Total Knee Joint Replacement Education Manual
Transcript of Total Knee Joint Replacement Education Manual
A partner for lifelong health
Total Knee Joint Replacement Education Manual
Please bring this booklet with you to:⚫ Everyofficevisitwithyourdoctor
⚫ Yourjointreplacementclass
⚫ Thehospitalwhenyouareadmitted
⚫ Everyfollow-upvisitwithyourdoctor
⚫ Yourphysicaltherapyappointments
2|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
3 Appointments for your total knee joint replacement surgery
4 Your questions
5-7 Phone numbers and LMH Health maps
8 Our commitment to you
9 Notes
10-16 Preparing for surgery (what you need to do)
17 Notes
18-23 Surgery and hospitalization
24-27 Recovery after discharge
28-30 Frequently asked questions
31 Notes
Contents
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Appointments for Your Total Knee Joint Replacement Surgery
Medical clearance:
Date:�������������������������������������������������������������������
Time:�������������������������������������������������������������������
Doctor:�����������������������������������������������������������������
Other necessary clearances:
�����������������������������������������������������������������������
�����������������������������������������������������������������������
Pre-admission phone call:
Date:�������������������������������������������������������������������
Time:�������������������������������������������������������������������
Joint replacement class:
Date:�������������������������������������������������������������������
Time:�������������������������������������������������������������������
ClasswilltakeplaceatLMHHealth.Reporttothemainlobbyonthewestsidenearadmissions.Bringalistofyourmedications,allergiesandquestions,aswellasthisbookandyourcompassionatecoach.
Surgery:
Date:�������������������������������������������������������������������
Time:�������������������������������������������������������������������
Post-operative surgeon office visit:
Date:�������������������������������������������������������������������
Time:�������������������������������������������������������������������
Doctor:�����������������������������������������������������������������
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LMHHealthsurgerydepartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-505-6480OrthoKansas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-843-9125Surgerypre-admissionnurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-505-6268OrthoKansasschedulers:(foranindividualscheduler’sphonenumber,seetheirbusinesscard). . . . . . . . . 785-843-9125OrthoKansasnursenavigator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785-838-7815Primarycarephysician. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ������������
Important Phone Numbers and Maps
Patient Parking
4 T H ST R E E T
3 R D ST R E E T3 R D ST R E E T
2 n d ST R E E T2 n d ST R E E T
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4th Street Health Plaza
Lawrence Memorial Hospital
Lawrence Health Plaza
EMERGENCY
225 Maine
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316 Maine
320 Maine
ReservedParking
for 320 Maine
ReservedParking
for 316 Maine
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First floor
Patient Rooms 201-214
Lawrence Health Plaza
4th Street Health Plaza
2 North
2 East
Lawrence GI Consultants 215
Lawrence Urology Specialists 205
Cardiopulmonary Services 2030• Anticoagulation Clinic• Echocardiology Services• Pulmonary Function Lab• EKG
Lawrence General Surgery 202Spencer Harrison, MD
Lawrence Pain Specialists 201
LMH Health System Pharmacy
Therapy& Wellness
Treatment & Procedure
Center
ICU Patient Rooms229-238
Patient Rooms 239-252
Chaplain
Chapel
Compliance Management
Cardiovascular Specialists of Lawrence 2050
Lawrence Pulmonary Specialists 2001Vascular Surgery Associates
Patient Rooms 215-228
LMH
Palliative Support Services 210
EMERGENCY
Lawrence Memorial Hospital
Volunteer ServicesRisk Management/Medical Sta� O�ceLab
Endoscopy Center
Lawrence Health Plaza
Ko�ee Korner
Gift Shop
SpecialProcedures
Imaging
Surgery
ExecutiveO�ces
Admissions/Patient Registration
Cotton O’Neil Clinic 110
Oncology/Hematology Center 105
Precision Cancer Care 120Radiation Oncology
Hospital Patient Accounts
D
Nursing Administration
4th Street Health Plaza
Pain Management
DaVita Dialysis 100
Elevators to Lower Level and Floors 2 & 3
Elevators to 4th Floor
Workplace Wellness 1020Information Technology 1010
Mario’s Closet
WellCare Clinic 1015
Second floor
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4th Street Health Plaza
Quest Diagnostics 3000
Total Family Care 3200Lawrence Endocrinology 3201Plastic Surgery Specialists of Lawrence 3202Lawrence Neurology Specialists 3203Lawrence Spine Care 3204
Cardiac & Pulmonary Rehabilitation 310Diabetes Education
Rooftop Garden
Lawrence OB/GYN Specialists 300
Care Coordination/Social Services
Patient Rooms 301-314
Patient Rooms 317-321 Patient Rooms 338-348
Patient Rooms 329-337
Pediatric Rooms 322-328 Family Birthing Center
Maternity Preadmission Clinic
Perfect Fit
Patient Rooms
370-387
3 West
3 North
Lawrence Health Plaza
LMH
Lower level
Third floor
Fourth floor
DiningCourt
Community Outreach & Engagement
MedicalRecords(HIMS)
Education/Learning ServicesConference Room A
Conference Room D North
Conference Room D South
Human Resources Auditorium
CafeteriaDining
Facilities Management
Environmental Services
ReceivingLoading Dock
Materials Management/
Purchasing
SterileProcessing
Biomedical
Lawrence Memorial Hospital
4 North
Rehabilitation Rooms 418-426
Transitional Care Unit Rooms 401-417
8|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Our Commitment to You
ThankyoufortrustingLMHHealthandOrthoKansaswithyourorthopedicsurgeryexperience.
Wearecommittedtobeingyourpartnerforlifelonghealthandassureyouthatourexperienced
teamofphysicians,nurses,therapistsandotherhealthcareprofessionalsarededicatedtoproviding
excellentorthopediccare.
Wewantyoutohaveapositiveexperiencefromthemomentyouscheduleyoursurgerythroughyour
recoveryprocess.Ourgoalistoassistyouingettingbacktoyournormalactivitylevelasquicklyas
possible.Wewanttoinvolveyouinyourtreatmenteachstepoftheway.
Theinformationinthisbookcanhelpyouunderstandthejointreplacementprocessandmakethe
preparationandrecoveryforyourupcomingsurgeryeasier.Anytimeyouhavequestions,pleaseask
yourdoctor,nursesoranyoneinvolvedinyourcare.
WethankyouforchoosingLMHHealthandOrthoKansas.Wevalueyourtrustinusandarecommitted
tohelpingyouachieveaspeedyrecovery.
Introduction to a new lifeJointreplacementisanelectiveoperation,meaningthatitisachoiceyoumakeafterconsultingwith
yourorthopedicsurgeon.Thedecisiontoproceedcanbedifficulttomakeandshouldnotbetaken
lightly.Jointreplacementisconsideredamajoroperation,andrecoverycanbepainfulandchallenging.
Thegoalsofthissurgeryincluderelieffrompain,improvedmobilityandrestoredfunction–allof
whichcanprovideyouwithanewoutlookonlife.
Theinformationinthisbookcanguideyouthroughtheprocessbyexplaininggeneralandspecific
medicalandsurgicalrisks,andbyansweringquestionsrelatedtopre-andpost-operativecareandthe
healingprocess.
Youareapartnerinthisprocesswithyourcareteam.Youplayalargeroleinshapingtheoutcome
ofyoursurgery.Supportfromyourfamilyandfriendsisalsoimportant.Eachsurgicalexperienceis
unique.Ourmainfocusisyoursafetyandwell-being.Pleasedonothesitatetoaskquestions.
Individualshavethecapacitytohealthemselvestoonedegreeoranother.Thisvariesanddependson
multiplefactorssuchasnutrition,weight,exerciseandleveloffitness,smokinganduseofalcoholas
wellasoverallgeneralhealth.
Attitudeiseverything!Themostimportantfactorsinasuccessfulrecoveryareyouroverallattitude,
motivationandefforts.Apositive,can-doattitudeandwillingnesstoworkhardwillgreatlyincrease
yourpotentialforasuccessfuljointreplacementandrenewedoutlookonlife.
Thank you for choosingLMH Health and OrthoKansasas your healthcare providers.
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Preparing for Surgery
Verify insurance benefits and coverageItisimportanttoverifybenefitsandcoverageandobtainauthorizationwhennecessarypriortoyour
surgery.Youwillreceivestatementsforchargesfrommultipleentitiesincluding,butnotlimitedto:
LMHHealthPhysicianBilling,LMHHealth,radiologyandanesthesia.
OrthoKansaswillprovideyouwithawrittenestimateofthechargesthatourofficewillsubmitto
yourinsuranceifyouhaveanon-Medicareinsuranceplan.Thesechargesincludeallcareprovided
byOrthoKansasdoctorsandphysicianassistantsforwhatisknownastheglobalperiod.Thisperiod
startsonthedayofyoursurgeryandcontinuesforasetnumberofdaysaftersurgery.Youwillbe
requestedtopayanyout-of-pocketcostspriortoschedulingyoursurgery.Ourfinancialcounselorwill
reviewthesecostswithyou.
IfyouhaveMedicarewithasupplementalplan,youwillnotneedtomeetwiththeOrthoKansas
financialcounselor.However,ifyouhaveMedicarewithnosupplementalplan,youwillberequestedto
payanyexpectedout-of-pocketexpensespriortoschedulingsurgery.Ifyouhavequestions,youcan
contacttheOrthoKansasfinancialcounselorat785-838-7854.
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Obtain medical clearance for your surgeryYouwillneedtohaveacompletephysicalexam
conductedbyyourprimarycarephysician
approximatelyonemonthbeforeyoursurgery
toassessyourgeneralhealthandruleoutany
conditionsthatcouldinterferewithyoursurgery.
Youalsomayberequiredtoobtainclearance
fromanyspecialistyouseesuchasacardiologist
(heartdoctor)orpulmonologist(lungdoctor).
Itisimportanttohavetheseexamsandall
testingdoneinatimelymannertoavoidlast-
minutedelaysorcancellations.Severaltests,
includingabloodtest,anelectrocardiogram
(EKG)andaurinetestwillbeperformedto
helpyourphysiciandetermineyourabilityto
undergosurgerysafely.Youshouldreviewyour
medicationswithyourphysiciantodetermineif
thereareanythatyouwillneedtostoptaking
priortosurgery.
Thefollowingmedicationsshouldbestopped
sevendayspriortosurgery.Theseareknown
asanti-inflammatories.Ifyoufeelthatstopping
thesewillcauseundueincreasedpain,pleasetalk
withyoursurgeon.
⚫ Celebrex
⚫ Voltaren(diclofenac)
⚫ Mobic(meloxicam)
⚫ Relafen(nabumetone)
⚫ Aleve(naproxen)
⚫ Naproxyn,Motrin/Advil(ibuprofen)
⚫ Feldene(piroxicam)
⚫ Clinoril(sulindac)
⚫ Lodine(etodolac)
⚫ Toradol(ketorolactromethamine)
⚫ Indocin(indomethacin)
Ifyoutakemedicationssuchasaspirin,Coumadin
(warfarin),Jantoven,Plavix,Effient,Brilinta,
Pradaxa,Xarelto,Eliquis,anyanti-coagulantor
anti-plateletmedication,youneedtocheckwith
yourprimaryphysicianorcardiologistabout
whentostopthismedicationpriortosurgery.
Thiswillberesumedaftersurgerywhenyour
surgeondecidesitissafetodoso.
Ifyoutakemedicationsthatsuppressyour
immunesystemsuchas:Humira,Remicade,
Enbrel,Methotrexate,orOtezla,youmayneed
todiscontinueuseweekspriortosurgery.
Yoursurgeonwilldiscussthiswithyouandyour
prescribingprovider.
MedicationsforweightlosssuchasPhentermine
andContraveneedtobestoppedtwoweeks
priortosurgery.Pleasediscusswithyour
prescribingprovider.
PleasenotifytheOrthoKansasnursenavigatorof
anymedicationchangespriortosurgery.
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Additional activitiesYouwillmeetandvisitwiththenursenavigator
whenyouscheduleyoursurgery.Heorshewill
helpguideyouthroughthisprocess.
Identifysomeoneasyourcompassionatecoach.
Thismaybeafamilymemberorclosefriendwho
willbeavailablebeforeandaftersurgerytohelp
youprepareforandrecoverfromyoursurgery.
Heorsheshouldattendthejointreplacement
classwithyouandattendatleastonephysical
therapysessionwithyouduringyourstayat
LMHHealth.Thispersonwillhelpwithyour
day-to-dayneedsandprogressafterdischarge
fromthehospitalandwilllikelyberequiredto
transportyoutofollow-updoctorvisitsandto
therapyappointments.Itisbestifthispersoncan
staywithyouforthefirstoneortwoweeksafter
surgery.
Attendjointreplacementclasswithyour
compassionatecoach.Don’tforgettobring
thisbook!
Stopsmokingpriortosurgery.Youwillnotbe
abletosmokewhileatthehospital.Smoking
reducescirculationtotissueandmakeshealing
moredifficult.Itreducesthesizeofbloodvessels
anddecreasestheamountofoxygencirculated
intheblood.Itcanincreasetheriskofbloodclots
whichisoneofthebiggestpost-operativerisks
associatedwithtotaljointreplacementsurgery.
Bloodclotscanleadtoheartorlungdamageand
increasetheriskofstroke.Ifyouwanthelpwith
smokingcessation,pleaseaskusaboutavailable
resources.
Preventinfections,especiallyintheteeth,skin
andurinarytract.Reportanysymptomstoyour
primaryphysician.Althoughrare,aninfection
canoccuraroundyourreplacedjointifbacteriais
allowedintothebloodstream.Toreducetherisk:
⚫ Haveacompletedentalexamnocloserthan
twoweekspriortoyoursurgerydatetobe
suretherearenopotentialproblems.
⚫ Avoidtreatmentofsignificantdentaldiseases
foratleastamonthpriortosurgery.Wealso
recommendavoidinganyelectivedentalwork
forthreemonthsaftersurgery.
⚫ Notifyyourprimaryphysicianifyoudevelop
anyurinarysymptomssuchasburningwith
urination,achangeinurinaryfrequencyor
bloodinurine.
⚫ Notifyyourprimaryphysicianifyoudevelop
anyskininfectionsorirritationonyour
operativeleg,orifyoudevelopchronic
swellingofthatleg.
ConsidercompletingaLivingWillandDurable
PowerofAttorney.Thisissimplyaprecaution.
Ifalreadydone,besuretotakeacopytothe
medicalrecordsdepartmentonthelowerlevel
ofLMHHealthorbringitwithyouthedayof
surgery.
Contactyourpreferredphysicaltherapylocation
andletthemknowyourdateofsurgeryand
whattypeofsurgeryyouwillhave.Ifyouintend
togotooutpatienttherapyimmediatelyafter
discharge,plantostartthisthreeorfourdays
aftersurgery.Ifyouwillbehavinghomehealth
therapy,plantostartoutpatienttherapy15-20
daysaftersurgery.
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Notes
Joint replacement classReviewthisbookpriortothedateofyourjoint
replacementclass,andbringitwithyoutoyour
scheduledclass.Usethespaceonthispageto
writedownanyquestionsthatcometomindand
wewilladdresstheminclass.
RepresentativesfromseveralLMHHealth
departmentswillbeapartoftheclass
experience.Theseincludesocialwork,pharmacy,
physicaltherapy,nursing,andothers.Itisvery
importantforyourcompassionatecoachto
attendthisclasswithyou.Theclasswilltake
approximatelytwototwoandahalfhours.
Bringyourmedicationlisttoreviewwitha
pharmacyrepresentative.Yourlistshouldinclude
allknownallergiesandintolerances.
14|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Pre-op instructionsArepresentativefromtheLMHHealthsurgerydepartmentwillcontactyoubytelephonepriortoyour
surgerydate.Youwillbegivenfinalpre-opinstructionsregardingwhentostoptakingmedicationsthe
daybeforesurgery. You will be instructed not to take anything by mouth after midnight the night before surgery.Thisincludesfluids,gum,candy,tobaccoandalcohol.Youalsowillbeinstructedwhat
timetoarriveatthehospitalthedayofsurgery.Inrareinstances,yourarrivaltimemayneedtobe
changedduetoachangeinthesurgeryschedule.Ifthishappens,youwillbenotifiedofyournewtime.
Itisimportanttobecarefulwithyourlegsinthedayspriortosurgery.Cuts,scrapesandscratcheson
youroperativelegcouldposeaninfectionrisksopleasenotifyyoursurgeonifthisoccurs.Youmaybe
askedtogotothesurgeon’sofficetohavethisevaluated.
Avoidusingnailpolishonyourfingernailsandtoenailsunlessitisclearpolish.
Practiceorreviewbreathingexercises.Theseexerciseswillbeimportantaftersurgerytokeepyour
lungsclearandreduceyourriskofinfection.Youwillreceiveanincentivespirometeraftersurgeryfor
useinthehospitalandathome,butpracticingdeepbreathingandforcedcoughingbeforesurgerywill
behelpful.Practicinginadvancewithoutthespirometerwillstrengthenthemusclesofyourabdomen
andchest.
For deep breathing:⚫ Breatheinthroughyournoseasdeeplyasyoucan.
⚫ Holdyourbreathfor5-10seconds.
⚫ Breatheoutasifyouwereblowingoutacandle.Trytobreatheoutfor10-20seconds.
⚫ Takeabreakbetweenbreathsthenrepeatthisexercise5-10times.
Coughing:⚫ Takeinaslow,deepbreaththroughyournose,fillinglungscompletely.
⚫ Breatheoutthroughyourmouthandconcentrateonemptyingyourlungscompletely.
⚫ Repeatbreathingin,butthistimeholdyourbreathandthencoughhard.Whenyoucough,focuson
emptyingyourlungs.
⚫ Repeatthesesteps3-5times.
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Preparing your homeTherearemanythingsyoucandobeforesurgery
toprepareyourselfandyourhomeforasafe
recovery.
Safety⚫ Putitemsyouuseoftenoncountersor
shelvesthatareeasytoreach.
⚫ Makesurestairrailingsaresecure.
⚫ Beawareofallfloorhazardssuchaspets,
powercordsandunevensurfaces.
⚫ Removeallthrowrugsfromyourwalkingor
standingpath.
⚫ Installnightlightsinbathrooms,bedrooms
andhallways.
⚫ Haveanon-slipmatinyourshower.
⚫ Havesupportlinedup,especiallyifyoulive
alone.Ifyouhaveconcernsaboutreturning
homeafterdischarge,pleasediscussthese
withthenursenavigator.
Comfort⚫ Shopahead.Freezemealsforuseafter
surgery.Considerstockinguponfoodsand
beveragesthatwillbeeasytoeatordrink
whenyourappetiteispoor,oryouhavenausea
orbowelproblems.
⚫ Checkchairandbedheightbysittingonthem.
Yourhipsshouldbehigherthanyourknees
whenseated.
⚫ Checktoiletheight.Addaseatriserifitis
toolow.
⚫ Arrangeforcareofpetsandcollectionofmail.
⚫ Cleanyourhouse.
⚫ Dolaundryandputitaway.
⚫ Putcleanlinensonyourbedandinthe
bathroom.
⚫ Haveyardworkdoneasneeded.
What to bring to the hospital⚫ Personalhygieneitems(toothbrush,
toothpaste,deodorant,batteryoperated
razor,comb,etc.)
⚫ Loose-fittingclothes(sweats,shorts,t-shirts,
bathrobe)
⚫ Slipperswithnon-sticksoles,flatshoesor
tennisshoes
⚫ Walkerorcrutchesifavailable,orborrow/
purchaseaftersurgery
⚫ Casesforglasses,dentures,hearingaidsand
extrabatteries
⚫ CopyofyourAdvanceDirectives
(ifyouhaveone)
⚫ Thishandbook
⚫ YourphotoIDandinsurancecard
⚫ AformofpaymentforMedstoBedsshould
youdecidetousethisservice
What to leave at home⚫ Homemedications,exceptinhalers(checkwith
thehospitalpharmacistformoreinformation)
⚫ Valuablesincludingmoneyandjewelry
Stop smoking⚫ Decidetoquit.
⚫ Choosethedate.
⚫ Talkwithyourprimarydoctoraboutsmoking
cessationresourcesandmedications.
⚫ Limittheareawhereyousmoke;don’tsmoke
athome.
⚫ Throwawaycigarettesandashtrays.
⚫ Don’tputyourselfinsituationswhereothers
smoke.
⚫ Rewardyourselfforeachdaywithout
cigarettes.
⚫ Staypositive.
⚫ Takeitonedayatatime.Youmightslip,but
ifyoudo,getbacktoyourdecisiontoquit.
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Further preparationHandicap parking placard Youmaywanttoobtainahandicapparkingpermitforthemonthsfollowingsurgery.Thiswillallow
youeasieraccesstoyourdoctor’soffice,therapyclinicsandshopping.Callyoursurgeon’snurseor
clinicalassistanttorequestanapplication.Oncecompleted,takeittoyourlocalcountytreasurer’s
office.
Therapy preparationItisimportanttobeasflexibleandasstrongaspossiblebeforehavingkneesurgery.Manypatients
witharthritistendtolimithowmuchtheyusetheirpainfulleg.Withlessuse,musclesbecomeweaker
whichleadstoaslowerandmorechallengingrecovery.Startingatherapy/exerciseprogrambefore
surgerycanmakeyourrecoveryfasterandeasier.Exercisesareincludedwiththishandbookthatalso
canbeusedafteryoursurgery.Starttheexerciseswithbothlegsaboutsixweeksbeforesurgery.
Performtheexercisestwiceadayfor15-20minutesforbestresults.Ifyouareable,youalsoshould
performlightenduranceactivitiestobenefityourheartandlungs.Trywalkingorcyclingfor
10-15minuteseachday.Poolexerciseisagoodalternativeifwalkingorcyclingistoopainful.
Tohelpyourphysicaltherapistbetterprepareyoutoreturnhomeaftersurgery,pleaseanswerthe
questionsbelowpriortoyoursurgery.
1. Doyouhavemainflooraccesstoyourbed,bathandtoilet?
2. Whichsideofthebeddoyougetinandoutof?
3. Whatistheheightofthetopofyourbedmattressfromthefloor?
4. Whatisyourtub/showerdesign?
5. Haveyoubeenfittocrutchesorawalker?
6. Howmanystairsdoyouhavetoclimbtogetintoyourhouse?
7. Doyouhaverailingsonyourstairs?Onwhichsidearetherailings?
18|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Surgery and Hospitalization
The day of surgeryRemembernottoeatordrinkanythingafter
midnight.
ArriveattheLMHHealtheastentrance(Maine
Street)promptlyatyourdesignatedtime.
Ifthereisachangetoyourarrivaltimeyouwill
benotifiedbyamemberofthehospitalstaff.
Ifyouhaveanylast-minuteissuesthatwill
preventyoufromarrivingatyourscheduled
time,pleasecontactthesurgerydepartment
at785-505-6482.
Anursewillcompleteyouradmissionactivities
andanyadditionalnecessarypreparation.
Thenursewillaskyouwhich,ifany,medications
youtooktodayandthelasttimeyouateor
drankanything.
Youwillchangeintoahospitalgown.Special
supportstockings(TEDhose)andcompression
deviceswillbeputonyourlowerlegstohelp
preventbloodclots.Arepresentativefromthe
laboratorywilldrawyourbloodtocheckyour
bloodtype.Shouldyouneedabloodtransfusion,
compatiblebloodwillbeavailable.
Youwillbeaskedtosignasurgicalconsentwhich
detailsyoursurgicalprocedure.
AnIVwillbestartedforadministrationoffluids
andmedications.Youwillreceiveatleastthree
dosesofantibioticsthroughyourIV.Besureto
mentionanyallergiesyouhavetomedications.
Ifyouhaveallergies,aspecialbraceletwillbe
placedonyourarmtoalertstaff.
Ananesthesiologistwillvisitwithyoupriorto
goingtotheoperatingroom.Heorshewill
considerwhichtypeofanesthesiawillbebest
foryou,takingintoaccountyourhealthhistory
andpreferences.Therearetwomaintypesof
anesthesiathatareused:
⚫ Generalanesthesiaproducestemporary
unconsciousness.
⚫ Spinalanesthesiainvolvestheinjectionofa
localanestheticprovidingnumbness,lossof
pain,orlossofsensationtothebody.Youalso
willreceiveadoseofmedicationthroughyour
IVthatwillrelaxyouandcreatewhatisknown
asconscioussedation.
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Youalsomayreceiveanadductorblockwhichis
aone-timeinjectionintoyourthigh.Thiswillhelp
reducepainaftersurgery.
Yoursurgeonwillvisityoubeforeyouaretaken
intosurgery.Heorshewilltalkwithyouand
reviewtheplannedsurgery.Thesurgeonwill
signthecorrectsurgicalkneepriortosurgery,
toensureaccuracy.
Whenyougototheoperatingroom,yourfamily
willbedirectedtothesurgerywaitingroom.
Theywillbegiveninstructionsonhowtocheck
yourprogressandknowwhensurgery
iscomplete.
Somepeopleexperienceanxietypriortosurgery.
Weencourageyoutoaskquestionsandtalkwith
thesurgerystaffifyouhaveconcerns.
Therewillbemanypeopleintheoperatingroom.
Thesurgicalteamincludesananesthesiologist,
yoursurgeonandhisorherphysicianassistant,
nurses,andotherprofessionals.Theywillbe
movingaroundtheroombeforesurgerymaking
sureeverythingisreadyforyourprocedure.
Onceyouentertheoperatingroomandare
situatedontheoperatingtable,youwillbeasked
yournameandwhatsurgeryyouarehaving
done.
Youwillhavemonitoringdevicessuchasablood
pressurecuffandaheartmonitorplacedonyou.
Theanesthesiologistusesthesedevicesand
otherstomonitoryourconditionthroughoutthe
surgery.Heorshewillmanageyourvitalsigns
suchasheartrateandrhythm,bloodpressure,
temperatureandbreathing.Heorshealso
willmonitoryourIVfluidandneedforblood
replacementifnecessary.Medicationwillbe
giventohelpyoufeelmorecomfortable.
Onceyouareasleep,aurinarycathetermaybe
placedtohelpdrainyourbladder.
Theentiresurgerytakesapproximatelyoneand
ahalftotwohours.Oncecomplete,yoursurgeon
willvisitwithyourfamily.
After surgery – Post Anesthesia Care UnitFollowingsurgery,youwillbemovedtothePost
AnesthesiaCareUnit.Youwillbemonitoredby
physiciansandnursesforanadditionaloneto
twohours.Yourvitalsignsandpainlevelwillbe
monitored.Youmayhaveonevisitoratatimein
thisareaifyouwish.
Dependingonthetypeofanesthesiaused,you
mayexperiencenausea,drymouth,chillsorother
symptoms.
MedicationwillbegivenbymouthorbyIVto
helpcontrolyourpainandothersymptomsas
needed.
Yourkneewillbecoveredwithadressing.
Youalsowillhavecompressiondevicesaround
bothlowerlegsthatworkbysqueezingthe
calvestohelppreventbloodclots.
Whenyouareawake,yourvitalsignsare
stableandyourpainiscontrolled,youwillbe
transportedupstairstoyourroomon3West.
Continued on page 20
20|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Pain controlMostoftheworstdiscomfortwilloccur12-24
hoursaftersurgery.Paincontrolisatoppriority
foryournursesandphysician.Youwillfrequently
beaskedquestionsthathelpstaffmonitorand
treatyourpain,butweencourageyoutolet
thestaffknowifyouarehavingpainoritisnot
well-controlledatanytime.AtLMHHealthwe
useanassessmentmethodcalledtheClinically
AlignedPainAssessment.Thismethodinvolvesa
conversationthatfocusesonthequalityofpain
andhowitaffectsyourabilitytocomfortably
performdailyactivities,ambulate,orcomplete
testsandtherapies.Youwillbeasked:
InregardtoCOMFORT,isyourpain…
⚫ Tolerable
⚫ Tolerablewithdiscomfort
⚫ Comfortablymanageable
⚫ Littleornopain
InregardtoFUNCTIONING,wouldyousay…
⚫ Ican’tdoanythingbecauseofthepain.
⚫ PainkeepsmefromdoingMOSTof
whatIneedtodo.
⚫ Icandomostthings,butpaingetsin
thewaysome.
⚫ IcandoeverythingthatIneedtodo.
InregardtoCHANGEINPAIN,isyourpain…
⚫ Gettingworse
⚫ Aboutthesame
⚫ Gettingbetter
InregardtoSLEEP,areyou…
⚫ Awakewithpainmostofthenight
⚫ Awakewithoccasionalpain
⚫ Sleepingnormally
Youalsomaybeaskedtorateyourpainona
scaleof0to10with0beingnopainand10being
theworst.
Itislikelyyouwillcontinuetoneedpain
medicationonceyouhavebeendischarged
fromthehospital.Youwillbegivenawritten
prescriptionforthispriortoleavingthehospital.
Youmaychoosetohaveitfilledatthehospital’s
pharmacythroughtheMedstoBedsprogram
beforedischarge.Opioidmedicationsmust
betakenasprescribedbecausetheycanhave
seriousconsequencesifnotusedcorrectly.
Yoursurgeonwillmanageyourpainmedication
followingdischargesoyouwillneedtocontact
hisorherofficetorequestrefills.Youwillwant
toplanaheadwhenyouarerunninglowon
medicationsinceyoursurgeonisofteninsurgery
andoutoftheoffice.Allowtwobusinessdays
forrefillstobewritten.You must pick up a written prescription in the office to take to your pharmacy.Theofficestaffisunabletophoneor
faxtheprescriptioninforyou.Afriendorrelative
onyourHIPAAlistmaypickupthewritten
prescriptionforyouifneeded.
3 WestYourstayon3Westisdesignedtogetyou
startedontheroadtorecoveryfromyourknee
surgery.
Anytimethereisashiftchange,thenurseswill
cometoyourbedsideanddiscussyourplan
ofcarewhichincludesyourhealthcareneeds
andtreatmentgoals.Yourinputinthisprocess
isencouraged.Youandyourcompassionate
coachmayusethistimetoaskquestionsorraise
concernswithyournurses.Youareapartnerin
thisprocessandshouldunderstandyourplanof
care.Pleasebeawarethatyoumaybeawakened
duringthenightforthenursetomonitoryour
condition.Thestaffwillmakeeveryattempt
toperformthesenecessaryinterruptionsinan
efficientmanner.
Surgery and Hospitalization continued from page 19
LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|21
Yoursafetyisofthehighestconcerntothestaff.
Youwillwearabraceletthatwillbescanned
priortoreceivinganymedicationtobesureyou
receivetherightmedication.Anadditionalred
braceletindicatesanyallergiestomedications
orproductsthatcontainlatexoradhesives.
Youalsowillhaveayellowbraceletthatindicates
youmightbeaFallRisk,meaningyourriskof
fallingisgreaterduetomedication,equipment
orhealthconditions.Pleaseuseyourcalllightto
letthestaffknowifyouneedassistanceorhave
otherneeds.
Yournursewillcheckyourvitalsignsand
conditionfrequently.Besuretolethimor
herknowifyouhavequestionsorconcerns.
Yourcompassionatecoachalsocanbe
helpfulincommunicatingwiththestaffsince
themedicationstocontrolpainmaymake
youdrowsy.Thosemedications,alongwith
anesthesia,cancausenauseaand/orvomiting.
Yournursecangiveyoumedicationforthisif
needed.Anothercommonproblemaftersurgery
isconstipation,forwhichmedicationswillbe
recommended.
Onceyourpainiswell-controlledwithoral
medicationsandyouaretoleratingoralfluids,
yourIVwillbediscontinued.Initially,youwillbe
givenclearliquidstodrink,andyourdietwill
beadvancedastolerated.Youmaynothave
muchappetiteaftersurgery,butyouwillbe
encouragedtoeatanddrink.Goodnutrition
isimportantforgoodhealing.Mealtimesat
LMHHealthareflexibleandarepresentative
fromdiningserviceswillcometoyourroomto
takeyourorderoffofamenuwhichcorresponds
withthedietyourphysicianhasordered.
Anincentivespirometerwillbeatyourbedside.
Youwillbeencouragedtouseitfrequently,much
likeyourpre-operativebreathingexercises.Thisis
tohelpdecreaseyourriskofpneumonia.
Youwillbeencouragedtodofootandankle
movementssoonaftersurgeryandthroughout
yourhospitalstay.
Continue to wear your TED hose (compression stockings) until your first post-op appointment at your surgeon’s office. Besuretohavethese
onwhenyouaredischargedfromthehospital.
Theyhelpminimizetheriskofbloodclotsand
reduceswelling.Removethestockingstoshower.
Youwillbeencouragedtouseacommodeor
standtourinate.Ifyouareunabletourinate,a
cathetermaybeplacedtemporarilytoempty
yourbladder.Difficultyinurinatingisnot
uncommonaftersurgery.Ifyouhaveaurinary
catheterinplacefromsurgery,itwillberemoved
shortlyaftersurgery.
Icepacksonyourkneeandcompressiondevices
onyourlowerlegswillhelpreduceswelling,
whichhelpslessenyourpain.
Intheeveningonthesamedayasyoursurgery
youwilllikelybeassistedtositontheedge
ofyourbed,andpossiblytostandattheside
ofyourbed.Youalsomaybeginwalkingwith
assistancethedayofsurgery.Thismayseemlike
adifficulttask,butitisthefirststeptowardyour
recovery.
Weencourageyoutohavevisitorsduringyour
hospitalstay,butkeepinmindthatyoualsoneed
timetorest.Youmayneedyourcompassionate
coachtolimithowmanypeoplevisitatatime,
andremindvisitorshowlongtheymaystay.
3WesthasadesignatedQuiet Time from 3:30 to 5 p.m. Thisisagoodtimetorestandrecover
fromtheday.Ourstaffwilltrynottodisturb
youduringthistime,butyouareencouragedto
notifythemusingthecalllightifneeded.
Planningforyourdischargewillbeginafter
surgery.Ateamofprofessionalsfrom
LMHHealthwillworkwithyouandyour
physician(s)todeterminethetimingand
conditionsofyourdischargefrom3West.
Thisteamincludesphysicalandoccupational
therapists,socialworkers,nurses,andpharmacy
staff.Somepatientsareabletoleavethehospital
3 West continued on page 22
22|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
afteroneortwodays,butsomestayuntilthe
thirddayaftersurgery.Priortosurgery,you
maywanttoconsiderwhatyouroptionsare
afterdischarge.Themajorityofpeoplegohome
withacaregiver,butsomepeoplemayneedto
transfertoarehaborskilledfacility.LMHHealth
hassuchafacilityonthe4thfloorandthereare
otheroptionsinthecommunity.Asocialworker
canhelpyouexploreyouroptions.Socialwork
willvisitwithyouandyourcareteamtohelp
makewhateverarrangementsareneeded.Donot
hesitatetoaskforinformation.
After surgery, while you are in the hospitalYourgoalforthesedaysistopreparephysically
andmentallytoleavethehospitalandcontinue
yourrehabilitation.
Laboratorypersonnelwilldrawyourblood
themorningaftersurgerytocheckyourblood
counts.Resultsofthesetestswillletthedoctor
knowifyoumayhaveaninfectionorifyou
havebecomeanemic.Anemiaishavingalow
redbloodcellcountwhichcancausefatigue,
weaknessandpaleskin.Itisnotuncommonfor
thistooccuraftertotaljointreplacementsurgery.
Ifyourredbloodcellcountgoestoolow,your
doctormayorderabloodtransfusion.Redblood
cellscarryoxygentovitalorgansincludingthe
brain,soit’simportanttomakesureyoumaintain
ahealthylevel.
Yoursurgeonand/orphysicianassistant
willcheckonyoudaily,usuallyearlyinthe
morning.Thisisagoodtimetoaskquestions
orcommunicateconcernswithyourphysician.
Askyournursewhattimeyoucanexpectyour
surgeonorphysicianassistantifyouwantto
arrangetohaveyourcompassionatecoach
presentduringthesevisits.
3 West continued from page 21
Surgery and Hospitalization
Youwillbeencouragedtochangefromahospital
gownintoyourown,loose-fittingclothes.You
mayweartheseforthedurationofyourstay.
Itwillbemorecomfortabletobeinyourown
clothes,especiallywhenworkingwithphysical
therapyoutsideofyourroom.Youwillcontinue
towearyourTEDhoseatalltimesexceptwhile
bathing.
Ourgoalisthatyouambulateshortlyafteryou
arrivetoyourroomon3Westaftersurgery.
Youwillbeencouragedtositinachairforyour
mealsratherthanstayinginbed.Youalsowill
beencouragedtogetuptousethebathroom
orcommodeforyourtoiletingneeds.Astaff
memberwillassistyouwithyourdailyhygiene.
Atsomepoint,onceyouareable,youwillbe
encouragedtotakeashower.Instructionsabout
howtokeepyourwounddrywillbeprovided.
Alwaysrequestassistancewhengettingoutof
bed.Astaffmemberwillneedtobepresentto
helpwithtransferstoachairortoescortyouto
thebathroom.Youwillbeunstableonyourfeet
andatahigherriskforfalls,especiallyinthefirst
severaldaysaftersurgery.
Medicationwillbegiventoyoutopreventblood
clots.Thismedicationwillbegiveneitherorally
orbyinjection,dependingonyourphysician’s
preferencesandyourhealthhistory.Thiswillbe
continuedafterdischargeandyouwillbegiven
instructionsfortakingthismediationathome.
Physicaltherapywillbeginrightaway.Therapy
staffwillworkwithyouonyourkneeexercises
andtransfersfromthebedtoachair.Theyalso
willhelpyoulearntouseyourwalkerorcrutches.
Yourcompassionatecoachisencouragedto
bepresentforatleastonetherapysessionto
learnyourroutinesoheorshecanassistyouat
home.Youwillbeexpectedtoexerciseatleast
twiceadayathome.Thegoalistogradually
increaseyourknee’srangeofmotionandthe
LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|23
distanceyouareabletowalk.Thesemayseem
likeimpossibletasksinthedaysimmediately
followingsurgery,butarekeyforasuccessful
recovery.Itisexpectedthatbyyourtwo-week
post-opappointmentatOrthoKansasyouare
abletobendyourkneeatleast90degrees.
Youalsomayhaveanoccupationaltherapist
workwithyouonactivitiesofdailylivingsuch
asdressing,bathing,usingadaptiveequipment,
etc.Adaptiveequipmentsuchasgrabberscan
bepurchasedthroughMedstoBeds.Therapy
alsowillmakesureyourassistivedevicessuch
asawalker,caneandcrutchesfitappropriately.
Theywillaskquestionsaboutyourhome
environmenttolearnaboutanyphysical
challengesyoumightfacesuchasstairsinside
andoutsidethehouse.
Usuallyontheseconddayaftersurgery,the
bulkydressingonyourkneewillberemoved
andreplacedwithasmallerdressing.Youwill
beinstructedonwhattypeofdressingsyou
willneedtopurchase,aswellashowoften
youwillneedtochangeyourdressing.Your
compassionatecoachwillneedtobeinstructed
onthisaswell.
Discharge from LMH HealthYourdischargefromLMHHealthwilloccurwhen
yourhealthcareteamdeterminesitissafeforyou
toleave3West.Dependingonyourcontinuing
careneeds,youroptionsafterdischargeinclude:
⚫ Homewithcompassionatecoach
⚫ Homewithoutpatienttherapy
⚫ Homewithhomecarenurseand/ortherapy
⚫ Transfertoskilledorrehabfacility
Mostpeoplegodirectlyhomeafterleaving
3Westaslongastheyhavetheabilitytowalk
safelywithawalker,transferinandoutofbed
safelywithoutassistance,andnavigatestairs.
TherearequalifyingfactorssetbyMedicareand
otherinsurancesthathavetobemetinorder
foranypatienttobetransferredtoaskilledor
rehabfacility.Asocialworkerwillexplainthese
qualifyingfactorstoyou.
Ifyouplantohavehomehealththerapy,post-
dischargetherapyorderswillbesenttothe
homehealthagencyofyourchoice.Otherwise,
theorderswillbesenttotheoutpatientphysical
therapylocationofyourchoice.Ifyouknowprior
tosurgerythatyourplanistogotoanoutpatient
therapyfacility,youwillwanttocontactthem
afewweeksbeforesurgerytosetyourfirst
appointments.Thesefacilitiescanbeverybusy
andtheremaybeawaitbeforeyoucangetin
toseeatherapist.Planningaheadmayhelpyou
avoiddelaysinreceivingtherapyaftersurgery.
LMHHealthhasseveraloutpatienttherapy
locationsinandaroundLawrence,oryoumay
considerotheroptions.
Priortodischarge,yournursewillreviewwritten
careinstructionswithyouandgiveyouacopy
totakehome.Theseinstructionswillinclude
informationaboutwoundcare,dressingchanges
andhowtoprotectyourincisionduringashower.
Yoursurgeonwillgiveyouaprescriptionfor
painmedicationandpossiblyabloodthinner.
LMHHealthhasapharmacyconvenientlylocated
onsite.WiththeMedstoBedsprogram,you
areabletohaveyourprescription(s)filledatthe
hospitalpharmacyanddelivereddirectlytoyour
roompriortodischarge.Yourcompassionate
coachwillneedtoarrangetohaveyourwallet
availablesoyoucanpayforyourmedication.
Thebenefitsofthisprogramareexplainedinthe
FrequentlyAskedQuestionssectionofthisbook.
Besuretotakeallofyourpurchasedassistive
devicesandequipmentwithyouwhenyouleave.
Theseincludeyourwalkerorcrutches,TEDhose,
incentivespirometerandcoldtherapymachine.
Anddon’tforgetthisbook!
Ifgoinghome,youwillneedtoarrangefor
someonetopickyouup.Ifyouaretransferring
toaskilledorrehabfacility,transportationwillbe
arranged.Yourdischargewillusuallytakeplace
between11a.m.and3p.m.
24|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Recovery After Discharge
Complications after joint replacement surgeryTwomaincomplicationsthatcanoccuraftertotal
jointreplacementsurgeryareinfectionaround
thenewjointandbloodclots,oftenreferredtoas
DVT(deepveinthrombosis).
Infection:Signsofinfectioninclude:
⚫ Feverwithatemperaturegreaterthan
101degrees
⚫ Chillsorshaking
⚫ Increasedredness,swellingorpainaround
theincision
⚫ Changeincolor,amountorodorofdrainage
⚫ Increasedjointpain
Youshouldnotifyyoursurgeonifyoudevelop
anyofthesesignsofinfection,oryouhave
anyconcernsaboutyourincision.
Blood clots:Signsofabloodclotinclude:
⚫ Increasedpain,tenderness,warmthorredness
intheleg(notdirectlyaroundtheknee)
⚫ Swellingortightnessinthecalforankle
Notifyyoursurgeonimmediatelyifyoudevelop
anyofthesesymptoms.Anultrasoundmaybe
donetoevaluateforbloodclots.Ifclotsdevelop,
medicationcanbeusedtotreatthem.
Anundiagnosedbloodclotinthelegcantravel
tothelungsandbecomeapulmonaryembolism.
Signsofthisinclude:
⚫ Suddendifficultybreathing,rapidbreathingor
feelingshortofbreath
⚫ Chestorbackpain
⚫ Coughingupblood
⚫ Sweating
⚫ Changeinmentalstatus(confusion)
Notifyyoursurgeonorgotothenearest
EmergencyRoomimmediatelyasthisisa
medicalemergency.Apulmonaryembolism
canbefatalifnottreatedquickly.
LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|25
RecoveryThenextseveralweekswillbeveryimportant
inthesuccessfulrecoveryfromyourtotalknee
replacementsurgery.Theseweekscanbe
difficultduetothechallengesofadaptingto
beingathomeandworkingthroughphysical
therapy.Yourgoalwillbetoregainuseofyour
kneeandreturntoanactivelifestylethatyou
mayhavebeenmissingpriortosurgery.Be
realisticaboutyourgoalsafterrecovery.Ifyou
coulddocertainactivitiespriortoyourknee
becomingarthriticandpainful,thereisagood
chanceyoucangetbacktothoseactivitiesas
longastheydonotplacetoomuchstresson
yournewjoint.However,ifyouwerelimitedby
otherhealthconditionspriortosurgery,youmay
continuetohavethesesameissues,butwithout
thekneeproblem.
Physical therapyYouwillcontinuewithphysicaltherapyeitherat
homewithahomehealthphysicaltherapistorat
anoutpatientfacility.Thearrangementsforthis
willbemadepriortoyouleavingthehospital.
Youshouldexpecttoworkwithatherapistthree
tofivetimesaweekafterthefirstfewweeks
aftersurgery.Inaddition,youwillbetaughta
homeexerciseprogramwithexercisesthat
youwillbeexpectedtoperformtwiceaday.
Yourtherapistwillhelpsetgoalsforfunctionand
activity.Thetherapistwilltakeintoconsideration
yourlevelofactivitypriortosurgeryandyour
goalsforaftersurgery.Youwillcontinuewith
therapyuntilyourgoalshavebeenmetoryou
demonstratetheabilitytoworkonyourown.
Insomecases,yourinsurancemayhavealimit
onhowmanytherapysessionstheywillcover
aftersurgery.
Incision careKeepyourincisioncoveredanddryuntilyou
seeyoursurgeonatyourpost-opappointment.
Beforeleavingthehospitalyouwillbetaught
howtochangeyourdressing.Mostpatientswill
gohomewithanAquaceldressing.Thistype
ofdressingischangedeverysevendaysunless
therearecircumstancesthatmakeitnecessaryto
changeitsooner.Somepatientsgohomewitha
Tegadermdressing.Tegadermdressingsshould
bechangedeveryotherdayunlessyouare
instructedtodootherwise.Ifyouhaveincreased
drainage,youmayneedtochangethedressing
moreoften.IftheTegadermdressinggetswet,
youwillneedtoremoveitandreplaceitwitha
dryone.Bothtypescanbepurchasedatthe
LMHHealthPharmacythroughMedstoBeds.
Besureyourhandsarecleanbeforechanging
yourdressing.Whilethedressingisoff,checkfor
anychangesintheappearanceoftheincision.
Ifthereareanysignsofinfection,notifyyour
surgeon.Donotapplyanylotions,ointments
orcreamsonordirectlyaroundyourincision.
Youwillbegivenadditionalwoundcare
instructionsatyourfirstpost-opappointment
whenyouhaveyourstaplesremoved.
ShoweringPriortoyourfirstpost-opappointmentwith
yoursurgeon,youmayshoweraslongasyou
protectyourincisionfromgettingwet.Tegaderm
dressingswillkeepmoistureout,butitisalways
goodtoreinforcethis.Aquaceldressingsare
waterproof.Besuretheyareintactandno
moisturegetsinsidethedressing.Donotsoakin
atuborsimilaruntilyouaretoldyouarecleared
todoso.Itmaybeweeksaftersurgerybefore
youwillbeallowedtosoakyourkneeinatub
orpool.Youwillreceiveinstructionsregarding
showeringandbathingwhenyouhaveyour
staplesorsuturesremovedatyourappointment
withyoursurgeon.
Continued on page 26
26|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
SwellingSwellingiscommonaftertotaljointreplacement,
generallyonlyintheoperativeleg.Areasmost
likelytobecomeswollenarethefoot,ankle,knee
andthigh.Useofcompressionstockings(TED
hose)canhelpavoidthis.Continuetousecold
therapy.Thisalsowillhelpreducetheamountof
swellinginyourknee.Swellinginthekneecan
maketherapymoredifficult,soworktoreduce
thisbyelevatingthelegswhenlyingdownor
whenseated.Donotallowyourlegstohang
lowerthanyourwaistforextendedperiodsof
time.Movingaroundfrequentlyalsowillhelp
reduceswellingbyincreasingbloodcirculation
inthelegs.
Bruising or redness on operative legYoumaynoticebruisinganywhereontheleg
fromyourhipdowntoyourfeet.Thisisnot
uncommonafterkneereplacement.Theupper
legcanbebruisedbecauseofthetourniquet
thatwasplacedduringsurgerytoreduceblood
loss.Lowerlegbruisingcanbearesultofinternal
jointbleedingthatcanoccurduringorafter
surgery.Bruisingaroundthereplacedkneeisalso
common.
DietSomelossofappetiteiscommonforseveral
weeksaftersurgery.Abalanceddietisimportant
topromotepropertissuehealingandrestore
musclestrength.Besureyouconsumeplentyof
proteinasthisisespeciallyimportantinhealing.
Asyoubegintobemoreactive,yourappetite
shouldimprove.Besureyouaredrinkingplenty
offluids.Hydrationwillhelpavoidconstipation
whichiscommonaftersurgery.Constipationcan
occurbecauseofdecreasedactivityandopioid
painmedicationuse.
Pain controlContinuetotakeyourpainmedication(s)as needed and as prescribedtokeepyourpain
undercontrolforthefirstfewweeks.Keepin
mindthatrecoveryfromkneereplacement
surgeryispainful,andmedicationmaynot
eliminateallofyourpain.Donotexceed
recommendedorprescribeddosesofyour
medication.Somemedications,iftakentoooften
orintoohighadose,cancauseover-sedation
orotherwiseputyourhealthatrisk.Donot
exceed3,000mgofTylenolina24-hourperiod.
Ifyouareprescribedapainmedicationthat
containsTylenol,staywithinthatdosinglimit.
Refillrequestsforcontrolledmedicationsmust
becalledintoyoursurgeon’sofficeandyouwill
needtopickupthewrittenprescriptionthere.
Overtime,yoursurgeonwillencourageyouto
tobackoffofstrongopioidpainmedicationand
beginusingover-the-countermedications.Most
peopleareabletoreduceoreliminatetheneed
forprescriptionpainmedicationwithinfourtosix
weeksaftersurgery.Ifyouhavequestionsabout
whatover-the-countermedicationsyoucantake,
contactyoursurgeon’soffice.
Besidesmedication,thereareotherwaystohelp
minimizethepainanddiscomfortfromyour
surgery.Continuetousecoldtherapyonyour
kneetohelpreduceswelling.Youalsoshould
elevateyourlegwhenlyingorsittingtoaid
inreducingswelling.Youshouldgetup,walk
andchangeposition.Althoughyourexercises
andtherapycanbepainful,theyalsocanaid
inreducingswellingbyincreasingcirculation.
Expectyournewkneetofeelstiffaftersittingor
lyingforextendedperiodsoftime.Youwillbe
encouragedtomovearoundfrequentlytoavoid
this.
Recovery After Discharge
Continued from page 25
LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|27
TravelingDonottravelalongdistance(overonehour)by
vehicleorairplaneuntilclearedbyyoursurgeon.
Thisrestrictionusuallylastseighttotwelveweeks
aftersurgery.Failuretofollowthisrestriction
increasesyourriskforbloodclots.Ifyouare
travelingbycar,besuretostopeveryhourto
getoutandstretchyourlegs,otherwiseyoucan
becomestiffandsore.Iftravelingbyairplane,
trytostandandstretchperiodicallyaswellas
dosomelowerlegstretchesorexerciseswhile
seated.
Yournewjointwilllikelyactivatemetaldetectors
thatareusedinsecuritychecksatairportsand
insomebuildings.Youwillreceiveacardatyour
surgeon’sofficethatyoucancarryinyourwallet
toshowtosecuritypersonnel.Accommodations
willbemadetoscreenyouforclearance.
Dental workForaperiodofatleasttwoyearsafteryourtotal
jointreplacement,youwillberequiredtotake
asingledoseofantibioticspriortoanydental
procedures.Theseincludecleanings,periodontal
procedures,fillings,etc.Yoursurgeon’sofficewill
prescribetheappropriatemedicationforyouto
take.Youneedtowaitthreemonthsaftersurgery
beforehavinganyelectivedentalworkdone.
Althoughtheriskisverysmall,yoursurgeon
wantstominimizetheriskofanyinfectioninyour
newkneeasaresultofbacteriafromyourmouth.
Activity after knee replacementExerciseisthekeytosuccessfulrecovery
followingjointreplacementsurgery.Oncecleared
byyoursurgeonintheweeksaftersurgery,you
shouldbeabletoresumemostnormalactivities.
Atfirst,someactivitiesmaybealittlepainful,but
overtimeyouwillfindyourselfparticipatingmore
intheactivitiesyouenjoy.
Startbackintoactivitygradually.Slowlyincrease
youractivityinyourhomebywalkingaround
thehouseandresuminghouseholdchores.
Eventually,youshouldbeabletoreturnto
walkingoutsideorgoingtoagym.Besureto
usecautiontoavoidfallsandinjuries.Swimming
isanexcellentformofexercisethathelps
strengthenyourlegswhileyouarerecovering.
Otheractivitiesthatyoumightconsiderinclude
golf,lighthiking,recreationalbikingonpaved
surfaces,dancing,bowlingandgardening.
Plantoexerciseatleastthreetofourtimesa
weekfor20to30minutesatatime.
Donotrunorparticipateinhigh-impactactivities.
Avoidactivitiesthatrequirealotofstops,starts,
turnsandtwistingmotions.Donotparticipatein
contactsportsthatincreaseriskofinjurytoyour
knee.Specificactivitiestoavoidincludevigorous
hiking,jogging,snowskiing,tennis,repetitive
aerobicstairclimbing,repetitiveweightliftingof
40poundsormore,football,basketball,baseball,
highimpactaerobics,racquetballanddeep
squats,tonameseveral.Theseactivitiesincrease
riskofinjuryorearlywearingoftheartificialjoint.
Sexual activityItisnotuncommonforyouoryourpartnerto
experienceanxietyaboutengaginginsexual
activityaftertotaljointreplacement.Thepainful
jointmayhavelimitedyourabilitytoenjoy
sexualactivitypriortosurgery.Thejointsurgery
willalleviateasignificantamountofthatpain
andjointstiffnessandallowyoutoresumethis
activitymorecomfortably.Itisgenerallysafeto
resumesexualactivityaboutfourtosixweeks
aftersurgery.Thejointrecoveryprocessmay
requireyoutotakeamorepassive“bottom
position”initially,butovertime,youshould
beabletotakeamoreactiveroleinsexual
intercourse.Ifyouhavequestions,youcanalways
checkwithyoursurgeon,nurseorphysical
therapist.
28|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
Frequently Asked Questions
What is osteoarthritis and why does it make my knee hurt?Osteoarthritisisthemostcommonformof
arthritis.Itiscausedbythewearingdownofjoint
cartilage,thetough,smoothtissuethatcovers
theendsofboneswherejointsarelocated.
Jointcartilagecushionstheboneduring
movementandallowsmotionwithminimal
friction.Asthecartilagewearsdownovertime
itexposestheendsoftheboneswhichleadsto
painfulbone-on-bonecontact,swellingandloss
ofmotioninthejoint.
What is a total knee replacement?Thetermtotalkneereplacementissomewhat
misleading.Thekneeisnotreplaced,butrather
animplantisusedtore-capthewornendsofthe
bone.Thisisdonebyremovingthewornsurfaces
oftheboneandimplantingmetalsurfaceswith
aplasticspacerinbetween.Thiscreatesanew,
smoothcushionandafunctionaljointthatcan
reduceoreliminatepain.
How long and where will my scar be?Surgicalscarswillvaryinlength,butyour
surgeonmakesitassmallaspossible.Itwill
startjustaboveyourkneeandextenddown
themiddleofyourkneetojustbelowtheknee.
Astimegoesby,thisscarwillfadeandbecome
muchlessnoticeable.Somepeoplenotice
numbnessaroundthescarwhichmaydecrease
overtimeormaybepermanent.
What is the recovery time after my knee surgery?Everyonehealsfromsurgeryatadifferentpace.
Peoplehavedifferentlevelsofpaintolerance
anddifferentlevelsofmotivation,andbothare
factorsthataffecthowsoonanindividualis
abletoworktowardrecovery.Youshouldplan
touseanassistivedevicesuchasawalker,cane
orcrutchesforamonthortwoaftersurgery.
Physicaltherapywillhelpyougetbacknormal
useofyourknee.Bythreemonthsaftersurgery
mostpeoplehaveregainedfulluseoftheirknee
andareabletoresumemostnormalactivities.
LMHHealthandOrthoKansasTotalKneeReplacementEducationManual|29
How long will I be on pain medication and why do I have to pick up a written prescription from my surgeon’s office?Mostpeopleareabletodecreaseoreliminate
theuseofnarcoticpainmedicationbyaround
fourtosixweeks.Refillswillbeatthediscretion
ofyoursurgeonandbasedonyourprogress
withtherapyandthelengthoftimethathas
passedsincesurgery.Thestrongnarcoticpain
medicationthatyoureceivedatthehospital
willgraduallybereplacedwithlowerdose
painmedications,andeventuallyyouwillbe
encouragedtouseonlyover-the-counter
medicationssuchasTylenoland/oranti-
inflammatories.Narcoticpainmedicationsare
rigidlycontrolledbytheDrugEnforcement
Agencyandpertheirguidelines,onlywritten,
signedprescriptionscanbeacceptedatthe
pharmacy.TheDEAmonitorsallcontrolled
substanceprescriptionswrittenbydoctorsas
wellasprescriptionsfilledbyindividuals.
How long will my new knee last and can a second replacement be done?Allimplantshavealimitedlifedependingonan
individual’sage,weight,activitylevelandmedical
conditions(s).Theimplantisamedicaldeviceand
issubjecttowearthatmayleadtomechanical
failureovertime.Thereisnoguaranteethat
yourimplantwilllastforanyspecifiedlengthof
time.However,mosttotalkneeimplantslastat
least15to20years.Animplantcanbereplaced,
althoughthesurgeryisalittlemorecomplicated.
How often will I need to see the surgeon after surgery?Youwillhaveaseriesofappointmentsduringthe
threetosixmonthsaftersurgery.Expecttosee
yoursurgeontwoweeksaftersurgeryandagain
atdifferentintervalsduringthattimeperiod.
Youalsowillfollowupwithyoursurgeonatyour
one-yearanniversaryofyoursurgery.Afterthat,
expecttofollowupeverythreetofiveyears
aftersurgerytobesureeverythingisgoingwell.
Youshouldnotifyyoursurgeonanytimeyou
haveconcernsorquestionsaboutyourknee.
When will I be able to return to work after surgery?Thatanswerdependsalotonwhattypeofwork
youdo.Ifyouworkatasedentaryjob,youmay
bereadytoreturntoworkinfourtosixweeks,
althoughtheremaybelimitationsinplaceand
youmayonlybeabletoworkparttimeforafew
weeks.Ifyouhaveajobthatismorephysically
demanding,itmaybeuptothreemonthsbefore
youcanreturntofullduty.
Can I drink alcohol during my recovery?Aslongasyouaretakingnarcoticpain
mediation,youshouldavoidanyalcohol
consumption.Bothhaveasedatingeffectand
cansuppressthecentralnervoussystem.Alcohol
alsocandecreaseyourabilitytowalksafely
andincreaseyourriskoffalling.Youshould
avoidalcoholifyoutakecertainprescription
medicationssuchaswarfarin.Checkwithyour
primarycaredoctorifyouhaveanyquestions
aboutthis.
Is it normal to feel depressed after surgery?Itisnotuncommontohavenewsymptomsof
depression(orworseningsymptomsifyouhadit
priortosurgery)afterjointreplacementsurgery.
Thismaybeduetoavarietyoffactorssuchas
limitedmobility,discomfort,temporarylossof
independence,lackofsleep,feelinghomebound
andmedicationsideeffects.Thesefeelings
shoulddiminishasyoubegintoresumeregular
activities.Ifthesymptomspersist,checkwith
yourprimarycarephysician.
Is it normal to have insomnia after surgery, and what can I do about it?Insomniaisverycommonaftertotaljoint
replacementsurgery.Patientsoftenreportthis
asoneoftheirchiefcomplaintsduringtheir
recovery.Thiscanresultfrompain,toomuch
napping,anxiety,oranynumberofreasons.
Yoursurgeonwillnotprescribesleepmedication
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30|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
What are the benefits of using Meds to Beds?Youwillbeabletopurchaseprescription
medications,assistivedevicesandmedical
equipmentsuchasdressingsoricepacksdirectly
fromtheLMHHealthpharmacy.
⚫ Yourprescriptionsareconveniently
deliveredtoyou.
⚫ Youcanavoidanadditionalstopatthe
pharmacyonyourwayhome.
⚫ Apharmacistorpharmacyinternwillmeet
withyoupersonallytoprovideone-on-one
dischargemedicationeducationandanswer
medicationquestionstoyoursatisfaction.
⚫ Remainingrefillswillbetransferredtoyour
pharmacyofchoiceandmedicationchanges
communicatedtoyourpharmacist.
⚫ Anupdatedmedicationlistwillbesenttoyour
primarycareprovider.
How long after surgery do I need to wear compression stockings (TED hose)? Youshouldcontinuetowearyourcompression
stockingsuntilyourtwo-weekpost-op
appointment.
How soon after surgery can I drive? Youcanusuallyresumedrivingtwotofour
weeksaftersurgery.Beforedrivingyouwillneed
tobeoffopioidpainmedication,havegood
legcontrol,andbefullyweightbearing.Your
surgeonwilldiscussyourprogressanddriving
potentialatyourtwo-weekpost-opvisit.
Frequently Asked Questions
foryoubecausethesedatingeffectofthat
withyournarcoticpainmedicationcanbea
dangerouscombination.Therearenatural,
over-the-counteroptionssuchasmelatonin
thatyoumightconsidertrying.
Is it normal for my leg with the joint replacement to feel longer now? Inmostcases,thelengthofyourlegwillnotbe
differentaftersurgery.However,insomecases
thelegislengthenedasaresultofstraightening
akneethatwaspreviouslybowed.Itmayfeel
awkwardatfirst,butmostpeoplebecome
accustomedtothedifference.Inrareinstances,a
shoeliftmaybenecessaryontheoppositeleg.
How do I get the cold therapy unit and how long will I need it?Whenyouschedulesurgeryyouwillbegiven
informationaboutwhotocontactandhowto
makearrangementstohavethecoldtherapy
machineavailablepriortosurgery.Youwillhave
thisinplaceimmediatelyaftersurgeryandwill
useitaslongasyoufeelitiseffectiveforyou.
Itismosteffectiveifyouuseitatleastthree
timesadayfor10-15minutesatatime.You
shouldexpecttouseitforatleastseveralweeks
aftersurgerytohelpkeepswellingundercontrol
andminimizepain.Ifyoudon’twanttopurchase
thecoldtherapymachine,youcanpurchaseor
makeyourowncoldpacks.
Who do I call after surgery if I have questions?ContactthenursenavigatoratOrthoKansasif
youhavequestionsorconcerns.Ifyoubelieve
youarehavingamedicalemergency,however,
youshouldcontact911orgodirectlytothe
EmergencyRoom.
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32|LMHHealthandOrthoKansasTotalKneeReplacementEducationManual
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