Total Joint PREP Class
Knee Replacement
T. Andrew Israel, MD
Luther Midelfort Orthopaedic &
Sports Medicine Center
Goals for you and your family
attending this class



Recognize knee replacement is a
reliable operation to relieve pain and
restore function.
Describe what to expect of the knee
replacement procedure.
Discuss the risks of knee replacement
surgery.
Goals of your knee
replacement




Improve your quality of life
Relieve your pain
Restore function (knee movement,
alignment)
Increase activity
Knee Arthritis
Loss of
cartilage leads
to narrowing
of the joint
space.
See the bone
spur
formation?
Knee Arthritis
As the
cartilage
wears, bone
spurs develop
which can
cause
stiffness
Surgical Technique
-Resurface the bony
surfaces with metal
and plastic
-Balance the
ligaments
-Restore alignment
and motion
(straighten the leg)
Implant materials
Metal and plastic are used

The metal is usually a cobalt-chrome
alloy.

The plastic is UHMWPE or “poly”.
Implants
-The end of the femur
is capped with a metal
component.
-The end of the tibia
may have a metal
plate or plastic.
-A plastic spacer goes
between the metal cap
and plate.
Implants
If the back of the
kneecap is worn, it is
resurfaced with a
plastic button
Surgical Technique
Incision

Made in front of the knee, usually from above the
kneecap down to bump on shin bone

Length of the incision depends on the thickness of
soft tissue

Surgeon will make the incision long enough to see
the area around the knee

Surgical techniques continue to improve as
technology advances

Surgeon will use techniques to spare muscle
Day of Surgery




Your surgeon will meet you in SurgiCenter to
initial your knee and answer final questions.
Family can wait with you in the SurgiCenter.
You will go to the Operating Room (OR) first,
then to Recovery (PACU).
Surgery lasts 1-2 hours, recovery 1-2 hours.
Finally, you will go to the Med-Surg Unit 4500.
Post-op
Therapy




Physical & Occupational Therapy is important for a
good outcome.
Your participation will improve your result
You may have a machine that bends the knee –
called a CPM.
Therapy starts the day after surgery
 Get you out of bed
 Bend the knee!
 Straighten the knee!
 Walk with a walker
Other Doctors




Additional Doctors take care of nonorthopedic issues (such as high blood
pressure or diabetes).
If you have an Internal Medicine doctor here
they will see you after surgery.
If your regular doctor does not see patients in
the hospital, a Hospitalist will see you after
surgery.
If you are not getting a medication you think
you should, please ask.
Blood Clot Prevention




You are at risk of a blood clot after knee
surgery.
You will receive medication (warfarin or
aspirin) after surgery to prevent blood clots.
TED hose should be worn for 3 weeks after
surgery, you may remove these at night.
SCD (calf squeezers) are used when you are
in the hospital and should be worn whenever
you are in bed.
Risks of Surgery
Blood Clots

High risk (>20%) if no treatment

Clots can go to the lungs and be fatal

Your risk is reduced to <1% if treated with
medication, squeezers

Getting out of bed and walking helps to
prevent blood clots
Risks of Surgery
Infection





You will get antibiotics at the time of surgery
and for 24 hours after surgery.
Surgeons, assistants and scrub techs wear
“spacesuits”.
Using all precautions, risk of infection is ~1%.
Infection may occur months or years after
surgery.
An infection may mean removal of your
implants.
Risks of Surgery
Blood loss





Tourniquets are used during surgery.
There may be some bleeding into the knee
after surgery.
Your surgeon may use a drain in the knee
and give you some blood back.
Your blood count will be checked each
morning after surgery.
If you have symptoms from a low blood count,
you may need a blood transfusion.
Risks of Surgery - Stiffness





It is painful to move the knee after surgery
and some people get stiff.
You need to work hard to prevent stiffness.
Work on both getting the knee straight (0
degrees) and bending the knee (90 degrees.)
Goal is more than 90 degrees flexion by the
first week
If you have limited motion at 6 weeks, your
surgeon may need to perform treatment
under anesthesia.
Risks of Surgery
Need for Revision




We encourage patients to wait as long as
possible before knee replacement.
Implants wear with time…
~90% of implants last 12 years
Revision surgery may involve changing the
plastic or changing one or both metal parts.
Revision surgery is more challenging with a
more difficult recovery.
Risks of Surgery
Medical Complications

Surgery is a stress to your body.

Heart and lung problems, stroke, stomach
problems, constipation all may occur.

A physical with your regular doctor and an
EKG are required before surgery.

Despite precautions, unforeseen medical
complications may still occur.
Risks of Surgery
Anesthetic Complications

You will meet the Anesthesia providers the
day of surgery.

They will discuss anesthetic options such as;
general, spinal, epidural, nerve blocks.

Nausea and vomiting are common but more
serious side effects or complications may
occur.

Please tell the anesthesia provider of any
past experience with anesthesia.
Summary

Knee replacement is a reliable operation to
relieve pain and restore function.

As with any operation, there are associated
risks.

All of the precautions we take are to minimize
risk and provide for a “routine” operation.

The purpose of this talk is to provide you with
information about knee replacement.
Questions or Concerns?
Joint PREP Class
Patient Resource and Education Program
Goals for you and your family
 Discuss steps to take to get ready for the
surgical procedure.
 Discuss what to expect of the surgical
experience.
 Identify what you need to do to achieve the
best outcome.
 Recognize why it is important for you to
participate in your plan of care.
Plan Ahead








Finish any planned dental work at least 2 weeks
before your surgery date.
Plan for your return home.
Identify who will take care of you after surgery.
Plan for about 2 weeks.
Simplify meals. Plan for 2 weeks of easy or no
preparation meals.
Prepare your home now- take notes today
and get started!
Plan Ahead
 Appointments:



Regular doctor for pre-surgery;
Blood work, EKG, Physical exam, discuss medications.
Surgeon for final discussion and update.
 Stop smoking – talk to your regular doctor to
get help.
 Call your surgeon if you get a fever, cold,
infection or rash before your surgery date.
What to bring to the hospital









Loose comfortable clothing
Comfortable nonskid walking shoes
Personal items
Copy of your advanced directives
Insurance cards
Medication list, inhalers, C-PAP mask
Any assistive devices you have
Prepaid long distance calling card (optional)
Your Total Joint Replacement information folder
What not to bring to the hospital
 Valuables/Jewelry
 Credit cards, check book or large sums of
money
 Your medications (except inhalers)
The day before surgery
 A SurgiCenter nurse will call you to:






Review your medications
Tell you what medications to take and not take the
day of surgery
Update your health history and review allergies
Review eating, drinking and smoking restrictions
Give hygiene instructions
Tell you what time to arrive at Luther Hospital
Day of surgery
 Take medications
 at home as
 instructed.
 Check in at
 Luther Hospital
 Registration
 Desk.
Day of Surgery
(continued)
 You will be taken to the SurgiCenter
 You will be asked your name and date
of birth by everyone who has contact
with you – this is done for your safety.
 Family and Friends are welcome. Try
to limit to 2 people on day of surgery.
SurgiCenter
 Nursing admission in the SurgiCenter- We will ask
you many questions and discuss your:




Medical history
Plan of care
Rights and
Responsibilities
Safety
 Anesthesia visit
 Surgeon visit
SurgiCenter (continued)
 If ordered for your surgery: blood work, x-
rays, clip hair at the surgery site.
 Your personal items are stored and later
taken to your hospital room.
 Leg squeezers (SCDs Sequential
Compression Devices) and TED hose are
applied.
Leg Squeezers – SCDs
Going to the Operating Room
Operating Room (OR)






Monitors
Antibiotics
Anesthesia
Surgical scrub
Foley catheter
Time in operating
room area
 OR Staff will
communicate to
your family if the
surgery is 2-3 hours
Recovery Room/Post Anesthesia
Care Unit (PACU)
 You will be in recovery
for about 1 hour.
 You will have Monitors
and Oxygen on
 Your nausea and pain
are monitored and
controlled
 When you are ready, you
will be transferred to a
hospital room.
Arrival in your Hospital Room
You will have…
Oxygen – to help breathing and healing
A foley catheter – to measure urine output
An IV – to give you fluids and medication
Incentive spirometer – to encourage you to
take deep breaths to prevent congestion in
your lungs.
 A pulse oximeter – a device that fits on your
finger to measure blood oxygen level





Pulse Oximeter
Arrival in your Hospital Room
(continued)
 We will check on you,
take your vital signs
 Start your Nutrition
 Activity as you tolerate
 Work together with you
to keep you safe.
 Help you with control of
pain and nausea
Pain Management
 It is vital for you to describe your pain and
where it is located.
 Rate your pain: The Pain Scale
0—1—2—3—4—5—6—7—8—9—10
NO
PAIN
MODERATE
PAIN
WORST
POSSIBLE PAIN
 We must work together to treat your pain-what
makes it better/worse?
 Using medication, deep breathing-relaxation,
distraction, position change are some ways to help
manage pain and discomfort
After Knee Surgery
 We will care for your skin and incision
 You may have a drain in your knee
incision area
 You may have a Cryo Cuff or ice pack
on your knee
 You will have a continuous passive
motion (CPM) machine
Continuous Passive Motion
Machine (CPM)
Post operative day ONE
 Blood work
 Medication

Pain control *Anticoagulation – Warfarin
 Catheter and drain removed.
 Nutrition as you tolerate
 Activity-Physical Therapy and Occupational
Therapy
 Work together to keep you safe.
 You are a Partner in your care!
Post operative day TWO plan
 The person who will be taking care of you after you go
home needs to come to the hospital to learn about:




Safety
Incision care
Activity – Physical and
Occupational Therapy
Medication for pain control
and anticoagulation
Day THREE/Discharge day.
 Prepare for discharge to home or transitional care
unit.
 The person who will be taking care of you after you
go home needs to come to the hospital again to
learn about and get discharge instructions for:






Incision care
TEDS and how to keep swelling down
How to take pain medications correctly
Anticoagulation – Warfarin and blood work
Antibiotic coverage card
When to contact your Surgeon
 You are a Partner in your care!
Elevation of your leg
 Elevate knee
above hip
 and toe above

knee
 to decrease
swelling and
pain
After Discharge
 A person to care for you will need to be
available 24 hours a day to:



assist you at home the first two weeks
drive you to appointments
encourage you in your therapy and progress
Bathing
 You may shower when your incision is dry (no
drainage)
 Place a new dressing on the incision after
shower
 Do not submerge the incision in a bathtub,
pool, hot tub, etc, until the incision is
completely healed
Driving
 Talk with your surgeon about when you
will be allowed to drive again.
 You must be:



off narcotic pain medicines to drive
able to sit in car comfortably
able to move foot from gas to brake pedal easily
 You need a valid driver’s license!
 Practice in a safe area.
A Follow-Up Appointment with your surgeon
will be made 10-14 days after surgery
 At your appointment we will:
 Remove your staples
 Give you care instructions about your:






Incision
Bathing
TEDS
Assistive devices
Medications – warfarin and pain control
Joint replacement - dental procedures and antibiotics
Questions or Concerns?
Start getting ready for surgery.
Make your plans.
Watch the Total Joint Replacement Video at
www.luthermidelfort.org
Click on Medical Services,
then Orthopedics Center
Thank you!
Joint PREP
Physical Therapy
Total Knee Replacement
Home Preparation
• Become familiar with
exercise handout
• If you have a walker,
practice using it and make
sure you can get through
your house with it.
Physical Therapy
 Your therapy will start the day after
your surgery
Activities include getting into a
chair, walking and working on the
exercises
Therapy will continue twice daily
until goals are met or you are
discharged from hospital
Therapy Goals
1. Independence with
mobility
Includes in/out of bed,
getting out of a chair,
walking and stairs
2. Independence with an
exercise program to
continue at home
Therapy Goals Cont’d
3. Learn appropriate use of walking
devices such as walker/crutches
Can bring your own to hospital to make
sure it’s sized correctly and get familiar
with it’s use
Goals Continued
4. Your family member or friend
should be available on the 2nd or 3rd
day after your surgery to become
familiar with the exercises and any
assistance that you will need at
home.
Gaining full knee
Range
of
Motion
extension
(straightening)
Is
KEY!
Range of Motion cont’d
Goal is 90 degrees
of flexion (bending)
by the
end of the
hospital stay
Range of Motion
CPM
(continuous passive
motion)
You will use this machine
while in the hospital
Exercise after Discharge
• WALK!
• Continue with exercises from
hospital
• Outpatient PT if ordered by your
surgeon
Questions or Concerns?
Rehabilitation Services
Joint PREP
Occupational Therapy
Why Occupational Therapy?
• Your occupational
therapist (OT) is
trained in the field
of rehabilitation
and is concerned
about your safety
in performing
activities of daily
living
Activities of Daily Living
• Your OT will show and teach you ways to
safely do your daily tasks
-Dressing
-Bathing
-Toileting
• Your goals for OT include:
-Increased Independence
-Increased Strength
-Increased Mobility
Adaptive Equipment
• Your OT will help you order/purchase
adaptive equipment if it is needed to
assist you with dressing and bathing
-Reacher
-Sock aid
-Long-handled shoe horn
-Dressing stick
-Elastic shoelaces
-Long-handled bath sponge
-Tub/shower chair or transfer bench
-Raised toilet seat
Before surgery…
• Prepare your home with safety in
mind
-Remove throw rugs and clutter
from traffic paths
-Rearrange your kitchen so you can
easily reach often-used items
-Install grab bars in bathrooms
In the hospital…
• Occupational therapy will begin the
day after your surgery
• You will be seen by your OT once a
day
Day One
• Your OT may…
-Learn about your home set-up and
help available to you at home
-Begin home safety instruction
-Discuss home equipment needs
-Instruct you in an upper body
exercise program
Day Two
• Your OT may…
-Practice with adaptive dressing
equipment
-Order dressing/bathing equipment
as desired
-Review upper body exercise
program
Day Three
• Your OT may…
-Work with you on safety with room
maneuvering
-Help you practice getting in and
out of a tub with the use of a tub
bench or chair
-Encourage you to participate in a
bathing/dressing session to
determine the level of assistance
you may need
When you leave the hospital…
• Keep SAFETY in mind!
• Stay ACTIVE and INDEPENDENT!
Questions or Concerns?
Thank You!
Joint PREP
Social Services and Case
Management
Department Role
• Social Services and Case
Management staff can assist with:
-Insurance concerns
-Home Health Services
-Skilled Nursing Care
-Community Services and referrals
-Power of Attorney for Health Care
-Counseling and Advocacy
Insurance Assistance
• Once you and your Doctor decide
you will proceed with surgery you
should :
-Pre-register at the front counter
-Notify your insurance company
-Get your insurance company’s
approval.
Insurance Verification continued
• Insurance plans vary in what is
required to authorize your surgery.
• Our insurance notification may not
be enough. Some plans require you
to call too.
• Many Medicare Advantage plans
require prior authorization.
• Your insurance company may take
15-30 days to complete this process.
During your stay
• Doctor decides when you are ready
for discharge to the next level of
care.
• The next level of care might be:
‫־‬home with or without Home Care
‫־‬Nursing home
‫־‬Rehabilitation Hospital
‫־‬Transitional Care Unit/Swing Beds
During your stay
• The usual hospital stay is 3 nights
and 4 days.
• Talk with your Case Manager about
services you want after discharge as
soon as possible.
• Check your insurance to see if it
limits who you can use.
Options for continuing care once you
can leave the hospital
1. Transitional Care Units or Swing
Beds
2. Skilled Nursing Facilities
3. Home Care options
4. Home with outpatient services.
Transitional Care Units
• Bloomer, Barron and Osseo
Transitional Care Units are owned by
Luther Midelfort .
• Other Transitional Care units include
Durand, Stanley, Spooner, Hayward,
and Medford to name a few.
• Medicare pays for your transitional
care stay like it would if you went to a
nursing home.
Continuing Care Discharge Options
• Transitional Care Units (also referred
to as Swing Beds) provide continued
skilled nursing and rehabilitation
care after your hospital stay.
• Can provide closer medical
monitoring and more intensive
rehabilitations therapies than regular
nursing homes.
Nursing Homes (skilled nursing
facilities)
• Area nursing homes offer a range of
services from short term rehabilitation
stays to long term medical and residential
care.
• Eau Claire area skilled nursing facilities
include:
Clairemont
Dove
Oakwood Villa
Syverson
Other nursing homes include but not
limited to:
•
•
•
•
•
•
•
•
•
•
Chippewa Manor-Chippewa Falls
Wissota Health and Regional Vent Unit-Chippewa Falls
Cornell Care Center- Cornell
American Lutheran Home-Mondovi/Menomonie
Hetzel Care Center-Bloomer
Dunn County Health Care Center
Colfax Area Nursing home-Colfax
Dallas Health Care-Dallas
Pepin Manor-Pepin
Spring Valley Nursing Home- Spring Valley
Medicare Skilled coverage
• Medicare requires the following to
pay for your nursing home or
transitional care stay:
1.You have a skilled nursing or
rehab need (PT/OT)
2. You participate in therapies and
show progress.
3. That you have a qualified 3 day
stay at a hospital.
Home Care options
• Medicare will pay for home care services:
-if you are homebound
-if you have skilled nursing needs.
-if you have skilled therapy needs.
Medicare does not pay for:
Help with meals, grocery shopping, etc.
Shopping
Personal Care (bathing, dressing, etc.)
Housekeeping services
What are Advance Directives?
• Written documents that tell your Doctor
what you want for care when you are
unable to speak for yourself.
• Allow you to describe the type of medical
treatment you would like to receive or not
receive.
• Allow you to identify the person you wish
to be your decision maker if you are
unable to make your own decisions.
How do you get an Advance Directive?
• Luther Hospital Social Services
• Luther Hospital Chaplaincy
• Your personal attorney
2 types of Advance Directives
• Declaration to Physicians or Living
Will
• The Power of Attorney for Health
Care
Power of Attorney for Healthcare
• With this document, you appoint a family member
or friend to follow you wishes and act as your
health care agent.
• Your Health Care agent will make decisions for
you only when you are unable to make your own.
• This document is recommended because it is
much more flexible that the Living Will and gives
health care providers a person to discuss your
wishes with.
• This document also lists what you want in
different situations when you are unable to speak
for yourself.
Safekeeping of Advance Directives
• You should always keep the original document.
• Copies can be given to family members.
• A copy can be brought to your doctor’s office or
to the hospital to be kept in your medical record.
• It is important that you discuss your wishes with
family and friends close to your.
• Decision making becomes easier when these
discussions have taken place and your wishes
are clear.
Questions or Concerns?