Transcript the Total Joint Replacement Preparation Guide.

Total Joint Replacement
Physical Therapy:

Therapy begins the day of or day after
surgery, depending on your doctor. You
are expected to participate in 2 sessions
per day.
Total Knee Replacement

Patients who have had a total knee
replacement will begin outpatient therapy
within a few days of leaving the hospital.
◦ If you are able to schedule your appointment
before you come for surgery, you will have a
better chance of getting the date and time
you prefer.
◦ A prescription for therapy (2-3 times a week)
will be given to you prior to discharge.
Total Hip Replacement

Standard Total Hip
◦ Hip precautions – to be followed for 8 weeks
unless your surgeon specifies otherwise.
 Do not bend your hip into more than 90 degrees
of flexion (right angle).
 Do not cross your legs, either at the knee or the
ankle.
 Do not let your toes (hip) rotate inward.

Anterior Approach Total Hip
• No precautions to follow, unless specified by
your surgeon.
• Outpatient physical therapy will be ordered
after your first follow up appointment if
needed.
Post-Op Activities
Please consult your physician with specific
questions about returning to activities.
 Driving – per physician guidelines
 Kneeling – 8 weeks
 Dancing – 8 weeks
 Bicycling – 4-8 weeks
 Golfing – 6-8 weeks

Exercises

Quad Sets – squeeze top of thigh, pushing
knee flat. Hold for 10 seconds. Repeat 20
times.
Exercises

Hamstring sets – tighten muscles on back
of thigh, digging heel down and back. Hold
10 seconds. Repeat 20 times.
Exercises

Heel slide – bend knee as far as you
comfortably can. Hold 5 seconds. Repeat
20 times.
Exercises

Short arc quad – with a rolled towel or
coffee can under knee, tighten muscles on
top of thigh and straighten knee. Hold 10
seconds. Repeat 20 times.
Exercises

Straight leg raise – keeping knee straight,
lift leg 6-8 inches off bed. Hold 5 seconds.
Repeat 20 times.
Exercises

Long arc quad – from a seated position,
straighten knee. Hold 5 seconds. Repeat
20 times.
Arm Exercises
Chair push-ups
 Bicep curls
 Shoulder raises
 Side (lateral) shoulder raises

Physical Therapy

A copy of the exercises is located in
the pamphlet that was mailed out to
you. If you need a new copy please
let us know.
Before Surgery

Prepare Home
◦ Remove rugs, railing for the stairs, bath bench, toilet seat riser,
or grab bars.
Walker/Crutches/Cane
 Make sure to set up a ride home after
discharge and a caregiver for
approximately 1 week.


You will receive two phone calls before surgery:
◦ Insurance confirmation - demographic information
◦ Nurse registration – to review medical history and
medications and confirm scheduled procedure
 Any patient on a blood thinner needs to speak with their primary
doctor and surgeon regarding use 1-2 weeks before surgery

Bring an overnight bag:
◦ All labeled medications in the prescription bottle (except
pain medication), loose fitting shoes, and comfortable
clothes
◦ CPAP if used for sleep apnea
Day of Surgery
Nothing to eat or drink after midnight
including coffee, water, gum, hard candy,
etc.
 Shower as instructed the night
before/morning of surgery.
 Medications as instructed during preprocedure phone call with nurse.

After Surgery
Surgeon will speak with family after the
procedure.
 Expect to be in recovery for 1-2 hours
after surgery.
 Wi-Fi is available within the building

Overnight Stay

Expect to stay 1-3 days
◦ See joint recovery plan
◦ Family allowed overnight; one visitor meal
provided per day
Equipment
Reason
Ted hose (white socks)
Prevent blood clots
Athrombics (leg massage)
Prevent blood clots
Ice (polar cooler or packs)
Decrease swelling/pain
Incentive spirometry (volurex)
Prevent respiratory complications
Continuous Passive Motion (CPM)
Assist with range of motion for
Total Knees
Pain

Goal: Well Controlled Pain Levels
◦ Scale 0-10
◦ Pain should be tolerable but not likely pain free.
◦ Be proactive, it is easier to control pain than catch up
to severe pain.
◦ An anesthesiologist will discuss pain control options
prior to surgery.
Common Medications
Narcotics
Morphine
 Dilaudid
 Tramadol
 Oxycodone
 Hydrocodone

◦Possible Side
Effects
 Constipation
Nausea
Itching
Drowsiness
Dizziness
Additional Pain
Antibiotics
Medications
 Tylenol
•
Ancef
•
Clindamycin
 Gabapentin
•
Vancomycin
 Celebrex
•
Keflex
 Toradol
 Vistaril
• Possible Side
Effects:
 Valium
• Rash
• Itching
 Naropin
• Flushed face
 Exparel
◦Side effects vary
based on the
medication given.
Common Medications Cont.
Blood Thinners
Fragmin
then
Aspirin
Xarelto then
Aspirin
Coumadin
Aspirin
◦Possible Side
Effects:
Mild bleeding
Bruising
Nausea &
Vomiting
Prevention
Zofran
Benadryl
Scopolamine
Patch
Decadron
Reglan
Phenergan
◦Possible Side
Effects:
Drowsiness
Dizziness
Constipation
Stool Softners
&
Laxatives
Colace
Miralax
Senna
Milk of
Magnesium
Prunes or Prune
juice
◦Possible Side
Effects:
Abdominal
Cramping
Diarrhea
Frequently Asked Questions
Why do I have to start therapy so soon?
 How often/how long will I have to go to
outpatient therapy after my knee
replacement?
 Do I still have to do my exercises at home
after I start therapy?
 Can I just do my exercises at home and
skip outpatient therapy?

FAQ, continued
Why do I need someone to stay with me
after I leave the hospital?
 How long will I need a walker/crutches?
 How long do I have to wear the TED
hose?
 Will we practice the stairs?
 Will I see my doctor before I leave?

Discharge Planning
A Discharge Planning, RN will speak
with you either the day of, or the day
after surgery regarding your needs and
plans for home.
 Assist with ordering equipment
 Assist with discharge needs

Discharge Planning Cont.
We try to take you and your family’s
preferences in to account.
 People typically do very well after surgery
and usually are safe to discharge to home.
 Please plan to discharge home. If swing
bed or home health services are medically
necessary we can help you set up these
services while you are in the hospital.

Please don’t compare your surgery to
anyone else’s or even to a previous surgery
that you’ve had.
Each surgery is unique and each person
heals differently.
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