• 530.541.3420 | 2170 South Avenue, S. Lake Tahoe, CA

Total Joint Replacement Handbook

Your guide to a successful recovery 

Thank you for choosing the Tahoe Center for Orthopedics and Barton Health for your upcoming total joint replacement.

We have developed this handbook to assist with your surgical and hospital experience. It is important that you and your family read this guide carefully and refer to it throughout the time prior to, during, and after your hospital stay. Some modifications may be made from the recommendations in this handbook to meet your individual needs.

We understand that you are coming to the hospital to have a joint replaced electively and not because you are ill. You and your family will be active participants in the care and rehabilitation that you receive. Our team will be with you every step of the way to help and encourage you.

Your success and satisfaction are important to us. We are looking forward to caring for you and will work hard to provide you with an exceptional experience. If there is anything we can do to help improve your time with us, please do not hesitate to ask.

Once again, thank you for choosing the Tahoe Center for Orthopedics and Barton Health.


Understanding Your Surgery Preparing for Surgery Your Hospital Experience Steps of Recovery Recovery at Home
PRE-ADMISSION TESTING
Location:
Barton Memorial Hospital
2170 South Street (Front lobby at the end of third street)
South Lake Tahoe, California 96150

Once you have been scheduled for surgery please call or come by the Preoperative Coordinator’s office at Barton Memorial Hospital:
(530) 543-5528, from Carson Valley: (775) 782-1500 x5528, or toll free: 1-866-541-4558.

Hours: 8:00 AM to 4:30 PM Monday through Friday (excluding major holidays)

Please bring the following with you for your Pre-Admission appointment:
  1. This Handbook
  2. A list of your current medications and doses, including over the counter medications.
  3. Copies of advanced directives (living will, durable power of attorney).
  4. Insurance cards (all that may apply) or industrial claim number.
  5. Insurance co-payment if applicable.
  6. Friend or family member to assist you during the process.

UNDERSTANDING YOUR SURGERY

DISEASE PROCESSES

OSTEOARTHRITIS
Osteoarthritis, or degenerative joint disease, affects the cartilage lining the ends of bones. The cartilage becomes worn, no longer allowing smooth movement inside the joint. With osteoarthritis, you may experience a painful, grinding sensation as the joint works, indicating that the bone surfaces are rubbing against each other. Pain stiffness, swelling and loss of function are common as the cartilage continues to wear away.

Rheumatoid Arthritis
Rheumatoid Arthritis is a systemic autoimmune disease that causes chronic inflammation of the joints. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness and redness in the joints and other tissues around the joints. In some patients, the chronic inflammation leads to destruction of the cartilage, bone, and ligaments, causing deformity of the joints.

AVASCULAR NECROSIS
Avascular necrosis is the lack of, or interruption of, blood supply to the bone, usually the femoral head, causing the bone tissue to die and the bone to collapse. Loss of blood supply can be caused by injury, long term systemic steroid use, radiation, excessive alcohol use or secondary from treatment of a fracture. Joint pain increases as bone collapses and the joint space narrows. Normal range of motion is limited due to pain.

Total Knee Replacement
TOTAL KNEE REPLACEMENT
Total knee replacement is surgery to replace an injured or worn knee joint with a man-made joint, called an implant or prosthesis. The prosthesis may be made of metal, ceramic, plastic or a combination of these materials.

Your orthopedic surgeon will make an incision over your knee to expose the joint. The damaged cartilage and bone will be removed with precision guides and instrumentation and then the prosthesis will be implanted to improve joint motion, correct alignment, and decrease pain.

 A “total joint” consists of two or three components: The tibial component (bottom portion) replaces the top surface of the tibia. The femoral component (top portion) replaces the bottom surface of the (femur). In many cases, a “button” may be placed on the back of the kneecap to help it track properly.

Once all of the components are in place, the surgeon will manipulate your leg to confirm the proper fit and function prior to closing the incision. The surgery should take about two to three hours for a single knee replacement and three to four hours for bilateral (both) knees. The surgery usually takes two to three hours and you will likely remain in the hospital for two or three days depending on how your rehabilitation progresses.

Most total knee replacements will last for many years. Like many moving parts, they can eventually wear out which can lead to a revision of the replacement in the future.
Unicompartmental Joint Replacement
UNICOMPARTMENTAL KNEE REPLACEMENT
A total knee prosthesis replaces the entire knee joint while a unicompartmental knee prosthesis replaces only part of the knee joint. A partial knee replacement may be indicated if the osteoarthritis or degenerative joint disease only affects one side, or compartment, of the knee joint while the other surfaces of the joint are healthy.

The partial knee replacement entails a smaller incision to allow the surgeon to remove only the diseased or damaged portion before placing the implant on one side of the knee. 

Once all of the components are in place, the surgeon will manipulate your leg to confirm the proper fit and function prior to closing the incision.

Most unicompartmental knee replacements will last for many years. Like many moving parts, they can eventually wear out which can lead to a revision of the replacement in the future.
Total Hip Replacement
TOTAL HIP REPLACEMENT
Total hip replacement is surgery to replace an injured or worn hip joint with a man-made joint, called an implant or prosthesis. The prosthesis may be made of metal, ceramic, plastic or a combination of these materials. The prosthesis may be held in place by a special bone cement or by your own bone as it grows into the prosthesis. Your surgeon will decide the type of prosthesis that is right for you based on your bone structure, joint, age, weight and activity.

Your surgeon will make an incision over your hip to expose the joint. Special instrumentation is used to remove the ball and replace the socket that has been damaged by arthritis. The prosthesis is then implanted to replace the bone that has been removed.

Total hip replacement implants usually consist of a femoral component (bottom portion or stem), a femoral head (ball), and an acetabular shell and liner (socket). Once all of the components are in place, the surgeon will manipulate your leg to confirm the proper fit and function prior to closing the incision.

The surgery usually takes two to three hours and you will likely remain in the hospital for two or three days depending on how your rehabilitation progresses.

Most total hip replacements will last for many years. Like many moving parts, they can eventually wear out which can lead to a revision of the replacement in the future.

PREPARING FOR SURGERY

PREPARING YOUR HOME
The following are suggestions to safely prepare your home prior to returning from the hospital. One of our home health therapists will be contacting you to offer a preoperative home safety assessment. The following suggestions will assist in a smooth post-operative recovery.

  1. Move all throw rugs out of your pathways.
  2. Adjust furniture to allow space for maneuvering with a walker.
  3. Survey your bathroom and consider making modifications to decrease your risk of falling. An occupational therapist can help with suggestions after your surgery.
  4. Consider installing nightlights in rooms or hallways you may use after dark.
  5. Move footstools, plant stands, or other low floor items a safe distance from walkways.
  6. Remove or tape down any cords or wires in pathways.
  7. Plan to use a chair with armrests (without wheels) to help you get up and sit down easily.
  8. Place a cushion or folded blanket in chairs that are low or hard to get out of.
  9. Make arrangements for assistance with pets or prepare a secure spot for them to stay while you are getting settled in your house.
  10. Move objects that you may frequently need access to so that you can easily reach them.
    1. Medications
    2. Phone
    3. Cooking utensils, dishes and pans
    4. Anything that is stored high or low that you might need.
    5. Have telephone numbers of helpful friends, family, doctor, etc. by the phones in case of an emergency.
  11. Prepare some nutritious meals and place in the freezer to simplify cooking after you get home.
  12. If your bedroom is upstairs, make arrangements to sleep downstairs for a few days.
    1. If you must negotiate stairs, additional training and resources will be provided for you.
  13. Try to arrange for a medium size, easily accessible vehicle to take you home.
    1. You may not be able to step up into a large truck or SUV.
    2. You will likely not want to try to squeeze into a small, compact car.

We strongly recommend that you have a responsible adult at home for a minimum of 3 days after discharge. You must have a responsible person to drive you home from the hospital (pillows and a blanket are recommended for your comfort).

CONTROLLING RISK FACTORS
With any surgery there are certain risks. It is important that you understand the risks and things you can do to minimize them to prevent post-operative complications.

Conditions that may increase your risk for post-operative complications include obesity, smoking, lung disease, heart conditions, diabetes, recent infections, and other chronic diseases. The following activities are important to help you prepare for surgery, to ensure a speedy recovery, and to help prevent complications after surgery.

HEALTHY EATING

Eat healthy and well-balanced meals. If you are overweight, losing weight will help reduce the pressure on your joints and may reduce your pain. Fad diets or starvation diets will not be healthy for the healing process.

Tell your surgeon if you have been following a physician-prescribed diet before hospitalization.

If you have diabetes, it is important to follow your physician’s orders. If you have any questions or concerns regarding your nutrition, weight status or diet prescription, please contact our Registered Dietician at (530) 543-5824.

SMOKING CESSATION
If you smoke or use smokeless tobacco, we strongly encourage you to stop at least two to three weeks (or more) before your total joint replacement surgery. This will decrease the chances of lung problems and speed your healing process.

Barton Health is Tobacco Free which means tobacco use of any kind is prohibited indoors or 25 feet from any entrance. Ask your nurse or doctor if assistance is needed to stop smoking. If you are interested in more information on how to quit smoking, please call Barton Health at (530) 543-5615.

Please call your surgeon if you have a fever, cold, flu or sore throat in the few days leading up to surgery. If you become ill the night before surgery and are unable to reach your surgeon, please notify the nursing supervisor at (530-543-5736.


NIGHT BEFORE SURGERY
Do not eat or drink anything after midnight, including water, chewing gum or mints/candy unless you are instructed to take any medications with a sip of water.

You may brush your teeth or rinse your mouth as frequently as you wish, and spit, but do not swallow.

Please refrain from smoking and do not use smokeless tobacco for 24 hours prior to surgery.

MEDICATION INSTRUCTIONS TO PREVENT A DELAY OF SURGERY

  1. Stop general use aspirin or other anticoagulant 1 week prior to surgery. Call your prescribing physician for exact instructions on stopping Coumadin, Plavix or aspirin. Your physician may prescribe another medication while you are off of these blood thinners.
  2. Stop any NSAIDS (Naproxen/Aleve, Daypro, Feldene, Clinoril, Relafen) 1 week prior to surgery.
  3. Stop Ibuprofen/Advil 48 hours prior to surgery.
  4. Stop Angiotensin Receptor Blockers (Losartan/Cozaar, Valsartan/ Diovan, Irbesartan/Avapro, Candesartan/Atacand, Telmisartan/ Micardis, Eprosartan/Tereten, Olmesartan/Benicar) 24 hours prior to surgery.
  5. Stop all diet drugs 14 days prior to surgery.
  6. Stop anti-diabetic medications that have metformin in them (examples: Metaglip, Avandamet, Metformin/Glugcophage, Glucovance) 24 hours prior to surgery. You will be given instructions regarding other diabetes medications (including insulin).
  7. Stop estrogen receptor (Raloxifen/Evista) 72 hours prior to surgery.
  8. Stop all herbal medications 2 weeks prior to surgery.
  9. Stop vitamin E/Fish Oil 2 weeks prior to surgery.
  10. Stop anti-diabetic medications that have metformin in them (examples: Metaglip, Avandamet, Metformin/Glugcophage, Glucovance) 24 hours prior to surgery. You will be given instructions regarding other diabetes medications (including insulin).
  11. Stop estrogen receptor (Raloxifen/Evista) 72 hours prior to surgery.

YOUR HOSPITAL EXPERIENCE

SCHEDULED DAY OF SURGERY
Report to the Surgical Desk in the front lobby of the hospital entrance. Our representative will obtain any final information that is necessary prior to surgery and you will then be escorted to the Ambulatory Surgical Unit. At times emergencies may require the surgery schedule to change. However, you will be notified by the Preoperative Coordinators Office if there has been a change. If you wish to confirm arrival time on the day of surgery please call the Ambulatory Surgical Unit at 530-543-5875. They will be able to let you know if your surgeon is running on time. We thank you for your flexibility and will make every effort to keep you informed of any changes.

ANESTHESIA
Prior to your surgery, your anesthesiologist will discuss your anesthetic options.

Some of the choices are:

  1. General Anesthesia renders you unconscious for the duration of the surgery, using a combination of anesthetic agents. This may include using a breathing tube to help you breathe adequately.
  2. Spinal or Epidural Anesthesia makes the lower half of your body numb, by injecting a local anesthetic around the nerves in your lower back. You may be offered a combination of general and spinal/ epidural anesthetic.
  3. Nerve blocks, which involve injecting a local anesthetic around specific nerves that control the surgical site. This may be a single injection or continuous infusion of the local anesthetic through a very small tube inserted close to the nerve, to provide pain control for the next 1-2 days, in combination with other pain medications.

There are potential risks associated with any anesthetic. Serious complications are extremely rare. Your anesthesiologist will be discussing with you the risks and benefits of the different anesthetic options available to you.

PREPARING FOR SURGERY
The operating room (OR) nurse will come to the ambulatory unit and introduce him or herself and ask you several questions. We understand that you will have answered many of these same questions multiple times, but each person who cares for you is responsible for your safety and will verify certain information for accuracy. We also encourage you to ask questions.

Prior to being taken to the operating room by your nurse and anesthesiologist, you will be given an antibiotic and a medication to help you relax. Once in the operating room, you will be transferred to another bed and a safety strap will be placed on you. There will be a lot of activity as the surgical team continues to prepare the room for you, however, you may not remember this part of the day due to the medications.

POST ANESTHESIA CARE UNIT (PACU)
After your surgery is completed, you will be transported to the PACU where our nursing team will carefully monitor your recovery. You will awaken in the PACU with:

  • An IV in your arm.
  • An oxygen mask on your face.
  • A blood pressure cuff on your arm.
  • A pulse oximeter on your finger.
  • A surgical dressing covering the incision.

And may also have:

  • A catheter in your bladder.
  • A drain from the incision site.
  • Compression stockings on your legs.
  • Sequential compression devices on your legs.

You will receive pain medication as well as some additional medications (anti-nausea, Benadryl, etc.) if they are needed. Do not hesitate to ask for pain medication when you need it and remember to rate your pain on a scale of 0 to 10 (0 meaning none and 10 meaning severe pain). Do not allow the pain or nausea to overwhelm you before seeking treatment.

Your family will be notified that surgery is complete and your surgeon will answer their questions. You will remain in the PACU until your vital signs are stable and you are fully awake (about an hour). At that time, you will be transferred to the nursing unit on the second floor where your family will be able to meet you.

NURSING UNIT
After you arrive on our nursing unit, you will have a team of registered nurses and nursing assistants who will be caring for you. This team is knowledgeable about your needs after surgery and is experienced in treating patients who have undergone joint replacement surgeries. They are focused on your safety, comfort, and progress. Please feel free to ask them questions about your surgery and contact them if you need assistance. They will do everything they can to make you comfortable, manage your pain, and get you on your way to recovery.

CASE MANAGEMENT
When you are admitted to the hospital, a nurse case manager will be assigned to you. He or she will work with you and your healthcare team to coordinate your care and to arrange a safe discharge plan.

For example, they may assist you with:

  • Arranging for services such as home healthcare or outpatient therapy.
  • Procuring medical equipment and/or medical supplies.
  • Understanding health insurance policies.
  • Coordinating transition to other inpatient facilities such as acute rehabilitation, skilled nursing, and/or long-term care facilities.
  • Discussing and determining additional needs at home.

If you have any questions please feel free to contact your nurse case manager.

PAIN MANAGEMENT
Managing your pain is important for your recovery. It is normal to experience post-operative pain, but together we can help you manage it. Our goal is for you to be able to move with less difficulty, get in and out of bed, participate in therapy, and rest comfortably. Individuals that take large amounts of pain medications prior to surgery may have a more difficult time managing their pain after surgery. Please remember to ask for pain medication if your pain increases above your tolerance.surgery. Please remember to ask for pain medication if your pain increases above your tolerance.

Patient controlled analgesia (PCA) after surgery is a way of administering intravenous pain medications through a machine that is under your control. It is programmed to limit the amount of medications to safe levels. For your safety, it is very important for you and your family to know that YOU (the patient) are the only one allowed to push the control button.

For additional pain relief, we may provide cold gel packs or help you reposition the operative knee or hip.

PREVENTING COMPLICATIONS/SIDE EFFECTS
As with any surgery, complications or side effects may occur. Precautions will be taken to reduce the chances of this happening.

NAUSEA
Some patients may experience some nausea and vomiting from the anesthesia and/or pain medications. Anti-nausea medications are available to help soothe these symptoms. Please notify your nurse if you experience nausea.

CONSTIPATION
Your bowel activity may be slow to return to normal due to anesthesia, pain medications, and your relative immobility the first few days after surgery. To prevent uncomfortable distention in your abdomen, your first meal should be clear liquids (juice, broth, gelatin, etc.)

To minimize constipation:

  • Drink plenty of fluids.
  • Walk with assistance.
  • Take a stool softener and/or laxative at the recommendation of your nurse.

Please notify the nurse if you feel constipated.

PNEUMONIA
After surgery, it is important to avoid a lung infection.

  • Cough and breathe deeply every hour while awake.
  • Use the incentive spirometer 10 times every hour while awake.
  • Sit up in a chair.
  • Walk with assistance.
  • Brush your teeth 4 times a day, especially after meals.

BLOOD CLOTS
Your decreased mobility following surgery and normal postoperative swelling put you at an increased risk for blood clot formation in your legs. Two or more of these steps will be taken to prevent this from happening:

  • Blood thinning medication(s).
  • Sequential compression devices on your legs while in bed.
  • Compression stockings (TED hose).
  • Leg exercises in bed
  • Walking with assistance.

INFECTION
We are committed to preventing surgical site infections. The chance of getting an infection following our surgery is extremely low.

  • An IV antibiotic is given in surgery and may be given up to 24 hours following surgery.
  • A hand gel sanitizer is mounted to the wall at the entrance of every patient’s room and throughout the halls of the hospital. Please encourage your visitors and/or hospital personnel to use it when entering your room.

SWELLING
Some swelling following your surgery is normal. The following strategies may help minimize swelling:

  • An ice pack may be placed on your surgical site.
  • Elevate or reposition your leg.
  • Notify your nurse immediately if your dressing or skin feels tight or you experience numbness or tingling.

FALLS
A fall during the first few weeks after surgery may damage your new joint and lead to further surgery.

  • Do not attempt to get up alone while you are in the hospital; use call light to notify nursing staff for assistance.
  • The physical therapy staff will help determine the correct assistive devices.

KNEE CONTRACTURE (TOTAL KNEE REPLACEMENTS)
Keeping your knee bent or immobile for prolonged periods of time can lead to stiffening of your new joint.

  • Do not place a pillow or towel roll under your knee.
  • Early range of motion of your knee is important.
  • In some cases, a continuous passive motion machine (CPM) will be ordered.

HIP DISLOCATION (TOTAL HIP REPLACEMENTS)
Follow the hip precautions as instructed. Hip precautions are discussed in more detail in the rehabilitation section on page 17.


STEPS OF RECOVERY

Our rehabilitation team will work with you to reach your maximum level of independence prior to being discharged. The physical therapy staff will assist you with exercises, strengthening, range of motion, bed mobility, walking, and stair climbing. The occupational therapy staff will instruct you on how to transfer properly, self-care activities, and use of adaptive equipment such as sock aids and reachers. 

We will provide the necessary assistive and adaptive equipment to be used while you are at the hospital. However, you are welcome to bring your own equipment; labeled with your name. Your case manager will discuss your options to obtain any necessary equipment prior to your discharge.

Your motivation and participation in the therapy programs are important to the speed and success of your long-range rehabilitation, as well as getting you ready to go home. This means you are the greatest influence in a successful recovery. As rehabilitation progresses, you will experience less pain and stiffness. Your therapists will work with you to develop a personalized home exercise program. Remember: activity and exercise are necessary for full recovery and should not stop once you leave the hospital.

EARLY REHABILITATION GOALS:

  • Fully straighten your knee (knee replacement).
  • Bend your knee to as close to 90 degrees as possible (knee replacement).
  • Get in and out of bed and chair safely.
  • Walk safely with a walker or crutches as determined by therapy staff.
  • Dress yourself as independently as possible, using adaptive equipment as needed.
  • Go up and down stairs safely.
  • Maintain hip precautions (hip replacement).

HIP PRECAUTIONS
It is important to know if your hip replacement was performed through an anterior (front) approach or posterior (back) approach. The respective precautions will need to be strictly followed for up to three months to help prevent your hip from coming out of the new joint. It is important that you maintain these precautions at all times.

Hip PrecautionsANTERIOR HIP PRECAUTIONS

  • Do not drag your surgical leg behind you or take very long strides when walking (hip extension).
  • Do not turn your surgical leg outwardly while lying, sitting or standing (external rotation).
  • Keep the foot of your operated leg placed forward when you are pushing up to stand.

POSTERIOR HIP PRECAUTIONS

  • Do not cross your surgical leg across the midline of your body.
  • Do not turn your surgical leg inwardly toward the midline of your body.
  • Do not bend forward at your surgical hip greater than 90 degrees or raise your knee higher than your surgical hip while sitting or getting up.

STRATEGIES TO MAINTAIN YOUR HIP PRECAUTIONS

  • Do not sit in low chairs, low toilets or soft couches that will cause your knees to be higher than your hips.
  • Always scoot to the front edge of the chair before getting up.
  • Keep your surgical leg placed forward when you are pushing up to stand.
  • Do not attempt to put on socks or shoes without adaptive equipment.
  • Do not attempt to pick objects up off the floor without a reacher.
  • Always keep the kneecap of your operative leg facing up/forward.
  • Keep a pillow or “abduction wedge” between your legs when sleeping.

It is very helpful that your family members are familiar with your hip precautions and help remind you to maintain them at all times. Keeping a pillow between your knees is a great, gentle reminder.

GETTING OUT OF BED
Move yourself close to th side of the bed. If you have had a hip replacement, maintain your hip precautions. Pivot on your hips, using your arms to help you move to sitting on the edge of the bed. Extend your operative leg out in front of you. Push from the bed with both hands to stand up.

SITTING IN A CHAIR

Use a firm chair with armrests and high seat. Back up until you feel the chair touching your leg. Reach for the armrests. Keep your operated leg slightly out in front. Lower yourself to sitting and then lean back in the chair. If you had a hip replacement follow your hip precautions. 

For standing, scoot forward in the chair. Move your operated leg slightly out in front. Push up using the armrests and your non-operative leg. Move your hands to the assistive device and stand up straight. Take a moment or two to get your balance before walking.

WALKING WITH A WALKER
Push your walker a few inches in front of you. Keeping your back straight, step into the center of the walker with your operative leg. As you step through with your nonoperative leg, push down on the walker to support weight as needed.

USING THE TOILET
Back up until you feel the toilet touch the back of your legs. Place your operative leg in front of you, keeping your weight on the other leg. Glance behind you and grasp the grab bar (or side rails, if you are using a toilet with rails). Lower yourself onto the front of the toilet, and then scoot back. To get up, reverse the steps. 

Patients with a total hip replacement will likely need a raised toilet seat at home in order to maintain their hip precautions.

GETTING INTO THE CAR
Be sure the car seat is all the way back. Keeping your operative leg forward, reach back and lower yourself onto the seat. Lean back into a semi-reclining position while you pivot your body and bring your legs into the car one at a time. Maintain your hip precautions and be careful to not twist your knee.


RECOVERY AT HOME

It is our goal for you to return home within three days after your surgery. If you require some extra recovery time or do not have the necessary resources for assistance and safety in your home, you may be referred to a skilled nursing facility or inpatient rehabilitation unit to continue your rehabilitation. 

Once you have returned home, you will either be referred to home health services or outpatient rehabilitation. These are important steps toward progressing your rehabilitation and it is highly recommended that you follow up with these services.

INCISION CARE & PREVENTING INFECTIONS

  • Check your surgical site daily for these signs of infection and notify your surgeon if you develop any of these signs:
    • Redness, tenderness, or swelling in the tissues surrounding the incision.
    • Swelling in your leg that is very warm to the touch
    • Persistent fever (higher than 101 degree)
    • Drainage that looks like “pus” or smells “bad,” or discharge that has changed in color or odor.
  • Increased pain with both activity and rest that is not controlled by pain medications.
  • Keep your incision and dressing clean and dry. It is important to follow your physician’s instructions for your dressing changes.
  • Wash your hands with soap and water or use a hand sanitizer before and after dressing changes.
  • Check with your surgeon before returning to recreational activities (examples: camping, beach activities, etc.).
  • Your incision may have staples which will be removed 10-14 days after surgery.
  • It is normal to feel some numbness in the skin around your incision.
  • Please wait to shower until cleared by your physician. (Usually 10-14 days after surgery).
  • Do not soak your incision in water (no baths, hot tub, pool) until it is thoroughly sealed, dried, and scab free.
  • Eating a healthy diet will aid in the healing of your incision and prevent infection.
  • Do not apply any lotion, oils, or balms to your incision unless you are told to do so by your healthcare provider.
  • Be sure to mention that you have had a joint replacement when planning to have a future dental or surgical procedure.
  • Your incision may have staples which will be removed in 10-14 days. You may feel some numbness in the skin around your incision.
  • No showering until indicated by your physician.
  • Avoid soaking the wound in water (no baths) until the wound is thoroughly sealed, dried, and scab free.
  • Eating a healthy diet will aid in the healing of your incision and prevent infection.

Be sure to mention that you have had a joint replacement when planning to have a future dental or surgical procedure.

MEDICATIONS

  • Continue your medications at home as prescribed by your surgeon and primary care physician. A list of medications that you will be taking at home will be given to you prior to discharge with instructions. (Remember, it takes about 30-45 minutes for pills to take effect, so do not wait until the pain is too severe). If you have any questions about your medications, please call your physician.
  • You will receive prescriptions for medications. Take pain medications as prescribed as needed for pain. Your pain medication may cause some constipation; a stool softener or fiber may help with this side effect.

BLOOD CLOT PREVENTION
A blood clot, also known as a Deep Vein Thrombosis (DVT), can occur during the first several weeks of your recovery. It commonly occurs in the calf, back of the knee, or thigh, and can potentially travel to the lungs. This is known as a Pulmonary Embolism (PE). You will be given step-by-step verbal and written instructions to prevent this from happening and to know the signs and symptoms of a possible DVT or PE.

To reduce the risk of blood clots:

  • Continue wearing TED hose as instructed until your follow-up appointment with the doctor. Remove them once a day to inspect your skin for breakdown (if necessary, apply lotion and replace stockings).
  • Keep your feet and legs moving: Pumping your feet up and down and squeezing your thighs throughout the day helps keep blood circulating in your legs.
  • Be mobile. Do not sit for long periods without moving or changing position.
  • Take your blood thinners as prescribed and complete lab tests if indicated.

Warning signs of possible blood clots in your leg include:

  • Increased pain and/or swelling in your knee, calf, ankle or foot.
  • Exquisite tenderness and/or redness above or below your knee. The area is quite warm to the touch.

***Notify your surgeon’s office immediately if you develop any of these signs or symptoms.***

Warning signs that a blood clot has traveled to your lungs include:

  • Sudden shortness of breath.
  • Sudden onset of localized chest pain.
  • New cough with possible blood or blood streaks in sputum.
  • Dizziness or lightheadedness.
  • Rapid heart rate.

***Seek medical treatment immediately if these signs or symptoms occur.***

Please call your surgeon or home health provider if you:

  • Fall or hit your head.
  • Have unusual bleeding that does not stop.
  • Have bleeding when you brush your teeth.
  • Have pink, red or dark brown urine.
  • Have excessive nosebleeds.
  • Vomit blood or material that looks like coffee grounds.
  • Have blood in your stool or your stool is dark or black.
  • Have faintness, dizziness or unusual weakness.
  • Have skin discoloration or bruises that appear suddenly or continue to enlarge.
  • Have not had a bowel movement for more than 5 days.

EXERCISES

  • Once home, continue with the exercises assigned to you by the Physical and/or Occupational Therapists at the hospital.
  • In most cases, a home health Physical Therapist will come to your home the day after you get home from the hospital. They will help progress your exercise program until you are ready to start physical therapy in the outpatient setting.
  • Practice walking as normally as possible WITH the use of an assistive device like a walker, crutches, or a cane.
  • Moving in/out of bed, getting up from chairs, and walking are great opportunities to develop “functional” strength.
  • If you have a hip replacement, remember to adhere to your precautions in order to keep your hip in a safe position.
  • If you have a knee replacement, try to straighten and bend your knee as much as you can.

GETTING IN AND OUT OF BED
When in bed:

  • Maintain hip precautions.
  • Keep pillow between your knees if you are rolling from side to side.

When moving from sitting to standing:

  • Move to edge of chair/bed.
  • Put affected leg forward.
  • Put one hand on the assistive device and one hand on the chair/ bed.
  • Push with arms and non-surgical leg.
  • Bring your nose over your toes and stand up tall while maintaining any weight bearing restrictions and/or hip precautions.

FALL PRECAUTIONS
Although your total joint replacement is very sturdy, it is normal for your balance, strength and reaction times to be diminished after surgery. Thus, it is very important to continue using your assistive device (walker, crutches, or cane) to help prevent falls. Your Physical Therapist will ensure proper use of the assistive device and also determine when, and if, it is no longer needed.

It is recommended for you to prepare your home for your recovery prior to your surgery. This will make it easier, safer, and more comfortable for you to get around after your surgery. An Occupational or Physical Therapist will call you prior to surgery to discuss your home environment and answer any questions you have regarding fall prevention tactics.

TO REDUCE THE RISK OF FALLS:

  • Review the home preparations list on page 6 to complete prior to surgery and ensure that they have been completed.
  • Remember to wear non-skid shoes and use your assistive device when walking.
  • Maintain proper lighting in areas.
  • Do not use bath oils in the shower.
  • Know where your pets are any time you are walking.
  • Use adaptive equipment, such as reachers, as instructed by your Occupational Therapist.

DAILY ACTIVITIES
It is important to resume your normal daily activities as soon as possible. However, seemingly small tasks such as getting dressed, brushing your teeth or making a small meal can often be very taxing. Set activity priorities during your first week(s) home and eliminate unnecessary tasks. Your body is recovering and needs ample rest time. Allow others to help you for the first few weeks.

BATHROOM
Survey your bathroom for safety and ability to maneuver.

  • A Commode over the toilet or at the bedside may be helpful.
  • Walk-in showers may work the best if you have one available, since you can use your walker or crutches for stability.
  • A shower chair or tub bench may be purchased to allow you to sit while you bathe.
  • Grab bars in the shower can help with your balance while getting in and out.
  • Pick up any throw rugs.
  • A non-slip mat or grip strips in the shower decreases the risk of slipping.
  • A handheld showerhead will make bathing easier from a seated position.
  • Pick up any throw rugs or bath mats until they are ready for use.

BATHING
Check with your surgeon as to when you can begin showering. Baths are not recommended until your incision is fully healed.

  • Remember to maintain your hip and fall precautions.
  • Utilize the long handled sponge to reach your feet.
  • Remember not to use bath oils while showering.
  • Do not submerge or scrub your incision

***Talk with your occupational therapist about your home environment.***

MEALS

  • Eat a healthy diet to help you heal, feel better, have more energy, and attain a desirable body weight. Follow a special diet if your physician has prescribed one for you.
  • Hopefully, you have prepared some meals ahead and placed them in the freezer. Do not place meals on low shelves.
  • Plan easy meals that do not require a lot of time or effort. It may be hard to stand for long periods of time in the first week or two after your surgery.
  • Allow friends and family to provide meals for you. It will allow them to feel good about helping you and will make your life easier.
  • Arrange work spaces for convenience. Place utensils and pots near the stove.
  • Have someone else retrieve items from bottom or top shelves if you have not done this prior to surgery.
  • Use countertop appliances whenever possible to avoid bending and reaching.
  • Slide objects or use a utility cart to move objects from one place to the other.

SHOPPING

  • Plan menus and make a shopping list.
  • Avoid frequent trips.
  • Shop when the stores are less busy.
  • Take someone with you to help.
  • Park close to the cart stall and take a cart into the store with you.
  • Use the motorized carts if you are easily fatigued.

HOUSEKEEPING

  • Arrange for assistance with larger household chores (vacuuming, sweeping, mopping, and laundry).
  • Do not perform heavy lifting for 6-8 weeks.

DRIVING
Your surgeon will advise you when you should resume driving. You should not experience pain when you apply pressure to the brake or acceleration pedals nor should you drive if you are still taking narcotic pain medications. Talk with your surgeon at your follow-up appointment about your readiness to drive safely.

For information on temporary disabled parking placards/stickers contact your local DMV for requirements and forms. The process may take some time to complete, so we suggest beginning the process as early as possible.

TRAVEL

  • Your new joint may activate metal detectors in airports or other buildings. If this is the case, tell the security agent about your joint replacement.
  • You may speak with your Surgeon’s office to obtain an identification card that confirms that you have a joint replacement.
  • Do not sit in one position for long periods of time.
  • Make frequent stops and stretch your legs if you are traveling by car (every one to two hours).
  • Periodic movement of feet, including foot pumps, will help with circulation and reduce pain and swelling.

WALKING
Walking helps build a more normal and more comfortable stride. It also helps build strength and helps reduce the risk of blood clots.

Begin by walking 3-5 minutes every 2-3 hours throughout the day.

Gradually increase the frequency until you are walking 3-5 minutes every hour. Once you reach this benchmark, begin extending the length of time you are walking.

RETURNING TO EVERYDAY ACTIVITIES

Within a few months after surgery, you will likely be back to your normal routine. This may include returning to work, depending on the type of work, and activities that you enjoy. Discuss with your surgeon those activities that you want to resume.

SEXUAL ACTIVITY
Talk to your surgeon about when you can safely resume sexual intercourse. It is important that you communicate with your partner about your joint replacement and the limitations that you may have, such as bending your knee or precautions for your hip.


Total Joint Replacement Handbook