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Contents
PART I: knee Replacement
This section contains general information you will need to fill out as well as tasks to
complete prior to surgery. It also contains checklists and reminders for you.
What Is a Knee Replacement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Process at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Joint Replacement Program Orientation Session . . . . . . . . . . . . . . . . . . . . 6
Hospital Preop Clinic Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Important Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
General Hospital Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medical Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Packing for the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part II: Patient Guide to knee Replacement Surgery
This section explains the surgical process—from the day of admission to the day of discharge.
Surgery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Understanding the Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Night before Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
The Remainder of Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . 18
Physical Therapy and Occupational Therapy . . . . . . . . . . . . . . . . . . . . . . 19
Total Knee Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Physical Therapy Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Self-Care after Knee Replacement Surgery . . . . . . . . . . . . . . . . . . . . . . . 26
Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
After Discharge from the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Living with Your New Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2
Knee
Replacement
Part I
Part I:
A Joint Approach
3
WHAT IS A KNEE REPLACEMENT?
A
knee replacement is a surgical
procedure in which a knee joint
that is worn out or injured and painful is
replaced with an artificial joint. The surgery
will benefit you by reducing knee pain,
increasing leg strength, and providing easier
movement.
How long will the surgery take?
The surgery will take about two hours.
How is the knee replaced?
The orthopedic surgeon makes an incision
on the front or side of the knee, and the
damaged bone is cleared away. The surfaces
are prepped and shaped to hold the new
joint. The new joint is aligned and secured
to the femur (thighbone), patella (kneecap),
and tibia (shinbone).
Patellar
component
Patella
Femoral
component
Femur
Tibial
component
Tibia
Healthy knee
4
Arthritic knee
Knee replacement component
THE PROCESS AT A GLANCE
O
utlined below is an overview of
the process of having total joint
replacement surgery. This summary
is to help you understand the general
progression of events and the stages
of the surgical and recovery process.
6. Have surgery.
1. You and your doctor have agreed
that you need surgery. Understanding
what is happening to you will make
your hospital visit more pleasant and
improve your recovery.
9. Take care of your new joint. Go to
all appointments set or suggested
by your doctor.
2. Your doctor’s office obtains medical
clearance for surgery.
3. You must read all the educational
information provided by your doctor
and the hospital. The information in
this Knee Replacement Handbook is for
you to read prior to surgery; it will
help you understand what will happen
once you come to the hospital.
7. Begin recovery and rehabilitation in
the hospital.
8. Be discharged from the hospital.
A partnership among you, the orthopedic
surgeon, the hospital, and your support
team is vital to the success of the surgery.
As a partner you need to be informed
and knowledgeable about every aspect
of the surgical and recovery process.
Your understanding, participation, and
commitment are important to the success
of the procedure.
4. You may attend the Joint Replacement
Program orientation session. A preop
clinic session will be scheduled at
the hospital. A date and time will be
set and communicated to you by the
hospital scheduling office.
Please bring this handbook with you to
all of your related appointments as well
as to the hospital on the day of surgery.
You may receive various instructions,
information booklets, and copies of forms
as well. That information should be kept
in this handbook. It is important that you
have at your fingertips all the information
you require when you need it.
5. On the day of surgery, come to
the hospital at the time reserved
for you.
Our goal is to help you have good results,
and we are committed to assisting you on
this successful journey.
5
JOINT REPLACEMENT PROGRAM
ORIENTATION SESSION
T
he Joint Replacement Program Coordinator
coordinator will
schedule
an educational
session
willcall
callyou
youto
during
the week,
prior to your
session,
to
review
the
equipment
you
will
need
after
surgery,
how
to
prepare
your
home
for
the
with classroom location
equipment, what to expect during your hospital stay, and the role of physical therapy in your
recovery.
Siskiyou Blvd.
North
Building
Main
Entrance
Emergency Entrance
Emergency
Emergency Parking
N
Gi Shop
Security
North
Elevators
Endoscopy
Rambling
Rogue Café
Ground Floor
Patient
Registration
Cashier
Short Stay
Surgery
Lab Outpatient Services
Pre-Surgery Clinic
ICU Elevators
Family
Birth
Center
West
Building
Dubs
Library
Cardiovascular
Recovery
Laboratory
Services
Medical Center Drive
Cath Lab
Infusion
Services
South
Elevators
Cath Lab and Pediatric
Assessment Clinic
WAIT AREA
West
Elevators
Cath Labs
Cardio
Pulmonary
Diagnostics
Employee
Health Administration
NICU
Family Birth Center
and Women’s Services
Overflow
Cardiac and
Pulmonary
Rehab
South
Building
East Barnett Road
6
Spiritual
Care
Rogue Credit Union
Conference Room
Mustard
Conference Room
Patient Experience
Conference Room
Volunteer
Services
Pediatrics
East
Building
Murphy Road
Black Oak Drive
ATM
Imaging
Services
B
efore having joint replacement surgery,
you will attend an orientation session
that is designed to provide you and your
caregiver with important information to
make your surgery and recovery successful.
The orientation session will last about two
hours. You may have your hospital preop
clinic session on the same day or return
another day to complete the process. This
is set and communicated to you by the
hospital scheduling office.
What will I do at the orientation session?
Please bring this handbook to the
orientation session. You will be given a
DVD to take home and watch. The DVD
is designed to provide you with information
about anesthesia, post-op exercises,
precautions, and infection prevention.
Please bring it back when you return for
surgery and give it to one of the nurses or
certified nurse assistants.
• Snack food, juice, coffee, and water
will be provided during the orientation
session.
•In this classroom setting, you will meet
with members of your health-care team:
A nurse will review information regarding your hospital stay, answer
any questions you may have, and
discuss equipment you may need and
where to obtain it. The nurse will also
discuss the occupational therapy role in
your rehab.
n
A physical therapist will briefly outline the
therapy you will undergo after surgery.
n
HOSPITAL PREOP CLINIC SESSION
REGISTRATION
• On the day of your scheduled hospital
preop clinic session, you will meet with
an admissions representative to complete
your registration paperwork. This may
or may not be on the same day as the
orientation session.
• You will meet with a nurse practitioner,
who will discuss your options for anesthesia
and review your medical history, allergies,
and medications. You will be instructed as
to which medications to take the morning
of surgery.
WHAT TO BRING
PREOP CLINIC
• Insurance/Medicare cards
• You will meet with a registered nurse, who
will review your current medication list,
including prescriptions, over-the-counter
drugs, vitamins, and herbal supplements.
•Identification
• You will have lab tests drawn, an
electrocardiogram (EKG), and any other
tests your doctor has ordered.
•This Knee Replacement Handbook. Please
complete the medical information on
page 10 or bring a printed medication
list if you already have one. Be sure to
include prescription and over-the-counter
medications as well as any vitamins or
herbal supplements you take. Include
doses and how often you take them.
7
IMPORTANT TELEPHONE NUMBERS
Please feel free to make photocopies of this completed page and share them with your
family, friends, and caregivers.
EMERGENCY CONTACT PERSON
Name ________________________________________________________________________________
Relationship __________________________________________________________________________
Home phone _________________________________________________________________________
Cell phone ___________________________________________________________________________
PHYSICIAN INFORMATION
Southern Oregon Orthopedics, Inc.
2780 East Barnett Road, Suite 200
Medford, OR 97504
Telephone: (541) 779-6250
Physician name _______________________________________________________________________
HOSPITAL INFORMATION
Asante Rogue Regional Medical Center
2825 East Barnett Road
Medford, OR 97504
Telephone: (541) 789-7000 or (800) 944-7073
Primary contact: Joint Replacement Program coordinator
Telephone: (541) 789-7548
ASANTE ORTHOPEDIC AND SPORTS MEDICINE
Asante Rogue Regional Medical Center, Fifth Floor, Nurses’ Station C
2825 East Barnett Road
Medford, OR 97504
Telephone: (541) 789-7530
8
GENERAL HOSPITAL INFORMATION
.
u Blvd
o
y
i
k
s
i
S
Road
Be
lkn
ap
Garfield St.
Exit
27
ASANTE ROGUE REGIONAL
MEDICAL CENTER
N
Murphy Road
ett Road
East Barn
1 mile
Parking
Medical
Parking
Black Oak Drive
e
Avenu
d
n
a
l
High
I-5
Ce
nter
Drive
DIRECTIONS TO THE HOSPITAL
Map is not to scale.
PARKING AT THE HOSPITAL
Patients are encouraged to use the
valet parking service located at the North
Lobby Entrance facing Siskiyou Boulevard.
This free service is available from 7 a.m.
to 5 p.m.
VISITING HOURS
Your caregiver or family member may stay
with you, if you desire, and may be an
active participant in your recovery.
Post-surgery therapy is very important
to your recovery. In an effort to avoid
interrupting your therapy sessions, please
advise your visitors that they may remain
during these sessions but that the therapist
will continue the treatment; your visitors
will be asked to wait until the therapy
session is finished.
Please inform the Joint Replacement
Program coordinator if you wish for
your caregiver to stay overnight. Most
of our rooms have a couch that converts
to a single bed, and we will make every
effort to accommodate you.
9
MEDICAL INFORMATION
Please fill out unless you already have this information completed. If you do, please attach a copy.
Do you have any allergies? If so, please list what you are allergic to and your reaction:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
List all prescription medications are you taking, including strength and amount:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
List all over-the-counter medications you take, including vitamins and herbal supplements,
e.g., aspirin, Tylenol, Motrin, glucosamine, chondroitin, MSM (methylsulfonylmethane),
saw palmetto, fish oil, and flax seed oil:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
What pharmacy do you use?
_____________________________________________________________________________________
Your prescriptions must be filled at a local pharmacy rather than at the hospital.
Have you had surgery before? If so, what surgery have you had and when?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
10
PACKING FOR THE HOSPITAL
THINGS TO BRING
TO THE HOSPITAL
THINGS WE ASK THAT
YOU DO NOT BRING
• This Knee Replacement Handbook
• Medications unless requested by the
nurse practitioner. This is for your safety.
• CPAP machine if you have and use one
• DVD
• Ice machine if you have purchased one
• Comfortable attire for exercise
if you desire, or you may wear
hospital attire
n
Shoes that you can slip in and out of easily, such as tennis shoes,
walking shoes, or slippers as
suggested by the nurse during the
orientation session; no high heels
• Valuables, jewelry, credit cards, insurance
card, and large amounts of cash. A
wedding ring will be covered with tape
for surgery if you decide to leave it on;
all other jewelry must be removed. Please
be aware that if your hand swells and it is
deemed unsafe, we may need to cut off a
wedding ring.
n Socks/undergarments if you desire (not required)
n Loose clothing, such as shorts and
T-shirts (elastic waist only)
• Knee-length nightgown and a
robe that opens all the way down,
if desired (not required)
• Toiletries (be sure to include eyeglass
case, contact lens case, hearing-aid
batteries, and other necessities)
• Cell phone, if desired (there are phones
available for each patient for local calls)
• A minimal amount of money—no more
than $5 or $10 (unless you need money
for transportation at discharge)
• Walker (you may bring yours to the
hospital if you desire, and the therapist
will check for correct height and good
repair status)
11
NOTES
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
12
Patient Guide to
Knee Replacement
Surgery
Part II
Part II:
A Joint Approach
13
SURGERY INFORMATION
Y
our surgery has been scheduled for a
specific date and time, but sometimes
it is necessary to change your arrival time
to the hospital due to circumstances over
which we have no control. If the surgeon
has a cancellation, for example, the lineup
has changed since you were scheduled, or
there is an emergency, your surgery and
arrival times may be changed.
To enable us to maintain the schedule as
efficiently as possible, a nurse from the
hospital preop clinic will call you the day
before your scheduled surgery if the times
have changed. If you do not receive a call,
please come at the time given to you at
the preop clinic session.
What kind of anesthesia will I have?
This depends on the type of surgery,
your health history, and what the
anesthesiologist feels is best for you.
• Spinal anesthesia is given through a
catheter that the anesthesiologist inserts
into your spinal column. It numbs from
the midchest to the toes. You will be
asleep during the operation.
• General anesthesia is given through an
intravenous (IV) line or by breathing
from a mask. It is like a deep sleep that
happens very quickly.
• Other medications for pain and
relaxation will be given.
UNDERSTANDING THE RISKS
A
s with any major surgery, there
are certain risks. This section outlines
some of the common complications
associated with knee replacement surgery
and the precautions you can take to
help prevent them.
INFECTION
With any surgery there is a risk of infection.
Presurgery test results will affirm that you
have no active infections, and antibiotics
administered to you before and after surgery
will further help prevent infection.
BLOOD CLOTS
With knee replacement surgery, circulation
is impaired during the healing process. To
counter this effect and promote circulation,
you may be asked to pump your feet and
exercise your ankles following surgery and
during your recovery. While in the hospital,
you will wear pneumatic air socks on
both legs while in bed; these help prevent
14
blood clots. A blood-thinning medication
that helps prevent blood clots will also be
prescribed for you. Each day in the hospital,
blood may be drawn to check levels.
PNEUMONIA
To help prevent pneumonia, you may be
asked to either use an incentive spirometer
or take several very deep breaths to prevent
fluid from pooling in your lungs. For the
same reason, it is important to get out of
bed often. Breathing deeply after surgery
and using an incentive spirometer are
important measures to prevent congestion
in the lungs, which can lead to pneumonia.
BLADDER INFECTIONS
Bladder infections may also occur, especially
if you had a catheter. It is important to
drink plenty of fluids to help prevent
infection. If a catheter is placed, it will be
removed the first day after surgery.
Understanding the Risks continued
NUMBNESS
You will experience some numbness on
both sides of your knee following surgery.
This is normal and should not be cause
for concern. During surgery the nerves
around the knee are disturbed; as these
nerves heal, you may experience tingling
sensations. You may have permanent
numbness in the area around the incision,
but this will not affect the function of your
new knee. In only rare situations is there
permanent numbness or weakness in the
knee as a result of trauma to a nerve.
SEVERE COMPLICATIONS
As with any major surgery, there is the
possibility that any of the foregoing
complications, as well as complications
from the anesthesia, could be severe
enough to result in death. If you have
any questions or concerns regarding
complications, please discuss them
with the orthopedic surgeon.
THE NIGHT BEFORE SURGERY
W
e recommend that you eat a
light meal the night before
surgery. Unless the anesthesiologist, nurse
practitioner, or registered nurse tells you
otherwise, you should have nothing to
eat or drink after midnight. This includes
but is not limited to water, coffee, food,
and any kind of gum or mints. If you
have any questions, please call the Joint
Replacement Program coordinator.
THE DAY OF SURGERY
BEFORE COMING TO THE HOSPITAL
• Unless told otherwise, do not eat or drink
after midnight before surgery. You can
brush your teeth and rinse your mouth,
but do not swallow.
• Take only the medications that the doctor
or nurse practitioner or your doctor has
told you to take, using just enough water
to swallow them.
WHEN AND WHERE TO REPORT
You will be given a specific time to arrive
at the hospital. We recommend that you use
the free valet parking at the North Lobby
Entrance, which opens at 7 a.m. From
the North Lobby, walk to the surgery
waiting area on the left, located next to the
gift shop. If an Auxiliary volunteer is at
the desk, give him or her your name. If no
one is at the desk, pick up the red phone,
and you will be given instructions. Someone
will escort you to the area where you will
be prepped for surgery.
ONCE YOU ARRIVE AT THE HOSPITAL
•A nurse will complete your paperwork
and finish the orders your doctor has
written. You will have one or two IV lines
started. You may have additional lab work
done as ordered by your doctor.
• An orderly will come with a gurney to
bring you to a holding area or directly
to the operating room (OR).
15
THE DAY OF SURGERY continued
• If you are wearing dentures, hearing aids,
socks, or jewelry, please remove them
unless arrangements have been made to
keep them with you. You will be given
a hat to cover your hair.
• The OR is bright and noisy. We can provide
you with a warm blanket. The OR nurse
will be with you throughout the surgery.
There will also be an anesthesiologist, a
scrub nurse or technician, and an assistant
for the surgeon.
AFTER SURGERY
W
hen the surgery is over, you will be
taken to the Post-Anesthesia Care
Unit (PACU). You will be cared for by
specially trained registered nurses, who will
monitor your vital signs (heart rate, blood
pressure, and temperature) and pain level.
A good indication of how much pain you
may be experiencing can be determined on
a scale of 0 to 10, with 0 being no pain
and 10 being the highest level of pain.
Your family is encouraged to stay in
the waiting area outside of surgery if they
wish to speak with the surgeon after the
surgery is over. A volunteer will escort them to
a private room, where the surgeon will apprise
them of your condition. Family members are
not permitted in the PACU, but you can see
them when you return to your room on the
fifth floor.
You will be in the PACU for one to
two hours, depending on the type of
anesthetic you had and how you are
feeling. The nurses will keep you
warm and comfortable.
16
EQUIPMENT YOU MAY SEE
WHEN YOU WAKE UP
Intravenous Line
An IV line is a tiny catheter that is inserted
into a vein in your hand or arm. Attached
to the catheter is a small tube that connects
to a bag of fluid. The bag will hang from a
pole near your bed.
Oxygen
You will receive oxygen through a nasal
cannula or an oxygen mask. The presence
of oxygen does not mean that there is a
problem or that you are having difficulty
breathing. The nursing staff will check your
oxygen levels with a finger sensor.
Foley Catheter
This tiny catheter is inserted into your bladder
to drain your urine. If a Foley catheter is used,
it will remain for a day or two.
Blood Retrieval System
If the surgeon advises, there may be a drainage
tube inserted into your knee through two sites
next to the incision. The purpose of the tube
is to capture blood draining from your knee,
filter it, and return it to your bloodstream
through the IV line, unless you do not want
to receive it. This is a closed system, and the
blood is reinfused for only six hours after
surgery. At that time it becomes a collection
chamber only and will be removed on the
second day.
Continuous Passive Motion Machine
If your surgeon has ordered a Continuous
Passive Motion Machine (CPM), your
operative leg will be put on the CPM,
while you are still in the recovery room or
shortly after you return to your hospital
room. Generally, your knee will be moving
before you wake up completely. This early
movement will increase your tolerance to
the CPM machine. Nurses and aides will
assist you with getting in and out of the
CPM machine for meals and bathing.
The CPM machine moves your leg most
of the day and night. It is used while you
rest in bed on your back. You will be out
of the machine only a few hours a day
for the first few days; this will lessen each
day as your mobility increases. The CPM
machine keeps the muscles and the joints
flexible and reduces swelling, allowing you
to gain motion in your knee more rapidly.
Although the CPM machine may be noisy
and uncomfortable at times, most people
find that they are more comfortable while
using it. If you wish to turn onto your
side, sit up for meals, or raise the head of
the bed, please use the nurse call system
for staff to assist you. Pain medication is
available, and you are encouraged to use
it as needed.
The therapists will also assist you with
getting in and out of the CPM machine
for your therapy sessions twice a day.
The physical therapist will gradually
increase the motion of the machine by
10 to 15 degrees each day, depending
on your tolerance. The machine will be
used only while you are in the hospital.
17
THE REMAINDER OF YOUR HOSPITAL STAY
• For safety reasons the staff will ask you
to repeat your name and birthday before
any procedure or medication.
• The nursing staff will closely monitor
your heart rate, blood pressure,
temperature, and oxygen level.
• The staff will ask you to rate your pain
on a scale from 0 to 10. This enables the
nurses to assess the effectiveness of the
pain medication.
• You will have a large dressing after
surgery to keep the wound clean and
absorb any fluid. Two days after surgery,
this will be changed to a small dressing,
and any drains will be removed.
• You will have an IV line in your hand or
arm for fluids until you are taking them
well by mouth. At that time the IV site
will be capped; and it will be removed
before you are discharged.
• After surgery you will be given ice
chips, then water, clear liquids, and full
liquids. The nursing staff will monitor
you for nausea and provide medication
as needed. If you are not nauseated
and have good abdominal sounds (as
determined by the nurse), you will
progress to solid food and a normal diet.
18
• The nursing staff will monitor your
oxygen levels using a finger sensor. You
may have oxygen on the night of surgery
through a nasal cannula. This will be
discontinued when you can maintain
good oxygen levels on room air.
• Lab work will be drawn early every
morning or every other morning,
depending on your doctor’s orders.
• You will wear pneumatic air stockings
on both legs while you are in bed. These
assist the blood flow back to your heart
and help prevent clot formation and
blood pooling in your legs.
• If you would like to turn onto your side,
please use the nurse call system so that
staff may assist you.
• Please ask nursing staff, therapists, your
doctor, the discharge planner, or the
Joint Replacement Program coordinator
any questions that may arise. We are
here to help you.
PHYSICAL THERAPY AND OCCUPATIONAL THERAPY
This section is designed to give you an outline of specific activities and exercises that
the therapist will be helping you with each day.
LEVEL I
Physical Therapy
• Instruction in upper-extremity
strengthening program, as needed
•Lying and sitting exercises: ankle pumps,
quad sets, heel slides, short-arc quads,
straight-leg raises, and active assistive
range of motion
• Review of ADL procedures; patient
handout provided
• Bed mobility and transfer training
• Standing with a walker and walking
if able; progress walking in the evening,
depending on tolerance
•CPM, if used, is increased 10 to
15 degrees
• Instruction and practice in shower/tub
transfer, as needed
LEVEL III
Physical Therapy
• Lying and sitting exercises (see level I),
toward goal of at least 90 degrees
• Review home exercise program
• Progress transfer training
LEVEL II
Physical Therapy
• Lying and sitting exercises: ankle pumps,
quad sets, heel slides, short-arc quads,
straight-leg raises, active assistive range
of motion, long-arc quads, knee flexion,
and stretches
• Review home exercise program,
including stretches
• Progress transfer training, including a
toilet transfer
• Progress walking, including to the
bathroom with staff (if safe) and stair
training (if able)
•CPM, if used, is increased 10 to
15 degrees
Occupational Therapy
• Evaluation of activities of daily living
(ADLs) and home needs
•If needed, instruction and practice in the
use of adaptive devices for ADLs
• Practice toilet transfer, with or without
durable medical equipment (DME)
• Progress walking as tolerated toward goal
of 200 feet; practice stair climbing
•CPM, if used, is increased 10 to
15 degrees
Nursing
• Sit in a chair for meals and walk to
bathroom with staff
GENERAL PRECAUTIONS
• Use a walker or crutches when walking
until the therapist says you no longer
need them.
• Do not lift or carry things while
walking.
• Avoid small pets, remove throw rugs,
and secure electrical cords on the floor
where you may walk.
• Do not drive for six weeks or as
instructed.
• Allow for adequate room at the side of
your bed to walk with a walker.
• Avoid pivoting on the operated leg.
19
TOTAL KNEE EXERCISES
D
o exercises three times per day, 10 repetitions each, to start. Gradually increase to three
sets of 10 repetitions each.
LYING SUPINE
Routine for:
Created by:
Ankle Pump
Quad Set
Move your foot back and forth as if
pressing on a gas pedal.
Tighten muscles on top of the thigh
by pushing the knee down. Hold for
5 seconds.
Heel Slide
Slide heel up toward bottom. Hold for 3 seconds, then slide heel down.
20
Short-Arc Quad
Straight-Leg Raise
With the knee bent over a bolster,
straighten the knee by tightening muscles
on top of the thigh.
Lift leg 12 inches with the knee straight
and the toes pointed up. Other knee
may be bent if needed.
TOTAL KNEE EXERCISES continued
STRENGTHENING EXERCISES
Long-Arc Quad
(seated)
Knee Flexion
(standing)
Sitting slumped, straighten your knee
and hold for 5 seconds. Return the knee
to bent position.
Holding on to a counter or table,
bend knee and hold for 5 seconds.
STRETCHES
D
o exercises three times per day for up to 20 minutes per session. Unless otherwise
indicated, perform each stretch five times and hold for 30 seconds.
Quad Stretch
Cross legs with the involved leg on
the bottom. Slide feet under the chair,
keeping hips on the chair.
Scooting
Quad Stretch
Sitting in a chair with the foot of the
affected knee back and the foot of the
other leg forward, scoot forward,
stretching the quadriceps of the affected
leg. Hold for 5 seconds. Do 10 repetitions
three times per day.
Hamstring Stretch
Sit with foot resting on stool or chair,
keeping your back straight. Gently lean
forward, stretching the back of the thigh.
21
Physical Therapy Visit Log
PHYSICAL THERAPY LOG
Date
Swelling (mild/
AAROM PROM moderate/severe)
Gait Assist
Level/Device
Wound Health
Comments
This tool is used to document your therapy progress and will be reviewed by your doctor.
Please bring this handbook with you to all therapy and doctor appointments.
22
Physical Therapy Visit Log
PHYSICAL THERAPY LOG
Date
Swelling (mild/
AAROM PROM moderate/severe)
Gait Assist
Level/Device
Wound Health
Comments
This tool is used to document your therapy progress and will be reviewed by your doctor
Please bring this handbook with you to all therapy and doctor appointments.
23
DURABLE MEDICAL EQUIPMENT
JACKSON COUNTY
Apria Healthcare, Inc. . . . . . . . . . .
Ashland Drug . . . . . . . . . . . . . . . . .
Black Oak Pharmacy . . . . . . . . . . .
Black Oak Pharmacy . . . . . . . . . . .
Lincare, Inc. . . . . . . . . . . . . . . . . . .
Majors Medical Supply . . . . . . . . . .
NU Motion . . . . . . . . . . . . . . . . . .
Pacific Medical . . . . . . . . . . . . . . . .
Phoenix Pharmacy . . . . . . . . . . . . .
Quest Health Care . . . . . . . . . . . . .
Southern Oregon
Medical Equipment . . . . . . . . . . . .
(541) 245-2400
(541) 482-3366
(541) 773-5356 (541) 690-1130
(541) 773-2211
(541) 665-0133
(541) 772-1771
(541) 292-5483
(541) 535-1561
(541) 665-4018
(541) 773-5994
765 South Riverside Drive, Medford, OR
275 East Main Street, Ashland, OR
2924 Siskiyou Blvd., Suite 102, Medford, OR
4800 Crater Lake Avenue, Medford, OR
918 Chevy Way, Medford, OR
540 East Vilas Road, Suite B, Central Point, OR
4823 Industry Drive, Central Point, OR
2780 East Barnett Road, Suite 110, Medford, OR
404 North Main Street, Phoenix, OR
540 East Vilas Road, Central Point, OR
1600 East Barnett Road, Medford, OR
Medical Equipment Loan Closets
Access . . . . . . . . . . . . . . . . . . . . . . (541) 779-6691 (extension 305) Rogue River Community Center . . (541) 582-1482
Monday through Friday, 8 a.m. to 5 p.m.
3630 Aviation Way, Medford, OR
Monday through Friday, 9 a.m. to 4 p.m.
132 Broadway, Rogue River, OR
Salvation Army . . . . . . . . . . . . . . . (541) 772-8149
Tuesday through Friday, 9 a.m. to 3 p.m.
922 North Central Avenue, Medford, OR
JOSEPHINE COUNTY
Apria Healthcare, Inc, . . . . . . . . . .
Grants Pass Pharmacy . . . . . . . . . . .
Lincare, Inc.. . . . . . . . . . . . . . . . . .
Southern Oregon
Medical Equipment . . . . . . . . . . . .
(541) 479-6919
(541) 476-4262
(541) 479-3743
1700 Nebraska Avenue, Grants Pass, OR
414 SW 6th Street, Grants Pass, OR
1610 NE 7th Street, Grants Pass, OR
(541) 471-0026
705 SW Union Avenue, Grants Pass, OR
Medical Equipment Loan Closets
HASL . . . . . . . . . . . . . . . . . . . . . . . (541) 479-4275
Illinois Valley/Cave Junction
Lions Club . . . . . . . . . . . . . . . . . . . (541) 592-4135
Rogue River Community Center . . (541) 582-1482
Daily Living Device Catalogs
North Coast Functional
Solutions . . . . . . . . . . . . . . . . . . . . (800) 235-7054
Sammons Preston
Enrichments . . . . . . . . . . . . . . . . . . (800) 323-5547
24
Monday through Thursday, 9 a.m. to 3 p.m. Friday, 9 a.m. to 2 p.m.; closed 12 to 1 p.m.
305 NE E Street, Grants Pass, OR
333 S Redwood Highway, Cave Junction, OR
Monday through Friday, 9 a.m. to 4 p.m.
132 Broadway, Rogue River, OR
DURABLE MEDICAL EQUIPMENT continued
YREKA
Lincare, Inc. . . . . . . . . . . . . . . . . . . (530) 841-0503
Madrone Hospice Shop . . . . . . . . (530) 842-6025
1530 Lucas Road, Yreka, CA
Monday through Friday, 9:30 a.m. to 5 p.m.
Saturday, 10 a.m. to 4 p.m.
209 West Miner Street, Yreka, CA
M C Medical Equipment . . . . . . . . (530) 842-4304
742 S Main Street, Yreka, CA
Scott Valley Respiratory
Home Care Inc. . . . . . . . . . . . . . . . (530) 841-3000
1714 S Oregon Street, Yreka, CA
BROOKINGS
Apria Healthcare, Inc. . . . . . . . . . . (541) 469-6674
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 469-3989
624 Railroad Avenue, Brookings, OR
16290 Tolman Lane, Brookings, OR
Medical Equipment Loan Closets
Elks Lodge . . . . . . . . . . . . . . . . . . . (541) 469-2169
Monday through Friday, 8 a.m. to 2 p.m.
800 Elk Drive, Brookings, OR
CRESCENT CITY
Apria Healthcare, Inc. . . . . . . . . . . (707) 464-4242
630 G Street, Crescent City, CA
Medical Equipment Loan Closets
Veterans Service Office . . . . . . . . . . (707) 464-2154
810 H Street, Crescent City, CA
KLAMATH FALLS
Apria Healthcare, Inc. . . . . . . . . . . (541) 273-5451
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 882-2325
Norco Medical . . . . . . . . . . . . . . . . (541) 885-2996
2815 Laverne Avenue, Suite E, Klamath Falls, OR
2795 Anderson Avenue, Suite 107,
Klamath Falls, OR
3310 Washburn Way, Klamath Falls, OR
Medical Equipment Loan Closets
Senior Center . . . . . . . . . . . . . . . . . (541) 883-7171
Monday through Thursday, 8 a.m. to 5 p.m.
Friday, 8 a.m. to 2 p.m.
2045 Arthur Street, Klamath Falls, OR
Veterans of Foreign Wars . . . . . . . . (541) 882-0057
515 Klamath Avenue, Klamath Falls, OR
ROSEBURG
Douglas Medical
Equipment Supply . . . . . . . . . . . . . (541) 229-4530
Lincare, Inc. . . . . . . . . . . . . . . . . . . (541) 957-0907
Parkway Mobility
& Medical Supply . . . . . . . . . . . . . (541) 677-2438
Rick’s Medical Supply . . . . . . . . . . . (541) 672-3042
1813 West Harvard Avenue, Suite 212,
Roseburg, OR
1810 NW Mulholland Drive, Roseburg, OR
2475 Stewart Parkway, Roseburg, OR
482 NE Winchester Street, Roseburg, OR
25
SELF-CARE AFTER KNEE REPLACEMENT SURGERY
TED HOSE/SUPPORT STOCKINGS
If you were given TED hose in the hospital,
they must be worn until you see the
surgeon after discharge. He will tell you
when you can discontinue their use. TED
hose should be removed at least once per
day for bathing and skin care. They are to
be worn about 20 hoursper day and should
be hand-washed and hung to dry. To speed
up the drying time, you can wring them dry
in a towel or place in a dryer on the “air”
setting (no heat).
SHOWERING
You may resume showering as directed
by your doctor. This is usually two days
to two weeks after surgery. Refer to the
discharge plan the nurse gives you when
you leave the hospital.
Place a rubber nonslip mat in the tub or
shower to prevent twisting your knee while
stepping in and out. Have a nonskid rug
outside the shower to prevent slipping
when stepping out. Do not shower if you
are weak, dizzy, or lightheaded.
Shower over Tub
Until you are able to safely step over the
edge of the tub, use a tub transfer bench.
The therapist will review the transfer and
set up a procedure with you. Use a towel
on the bench so that your skin does not
stick to the plastic seat. Do not soak in a
tub until cleared by your doctor.
DRESSING
We recommend that you return to dressing
without devices as soon as possible. You
can use a footstool to make lower-body
dressing easier. When donning pants,
start with your operated leg first. Remove
clothes from the operated leg last. When
donning elastic hose, make sure your
skin is fully dry, then scoop the top of
26
the stocking over your foot, pulling the
material on at ankle level. Do not gather
the stocking material before putting them
on; it makes pulling the stocking over the
foot more difficult.
HOME MOBILITY AND SAFETY
To carry items around the house, use a bag
or basket on your walker. You can cut the
handles on a plastic grocery bag and tie it
to the front of the walker, or you can
purchase a walker basket from a medical
equipment supplier. A rolling cart is useful
for helping move larger items around the
house, especially in the kitchen.
• To decrease bending and reaching, keep
frequently used items within easy reach
(shoulder to waist level).
• Leave frequently used items out.
• A reacher helps you retrieve objects from
the floor or high places; attach a reacher
to your walker with sticky-backed Velcro.
• When alone, carry a portable phone or
a personal alarm, or sign up for Asante
Lifeline, a local emergency alert system.
E-mail [email protected].
• Use a high stool in the kitchen for
meal preparation. Slide objects across
countertops instead of carrying them.
• Remove throw rugs to decrease your risk
of tripping.
• Move pet bowls up on a raised surface
to decrease the need for bending to
the floor.
DISCHARGE PLANNING
What is discharge planning?
Medicare defines discharge planning as “a
process used to decide what a patient needs
for a smooth move from one level of care
to another.” Discharge from a hospital does
not mean that a patient is fully recovered.
It simply means that a doctor has
determined that the patient is stable and
no longer needs hospital-level care.
Who can assist me in planning for my
discharge?
Only a doctor can authorize a hospital
discharge, although many other people are
involved in working out the details of the
discharge plan. You and your significant
others are the most important people
involved, as you understand the home
situation and the available support system.
The discharge planner is a nurse who can
help make some of the arrangements for
your care following discharge.
I live alone and will need help cleaning
my home and preparing meals. Can the
discharge planner arrange for this?
There are many services that may be of
benefit to you, such as housekeeping and
meal preparation, but your insurance
company does not cover these. The
discharge planner can give you lists of
providers, but the actual arrangements
for the services and the payment need
to be made by you or your representative.
If you have long-term-care insurance, it
may include a provision for in-home care
that is not covered by Medicare or your
medical insurance.
My neighbor had surgery, and a nurse
came to her home to check on her a
couple of times a week. Could I have
this same follow-up care?
Medicare and most private insurance
companies pay only for care that is
considered “medically necessary.” There
are specific requirements that also must be
met. For instance, home health care
is covered only if the patient is
“homebound” and has care needs that
can be provided only by a professional,
such as physical therapy or dressing
changes. A doctor’sorder is required for
home health care.
Is there help for patients who are
unable to pay for their prescription
medications?
If you do not have money to purchase your
medications upon discharge, please tell
the nurse that you wish to speak with the
social worker. There are several agencies
in Southern Oregon that can help with
accessing drug assistance programs as well
as discount prescription drug cards.
Will I need a hospital bed or
other medical equipment when
I return home?
Most patients will not need any special
medical equipment upon discharge from
the hospital. Remember, Medicare and
most private insurance companies will
pay only for equipment that is “medically
necessary.” Some items such as grab bars
for your bathroom or a shower bench,
although helpful, are considered “comfort
or convenience” items and are not
reimbursable. If your doctor and therapist
recommend certain medical equipment,
the discharge planner can assist with the
arrangements for delivery to your home.
27
DISCHARGE PLANNING continued
I have no one to assist me at home,
so I prefer to go to a rehabilitation
facility to continue my recovery after
discharge. Will Medicare pay for this
level of care?
Medicare provides payment for care in a
skilled-nursing rehabilitation facility if the
following requirements are met:
• The admission to the rehabilitation
facility must occur within 30 days of a
hospital stay of three or more days. The
three-day stay in the hospital must meet
Medicare criteria for inpatient hospital
admission. For example, a night spent
in outpatient status for observation
does not count toward the three-day
qualifying stay.
• The care received in the facility must be
an extension of treatment of a condition
requiring daily skilled-nursing care.
• After the first 20 days of care in a
rehabilitation facility, there is a copayment. Some insurance supplements
cover the co-payment amounts.
Other options available for those who live
alone and do not feel comfortable about
returning directly home from the hospital
include the following.
• Assisted-living facilities provide
various levels of help, from medication
management to dressing and bathing.
• Foster homes are privately owned
homes providing different levels
of assistance.
The patient is responsible for payment
unless eligible for other coverage. Please
ask to speak with a discharge planner if
you have any questions.
AFTER DISCHARGE FROM THE HOSPITAL
A
fter discharge from the hospital,
whether you go home or to a
rehabilitation facility, the following factors
will be important for the care of your
new joint.
PHYSICAL THERAPY
Your physical therapy will continue as
your new knee improves. You will go to
an outpatient physical therapist two to
three times a week for about six weeks,
as ordered by your doctor. If you are
homebound, a therapist may see you at
home for a week or two. If you go to a
rehabilitation facility, you will receive
physical therapy there.
You will also be responsible for following
a daily exercise program that will be
outlined by the physical therapist while
28
you are still in the hospital. The success of
your knee replacement surgery depends
largely on your diligence, cooperation,
and attention in adhering to your physical
therapy program. Remember to take your
pain medication at least 30 minutes prior
to your planned activity.
ICE
You may apply ice packs or your ice
machine to your knee as often as needed.
Applying ice may be especially helpful
before and after your exercise sessions and
in the evening hours if your knee becomes
swollen. Due to trauma to the joint from
surgery and the exercise program you
will follow thereafter, it is normal that
your knee will feel warm and swell slightly.
Heat is not recommended, as it may
increase swelling.
AFTER DISCHARGE FROM THE HOSPITAL continued
BLOOD-THINNING MEDICATION
You will be on blood-thinning medication
or aspirin after you are discharged from
the hospital. Depending on the specific
medication ordered, you may need to
have blood drawn to check your bloodthinning level.
There are warning signs that your blood
might be too thin, such as nosebleeds,
bleeding gums, excessive bruising, and
blood in the urine. Please call your doctor
if you have any of these symptoms. It is
also dangerous to take aspirin, ibuprofen
(Advil, Motrin, or Nuprin), and any
over-the-counter or prescription arthritis
medicine while you are taking bloodthinning medication. You may take
acetaminophen (Tylenol) or pain pills that
have been prescribed for you. You will
be able to resume arthritis medicine and
aspirin as needed after the blood-thinning
medication is discontinued.
DRIVING
You will not be able to drive for the first
six to eight weeks following surgery.
Although you may feel capable, you will
need written approval from your doctor;
otherwise your insurance coverage may
be jeopardized and the safety of your new
joint compromised. Your safety and wellbeing are of prime concern during the
healing process.
SEXUAL ACTIVITY
Once cleared by the surgeon, you may
resume sexual activity. If you have specific
questions, please do not hesitate to ask the
doctor, nurse, or other staff member.
YOUR KNEE INCISION
• Leave the dressing in place, as
instructed.
• After the adhesive skin closures fall off,
keep the scar clean and dry.
• Report to your doctor any redness,
increased warmth to the touch, wound
separation, or increase in localized pain,
bruising, or drainage.
• If your knee swells excessively,
elevate your leg above heart level and
apply ice.
29
LIVING WITH YOUR NEW KNEE
INFECTION
Your new knee is a metal and plastic
prosthesis, so the body considers it a
foreign object. If you become sick with
a serious infection, bacteria can circulate
in your body, go to the prosthesis, and cause
a bacterial infection in your new joint.
For this reason, if you become ill with an
infection or a high fever, your doctor should
evaluate you immediately.
SURGICAL PROCEDURES
If you are scheduled for a medical
procedure, even a minor one such as dental
cleaning or surgery for an ingrown toenail,
you may be asked to take antibiotics before
the procedure in the first two years after
your knee replacement surgery. If the doctor
is not sure of the appropriate antibiotics
for you, please ask him or her to call your
orthopedic surgeon. This may also apply to
invasive procedures using a scope, such as a
cystoscopy, bronchoscopy, or gastroscopy.
DENTAL WORK
You may be asked to take antibiotics before
dental work; this includes routine cleanings.
The reason for taking antibiotics is that
bacteria are present in the mouth that are
not present anywhere else in the body.
When you have your teeth cleaned, bacteria
gain entry into the bloodstream and can
circulate to the knee prosthesis, causing
it to become infected. Antibiotics kill the
bacteria that cause this type of infection, so
it is imperative that you notify your dentist
of your prosthesis. If your dentist is not
familiar with the correct type of antibiotics
to give you, ask him or her to call your
orthopedic surgeon prior to scheduling the
dental procedure. Routine daily flossing,
twice-a-day brushing, and cleanings every
six to 12 months are strongly advised.
30
We recommend the following guidelines:
•If you have rheumatoid arthritis, systemic
lupus erythematosus, insulin-dependent
diabetes, previous total joint infection,
malnourishment, or hemophilia, or if you
have had radiation or drugs to decrease
your immune system, you may need to
take antibiotics before certain dental
procedures.
• If you are otherwise healthy, for two years
after surgery you may be asked to take
antibiotics briefly if any dental work being
done could cause bleeding in the mouth.
The suggested use of antibiotics is as follows:
• Patients not allergic to penicillin: take
four 500-milligram amoxicillin tablets
one hour before the procedure.
•P
atients allergic to penicillin but able to
take cephalexin: Take four 500-milligram
cephalexin tablets one hour before the
procedure.
•P
atients allergic to penicillin and
cephalexin: Take 600 milligrams of
clindamycin one hour before the
procedure.
If oral medications cannot be taken,
intramuscular or intravenous drugs should
be given.
This relates only to preventing the spread
of bacteria from your mouth to your
prosthesis during dental work. If you
develop a bacterial infection of the skin,
lungs, gastrointestinal tract, urogenital tract,
or other site, it should be treated for as long
as it takes to eliminate the source of the
infection. Viral infections such as colds
and flu do not require antibiotics to protect
your new joint.
LIVING WITH YOUR NEW KNEE continued
Your dentist is ultimately responsible
for making the decision for or against
antibiotics based on his or her knowledge
of the dental work to be done. If you or
your dentist has any questions, please have
him or her call your orthopedic surgeon.
SKIN CONDITIONS
It is important that you advise your
orthopedic surgeon of any skin conditions
or problems prior to surgery. These may
include athlete’s foot, dermatitis, nail biting
with or without bleeding, and rashes or skin
breakdown in skin folds, under the arms, or
in the groin. Your doctor can instruct you in
the care needed to heal these conditions.
FOLLOW-UP CARE
Although your knee may feel fine, it is
important to remember that your new
joint has artificial components, and for
this reason you must see your surgeon at
the routine six-week, three-month, sixmonth, and annual visits thereafter. Routine
examinations to continually monitor your
prosthesis are recommended because certain
minute changes apparent only on an X-ray
or in an examination may be detected.
It is important to stay up-to-date on your
health immunizations, especially flu shots,
Pneumovax, and tetanus booster.
If you have foot problems, it is important
that you dry your feet well after bathing
or swimming, wear well-ventilated shoes
and absorbent socks, and apply anti-fungal
ointment or powder as directed.
Use a first-aid cream on minor cuts and
abrasions to prevent infection, before and
after surgery, indefinitely.
Do not razor-shave your legs, armpits, or
face within two days of surgery because it
can contribute to wound infection of your
new joint.
31
NOTES
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32