 Welcome to the Total Joint Replacement class. As you prepare to have your knee or hip replaced, there may be questions and concerns that you may have. Our goal is that this class will help answer these questions and ensure that you come ready and prepared for your surgery. As you view the presentation, please pay extra attention to the pages in the book that are referred to. These pages will aid you in your preparation for your surgery and recovery time following. Having a joint replacement is a big decision and we want to make sure that your experience at MidMichigan Health is an excellent one. Thank you for choosing us. What should you do to prepare for surgery? Start with these homework assignments prior to your surgery date. First, please identify a support person who will be available to help you at home after your surgery. Many people will need assistance during the recovery period for mobility or activities in the home. It is important to have someone available if these needs arise. If you have a pet, consider some options ahead of time in case you are unable to provide care for them. Another step to take is to safety-proof your home. Remove all throat rugs, any electrical cords and walkways, and all other objects that may increase your risk of falls at home. Make sure you have pathways in your home to the areas that you will need to access in those first days and weeks after surgery. Work on getting ready for your surgery by completing any recommended pre-operative exercises. You may also be referred to some physical therapy ahead of time to strengthen for your upcoming surgery. Exercises will be demonstrated for you by the physical therapist or occupational therapist later in the presentation and are also listed on pages 5 and 6 in your joint replacement book. Gather items for your hospital stay. It is a good idea to bring your guide to total joint replacement. This is a good resource with references you can use during your stay. If you have advanced medical directives such as a durable power of attorney, bring this in so that we may make a copy and add it to your mid-Michigan electronic medical record. Bring your updated prescription medications list with you. Our pharmacy will provide your medications during your stay for your nurse to dispense per your surgeon's order. This will prevent any discrepancies and ensure that all medications are appropriate to be taken after surgery. Your surgeon will be prescribing medications such as antibiotics and pain medications and pharmacy will verify that all medications are appropriate to be taken together. It is important to pack comfortable, loose-fitting clothing for your stay. You will attend therapy sessions so you'll want to wear something that you will feel comfortable moving about in. Loose-fitting clothing such as sweats, athletic shorts, or lounge pants work the best. For shoewear, avoid backless shoes or slippers as these can pose a tripping hazard when walking. Shoes should be supportive and evenly worn. Keep in mind when choosing footwear that you may have some swelling in your feet due to surgery. If you have a front-wheeled walker, please bring this in with you to the hospital stay on your surgery day. Bring along any personal hygiene items you wish to have with you during your stay and discharge home will occur the same day of surgery or the day after. Consider having stool softeners such as Seneca or Meralax available as major side effects of your pain meds will be constipation. Consider options of medical equipment to make your recovery easier. Please make sure that you have transportation arranged for discharge as needed in the days and weeks ahead. Call the hospital as noted on page 3 in your workbook for your arrival time. On page 9 in your booklet, you will find detailed instructions on skin preparation. You must wash with an antibacterial soap called Clorexidine Gluconate or CHG which may be obtained from your surgeon's office for your short wash daily three days prior to surgery. Do not shave the surgical area within 72 hours of surgery as this can increase infection risk. What should you do the night before your surgery? Please do not drink alcohol for 24 hours prior to surgery and after midnight. Don't eat anything including gum or throat lozenges. Do brush your teeth but be sure not to swallow any water and once again use the antibacterial wash. When you arrive for your surgery, you will arrive at the main hospital entrance. A greeter will direct you to the surgical services area. Nurses will complete your check-in at this time and anesthesia will meet with you and discuss your plan for anesthesia. Most patients will have spinal anesthesia for their procedures but sometimes general anesthesia is used for total joint replacements. Due to HIPAA privacy laws, we are unable to give any of your health information over the phone to family or friends during your stay unless they provide your PIN number. You will be provided this four-digit number at the beginning of your hospital experience, so please share this number with a few close people you know and trust to check in on you. It is not advised to share this number publicly. After surgery, you will be able to order food after arriving to your room. For most people, there will be approximately an hour of recovery time before you're brought to your room. You will be up and moving as soon as possible after your surgery. For most patients, this will be within the first four to six hours after surgery is completed. For your safety, you will always ambulate with a gate belt and hospital staff. This means you may not move around your room without assistance from staff at any point during your stay. Please call before you get up for any reason. It is helpful to know some of the equipment you may encounter during your stay. Expect to have intravenous or IV access throughout your stay. This will likely be in one of your arms and provide fluids and antibiotics as needed as well as pain or nausea medication. You will likely be disconnected from these fluids at some point during your hospital stay, but the IV itself will remain in place until discharge in case any of these medications is needed. Ted Hose are tight white stockings that help keep compression to the legs to reduce swelling and risk of blood clots after surgery. These come in knee-high or thigh-high versions and will be in place throughout most of your stay. You will be asked to wear these at home as well per your physician's guidelines. A Foley catheter is a urinary catheter that helps drain urine from the bladder. This is physician-specific and not all patients will have a Foley catheter. If you do, it will likely be for the first part of your stay only and will be removed to get you urinating on your own. Compression boots or sleeves are another form of blood clot prevention. These are a device with velcro straps that go around the legs or feet that are hooked to a machine that fills them with air that massages the leg to promote blood flow. A drain may be placed during your surgery depending on your provider. These, if placed, are only in place for one or two days and are removed before you go home. They help with the healing process to help drain extra swelling and bleeding from the surgical site. Most patients will require some oxygen in the recovery period as your body wakes from anesthesia. This is typically given via a small nasal cannula and you will be weaned off this as soon as possible. An incentive spirometer is simply a device we use to help you achieve good deep breathing post-operatively to reduce risks such as pneumonia. It ensures air gets to the base of your lungs. An abduction pillow is a foam wedge placed between the legs and is used for some, but not all total hip replacements depending on your restrictions. It is a pillow with velcro straps which keeps your legs in an abducted position, preventing movements that may cause damage or injury to your new surgical joint and will be removed when up. The day after surgery you can expect to start your day early. Joint cat mornings start early because all patients need to be ready for the day before 7 a.m. when PT, OT, and physicians come through. This means all patients need to be moved from their bed to the chair, get washed up and dressed, have drains, catheters discontinued, and have medications given, which means we need to start early. We apologize for this as we know not everyone is a morning person. The hospital is the place where you need sleep the most and you will find it is the hardest place to get sleep. You will be up and walking with a physical and occupational therapist during the day. Your coach and or care partner should attend the family training with you. These times and dates will be posted on the communication board in your room. I3 doses of IV antibiotics are generally given after surgery and often times patients will need anti-nausea medications. There are many cases of nausea, medications, empty stomach, and pain itself can cause nausea. Your nurses are on the lookout for nausea and other side effects of medications, but please be on the lookout as well. If any medication is not working or not tolerated, please let your nurse know. We are in the line of communication to the physician and can try to change medications if needed. Many of your medications, such as pain and nausea medications, are considered PRN meds or by request. So always let us know if you need something for pain or nausea. Using a notepad to keep track of your medication, times, and pain level may help. What medications will you need when you are in the hospital? Everyone will receive some type of blood thinner to reduce risk of postoperative complication of blood clots. Aspirin is the most commonly used. Other blood clot prevention medications may be used as directed by your surgeon. Pain is an expected part of the postoperative process following total hip or knee replacement. So do expect pain, but our goal will be to keep you at a tolerable pain level during your stay. This means a target of 3 or 4 or less out of 10. Zero pain would be a wonderful goal to have. Unfortunately for many or most patients, this is not a realistic expectation. Sometimes a narcotic or opioid will be necessary to control your pain. Sometimes Tylenol or other non-narcotic can control your pain enough. And if that is the case, we will try that route. Some other non-opioid pain options are ice and elevation, turning the lights down, and using distraction such as TV, visitors, or listening to music. If you have an ice man machine from a previous surgery or have one that you can borrow from a friend, please feel free to bring this in and we will use it at the hospital. Our goal will be for you to be discharged home by the day after surgery. Some may go home the same day. Some of the criteria we look for are that you are walking greater than 50 feet, you are sitting and standing with minimal assistance, and that your pain is controlled with oral medication. You will also need to be able to tolerate food and urinate. At home, remember that movement is the key. You should be able to get up and move around often, do your exercises, and take short naps. Constipation is very common after surgery. This can happen as a result of taking pain medications, less activity, and being outside your normal routine. The following are some tips on how to manage constipation after surgery but should not take the place of advice from your physician. Make sure to include plenty of fiber in your diet. The goal is 25 to 35 grams daily. Eating fruits, vegetables, legumes, and whole grains can increase your fiber intake. Fiber supplements are also available over the counter. 6 to 8 glasses of non-carbonated fluids per day is recommended to help maintain healthy bowel habits. Caffeine should be avoided due to that it is a mild dyretic and it can cause fluid to shift from the bowels to the kidneys, which can cause drier, harder stools. Don't skip breakfast. It is one of the most important meals of the day to promote normal bowel function. If you feel the urge to have a bowel movement, don't wait. Waiting can lead to constipation. Make sure when the time comes that you are positioned comfortably on the toilet or commode. Try to relax. This will make it easier to have a bowel movement. Relax your throat and open your mouth. This allows for the pelvic floor muscles to relax, making it easier to have a bowel movement. Do not strain to try to have a bowel movement. Try breathing in through your mouth and out as you are trying to blow up a balloon. If needed, you may also take a laxative or stool softener. It is best to take what you have used in the past for constipation or ask your physician for a recommendation. Now that we've covered your hospital stay, let's discuss briefly what to expect in your recovery time at home. Having a total knee or hip replacement is a big decision. It can be a challenging experience, but it can also be a very worthwhile experience. Mid-Michigan Medical Center has a lot of repeat customers who are glad that they had their joint replaced and say that it was the right decision. Remember, each day gets a little easier, so keep your chin up and keep working hard. Fatigue will occur at home during exercise, so rest as necessary and take short naps. Expect that especially for knees, but occasionally for hips, outpatient physical therapy may be even necessary and your provider will let you know if they recommend this for you and your case. Some patients will experience post-surgery blues, so do your best to plan activities and have visitors. Regarding your dressing incision, most patients currently go home with a dressing called mepilex, which stays in place until the physician or assistant removes it at your follow-up appointment. These are water-resistant but not waterproof, so avoid soaking or swimming, but you may shower with the dressing on. Gently dab dry when you are done. Reinforce the dressing if necessary with paper tape and notify your surgeon's office if the bandage comes off. Please take your time to read through the following and final screen to familiarize yourself with what is normal and expected, what are reasons to call your physician and what is an emergency situation necessitating a call to 911 or a trip to the emergency room. Hi, my name is Alyssa and I'm an occupational therapist here at MidMichigan Health. And my name is Kim and I'm one of the physical therapists assistant here at MidMichigan Health. Physical therapy will educate and address your bed mobility, walking, strengthening, range of motion, and any equipment needs that you may have at home, including a two-wheeled walker. If you have hip precautions, you will not be allowed to bend past 90 degrees, no twisting on that hip joint, and no crossing your legs. Knees, no twisting at the knee joint. Pre-op and post-op exercises. The following exercises can be completed while lying in bed or in a chair. Ankle pumps. Bend the ankles going up and down 10 times. Then make circles going in clockwise direction 10 times and counterclockwise 10 times. Glute sets. Squeeze both buttock muscles together as tightly as possible and hold for five seconds. Do 20 times. Quad sets. Use the front muscle of your thigh to press up the back of your knee against the bed. With toes up, straighten the knee on your surgical leg as much as possible. Hold it for five seconds. Do 20 times. Short arc quads. Place towel roll or coffee can under the knee on your surgical leg. Keep your knee on the roll. Point toes up and try to straighten it by lifting your foot towards the ceiling and hold it for five seconds. Then slowly return to starting position. Do 20 times. Heel slides. Gently bend knee on surgical leg by sliding the heel up towards your buttocks, keeping the heel on the bed. Don't let your knee fall in or out. Keep it straight. Make sure you do not bend your hip more than 90 degrees if you have hip precautions. Hold this exercise for 20 to 30 seconds and then slowly return down to straighten out the knee. Do 20 times. Abduction. Hips only. Keeping your surgical leg straight, slowly move it out to the side. Carefully return it to the starting position, being careful not to cross the midline. Do not turn toes in or out. Keep up and straight. Do 20 times. Do not do this exercise if you have anterior lateral precautions following surgery. Straight leg raises. Knees only. Slightly bend your non-surgical knee and place that foot flat on the bed. Lift the surgical leg up towards the ceiling approximately 8 to 10 inches, holding for 3 to 5 seconds and keeping the knee as straight as possible and slowly return it down to a flat position. Do 10 times. Seated knee flexion. Knees only. While sitting in a straight back chair, bend your surgical knee underneath the chair as far as possible. Hold the stretch for 30 to 60 seconds, remembering not to force the knee. Slowly return to starting position. Do 10 times. Long arc quad. Hips and knees. Sitting in a chair with your knee in a bent position, slowly straighten your knee as you raise your foot upwards. Hold for 3 to 5 seconds and slowly lower back down towards starting position. Do 20 times each leg. Using your two-wheeled walker. Move the walker forward. With all four walker legs firmly on the ground, step forward with the surgical leg. Place the foot in the middle area of the walker. Do not move it past the front feet of the walker. Step forward with the non-surgical leg. Take small steps. Your doctor and physical therapist will instruct you in your proper weight-bearing status. Do not carry items in your hands while using your walker. Your hands must be directly on the walker handles. Getting into bed. Back up to the bed until you feel it on the back of your legs. You need to be midway between the foot and the head of the bed. Reaching back with both hands, sit down on the edge of the bed extending your surgical leg. And then scoot as far back towards the center of the mattress as you can. Move your walker out of the way, but keep it within reach. Scoot your hips around so that you are facing the foot of the bed. Lift your leg onto the bed while scooting. Keep scooting and lift your other leg onto the bed. Scoot your hips towards the center of the bed. Getting out of bed. Sit up, scoot your hips to the edge of the bed. While lowering, your surgical leg to the floor and then the other leg onto the floor. Scoot to the edge of the bed. Grabbing your walker to put in front of you, use both hands to push off the bed. Balance yourself before grabbing the walker. Going up and down the stairs. Is recommended that you have at least one handrail installed prior to your surgery date. To go up the stairs, lead with your non-surgical leg followed by your surgical leg. Non-surgical leg, surgical leg. To go down the stairs, lead with your surgical leg followed by your non-surgical leg, surgical leg, non-surgical leg. Occupational therapy will address your ability to perform self-care tasks following surgery, including equipment needs for your bathroom and dressing, dressing, bathing, and toileting, transferring in and out of your vehicle, shower, and toilet. Some things to keep in mind and prepare for at home prior to your surgery includes adequate lighting, especially nightlights within your bathroom, bedroom, and kitchen. It is also very important to make items accessible. This includes keeping frequently used items within easy reach, especially in the kitchen, bathroom, and bedroom. And finally, laundry and cleaning. Make sure you have a few weeks of clean clothing available as you will not be able to carry a laundry basket while using your walker. Equipment that the occupational therapist will address with you includes in the bathroom, a shower chair, a toilet riser, or commode. The occupational therapist will also address your ability to get dressed. If you are a patient with hip precautions, you will be given the following equipment, saccade, shoehorn, reacher, and long-handled sponge. The occupational therapist will go over this equipment with you in regards to the proper use, and you will have the ability to practice using this equipment prior to going home. The following slide is a visual of all the equipment that you may need for home, including the shower chair, a tub transfer bench, a toilet safety frame, toilet riser, bedside commode, and finally the dressing equipment. Getting into the tub. Shower chairs, grab bars, and hand-held shower heads make bathing easier and safer. Use a rubber mat or non-skid adhesive on the bottom of the shower or tub. First, place the shower chair in the tub facing the faucets. Back up to the tub until you can feel it at the back of your knees. Be sure you are in front of the shower chair seat. Reach back with one hand for the shower chair. Keep the other hand gently on the walker. Slowly lower yourself onto the shower chair, keeping the surgical leg out in front. Move the walker out of the way, but keep it within reach. Turn and lift your legs into the tub. Do not cross your legs while doing this. Getting out of the tub. Turn and lift your legs over the outside of the tub without crossing legs. Scoot to the edge of the shower chair. Push up with one hand on the back of the shower chair while holding the walker gently with the other hand. Balance yourself before grabbing the walker. You will use the same technique for getting into and out of the vehicle using the front passenger seat. Getting onto the toilet. You will need a raised toilet seat or a 3-in-1 bedside commode over your toilet following surgery. Your occupational therapist will assist with this information. First, take small steps and turn until your back is to the toilet. Never pivot. Back up to the toilet until you feel it touch the back of your legs. Keep one hand on the walker while reaching back for the toilet seat with the other hand. Slide your surgical leg out in front of you before sitting down. When getting up from the toilet, place one hand on the walker, slide your surgical leg out in front of you and push off the toilet seat with the other. Balance yourself before grabbing the walker. Again, we are so glad that you have chosen MidMichigan Medical Center for your total joint replacement. We will work with you to best ensure that you have an excellent experience. Please let us know how we can best help to achieve that. Thank you for attending this virtual class. We look forward to seeing you on the day of your surgery.