Reasons for deciding to have
Joint Replacement
 Improve quality of
living
 Tired of living in pain
 Not being able to do
things you like to do
NORMAL AND ABNORMAL XRAYS
Preoperative testing
 Need clearance from Primary Care Physician
 They will send you for blood work, EKG, CXR,
urinalysis, and sometimes other tests
 Must be within 30 day window of surgery date
 Some of you will be asked to donate your own
blood- GBMC’s Blood Donor Room phone #
443-849-2817. Call for an appointment.
10 days before surgery-page 24
 Stop taking Aleve, Ibuprofen, Motrin, Advil, Aspirin
products. Tylenol is okay to continue using
 Stop taking Vitamin E
 Stop taking herbal products
 If taking Coumadin, Plavix, or other blood thinners,
talk to your prescribing physician about what to do
with these medications
24 hours before surgery
 If you are taking Avandamet, Actoplus, Glucophage,
Metforman, or Glucovance – STOP TAKING 24
HOURS BEFORE SURGERY! These medications can
cause your surgery to be cancelled if taken within this
time period.
 If you are on insulin, talk to your prescribing physician
about how many units they want you to take the
evening before surgery
Night before surgery
 NPO after midnight – no eating or drinking except in
the morning you may take your blood pressure, or
cardiac medications with a sip of water (if instructed
to do so by your physician)
 If you keep a drink on your bedside table, remove it
before you go to sleep. Old habits are hard to break!
 No chewing gum or mints
Morning of Surgery
 Blood pressure/Cardiac medication- Talk to your primary
care or cardiologist to discuss which medications you should
take in the morning of your surgery. Typically, they will get you
to take them with a sip of water depending on the medication.
 Heartburn or ulcer medicine- acid blockers (Zantac, Pepcid,
Axid, Prilosec, Propulsid, Reglan) should be taken on the
morning of the surgery to reduce the risk of aspiration
pneumonia. Antacids like Maalox, Tums, or Carafate should
NOT be taken because they contain particulate material that
may damage the lungs if aspirated.
Day of Surgery
 Bring with you to the hospital – anything your surgeon
has asked for you to bring, medication list, green
blood donation cards (if donated blood)
 Be at the hospital 2 hours before your surgery time
 Follow directions on the purple hand-out in your
packet to admitting area
Pre-op area
 Turn in the paperwork that you brought with you
 You will be given a hospital gown to change into
 Meet your surgical team – surgeon, nurse,
anestheologist, tech
 Many questions will be asked – “Do you know why
you are here?” Don’t panic, they do know. They
want to make sure you are in agreement to what
procedure is being done
 Vital signs and IV will be started
Preventing Infections and other
complications
 Control your blood sugar before, during and after your
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surgery
Exercise and healthy weight loss
Try to stop smoking
Good nutrition with adequate calories and protein
Make sure skin is dry in between skin folds
Dental Health-make sure you have had a dental
examine in the past 6 months
Please be sure to keep pets away from the incision site
Do not let pets sleep with you after surgery
Apply fresh linens to bed before surgery
Pre-op skin preparationChlorhexidine gluconate(CHG)
 Preparing or prepping the skin before your surgery
can reduce the risk of infection at the surgical site.
GBMC will be providing 3 packs of CHG wipes
which you are receiving today in this class. You
will start using these wipes the 3 days prior to your
surgery. One more CHG bath will be done in the
pre-op area the day of surgery.
 Do not shave legs the 3 days prior to surgery
Things not to do
 Don’t write on
extremities – For
example – “Wrong
leg!” Your surgeon will
initial the limb being
operated on
Types of Anesthesia
 General Anesthesia
Most commonly used
 Spinal
Operating Room
 Surgery will take
approximately
2 to 2-1/2
Bilateral knees will take
longer.
Recovery Room
 Wake patient
 Monitor Vital Signs
 Control Pain
Pain Management
 One concern patients have is how much discomfort
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will they have. We use different techniques or
modalities to help:
PCA pumps
Lumbar Plexus nerve blocks for hips
Femoral nerve blocks for knees
“Cocktail” mixture of pain medication, local
anesthetic, and anti-inflammatory injected into the
knee
Epidural Blocks
PCA
 Pain pump connected to your IV
 Only patient should push button to receive medication
 Programmed to only allow a certain amount of
medication in a period of time
 Pain scale 0-10
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0 means no pain and 10 the worst pain that you have ever had
Stryker Drain
 A drain that is inserted near your surgical site during
surgery to collect bloody drainage.
 Blood can be re-infused back into your IV within a
certain time frame.
 Decreases swelling at surgical site
Equipment used
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Sequential Compression Device (SCD’s)
Ted Stockings
Stryker Drain
Patient Controlled Analgesia (PCA)
Oxygen
Foley catheter
Abduction Pillow (Hips only)
Incentive spirometry
AV Boots and TED Stockings
 Used on your lower extremities to help circulation
 Help prevent blood clots
Abduction Pillow(for hips only)
 Placed between legs while in bed
 Hip precautions
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Don’t cross legs
Don’t turn toes inward
Don’t bend beyond 90 degrees
Don’t twist
Incentive Spirometry
 Exercise your lungs
 Use 10 x per hour
 Place mouth on mouthpiece
 Take a slow, deep breath in and hold for 3 seconds
 Exhale
The Joint and Spine Center
Unit 58
 Transfer to Unit 58
 Private Rooms
 Dedicated staff
Day of Surgery
 You will probably feel sleepy for most of the day
 Vital signs checked frequently, every 4 hours
 Continuous pulse ox placed on finger to monitor your
oxygen level
Knee Patients
 Do NOT place a pillow under your knee because it
makes it harder to get your knee straight. It may be
more comfortable, but you should NOT do this.
Day after Surgery
POD # 1
Busy Morning
 Nurse Practitioner will remove Stryker Drain (if used)
and change dressing
 Foley Catheter removed
 Evaluated by Physical Therapist (P/T) and
Occupational Therapist (O/T)
 PCA will be discontinued and you will be started on
oral pain medication
PATIENT SAFETY
Fall Prevention
“Do not get up
without the help
of staff!”
HAVING KNEE OR HIP REPLACEMENT MAKES YOU A
FALL RISK
SO FOR PATIENT SAFETY….
“Do not get up
without the help
of staff!”
AND
Orange or Red non-skid socks will be placed on you when you
are admitted to GBMC to signal you are a fall risk.
Case Manager
 The case manager on Unit 58 will come in to visit you
to start working on your discharge planning needs.
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Home Physical Therapy,
Out-Patient Physical Therapy or
Sub-acute Rehab
Order equipment needed for home
First Ice Compression Wrap
 Placed on your operative leg on Unit 58
 Decreases pain levels and swelling
 The ice wrap is purchased for you by The Joint Center
Knee Wrap
Hip Wrap
Afternoon POD # 1
 Group Therapy at
approximately 2 p.m.
in our Clubroom
(Coaches should
attend if possible)
Therapy session lasts
about 1 hour
Coaches
 If possible ask a family
member or friend to
attend the group
therapy sessions to
help learn and assist
you with your
exercises.
Same day of surgery or POD#1
 CPM will be placed on
Total Knee Replacements
(if ordered)
 Usually, it will be placed
after dinner
 The goal is to keep it on for
at least 2 to 3 hours
 Ask for pain medication
before being placed in
CPM
Bedside Reporting
 The nurses do their reporting to the next shift at your
bedside.
POD # 2
 Early rising! To ensure that
each patient is ready for
physical and occupational
therapy, you will be
awakened very early
(between 5:00 and 5:30
a.m.) by Unit 58 staff
 Staff will assist you with
bathing and getting
dressed
POD # 2
 PT will walk you in the
morning individually
 OT will assist you with
ADL’s
 Group Therapy at
approximately 10 am
and 2:00 pm
POD #2 or POD# 3
 Group Therapy in
Clubroom at
approximately 10 a.m.
 Plan for discharge by
12-1 p.m.
 You will receive:
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Discharge Instructions
Paperwork with name of
agency providing Home
Physical Therapy (if
appropriate)
Dressing materials and
TED stockings
Preventing Blood Clots
 Everyone will be on either Lovenox, Arixtra, Xarelto,
Aspirin or Coumadin(Warfarin) to help prevent blood
clots. If you are on one of the injectables(lovenox or
arixtra), you or a family member will be instructed
how to administer it. It is only given in the abdomen.
Group Lunch
 Group lunch is held on
Thursdays at
approximately 12 noon in
the Clubroom. Coaches
are welcome.
 Great way to get
camaraderie!
Parking Passes
 See form on Parking in Packet
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Weekly parking passes available for purchase once you are
here for surgery
$15.00 weekly pass must be purchased when you are admitted
The passes are available from the gift shop
What is MOLST
 Maryland MOLST is a portable medical order form
covering options for cardiopulmonary resuscitation and
other life-sustaining treatments
 The medical orders are based on a patient’s wishes
about medical treatments
 The original, copy, or faxed MOLST form are all valid
orders
 MOLST orders are still valid even if written by a
practitioner who is NOT on their medical staff
 MOLST orders do not expire
•Who Needs a MOLST FORM
 MOLST will be necessary for all admitted/observation
patients
 All patients that are transferred to another facility will
also require a MOLST form prior to EMS transport
Physical Therapy
 Explanation of PT services
 2 sessions a day
 Ask for pain medication at least 30 minutes prior to
PT/OT sessions
Information to know/things to
bring
 Social information-live alone or have help
 Environment-do you live on one level or more, do
you have stairs to enter?
 Prior level of function-how were you doing before
you came into the hospital?
 Bring rolling walker from home to ensure proper
fit and condition. Don’t buy RW’s.
 Bring loose fitting shorts or pants; elastic waist is
easiest
 Walking shoes with good ankle support(no open
heel shoes)
Pre-operative Exercises
 Turn to guidebook page 28 for both Hip and Knee
 Begin pre-op exercises at home, 2-3 times a day to
strengthen your body before surgery
 Stop, or do less repetitions if pain increases
(1) Ankle Pumps
 Move ankle up and
down. Repeat 20
times.
(2) Quad Sets
 Lie on back, press knee
into mat, tightening
muscles on front of
thigh. Hold for count
of 5. Do NOT hold
breath. Repeat 20
times.
(3) Gluteal Sets
(Bottom squeezes)
 Squeeze bottom
together. Hold for
count of 5. Do NOT
hold breath. Repeat 20
times.
(4) Hip Abduction and
Adduction(slide heels out and in)
 Lie on back, slide legs
out to side. Keep toes
pointed up and knees
straight. Bring legs
back to starting point.
Repeat 20 times.
(5) Heel Slides
(slide heel up and down)
 Lie on couch or bed.
Slide heel toward your
bottom. Repeat 20
times.
(6) Short Arc Quads
 Lie on back, place
towel roll under thigh.
Lift foot, straightening
knee. Hold for count
of 5. Do not raise thigh
off roll. Repeat 20
times.
(7) Long Arc Quads
 Sit with back against
chair. Straighten knee.
Hold for count of 5.
Repeat 20 times.
(8) Armchair Push-Ups
 This exercise will help
strengthen your arms for
walking with crutches or a
walker. Sit in an armchair.
Place hands on armrests.
Straighten arms, raising
bottom up off chair seat if
possible. Feet should be
flat on floor. Repeat 20
times.
(9) Seated Hamstring Stretch
For Knees
 Sit on couch or bed
with leg extended.
Lean forward and pull
ankle up. Stretch until
pull is felt.
(9) Mini Squats
 Holding on to a stable
object, slightly bend
knees and slowly
straighten. Repeat 20
times.
(10) Straight Leg Raises
For Knees
 Lie on back, unaffected
knee bent and foot flat.
Lift opposite leg up 12
inches. Keep knee
straight and toes
pointed up. Relax.
Repeat 20 times.
(10) Seated Hamstring Stretch
For Hips
 Sit on couch or bed
with leg extended.
Lean forward and
ankle up. Stretch until
pull is felt. Hold for
20-30 seconds. Keep
back straight. Relax.
Repeat 5 times.
(11) Knee Extension Stretch
For Knees
 Prop foot of affected
leg up on chair. Place
towel roll under ankle
and ice pack over knee.
Put 5-10 lbs. of weight
on top of knee( a 5-10
lb. bag of potatoes or
rice works well). Do
for 20 minutes.
Occupational Therapy(OT)
 Introduction of OT services
 1 session a day
ADL Equipment
 See handout for where to purchase recommended
equiptment such as:
 reacher
 sock aid
 long handled shoehorn
 long handled sponge
 elastic shoelaces
 dressing stick
 bedside commode
 tub seat
 Equipment usually not covered by insurance
 Shower doors on bathtubs may need to be removed
See you soon at the Joint Center