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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