Total Hip and Knee Replacement

The Integrated Care Program

Weoffer a unique approach–ourIntegrated Care Program -- to prepare and care for patients who are undergoing total joint replacement surgery. The Integrated Care Program is a team approach. It includes your surgeon and healthcare team, a Specialty Care Coordinator, and you. Most patients who have undergone joint replacement surgery at our care facilities have been managed through our Integrated Care Program. Patients who become active partners in their own care achieve better outcomes. By participating in the Integrated Care Program, patients experience:
  • Shorter hospital stays
  • Lower infection rates
  • Shorter recovery with early return to activity
 

How Does The Integrated Care Program Work?

Your surgeon and healthcare team evaluate and address your individual needs and develop a customized care plan. A Specialty Care Coordinator will work with you to help you prepare for surgery, ensure your plan of care is completed and, if necessary, assist with your discharge and follow-up care. This caregiver will be a key contact for you and your family before, during, and after your surgery and hospital stay.  

Pre-Operative Total Joint Education Class

The Integrated Care Program begins with an educational class for you and the individuals who will be assisting you through your surgical preparation and recovery. During class you will receive useful information about your surgery and recovery. You will also have the opportunity to ask questions. A schedule of total joint classes is regularly updated on the website.  

Overview of Total Knee Replacement

Total_Knee_Replacement_1The knee joint is the largest joint in the body. It is the “hinge”joint of the leg. It’s the joint that allows the leg to bend and straighten. The knee joint is located at the meeting point of the thigh bone (femur) and the shin bone (tibia). The knee cap (patella) covers the area where the two bones meet. During total knee replacement surgery, the damaged part of your knee is removed and replaced with an implant. Implants are made of various materials: stainless steel, titanium,Total_Knee_Replacement_2 chrome, cobalt, or polyethylene. Bone cement may also be used in the repair. The choice of implants varies from person to person. Factors considered are your age, activity level, body type, and the amount and strength of your bone and bone tissue. Your surgeon will choose the implant that is best suited for your needs and lifestyle. During total kn ee replacement surgery, a relatively thin amount of bone is removed from the end of the thigh bone, the top of the leg bone, and the underside of the kneecap. This creates bone surfaces that allow the implant to have a good fit. Most of the major ligaments and tendons of the knee are left in place so that the knee can bend and straighten, yet remains steady in position from side-to-side and front-to-back.  

Overview of Total Hip Replacement

The hip joint helps us keep our balance and supports our weight in all of its movements. The upper end of the leg bone (femur) has a rounded head (femoral head) that fits into a socket (acetabulum) in the pelvis to form the hip joint. During total hip replacement surgery, the damaged part of the hip is removed and replaced with implants, called components. Your surgeon selects the components that are best for you based on your age, activity level, and body type.  

Preparing for Surgery

Exercise

Exercising, up to the day before your surgery, helps improve your strength, range of motion and endurance. This helps lead to a successful outcome and recovery. Talk with your surgeon about a referral to physical therapy if you would like help developing an exercise program.

Why is exercise so important for your recovery?

  • Strengthening exercises for the hip or knee joint improves recovery.
  • Upper body conditioning exercises help reduce muscle soreness and fatigue caused by the use of a walker crutches, a cane, or other aids.
  • A walking exercise program increases endurance, flexibility, and overall strength

Circulation Exercises

Although swelling is a normal response after surgery, circulation exercises help control swelling and prevent more serious complications, such as blood clots. Review and learn the circulation exercises (see Physical Therapy section) before surgery to make them easier to perform after your surgery.

Diet and Nutrition

Healthy eating and proper nutrition before your surgery aids the healing process.
  • Drink plenty of fluids and stay hydrated.
  • Eat more fiber to help avoid constipation (often caused by pain medications). Foods thatcontain fiber include corn, peas, beans, brown rice, lotus stem, carrot, cucumber, broccoli,porridge.
  • Eat foods rich in iron, such as lean red meat, dark green leafy vegetables, raisins, and prunes.
  • Eat foods high in Vitamin C to help your body absorb iron. Foods that are high in vitamin C include oranges, muskmelon, and tomatoes.
  • Make sure you are getting enough calcium, which is needed to keep your bones strong. Foods that are high in calcium include milk, cheese, yogurt, dark leafy greens, and fortified cereal.
Eat light meals, especially the day before surgery. The combined effects of anesthesia and your medication may slow down your bowel function. This can cause constipation after surgery.

Smoking and Alcohol Use

Smoking - Smoking causes breathing problems, increases the risk of medical complications, and slows recovery. Smoking also increases the risk of infection and blood clots after surgery. If you smoke, we encourage you to quit at least a few weeks before surgery. Alcohol Use - Before surgery, it is important to be honest with your health care providers about your alcohol use. Tell your health care provider how many drinks you have per day (or per week). This information helps determine if you are at risk for alcohol withdrawal or other alcohol-related problems that could occur after surgery and affect your recovery. We are here to help you prepare and recover from your surgery as quickly and safely as possible.

Diabetes Guidelines and Blood Glucose Management

Managing your blood glucose is always important, but it is extremely important before surgery. In fact, managing your blood glucose before surgery can help reduce the risk of problems after surgery, such as infection and other complications. Surgery can affect your blood glucose control in many ways. Stress before and after surgery can cause your body to release hormones that may make it more difficult to manage blood glucose levels. Surgery can also affect your normal diet, and may change your usual medication routine. Your diabetes will be managed throughout the entire surgical process, starting with a thorough review during the pre-operative testing and continuing through the post-op period.

Medications

Some medications thin your blood, increase the risk of bleeding after surgery, or interfere with healing. These medications may need to be stopped before surgery. If you take medications that contain aspirin, blood thinners (such as warfarin, [Coumadin®]) or arthritis medications, ask your surgeon when to stop taking these medications. Because blood-thinning medications affect clotting and bleeding, these medications (plus all your other medications) will be reviewed with you either at your pre-admission visit or by your surgical team. If you have any questions about your medications, please contact your surgeon’s office.

Home Safety Preparation

Setting up your home for your return before you have surgery will help keep you safe, make your life easier, and aid in your recovery. Listed below are suggestions for preparing your home for a safe recovery.

Traffic pattern

Move obstacles –such as throw rugs, extension cords, and footstools –out of your walk way. Create a wide, clear path from your bedroom to your bathroom and kitchen so you can easily move about with a walker or crutches.

Bathroom

You will likely need an elevated toilet seat or commode and a shower chair.

Sitting

Sit in chairs that keep your knees lower than your hips. Choose a firm, straight-back chair with armrests. A dining room chair may work if you don’t have other chairs. Add a foam cushion or folded blanket if you need to raise yourself up, but avoid sitting on a soft pillow. Also, avoid sitting in rolling chairs or recliners.

Children and Pets

Small children and pets can pose a safety hazard. Small children may need to be taught how to interact with you in ways that keep you safe. If you have pets, make arrangements to keep pets in another area of the house when you arrive home.

Access to Items

To avoid reaching or bending, keep frequently used items within easy reach, especially in the kitchen, bathroom, and bedroom, for example, food, medications, phone. It’s a good idea to carry a cell phone or portable phone with you at all times during your recovery.

Stair climbing

It’s okay to climb stairs without assistance, if you are able. However, you may need help with climbing stairs when you first get home. Consider installing handrails or make sure existing handrails are secure.

Driving

Absolutely do not drive while taking narcotic medications. Do not drive until you have regained the range of motion, strength, and reaction time needed to drive safely.

Pre-Admission Testing

A pre-operative work-up is mandatory for all joint replacement patients. At this visit, you will be asked about your medical history, previous surgeries, illnesses and current state of health. You will also undergo a series of tests, such as lab work, urinalysis, nasal swab, X-ray, ECG and / or stress test.

The Day Before Surgery

You should receive a call from the surgeon’s office to confirm your procedure and the time you need to arrive at the hospital. You will be told which medications to take the morning of surgery with a small sip of water.

Do

  • Remove nail polish.
  • Shower and wash your hair the night before. Bathing helps reduce the amount of bacteria on the skin and may lessen the risk of infection after surgery.•Sleep in clean pajamas or clothes.
  • Sleep on freshly laundered linens.
  • Get a good night’s sleep –it’s important to be well-rested before surgery.

Do Not

  • Do NOT eat or drink anything after the time you were instructed; ice chips, gum, or mints are NOT allowed.
  • Do NOT use lotions or powders.
  • Do NOT shave before surgery.

The Day of Surgery

On the day of surgery, you must remember several important things:
  • Take only the medications you have been told to take; take them with a small sip of water.
  • Comply with the strict instructions about food / beverage consumption.
  • Do not wear make-up or jewellery.
  • Do not take insulin unless otherwise instructed.
  • Do not take your oral diabetes medication (pills) on the morning of your surgery.

Just before surgery

  • You will be asked to empty your bladder.
  • Any glasses, contacts, hearing aids, or dentures will be removed before surgery and returned after surgery.
  • Advanced directives will be noted.
  • You will have your vital signs checked (Vital signs are your heart beat rate (pulse), breathing rate, body temperature, and blood pressure).
  • Your operative site will be prepped and the surgeon will review the procedure.
  • An intravenous (IV) line will be started to give you fluids and medication.

Anesthesia

The anesthesiologist or nurse anesthetist will talk with you about the types of anesthesia used during surgery. General Anesthesia puts you to sleep following an injection of medications into your IV. You will not feel pain and will be completely asleep throughout your surgery. Regional Anesthesia numbs a part of your body with an injection of local anesthetic. For total joint replacement surgery of the knee and hip, regional anesthesia may involve injections into your back or around the nerves in your leg or hip. You will be awake but will not feel any pain.

The Surgery

Your surgery takes about one to three hours to complete. While you are in the operating room, your loved ones may wait in the waiting room. The surgeon or representative will speak with your family while you are recovering.

Right After Surgery

You will recover in the Post-Anesthesia Unit (HDU) and be cared for by a nurse before being taken to your hospital room. The average time in this unit is about two hours. While here:
  • Your vital signs will be checked.
  • You will be asked questions to determine if anesthesia is wearing off.
  • Your pain medications will be started.
  • You will be warmed with blankets if you are cold.
  • You will be given oxygen to help you breathe (if needed).
  • You will wear compression sleeves on your lower legs to help prevent blood clots.
  • Your surgical site will be wrapped with a cold pack to reduce swelling and pain.
  • You might have a urinary catheter placed to empty your bladder.
  • You may have an x-ray taken of your joint replacement.
 

Your Hospital Stay

After your stay in the HDU (few hours to a day), you will be moved to your room. It is normal to drift in and out of sleep until the anesthesia completely wears off. Because it’s important to rest as much as possible, we encourage friends and family to limit their visits. While in your hospital room, your nurse will:
  • Monitor your vital signs frequently.
  • Check your incision.
  • Give IV fluids and antibiotics.
  • Check your urinary catheter (if one is present).
  • Check your oxygen level.
  • Help you use an incentive spirometer (this breathing device helps keep your lungs clear and helps prevent pneumonia).
  • Assess blood clot prevention, administer oral blood-thinning drugs, and assist with getting out of bed and starting to walk.
  REMEMBER: Do not get out of your bed without assistance. Although getting up on the day of surgery aids in your recovery and helps prevent complications. You MUST not do so without assistance. Within 24 hours after arriving to your hospital room you will receive a visit from a physiotherapist to begin mobility exercises. You may also receive a visit from:
  • Your surgeon or his assistant •A medical doctor
  • An anaesthesiologist•Your Specialty Care Coordinator
A physical therapist or nurse will help with bedside activities.