What We Will Cover Today

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2. What We Will Cover Today • How to prepare for surgery • What to expect after surgery • Recognizing and preventing complications • Staying active after surgery

3. Preparing for Surgery • Patient Guide for total hip or total knee replacement • Review it • Bring it to all visits • Hospital • Surgeon • Therapist

4. Enlist a Coach • Find someone to be your coach • Family member • Close friend • Every patient benefits from the assistance and motivation of a coach • Value of Coaches • Build Confidence • Support • Faster Recovery / Home Earlier • Improved Results

5. Make Discharge Plans • Have someone available to drive you home from the hospital following afternoon PT on post-op day # 2 • Important to arrange transportation prior to surgery • Have someone who can help you at home for 7 -14 days.

6. Obtain Equipment • Sock aid • Long-handled reacher • Raised toilet seat • Shower seat • Please bring your walker or crutches with you on day of surgery (If you own or have access to an assistive device already)

7. See your Medical Doctor • Will make sure you are ready for surgery • May order lab tests • May need cardiac work up

8. Report any Infections or Cuts • Tell your surgeon if you have any cuts or infections • Any untreated infection could travel to the prosthesis post operatively and cause a wound infection

9. Medication Instructions • Stop medications that may increase bleeding 7 days before surgery • Aspirin • Anti-inflammatory medications • Vitamin E • Herbal Medications • Please contact prescribing physician regarding blood thinners administered for cardiac and/or medical problems

10. Medication Instructions • Usually okay to take • Acetaminophen (Tylenol) • Always check with your surgeon

11. Coumadin • Must get specific instructions from your surgeon • Anti-coagulant: Helps prevent blood clotting • Levels will be checked twice a week upon discharge

12. Arixtra (Fondaparinux) • 14 day regiment per Doctors order starting POD 1 • Self injectable shot • A Demonstration and Education will be done before discharge • Arixtra Kit will be provided

13. Xarelto (Rivaroxaban) • 14 day regiment per Doctors order starting POD 1 (Duration of Xarelto may vary depending on surgery or surgeon) • Oral anticoagulant / Blood thinner

14. Day Before Surgery • Pre - Registration to call you at home • Pre-Registration – 708-783-5735 • Surgery department will contact you regarding your day/time of surgery or if the schedule has been changed • Nothing to eat or drink after midnight prior to surgery—even gum

15. What to Bring to the Hospital • Loose-fitting clothes • Shorts, sweats, etc • Walking/Gym Shoes • Leave valuables and large amounts of cash at home • Health Insurance card, ID, & credit card

16. Hospital Care

17. Day of Surgery • Check with your surgeon regarding medications for: • Blood pressure • Heart • Thyroid • Do NOT take medications for diabetes

18. Day of Surgery • Report to 2nd floor – Ambulatory surgery (A elevator) • Preparation for surgery • IVs • Blood work • Consent • Family to wait in surgical area • Surgeon will speak with your family immediately following surgery

19. What to Expect: In the Hospital after Surgery

20. After Surgery • Pain control: at discretion of your physician • PCA • Pain Cocktail • Incentive spirometer • Helps clear lungs • Helps you feel better • Rest immediately following surgery • Clear liquids when ready and then advance • Physical Therapy/Nurse to sit patient up at side of bed & ambulate Day of Surgery.

21. Pain Management: Patient Responsibility • Intercept the pain; ask for medication when the pain starts to escalate – do not wait. • Take your pain medication on a regular basis. • Tell the nurse if the medication is not effective. • Ask questions; be sure you understand the pain management efforts that are in place. • Our aim is to manage the discomfort so that you can eat, sleep and move around

22. Post-Op Day 1 - Discharge • Blood work and vital signs in the a.m. • Out of bed in recliner by 7 a.m.Dressed and bathed with the assistance of Nurse or PCT • Breakfast will be served between 7 and 7:30 a.m. • Walk after breakfast with physical therapist • 1:1 Therapy in the A.M. & Group therapy in the afternoon

23. Group Therapy • Exercise as a group • Support and encourage each other • Camaraderie • Coach participation

24. Discharge Day • Monday - Sunday • Independent ambulation/stairs • Discharge instructions • Therapist – Exercise Program • Nurse Education • Social Work / Case Manager– Finalize discharge plan

25. First Post-Op Visit • Surgeon’s office • Typically two to three weeks for first follow up

26. Post-Hospital Care • Sub-Acute Rehab • Home Services • Nurse • Blood Work • Therapy • Outpatient Services • Blood Work • Therapy

27. Sub-Acute Rehab • Insurance Rules • Transportation: Not covered under most plans • Back-up plan, if no one to assist at home or discharge plan changes • PCP preference/privileges • Visit location before surgery

28. Home Services • Physical Therapy • Nursing • Caregiver (out of pocket) • Progress to Outpatient Services

29. Outpatient Services • Please select location prior to surgery • Physical Therapy • Lab • Equipment • Caregiver

30. Recognizing & Preventing Complications

31. Some Potential Complications • Blood Clots • Infection • Pneumonia • Hip Dislocation

32. Blood Clots • Swelling in calf, thigh or ankle that does not go down with elevation • Pain or tenderness in calf • Can be in either leg • Please notify your physician

33. Pulmonary Embolism • Sudden chest pains • Difficulty or rapid breathing • Shortness of breath • Sweating • Confusion • Call 911

34. Preventing Blood Clots • Ankle pumps • Early walking • Blood thinners • Coumadin • Arixtra or Lovenox • ASA

35. Preventing Infection • Weight loss if indicated (discuss with your PCP/surgeon) the importance of optimizing body mass index (BMI) which compares weight to height • Quit smoking • If you have diabetes, test your blood sugar level and keep it under control • Make an appointment with your dentist prior to your total joint replacement to ensure good dental health as an infection in your mouth could spread to the newly implanted joint

36. Preventing Infection • Practice good skin hygiene prior to surgery (showering/use of antiseptic cloths) • Notify your surgeon if you develop a cold, fever, infection of any type or a blister, abrasion, pimple or lesion of any type to the area that your surgeon will be operating on or in another area (e.g. ingrown toenail, dental problems, urinary tract infection) as an underlying infection could spread to a newly placed total joint implant • If there is any question regarding a potential infection prior to your surgery, it is better to post-pone your procedure than risk a joint infection

37. Signs/Symptoms of Infection • Red wound • Increasingly painful • Increasingly swollen • Draining • Temperature elevation > 101° • Notify your physician

38. Preventing Infection • Keep incision clean • Avoid immunosuppressive drugs

39. Signs/Symptoms Pneumonia • Cough • Fever • Shortness of Breath

40. Preventing Pneumonia • Deep breathing • Get moving • Incentive Spirometer

41. Dislocation of Hip • Risk to total hip replacement patients • Follow hip precautions • Sudden increased pain & inability to walk

42. Discomfort • Take oral pain medication • After PCA discharged on POD #1 • Every four to six hours • Before therapy sessions • Ice pack

43. Rest • Don’t sleep too much during the day • Get out and get back to normal • Enjoy your new joint • Walk after surgery

44. Advance Directives • Advance Directives are documents that state your choices about medical treatment or name someone to make decisions about your medical treatment if you are unable to make these decisions yourself.

45. A Living Will is a document that tells your doctor or other health care provider whether or not you want death-delaying treatments or procedures administered to you if you are in a terminal condition. It is called a living will because it takes effect while you are still living. Living Will

46. Durable Power of Attorney for Health Care • A Durable Power of Attorney for Health Care is a legal document that allows you to appoint another individual to act on your behalf for medical decision-making if you become temporarily or permanently unable to make those decisions yourself.

47. Physical Therapy *The physical therapist may attempt to perform the initial evaluation the same evening of your surgery in order to: -fit you for a correct size walker -assist you to move to the bed side chair or dangle your legs at the side of the bed. * It is GOOD to move after your surgery!

48. Explore Chicago Board • Tourist figures help you track walking distance in feet • Helps you visualize your goal • Race toward a Chicago destination • Encourages you to perform your best • Goal is to walk 2000 feet before you leave

49. Physical Therapy – POD 1 • Physical Therapy – 2 times each day. 1. Evaluation/Individual Session • 7:00 am –12:00 am 2. Physical Therapy Group or individual session

50. Physical Therapy – POD 2 • Physical Therapy Individual session • 7:00 am –12:00 am • Walking, stairs, & bed mobility • Physical Therapy PM Group • 1:00 pm • Patients are discharged after PM group, approximately around 3:30 pm