Download Knee Replacement Patient Guidebook

Knee Replacement
Patient Guidebook
NoteBook™ For Knees
Copyrighted Material
©
This notice is to inform the user of these materials that all
materials found in this package are copyrighted. This
material is to be used only as specified and cannot be copied
or used in any other capacity without the express written consent
of Indian Path Medical Center.
NoteBook™ is a trademarked publication of TVC.
Patient Surgery/Procedure Information
Indian Path Medical Center
Your surgery date: _________________________________________
Pre-Admission Testing (PAT) on: ________________ at ___________
Report to the Outpatient Department at IPMC.
Final pre-op appointment with your surgeon on: ________________at ___________
You have been given a schedule for a preoperative education class. Please attend one class at least
three to four weeks prior to your surgery. (See “Attend Preoperative Class” in Section 3 of this
notebook for details.)
Call DeDe Hope, RN, BSN, the Joint Program Coordinator, at
423-857-7699 if you have any questions.
Please bring this book with you to:
o Every office visit
o Your hospital pre-op class
o The hospital on admission
o All physical therapy visits after surgery
Table of Contents
.
SECTION 1 Clinical Diary
Using the Clinical Diary ...................................................................................................2
Preoperative Exercise Chart ..............................................................................................3
SECTION 2 General Information
Welcome...........................................................................................................................8
The Purpose of this Notebook...........................................................................................8
Joint Camp.......................................................................................................................9
Features of Joint Camp......................................................................................................9
Total Knee Replacement Q and A...................................................................................10
SECTION 3 Pre-Op Check List
The Total Joint Care Team...............................................................................................16
Pre-Admission Testing.....................................................................................................16
Billing for Services...........................................................................................................17
Start Preoperative Exercises..............................................................................................17
Attend Preoperative Class................................................................................................17
Review “Patient Bill of Rights”........................................................................................18
Donating Your Blood......................................................................................................18
Read “Basics of Anesthesia”.............................................................................................18
Preoperative Visit to Surgeon...........................................................................................18
Arrival Time at Hospital..................................................................................................18
Parking............................................................................................................................19
Prepare Your Home for Your Return from the Hospital...................................................19
The Night Before Surgery................................................................................................19
Special Instructions.........................................................................................................20
What to Bring to the Hospital.........................................................................................20
.
SECTION 4 Preoperative Exercise and Activity Guidelines
Activity Guidelines..........................................................................................................22
Preoperative Exercises......................................................................................................23
SECTION 5 Hospital Care
Day of Surgery................................................................................................................32
Post Surgery....................................................................................................................33
Pain Control...................................................................................................................34
.
.
SECTION 6 Postoperative Care
Caring for Yourself at Home............................................................................................36
Controlling Your Discomfort...................................................................................36
Body Changes.........................................................................................................36
Lovenox...................................................................................................................36
Stockings (TEDS)...................................................................................................36
Caring for Your Incision..................................................................................................37
Infection.........................................................................................................................37
Recognizing and Preventing Potential Complications......................................................37
Blood Clots.............................................................................................................37
Pulmonary Embolus................................................................................................38
SECTION 7 Postoperative Exercises and Goals
Activity Guidelines..........................................................................................................40
Postoperative Exercises....................................................................................................40
SECTION 8 Daily Living and Safety Tips
Precautions and Home Safety Tips..................................................................................48
Lying in Bed............................................................................................................48
Transfer Into Bed.....................................................................................................48
Transfer Out of Bed.................................................................................................49
Transfer Tub............................................................................................................49
Transfer Car.............................................................................................................50
Walker Ambulation.................................................................................................50
Around the House...........................................................................................................51
Kitchen....................................................................................................................51
Bathroom................................................................................................................51
Avoiding Falls..................................................................................................................51
Dos and Don’ts for the Rest of Your Life.........................................................................51
What to Do in General...................................................................................................52
What to Do for Exercise..................................................................................................52
SECTION 9 Appendices
Directions to IPMC........................................................................................................54
Hotel Infromation...........................................................................................................55
Campus Map..................................................................................................................56
Patient Bill of Rights.......................................................................................................57
Advance Directives..................................................................................................57
What I Need to Know About Blood Transfusions............................................................58
Basics of Anesthesia.........................................................................................................60
About Lovenox................................................................................................................61
Acknowledgements
This project was developed through the
cooperation and collaboration of the following:
The Joint Replacement Center at Indian Path Medical Center
The Wellness Center
Mountain States Health Alliance Home Health Services
Appalachian Orthopaedic Associates
Watauga Orthopedics
Anesthesia and Pain Consultants
TVC
Clinical Diary
Using the Clinical Diary
Instructions for the Use of the Clinical Diary
The clinical diary section of this notebook is for your personal use. It provides a chart to log in your preoperative exercises. It also provides sections for you to record physician, surgical, physical therapy and occupational
therapy information of which you may want to keep a permanent record.
CLINICAL DIARY - KNEE
Pre-Hospitalization Information
Physician/Physician’s Assistant
Phone
Patient
Diagnosis
Date:
Surgery Information
Physician/Physician’s Assistant
Phone:
Date:
Prosthetic type:
Cemented
Non-Cemented
Special Procedures/Precautions
Weight Bearing
%PWB
WBAT
Findings/Concerns:
Physical and Occupational Therapy Information
Knee ROM: Flexion:
Extension:
ADL: Equipment Issued:
Reacher
Sock Aid
Distance ambulated and assistive device:
page 2 | orthopedic and neurological services | www.msha.com
Long Shoe Horn
Preoperative Exercise Chart
Ankle
Pumps
Quad
Sets
Gluteal
Sets
Abduction
and
Adduction
Heel
Slides
Short
Arc
Quads
Long
Arc
Quads
Arm
Chair
Push-ups
Seated
Hamstring
Stretch
Leg
Raises
Knee
Ext.
Date:
# Reps:
Times:
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www.msha.com | orthopedic and neurological services | page 3
Preoperative Exercise Chart
Ankle
Pumps
Quad
Sets
Gluteal
Sets
Abduction
and
Adduction
Heel
Slides
Short
Arc
Quads
Long
Arc
Quads
Date:
# Reps:
Times:
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page 4 | orthopedic and neurological services | www.msha.com
Arm
Chair
Push-ups
Seated
Hamstring
Stretch
Leg
Raises
Knee
Ext.
Preoperative Exercise Chart
Ankle
Pumps
Quad
Sets
Gluteal
Sets
Abduction
and
Adduction
Heel
Slides
Short
Arc
Quads
Long
Arc
Quads
Arm
Chair
Push-ups
Seated
Hamstring
Stretch
Leg
Raises
Knee
Ext.
Date:
# Reps:
Times:
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www.msha.com | orthopedic and neurological services | page 5
Preoperative Exercise Chart
Ankle
Pumps
Quad
Sets
Gluteal
Sets
Abduction
and
Adduction
Heel
Slides
Short
Arc
Quads
Long
Arc
Quads
Date:
# Reps:
Times:
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page 6 | orthopedic and neurological services | www.msha.com
Arm
Chair
Push-ups
Seated
Hamstring
Stretch
Leg
Raises
Knee
Ext.
General Information
Welcome
Thank you for choosing The Joint Replacement
Center to help restore you to a higher quality of
living with your new prosthetic joint.
Annually, more than 400,000 people undergo total
joint replacement surgery. Primary candidates are
individuals with chronic joint pain from arthritis
that interferes with daily activities, walking, exercise,
leisure, recreation and work. The surgery aims to
relieve pain, restore your independence and return
you to work and other daily activities.
Total knee replacement patients recover quickly.
Patients will be able to walk the first day after
surgery. Generally, patients are able to return to
driving in two to four weeks, dance in four to six
weeks and golf in six to 12 weeks.
The Joint Replacement Center at Indian Path
Medical Center has developed a comprehensive,
planned course of treatment. We believe that you
play a key role in ensuring a successful recovery.
Our goal is to involve you in your treatment
through each step of the program. This patient
guide will give you the necessary information
needed for a safe and successful surgical outcome.
Your team includes physicians, physician’s assistants,
nurses, patient care partners, and physical and
occupational therapists specializing in total joint
care. Every detail, from preoperative teaching
to postoperative exercising, is considered and
reviewed with you. The joint care team will plan
your individual treatment program and guide you
through it.
The Purpose of the Notebook
Preparation, education, continuity of care and a pre-planned discharge are essential for optimum results in joint
surgery. Communication is essential to this process. The notebook is a communication and educational tool for
you. It is designed to educate you so that you know:
• What to expect every step of the way.
• What you need to do.
• How to care for your new joint for life.
Remember, this is just a guide. Your physician, physician’s assistant, nurse or therapist may add to or change
any of the recommendations. Always use their recommendations first and ask questions if you are unsure of any
information. Keep your notebook as a handy reference for at least the first year after your surgery.
Using the notebook
Instructions for Patients
• Read Sections 1 and 2 for general information.
• Use Section 3 as a checklist in preparing for your surgery.
• Read Sections 4, 5 and 6 for surgical and post-op information.
page 8 | orthopedic and neurological services | www.msha.com
“JOINT CAMP”
Many of our patients have referred to The Joint Replacement Center as “Joint Camp.”
“Joint Camp” is unique. It is a dedicated center located on the 6th floor at Indian Path Medical
Center. Patients are returning home in three to four days after having surgery.
Features of the “Joint Camp” program include:
• Orthopedic-certified nurses and
therapists who specialize in the care of
joint patients
• Private rooms
• Group therapy and education activities
as well as individual care
• Family and friends are educated to
participate as “coaches” / VIPs (Very
Important Partners) in your recovery
process
• A comprehensive patient guide for
you to follow from pre-op through
discharge from the hospital and beyond
• Public education seminars about knee
and hip pain
www.msha.com | orthopedic and neurological services | page 9
We are glad you have chosen The Joint Replacement Center to care for your knee surgery.
Patients have asked many questions about total knee replacements. Below is a list of
the most frequently asked questions along with their answers. This notebook provides
additional information. If there are any other questions that you need answered, please
ask your surgeon or the Joint Program Coordinator, DeDe Hope. We want you to be
completely informed about this procedure.
What is arthritis and why does my knee hurt?
In the knee joint there is a layer of smooth cartilage on the
lower end of the femur (thighbone), the upper end of the tibia
(shinbone) and the undersurface of the kneecap (patella). This
cartilage serves as a cushion and allows for smooth motion of
the knee. Arthritis is a wearing away of this smooth cartilage.
Eventually it wears down to bone. Rubbing of bone against
bone causes discomfort, swelling and stiffness.
BEFORE:
Raw bone rubbing
on raw bone.
What is a total knee replacement?
A total knee replacement is really a cartilage replacement
with an artificial surface. The knee itself is not replaced, as is
commonly thought, but rather an artificial substitute for the
cartilage is inserted on the end of the bones. This is done with
a metal alloy on the femur and plastic spacer on the tibia and
kneecap (patella). This creates a new smooth cushion and a
functioning joint that does not hurt.
AFTER:
A new surface creates a
smooth-functioning joint.
page 10 | orthopedic and neurological services | www.msha.com
What are the results of total knee replacement?
Ninety percent to 95 percent of patients achieve
good to excellent results with relief of discomfort
and significantly increased activity and mobility.
Should I exercise before the surgery?
Absolutely. You should follow the exercises listed
in this notebook. These will be reviewed with you
during your scheduled pre-op education class.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you are a
candidate for the surgery. This will be based on your
history, exam, X-rays and response to conservative
treatment. The decision will then be yours.
Will I need blood?
You may need blood after the surgery. Bank blood
is considered safe, but we understand if you want to
use your own. For more information read “What
I Need to Know About Blood Transfusions” in the
notebook appendix.
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,
active life. You may be asked to see your personal
physician for his/her opinion about your general
health and readiness for surgery.
How long will my new knee last and can a second
replacement be done?
We expect most knees to last more than 10-15 years.
However, there is no guarantee, and 10 percent
to 15 percent may not last that long. A second
replacement may be necessary.
Why do they fail?
The most common reason for failure is loosening of
the artificial surface from the bone. Wearing of the
plastic spacer may also result in the need for a new
spacer.
What are the major risks?
Most surgeries go well, without any complications.
Infection and blood clots are two serious
complications that concern us the most. 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
chances of this happening in your lifetime are 1
percent or less.
How do I donate my own blood?
If you wish to donate blood for yourself, contact
your physician to see if you meet the requirements
for donating your own blood. Your physician’s
office will make arrangements for you if you meet
the requirements.
How long will I be incapacitated?
You will probably stay in bed the day of your
surgery. However, the next morning you will get up,
sit in a chair or recliner and will be walking with a
walker or crutches later that day.
How long will I be in the hospital?
Most knee patients will be hospitalized for three
days after their surgery. There are several goals that
you must achieve before you can be discharged.
What if I live alone?
Two options are usually available to you. You may
either stay at a sub-acute (skilled nursing) facility
following your hospital stay, or a home health nurse
and a home physical or occupational therapist may
assist you at home.
www.msha.com | orthopedic and neurological services | page 11
How do I make arrangements for surgery?
Your surgeon’s office has scheduled you for
your surgery and your pre-admission testing
(PAT). They have also given you a schedule of
dates available to attend a preoperative
education class. You may choose whichever
date is most convenient for you to attend this
class; however, we do recommend you attend a
class at least three to four weeks prior to your surgery.
The classes are held at IPMC in the Tenasi classroom
(main entrance 1st floor). If you have questions, you
may call DeDe Hope, the Joint Program Coordinator,
at 423-857-7699.
How long does the surgery take?
We reserve approximately one and a half to
two hours for surgery. Some of this time is taken by the
operating room staff to prepare you for the surgery.
Do I need to be put to sleep for this surgery?
You may have a general anesthetic, which most people
call “being put to sleep” or a regional anesthetic. The
choice is between you and the anesthesiologist. You
will discuss this with your anesthesiologist prior to
your surgery. For more information read “Basics of
Anesthesia” in your notebook appendix.
Will the surgery be painful?
You will have discomfort following the surgery, but we
will keep you comfortable with appropriate medication.
Generally most patients are able to stop very strong
medication within one day. You may receive pain
medication by a special pump (PCA) that delivers the
drug directly into your IV, and you may have a nerve
block.
Who will be performing the surgery?
Your orthopedic surgeon will do the surgery. An
assistant often helps during the surgery.
How long and where will my scar be?
The scar will be approximately six inches long. It will be
straight down the center of your knee unless you have
previous scars, in which case we may use the prior scar.
There may be some numbness around the scar. This will
not cause any problems.
page 12 | orthopedic and neurological services | www.msha.com
Will I need a private nurse?
No. You do not need a private nurse, but if you
want one, we can provide a list of agencies for you.
Will I need a walker, crutches or a cane?
Yes. For about six weeks we do recommend that you
use a walker, a cane or crutches. The case manager
can arrange for them if necessary.
Where will I go after discharge from the hospital?
Most patients are able to go home directly after
discharge. Some may transfer to a sub-acute facility.
Stays there are from three to five days. Your case
manager will help you with this decision and make
the necessary arrangements. You should check with
your insurance company to see if you have subacute rehab benefits.
Will I need help at home?
Yes. The first several days or weeks, depending on
your progress, you will need someone to assist you
with meal preparation, etc. Family or friends need
to be available to help if possible.
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 put on the bed and single-portion
frozen meals will reduce the need for extra help.
Home health nursing and therapy will be arranged
if ordered by your physician.
Will I need physical therapy when I go home?
Yes. You will have either outpatient or in-home
physical therapy. Patients are encouraged to utilize
outpatient physical therapy. The case manager will
help you arrange for an outpatient physical therapy
appointment. If you need home physical therapy,
we will arrange for a physical therapist to provide
therapy at your home. Following this, you may go
to an outpatient facility up to three times a week
to assist in your rehabilitation. The length of time
required for this type of therapy varies with each
patient.
When will I be able to get back to work?
You will need to discuss this with your orthopedic
surgeon. Getting “back to normal” will depend on
your progress, and if your job is quite sedentary or
not. An therapist can make recommendations for
joint protection and energy conservation on the job
when you do return to work.
How long until I can drive and get back to
normal?
Do not drive until you return to your surgeon for
your first post-op office visit. Your surgeon will
instruct you on when you are cleared to drive. The
ability to drive depends on whether surgery was on
your right leg or your left leg, and the type of car
you have. If the surgery was on your left leg and
you have an automatic transmission, you could
be driving at two weeks. If the surgery was on
your right leg, your driving could be restricted as
long as six weeks. Getting “back to normal” will
depend somewhat on your progress. You will not
be able to drive while you are taking narcotic pain
medications.
When can I have sexual intercourse?
The time to resume sexual intercourse should be
discussed with your orthopedic surgeon.
How often will I need to be seen by my doctor
following the surgery?
Seven to 10 days after discharge, you will be
seen for your first postoperative office visit. This
appointment will be scheduled for you before you
are discharged from the hospital. The frequency
of follow-up visits will depend on your progress.
Many patients are seen at six weeks, 12 weeks and
then yearly.
Do you recommend any restrictions following
this surgery?
Yes. High-impact activities, such as running,
singles tennis and basketball are not recommended.
Injury-prone sports such as downhill skiing are also
dangerous for the new joint.
www.msha.com | orthopedic and neurological services | page 13
What physical/recreational activities may I
participate in after my recovery?
You are encouraged to participate in low-impact
activities such as walking, dancing, golf, hiking,
swimming, bowling and gardening.
Will I notice anything different about my knee?
Yes. You may have a small area of numbness to the
outside of the scar that may last a year or more and is
not serious. Kneeling may be uncomfortable for a year
or more. Some patients notice some clicking when
they move their knee. This is the result of the artificial
surfaces coming together and is not serious.
page 14 | orthopedic and neurological services | www.msha.com
Pre-Op Check List
The Total Joint Care Team
The Total Joint Care team will be responsible for your care needs from the
preoperative course through discharge and post-discharge follow-up.
The Total Joint Care Team will:
• Obtain medical history.
• Assess your needs at home including caregiver availability.
• Coordinate your discharge plan to outpatient services, home or a sub-acute facility.
• Assist you in getting answers to insurance questions.
• Answer questions and coordinate your hospital care.
You may call DeDe Hope, the Joint Program Coordinator, before or after surgery to ask any questions or raise
concerns about your surgery at 423-857-7699. Please leave a message and your call will be returned as soon as
possible.
Pre-Admission Testing (PAT)
When you are scheduled for surgery, your physician’s office also schedules you for pre-admission testing (PAT).
Please see the first page of this notebook for date and time. Follow the instructions given to you at your
physician’s office, and report to the Outpatient Department at Indian Path Medical Center at the appropriate
time. (See “Your Guide to Indian Path Medical Center” in appendix for location). When you report for preadmission testing, you will be asked for the following information in order to pre-register you for surgery:
• Patient’s full legal name and address, including county
• Home phone number
• Bring your current insurance card and driver’s license or photo ID
• Patient’s employer, address, phone number and occupation
• Emergency contact information (name, address and phone number)
• Current medication list (bottles preferable) for accuracy
Pre-Admission Testing will include:
• Obtain medical history
• Assess & plan for your specific care needs such as anesthesia and medical clearance for surgery
• Complete testing: labwork, EKG and chest X-ray
page 16 | orthopedic and neurological services | www.msha.com
Billing for Services
After your procedure, you will receive separate bills from the surgeon, anesthesiologist and the hospital.
Start Preoperative Exercises
Many patients with arthritis favor their joints and thus become weaker. This interferes with their recovery. It is
important that you begin an exercise program before surgery.
Attend Preoperative Class
A special class is held once a month (on Thursday
afternoons from 2-3:30 p.m.) for patients scheduled
for joint replacement surgery. Your surgeon’s
office has given you a schedule of when this class
is offered. You will only need to attend one class.
Select a date that is convenient for you to attend
and arrive at IPMC’s Tenasi room (main entrance)
15 minutes prior to class to complete required
paperwork. No registration is required. We do
recommend you try to attend a class at least three
to four weeks prior to your surgery. DeDe Hope,
the Joint Program Coordinator, is available for
one-on-one sessions if there are conflicts with the
scheduling. Please call DeDe at 423-857-7699 if a
one-on-one session is needed.
We recommend that you bring your “coach.” The coach’s role will be explained in class.
Pre-op Class Information Includes:
• Pre-Admission Testing (PAT)
• What to Expect Each Day You’re in the Hospital
• Pain Control
• Drains
• Signs and Symptoms of Infection and DVT
• Physical and Occupational Therapy
• Introduction to Equipment and Assistive Devices
• Hip and Knee Precautions
• Role of Your “Coach” / Caregiver
• Discharge Planning
• Questions and Answers
www.msha.com | orthopedic and neurological services | page 17
Review “Patient Bill of Rights”
(see Appendix)
You have the right to make decisions about your medical care. You have to be informed
of treatment and consent to be treated. You can refuse or have taken away any medical
treatment, with very limited exceptions. If you have advance directives, please bring
copies to the hospital on the day of surgery.
Donating Your Blood
If you wish to donate your own blood, contact your surgeon’s office.
Read “Basics of Anesthesia”
(see Appendix)
Total joint surgery does require the use of either general anesthesia or regional anesthesia. Please review “Basics
of Anesthesia” (see appendix) provided by our anesthesia department. You will discuss this with the anesthesiologist at the time of your pre-admission appointment.
Preoperative Visit to Surgeon
You may have an appointment in your surgeon’s office the week before your surgery. (Refer to first page of notebook for date and time). This will serve as a final checkup and a time to ask any questions that you might have.
Arrival Time at Hospital
When you have your pre-admission testing done,
you will be instructed on what time to arrive at
the hospital the morning of your surgery. You will
get a reminder phone call from the pre-admission
testing staff (423-857-7490). You will be asked to
come to the hospital two hours before the scheduled
surgery time to give the nursing staff sufficient time
to prepare you for surgery. It is important that you
arrive on time to the hospital because sometimes
the surgical time is moved up at the last minute and
your surgery could start earlier. If you are late, it
may create a significant problem with starting your
surgery on time. In some cases lateness could result
in moving your surgery to a much later time.
page 18 | orthopedic and neurological services | www.msha.com
Parking
Parking is available in visitor lots for free.
Prepare Your Home for Your
Return from the Hospital
Have your house ready for your arrival back home. Clean. Do
the laundry and put it away. Put clean linens on the bed. Prepare
meals and freeze them in single-serving containers. Cut the grass,
tend to the garden and other yard work. Pick up throw rugs and
tack down loose carpeting. Remove electrical cords and other
obstructions from walkways. Install nightlights in bathrooms,
bedrooms and hallways. Arrange to have someone collect your
mail and take care of pets or loved ones, if necessary.
The Night Before Surgery
Do Not Eat or Drink
Do not eat or drink anything after midnight, EVEN WATER,
unless otherwise instructed to do so. No chewing gum. Please
do not smoke 24 hours prior to your surgery.
Infection Prevention
Please do not shave the operative leg three days prior to surgery.
The night before or the morning of surgery, wash the operative
leg with an antibacterial soap.
NOTE: If your procedure is in the warmer months, please be
cautious of bug bites. Any open area on the operative site could
result in surgery cancellation.
www.msha.com | orthopedic and neurological services | page 19
Special Instructions
What to Bring to the Hospital
Follow specific instructions given to you at your
physician’s office and at your pre-admission testing
regarding medications.
Personal hygiene items (toothbrush, powder, deodorant, etc.), comfortable clothes, and well-fitted,
slip-resistant shoes.
You must bring the following to the hospital:
• Your patient notebook.
• A copy of your Advance Directives.
• Your insurance card, driver’s license or photo
ID and any co-payment required by your
insurance company.
NOTE:
• Please leave jewelry, valuables and large
amounts of money at home.
• Makeup must be removed before your procedure.
• Nail polish must be removed.
page 20 | orthopedic and neurological services | www.msha.com
Preoperative
Exercises, Goals
and Activity Guidelines
Activity Guidelines
Exercising Before Surgery
It is important to be as fit as possible before undergoing a total knee replacement. This will make your recovery
much faster. Eleven exercises are shown here that you should start doing now and continue until your surgery.
You should be able to do them in 15-20 minutes, and it is recommended that you do all of them twice a day. It
is not harmful for you to do more. Consider this a minimum amount of exercise prior to your surgery. You can
document this on your exercise chart in your clinical diary section.
Also, remember that you need to strengthen your entire body, not just your leg. It is very important that you
strengthen your arms by doing chair push-ups (exercise #8), because you will be relying on your arms to help
you get in and out of bed, in and out of a chair, walk, and to do your exercises postoperatively.
Stop doing any exercise that is too painful.
Pre-op Knee Exercises
See the following pages for descriptions:
1.
Ankle pumps20 reps2 times/day
2.
Quad sets (knee push-downs)
20 reps 2 times/day
3.
Gluteal sets (butt squeezes)
20 reps 2 times/day
4.
Abduction and adduction
(slide heel out and in)
20 reps 2 times/day
5.
Heel slides
(slide heel up and down)
20 reps 2 times/day
6.
Short arc quads
20 reps 2 times/day
7.
Long arc quads20 reps2 times/day
8.
Arm chair push-ups
20 reps 2 times/day
9.
Seated hamstring stretch
5 reps
2 times/day
10.
Straight leg raises
20 reps 2 times/day
11.
Knee extension stretch
20 minutes 2 times/day
page 22 | orthopedic and neurological services | www.msha.com
Exercise #1
Ankle Pumps
Move ankle up and down.
Repeat 20 times
Exercise #2
Quad Sets - Knee Push-Downs
Lie on back, press knee into mat,
tightening muscle on front of thigh.
Do NOT hold breath.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 23
Exercise #3
Gluteal Sets - Butt Squeezes
Squeeze bottom together. Do NOT hold breath.
Repeat 20 times.
page 24 | orthopedic and neurological services | www.msha.com
Exercise #4
Hip Abduction and Adduction
(Slide Heels Out and In)
Lie on back, slide legs out to side.
Keep toes pointed up and knees straight.
Bring legs back to starting point.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 25
Exercise #5
Heel Slides (Slide Heels Up and Down)
Lie on couch or bed. Slide heel toward your bottom.
Repeat 20 times.
Exercise #6
Short Arc Quads
Lie on back, towel roll under thigh.
Lift foot, straightening knee.
Do NOT raise thigh off roll.
Repeat 20 times.
page 26 | orthopedic and neurological services | www.msha.com
Exercise #7
Long Arc Quads
Sit with back against chair.
Straighten knee.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 27
Exercise #8
Arm Chair Push-ups
This exercise will help strengthen your arms for walking
with crutches or a walker. Sit in an armchair.
Place hands on armrests. Straighten arms,
raising bottom up off chair seat if possible.
Repeat 20 times.
page 28 | orthopedic and neurological services | www.msha.com
Exercise #9
Seated Hamstring Stretch
Sit on couch or bed with leg extended.
Lean forward and pull ankle up.
Stretch until pull is felt.
Hold for 20-30 seconds.
Relax.
Repeat 5 times.
Exercise #10
Straight Leg Raises
Lie on back, unaffected knee bent and foot flat.
Lift opposite leg up 12 inches.
Keep knee straight and toes pointed up.
Relax. Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 29
Exercise #11
Extension Stretch
Prop foot of operated leg up on chair. Place towel roll under ankle, and ice pack over knee.
Put 5-10 lb. of weight on top of knee (a 5-10 lb. bag of potatoes or rice works well).
Be sure your back is supported.
Do for 20 minutes.
This is a preoperative exercise to help extend operative leg with the
goal of zero-degree extension.
page 30 | orthopedic and neurological services | www.msha.com
Hospital Care
Day of Surgery
What to Do
Arrive at Indian Path Medical Center. You will be given
specific directions by the preadmission nurse including
arrival time and location.
What to Expect During the Surgical Experience
Upon arrival, you will be prepared for surgery in your
room. A health history will be obtained and the nurse
will cleanse the operative site. At the appropriate time
you will be escorted to the surgery holding area where
you will meet the surgical team. Following surgery you
will be taken to a recovery area where you will remain
for one to two hours. During this time, pain control
will be established, your vital signs will be monitored
and an X-ray will be taken of your new joint.
The surgeon will talk with your family or “coach”
when your surgery is completed to let them know
how the surgery went. You will return to your room
where a total joint nurse will care for you. Most of the
discomfort occurs the first 24 hours following surgery.
During this time, you will be receiving pain medication
through your IV (PCA). You will probably remain in
bed the first day. It is very important that you begin
ankle pumps on this first day. This will help prevent
blood clots from forming in your legs. You should also
begin using your Incentive Spirometer and doing the
deep breathing exercises that you learned in class. Each
day you will receive “KneeKnotes,” a daily newsletter
outlining the day’s activities.
Your physical therapist will set you up on your CPM
(continuous passive motion) machine in the recovery
room or in the afternoon when you have returned to
your room. Your operated leg will be placed in the
CPM machine twice a day (5 a.m. and 5 p.m.) for two
hours. Again, our goal is to get your knee bending to
90 degrees.
page 32 | orthopedic and neurological services | www.msha.com
Post-Surgery
Day 1 – After Surgery
On day one after surgery you will be helped out
of bed early by physical therapy and assisted to
a chair. You will be seated in a recliner in your
room. Your surgeon or physician’s assistant will
visit you. The physical therapist will assess your
progress and get you walking with a walker. IV
pain medication will be tapered and you will
begin oral medication. Remember to ask for your
pain pills.
The physical therapist will begin your exercises
with individual therapy sessions twice a day.
As the week progresses and you are able to
participate, the therapist may encourage group
therapy. Our case manager will visit with you to
discuss your needs for discharge from the hospital
and begin making any necessary arrangements
you will need.
Day 2 – After Surgery
On day two after surgery you will be helped out
of bed early and will walk with a therapist.
Day 3/4 – Discharge Day
Day three is similar to day two in the morning
and you will walk on stairs. You will be discharged
in the afternoon. This will occur after the
afternoon therapy session. Discharge teaching
will be done by nursing and physical therapy.
If You are Going Directly Home
Someone responsible needs to drive you. You will
receive written discharge instructions concerning
medications, physical therapy, activity, etc.
Arrangements for equipment will have been done
by Case Management.
If You are Going to a Sub-Acute Rehab (Skilled
Nursing) Facility
The decision to go home or to sub-acute rehab
will be made collectively by you, the case
manager, your surgeon, your physical therapist
and your insurance company. Every attempt will
be made to have this decision finalized in advance
but may be delayed until the day of discharge.
We will help you arrange for transportation.
Transfer papers will be completed by nursing
staff. Either your primary care physician or
one of our hospitalists will be caring for you in
consultation with your surgeon. Expect to stay
for approximately one week, based upon your
progress. Upon discharge home, instructions will
be given to you by the sub-acute rehab staff.
Please remember that sub-acute stays must be
approved by your insurance company. A patient’s
stay in a sub-acute rehab facility must be done
in accordance with guidelines established by
Medicare/private insurance. Although you may
desire to go to sub-acute when you are discharged,
your progress will be monitored by your insurance
company while you are in the hospital. Upon
evaluation of your progress, you will either meet
the criteria to benefit from sub-acute rehab or
your insurance company may recommend that
you return home with other care arrangements.
Therefore, it is important for you to make
alternative plans preoperatively for care at home.
In the event sub-acute rehab is not approved by
your insurance company, you can always go to
sub-acute rehab and pay privately.
Please keep in mind that the majority of our patients do well and don’t meet
the guidelines to qualify for sub-acute rehab. Also keep in mind that insurance
companies do not become involved in “social issues,” such as lack of caregiver,
animals, etc. These are issues you will have to address before admission.
www.msha.com | orthopedic and neurological services | page 33
Pain Control
Pain control during and after surgery is one of
the most common concerns of joint replacement
patients. With today’s pain management techniques
you should be kept comfortable.
Anesthesia During Surgery
Anesthesia is the loss of sensitivity to pain brought
about by various drugs known as anesthetics.
There are several types to choose from. Your
anesthesiologist will discuss the one best suited for
you.
• General anesthesia was the most common
form of anesthesiology for many years. The
patient is put into a deep sleep and will not
feel any sensation.
• Spinal or epidural anesthesia targets a specific
area, like a joint, and totally numbs it.
Although you are awake, you do not feel pain.
Typically with spinal or epidural anesthesia
another medication is administered to make
you very relaxed and enter a light sleep state.
As with general anesthesia, you will not
remember the surgery.
Post-Op Pain Control
There are several different types of pain control
methods available that will keep you comfortable
and allow you to be up and walking shortly after
surgery. Your doctor will choose the method right
for you based upon your medical history, the
amount of pain you are having and your phase of
recovery.
• Oral medications are often used to control
pain. These may be administered prior to
surgery to get a start on pain control and may
be continued throughout your hospital stay.
Most likely you will be given a prescription for
oral medication to use after discharge.
• A nerve block is sometimes an effective
method of pain control used for total knee
replacement. Basically, a local anesthetic is
injected into or near the femoral nerve in the
thigh. Nerve blocks prevent the pain signals
from reaching the brain. Consequently you
feel no pain.
• Pain medications can be given intravenously
through a vein in the arm. The IV method
can be used with a PCA pump. The pump
can be regulated to provide a continuous
supply of pain medication. If you begin to feel
uncomfortable, simply press the button on the
pump and it will deliver a booster dose of pain
medication. The pump has safety features to
ensure that the correct dosing is delivered with
no threat of overdosing. After you push the
button, simply relax and your discomfort will
be gone shortly.
• Other types of pain pumps can be used to
deliver an anesthetic agent directly into the
joint. Like the PCA, you can control the dosage.
It is important for you to tell your healthcare team
if the pain medication is not sufficient, if you feel
nauseous or if you are not as alert as you feel you
should be. Adjustments can be made.
Prevent the Pain Cycle
Pain has a cycle. It begins and increases until
medication interrupts it. The aim of good pain
control is to stop pain before it becomes intolerable.
If you begin to feel the pain increasing, activate the
PCA, or if you are not on a PCA, call the nurse and
request medication. This is one time that you do not
want to tough it out. If the pain cycle takes hold, it
will be harder to control.
Pain Scale
You will be asked to use a pain scale to help describe
your pain level. If “0” means no pain and “10” is
the worst pain possible, how would you rate the
pain level? To relieve your pain most effectively, your
healthcare team needs to know how well pain relief
measures are working for you. Medications can be
adjusted to meet your needs.
Other Methods to Decrease Pain
It is most important to try to relax after your
surgical procedure. When you are relaxed, pain
medications work better. You can also position
yourself for comfort and ease of breathing. Applying
ice to the area for 15-minute intervals may help.
CAUTION! If you have a nerve block for pain control DO NOT GET UP ALONE!
page 34 | orthopedic and neurological services | www.msha.com
Post-Op Care
Caring for Yourself at Home
When you go home there are a variety of things you need to know for your safety,
your speedy recovery and your comfort.
Control Your Discomfort
• Take your pain medicine at least 30 minutes
before physical therapy.
• Gradually wean yourself from prescription
medication to Tylenol. You may take two
extra-strength Tylenol in place of your prescription medication up to four times per day.
• Change your position every 45 minutes
throughout the day.
• Use ice for pain control. Applying ice to your
affected joint will decrease discomfort, but
do not use more than 20 minutes at a time
each hour. You can use it before and after
your exercise program. A bag of frozen peas
wrapped in a kitchen towel makes an ideal ice
pack. Mark the bag of peas and return it to
the freezer (to be used as an ice pack later).
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. Don’t sleep or nap too much during the
day.
• Your energy level will be decreased for the first
month.
• Pain medication that contains narcotics
promotes constipation. Use stool softeners or
laxatives such as milk of magnesia if necessary.
Lovenox
Lovenox is a medication that you may be given to
prevent a blood clot in your blood vessels. Your
physician will prescribe your exact dose. It is given
as a subcutaneous injection. You will be instructed
on self-administration and possible side effects prior
to your discharge from the hospital.
Stockings (TEDS)
You will be asked to wear special white stockings.
These stockings are used to help compress the veins
in your legs. This helps to keep swelling down and
reduces the chance for blood clots.
• If swelling in the operative leg is bothersome,
elevate the leg for short periods throughout
the day. It’s best to lie down and raise the leg
above heart level.
• Wear the stockings continuously, removing for
one to two hours twice a day.
• Notify your physician if you notice increased
pain or swelling in either leg.
• Ask your surgeon when you can discontinue
stockings. Usually, this will be done three
weeks after surgery.
page 36 | orthopedic and neurological services | www.msha.com
Caring for Your Incision
• Keep your incision dry.
• Keep your incision covered with a light, dry dressing until you do not have any drainage.
• You may shower 24-48 hours after surgery, unless instructed otherwise. After showering, apply a dry dressing if incision is still draining.
• Notify your surgeon if there is increased drainage, redness, pain, odor or heat around the incision.
• Take your temperature if you feel warm or sick. Call your surgeon if it exceeds 101.5° F for more than 24
hours.
Follow specific incision care instructions if given by your surgeon.
Infection
Signs of Infection
• Increased swelling, redness at incision site
• Change in color, amount, odor of drainage
• Increased pain in knee
• Fever greater than 101˚ F
Prevention of Infection
• Take proper care of your incision as explained.
• Take prophylactic antibiotics when having dental work or other potentially contaminating procedures.
This needs to be done for at least two years after your surgery.
• Notify your physician and dentist that you have a total joint replacement.
Recognizing & Preventing Potential Complications
Blood Clots in Legs
Surgery may cause the blood to slow and coagulate in the veins of your legs, creating a blood
clot. This is why you take blood thinners after surgery. 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 pulmonary embolus.
www.msha.com | orthopedic and neurological services | page 37
Pulmonary Embolus
An unrecognized blood clot could break away from the vein and travel to the lungs. This is an
emergency and you should CALL 911 if suspected.
Signs of a Pulmonary Embolus
• Sudden chest pain
• Difficult and/or rapid breathing
• Shortness of breath
• Sweating
• Confusion
Prevention of Pulmonary Embolus
• Prevent blood clot in legs
• Recognize a blood clot in leg and call physician promptly
page 38 | orthopedic and neurological services | www.msha.com
Postoperative
Exercises & Goals
Activity Guidelines
Exercising is important to obtain the best results
from total knee surgery. You may receive exercises
from a physical therapist at an outpatient facility or
at home. In either case you need to participate in
an ongoing home exercise program as well. After
each therapy session, ask your therapist to instruct
you on home exercises to do on non-outpatient
therapy days.
On the following pages there are home exercises
that are essential for a complete recovery from your
surgery. Exercising should take approximately 20
minutes and should be done twice daily. If you are
recovering quickly, it is recommended that you
supplement these exercises with others that your
therapist recommends.
Exercise #1
Ankle Pumps
Move ankle up and down.
Repeat 20 times
page 40 | orthopedic and neurological services | www.msha.com
Exercise #2
Quad Sets – Knee Push-Downs
Lie on back, press knee into mat,
tightening muscle on front of thigh.
Do NOT hold breath.
Repeat 20 times.
Exercise #3
Gluteal Sets - Butt Squeezes
Squeeze bottom together. Do NOT hold breath.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 41
Exercise #4
Hip Abduction and Adduction
(Slide Heels Out and In)
Lie on back, slide legs out to side.
Keep toes pointed up and knees straight.
Bring legs back to starting point.
Repeat 20 times.
Exercise #5
Heel Slides (Slide Heels Up and Down)
Lie on couch or bed. Slide heel toward your bottom.
Repeat 20 times.
page 42 | orthopedic and neurological services | www.msha.com
Exercise #6
Short Arc Quads
Lie on back, towel roll under thigh.
Lift foot, straightening knee.
Do NOT raise thigh off roll.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 43
Exercise #7
Straight Leg Raises
Lie on back, unaffected knee bent and foot flat.
Tighten muscles around knee on your surgical leg and lift up 12 inches.
Keep knee straight and toes pointed up.
Lower down slowly.
Relax.
Repeat 20 times.
page 44 | orthopedic and neurological services | www.msha.com
Exercise #8
Seated Knee Flexion
Sitting on straight-back chair, cross legs with affected leg on bottom.
Slide feet underneath chair.
Keep hips on chair. Try to gently stretch and bend knee as far as possible.
Plant foot and move bottom forward on chair.
Repeat 20 times.
www.msha.com | orthopedic and neurological services | page 45
Exercise #9
Extension Stretch
Prop foot of operated leg up on chair.
Place towel roll under ankle and ice pack over knee.
Put 5-10 lb. of weight on top of knee
(a 5-10 lb. bag of potatoes or rice works well).
Do for 5-10 minutes 4 to 5 times a day.
There are more advanced exercises that may be added to your continued rehab program.
These may be done standing, lying on your stomach or lying on your side. These will be
determined by your therapist and added to your program if indicated.
page 46 | orthopedic and neurological services | www.msha.com
Activities of Daily Living,
Precautions
and
Home Safety Tips
Precautions and Home Safety Tips
Lying in Bed – Keep Knee Straight
DO NOT put a pillow under your knee.
Knee should be kept as straight as possible.
Place a small pillow under your ankle to assist in straightening.
Transfer - Into Bed
When getting into bed:
1. Back up to the bed until you feel it on the back of
your legs (you need to be midway between the foot
and the head of the bed).
2. Reaching back with both hands, sit down on the edge
of the bed and then scoot back toward the center of
the mattress.
3. Move your walker out of the way, but keep it within
reach.
4. Scoot your hips around so that you are facing the foot
of the bed.
5. Lift your leg into the bed while scooting around (if
this is your operated leg, you may use a cane, a rolled
bed sheet, a belt, or your theraband to assist with lifting that leg into bed).
6. Keep scooting and lift your other leg into the bed.
7. Scoot your hips toward the center of the bed.
page 48 | orthopedic and neurological services | www.msha.com
Transfer - Out of Bed
When getting out of bed:
1. Scoot your hips to the edge of the bed.
2. Sit up while lowering your unoperated leg to the
floor.
3. If necessary, use a leg-lifter to lower your operated leg
to the floor.
4. Scoot to the edge of the bed.
5. Use both hands to push off the bed. If the bed is too
low, place one hand in the center of the walker while
pushing up off the bed with the other.
6. Balance yourself before grabbing for the walker.
Transfer - Tub
Getting into the tub using a bath seat:
1. Place the bath seat in the tub facing the faucets.
2. Back up to the tub until you can feel it at the back
of your knees. Be sure you are in front of the bath
seat.
3. Reach back with one hand for the bath seat. Keep
the other hand in the center of the walker.
4. Slowly lower yourself onto the bath seat, keeping
the operated leg out straight.
5. Move the walker out of the way, but keep it within
reach.
6. Lift your legs over the edge of the tub, using a leg
lifter for the operated leg, if necessary.
Getting out of the tub using a bath seat:
1. Lift your legs over the outside of the tub.
2. Scoot 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 by pushing down on walker - DO
NOT PULL UP ON WALKER
NOTE: Although bath seats, grab bars, long-handled bath brushes and hand-held showers make bathing easier
and safer, they are typically not covered by insurance.
NOTE: ALWAYS use a rubber mat or non-skid adhesive on the bottom of the tub or shower. Wet, bare feet are
slippery. Place non-skid bath rug on floor next to bathtub.
NOTE: To keep soap within easy reach, make a soap-on-a-rope by placing a bar of soap in the toe of an old pair
of pantyhose and attach it to the bath seat.
www.msha.com | orthopedic and neurological services | page 49
Transfer - Car
1. Push the car seat all the way back; recline it if possible, but
return it to the upright position for traveling.
2. Place a plastic trash bag on the seat of the car to help you
slide and turn frontward.
3. Back up to the car until you feel it touch the back of your
legs.
4. Reach back for the car seat and lower yourself down. Keep
your operated leg straight out in front of you and duck your
head so that you don’t hit it on the doorframe.
5. Turn frontward, leaning back as you lift the operated leg
into the car.
Walker Ambulation
Walking
1. Move the walker forward.
2. With all four walker legs firmly on the ground, step forward with
operated leg. Place the foot in the middle of the walker area. Do
not move it past the front feet of the walker.
3. Step forward with the unoperated leg.
NOTE: Take small steps. Do NOT take a step until all four walker
legs are flat on the floor.
Stair Climbing
4. Ascend with unoperated leg first (“Up with the good.”)
5. Descend with the operated leg first (“Down with the bad.”)
page 50 | orthopedic and neurological services | www.msha.com
Around the House
Saving energy and protecting your joints
Kitchen
• DO NOT get down on your knees to scrub
floors. Use a mop and long handled brushes.
• Plan ahead! Gather all your cooking supplies
at one time. Then sit to prepare your meal.
• Place frequently used cooking supplies and
utensils where they can be reached without
too much bending or stretching.
• To provide a better working height, use a high
stool, or put cushions on your chair when
preparing meals.
• Slide heavy cookware along countertops, using
a towel or pot-holder to decrease risk of dropping or spilling.
Bathroom
• DO NOT get down on your knees to scrub
bathtub. Use a mop or other long handled
brushes.
Safety and Avoiding Falls
• Pick up throw rugs and tack down loose
carpeting. Cover slippery surfaces with carpets
that are firmly anchored to the floor or that
have non-skid backs.
• Be aware of all floor hazards such as pets,
small objects, electrical cords or uneven surfaces.
• Provide good lighting throughout. Install
nightlights in the bathrooms, bedrooms and
hallways.
• Keep extension cords and telephone cords out
of pathways. DO NOT run wires under rugs;
this is a fire hazard.
• Sit in chairs with arms. It makes it easier to
get up.
• Rise slowly from either a sitting or lying position so as not to get light-headed.
• DO NOT lift heavy objects for the first three
months, and then only with your surgeon’s
permission.
• Stop and think. Use good judgment.
• DO NOT wear open-toe slippers or shoes
without backs. They do not provide adequate
support and can lead to slips and falls.
Dos and Don’ts For the Rest of Your Life
Whether you have reached all the recommended goals in three months or not, all joint patients
need to have a regular exercise program to maintain fitness and the health of the muscles around
your joints. With both your orthopedic and primary care physicians’ permission you should
be on a regular exercise program three to four times per week lasting 20 – 30 minutes. Impact
activities such as running and singles tennis may put too much load on the joint and are not recommended. High-risk activities such as downhill skiing are likewise discouraged because of the
risk of fractures around the prosthesis. Infections are always a potential problem and you may
need antibiotics for prevention.
www.msha.com | orthopedic and neurological services | page 51
What to Do in General
• Take antibiotics one hour before you are having dental work or other invasive procedures for two years
after surgery.
• Although the risks are very low for post-op infections, it is important to realize that the risk remains. 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 more than 101˚ F, or suffer an injury such as a deep cut or puncture
wound, you should clean it as best you can, put a sterile dressing or Band-Aid on it and notify your 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 doctor if the area is painful or reddened.
• When traveling, stop and change position hourly to prevent your joint from tightening.
• See your surgeon yearly unless otherwise recommended.
What to Do for Exercise
Choose a Low-Impact Activity
• Recommended exercise classes
• Home program as outlined in Patient Guide
• Regular one- to three- mile walks
• Home treadmill
• Stationary bike
• Regular exercise at a fitness center
• Low-impact sports - golf, bowling, walking,
gardening, dancing, swimming, pool exercise, etc.
What Not to Do
• Do not run or engage in high-impact
activities.
• Do not participate in high-risk activities such
as downhill skiing, walking on ice, etc.
page 52 | orthopedic and neurological services | www.msha.com
Appendices
Directions to Indian Path Medical Center
Traveling from Knoxville TN
North on I-81, take Exit 57B onto Interstate 181N
to Kingsport. After 5 miles, take exit 51 (Wilcox
Drive) right onto Highway 93N (John B. Dennis
Highway). Go 6 miles. Hospital will be on left. Take
first Medical Center entrance.
Traveling from Bristol VA
South on I-81. Take exit 74 onto US-11W, TN-1
and go West for 17.6 miles. Bear right onto John B.
Dennis Highway. Proceed .2 miles. Hospital will be
on left. Take first Medical Center entrance.
page 54 | orthopedic and neurological services | www.msha.com
Local Hotel Rates
The following hotels offer discounted rates for family members of patients at IPMC. Upon registering, notify the
hotel that you have a family member in the hospital.
$62.99 + tax
Jameson Inn
3004 Bays Meadow Place
Kingsport, TN
423-230-0534
Need a special form completed by hospital staff to show at
registration. Contact Tracy Boling at extension 7274 or House
Supervisor by calling “0.”
$42.99 + tax
Ramada Inn
2005 La Masa Drive
Kingsport, TN
423-245-0271
Does not include breakfast.
Need to show something from the hospital to prove that stay
is legitimate.
Microtel Inn
1708 E. Stone Drive
Kingsport, TN
423-378-9220
Sun-Thurs $37.95 + tax
Fri-Sat $42.95 + tax
Sleep Inn
2000 Hospitality Place
Kingsport, TN
423-279-1811
$44.99 + tax
Westside Inn
1017 W. Stone Drive
Kingsport, TN
423-247-2176
$35 + tax ( 1 bed)
$39 + tax (2 beds)
Comfort Inn
Indian Center
(just below hospital)
423-378-4418
$62.99 + tax
Includes Breakfast
PLEASE NOTE THAT DISCOUNTED RATES MAY NOT BE HONORED DURING SPECIAL EVENTS WEEKENDS.
(i.e. Race Week & Story Telling Week)
www.msha.com | orthopedic and neurological services | page 55
Welcome to the Joint Replacement Center at Indian Path Medical Center
Our facility specializes in the diagnosis, treatment and care of people who have hip and knee problems. Your
team includes physicians, physician’s assistants, patient care partners, nurses, and physical and occupational
therapists specializing in total joint care. Our highly trained nurses, technicians, pharmacists and therapists are
dedicated to making your experience as pleasant and productive as possible.
2000 Brookside Drive
Kingsport, TN 37660
423-857-7000
www.msha.com
page 56 | orthopedic and neurological services | www.msha.com
Patient Bill of Rights
The facilities of Mountain States Health Alliance, including Indian Path
Medical Center and The Joint Replacement Center, support an individual’s
right to participate actively in his or her healthcare decision-making.
What is an Advance Directive?
Advance directives are documents that express your wishes if you
are very ill or unconscious. By completing an advance directive
before you are very ill, you let your doctor know what you want.
If you are already very ill, it gives your doctor a better idea of
what you want if you are going to pass away within a short time.
There are different types of Advance Directives:
What is a Living Will?
It is a legal document that allows you to state that
you want your death to be a natural death. The
form lets you say that you don’t want to be kept
alive in certain situations. Unlike a normal will, a
living will says nothing about who gets your money
when you pass away. It does allow you to avoid
certain treatments and make decisions about your
medical care.
What is a Durable Power of Attorney for
Healthcare?
It is a document used to give someone the right
to make a decision for you. A Durable Power of
Attorney for Healthcare lets you assign a person
(called a healthcare agent, attorney-in-fact or proxy)
to make healthcare decisions for you. This person
can be the next of kin, an adult child, a friend or
acquaintance. A Durable Power of Attorney for
Healthcare doesn’t allow someone to make financial
decisions for you.
At your Pre-Admission Testing (PAT) appointment
and on admission to the hospital you will be asked
if you have an Advance Directive. If you do, please
bring copies of the documents to the hospital
with you so they can become part of your medical
record. Advance Directives are not a requirement for
hospital admission.
If you would like more information or forms for
completing a Tennessee Living Will or Tennessee
Durable Power of Attorney for Healthcare, please
ask the admitting staff or your nurse.
www.msha.com | orthopedic and neurological services | page 57
What You Need to Know About Blood Transfusions
This teaching sheet is to inform you about the benefits, risks and alternatives to blood transfusion. When
your physician orders a blood transfusion, she/he should explain the reason it is needed. The benefits of blood
transfusion include maintenance of adequate oxygen levels and prevention of continued bleeding.
Source and Testing
Only blood that has been freely donated by
volunteers is used for transfusions at Indian Path
Medical Center.
The blood donor is tested for Hepatitis viruses
B and C, syphilis, the AIDS antibody and other
factors. This greatly reduces your risk of getting
these diseases from a transfusion. The blood you
will receive is cross matched (or tested) against
your own blood for compatibility. The cross match
can be done up to three days before the blood is
transfused to you.
You will have a special armband placed on your
arm when your blood is tested. Do not remove
the armband until instructed by your healthcare
provider. This armband is required to identify you
at the time you are transfused. If this armband is
removed before transfusion, another test for type
and cross match would have to be done before you
receive blood.
Receiving Blood
Your healthcare provider will check your
temperature, heart rate, blood pressure and
breathing frequently while you are receiving blood.
Each unit of blood will take 90 minutes to four
hours to be given, depending on your doctor’s
orders. You will receive an IV (intravenous)
solution containing saline with each unit of blood.
Going Home After Receiving Blood
If you are going home the same day you receive
blood, do not leave until your nurse or doctor tells
you that you are ready to leave. Someone should
drive you home in case you become ill. You may
eat or drink as usual, but should delay participating
in any potentially hazardous activities (climbing,
swimming, etc.) for at least 24 hours.
Alternatives to Blood Transfusion
If you wish to donate blood for yourself, contact your physician to see if you meet
the requirements for donating your own blood. If a family member or friend
wishes to donate blood for you, contact your physician for assistance. Blood must
be donated at least one week before you need to receive it. The donor’s group
and type must be known prior to donation of blood and it must be compatible
with your blood type. If surgery is required, you may receive your own blood
immediately during or after the procedure, depending on the kind of surgery.
Your physician will be able to explain how this is accomplished.
page 58 | orthopedic and neurological services | www.msha.com
Adverse Reactions/Side Effects - Non-Infectious
The majority of people who receive blood have NO
ADVERSE REACTIONS or SIDE EFFECTS.
Although most reactions occur during or shortly
after the blood is transfused, some reactions may
occur hours to 14 days after the transfusion. For
this reason, please contact your doctor or the
emergency department immediately for further
evaluation if you should experience any of the
following symptoms:
•
•
•
•
•
•
•
•
•
•
Fever/chills
Rash/itching
Swelling
Nausea/vomiting
Flushing
Pain in the neck or back
Coughing
Difficulty breathing
Blood in your urine
Uncontrollable bleeding at the site of needle
puncture
• Unexplained new symptoms or problems
Some mild reactions may be due to anxiety
about the transfusion.
A mild allergic reaction to blood is the most
common and is due to a reaction with the plasma
in the donor’s blood. This can usually be promptly
controlled with medication.
Rare, but severe, reactions may occur because
your blood is not compatible with the blood you
received. Almost all severe reactions occur very
shortly after beginning the transfusions.
Adverse Reactions - Infectious
Today, infectious disease transmission through
blood transfusion is extremely uncommon.
Infectious diseases transmitted by transfusion can
be Hepatitis B, Hepatitis C and HIV, which causes
AIDS. The risk of becoming infected with Hepatitis
B virus is estimated at less than 1 per 150,000 units,
and the risk of receiving an HIV- or Hepatitis Cpositive unit of blood through a blood transfusion is
estimated at 1 per 2 million units.
General Information
Please let your nurse or physician know if you have questions or concerns regarding a blood
transfusion or if you have chosen to refuse a blood transfusion.
While the blood you receive is voluntarily given, there are two charges
for processing and testing the blood:
The blood-processing fee covers the cost of collecting, testing, shipping and storing the blood. This
fee will be charged only if you receive the blood. The blood cross match fees are the laboratory
charges for cross matching (testing) your blood. These fees are charged when your doctor orders a
cross match test and are not related to whether or not you actually receive the blood.
www.msha.com | orthopedic and neurological services | page 59
Basics of Anesthesia
What types of anesthesia are available?
Decisions regarding your anesthesia are tailored to your personal needs.
Certain illnesses can potentially make one type of anesthetic better than another.
For instance, a patient with emphysema would probably do better with a spinal.
Meanwhile, a patient with a bleeding disorder or on anticoagulants cannot
have a spinal due to the risk of bleeding in the spinal canal.
The types available for you are:
GENERAL ANESTHESIA renders the patient unconscious for
the duration of surgery. The patient is typically sedated prior
to surgery and put to sleep once in the operating room and
awakened in the recovery room.
REGIONAL ANESTHESIA techniques include spinal blocks,
epidural blocks, and arm and leg blocks. Patients undergoing
spinal block are also usually sedated prior to surgery, and the
spinal is placed in the operating room. This involves sitting the
patient upright on the operating table, numbing the skin low
in the middle of the back, and with a small-diameter needle
injecting a dose of local anesthetic, which begins to work
almost immediately. Patients are then sedated for the rest of the
operation and allowed to stay in the recovery room until most of
the spinal has worn off.
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 (1-10) 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. He or she will also answer any further
questions you may have.
page 60 | orthopedic and neurological services | www.msha.com
About Lovenox
Lovenox is an anticoagulant (“anti” means against and “coagulant” refers to clotting) that is used to help prevent
the formation of blood clots in patients at risk.
Lovenox is given by injection, which can be done by you or an appropriate caregiver (your nurse will show you
or your caregiver how to do this). In the hospital you will be given Lovenox beginning the first day after surgery.
The dosage will be determined by your surgeon. When you are discharged, you will continue to take an anticoagulant. Depending upon your particular needs the surgeon will prescribe the appropriate medicine. A prescription will be given to you at the time of discharge from the hospital. Lovenox is the common medication given;
however, there are other alternatives available which your surgeon may use.
Your doctor will determine how long you will need to take this medication. DO NOT change your dose or stop
taking this medication unless instructed by your doctor.
How Lovenox Should Be Taken:
• It is important to take Lovenox at the same
time every day. If you need to, mark the
calendar as you take it to remind yourself that
you have taken it for the day.
• Take only the amount of Lovenox prescribed
for you.
• Continue the injections for exactly the number
of days specified by your doctor.
• Look at your old injection sites for the
following: redness, pain, warmth, puffiness,
discoloration of the skin or oozing, which
could be signs of infection or skin reaction.
• If you forget to take your dose, DO NOT
double your dose the next day, but take your
regularly prescribed dose.
• Lovenox should be stored at controlled room
temperature, 59˚ F to 77˚ F.
• Accidental overdose may result in severe
bleeding, which cannot be treated at home.
If you suspect that you have used too much
Lovenox, it is important to call your doctor
immediately, even if you have not observed any
unusual symptoms. Your doctor can make a
decision on proper treatment.
Special Instructions While on Lovenox:
• Brush your teeth with a soft toothbrush to
avoid scratching your gums. Inform your
dentist, dental hygienist or any other doctor
treating you that you are taking Lovenox.
• Inform the doctor if you are planning any
dental work or any surgical procedure while
you are taking Lovenox.
• Use an electric razor for shaving rather than a
straight-edge razor.
• Avoid scratching the skin, which might break
the surface or irritate it.
• Wear gloves when gardening. Be careful when
you use sharp items such as knives or power
tools.
• Always wear shoes or slippers to protect the
soles of your feet. Never trim corns, calluses,
or nails with a sharp knife or razor blade.
• To prevent falls, place a non-slip bathmat in
the tub and remove throw rugs.
• Avoid activities or contact sports that could
easily lead to injury and bleeding.
• If you are to be away from home for any length
of time (such as a vacation), inform your
doctor.
• Check with your doctor before drinking
alcoholic beverages. Alcohol may increase the
risk of stomach irritation and bleeding.
• Avoid smoking.
• Avoid use of estrogen products and oral
contraceptives. Check with your doctor for
alternative methods of birth control.
• Avoid blowing nose forcefully.
• Maintain adequate fluids.
• Keep Lovenox and all medications out of the
reach of children.
www.msha.com | orthopedic and neurological services | page 61
Xarelto® (rivaroxaban)
Xarelto is an oral coagulant used to prevent blood clots after hip or knee replacement surgery.
Xarelto is given once a day, with or without food, as directed by your doctor. You will take one 10mg
pill per day for 12 days (Total Knee), or as directed by your doctor. Do not skip a dose unless advised
by your doctor. Skipping a dose may increase your risk of a blood clot. If you do miss a dose, take the
next dose as soon as possible.
Prior to taking Xarelto, tell your doctor if you have a bleeding disorder or any problems with your
liver or kidneys.
Xarelto may cause you to bruise or bleed more easily and bleeding may take longer than usual to stop.
It may also cause wound leakage and itching.
If you have any additional questions about my procedure, Xarelto, insurance coverage or
eligibility for financial assistance ask your doctor or call 1-888-XARELTO (927-3586) or go to
www.XARELTOCarePath.com
page 62 | orthopedic and neurological services | www.msha.com
Joint Camp Notes
Knee Replacement Patient Guidebook
For more information, call our
Joint Program Coordinator:
423-857-7699
Or t h o - Neu ro Ser vic es | mountain s tate s h e a lth a l l ia nce | w w w. m s ha. com
IPMC-00028 > 01/2012