Your Guide To Total Knee Replacement

Transcription

1 Your Guide To Total Knee Replacement 41 Ramsey Lake Road, Sudbury, Ontario P3E 5J1 (705) PRE ADMISSION CLINIC PATIENT INFORMATION 1 (disponible en Français)

2 REV October

3 Car long-handled sponge and a shower hose to increase safety during bathing. It is recommended to wait approximately 3 months prior to returning to driving. You may consult your physician prior to resuming driving. It is easier if you sit in the front seat. Move the seat as far back as possible and recline the backrest if able. If the seat is low, sit on a firm pillow. Back up to the car with your walker Lower yourself slowly to the seat. Move your buttocks back and turn to face the front. Discharge Before going home, your physiotherapy follow-up appointment will be arranged with the hospital s outpatient physiotherapy services or a private community clinic to improve your rehabilitation. You must make your own arrangements to rent, borrow or buy to rent a walking aid (walker, crutches or cane) before going home. Over the next several weeks and months, you will gradually return to your normal daily routines. You will begin to walk more normally and with less pain. Speak to your physiotherapist about resuming activities you enjoy (gardening, bicycling, long walks). Your orthopedic surgeon will check your healing and recovery at the outpatient clinic where your staples from your incision will be removed. At this appointment your surgeon will answer any other questions you may have. 14 This booklet has been written to help you prepare for your total knee replacement surgery. Please take the time to read the information provided. It will prepare you for admission, help you take part in your treatment in hospital and plan for you discharge. You will be in hospital 3-5 days depending on your condition. Please have a ride available once you are discharged. This could be early in the morning, or later in the day. Please plan a ride to be available on short notice. General Information: Structure of the knee: The knee is a hinge joint. The bones that make up the knee are the femur, the tibia and the patella (knee cap). The meniscus is the cartilage that acts as a cushion between the femur and the tibia. The muscles and ligaments help to move and support the knee join How to prepare for surgery: A. Attend the pre-op classes for the Total Knee Replacement. B. Preparing your home: Clear floor spaces of obstacles or hazards such as telephone/electrical cords, loose rugs and any other objects that may be cluttering your floor space or exits. Fasten area rugs securely to the floor. 3

4 Remove frequently used items from low cupboards or high spaces and place them in areas that are at waist level and easy to reach. (i.e. kitchen and bathroom) Set up a recovery center in your home with the items you use the most. It should have your telephone, telephone numbers, television, remote control, radio, tissues, waste basket, pitcher, glass, medications, reading materials and any other frequently used items. If you have a water bed it should be replaced with a mattress and box spring. Preferably your bed would be located on the main floor of your home. All stairs should have a sturdy railing on either the left or the right side. Arrange for any necessary repairs. Use night lights in the evenings in hallways, bedrooms, bathrooms. Items such as cordless phones or a carpenter s apron can come in handy. Prepare a chair with armrests and a firm higherthan-average seat. A boat cushion or other firm pillow can help to raise a low seat. Examples of possible chairs with arm rests are captain s chairs or wing chairs, NO swivel chairs and NO office chairs with casters or wheels. C. HOUSEHOLD MANAGEMENT: Prepare and freeze meals in advance and store in the freezer in an easy to get at place. Stock up on other easy to prepare foods. Meals on Wheels may also be an option. 4 small (1lb) coffee can with a towel or by rolling up 2 or 3 towels to measure about 16 inches around. Before trying, make sure you discuss kneeling and bicycle riding with your Doctor or physiotherapist. Activities of daily living (personal care) Following your total knee replacement, if necessary, an occupational therapist will review potential equipment needs and teach you special techniques to accomplish your daily activities independently. Bathing You must not sit in the bathtub for 6 weeks after surgery. Shower Tub You may choose to stand or to use a shower chair in the shower. There should be a rubber mat or a non skid surface on the floor to prevent slipping. If you have a shower stall, place shower chair near the shower door. Walk to the shower with your walker, turn and sit on the chair as you would on a regular chair. Once sitting, lift your body with your arms and gently bring your legs into the shower stall. A long handled sponge or hand-held shower might also be helpful. You may not sit down in the bathtub for 6 weeks after surgery. You may use a bath chair or tub transfer bench in the tub for a sitting shower. Note: You may want to consider installing a bathtub safety rail or grab bar as well as using a 13

5 You will be instructed about walking with a walker, using crutches and stair climbing before discharge. Your doctor will tell us how much weight you can put on your operated leg and you must not put more than you are allowed. When walking with your walker or crutches: Reminders move the walker or crutches ahead first then move the operated leg then move the unoperated leg Your exercise program is not temporary. It is continuous and is an important part of the ongoing management of your total knee replacement. NEVER put pillows under your knees You may want to apply ice for 15 to 20 minutes after the exercises to decrease the swelling and pain in your knee. Continue to use your walker, crutches or cane until you are given further orders by your Doctor or physiotherapist. When you are allowed to use a cane, hold it in the hand opposite the operated knee. NEVER hold onto only the walker to stand up or sit down. Hold onto the chair or bed. Use stairs only when necessary and not as an exercise. When going up stairs lead with the un-operated leg and when coming down the stairs, lead with the operated leg. You can make a small towel roll by covering a Make arrangements for someone to tend to your yard (i.e. cut grass, shovel snow). Hire a student; ask a neighbor, friend or relative. Arrangements should also be made for your heavier household chores such as laundry, vacuuming, washing floors, etc. Make arrangements for transportation (i.e. discharge home from hospital, follow- up appointments to your doctor) as you will not be allowed to drive for about 3 months. If a friend or relative is unable to drive you, here are some community agencies that can help: Wheelchair Taxi, Handi-Transit (registered with City Hall) or Canadian Red Cross volunteer drivers. If possible, arrange for someone to stay with you for a few days, once you have been discharged home. If you live alone you might consider spending your convalescence in a retirement residence (see Retirement Communities and Homes in the yellow pages of the phone book). Equipment Rentals If you plan to attend the pre-op total knee class, your equipment needs will be discussed with you. In hospital you will not require these items. You will be assessed prior to discharge by the physiotherapist to see what your needs are with regards to: Walker Crutches cane 12 5

6 Equipment To purchase or rent these items, look in the yellow pages under Hospital Equipment and supplies. Many pharmacies rent/sell medical equipment. A vendor list will be supplied to you at the pre-op class or while in the hospital. On the Day of Your Surgery/Procedure: Hamstring Sets With your operated leg straight, push your heel into the bed without letting your knee bend. Hold for a slow count of 5. Relax Figure 4 Come to Registration/Day Surgery as instructed. This allows us enough time to ensure that you are properly prepared. In the Day Surgery area, the nurse will check your temperature, pulse and blood pressure. You will be asked to remove all your clothing (including underwear), dentures etc., and put on a hospital gown. You will be given a garment bag for your belongings. It is best if your family/friend with you takes this bag and brings it to your room later. If there is no one with you, the nurse will send it to your room later in the day. You will be escorted to the Operating Room where a nurse will greet you. In the Operating room, the anaesthetist will start an IV and give you an anaesthetic. The anaesthetist will discuss with you which type of anaesthetic is appropriate for your operation. From there, you will be brought to the Recovery Room. Strengthening Knee Muscles To make sure your new knee works as well as possible, you will need to strengthen your knee. The physiotherapist will teach you the exercises and soon you will be able to do them on your own. You will find your knee getting stronger and the exercises easier with each passing day. Walking Bring comfortable well fitting shoes (e.g. running shoes) or non slip slippers with a closed heel and toes. Walkers are provided in the hospital, but if you have your own crutches or cane, a family member should bring them in 3 days after surgery. The nurse or the physiotherapist will help you to stand until you are strong enough to get up on your own. You may be light-headed or dizzy at first. You may wear a transfer belt around your waist so the physiotherapist or nurse can assist you to stand and keep your balance when you are on your feet. 6 11

7 Ankle Pumps Point both feet up then point feet down. Repeat 10 times. Make ankle circles. Repeat 10 times in each direction Knee Bending In a sitting position, slide your operated leg back under the chair until you feel a stretch. Help with your unoperated leg. Figure 1 Figure 2 Your stay in the Operating Room and Recovery Room will be about 4-5 hours after which you will be taken to your in-patient room. Recovery After surgery, your diet will be increased from fluids to your usual diet as tolerated. The intravenous (IV) will remain in for 24 to 48 hours. The IV will be used to give your body fluids and medication during this time. You will receive antibiotics through the IV. Resting in bed and the anesthetic you received can cause chest congestion. Do the following breathing exercises to help clear your chest. Quad Sets With your knee straight, tighten your thigh muscle by pushing the back of your knee down on the bed. Hold for a slow count of 5. Relax Figure 3 Breathing Exercises Lie or sit in a relaxed position. Place you hands on your lower rib cage. Take in a deep breath slowly through your nose. Make sure it is a deep breath. Feel your ribs push upwards as you take air in. Hold your breath for 2-3 seconds. Slowly let the air out of your mouth through pursed lips. Repeat this exercise 5-10 times each hour. If you have mucous in your chest, you should follow the fifth breath with a cough. This action will help to remove the mucous. One of the risks of the surgery is the potential for blood clot formation, especially in the calf of the leg. The following steps will help try to prevent this from happening. 10 7

8 Your Doctor will prescribe a blood thinner in needle form to begin after your operation and continue after discharge up to 10 days. You will wear white support stockings (TED hose) throughout your stay. Pneumatic stockings are applied in the operating room to your legs. These inflatable stockings help to improve your circulation and are worn for about hours when you are in bed. You will also need to do some feet and ankle exercises called Ankle Pumps in the Physiotherapy section. Begin immediately after your operation. As with any operation, a certain amount of pain is expected. The total knee replacement is no exception. Your Doctor will prescribe medication to control your pain. You should ask your nurse when you need this medication. Ice packs will also be useful to control your pain and swelling. They should be applied to your knee for minutes at a time and then removed. Your nurse will also assist you to find a comfortable position. You may find that taking nice, slow deep breaths when turning or exercising helps you relax and decrease the pain. You will have a large dressing on your leg for 1-2 days. When it is removed, a lighter one will be applied. You will also have a drain (Hemovac) in place that will be removed approximately 1-2 days after surgery. You will have a urinary catheter (tube) into your bladder for the first 1-2 days after surgery. This tube will keep your bladder emptied. After it is removed, you will walk to the bathroom using a walker. The combination of decreased activity and pain medication can cause constipation. Your doctor will prescribe a stool softener and laxative for you. To help prevent constipation, drink plenty of fluids 8 glasses or more a day. Eating a high fiber diet will also help prevent constipation. Some suggested foods are: Bran cereals and muffins Whole wheat bread Fruits and vegetable Prunes and prune juice Physiotherapy You will begin your physiotherapy program after surgery. The goals of your treatment program will be to: Reduce swelling Prevent blood clots Improve knee bending and straightening Strengthen knee muscles Walk alone using a walker, crutches or cane(s) You are responsible for doing your exercise program every day during your hospital stay and after discharge home. You may not put a pillow under knee when lying on your back. You may have one under your ankle. This may help to get your knee completely straight. The continuous passive motion (CPM) machine may be used to help bend your knee. This machine slowly increases your knee s range of motion. It may be placed on your knee for hours at a time each day. 8 9