Download Joint Wellness Program

Joint Wellness Program
Orthopedic Playbook for Hip Replacement Surgery
Joint Wellness Program
Orthopedic Playbook for
Hip Replacement Surgery
© 2012 Baylor Health Care System. All rights reserved.
2
Joint Wellness Program
Baylor Medical Center at Irving
Orthopedic Playbook for Hip Replacement Surgery
Contents
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Important Appointment Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The Orthopedic Center of Excellence: Getting to Know Your Team. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Your Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The Day Before Surgery Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Anesthesia: What to Expect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Hospital Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Post Operative Requirement–Simple Physical Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
The Can and Can’t Do’s Post-Op Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Preventing Infection in the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
After Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Discharge Instructions After Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Options for Care After Leaving the Hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Infection and Blood Clots: What You Need to Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Medications Used to Prevent Blood Clots (“Anticoagulants”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Post-Operative Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Everyday Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Answers to Frequently Asked Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Glossary of Hospital Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Prescription and Non-Prescription Drugs: What to Know. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Campus and Area Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Prepping Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
© 2012 Baylor Health Care System. All rights reserved.
1
Joint Wellness Program
Welcome
The team at Baylor Medical Center at Irving looks forward to assisting you in your journey toward an
improved level of activity and higher quality of life following your joint replacement surgery.
Each year, over 500,000 people in the U.S. undergo total joint replacement surgery. Typically candidates
for this surgery are individuals with chronic joint pain from arthritis that severely diminishes their
ability to perform normal daily activities. This often leads to a loss of independence and self esteem.
A replacement joint can make a big difference in your ability to return to work or other activities that
you enjoy.
Total joint replacement patients usually recover quickly. The hospital stay is typically 2–3 days. New
surgical techniques and improved analgesic methods have allowed us to quicken the recovery process.
In fact, most patients will be expected to walk on the day of surgery.
Quick recovery usually allows the return to most activities in six to eight weeks for motivated
individuals. This includes driving, walking distances, swimming and golfing. How quickly you return
to normal activity is highly dependent upon your preoperative physical conditioning. The better your
physical condition is prior to surgery, the quicker your recovery to more normal activity will be.
Patients who take an active role in their recovery experience the most positive results. This patient
Orthopedic Guide is designed to give you information needed to inform and guide you to a safe and
successful surgical outcome.
It’s a joint effort at Baylor and we appreciate the opportunity to assist you on your road to
recovery, to a better tomorrow.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Important Appointment Sheet
Bring this orthopedic guide with you to every appointment and to the hospital.
Schedule of Appointments
Patient Name
Surgeon’s Name
SURGERY
DateTime
PRE-OP CLASS
Date
Time
Date
Time
POST-OP VISIT WITH SURGEON Date
Time
POST DISCHARGE THERAPY
Phone #
PHYSICIAN CLEARANCE
PRE-OP SURGEON VISIT
© 2012 Baylor Health Care System. All rights reserved.
Name
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Joint Wellness Program
Contact Your Insurance Company
Before surgery, we will be contacting your insurance carrier to inquire whether authorization,
pre-certification, second opinion, or a referral form are required.
Pre-Register
You will need to pre-register in the admitting department at the hospital prior to your surgery day.
Please bring with you:
n
Physician’s orders if they have not already sent them to the hospital
n
Insurance/Medicare cards and photo ID (driver’s license)
n
List of all previous surgeries
n
All current medications* including names and doses
n
List of allergies and reactions
n
List of last flu, pneumonia vaccinations
n
Copy of Directives or Living Will
n
Completed questionnaire
*Medications
Discontinue the use of Aspirin, Aspirin-like products, non-steroidal anti-inflammatory medications one
week prior to your surgery.
If you are on a blood thinner such as Coumadin, Pradaxa, Xarelto, Lovenox, Arixtra, or Heparin please
let our office know so appropriate arrangements can be made prior to surgery.
Please take your usual morning prescription medications on the morning of your surgery unless
instructed by your medical clearance physician. Take the medication with a small sip of water.
Medical Clearance
Your surgeon’s office may schedule you for a medical clearance with your primary care physician.
This appointment is extremely important and must not be cancelled. Without pre-operative medical
clearance, your surgeon will not perform the surgery.
Please remember to check with the medical clearance physician for special instructions on medications
that you take routinely, such as heart medications, Insulin, Coumadin, etc.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
The Orthopedic Center of Excellence
Getting to Know Your Team
Features of The Joint Team Program
n
A dedicated team of physicians, physician assistants, nurses, patient care technicians, care managers,
physical therapists, and occupational therapists who specialize in the care of joint patients
n
Comprehensive patient education prior to surgery
n
A comprehensive patient Playbook for you to follow from two weeks pre-op until three months
post-op and beyond
n
Emphasis on individual care
n
Family and friends educated to participate in the recovery process
Goals of The Joint Team Program
n
Improve patient quality of life
n
Increase quality of patient care
n
Increase patient satisfaction
n
Improve outcomes/minimize problems
n
Increase patient knowledge of events to come
n
Reduce length of hospital stay
n
Increase public awareness of program
n
Promote independence through therapeutic activities/exercises
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Value and Purpose of a “Coach”
Every patient can benefit from the assistance and
motivation of a coach. Your coach can be your
spouse, family member or close friend.
The value of enlisting a coach is to speed your
recovery. A coach can help to build your confidence, offer support, improve your results, and
ultimately get you home earlier.
Your coach should be reliable, and someone who
is available to attend education sessions with
you, be actively involved with your care, help
with your therapy, even drive you home from
the hospital and help you once you return home.
This Playbook is Designed to Educate You So That You Know:
n
What to expect every step of the way
n
What you need to do
n
How to care for your new joint
Remember This is Just a Guide.
Your orthopedic team may add to this or change many of the recommendations. Always use their
recommendations first and ask questions if you are unsure of any information. Keep your Playbook as
a handy reference for at least the first year after your surgery.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Your Operation
A Healthy hip
Your hip has become diseased or injured. Simple movements may
be painful, such as standing or walking. You and your doctor have
decided that a total hip replacement operation may help you.
How the Hip Works
The hip is a ball-and socket joint where the thigh bone joins the
pelvis. To see what a ball-and-socket joint is like, make a fist with
one hand. This is like the ball. Cup the fist with your other hand.
This is like the socket. Swivel the fist. This is similar to the way
the hip joint works.
Cartilage is a body tissue on the ends of the hip bones. It cushions
the joint. If the hip is healthy, the cartilage is smooth. When you
move, the parts of the joint that touch slide smoothly against each
other.
smooth cartilage on
weight-bearing surfaces
A problem hip
narrowed
joint space
When a hip is diseased or injured, the cushion wears out. The
bones rub together. They become rough and grind against each
other causing stiffness and pain.
Total Hip Replacement
The operation you are having takes out the diseased or injured hip
joint. An artificial hip joint replaces it. This artificial hip joint is
called a prosthesis and is composed of plastic and metal components. The prosthesis works like a normal hip. It has a ball which
is like the head of the thigh bone. The ball has a stem which goes
down into the center of the thigh bone. This holds the ball in
place.
worn, rough
cartilage and bone
bone spur
A hip with prosthesis
cup
The prosthesis has a cup, which is like the socket. It replaces the
socket in the pelvis. The ball moves inside it like your hip.
The parts of the prosthesis that touch are smooth. They move
easily against each other as a healthy hip would.
© 2012 Baylor Health Care System. All rights reserved.
ball
stem
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Joint Wellness Program
Having Orthopedic Surgery
As a patient undergoing orthopedic surgery at Baylor Medical Center at Irving, we want your experience
to be as stress-free as possible. This will explain the procedures, equipment, the operation, as well as the
pre-and post-operative care. When you know what to expect and when to expect it, you are less likely to
feel anxious.
We individually plan your care, and then adjust it according to your needs. Further, by the time you
leave the hospital, you will know how to better help yourself during your recovery process at home.
Straight Talk with Health Care Providers
You are not a statistic or a number while you are at Baylor Medical Center at Irving. You will benefit
from interaction with many different hospital employees—physicians, specialists (like anesthesiologists),
nurses, physical and occupational therapists, and other members of the health care team whose job it is
to care for you.
Again, please do not be shy about asking questions and tell someone if you are feeling anxious at any
time. Certainly, many people will be asking you questions and talking to you about a variety of topics.
Your feedback helps us plan your operation and follow up care. Please be thorough when you answer a
question from anyone caring for you. All information is strictly confidential.
Your doctor already knows a great deal about your medical history. However, to learn even more about
you, pre operative tests may be ordered. The following tests are common: blood, urine, electrocardiogram (ECG) and X-rays.
Prior to your operation, hospital protocol requires that each patient sign consent forms for anesthesia
and surgery. Please try to have questions about your surgery and anesthesia answered before it is time to
sign the consent forms.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
The Day Before Surgery Checklist
You must do the following:
n
Bring your patient Playbook to the hospital
n
Bring a copy of your advance directives if you have them*
n
Bring a list of your medications
n
Bring your insurance card, driver’s license or photo I.D., and any co-payment required by your
insurance company
n
Bring your BIPAP/CPAP machine
n
Bring your assistive devices (walker)
n
Please label all personal belongings
n
Bring loose clothing (shorts) and comfortable shoes
n
Please leave jewelry, valuables, and large amounts of money at home
n
Do not wear any makeup
n
Nail polish may be kept on
Before surgery, you can play an important role in reducing your risk of infection at the surgical site by
decreasing the number of germs on your skin. Please follow the prepping instructions located in the back
of this binder. You should use two (2) packets the night before surgery (at least 1 hour after taking bath
or shower) and one (1) packet the morning of your surgery.
REMEMBER: Do NOT eat or drink anything after midnight unless you have been specifically
told to do so by your physician. Your surgery will be cancelled if you do not follow this very
important instruction.
*The law requires that everyone being admitted to a medical facility have the opportunity to make
advance directives, concerning future decisions regarding their medical care. Although you are not
required to do so, you may make the directives you desire. If you have advance directives, please
bring copies to the hospital on the day of surgery.
© 2012 Baylor Health Care System. All rights reserved.
11
Joint Wellness Program
Anesthesia: What to Expect
What Types of Anesthesia Are Available?
Decisions regarding your anesthesia are tailored to your personal needs.
The Types Available to You Are:
GENERAL ANESTHESIA—Provides loss of consciousness.
REGIONAL ANESTHESIA—Involves the injection of a local anesthetic to provide numbness, loss of
pain or loss of sensation to a large region of the body. Regional anesthetic techniques include epidural
blocks, and arm and leg blocks.
NOTE: Medications can be given to make you drowsy and blur your memory.
Will I Have Any Side Effects?
Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options,
as well as any complications or side effects that can occur with each type of anesthetic.
Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Although less of a
problem today because of improved anesthetic agents and techniques, these side effects continue to
occur for some patients. Medications to treat nausea and vomiting will be given if needed. The amount
of discomfort you experience will depend on several factors, especially the type of surgery.
Your doctors and nurses can relieve pain with medications. Your discomfort should be tolerable, but do
not expect to be totally pain free. The staff will teach you the pain scale (0–10) to assess your pain level.
What Will Happen Before My Surgery?
You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review
all information needed to evaluate your general health. This will include your medical history, laboratory
test results, allergies, and current medications. With this information, together you will determine the
type of anesthesia best suited for you. Your anesthesiologist will also answer any further questions you
may have.
You will also meet your surgical nurses. Intravenous (IV) fluids will be started and pre-operative medications may be given, if needed. Once in the operating room, monitoring devices will be attached such as a
blood pressure cuff, EKG and other devices for your safety. At this point you will be ready for anesthesia.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
During Surgery What Does My Anesthesiologist Do?
Your anesthesiologist is responsible for your comfort and well being before, during and immediately
after your surgical procedure. In the operating room, the anesthesiologist will manage vital functions,
including heart rate and rhythm, blood pressure, body temperature and breathing. The anesthesiologist
also is responsible for fluid and blood replacement when necessary.
Hospital Care
What to Do:
Enter the front entrance of Baylor Medical Center at Irving (complementary valet parking is available).
Proceed to registration desk. You will be checked in and escorted to Day Surgery on the 2nd floor and
prepared for surgery. Please leave all valuables at home including money, jewelry, purses and wallets.
Bring only your identification and insurance cards.
What to Expect:
In the Day Surgery area you will be prepared for surgery. This includes starting an IV, confirming the
planned procedure and reviewing your medical history. You will then be escorted to the operating room
where you will see your surgeon. Following surgery you will be taken to the recovery room where you
will typically remain for one to two hours. During this time, pain control will be established and your
vital signs will be monitored.
You will then be taken to the 3rd floor of the hospital where The Joint Team of nurses and patient care
technicians will care for you. Only one or two very close family members or friends should visit you on
this day. Most of the discomfort occurs the first 12 hours following surgery, so during this time you will
be receiving pain medication as directed by your surgeon or anesthesiologist.
Generally, you should expect to walk the day of surgery. This will help prevent blood clots from forming
in your legs. Also, you will be wearing massaging sleeves on your lower legs for the same purpose. The
physical therapist will assist you in walking shortly after surgery.
© 2012 Baylor Health Care System. All rights reserved.
13
Joint Wellness Program
Surgery Day
n
You will be given a hospital gown to be worn during surgery. No other clothing is allowed. Your
privacy and modesty will be respected and protected at all times.
n
All personal items must be removed, including hair accessories, jewelry, glasses, contact lenses,
hearing aids and prostheses (such as artificial limbs or eyes).
n
Remove any artificial dental work unless otherwise instructed by your doctor. We recommend that
you let family or friends hold your valuables.
n
About an hour before surgery, you may be given medication to help you relax. Just before receiving
this medicine you will be asked to empty your bladder. The medication may cause drowsiness or
lightheadedness.
n
Your mouth may become dry and your eyesight may seemed blurred. For your safety, the side rails
on your bed will be raised. Please do not get out of bed without asking the nurse for help.
The Operating Room
The OR holding area is a busy, active place. When you arrive, an OR nurse will ask your full name,
confirm that it matches your identification bracelet and ask you a few other questions. The nurse will
always explain what is happening and you may also ask questions.
In the OR you will be moved to the operating table, you may also notice that the operating room is
brightly lit. Doctors, nurses, and other OR staff will be preparing for surgery and talking with you.
Waking Up from Surgery
Following surgery you will go the Recovery Room (PACU—Post Anesthesia Care Unit). Nurses will
be closely monitoring you. Other recovering patients will be around you and you may hear sounds like
monitors and other machines at work or the hum of conversations.
You will probably be sleepy and confused upon waking up because the anesthetic has not completely
worn off. You may feel yourself drifting in and out of sleep as you slowly become more alert.
Opening your eyes will be hard at first. Your eyesight may be blurred because of the ointment applied
during surgery to keep them moist. The nurse will wipe your eyes for you. Your mouth will be dry, so
the nurse may give you ice chips. Your incision will probably feel uncomfortable and your throat may
feel sore. The nurse may give you pain medication.
You may have an oxygen mask on your face or a breathing tube in your mouth. If you have a breathing
tube you will be unable to talk. The breathing tube will be taken out as soon as you are awake enough
to take deep breaths. To do this the nurse will help you turn and cough.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Once in Your Room
When you arrive to your room, your nurse will
be waiting for you. He or she will check on you
often to make sure you are comfortable and
have what you need. For the first 48 hours vital
signs and bandages will be checked frequently
throughout the day and night.
Tubes
Depending on your surgery you may be connected to a number of tubes. You may have a
bladder
catheter during the operation that may still be
in place. The bladder catheter will be removed
based on your physician’s orders.
Also, you will probably still have your IV in since it is the most effective way to transfer fluids and medications into your system. The nurse will check your IV often, but if you notice the skin becoming red,
swollen, or tender near it, tell your nurse right away.
Lastly, you may have drainage tubes positioned near your incision. These tubes drain fluids from the
area around the incision to promote healing. Your doctor will decide when it is safe to remove the
incision drainage tubes.
Pain Management
The incision area may burn and you may feel stiff, but as soon as your body heals you will increasingly
feel more comfortable. Pain medication may be given by injecting it into your IV, using a PCA (Patient
Controlled Analgesia), or in pill form.
Do not hesitate to ask for pain medication at the first sign of discomfort. The nurse will frequently ask
you what your pain level is at, 0 being no pain and 10 being worst possible. Asking for the medication
is better than letting the pain become more severe. If it is too soon for more medication, the nurse may
change your position, turn your pillow or try other alternatives until it is safe for more medication, ice
packs are often helpful.
Pain medication will not completely stop the pain, but it will take the edge off. When pain is manageable you will be more inclined to get started with the simple exercises you have been taught.
© 2012 Baylor Health Care System. All rights reserved.
15
Joint Wellness Program
Adjusting, Knowing Your Limits
The post-operative healing process may be hard work for your body. During this period, you may feel
strange sensations such as mood swings, night sweats, bad dreams, and some people run a low grade
temperature. You may know you do not feel well yet lack any ability to describe how or where, if those
feelings persist or worsen, tell your nurse or doctor.
Post Operative Requirement—Simple Physical Activities
You will be asked to perform these simple activities after your surgery. Exercising will help work off the
effects of anesthesia, stimulate blood circulation and keep your muscles strong. Granted, much of your
care will be handled by doctors and nurses, however it is your job to do these exercises. If you do, you
will recover faster—so be familiar with the following before your surgery:
Deep Breathing
Some anesthesia gases remain in the lungs after surgery. Deep
breathing is crucial for expanding and clearing the lungs. To practice, lie on your back, set a tissue box on the middle of your chest
and slowly inhale through your nose. Observe how the box rises
and make sure to breathe deeply enough so that your whole chest
expands. Let all the air out through your mouth and watch the box
descend. You can begin deep breathing any time after surgery. You
will be instructed on the use of the incentive spirometer and will be
asked to perform coughing and deep breathing exercises.
Coughing
Fluid or mucus may collect in the lungs during surgery, coughing is
the best way to get rid of it. After taking three deep breaths, cough
several times as hard as you can. Do not be discouraged if it is difficult at first.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Hand and Foot Exercises
Even the smallest movements with your hands and feet help improve your circulation. Do the following
simple movements several times a day:
1. Point your toes away from your body
2. Roll your ankle
3. Point your toes toward your head
4. Swivel your ankle
5. Clench your fists
6. Reach overhead
7. Bend and straighten elbows
Walking
Walking is very important to your recovery. You will begin walking with our physical therapists,
sometimes even the day of your surgery.
You may think the last thing you will want to do after surgery is exercise; however these simple activities
are critical to your recovery. We understand that you may feel some discomfort when doing them, but
please remember the benefits are well worth the effort. Studies have proven that people who exercise heal
faster and better than those who do not.
The Can and Can’t Do’s Post-Op Activities
Diet
Hospital dietitians are very aware of your digestive system’s responses to anesthetic. As your meals
gradually go from liquid to solid, they may give you diet instructions or help you make food choices.
Your appetite may be irregular, but eat as healthy as you can. Without good nutrition, it takes longer to
heal and begin feeling better.
Getting Up and Around
When you are allowed to resume activity, you will be instructed on how much you can do. Remember
it is imperative that you do your exercises. You may be weak and uncomfortable at first, but the earliest
movements are necessary for healing and recovery. Your nurse or therapist will help you as you gain
strength. Do not attempt to get up by yourself without help until given permission. Please use your call
light for assistance.
© 2012 Baylor Health Care System. All rights reserved.
17
Joint Wellness Program
Standing Up
We encourage you to sit on the edge of bed before proceeding to the standing position for a few
moments. Take several slow deep breaths before you stand up which will return blood to your heart and
head. Deep breathing should help prevent dizziness and fainting. Please take it easy and slow.
Walking
Walking “wakes up” all your body’s systems and helps them return to normal. Stand and walk as straight
as you can (stooped shoulders may cause tight, sore muscles in your back and legs), good posture contributes to breathing, circulation and speedy healing. Again start slowly and stop after short distances.
Your body will tell you when it is time to rest; however push yourself to walk a bit further each day.
Generally, the more you can do for yourself, the sooner you can go home.
Rest
Resting is also important for your recovery. You do not even have to go to sleep, but try to get in the
habit of lying down after meals and baths once at home.
Visitors
Visits from friends and family can cheer you up and make you feel better. However too many visitors
can tire and disturb your rest. Even a ringing telephone can interrupt important rest time. Visitors are
encouraged to use the alcohol hand foam at the door to clean hands before entering the room.
Before Your Surgery
A little planning before you leave home will help you while you’re in the hospital and when you get back
home.
Plan for Your Return Home
1. Plan easy meals in advance.
2. Organize your kitchen so that supplies are at shoulder or waist level to avoid excessive lifting,
bending or reaching.
3. Prepare a room downstairs if you live in a two-story house to reduce the amount of stair climbing.
4. Clear your house of obstacles and remove any throw rugs for safe walking.
5. Have a firm chair with armrests and good height available.
6. Arrange for help from a friend or family member to assist with housekeeping, shopping or driving.
For information on area hotels, please call Guest Services at 972.579.4358.
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© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Therapy Discharge Goals
Physical Therapy:
n
Get in and out of bed without physical assistance
n
Transfer from bed to chair safely with use of walker/crutches without physical assistance
n
Walk 150 feet with walker/crutches safely without physical assistance
n
Climb and descend curb/stairs with/without rail with supervision or no physical assistance needed
n
Perform home exercise program with physical assistance if needed
Occupational Therapy:
n
Safely manage toileting with walker/crutches without physical assistance
n
Perform safe tub/shower transfer with minimal to no caregiver assistance
n
Able to dress self with minimal to no caregiver assistance utilizing adaptive equipment as needed
n
Communicate an understanding of hip precautions if applicable
n
Adaptive equipment, education, and training to promote independence
Going Home
When you are ready to go home, your health care team will tell you what to do. Carefully follow their
instructions.
Before you leave the hospital, be sure to know about:
nMedications
nDiet
n
Activity and exercise
n
Going back to work
nDriving
nRest
n
Incision care and removal of stitches
n
Airport metal detectors
n
Follow-up visits with the doctor
n
Adaptive equipment including reachers and sock aid
n
Durable medical equipment including walker and 3-in-1 bedside commode
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Preventing Infection in the Hospital
What You as a Patient Can Do
Infections can occur after many types of medical procedures. This is particularly true if you are having
surgery. You can prevent infections from developing in the hospital.
Hand washing is the most important thing you can
do to prevent infection.
n
Use alcohol foam or wash your hands carefully after
handling any type of soiled material—especially after
using the restroom.
n
Since you are part of your health care team, do not
hesitate to remind doctors, nurses, and visitors to use
alcohol foam or wash their hands before caring for
you.
n
If you have an intravenous catheter or dressing on
a wound, keep the skin around the dressing clean and dry. Tell your nurse promptly if the dressing
becomes loose or gets wet.
n
If you have any type of catheter or drainage tube, notify your nurse promptly if it becomes loose or
clogged.
n
If you are overweight, losing weight will reduce the risk of infection following surgery.
n
If you have diabetes, discuss with your doctor the best way to control your blood sugar before, during and after your hospital stay. High blood sugar increases the risk of infection.
n
If you are a smoker, consider a smoking cessation program. This will reduce the chance of developing a lung infection while in the hospital and may also improve your healing abilities following
surgery.
n
Ask your friends and relatives not to visit if they feel ill.
n
Ask questions about your care so that you fully understand your treatment plan and expected
outcomes. You and your family/friends will be able to better facilitate your recovery.
n
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Joint Wellness Program
Pain Management
Pain Management is a top priority.
0
2
4
6
Distressed
8
10
No Pain
Mild Pain
Discomfort
Severe
Excruciating
Relaxed, Calm
Expression
Stressed,
Tense
Expression
Guarded
Moaning,
Crying
Movement,
Restless
Out
Grimace
Increased
Intensity
of Behaviors
Patient-Controlled Analgesia (PCA)
After your surgery, your doctor will want you to receive pain medication. The best method of giving
that medication is through a PCA pump because it allows you to give yourself pain medication.
n
When you press the button connected to the PCA pump, you will hear a beep and the pump will
deliver a specific amount of pain medication.
n
If you press the button, but you do not hear a beep, that means that you have already received the
maximum pain medicine set for the pump for that time period.
n
The dose is determined by your doctor based on your size, age, and diagnosis.
n
The PCA pump has safety features which help prevent you from getting too much medicine.
n
You should press the PCA button before your pain becomes severe or
when it first begins
With the help of the pump we would like to keep your level of pain at a
comfortable level. If pushing the button does not relieve your pain, please
notify your nurse. Pain medications are also available to control your pain.
It is recommended that you take the medication 30 to 45 minutes prior
to walking with the therapist. Remember, most patients will experience
some pain after surgery, particularly when using the muscles near the
incision. Other methods of pain control such as proper positioning,
decreasing environmental noises, and supporting the incision with a
pillow during movement may be helpful.
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Joint Wellness Program
Side effects which may occur include with patients receiving pain medications include:
n
Sleepiness or feeling drowsy
nNausea
n
Difficult urination
nItchiness
nConstipation
Let your nurse or doctor know if you experience any of the side effects listed above. Your doctors and
nurse will also assess you regularly for side effects from the pain medication.
Although pain medication often makes you sleepy, it is important that you stay awake enough to participate in activities which are an important part of your recovery such as walking, deep breathing and
completing some of your own care. Therefore you may need to balance your pain control and sleepiness.
Safety Instructions
1. You are the only person who should push the PCA button. Your family or friends are not allowed to
press the PCA button.
2. Do not attempt to eat or drink if you feel very sleepy or drowsy. Do not allow visitors to feed you
while you are feeling sleepy or drowsy. Wait until you are more awake.
3. If you feel dizzy or weak, call the nurse for assistance before attempting to walk or get out of bed.
4. Please remember that your comfort is important to us. Your input is helpful. Please don’t hesitate to
ask your nurse or physician questions.
Medications after Joint Surgery
Arixtra, Lovenox, Xarelto or Coumadin
n
Used to prevent and treat blood clots
n
First few doses will be given in the hospital
n
You or your trainer will be taught how to give the medicine at home
Foley Catheter
A Foley catheter will be inserted in surgery while you are asleep. It is used to drain and collect urine
from your bladder. The catheter will be removed on the first or second day after surgery.
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After Surgery
Day 1—After Surgery
On Day 1 after surgery between 7:00 and 9:00 a.m., you will be assisted with your AM care, and seated
in your recliner for breakfast. Your surgeon and/or his physician assistant will typically visit you early in
the day. On surgery days for your surgeon, visitation may be later in the day.
The physical therapist will assess your progress and you will continue ambulating with a walker.
Individualized therapy sessions will occur that day. Throughout the day, you should continue to practice
your “ankle pumps,” use your incentive spirometer every hour, as well as your cough and deep breathing
exercises. Your “massaging sleeves” should be on both legs when you are idle in your bed or while
sleeping. Your designated “coach” is encouraged to be present as much as possible.
Day 1 at a Glance
3:00 a.m.–7:00 a.m. 8:30 a.m.–11:00 a.m. 12:00 noon 1:00 p.m.–4:30 p.m. Blood drawn and vital signs
Physical therapy evaluation and treatment (30 minute session)
Lunch
Physical and Occupational therapy evaluation and treatment
(30 minute session)
Don’t forget to walk in the afternoon with your coach.
Day 2—After Surgery
Day 2 will start in a similar manner to Day 1. You will be assisted with AM care, dressed, and seated in
your recliner. Your surgeon and/or physician’s assistant will visit you.
Please remember to walk as much as possible throughout the day without assistance only if your physical
therapist has assessed you to be safe, and able to walk independently. Your “coach” should always
accompany you.
Throughout the day, you should continue to practice your ankle pumps, use your incentive spirometer
every hour, as well as your cough and deep breathing exercises. Your massaging sleeves should be on both
legs when you are in your bed idle or sleeping.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Day 2 at a Glance
3:00 a.m.–6:00 a.m. 7:00 a.m.–8:00 a.m. 8:00 a.m.–11:00 a.m. 12:00 noon 1:00 p.m.–4:30 p.m. Blood drawn and vital signs
Bath, and out of bed to recliner for breakfast
Walk in hallway for physical therapy session, as well as individualized
occupational therapy session to instruct on dressing, assistive device training, self care, bathing and standing (30 minute session)
Lunch
Physical therapy (30 minute session)
Don’t forget to walk in the afternoon with coach, if cleared by therapy, or with staff on the unit.
Day 3–After Surgery
We encourage your “coach” to be here at the start of your day, to assist you with your AM care, dressing
and ambulation. You will be discharged after the therapy session before 11 a.m.
Discharge Instructions After Surgery
Diet
n
Diet as tolerated if you are not nauseated.
n
Drink plenty of fluids.
n
Increase the fiber in your diet as you may become constipated with pain medication.
n
Take a multivitamin and a vitamin C to help with your general well-being and with the healing
process.
Activities
Physician will clarify weight bearing status after surgery. (After hip surgery, please follow hip
precautions.) Follow the physical therapy (PT) and occupational therapy (OT) instructions regarding
activity at home.
Walk with the device as instructed while you were in the hospital.
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Home Health therapy or outpatient therapy should be initiated as soon as possible.
Contact information for Home Health will be provided on the day of discharge.
Home Health contact:
Outpatient PT contact:
Equipment for Home (CPM) contact:
Ice Machine
If an ice machine is provided, you are encouraged to use it as needed for pain and swelling.
Medications
Take medications as instructed by physician and/or your nurse.
TED Hose
To prevent blood clots, please wear the TED hose on both legs for 6 weeks—even though they may be
uncomfortable at times. TED hose may be removed before showering and at night if approved by your
doctor.
Wound Care
You will be discharged home with a (waterproof/non waterproof ) _________ dressing on your wound.
If waterproof, you may shower with the dressing. Call the physician’s office if the dressing peels off or if
water gets into the dressing.
Keep the operative area clean and dry at all times.
No baths, pool, hot tub until cleared by physician.
n
NOTIFY your physician if you experience any signs of infection: redness, swelling, unusual
drainage, fever over 101.5 degrees F.
n
Staples will be removed at the follow-up visit with your physician.
n
n
Follow-up Instructions
Call your physician’s office to schedule a follow-up appointment after discharge. Call the Orthopedic
Services Department at 972.579.8396 if you have any questions.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Options for Care After Leaving the Hospital
After surgery, all patients will participate in therapy to strengthen and increase mobility in their new
joint. Since every patient is different, the length and level of therapy may vary. Many patients will walk
out of the hospital and return home with outpatient therapy or the services of a home care agency.
Other patients may require a focus on prior medical problems in addition to their rehabilitation. This
usually occurs in a skilled nursing facility. Still other patients may require more intensive rehabilitation
which would occur in an acute care rehabilitation facility such as Baylor Institute for Rehabilitation
(BIR).
Your physician, in consultation with the health care team members, will decide which level of care is best
for you.
Home Health Care
The majority of patients undergoing joint replacement will return home immediately following their
hospitalization. Patients who do not have any medical conditions that make it difficult to heal often
return home after 2 or 3 days in the hospital. In this case, a nurse care coordinator will help make
arrangements for home health care. Home health is a service that allows a nurse or therapist to come to
your home to help with your rehabilitation. The home care nurse or home care therapist will continue
the orders started by your doctor while you are in the hospital. This service will allow you to make a
smooth transition back to your prior level of functioning. Home health care services are ordered for
patients who are unable to leave their home for continued therapy.
Outpatient Therapy
If you are not home bound after discharge, or you do not reach your fullest rehabilitation potential upon
completion of home health services, your physician may order therapy services in an outpatient clinic.
Skilled Nursing Facility
A Skilled Nursing Facility (SNF) offers patients with more complex medical problems care after surgery.
For instance, a patient who has diabetes or heart disease may recover more slowly than someone who has
no medical problems. SNF level care is offered by a number of different facilities, and is appropriate for
patients who can participate in at least one hour of rehabilitation a day. If you and your doctor believe
that you may need extra time to recover after your surgery, it is recommended that you consider two or
three options for SNF care prior to coming into the hospital. Planning ahead will allow your caregiver to
concentrate on you during your hospitalization, and will provide you greater assurance that you will be
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comfortable with the facility you choose. Once your doctor feels you are ready for SNF level care, your
social worker will assist in making the transition.
Acute Rehabilitation Facility
An acute rehabilitation facility, such as the nationally recognized Baylor Institute for Rehabilitation, is
available for patients who need extra focus on rehabilitating their joint. An example would be a patient
who has had a stroke in the past, and may need more directed rehabilitation after joint replacement.
At an acute rehabilitation facility, patients must be able to participate in a minimum of three hours of
therapy a day. There are several acute rehabilitation facilities in your area. Your doctor, social worker
and care coordinator will work together to help you make arrangements to be admitted at the acute
rehabilitation hospital that best meets your needs. All patients must meet certain criteria to be eligible
for an acute rehabilitation facility and is subject to your insurance company’s approval.
Caring for Yourself at Home
When you go home there is a variety of things you need to know for your safety, speedy recovery and
comfort. If you follow these simple guidelines, you will greatly improve your chances of a successful
recovery!
Control Your Discomfort
Take your pain medicine at least 30 minutes before physical therapy.
You may need pain medication for several weeks, but be careful as narcotic pain medicine is very
addictive.
Gradually wean yourself from prescription medication to Tylenol in place of your prescription
medication up to four times per day.
Change your position every 45 minutes throughout the day.
Leg cramps and muscle aches are common and generally get better with movement, so walk as tolerated.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Body Changes
Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Your desire for solid
food will return.
You may have difficulty sleeping. This is normal. Try not to sleep or nap too much during the day.
Your energy level and mental concentration will be decreased for the first month or so.
Pain medication that contains narcotics and a poor appetite promotes constipation. Use stool softeners
or laxatives such as milk of magnesia if necessary. Often patients won’t have a bowel movement until 3-4
days after joint replacement surgery.
Wound Care Instructions
Hand washing is the greatest prevention against infection and it is all the more important since you
had a joint replacement. You and your caretaker should wash your hands before dressing changes or any
contact with the wound.
Report to your physician if you see changes in the wound such as redness, swelling or drainage from the
incision and/or if you have a temperature greater than 101.5 degrees F or pain that is not controlled by
pain medication that was prescribed.
REMEMBER: Good hand washing and good personal hygiene are very important for effective and
good wound healing and to reduce the chances of infection.
Infection and Blood Clots: What You Need to Know
Infection in your total joint replacement is one of the most feared complications of this operation.
Although the risks are very low for post-op infections, it is important to realize that the risk remains.
Great lengths are taken by your surgical team to prevent an infection in surgery and immediately
post-op, but infections still occur at a rate of about 1% of all first time joint replacements. (There is still
a higher risk in revision joint surgery.)
In addition, a prosthetic joint could possibly attract the bacteria from an infection located in another
part of your body. If you should develop a fever of 101.5 degrees F or more, or sustain an injury such as
a deep cut or puncture wound, you should clean it as best as you can, put a sterile dressing or band-aid
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Joint Wellness Program
on it and notify your primary doctor. The closer the injury is to your prosthesis, the bigger the concern.
Occasionally, antibiotics may be needed. Superficial scratches may be treated with topical antibiotic
ointment. Notify your primary doctor if the injured area becomes painful or reddened.
REMEMBER: Hand washing is the most effective way to prevent infection.
Signs of infection
n
Increased swelling, redness at incision site
n
Change in color, amount, or odor or drainage
n
Increased pain at surgical site
n
Fever greater than 101.5 degrees F.
Prevention of Infection
n
Take proper care of your incision as explained.
n
Notify all physicians and dentist that you have had a total joint replacement.
n
When having dental work, or other potentially, contaminating procedures such as colonoscopy or
endoscopy, prophylactic antibiotics are required prior to the procedure.
Blood Clots in the Legs
Surgery may cause the blood to slow and coagulate in the veins of your legs, creating a blood clot or
what we call a “deep venous thrombosis (DVT).” This is why you take blood thinners after surgery, to
prevent DVTs. If a clot occurs despite these measures, you may need to be admitted to the hospital to
receive intravenous blood thinners. Prompt treatment usually prevents the more serious complication of
a pulmonary embolus.
In general, extended travel by car or airplane within the first six weeks of surgery is considered more
risky in the development of a blood clot. If you must travel, stop and change position hourly to prevent
your joint from tightening. Drink plenty of water, perform frequent ankle pumps and plan frequent
bathroom breaks. If you are traveling by air, drink plenty of water to keep hydrated which will likely
result in your need to use the bathroom and force you to get up and walk. Pressurized airplanes,
cramped seats and immobility are a set up for a DVT. Take an aspirin (if not allergic) on travel days.
Signs of Blood Clots in Legs
Swelling in thigh, calf or ankle that does not go down with elevation
n
Pain, tenderness in calf
n
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Joint Wellness Program
Blood clots are hard to diagnose by physical exam. When suspected, an ultrasound test is performed.
NOTE: Blood clots can form in either leg.
If you have any of these signs or symptoms, contact your physician.
Pulmonary Embolus
This is a VERY serious (but very rare) complication where a blood clot in a leg vein grows big enough to
a point where a piece breaks off, floats in the vein and travels to the heart and lungs.
This is an emergency and you should CALL 911 if any of the following symptoms are noticed or
suspected.
Signs of a Pulmonary Embolus
n
Sudden chest pain
n
Difficult and/or rapid breathing
n
Shortness of breath
nSweating
nConfusion
Prevention of Pulmonary Embolus:
n
Prevent blood clot in legs
n
Recognize a blood clot in leg and call physician promptly
Prevention of Blood Clots
n
Foot and ankle pumps
nWalking
n
Blood thinners such as Coumadin, Lovenox, Arixtra, or Xarelto
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Joint Wellness Program
Medications Used to Prevent Blood Clots
(“Anticoagulants”)
Your surgeon will prescribe you a short-term medication to take in the hospital and after discharge to
prevent blood clots. These medications work to keep your blood from clotting too fast, and basically
“thin your blood.” These medications are referred to as “anticoagulant” medications. There are several
different types of anticoagulants that your surgeon may prescribe, and the different types are listed
below. It is very important that you take your anticoagulant medication exactly as your surgeon
instructs and for the number of days that your surgeon prescribes.
Since these medications are thinning your blood, you are at a higher risk for bleeding and should be
more careful to avoid situations that could cause bleeding problems, accidents, or falls. If you experience
any serious or unusual bleeding problems such as coughing up blood, dark stools/bloody bowel movements, blood in your urine, or severe nosebleeds, you should contact your physician immediately.
Be cautious if you regularly take certain pain medications with your anticoagulant medication such as
ibuprofen (Motrin, Advil), naproxen (Naprosyn, Anaprox, Aleve), etodolac (Lodine), meloxicam
(Mobic), or aspirin (Bufferin, Excedrin) for pain relief. Use of these medications can cause bleeding.
If you need to regularly use these types of pain medications, discuss this with your doctor.
In most situations, you should not be taking two different anticoagulant medications at the same time
after discharge. Anticoagulant medications include Lovenox, Arixtra, Xarelto, Coumadin, Heparin and
Pradaxa. Some patients may be taking one of these anticoagulant medications prior to their surgery
for other conditions. Make sure that your nurse and surgeon are aware of all medications that you are
taking at home to ensure you are properly evaluated for your anticoagulant medication needs after your
surgery.
Different types of anticoagulant medications used to prevent blood clots after surgery include the
following:
Lovenox (enoxaparin) and Arixtra (fondaparinux)
n
These are available in syringes and should be injected daily, around the same time each day.
n
Your nurse will teach you how to give yourself these injections.
n
It is important that you get your prescription filled very soon after discharge if your physician
asks you to continue Lovenox or Arixtra. However, not all pharmacies carry Lovenox and Arixtra.
Brown’s Pharmacy, located on the first floor of Baylor Medical Center at Irving Medical Office
Building 2, carries these medications.
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Joint Wellness Program
Xarelto (rivaroxaban)
n
Xarelto is a tablet that is taken once daily by mouth, around the same time each day.
n
It is important that you get your prescription filled very soon after discharge if your physician asks
you to continue Xarelto. Most pharmacies should carry Xarelto.
Coumadin (warfarin)
n
Coumadin is a tablet that is taken once daily by mouth, around the same time each day.
n
While you are taking Coumadin, check with your pharmacist if you start any new medications,
including over the counter medications and antibiotics, to make sure there are not any drug-drug
interactions with Coumadin.
n
While on Coumadin, you will need to have a blood test checked at a lab. These lab tests are very
important to evaluate your Coumadin dosing. Your physician will instruct you on when and where to
have these checked.
n
It is important that you get your prescription filled very soon after discharge if your physician asks
you to continue Coumadin. Most pharmacies will carry Coumadin.
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Joint Wellness Program
Post-Operative Exercises
Safe Movements and Positions
When you go home you’ll still have to keep your
hip in certain positions. You’ll have to move in
ways that are safe. If you don’t your prosthesis
can shift out of place. Your doctor will talk to you
about how long you’ll have to limit your movements.
Remember Safe Positions by Thinking of
the Letters “L” and “H”, for Love My Hip.
L When you sit or bend, think about the angle your body and legs are making. Think of them as forming a capital L with your hips at the angle. Never close up the L when you sit or bend.
L Do’s
Do keep your knees below your hips when you
sit. You may need a small pillow to sit on.
Do use long-handled grippers to get things on
the floor or out of your reach.
L Don’ts
Don’t sit on low stools or chairs.
Don’t bend at the waist or lean too far forward
while sitting.
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Joint Wellness Program
H Think of your legs and body as forming a capital H. Keep your legs like the bottom part of the H. Never let them cross.
H Don’ts
Don’t cross your legs while lying down or sitting.
H Do’s
Do sit with your feet 3–6 inches apart.
Don’t let your legs cross over while standing or
exercising.
Don’t let your toes point excessively in or out.
Do stand up straight with legs straight.
Do always lie down with pillow between legs.
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Joint Wellness Program
After Your Operation—Exercising
Exercising after surgery is very important. How well you can use your hip depends on how well you
exercise. Exercise brings back your strength to walk and get well faster. You may exercise any time you
want, but do it at least 2–3 times per day.
Ankle Pumps
Lie on your back or sit in a chair. Gently point
and flex your ankles. Repeat 20–30 times.
Special Instructions:
Quad Sets
Tighten the muscles on top of both thighs, pushing the back of your knee into the bed. Hold 5
seconds. Relax. Repeat 20–30 times.
Special Instructions:
© 2012 Baylor Health Care System. All rights reserved.
Heel Slides
Lie on your back with your knees out straight.
Bend your operated hip and knee by sliding your
foot along the bed. Remember to raise and lower
your leg slowly. Repeat 20–30 times.
Special Instructions:
Hip Abduction and Adduction
Lie on your back. Slide operated leg out to the
side, then return back to the middle. Keep knee
straight and toes pointed up to the ceiling.
Repeat 20–30 times.
Special Instructions:
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Joint Wellness Program
Short Arc Quads
Place a towel roll under your the knee of your
operated leg. Raise your foot until your leg is
straight. Hold 5 seconds. Repeat 20–30 times.
Special Instructions:
Knee Flexion-Active Assistive
Sitting, slide operated foot underneath chair.
Keep hips on the chair. Repeat 20–30 times.
Cross non-operated leg over the operated leg
for the last 5 repetitions and hold each one for
5 seconds.
Knee Extension
Sit with back against the chair. Straighten
operated leg. Hold 5 seconds. Repeat 20–30
times.
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Joint Wellness Program
Everyday Living
Climbing Stairs: Up with the Good, Down with
the Bad
Going up stairs:
1. Using the handrail for support, start by
placing the non-surgical leg on the first step.
2. Bring the surgical leg up to the same stair.
3. Repeat until you reach the top.
4. DO NOT climb the stairs in a normal foot
over foot fashion until your surgeon or
therapist tells you that it is safe to do so.
Going down stairs:
1. Using the handrail for support, place the
surgical leg on the first step.
2. Bring the non-surgical leg down to the same
stair.
3. Repeat until you reach the bottom.
4. DO NOT descend the stairs in a normal foot
over foot fashion until your surgeon or
therapist tells you that it is safe to do so.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Getting In and Out of the Car
1. Move the front passenger seat all the way back
to allow the most leg room.
2. Recline the back of the seat if possible.
3. If you have fabric seat covers, place a plastic
trash bag on the seat cushion to help you slide
once you are seated.
4. Using your walker, back up to the front
passenger seat.
5. Steady yourself using one hand on the walker.
With the other hand, reach back for the seat
and lower yourself down keeping your surgical
leg straight out in front of you. Be careful not
to hit your head when getting in.
6. Turn frontward, leaning back as you lift your
surgical leg into the car.
7. Return the seat back to a sitting position.
8. When getting out of the car, reverse these
instructions.
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Joint Wellness Program
Getting In and Out of a Chair
For the next 12 weeks, it is best to use a chair that
has arms.
Getting into a chair:
1. Take small steps; turn until your back is
towards the chair. DO NOT pivot.
2. Slowly back up to the chair until you feel the
chair against the back of your legs.
3. Slide your surgical leg forward.
4. Using the arm of the chair for support of one
hand while holding the walker with the other
hand, slowly lower your body into the chair.
5. Move the walker out of the way but keep it
within reach.
Getting out of a chair:
1. Position yourself near the front edge of the
chair.
2. Place one hand on the arm of the chair and
the other hand on the walker, then lift yourself
off the chair. Be careful not to twist your body.
3. DO NOT try to use the walker with both
hands while getting out of the chair.
4. Balance yourself before grabbing for the walker
and attempting to walk.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Getting In and Out of the Bathtub
Getting into the bathtub using a bath seat:
1. Always use a rubber mat or nonskid adhesive
strips on the bottom of the bathtub or shower
stall.
2. Place the bath seat in the bathtub facing the
faucets.
3. Back up to the bathtub until you can feel the
bathtub. Be sure you are in front of the bath
seat.
4. Reach back with one hand for the bath seat.
Keep the other hand on the walker.
5. Slowly lower yourself onto the bath seat,
keeping the surgical leg out straight.
6. Move the walker out of the way, but keep it
within reach.
7. Lift your legs over the edge of the bathtub,
using a leg lifter for the surgical leg, if
necessary.
8. Keep your incision dry until the staples are
removed.
Getting out of the bathtub using a bath seat:
1. Lift your legs over the outside of the bathtub.
2. Move to the edge of the bath seat.
3. Push up with one hand on the back of the
bath seat while holding on to the center of the
walker with the other hand.
4. Balance yourself before grabbing the walker.
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Joint Wellness Program
Getting into Bed
When getting into bed:
1. Back up to the bed and position yourself
halfway between the foot and the head of the
bed. If you have access from either side of the
bed choose the side which will allow you to get
your non-surgical leg in first.
2. Reaching back with both hands, slowly sit
down on the edge of the bed. Move toward the
center of the mattress. Silk or nylon bed wear,
or sitting on a plastic bag may make sliding
easier.
3. Once you are firmly on the mattress, move
your walker out of the way, but keep it within
reach.
4. Rotate so that you are facing the foot of the
bed.
5. Lift your leg and pivot into the bed. When
lifting your surgical leg, you may use a cane, a
rolled bed sheet, or a belt to help with lifting.
6. Lift your other leg into the bed.
7. Move your hips towards the center of the bed
and lay back.
© 2012 Baylor Health Care System. All rights reserved.
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Joint Wellness Program
Lying in Bed
When lying on your back:
1. Position a pillow between your legs when
lying on your back.
2. Keep the surgical hip/leg positioned in bed
so the kneecap and toes are pointed to the
ceiling.
3. Avoid letting your foot roll inward or outward. A blanket or towel roll on the outside of
your leg may help you maintain this position.
Getting Out of Bed
When getting out of bed:
1. If possible, exit the bed from the side that will
allow you to lower your nonsurgical leg first.
2. Move your hips to the edge of the bed.
3. Sit up with your arms supporting you then
lower your non-surgical leg to the floor.
4. Lower your surgical leg to the floor.
5. If necessary, you may use a cane, a rolled bed
sheet, or a belt to assist with lowering your leg.
6. Use both hands to push off the bed. If the
bed is low, place one hand in the center of the
walker while pushing up from the bed with
the other.
7. Once you are up and stable, reach for the
walker.
42
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Using the Toilet
When sitting down on the toilet:
1. Take small steps and turn until your back is to
the toilet. DO NOT pivot.
2. Back up to the toilet until you feel it touch
the back of your leg.
3. Slide your surgical leg out in front when
sitting down.
4. If using a commode with arm rests, reach back
for both arm rests and lower yourself onto
the toilet. If using a raised toilet seat without
arm rests, keep one hand in the center of the
walker while reaching back for the toilet seat
with the other.
When getting up from the toilet:
1. If using a commode with arm rests, use the
arm rests to push up.
2. If using a raised toilet seat without arm rests,
place one hand on the walker and push off the
toilet seat with the other.
3. Slide surgical knee/leg out in front of you
when standing up.
4. Balance yourself before grabbing the walker
and attempting to walk.
© 2012 Baylor Health Care System. All rights reserved.
43
Joint Wellness Program
Putting on Pants
Use a “reacher” or “dressing stick” to pull on
pants and underwear:
1. Sit down.
2. Attach the garment to the reacher. Position
the garment by your feet.
3. Put your surgical knee/foot in first followed
by your other leg.
4. Bring the reacher towards you guiding the
waistband over your feet and up your legs.
5. Pull your pants up over your knees, within easy
reach.
6. Stand with the walker in front of you to pull
your pants up the rest of the way.
Taking off pants and underwear:
1. Back up to the chair or bed where
you will be undressing.
Unfasten your pants and
let them drop to the floor.
2. Push your underwear down to your knees.
3. Lower yourself down onto the bed, keeping
your surgical knee/leg straight.
4. With the help of the reacher, take your non
surgical knee/foot out first and then the other.
5. Using the reacher can help you remove your
pants from your foot and off the floor to
prevent a possible trip and fall.
44
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Putting on Socks
Use a sock aid to put on socks:
1. Sit on a chair or bed. Slide the sock onto the
sock aid.
2. Hold the cord and drop the sock aid in front
of your foot. It is easier to do this if your knee
is bent.
3. Slip your foot into the sock aid.
4. Straighten your knee, point your toe and pull
the sock on.
5. Keep pulling until the sock aid pulls out.
Putting on Shoes
Use a long-handled shoe horn to put your
shoes on:
1. Sit on a chair or bed.
2. Wear sturdy slip-on shoes or shoes with
Velcro® closures or elastic shoe laces. DO
NOT wear high-heeled shoes or shoes without
backs.
3. Use the long-handled shoehorn to slide your
shoes in front of your feet.
4. Place the shoehorn inside the shoe against the
back of the heel. The curve of the shoehorn
should line up with the inside curve of the
shoe heel.
5. Lean back, if necessary, as you lift your leg and
place your toes in your shoe.
6. Step down into your shoe, sliding your heel
down the shoehorn.
© 2012 Baylor Health Care System. All rights reserved.
45
Joint Wellness Program
Answers to Frequently
Asked Questions
What is arthritis and why does my hip hurt?
In the hip joint there is a layer of smooth cartilage
on the ball of the upper end of the thighbone
(femur) and another layer within your hip socket.
This cartilage serves as a cushion and allows for
smooth motion of the hip. Arthritis is a wearingaway of this cartilage. Eventually, it wears down
to bone. Rubbing of bone against bone causes
discomfort, swelling and stiffness.
What is Total Hip Replacement?
A total hip replacement involves an operation that
removes the arthritic ball of the upper thighbone
(femur) as well as damaged cartilage from the hip
socket. The ball is replaced with a metal ball that
is fixed solidly inside the femur. The socket is replaced with a plastic or metal liner that is usually
fixed inside a metal shell. This creates a smoothly
functioning joint that does not hurt.
When should I have this type of surgery?
Your orthopedic surgeon will determine if you are
a candidate for the surgery. This will be based on
your history, physical exam, x-rays and response
to conservative treatment. The decision will then
be yours.
Am I too old for this surgery?
Age is not a problem if you are in reasonable
health and have the desire to continue living a
productive and active life. You may be asked to
see your personal physician for their opinion
46
about your general health and readiness for
surgery.
How long will my new hip last, and can a
second replacement be done?
All implants have a limited life expectancy
depending on an individual’s age, weight, activity
level and medical condition(s). We expect most
hips to last more than 15–20 years. However,
there is no guarantee, and 10–15 percent may not
last that long. A second replacement or revision
may be necessary.
Why might I require a revision?
Just as your original joint wears out, a joint
replacement will wear out over time as well. The
most common reason for revision is loosening of
the artificial surface from the bone. Wearing of
the plastic spacer may also result in the need for
a new spacer. Dislocation of the hip after the
surgery is a risk. Persistent instability of the hip
may require revision. Your surgeon will explain
the possible complications associated with the
total hip replacement.
What are the major risks?
Most surgeries go well, without any complications.
Infection and blood clots are two serious complications that concern us greatly. To avoid these
complications, we use antibiotics and blood
thinners. We also take special precautions in the
operating room to reduce risk of infections. The
chance of infection is very small, but it can occur
even many years after surgery. In addition, there
is the possibility of dislocation, leg length discrepancy, persistent limp, permanent nerve and artery
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
injury and significant blood loss. Although rare,
stroke, heart attack and death have occurred with
this surgery.
Should I exercise before the surgery?
Yes. You will be directed to a physical therapist
for instruction or follow the exercises listed in
your Playbook. Exercises should begin as soon as
possible.
Will I need blood?
You may need blood during or after the surgery.
It has been shown that if you have a low blood
count prior to surgery, you will probably need
donated blood after surgery.
How long will I be in the hospital?
Most hip patients are hospitalized for three days.
How long and where will my scar be?
It is our belief that smaller incisions cause less
pain. We will try to make the smallest scar
possible that still allows us to do a satisfactory
procedure. Usually the scar will be approximately
3–6 inches long and located along the backside of
your hip.
How long will I be incapacitated right after
surgery?
We anticipate that you will be walking the day of
surgery, usually with a walker. Typical activity is
resumed within 4 to 6 weeks.
Will I need help at home?
Maybe. Most patients that have done their preop physical therapy are able to function well at
© 2012 Baylor Health Care System. All rights reserved.
home without great assistance. For the first several
days or weeks, depending on your progress, you
will benefit from someone to assist you with meal
preparation. The care manager will arrange for
a home health care nurse to come to your house
as needed. Preparing ahead of time, before your
surgery, can minimize the amount of help needed.
Having the laundry done, house cleaned, yard
work completed, clean linens on the bed, and
single portion frozen meals will reduce the need
for extra help.
What if I live alone?
Most patients leave the hospital independent
enough to function at home without great
assistance. If you are frail or ill, two options are
available to you. Option 1: You may either stay
at a sub-acute facility following your hospital stay
provided your insurer will cover you for this stay.
Option 2: A home health nurse and/or a home
physical therapist may be arranged to assist you
at home. You should make all attempts to arrange
for a relative or friend to stay with you for at least
the first week after discharge because the home
health nurse and physical therapist are with you
for only a short period of the day.
Will I need physical therapy when I go home?
Yes. You will typically have home physical therapy
come to your home for about 1–2 weeks. Patients
are encouraged to utilize outpatient physical
therapy as soon as possible. Your orthopedic team
will help you arrange for an outpatient physical
therapy appointment. The length of time required
for this type of therapy varies with each patient.
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Joint Wellness Program
Will I need any other equipment?
After hip replacement surgery, you will need a
high toilet seat for about three months. We can
arrange to have one delivered to you, or you may
rent or borrow one. You will also be taught to
use assistive devices to help you with lower body
dressing and bathing. You may also benefit from a
bath seat or grab bars in the bathroom, which can
be discussed with your physical therapist.
When can I take a shower?
You will be allowed to shower shortly after surgery
if your wound is dry. You may not go into a pool,
bath, hot tub, or the ocean until you have been
advised to do so.
How long until I can drive and be back to
normal?
You need to be off of all narcotic pain medications, and no longer requiring a walker to legally
be permitted to drive a motor vehicle. Most
patients attain this goal within 4 weeks.
When will I be able to get back to work?
We recommend that most people take at least one
month off from work, unless their jobs are quite
sedentary. An occupational therapist can make
recommendations for joint protection and energy
conservation on the job.
Do you recommend any restrictions following
this surgery?
Yes. High-impact activities, such as running,
singles tennis and basketball are not recommended. Injury-prone contact sports such as downhill
skiing are also dangerous for the new joint.
Common sense applies here.
What physical/ recreational activities may I
participate in after my recovery?
You are encouraged to participate in low-impact
activities such as walking, dancing, golfing, hiking,
swimming, bowling and gardening.
Getting “back to normal” will depend greatly on
your pre-operative physical condition and what
you consider to be normal activity. Consult with
your surgeon or therapist for their advice on your
activity.
48
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Glossary of Hospital Terms
Anesthesia
Partial or complete loss of feeling during which
patient may or may not be asleep.
Anesthetic
Medication usually given by injection, IV
(intravenous tube or small needle) or inhalation
to block any sensation of pain or discomfort.
General anesthetic is frequently administered
during surgery. Local anesthetic may be injected
into and around a specific operative area. Local
anesthetic greatly diminishes trauma to nerves
in and around the operative site during surgery,
therefore dramatically lessening postoperative
pain.
Anesthesiologist
A specialized physician who calculates and
administers a pre-determined amount of anesthetic depending on specific data relative to the
patient and his/her operative procedure. This
doctor is present throughout surgery to make
certain your body is constantly functioning
properly.
Anti-Embolism Reduction Devices
Elastic Support Stockings (TED Hose)
Stockings which stimulate blood flow in the legs
and help reduce blood clots following surgery;
these are worn by both men and women.
© 2012 Baylor Health Care System. All rights reserved.
Foot Pumps and Sequential Compression
Devices
Automated devices designed to pump the blood
from the foot and lower leg to help circulation
and reduce the possibility of blood clots.
Bladder Catheter
A small tube inserted into the bladder to drain
urine.
ECG or EKG (Electrocardiogram)
A graphic recording or the heart’s activities.
Holding Area
A room near the operating room where the
patient waits before surgery.
Incentive Spirometer
A device used by a patient in a hospital setting or
as prescribed by a physician that measures how
full your lungs inflate with each breath you take.
It is used to assist in keeping the lungs clear after
surgery.
Incision
A precision cut made in the body during an
operation.
Incision Drainage Tube
A tube placed in or near the incision to drain fluid
from the area.
Injection
A “shot”
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Joint Wellness Program
IV (Intravenous)
A thin needle or tube placed in a blood vein to
transport liquids, medicine or nutrients into the
body during and following surgery.
PCA (Patient Controlled Analgesia)
Gives you control over any pain you may experience by pushing a button you will receive a very
small dose of pain medication through your IV.
NPO
An abbreviation for the Latin terms, nil per os,
meaning “nothing by mouth”, including food,
drink, chewing gum, tobacco or other substances.
PRN
An abbreviation for the Latin terms, pro re na’ta,
meaning “according to the circumstances.” For
example, pain medicine is given PRN, or when it
is needed.
Nurse Anesthetist
A registered nurse trained to give anesthetics.
OT (Occupational Therapist)
An occupational therapist is a physical therapist
who helps people re-learn to do things that help
them with their daily lives, such as brush their
teeth or wash dishes through prescribing and
assisting them in various exercises.
OR (Operating Room)
The specialty equipped room where surgery is
performed.
PACU (Post Anesthesia Care Unit)
An area outfitted with special equipment and
monitored by post anesthesia trained staff to assist
patients as they wake up after surgery.
Pre-Op (Pre-Operative)
Before surgery.
Post-OP (Post-Operative)
After surgery.
50
PT (Physical Therapist)
A licensed therapist who is trained to treat a
physical dysfunction or injury with the use
of therapeutic exercise and the application of
modalities that are intended to restore or facilitate
normal function or development.
Recovery Room
Same as PACU
Shave and Prep
The pre-op special cleansing (sterilization) or
removing of hair around the operative area. Hair
may be removed by shaving or using hair remover
cream.
Surgeon
A doctor specially trained to perform surgery.
Vital Signs
Temperature, pulse, blood pressure and breathing
rate
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Prescription and
Non-Prescription Drugs:
What to Know
The next few pages provide a list of medications
that your physician may want you to stop taking
before your surgery. If you are taking any of these
medications, please inform your surgeon as soon
as possible. Do not discontinue any of your
prescription medications without first discussing
this with your physician and surgeon. If you
are on Coumadin, Heparin, Pradaxa, Xarelto,
Lovenox, Fragmin, Arixtra, Plavix, Brilinta,
Effient, Persantine, or Aggrenox, it is very
important that your surgeon is aware. There may
be other drugs, prescription or non-prescription,
which may not be on this list so please make sure
that you inform your surgeon of all medications
that you are taking, prescription, herbal, and
over-the-counter.
A
Advil Tablets/
Suspension
Aggrastat Injection
Aggrenox
Agrylin
Aleve
Alka Seltzer
Effervescent Tablets
Alka Seltzer Cold
Medicine Tablets
Anaprox
Anegrelide
Ansaid
Arixtra
Arthritis Pain
Formula Tablets
Arthritis Strength
Bufferin Tablets
Arthrotec
A.S.A. Tablets and Enseals
Ascriptin A/D Tablets
Ascriptin w/Codeine Tablets
© 2012 Baylor Health Care System. All rights reserved.
Ascriptin Extra-
Strength Tablets
Aspergum
Aspirin
B
Bayer Aspirin Tablets and Caplets
Bayer Children’s
Aspirin
Bayer Time-Release Aspirin Tablets
BC Powder
Brilinta
Bufferin Tablets
Butalbital Capsules
C
Caldolor
Cama Arthritis Pain
Cambia
Carisoprodol and
Aspirin Tablets
Cataflam
Celebrex
Clinoril
Clopidogrel Bisulfate
Cope Tablets
Coumadin
D
Dabigatran
Daypro
Diclofenac
Diflunisal
Dipyridamole
Doan’s Pills
Dolobid
Duexis
Durasal Tablets
E
Easprin
Ecotrin Tablets
Effient
Empirin Tablets
Endodan Tablets
Enoxaparin
Epoprostenol Injection
Equagesic Tablets
Etodolac
Excedrin Tablets/
Capsules
F
Feldene
Fenoprofen
Fiorinal Tablets
Fiorinal w/Codeine
Fiortal Capsules
Fiortal w/Codeine
Flolan Injection
Flurbiprofen
Fondaparinux
Injection
Fragmin Injection
G
Genpril
Goody’s Powder
H
Halfprin Tablets
Heparin Injection
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Joint Wellness Program
I
Ibudone
Ibuprofen
Indomethacin
Indocin
Indo-Lemmon
Capsules
Integrilin Injection
J
Jantoven
K
Ketoprofen
Ketorolac
L
Lodine
Lovenox Injection
M
Meclofenamate
Mefenamic
Meloxicam
Midol Caplets
Mobic
Motrin
N
Nabumetone
Naprelan
Naprosyn
Naproxen
Norgesic Forte Tablets
Nuprin
52
O
Orgaran Injection
Oxaprozin
Oxycodone and
Aspirin Tablets
P
PediaCare Fever
Liquid
Pentoxil
Pentoxifylline
Pepto-Bismol Tablets
Pepto-Bismol
Suspension
Percodan Tablets
Persantine
Percogesic Backache
Relief
Piroxicam
Plavix
Ponstel
Pradaxa
Prasugrel
R
Reprexain
ReoPro Injection
Rivaroxaban
Rufen
S
St. Joseph’s Aspirin
for Children
St. Joseph’s Cold
Tablets for Children
Saleto Tablets
SK-65 Compound Capsules
Soma Compound
Stanback Tablets/
Powder
Sulindac
Synalgos-DC Capsules
Z
Zileuton
Zipsor
Zyflo
T
Theraproxen
Ticagrelor
Ticlid
Ticlopidine
Tolmetin
Toradol
Trental
Trepoxen
Treximet
Triaminicin Tablets
V
Vanquish Caplets
Vicoprofen
Vimovo
Voltaren
W
Warfarin
X
Xarelto
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Resources
Orthopedic Services Department: 972.579.8396
Our goal is that you continue physical therapy (PT) after discharge. Your Orthopedic Surgeon may
choose to send you home with either Home Health PT or outpatient PT.
Care coordinator will set up your Home Health PT and provide you with contact information.
A representative will notify you after discharge to set up your initial appointment for PT at home.
Our social worker will set up the outpatient PT and they will contact you with the first available
appointment.
Initiating PT as soon as possible is very important, so please contact the care coordinator or social
worker if you have any problems or questions.
Thank you for choosing Baylor Medical Center at Irving as your health care provider for your Joint
Replacement Surgery. We strive to provide very good care to you and your family during your time of
healing. After you leave the hospital you may receive a survey regarding your care. Please help us to
continue to grow as an organization and provide feedback about your visit. We use your feedback to
make improvements and to recognize our staff. At Baylor Medical Center at Irving, we hope that you
are very satisfied with all the care we provide.
1901 N. MacArthur Blvd.
Irving, TX 75061
1.800.4BAYLOR
BaylorHealth.com/Irving
Physicians are members of the medical staff at one of Baylor Health Care System’s
subsidiary, community or affiliated medical centers and are neither employees nor
agents of those medical centers, Baylor Medical Center at Irving or Baylor Health
Care System. ©2012 Baylor Health Care System. BMCIRV_450_2012 DH
© 2012 Baylor Health Care System. All rights reserved.
53
Joint Wellness Program
Hwy. 183
Hw
O’Connor Blvd.
Mac Arthur Blvd.
Story Road
y.
Hwy. 161
Rock Island
Baylor Medical
Center at Irving
Blv
d.
Road
4
West Airport Fwy.
Irv
ing
11
Loop 12
• Park in front parking lots, parking garage or
use our complimentary valet service at the
main entrance, if available.
• Enter through the main hospital entrance.
• Follow main hallway on the first floor toward
the cafeteria.
• Take Elevator A or B across from the cafeteria.
• Go to the third floor and go down the ramp
toward 3 East, rooms 350 to 384. This is the
orthopedic services floor.
• Feel free to ask a staff member for assistance
if you get lost.
Belt Line Road
Hw
y.
1
61
Campus and Area Maps
Shady Grove Road
Hwy. 183/Airport Fwy.
Parking
Public Only
Parking
Medical
Office II
Public Only
Free Valet Parking
Main Entrance
Parking
Public/Staff
Outpatient
Lobby
N. MacArthur Blvd.
Medical
Office I
Sammons
Cancer Center
Morris Parrish Blvd.
West Park Lane
Sky Bridge
Parking
Physicians
Hospital
Emergency Entrance
Parking
Parking
Staff
Parking
Emergency
Lane Street
54
CopperTree Medical Office Bldg.
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Notes
© 2012 Baylor Health Care System. All rights reserved.
55
Joint Wellness Program
Notes
56
© 2012 Baylor Health Care System. All rights reserved.
Joint Wellness Program
Prepping Instructions
Preparing or “prepping” skin before surgery can reduce the risk of infection at the surgical site.
To make the process easier, Baylor Medical Center at Irving has chosen disposable cloths moistened with
a rinse-free 2% Chlorhexidine Gluconate (CHG) antiseptic solution designed to reduce the bacteria on
the skin.
Once prepping begins, do not apply lotions, moisturizers or makeup. If showering or bathing is desired,
do so at least one hour prior to the use of the disposable cloth. DO NOT shower, bathe, or shampoo
hair AFTER you have prepped the skin with the CHG cloth. DO NOT allow this product to come in
contact with your eyes, ears, mouth and mucous membranes.
Directions for Two-Step Procedure (follow carefully)
STEP 1: NIGHT BEFORE SURGERY
n
To open the package: remove and discard cellophane film. Cut off the top of two (2) red packages.
n
Use all four 4 cloths to wipe down your body (front and back):
1.neck, chest, stomach
2.both arms
3.both legs
4.surgical site—scrub back and forth, make sure to wet the entire area.
n
Allow your skin to air dry for one minute. DO NOT RINSE. Put on clean clothing.
n
Discard cloths in the trash.
It is normal for the skin to have a temporary “tacky” feel for several minutes after the antiseptic solution
is applied.
STEP 2: MORNING OF SURGERY (before coming to the hospital)
n
Do not shower, bathe or shampoo hair the morning of your surgery.
n
Open the last package and follow the instructions listed above.
n
Remember to use one of the disposable cloths to scrub the area around the actual surgical site.
n
Allow skin to air dry for one minute. Do not rinse.
Place the PREP CHECK sticker from the
package at the bottom of this handout.
Return this sheet when admitted for surgery.
© 2012 Baylor Health Care System. All rights reserved.
57
1901 N. MacArthur Blvd.
Irving, TX 75061
972.579.8100
BaylorHealth.com/Irving