Patient s Guide to Total Joint Replacement at an Ambulatory Surgery Center

Transcription

1 Patient s Guide to Total Joint Replacement at an Ambulatory Surgery Center

2 2 THE PATIENT'S GUIDE TO OUTPATIENT TOTAL JOINT REPLACEMENT WELL BEING TABLE OF CONTENTS Welcome Teaming up for Success Outpatient Total Joint Replacement Preparing for Surgery Medications.. Medical History and Health Status Pre-Operative Orientation Pre-Operative Exercises Being Prepared.. Leading up to Surgery Surgery Post-Operative Care Adjusting to your New Total Joint

3 3 RETURING TO YOUR BEST PHYSICAL Welcome Do you suffer from pain, aching, swelling, and decreased range of motion? Osteoarthritis is the most common joint disorder in the United States, affecting over 30 million adults. The Center for Specialty Care staff is working together to re-establish your best physical well-being. For many people suffering from osteoarthritis everyday tasks can be challenging, even something as simple as walking. Dr. Welchlin and his staff have spent many years studying how to battle the effects of arthritis. They use advanced surgical techniques to affectively decrease your pain and improve your range of motion. Total Joint Replacement is a surgical procedure in which parts of the damaged joint are removed. It is then replaced with an implant designed to replicate the movement of a normal, healthy joint. The benefits of our outpatient Total Joint Replacement eliminates hospital stays and fully supports your recovery. Our goal with this patient guide is to properly educate you to ensure the best outcome with your Total Joint Replacement.

4 4 Teaming up for Success Now that you and Dr. Welchlin have decided that your symptoms are long term and are too severe to continue with conservative treatment, surgery is in your best interest. Understanding the Total Joint Replacement process from beginning to end will make your journey to a better quality of life easier and more successful. We encourage you, and your post-operative caregiver to read through this booklet together to obtain the best outcome of your Joint Replacement. As you read through this and have any questions please call our office at (507) during hours and (507) after hours. IMPORTANT: As soon as you get this booklet, begin doing pre-surgical exercises in order to build strength for a faster recovery.

5 5 RETURNING TO YOUR BEST PHYSICAL RECLAIMING YOUR QUALITY OF LIFE: OUTPATIENT JOINT OUTPATIENT REPLACEMENT JOINT REPLACEMENT What is it? A Total Joint Replacement is a surgical procedure in which parts of an arthritic or damaged joint are replaced with a metal, plastic, or ceramic implant also known as a prosthesis. An outpatient joint replacement is where the joint is replaced in an outpatient surgery center. How long will surgery take? Your surgery will take one to two hours on average. Plan to be at the surgery center for at least five hours from admitting to recovery. What kind of anesthetic will I have? In most cases, the anesthesia provider will administer a spinal anesthetic along with medications for sedation given through an IV line. Knee Replacement: What are the risks of surgery? Dr. Welchlin and the staff at Center for Specialty Care have safely performed many joint replacement procedures throughout the years. However, as with every surgery there are potential risks associated with the surgery. Listed below are some of the possible complications which could occur with joint replacement and some safety measures that can be taken to help prevent these complications: Infection With any surgery there is a risk of infection. A nosocomial infection is one that is acquired in a hospital. Cleaning the surgical site with the hibiclens packet provided to you, along with antibiotics pre and post-operatively will help prevent infection. Bladder Infections Bladder infections may occur after surgery due to being immobilized or possibly having a urinary catheter placed preoperatively. Staying hydrated before surgery will help prevent this type of infection. Instability When replacing a total joint with a prosthetic implant there is always a possibility of that joint becoming instable or even dislocating. With the new surgical techniques this is not very common. The home exercise provided to you will help strengthen those muscles, decreasing your risk for instability. Hip Replacement: Blood Clots There is risk of blood clots after surgery due to the lack of circulation in that area. We will put sequential compression devices (SCD) on your legs to help keep the blood circulating during and after surgery. After surgery you will be instructed to take one aspirin once a day to help prevent blood clots. Pneumonia This is an infection that occurs in your lungs and can be caused by decreased lung expansion with immobility. You will be given an incentive spirometer and your nurse will go over how to use it to keep your lungs clear. It is important to continue exercises at home after discharge. Severe Complications With any major surgery these complications are always a risk. Some of these complications can be severe and can even result in death. Any questions and concerns can be discussed with Dr. Welchlin, CSC staff or the anesthesia department.

6 6 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Scheduling Insurance companies will typically require a prior authorization for a major surgery. The surgical coordinator will call your insurance company prior to scheduling your surgery to check your full benefits and eligibility along with starting the authorization process. The process can take anywhere from a few days to a couple weeks, depending on your insurance. The moment we have the authorization in our hands the surgical coordinator will reach out to you and schedule your surgery along with any other appointments that need to be made. Medications Once your surgery is scheduled, please inform the surgical coordinator if you are taking any of the medications listed below. It is important that you stop taking them as instructed. These medications cause your blood to become too thin which causes risk of bleeding during surgery. Lovenox Heparin (draw PTT) Ticlid Coumadin o (INR morning of surgery) Plavix Trental Eliquis Methotrexate St. John's Wort Prescription diet pills 12 Hours 24 Hours 3 Days 5 Days 7 Days 7 Days 2 Days Two Weeks Two Weeks Two Weeks Aspirin 10 Days All vitamins and supplements 10 Days U Anti-inflammatory medications 10 Days (Advil, ibuprofen, Aleve, Naprosyn, Relafen, Diclofenac) CI Hormone replacement therapy 7 Days Celebrex can be taken until day of surgery.

7 7 RECLAIMING YOUR QUALITY OF LIFE: RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Medical history and current health status Before you can have your surgery and undergo anesthesia you will need to have a complete history and physical in order to be cleared by a medical doctor. Listed below are some of the questions that will be asked during this visit: Do you have any serious health issues such as diabetes, high blood pressure, bleeding disorder or heart disease? Are you currently taking any medications? ( Including over-the- counter products) Do you have any known drug allergies? Do you have any contact allergies such as betadine, latex, or nickel? Are you currently experiencing any health issues? (Cold, fever, fatigue, or infection?) Have you had previous surgeries or an adverse reaction to anesthesia in the past? Are you or could you be pregnant? Do you have any history of blood clots? If yes, are you taking anything to help prevent them now? Any blood relatives have history of serious health issues? Pre-operative testing At the Center for Specialty Care, along with being cleared by a medical doctor, we do require you to have blood drawn for labs. Depending on your age, some additional test may be required such as: Chest X-Ray Blood Test Nasal MRSA Culture Urine Test Electrocardiogram (EKG) Dental Exam (up to date?) Metal Allergies (Jewelry) IMPORTANT: If you get a fever, cold, or rash after your H&P please call the office and inform them of the health changes. We will set up an appointment with the family doctor to review health and see if surgery is still safe in your condition. Surgery may be postponed until you re back to your normal health.

8 8 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Pre-operative coordination Before your surgery, we ask that you set up a pre-surgical visit at least one week before. This visit will allow you to meet with your surgeon and go through any last minute questions you may have. During this visit, we will also have you meet with a physical therapist so they can discuss your upcoming total joint replacement and what to expect for therapy in the days after. They will also set up your first initial therapy day. They will go over these details with you: What to bring the day of surgery Go over the exercises given to you in the packet What equipment and braces you will need after surgery Inform your caregiver what to expect What to expect before, during, and after surgery Prior to surgery: A nurse from the surgery center will call you the day before, confirming your surgery date and arrival time for your surgery. Confirm that all therapy appointments have been set up and approved by insurance. You will be prescribed all of the necessary medications needed pre-operatively and post-operatively. Please be sure to look over your current medication list and review which ones you may continue taking and the ones you will need to discontinue taking prior to surgery. A medical doctor will review your labs and any other pre-operative testing that was required. Confirm that you have been medically cleared for surgery. The Center for Specialty Care and the South Central Surgical Center both communicate with patients via and phone; we will need both on file.

9 9 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Pre-operative Pre-surgical exercises Exercises / Hip/Knee Conditioning Program Beginning a hip and/or knee exercise and conditioning program prior to surgery is one of the best ways to ensure quick and complete recovery. It's best to begin this program several weeks before surgery. Perform exercises two times a day. They should take about minutes to complete. Don't do any of the exercises if they become too painful. (If you are having a total shoulder please request a separate exercise packet) Getting Started: Warm up before exercising by walking or riding an exercise bike for minutes Do the stretching exercise (#1 and #2) before moving on to the strengthening exercises. Do not ignore pain if you're sore from exercise that's ok, but do not do any exercise that's painful 1. Standing Iliotibial Band Stretch Stand next to a wall for support Cross the leg closest to the wall behind the other leg Lean your hip toward the wall until you feel a stretch at the outside of the hip Hold for 30 seconds Repeat the sequence 4 times

10 10 Preparation for Surgery Pre-operative Exercises / Hip/Knee Conditioning 2. Seated Rotation Stretch Sit on the floor with both legs straight in front Cross one leg over the other Slowly twist the bent leg, put your hand behind you for support Look over your shoulder and hold the stretch for 30 seconds Repeat 4 times 3. Knee to Chest Lie on your back with your legs extended Bend one knee and grasp that knee with your hands Pull your knee to your chest as far as it will go Hold for 30 seconds and then relax for 30 seconds Repeat on the opposite knee Repeat 4 times

11 11 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Pre-operative Pre-surgical exercises Exercises // Hip/Knee Conditioning Conditioning Program 4. Hamstring Stretch Lie on the floor with both knees bent Bring your knee toward your chest place your hands behind your thigh below your knee if you have difficulty doing this, you can loop a towel around your thigh. Straighten your knee and pull your leg toward your head until you feel a stretch Hold for 30 seconds, then relax for 30 seconds Repeat 4 times 5. Hip Abduction Lie on your side with the bottom leg bent to give support Straighten the top leg and raise to 45 degrees, keep the knee straight Hold this position for 5 seconds, then relax for 5 seconds Repeat 4 times

12 12 Preparation for Surgery Pre-operative Pre-surgical exercises Exercises // Hip/Knee Conditioning Conditioning Program 6. Hip Abduction Lie on the side of the affected hip with both legs straight Bend the top leg across the lower leg Raise the lower leg 6 inches off the floor Hold for 5 seconds, then relax for 5 seconds Repeat 4 times 7. Prone Hip Extension Lie on your stomach on a firm surface Bend the knee to 90 degrees Lift the knee, hold for 5 seconds, then slowly lower the knee, and relax for 5 seconds Repeat 4 times

13 13 Preparation for Surgery Pre-operative Pre-surgical exercises Exercises / Hip / Hip/Knee Conditioning Conditioning Program 8. Hip Rotation Lie on the side of the unaffected hip with both legs straight Bring the top leg forward, flex the knee, and lower the foot as in the "start" position Rotate the hip as high as possible, into the "finish" position Hold each position for 5 seconds, then relax for 5 seconds Repeat 4 times Exercise regularly and in moderation to prepare for your surgery Don t overdo it or injure yourself by being too aggressive

14 14 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery Preparing your home for your return It is important that you have a safe environment at home, to prevent injury and to speed recovery. The following are some of the things to do in preparation for your surgery: Prepare meals ahead of time and put fresh linens on your bed. Make sure you have an armchair with a firm cushion that you can sit on. A flat, firm mattress should be in place. Have an ample supply of your prescription medications available. Remove all obstacles that may become a tripping hazard. Put night lights in rooms that will be dark. Place non-skid mats on the inside and outside of your shower or tub. Post-op Assisting Devices: A representative will meet with you at the pre-surgical consult meeting to discuss these devices. Equipment may include: Walker Crutches Cane Brace Elevated toilet seat Hand rail Cold Therapy Prepare a comfortable rest area with all necessities in arms reach so you do not have to rush and get anything. If you are going to be home alone for a few hours be sure to carry a mobile phone so in case of an emergency you can call 911. Have non-skid shoes available. Arrange transportation for follow-up visits.

15 15 Preparation for Surgery Two weeks before surgery Pre-operative therapy consult (if not already completed) Continue pre-operative exercises Stop taking anticoagulants that are listed on page 6 One week before surgery Schedule a pre-surgical visit- (if not already completed) Confirm that all your prescriptions have been received: Celebrex, Zofran, and postoperative pain medications (OxyContin, Hydrocodone, Gabapentin) Receive Hibiclens packets and any assistive devices such as; walker, brace, sling etc. Obtain over-the-counter medications: Aspirin 325 mg (#60), laxatives, and Extra- Strength Tylenol. Stop taking all anticoagulants. Refer back to page 6 Continue pre-surgical exercises. Two days before surgery Shower Continue with pre-surgical Hibiclens exercises to build strength and stamina STOP SMOKING!

16 16 RECLAIMING YOUR QUALITY OF LIFE: Preparation for Surgery One day before surgery Shower with Hibiclens that night Nothing to eat or drink after midnight the night before- this includes smoking, gum, mints, or water Resume your regular diet up until midnight. Do not over eat. Can take the following medication with food: 400 mg of Celebrex (2 tablets) 300 mg of Gabapentin (1 tablet) Take all routine medications except for those discussed with your primary care provider, such as aspirin, NSAIDS, and all other blood thinners. If you have any questions please call our office at (507) during hours and (507) after hours.

17 17 RECLAIMING YOUR QUALITY OF LIFE: Morning of Surgery Shower with Hibiclens that morning. Wear comfortable, loose clothing Do not use any personal hygiene products such as: lotion, deodorant, perfume, make-up etc. Also remove nail polish. Take heart and blood pressure medications, 200mg Celebrex (1 tab), and 300mg Gabapentin (1 tab) with sip of water. Do not take insulin or diabetes medications unless instructed to do so. Nothing to eat or drink. At the Surgery Center Bring your assistive device(s) No valuables or jewelry Family member, friend, or significant other must accompany you to the surgery center In the pre-op area: You will sign the surgical and anesthesia consent forms IV will be started and pre-op fluids and antibiotics will be administered You will be asked to mark your surgical site with an S" for site Vital signs will be taken and anesthesia will be discussed.

18 18 WELL BEING: Day of Surgery Post-Op I Recovery After surgery, you will be transferred to the recovery area. If you have had a spinal anesthetic, it may take 1-2 hours for feeling to return to your legs. The nurses will monitor your vital signs closely and keep you comfortable. Medications will be administered as necessary for pain or nausea. You will be monitored in the recovery area for a few hours. Once you are awake and alert, you will be given something to eat and drink. You will be able to go home once you have met all the discharge criteria. We will be sure your pain is under control and well managed before leaving the surgery center. However, it is very important that you follow the post-operative pain management protocol given to you on pages in order to stay on top of your pain. Physical therapy will be arranged to meet with you and have you walk to confirm you are stable enough to be safely discharged. You will be given a copy of your discharge instructions complete with your post op appointments.

19 19 After Your Surgery HAND WASHING HELPS PREVENT INFECTION Hand hygiene is one of the easiest most effective concepts of controlling the spread of bacteria. It is important that all visitors and caregivers that come in contact with the patient wash their hands before and after. This simple act can help prevent serious infections such as MRSA, which is a bacterium that inhabits the skin or nose of patients. *If you or a family member has a history of MRSA please notify out staff prior to having surgery so the proper tests and protocols can be followed* TOILET It is best to have an elevated toilet seat and/or hand rails. When standing up, do not pull yourself up with the walker. Instead, push yourself up off the toilet to stand. When out in the community, use bathroom stalls that accommodate people with disabilities as they will have hand rails.

20 RETURNING TO YOUR BEST PHYSCIAL RECLAIMING YOUR QUALITY OF LIFE: After Your Surgery SHOWER Make sure to use a non-skid shower mat in and outside of the shower to decrease your risk of slipping. An easy trick to help prevent a fall due to dropping your bar of soap in the shower is to cut off legs of panty hose as a soap holder. Cut them down the center leaving the foot end mostly intact. Put a bar of soap in the foot end. Tie the two top ends together. Hang around your neck. PRECAUTIONS Use your walker or cane when ambulating. Avoid lifting or carrying heavy objects. Remove all obstacles that may be a tripping hazard such as cords and throw rugs. Also be cautious if you have small pets around. Do not drive while taking pain medications. Avoid pivoting on your affected joint. Do not allow yourself to get exhausted. Wear or hang an apron with pockets to keep your hands free. Avoid reaching far overhead or down low. Call Our Office (during hours: ; after hours: ) if: You are running a fever over 100 degrees. Your incision becomes painful, red, hot to the touch, and swollen. You notice any yellow like discharge or bad odor. Your incision looks open or bleeds a lot. Your medications and pain management plan is not controlling your pain. You are having side effects from your prescribed medication such as vomiting or rash. You have fallen. Difficulty breathing. Unbearable pain in your surgical area.

21 21 RETURNING RECLAIMING TO YOUR QUALITY BEST PHYSICAL OF LIFE: After surgery After Your Surgery Hip Positioning Precautions Depending upon the exact nature of your specific surgical procedure, and the location of the incision, your surgeon may instruct you to follow some temporary positioning precautions. These are not always necessary, but your surgeon may feel that some short-term restrictions with regard to certain motions and positions are necessary to optimize healing and prevent dislocation. If recommended by your surgeon, you may be asked to follow one of the two protocols listed below. This will be confirmed in more detail by your surgeon at the time of your surgery, prior to your discharge from the surgery center. Anterior and inferior approach surgery. (please follow for six weeks) o Do not extend your hip more than 10 degrees. o Do not cross your legs. o Do not lean forward when sitting. o Do not turn your operated leg out. Posterior approach surgery. (please follow for six weeks) o Do not flex your hip more than 90 degrees. o Do not cross your legs. o Do not turn your operated leg in. o Do not lean forward when sitting. o You may be given an abduction pillow to use at home for several weeks after surgery

22 22 After Your Surgery Home: Post-op night night of of surgery surgery Keep surgical dressings dry and intact Take one Aspirin PM Take one Gabapentin PM OxyContin every 12 hours take first dose immediately upon arriving home to maintain your pain control. Use Zofran for nausea as needed. Take one of the over-the-counter laxatives to help prevent constipation due to taking pain medications. In addition it is ok to take Extra-Strength Tylenol do not exceed more than 6 in a 24 hour time span (maximum 3000 mg Tylenol). Be careful getting in and out of bed and chairs Do not bend or over rotate the joint If your surgery required a brace be sure to wear it at all times until approved through therapy or the doctor to take it off. Day One Post-op Day One Post-op Continue drinking fluids to stay hydrated, resume Resume normal Fluids, diet. Resume Healthy Diet Bowel Take management over-the-counter - Take an laxative over-the-counter to avoid constipation. laxative pain medications are constipating. Take Take one one aspirin(325 (325 mg) mg) twice once a day a day to further to help help avoid blood clots. Patients with a history of blood clots may prevent blood clots. Patients with a history of blood be prescribed a different medication to take. This will be clots discussed may be in prescribed your pre- surgical daily Lovenox visit. (heparin) Take injections 200 mg or of other Celebrex medications. (which is one tablet). Take Take 200 Gabapentin mg of Celebrex twice daily (one tablet) one in the morning, Take and Gabapentin the other in mg the twice evening. daily one tab in the Take pain medication morning, and as instructed another on the the evening bottle. Take Transition Dilaudid from (pain OxyContin medication) to as Hydrocodone prescribed. as pain level Transition decreases. to Hydrocodone as pain level allows. Continue Continue post-operative exercises,. exercises. (Do not overdo it) Move from bed to chair with a walker or a cane.

23 23 RETURNING TO YOUR BEST PHYSCIAL RECLAIMING YOUR QUALITY OF LIFE: After Your Surgery Day Two Post-Op Continue drinking plenty of fluids, resume a healthy diet, continue laxative. Step down from strong pain medication to Hydrocodone. Continue Aspirin 325 mg once daily until one month after surgery. Continue Celebrex 200 mg daily until two weeks after surgery. Continue Gabapentin twice daily until 7 days after surgery. When walking, continue using walker or cane. Transition from walker to cane if you feel safe and stable enough. Day Three Post-Op It is ok to shower- you can remove all the dressing from incision, and then pat the incision with a clean dry washcloth. Continue Aspirin 325 mg once daily. Continue decreasing the amount of pain medications as tolerated. Continue your independent home exercises. Continue Celebrex 200 mg daily. Continue Gabapentin twice daily. Day 4 through 13 Post-Op Physical therapy will start. Outpatient physical therapy will be 2-3 times a week at the office. Increase activity as tolerated. Continue Aspirin 325 mg once daily. Continue Celebrex 200 mg daily. Continue Gabapentin twice daily.

24 24 RECLAIMING YOUR QUALITY OF LIFE: After Your Surgery Two Weeks Post-Op Continue Aspirin 325 mg daily. Post op appointment with your surgeon and/or with their Physician's Assistant/Nurse Practitioner: X-ray will confirm implant position, incision check, review outpatient PT program, evaluate functional status of joint, and level of discomfort Continue activity as tolerated. Although you may feel that you are doing very well at this point, it is important to be seen in our office for all routine follow-up appointments which are at 2 weeks, 6 weeks, 3 months, and 1 year after surgery. IMPORTANT!! PLEASE CALL OUR OFFICE (during office hours) (our 24 hour hotline) IF YOU EXPERIENCE ANY OF THE FOLLOWING: Fever greater than 101 degrees Increased pain in joint area Any drainage, swelling or redness on or around the incision Chest pain Chest congestion Troubles breathing or shortness of breath

25 25 RECLAIMING YOUR QUALITY OF LIFE: Post-Op Physical Therapy Reminders Using your walker safely Keep your hips straight when using the walker FWBAT (Full Weight Bearing As Tolerated). Do not use the walker as a support when getting in or out of the sitting or lying positon. The walker is not stable enough in that position. When you are trying to lower yourself down into a chair be sure to back up to the chair until you can feel it on the back of your legs. Reach down until you feel the arms of the chair and slowly lower yourself safely. Follow these precautions for 6 weeks In and out of bed (for lower extremity replacements) When getting into bed, back your bottom all the way until your thighs are completely on the bed. Rotate your body with your non-affected leg first, and then use your arms to help your affected leg into bed. Knee patients only: o Make sure to always wear your where knee your immobilizer knee immobilizer at all times with until ambulation you are until approved by by physical therapy to to remove it. it.

26 26 RETRUNING TO YOUR BEST PHYSICAL RECLAIMING YOUR QUALITY OF LIFE: Post-Op Physical Therapy Regular exercises to restore your normal hip/knee motion and strength and a gradual return to everyday activities are important for your full recovery. Early Post-Operative Exercises These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve your hip/knee movement. Start slowly. Do all exercises 2 or 3 times a day, gradually increase the number as you get stronger If you start to feel pain, swelling, increased warmth or tenderness in your hip/knee, do the exercises slower. If problem continues, call your doctor or therapist. Ankle Pumps Slowly push your foot up and down. Do this several times a day. Standing Leg Abduction Keeping your hip, knee and foot pointing straight forward and your body straight, Place a rolled up towel or object lift your leg out to the side while keeping your under knee your straight. knee and Slowly slowly lower your leg, repeat. straighten your knee as you raise up Repeat Hold Complete Perform 10 times 1 Second 1 Set 3 or 4 Time(s) a Day

27 27 Post-Op Physical Therapy Early Post-Operative Exercises Heel Slides SUPINE Lying on your back with knees straight, slide the affected heel towards your buttocks as you bend your knee. Slide your heel toward your buttocks, bending Hold a gentle your knee stretch and keeping this position your heel and on then the return bed. to Do original not let position your knee roll inward. Repeat Hold Complete Perform 10 Times 1 Second 1 Set 3 or 4 Times a Day Glute Set - Supine While lying on your back, squeeze your buttocks and hold. Repeat. Repeat Hold Complete Perform Times 3 Seconds 1 Set 3 or 4 Times a Day Long (5) Straight Arc Quad Le High Seat While seated with your knee in a bent position, slowly straighten your knee as you raise your foot upwards as shown. Repeat Hold Complete Perform Times 3 Seconds 1 Set 3 or 4 Times a Day

28 28 Post-Op Physical Therapy Early Post-Operative Exercises Standing Leg Raise (at 6 weeks post-op THA) Lift your leg toward your chest. Do not lift your knee higher than your waist. Hold, then lower your leg. Repeat. Straight Leg Raises (SLR) Tighten your thigh muscle. Try to straighten Repeat Hold Complete Perform 10 Times 2 or 3 Seconds 1 Set 3 or 4 Times a Day While lying or sitting, raise up your leg with a straight knee. Keep the opposite knee bent with the foot planted to the ground. Repeat Hold Complete Perform Times 3 Seconds 1 Set 3 or 4 Times a Day Standing Hip Extensions (at 6 weeks post-op THA) Life your leg backward slowly, try to keep your back straight. Hold and repeat. Repeat Hold Complete Perform 10 Times 2 or 3 Seconds 1 Set 3 or 4 Times a Day

29 29 Post-Op Physical Therapy Walking and Early Activity Soon after surgery, you may begin to walk short distances and perform light everyday activities. This early activity helps your recovery by helping your hip/knee muscles regain strength and movement. Walking with Walker, Full Weightbearing Weight-Bearing Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step allow your toe to lift off the floor. Move the walker again and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can, don't hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg. Walking with Cane or Crutch A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch may be used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand opposite the operated hip/knee. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker. Stair Climbing and Descending The ability to go up and down stairs requires both flexibility and strength. At first, you will need a handrail for support and you will only be able to go one step at a time. Always lead up the stairs with your good leg and down the stairs with your operated leg. Remember "up with the good" and "down with the bad." You may want to have someone help you until you have regained most of your strength and mobility. Stair climbing is an excellent strengthening and endurance activity. Do not try to climb steps higher than those of the standard height of seven inches and always use the handrail for balance.

30 30 Living with your New Joint To ensure the health of your new joint, it s important you take care of it for the rest of your life. SPORTS AND ACTIVITIES Your new joint is designed for activities such as walking, swimming, and cycling as well as your daily living tasks. Aggressive sports, such as jogging, jumping, repeated climbing and heavy lifting should be avoided. These types of activities can compromise your new joint. INFECTION Your body considers your new total joint as a foreign body. If you get a serious infection anywhere in your body it can cause your new joint to become infected. If you become ill with an infection or high fever, you should see a doctor immediately and be treated. SURGICAL PROCEDURES If you're scheduled for any kind of surgery, your doctor should prescribe antibiotics before and after. Make sure your performing surgeon is aware that you have a joint implant. DENTAL WORK Antibiotics are highly recommended before having any dental work completed, including routine cleanings. Bacteria present in the mouth can scatter throughout the bloodstream and accumulate around your new joint. It's important that you let your dentist know about your joint replacement. Please call our office for antibiotics prior to scheduled dental appointments if your dentist does not prescribe you any.

31 The Outpatient Total Joint Replacement Program at Center for Specialty Care / South Central Surgical Center 717 S. State St. Fairmont, MN General Surgery