necessary for all patients. Your therapist may tell you other ways to dress and undress, based on your needs.


Getting Around After Leg Surgery How to transfer yourself to and from beds, cars, chairs and toilets.

Toilet Transfers

Sitting down on a toilet:

1. Use your walker, cane, or crutches for support to back up to the toilet until you feel it behind your legs.

2. Keep your weaker leg slightly in front of you.

3. If you have an elevated toilet seat or commode with armrests, let go of assistive device and reach back with both hands (see picture below). Otherwise, leave one hand on the walker, cane, or crutch and reach back to the toilet seat with the other hand. (If safety bars or walls are close by, they may be used for assistance.)

4. Use your stronger leg and arms to slowly lower yourself onto the seat.

Getting up from the toilet:

1. To get up, put your weaker leg slightly in front of you and bend your stronger leg.

2. Use your arms to help push off from the rails or seat to standing.

3. Once standing, get your balance before reaching for your walker, cane, or crutches.

Safety tips for Toilet Transfers:

• An elevated toilet seat or raised commode (with handrails) may prove helpful and more comfortable for this transfer.

• Do not pull up on your walker. This could cause the walker to tip, and you could fall.

• Tuck foot of your leg close to the commode to stand. • Be sure you have your balance before reaching for your walker, cane, or crutches.

Note: Your therapist may show you different ways to get on and off the toilet or bedside commode,

depending on your situation. Follow the instructions you are given.


Chair Transfers Sitting down:

1. Choose a sturdy chair with armrests. DO NOT sit on a chair with wheels!

2. Use your walker, cane, or crutches for support and back up to the chair until you feel it behind your legs.

3. Move your weaker leg forward, so that it is slightly in front of you.

4. Bend your stronger leg as your reach back for the armrests with both hands. Slowly lower yourself into the chair. (DO NOT plop!)

Getting up:

1. Scoot forward in the chair until sitting on front half of chair. Gently slide your buttocks forward by shifting your weight side to side, keeping your weaker leg slightly in front of you. (Do NOT just bend forward at the waist to move to the front of the chair!)

2. Bend the knee on your stronger leg so your foot is close to the seat, then push up on the armrests using both hands and your stronger leg to stand up.

3. Wait after standing to get your balance, reach your assistive device, then start walking.

Safety tips for Chair Transfer:

• Do not pull up on your walker. This can cause the walker to tip. • Tuck your stronger foot under your thigh/closer to the chair to stand. • Add pillows to low, soft chairs to raise the seat height. • Always wait a few seconds after standing before you start to walk.

Note: Your therapist may show you different ways to get in and out of a chair depending on your situation. Follow the instructions you are given.


Car Transfers

Getting safely in and out of a car takes a lot of bending. These tips will make it easier for you to learn how to get in the back or front seat of your vehicle. Avoid low riding vehicles if possible. Getting in/out of the BACK seat of a car:

1. Be sure the front seats of the car are as far forward as possible.

2. If your right leg is hurt, you should enter the back seat on the passenger’s side of the car. If your left leg is hurt, enter the back seat on the driver’s side.

3. The car should be parked several feet away from the curb. With the back car door open, stand on the street as close to the car as possible.

4. Turn so your back is to the seat. Back up until you feel the car seat behind both legs.

5. Place one hand on the back of the front seat. Place your other hand on the back seat. Never use the car door for support. (Let the driver put your assistive device into the car for you.)

6. Carefully lower yourself onto the car seat. Use your hands and other leg to slide back along the seat, keeping your injured or surgical leg on the seat.

7. Do the reverse to get out of the car.


Getting in/out of the FRONT passenger seat of a car:

1. Be sure the front seat is as far back as it will go. Recline seat all the way back.

2. The car should be parked several feet away from the curb. With the front door open, stand on the street, as close to the car as possible.

3. Turn so your back is to the seat. Back up until you feel the car seat behind both legs.

4. Place one hand on the back of the car seat. Place your other hand on the car dashboard. Never use the car door for support. (Let the driver put your assistive device into the car for you.)

5. Carefully lower yourself onto the car seat. Use your hands and other leg to slide back as far as you can. Lean backward, keeping your shoulders behind your hips as you slide back.

6. Bring your legs into the car one at a time. Move each leg a few inches at a time. If you need to, use your hands to help move your legs.

7. Continue to do this slowly until you are facing forward. Be sure that your hips are at, or slightly higher than, the level of your knees while seated.

Safety Tips for car transfers: • If you have had a total hip replacement and the car seat causes your knees to be higher

than your hips, use a firm pillow to essentially raise the level of the seat. • Place the pillow in a garbage bag and then put it on the seat. This will make it easier

for you to move on the seat. • Use pillows to support your back, if your doctor says you may. • Always wear your seat belt. Note: Your therapist may show you different ways to get in and out of a car, depending on your situation. Follow the instructions you are given.


Bed Transfers Keeping your operated leg on the outer side of the bed that you will get in and out of will make moving around in bed much easier. Use a leg lifter if needed. Getting INTO bed, toward your stronger side (see pictures below):

1. Sit on your bed — closer to the head of the bed than the foot of the bed.

2. Scoot back as far as you can onto the bed (to the backs of your knees, if possible). While scooting, keep your hands flat on the bed, behind your hips.

3. Using your arms to support yourself, turn your body a little toward the foot of the bed as you slide your stronger leg onto the bed. Then slide your weaker leg onto the bed. You may bend your stronger leg to help you get onto the bed.

4. Gently lower yourself back onto the bed.

Getting INTO bed, toward your weaker side (see picture below):

5. Sit on the edge of your bed.

6. Scoot back while angling toward the head of the bed.

7. Slide your surgical leg onto the bed while pushing back with your stronger leg (either on floor or bed). Do this until you are well positioned on the bed. A leg lifter may help.

8. Gently lower yourself back onto the bed.


Getting OUT OF bed:

1. Push yourself up into a sitting position (with your legs straight out in front of you). Place your hands flat on the bed slightly behind your hips.

2. Move your weaker leg while you turn your body to face the edge of the bed. Slide your weaker leg off the bed (if it is on the outside), then slide your stronger leg off of the bed. A leg lifter may be helpful to support the weight of the weaker leg. (DO NOT use your stronger leg to lift your weaker leg unless specifically instructed to do so by your therapist.)

3. Scoot forward until your feet are touching the floor. Wait a moment and then slowly stand.

Note: Your therapist may show you different ways to get in and out of bed, depending on your situation. Follow the instructions you are given.


Bed Positioning Following Surgery

Use pillows to keep you comfortable — and to keep your legs apart.

Top-down view — using a pillow to keep your knees apart:

When resting on your side, use a large pillow to keep your legs apart and do not bend your knees or hips.

Do not cross your legs.


Bathing Following Surgery Before you shower or bathe, be sure you have everything you will need — shampoo, soap, sponge, long-handled brush, and towel — within reach. You may also want a bathrobe or your clean clothes nearby. Some people will require assistance for transfers and/or bathing following their surgery. Don’t be afraid to ask for help! Have non-skid bath mats in place for safety. Properly installed grab bars can also be useful. A tub seat/shower chair and hand-held shower head may also be helpful. Do NOT lower yourself to sit in the base of the tub. See your post-operative instructions for water immersion precautions. Getting into a shower stall with chair facing shower controls:

1. Using your walker, cane, or crutches for support, walk to the edge of the shower stall, then turn so your back is to the stall. DO NOT step into the shower stall.

2. Place one hand on the shower chair backrest, keep your weaker leg slightly in front of you, and leave your other hand on the walker, cane, or crutches (see picture below).

3. Use your hands and stronger leg to lower yourself onto the shower chair, then set your walker, cane, or crutches safely nearby.

4. Scoot back so you’re firmly on the chair. 5. Lift your legs over the edge of the shower stall as you turn to sit facing the shower

controls. 6. Shower and then dry off while still seated. If you have a robe or clean clothes

nearby, you may prefer to get dressed right here. Getting out of a shower stall:

1. While seated, turn your body and legs to face the opening of the shower stall.

2. Scoot forward on shower chair, keeping your weaker leg slightly in front of you.

3. Bend your stronger leg and stand, pushing off the back of the shower chair to help.

4. Once you have your balance, reach for your walker, cane, or crutches and carefully step out of/ away from the shower stall.


Getting into a bathtub with tub seat facing the faucet:

1. Using your walker, cane, or crutches for support, walk to the side of the tub, then turn so feel the tub on the back of your legs. DO NOT step into the tub.

2. Place one hand on the tub seat backrest, keep your weaker leg slightly in front of you, and leave your other hand on the walker, cane, or crutches (see picture below).

3. Use your hands and stronger leg to slowly lower yourself onto the seat, then let go of your walker, cane, or crutches.

4. Scoot back so you’re firmly on the seat. 5. Lift your legs over the edge of the tub one at a time as you turn to sit facing the

faucet. 6. Wash (a special hand-held shower hose attachment for your faucet can make this

easier) and then dry off while still seated. If you have a robe or clean clothes nearby, you may prefer to get dressed right here.

Getting out of the tub seat:

1. While seated, turn toward edge of tub and lift your legs over the side one at a time. 2. Scoot forward on tub seat if possible, keeping your weaker leg slightly in front of

you. 3. Bend your stronger leg and stand, pushing off the back of the tub seat to help. 4. Once you have your balance, reach for your walker, cane, or crutches and

carefully walk away from the bathtub. Note: Your therapist may show you different ways to get in and out of the shower or tub depending on your situation. Follow the instructions you are given.


Using Walkers Tips for walking, negotiating curbs and stairs, and being safe.

Safety Tips for Using a Wheeled Walker

• Do not take a step unless all 4 legs/wheels of the walker are on the ground.

• Do not push the wheeled walker too far ahead of you. Keep the walker’s back legs at least even with your toes.

• Always keep part of your body (at least your toes) inside the frame of the walker.

• Do not lean forward over your walker. Work at maintaining good posture.

• To get up from sitting, do not pull up on your wheeled walker. Instead, push up from your seat.

• To turn or change direction you may need to lift your wheeled walker slightly. Make sure all legs/wheels are firmly on the ground before starting to walk again.

• Be careful when you walk from a tile or hardwood floor to a carpeted floor, or into/out of an elevator. You may need to lift your wheeled walker at the threshold.

• Do not use your wheeled walker on stairs or an escalator.

• Check the tips on the back legs of your wheeled walker often. Replace the tips when they become worn. You can buy new tips from a drugstore or medical supply store.

• Use sliders on the back legs of a wheeled walker to reduce wear on your floors.

STAIRS: Safety Tips for Negotiating Stairs

• Be careful when you walk on wet or uneven surfaces.

• Maintain good posture when walking.

• Do not take a step unless all 4 legs of the walker are firmly on the curb or ground.

• Carry items in a backpack, walker bag, or basket.

• Wear shoes that fit well, support your feet, and are comfortable.

• If you cannot bear weight through a leg, keep it straight out in front of you when maneuvering the curb. This will take practice to do well, but your therapist will help!

Note: Your therapist may show you different ways to move safely,

depending on your situation or environment.


Walking (Front-wheeled Walkers)

1. Stand in the middle of the wheeled walker and grasp the wheeled walker handgrips with your hands.

2. Push the walker forward an arm’s length that feels comfortable. (The back legs of the walker should be even with your toes.)

3. Step forward with your affected (weaker) leg into the middle of the wheeled walker. (See the white footprint in the diagram at right.) Continue to grasp the walker grips with your hands.

4. Then step forward with your stronger leg. (See the darker footprint on the diagram.) As you do, keep weight off your weaker leg by supporting some of it with your arms.

5. Repeat steps 2, 3, and 4 above — move the wheeled walker, then your weaker leg, and then your stronger leg.

Note: Your therapist may give you other methods for safe walker use based on your needs.


Managing Curbs Going Up — Forward Method

1. Move to the edge of the curb with your walker.

2. Put all 4 legs of the walker up on the curb.

3. Step up with your stronger (non-surgical) leg.

4. Lean onto the walker and — using your arms and strong leg — lift your body and weaker leg up onto the curb.

Going Up — Backward Method

1. Back up to the curb. 2. Lean on the walker. Step up onto the curb with your strong leg.

3. Straighten your strong leg as you step up with your weaker leg. Bring the walker up so it is on the curb with you.

Going DOWN Curbs

1. Move to edge with your walker and put the walker on the floor or ground below you.

2. Step down with your weaker leg.

3. Step down with your stronger leg.


Using Crutches Many simple actions are more difficult with crutches and it may take you some time to get used to using them. Below are tips for safely sitting down and standing up, walking, and going up and down stairs. Safety Tips: • Carry items in a backpack. • Do not hang on or lean on your crutches. Instead, support your weight through your hands

and upper arms, not your underarms. • Maintain good posture when walking. • Use a safe, comfortable pace. • Wear shoes that fit well, support your feet, and are comfortable. • Be careful when walking on uneven or wet surfaces. Sitting Down

1. Use your crutches to back up to the chair or bed until

you feel it behind your legs.

2. Take the crutches from under your arm, put them together,

and hold onto both handgrips with one hand.

1. Reach back for the chair or bed with your free hand.

2. Slowly lower yourself onto the surface as you keep your involved leg

in front of you.

Standing Up

3. Hold the handgrips of both crutches in one hand.

4. Push off from the chair or bed with one hand, with the

crutches in your other hand.

5. Stand, and then check your balance.

6. Place the crutches under your arms, and press them to your sides.


Walking with Crutches General Directions: 1. Place the crutches under your arms and squeeze them to the sides of your body. 2. Move the crutches 6 to 12 inches ahead and keep them slightly away from your body. 3. Push down on the handgrips, then step past the crutches. 4. Support your weight through your hands and arms, not leaning onto your underarms. 5. Check your balance before you take another step.

Walking with Crutches / 3-Point Sequence:

START: Stand in the

middle of your crutches.

1. Place crutches in front of you. They should be a comfortable arm’s length

away.

2. Push down on the handgrips. Step forward with your weaker leg, only putting as much

weight on leg as allowed.

3. Keep pushing down on the handgrips and limit the weight

on your weak leg. Step past the crutches with your

stronger leg.

Repeat the same sequence:

1. Place crutches forward. 2. Step with weaker leg. 3. Step with stronger leg.


Maneuvering On Stairs with Crutches Hold onto the handrail with one hand. Hold both crutches under your opposite arm. (If there is no handrail, keep a crutch under each arm.) Crutches should be in the middle of the step, away from the front edge. Going UP: 1. Start with your toes close to the bottom step. 2. Keep the crutches on the step where you're standing; step up

with your stronger leg. 3. Push down on your crutches and railing as you straighten the

stronger leg and step up with your weaker leg. 4. Once both feet are on the same step, bring your crutches up. 5. Check your balance before you move to the next step. 6. Repeat steps 1 through 6. Going DOWN: 1. Start with your toes near the edge of the step. 2. Put your crutches down on the next step. 3. Step down with your weaker leg, using your stronger leg,

crutch and railing for support. 4. Step down with your stronger leg. 5. Check your balance before you move to the next step. 6. Repeat steps 1 through 6. Stair Safety Tips 7. Remember, “Up with the good, down with the bad.” This means when going up the stairs,

lead with your stronger (“good”) leg. When you are going down the stairs, lead with your crutches and weaker (“bad”) leg. Use the crutches support your weaker leg.

8. Your doctor may tell you that you are not allowed to put your weaker foot down on the ground at all (non-weight bearing). In this case, when going up steps, bend your knee and keep your foot behind you. When coming down stairs, extend your weaker (non-weight bearing) leg in front of you.

9. It's also a good idea to make sure someone is nearby in case you need help or feel off-balance. Once you feel more comfortable using your crutches, you can step with your weaker leg and the crutches at the same time.

Note: Your therapist may show you different ways to move safely with crutches,

depending on your situation or environment.


Your Therapy and Home Exercise Program

Add any new instructions and other handouts you may receive here.

D: Going Home

Alpenglow Academy | Going Home, D1

Going Home

Pain Management Pain management is one of the most important aspects of your recovery. Surgery causes pain and swelling, which leads to compression, stiffness and more pain. Your doctor will order pain medication for you. Take all medications as instructed. You may wean off pain medications as soon as you wish – but keep in mind that maintaining mobility is key. Don’t let trying to get off pain pills affect your activity level. If you find yourself self-limiting your actions, re-evaluate your pain regimen. Refer to your surgeon's specific instructions and don’t hesitate to call their office with any questions. Proper usage of prescribed medications, frequent movement (WALKING) and proper usage of cold therapy will all help to improve this cycle. The relief of pain will also aid you in successfully completing your exercises and getting out of bed as much as possible. Be aware that surgical pain can present itself in different ways, such as: soreness, burning, stabbing, throbbing, and aching. If you are experiencing these, you should take the pain medications as prescribed, apply an ice pack (or other cold therapy as instructed) and elevate the swollen or painful area. If you experience increased pain and/or if these measures do not help alleviate the pain, you need to contact your surgeon’s office. Cold Therapy Cold therapy can be intermittently used throughout the day and night as needed to alleviate pain and swelling. You should allow time between applications of icing for the skin to return to normal temperature before reapplying ice – apply for 20 minutes then remove for 20 minutes. Avoid prolonged use of cold therapy as it can lead to frostbite.

• Do not apply ice in direct contact with your skin; place ice bag into a pillowcase or wrap in a thin towel

• Do frequent skin checks when using cold therapy; frostbitten skin appears white and does not return to pink after being pressed by fingers. If your skin appears this way, remove ice and contact your surgeon’s office.

Your surgeon may arrange for a specific cold therapy device or advise on use of cold pack application. If you have been prescribed an ice machine please refer to your specific instruction handouts for appropriate use and time of application. If you are creating your own ice packs with zip-lock type bags, be sure and double bag it and cover the ice pack with a thin cloth to prevent wetting your dressing. Be sure to dry your skin thoroughly after removing. If you still have a dressing over the surgical wound, ensure that the dressing remained dry during ice application. If it has gotten damp you must change the dressing.


Showering/Bathing You are able to shower the morning after your nerve block has been removed. Depending on the type of surgical closure, your showering instructions will vary. Do NOT submerge your incision in a bath, swimming pool, hot tub/spa or any other form of water until your incision is healed and you have been cleared to do so by your surgeon. Swelling Swelling to the operative area can be normal after surgery. There are many factors that contribute to this. Be sure to ice and elevate the extremity above your heart. This can be a challenge! Elevating your knee can be done by using pillows to prop your leg up – be sure your entire leg is kept straight, you do not want pillows left directly under your knee. If you are concerned about the swelling, contact your provider’s office. Caring for your Incision It is very important that your incision remain clean and dry. Do not get your incision wet until told to do so. Do not apply creams, ointments, lotions, oils, powders, etc. Instructions for dressing changes may vary depending on your surgeon. The process for a standard dry dressing change is listed below. Dressing Changes:

• Wash hands before and after a dressing change. • Carefully remove all exterior adhesive tape. You can moisten tape around the

edges of the dressing to loosen the adhesive if needed • Remove the old dressing. If steri-strips (paper tape strips across the incision) have

been applied, do not remove these; they will fall off on their own within 2-3 weeks. You may trim the ends of the steri-strips if they are no longer sticking to your skin.

• Inspect the wound for signs of infection: increased redness, odor, surrounding skin is hot to touch, or concerning drainage color (such as yellow, green or white).

• If the area has gotten wet, lightly pat dry with a clean towel. Do not use any creams or lotions.

• Cover the incision with a clean gauze dressing and secure. There are many ways to secure your dressing; follow your surgeon’s preferences.

Caring for your Continuous Nerve Block It can be normal to have clear or pink-tinged drainage from the insertion site of your nerve block (On Q). While it is in place you may need to reinforce the dressing; apply dry gauze over the insertion site dressing and cover with tape, remove this exterior dressing and replace as needed. The nerve block catheter is removed when the medicine is fully infused. Follow instructions provided by the surgery center. If you experience bright red drainage from the site, contact the Anesthesiologist for further instructions. This phone number should be provided on your discharge paperwork from Alpine Surgery Center.


CPM use • Always refer to specific instructions from your surgeon’s care team when it comes

to CPM use. • General rules of thumb when using the CPM:

1. Start where you left off last time. Starting where you left off allows your knee

to warm up. After some time during each session, increase your flexion (bending) a few degrees, as you tolerate. General goals are to increase flexion 5 degrees per day. You do not have to increase flexion all at once; this can be done gradually over your session.

2. Use your CPM 3 times per day for 2 hours each time.

• The heel slide exercise is where you will GAIN range of motion, using the CPM helps you to maintain range of motion.

Decreasing Your Risk for Lung Complications After your surgery you will find that there is a decline in your daily activities. Post-surgical lung complications are avoidable by performing deep breathing and coughing exercises as directed by your nursing staff. If you have been prescribed an Incentive Spirometer, continue to use this 8-10 times per hour, while awake. It is important to stay active and WALK as much as possible, this allows your lungs to fully expand and helps reduce your risk for atelectasis, the beginning stage of pneumonia. Signs and Symptoms:

• Difficulty breathing (dyspnea). • Rapid, shallow breathing. • Coughing.

Decreasing Your Risk for Blood Clots Surgery may slow down blood circulation to your legs resulting in the formation of blood clots in the veins of your legs. A blood clot in your leg can develop into a blood clot in your lungs, called a pulmonary embolus (PE). You can help prevent blood clots by WALKING, wearing prescribed equipment (i.e., support hose or sequential compression devices), exercising as specified by your surgeon or physical therapy, and taking blood thinning medication if prescribed by your surgeon. Watch for these signs and symptoms and call your surgeon if you have them:

• Swelling in thigh, calf or ankle that does not go away with elevation. • Pain/tenderness in calf. • Unusual warmth. • Redness or discolored skin to the area of concern.


Call 911 if you notice the following signs of a possible Pulmonary Embolism (PE):

• Difficulty breathing • Chest pain • Coughing up blood

Decreasing Your Risk for Infection The most efficient way to decrease your risk for infection is proper hand hygiene. When doing dressing changes, be sure to inspect the incision for signs of infection as mentioned earlier. It is very important to keep your dressings clean and dry. Notify your surgeon if you observe signs of infection such as:

• Fever above 101.00 F. • Uncontrolled shaking or chills. • Increased redness, heat, drainage or swelling in or around the incision. • Increased pain not relieved with pain medications.

An infection elsewhere in your body could cause an infection to your new joint. If you are treated for any type of infection, you should notify your surgeon. If you are experiencing symptoms of a bladder infection (frequent urination, pain or burning with urination, or cloudy urine), contact your primary care physician for treatment and inform them of your recent total joint replacement.

E: Resources

Alpenglow Academy | Resources, Page E1

Frequently Asked Questions About Total Knee Surgery

We are honored you have chosen Orthopedic Physicians Alaska for your care. Patients have many questions about total knee replacements. Below you will find a list of frequently asked questions with answers. If there are any other questions that you need answered, please contact your surgeon. What is a Total Knee Replacement? A total knee replacement is called a total knee arthroplasty or TKA for short. A TKA is a surgical procedure designed to replace the injured and/or diseased knee joint with artificial materials, most commonly for osteoarthritis. See a 3-D animation of a knee replacement at opalaska.com/3d-animation Click on "Knee" and scroll down to "Total Knee Replacement"

When should I have a Total Knee Replacement (TKA)? A total knee replacement is usually recommended after all other conservative treatments have been utilized. Including activity modification, weight reduction (if indicated), nonsteroidal anti-inflammatory medications, corticosteroid injections, or braces. A TKA is usually warranted when pain gets too severe, limiting mobility and activities of daily living. Your surgeon will decide if you are a candidate for surgery. This will be based on your history, exam, and radiologic findings. Your surgeon will ask if your discomfort, stiffness, and disability justify undergoing surgery. Age is also a determining factor. What are the risks of surgery? Most surgeries go well with minimal complications. Infection and blood clots are two serious complications that are of highest concern. To decrease your risk for infection, antibiotics and proper hygiene protocols are followed; to decrease your risk for blood clots, blood thinning medication and/or equipment such as support hose or sequential compression devices may be ordered. Other complications that are possible but very rare nerve injury, stiffness, wound healing problems, fractures, or loosening of hardware. When will I be able to get back to work? It is recommended that most people take at least one month off from work, unless their jobs are sedentary and they can return to work with an assistive device. You should discuss a return to work date with your surgeon prior to surgery.


May I shave my legs before surgery? No. Do not shave your legs within 3 days of surgery. Shaving causes small cuts in the skin and can cause complications. What type of anesthesia is used during the procedure? There will be a combination of techniques used to administer anesthesia during a total knee replacement, typically either "general" (you are put to sleep) or "spinal block" (you are awake but your body is numb from the waist down). The anesthesiologist will discuss your options with you and you will decide together what the best option is. In addition, a combination of numbing medicine, pain medicine, and anti-inflammatory medicine are injected into the tissue around the knee at the end of the procedure that will also help with post-operative pain control. How soon can I drive again? This will be dependent on multiple factors: one of them being when you are no longer taking narcotics and the second being which knee was replaced. Typically you cannot drive for 6-8 weeks. Ask your surgeon during your follow up for more detailed information. What do I do at the airport? Tell TSA agents about your new hardware. You will likely go through the advanced imaging technology machines, like the general public. Additional screening may take place. When is it safe to resume sexual activity? Some form of sexual activity may be resumed as early as a week or two after surgery. However, your comfort and safety are most important. Do not do anything that causes discomfort to the hip. In general, common sense should be utilized when resuming sexual activity. Please ask your surgeon or physical therapist if you have further questions. What if my insurance doesn’t cover the cost of my assistive devices or I don’t have the money to pay for them? There are several companies around town that sell or lend assistive equipment. Many pharmacies or hardware stores sell assistive equipment. Some pharmacies have rental programs for crutches. There are also loan closets available within the Anchorage and Mat-Su area.


Helpful Links

Orthopedic Physicians Alaska Visit OPAlaska.com for a wealth of information. Here are a few specific links of interest: opalaska.com/knee This is the OPA website with helpful information regarding what is done during surgery. This page also gives information on our knee treatment specialists. opalaska.com/deep-dives Click on "Explore the Knee" for 3D interactive imagery, explanations of various conditions and actual surgery images and videos in the "Media Browser." opalaska.com/3d-animation See a 3-D animation of a knee replacement surgery; click on "Knee" and scroll down to "Total Knee Replacement." Medline Plus www.nlm.nih.gov/medlineplus/ency/presentations/100088_1.htm This site shows an overview of the short series of steps done during a total knee replacement.


About the American Joint Replacement Registry

Quality Improvement Project Alpine Surgery Center and OrthoAlaska (OPA) are proud to participate in the American Joint Registry Quality Improvement Project — a nationwide database of implants and other aspects of hip and knee joint replacement.

PURPOSE OF THE PROJECT: To improve the quality of care for patients around the nation who have had a hip or knee replacement. The data may also be used for future research studies related to surgical techniques and devices for patients who have had hip or knee replacement.

INFORMATION SHARED: The information to be shared includes:

• Where your surgery took place (Alpine Surgery Center). • Surgeon name. • Specific type of implant you received. • Side and part of your body on which you were operated. • Your age and other selected medical information that might have impact on the

results of your surgery, such as diabetes or heart disease. • Your social security number, which is fully encrypted and secure in transit and at

rest making it impossible for anyone to make out the number.

WHAT ARE THE RISKS? There are no known risks associated with this project. AJRR protects all information in the database by storing it on dedicated servers that have physical and electronic protections verifying that all communications with the registry are from valid sources. In order to track information about your hip or knee surgery, Alpine Surgery Center and the AJRR create a patient identification number that is linked to your social security number. Your information is used for research purposes; the only reason to connect your information back to you would be if some problem were to be discovered by the database.

WHAT ARE THE BENEFITS? You may not receive a direct benefit if you participate. However, AJRR has alerted hospitals and surgery centers in the past that some of their patients have an implant that is underperforming. Registries like AJRR in other countries help your surgeon select the best implants for you. This information helps us to help you. Additionally, people who will have joint replacement in the future may benefit from the information obtained in this QI project.

WHO CAN I CONTACT FOR QUESTIONS OR ADDITIONAL INFORMATION? Contact Mary Hopkins, RN, at Alpine Surgery Center (907-563-1333). You can also learn more about the AJRR at its website at www.ajrr.net.


Herbal Supplements that can Pose a Risk in Surgery

Like prescription drugs, herbal supplements also carry a risk of side effects and drug interactions. The following is a list of common supplements that should be stopped prior to surgery. Please inform your surgeon and anesthesiologist about ALL you are taking.

• Echinacea: Use with caution in patients with asthma or allergic rhinitis. Discontinue use as far in advance of surgery as possible

• Ephedra: Has been responsible for fatal cardiac and central nervous system complications. Discontinue use at least 24 hours prior to surgery.

• Feverfew: Inhibits platelet function and therefore can increase bleeding. Discontinue 7 days prior to surgery.

• Garlic: Inhibits platelet function and therefore can increase bleeding. Discontinue 7 days prior to surgery.

• Ginko: Inhibits platelet function and therefore can increase bleeding. Discontinue 7

days prior to surgery.

• Ginseng: Inhibits platelet function and therefore can increase bleeding. Discontinue 7 days prior to surgery.

• Ginger: May increase the sedative effects of anesthetics. Discontinue at least 7 days

prior to surgery.

• Kava: Can increase the sedative effects of the anesthetics. Discontinue at least 24 hours prior to surgery.

• St. John’s Wort: Can significantly increase the metabolism of many drugs.

Discontinue at least 5 days prior to surgery.

• Valerian: Can increase the sedative effects of anesthetics. Taper the dose for several weeks prior to surgery. DO NOT STOP ABRUBTLY BECAUSE OF RISK OF WITHDRAWAL.

Sources: Journal of the American Medical Association. Ang-Lee, Moss J, Chun-Su Y. Herbal medicine and perioperative care. 2001;286:208-16. American Society of Anesthesiologist brochure for members. What you should know about your patients’ use of herbal medicines. Copyright 1999

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