Download Affinity Orthopaedics

Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Total Hip Replacement Surgery Packet
I.
Instructions for Total Joint Replacement
II. Packing List
III. Preparing Your Home
IV. Equipment Needs Following Total Hip Replacement
V. Herbal Supplements and Orthopaedic Surgery
VI. Managing Pain Prior to Orthopaedic Surgery
VII. Autologous Blood Donation
VIII. Iron Supplements
IX. General Anesthesia
X. Regional Anesthesia
XI. Total Joint Replacement and Dental Procedures
XII. Classes to Prepare for Total Joint Replacement
XIII. Total Joint Replacement Questionnaire
XIV. Physical Therapy Following Total Hip Replacement
Total Hip Replacement Packet, Page 1 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Instructions for Total Joint Replacement
Your doctor has recommended that you have the following procedure:
_____________________________________________________.
You will be scheduled for admission to St. Elizabeth’s Hospital on the
following date:
_______________________.
Things to do before surgery:
1. You should have an appointment in Anesthesia prior to your surgery date.
You will be notified of the time and date. Please call xxx-xxxx if you have any
anesthesia questions.
2. If you are already taking routine medications for your health care, the
practitioners from Anesthesia will decide how/when you should take the
medications prior to surgery.
3. One week prior to surgery, please stop taking any anti-inflammatory
medications and avoid using aspirin. These medications may interfere with
your blood counts and prevent you from having surgery on the scheduled date.
4. If your health insurance company requires a co-payment, please make
necessary arrangements as soon as possible before surgery.
5. Please shower the evening and morning before coming to St. Elizabeth’s for
your surgery. This will help to prevent infection. Use an antibacterial soap
such as Dial™ or Lever 2000™.
Total Hip Replacement Packet, Page 2 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Packing List
It would be helpful if you brought a list of medications you are taking including
time schedule and dosage. If you bring your medications, please let your nurse
know you have them.
Please leave valuables and all jewelry at home.
Television is available for each patient in every room.
At the hospital, you will be working with the physical therapist outside your
room. They would like you to feel comfortable and potentially wear your own
clothes. Previous patients have told us that the most comfortable clothes for
working with physical therapy are:
1. Short bathrobe
2. Boxer shorts and T-shirt; satin or other slinky material helps
3. Good support shoes
4. Sweat pants
5. Loose-fitting leisure clothes
6. Crutches or a walker labeled with your name
You may also want to bring: your own pajamas or nightgown, underwear,
toiletries, a comfortable pillow, reading books, battery-operated radio/CD
player with headset, other handiwork.
Total Hip Replacement Packet, Page 3 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Preparing Your Home Before Hip
Replacement Surgery
There are certain things you’ll want to do to prepare your home before your joint
replacement surgery. This will make it easier for you once you return home post-operatively.
Bathroom
If you are 5’3” or taller, you will need an elevated toilet seat. If you use a tub shower with a
door, you may need to have the door removed. Grab bars are an optional item. You may
need a raised or adjustable tub bench for use in the tub. You may also use two plastic lawn
chairs stacked together. Practice with your equipment prior to surgery.
Bedroom
Place your bedroom on the first level if possible. Raise your bed to increase height if the bed
is too low to the floor. For example, placing blocks or books under the legs. Place your bed
so that transfers can be made in and out with ease. Practice transfers in and out of bed
maintaining your hip precautions, keeping your legs apart and not bending forward. You will
not be able to use a waterbed. Rearrange items in your drawers and closets to higher levels.
You will not be able bend down low right after hip replacement surgery.
Kitchen
You may want to freeze some meals ahead of time or purchase microwave food that can be
easily prepared when you get home. Place your most frequently used pots and pans to a
higher level to prevent you from excess stooping.
Around The House
Remove throw rugs to prevent tripping. Be especially careful if you have cats and dogs,
since they tend to be “underfoot.” You will need a chair with arms (similar to a captain’s
chair) or an elevated recliner. Do not use a low sofa or low chair. If you are 5’6” or taller,
you may need a lift under the chair (like a pallet). Practice getting up and down from a chair
keeping your involved leg forward.
Equipment
The Hospital does not provide equipment to take home. Please call your insurance company
to find out what vendor to use. You may also choose to borrow items from a friend. See the
equipment list on the next page of this packet. Please label your equipment when you bring
them to the hospital. If you live any distance from Appleton, bring your elevated toilet seat
so you have it available during the ride home.
Total Hip Replacement Packet, Page 4 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Equipment Needs Following Total Hip
Replacement Surgery
Before returning home, your physical therapist at St. Elizabeth’s will likely
recommend the following equipment to help with your safety and independence
at home.
1. Crutches or a walker
2. Tub bench
3. Raised toilet seat, if you are 5’3” or taller
4. Hand held shower (optional)
Affinity Orthopaedics and Sports Medicine does not provide this equipment for
you. You will be responsible for obtaining and/or arranging for delivery of
these items. Your insurance company may have someone that they prefer you
to use to obtain this equipment (called a vendor). Be sure to check with your
insurance company before ordering. Listed below are a few vendors in the Fox
Valley area who may be able to assist you in supplying the needed equipment.
Westhill Rehab
920 Westhill Blvd
Appleton, WI 54914
(920) 749-3777
WIVA-Affinity Plus
2725 Jackson St
Oshkosh, WI 54901
(920) 303-3475
WIVA-Affinity Plus
3000 C Enterprise Dr
Appleton, WI 54911
(920) 832-8836
Walgreen’s Health Initiative
2130 S Memorial Drive
Appleton, WI 54915
(920) 733-1010
Area drug stores such as Shopko, Wal-Mart, and Osco Drug are places that may
also have these items at a good price.
Total Hip Replacement Packet, Page 5 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Herbal Supplements and Orthopaedic Surgery
Many people take vitamins and herbal supplements either once in a while, or all
of the time. These “herbs” are very popular, and many media outlets such as
television or Internet or magazines describe them as being totally “natural and
safe.” However, research has shown that some of these herbs can cause
abnormal blood pressure, heart rates, bleeding, or over-sleepiness. “Herbs” can
also interfere with medicines that your health care provider gives you. The
effects of herbal treatments could cause problems if you are having surgery and
anesthesia.
It is very important that you tell all your doctors if you are taking any
“over-the-counter” medications, including aspirin, herbs, vitamins, and
dietary supplements.
Many orthopaedic surgeons and anesthesiologists feel that all herbs should be
stopped one week prior to surgery to keep you from having any problems.
Your doctor suggests that you stop the following herbal treatments prior to
surgery, as they have a proven to cause excessive bleeding*:
Dong Quai
Turmeric (curcuma longa)
Quercetin
Gingko Biloba
Boswellia (bosellia serrata)
Reservatrol
Ginger
Stinging Nettle (urtica dioica)
Cayenne
Ginseng
Cat’s Claw (uncaria tomentosa)
Omega-3 FA
White Willow Bark (salix alba)
St. John’s Wort
Devil’s Claw (harpagophytum procumbens)
*AAOS, August 2001
Total Hip Replacement Packet, Page 6 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Managing Pain Prior to Orthopaedic Surgery
Your orthopaedic surgeon is asking you to stop taking any non-steroidal antiinflammatory medications or any medicines containing aspirin at least one
week before your total joint replacement surgery.
Non-steroidal anti-inflammatory medications are also
called NSAIDs. Examples of these medicines include
Ibuprofen, Advil®, Motrin®, Naprosyn®, Celebrex®,
Vioxx®, Relafen®, Clinoril®, Lodine®, Tolectin®,
Orudis®, Daypro®, Voltaren®, and Anaprox®.
You need to stop taking these medications because they prolong the time it
takes your blood to clot. This can cause serious problems after surgery. Failure
to stop these medications in time may prevent you from having surgery on your
scheduled date.
In place of these medications you may use: Tylenol® or Extra-Strength
Tylenol® as directed. If this plan does not provide adequate pain relief, please
call Affinity Orthopaedics and Sports Medicine at 996-3700.
Total Hip Replacement Packet, Page 7 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Autologous Blood Donation
Some people want to give their own blood to receive during or after surgery.
This is called an autologous blood donation. You may donate one unit of blood
per week, starting several weeks before surgery. The latest possible donation
time is one week prior to surgery. If you have heart problems, you will need a
letter from your primary doctor stating it is alright to give autologous blood.
If you are giving your own blood, you should take iron supplements. Start
taking them one week before you start giving your own blood. Please see the
separate instruction sheet for directions and dosage.
If you are unable to give blood, a directed blood donation can be arranged. A
directed donation is when someone else with the same blood type gives blood
for you. Directed donations can be done closer to the time of surgery. If there
are reasons you prefer not to give blood, please discuss this with your
orthopaedic surgeon. If you plan to set up an autologous or directed blood
donation, please call the blood bank and schedule the necessary appointments.
Community Blood Center
4406 W Spencer
Appleton, Wisconsin 54914
(920) 738-3131
Total Hip Replacement Packet, Page 8 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Iron Supplements
These supplements are used to treat low blood iron or anemia by helping the body make red
blood cells. You should not use this medicine if you have had an allergic reaction to iron
supplements.
Brand Name(s): Feosol®, Fer-In-Sol®, Slow-Fe®, Femiron®, Feostat®, Fergon®,
Ferralet®, Ferra-TD®, Mol-Iron®, Niferex®, Hytinic®, Nu-Iron®
Other brands are available.
How to use and store this medicine:
Your doctor will tell you how much medicine to take and how often. Take with plenty of
fluids to avoid the problem of constipation. Store at room temperature and out of reach of
children; too much iron can be very dangerous to them.
Tablets: Is best taken on an empty stomach, although it can be taken with food if upset
stomach occurs.
Liquid: Is best taken on an empty stomach, although it can be taken with food if upset
stomach occurs. Iron may stain your teeth. This problem can be avoided by mixing with
water or other liquids (fruit or tomato juice) and drinking the medicine through a straw.
Stains can be removed by brushing with baking soda or peroxide. Store this medicine at
room temperature only, and avoid heat, direct light, or moisture.
If you miss a dose: Take the missed dose as soon as possible. Skip the missed dose if it is
almost time for the next regular dose. You should never take two doses at a time.
Drugs and foods to avoid: Tell your doctor if you are taking any antibiotics or Vitamin E.
If you are taking ciprofloxacin or tetracycline, then take these medicines three hours before
or two hours after the iron supplement. You should not use iron at the same time as antacids
(such as Maalox® or Mylanta®). You should not use iron at the same time as certain foods
such as eggs, milk, cheese, yogurt, coffee, tea, cereals, or whole-grain bread.
Warnings: If you are pregnant or breastfeeding, talk to your doctor before taking iron.
Make sure your doctor knows if you have hiatal hernia, stomach ulcers, intestinal ulcers, or
bleeding problems. Iron can cause dark stools. This is normal.
Side Effects: Call your doctor right away if you have bloody diarrhea, severe vomiting,
unexplained weakness, nausea, darkened urine, heartburn, constipation, or staining of the
teeth.
Total Hip Replacement Packet, Page 9 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
General Anesthesia
“Anesthesia” is the loss of feeling or sensation. General anesthesia can be used
for surgery, and puts you into a deep sleep. This means you are unaware and do
not feel anything going on during surgery. General anesthesia acts on the brain,
causing you to not feel any of your body. Since consciousness is lost, there is
usually no memory of the surgical event. Some people remember events at the
ends of a procedure, such as a dressing being applied. This is because the drugs
used to keep you asleep have been stopped, in order to allow you to awaken.
At first, general anesthetics are given through the bloodstream using the
intravenous access (iv) to get you to sleep. A mask is placed over your face
with oxygen flowing through it. Once you are asleep, the anesthesiologist
places a breathing tube into your windpipe. The tube is about the size of your
index finger and helps you breath while you are in the deep sleep. Once asleep,
inhaled gaseous medicines that go to the lungs may be administered through the
breathing tube. These medications are designed to keep you asleep. To aid the
surgeon, a medicine to relax your muscles may also be used.
Benefits of General Anesthesia
General anesthesia is usually reserved for long or extensive surgical procedures.
It may also be used for shorter surgeries when indicated. The purpose of the
general anesthesia is for you to be unaware and not feel anything going on
during your surgery.
Risks of General Anesthesia
Some people feel sick to their stomach (nausea) and experience vomiting after
general anesthesia. Your anesthesiologist orders medication to help with this, if
needed. Other side effects of general anesthesia may include:
 Damage to the tongue or a tooth during breathing tube insertion
 A sore or “scratchy” throat from the breathing tube
 A headache after surgery
 Muscle aches
 Feeling tired up to a few days after surgery
Total Hip Replacement Packet, Page 10 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Regional Anesthesia
Regional anesthesia is a type of anesthesia used for surgeries that only need
a part of the body numb, or without feeling. A medicine called a local
anesthetic is used to make the necessary part of the body lose feeling.
Local anesthetics are injected with a needle near a group of nerves and
“block” or stop feelings of pain. They also stop the movement of muscles
in that area until the anesthetic wears off. Before receiving a local
anesthetic, the skin area is cleaned with a soap that kills germs and then
numbed with a small shot. Regional anesthesia allows you to not feel the
surgery without using general anesthesia (putting you completely to sleep).
A regional anesthesia technique can spare you many of the side effects of
using a general anesthesia during the recovery phase of your surgery.
Though you will be awake during surgery, sedative medicines are given to help you relax. These may
even cause you to doze off during the procedure. You may not remember much of the surgery. Of
the common types of regional anesthesia listed below, epidural and spinal anesthesia are used (most
commonly in obstetrics) for surgery of the lower stomach, pelvis, and legs.
 Epidural-Local anesthetic is injected in the fatty area outside the spinal
canal where the nerves are located, low enough in the back to be below
the spinal cord. A small plastic catheter can be placed here to continue
the flow of anesthetic for several days if needed.
 Spinal-Local anesthetic is injected into the spinal fluid low enough on the
back to be below the spinal cord.
 Arm & leg blocks-Local anesthetic is injected around the nerves running
to the area.
Benefits of Regional Anesthesia
Regional anesthesia allows you to have surgery without the side effects of being put into deep sleep.
With a regional anesthetic, you only receive sedatives to make you relaxed or sleepy. Many patients
actually fall asleep from these sedatives and remember nothing from surgery. When the procedure is
finished, you will be awake and aware of things around you much faster than if you had been put to
sleep. You will usually experience less nausea and have less pain right after surgery.




Risks of Regional Anesthesia
It may feel a little hard to breathe during surgery, if the local anesthetic relaxes the muscles of
your chest.
Lower blood pressures may occur. This may make you feel dizzy or lightheaded, and you
could feel sick to your stomach for a short time.
Many people complain of aching pain in the low back area for a few days after a spinal or
epidural anesthesia. It feels the same as your arm feels after getting a shot, or similar to
backache after heavy lifting or shoveling.
About 1 out of 200 people may get a “spinal headache” after spinal or epidural anesthesia.
The headache may last a few days. If you get one, you will be given suggestions of things
that can be done to make it go away faster.
Total Hip Replacement Packet, Page 11 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Total Joint Replacement and Dental
Procedures
It is very important for total joint replacement patients to remember that
bacteria in your blood stream can get into your artificial joint and cause
infection. If you get an infection in your teeth, sinuses, throat, bladder, feet or
any place else, it must be treated. You will always need antibiotic coverage
when you have dental work, endoscopy procedures, flexible sigmoidoscopies,
or other surgical procedures that may put you at risk for an infection. You
should always tell (and remind) your primary care doctor that you have had a
joint replacement.
The American Dental Association and the American Academy of Orthopaedic
Surgeons recommend that prophylactic antibiotics be administered to patients
who have had total joint replacements prior to any dental work including
routine cleaning*. Antibiotics should also be used prior to any urologic
manipulation or any procedure which may potentially cause a transient
bacteremic state.
Suggested Antibiotic Prophylaxis Regimen (no second doses recommended)
Patients not allergic to Penicillin: use Cephalexin, Cephradine, or Amoxicillin
2 grams given orally 1 hour prior to dental procedure
Patients not allergic to Penicillin and unable to take oral medications: Cefazolin or Ampicillin
Cefazolin 1 gram or Ampicillin 2 grams given intramuscular or intravenously 1 hour prior to
dental procedure
Classes to Prepare For Total Joint
Patients allergic to Penicillin: Clindamycin
Replacement
600 milligrams given orally 1 hour prior to dental procedure
Patients allergic to Penicillin and unable to take oral medications: Clindamycin
600 milligrams given intravenously 1 hour prior to dental procedure
*JADA, Vol. 128, July 1997
Total Hip Replacement Packet, Page 12 of 14
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Total Joint Replacement Questionnaire
Name:
Address:
City/State/Zip:
Phone # (home):
Date of Surgery:
Type of Surgery:
Height:
Weight:
Phone # (work):
Surgeon:
1. Who will help you after surgery?
2. Do you have steps into your home?
3. Do you have stairs inside your home?
Yes
Yes
4. Do you have railings with your steps and stairs?
No How many?
No How many?
Yes
No
5. Do you have a bathroom on the main level of your home?
6. Indicate which features your main level bathroom has:
walk-in shower
glass shower door
tub
shower/bath seat
shower curtains
raised toilet seat
Yes
grab bars/support rail
other: specify
7. Do you have any of the following equipment at home?
crutches
wheelchair
walker
8. Have you walked with crutches or a walker before (describe)?
9. Please list any questions you may have below:
Total Hip Replacement Packet, Page 13 of 14
No
Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.
1531 S. Madison Street, Appleton, WI 54915
(920) 996-3700
Physical Therapy Following Total Hip
Replacement
Your therapist recommends each of these exercises. Perform them slowly, two
or three times per day.
1. Isometric Quad Sets:
Tighten the front thigh muscles and hold for five counts
2. Isometric Gluteal Sets:
Tighten the buttocks together and hold for five counts
3. Hip/Knee Flexion:
Keep your foot touching the bed. Slide the foot
toward your buttocks, then slide it out toward the
end of the bed, straightening your leg again.
4. Hip Abduction/Adduction:
Slide your leg out to the side and then back to the starting
position. Remember, it is important not to bring your
legs close together.
5. Short-Arc Quad Sets:
Place your leg over a roll (a three-pound coffee can
wrapped with a towel). Straighten your knee, lifting your
foot off of the bed. Hold for five counts, then slowly allow
the knee to bend until the foot touches the bed.
6. Ankle Exercises:
Pump your foot up and down. Make wide circles with your ankles.
Total Hip Replacement Packet, Page 14 of 14