Early Preparation for Surgery
Being prepared includes: Understanding Osteoarthritis Setting Goals Physical Activity Home Safety Nutrition & Weight Management Pain Management
People who are prepared for surgery have Better hospital experiences Fewer complications Smoother, faster recovery
What is Osteoarthritis? Breakdown of cartilage May cause joint pain, stiffness & swelling Typically affects weight bearing joints
Anatomy 101 Hip X-Rays NORMAL Pfizer 2004 The Arthritis Society OSTEOARTHRITIS
No bending past 90º L -shape No crossing the legs No twisting See p.10 Before, During and After Hip Precautions; For 3 months post-op
Anatomy 101 Knee X-Rays NORMAL OSTEOARTHRITIS Pfizer 2004 The Arthritis Society
No pillow under knee No squatting No kneeling No twisting See p.18 Before, During and After Knee Precautions; For 3 months post-op
Setting Goals
SMART Goals Specific Measureable Action-based Realistic Timely
SMART Goal Setting I am going to start exercising more VS. I am going to walk around the park for 10 minutes, 3 times a week This month, I am going to do water exercises for 20 minutes, once a week
Tips to succeed Write your goals down Post them where you see them Share your goals with friends and family Have a back up-plan
Physical Activity
Benefits Strong muscles less joint stress Joint mobility Endurance Weight control
But it hurts! Start small, increase gradually Break up the activity (2, 3, or 4x/day) Minimize joint stress Water Exercise bike Walking aids Respect your limitations
Avoid over-doing it 2-hour pain rule Extra joint pain for more than 2 hours after the exercise - you probably did too much, too fast! Slow down and do less next time Apply ice or heat to relieve symptoms
Move It! Gentle movement, 5 to 10 repetitions Stretch leg muscles, 20 30s hold Watch PreHab exercise videos Range of Motion, Stretching
Strength Arm and leg muscles 8 to 15 repetitions Watch PreHab exercise videos Arm Strength, Thigh muscle Strength
Balance
Fitness Options Arthritis Society programs: Water Works, Joint Works Community Centers / Pools Physiotherapy clinics www.bcphysio.org Knee Replacement Exercise Guide (OASIS website) Physical Activity Line (PAL)
Additional Reading (and a break) Heal Your Knees: How to Prevent Knee Surgery and What to Do If You Need It Klapper & Huey Heal Your Hips: How to Prevent Hip Surgery and What to Do If You Need It Klapper & Huey Total Knee Replacement & Rehabilitation; The Knee Owner s Manual Brugioni & Falkel
Home Safety Be prepared
Home Set-up Install stair railings, grab bars Remove clutter, tripping hazards Seats 2 above knee Foam cushion, bed blocks Move frequently used items to waist-height
Bathroom Equipment Raised toilet seat Bath stool or bench Grab bars Rubber bath mats
Other Equipment Crutches Walker Long-handled reacher Long-handled shoe horn Elastic shoe laces Sock aid
Where can I get equipment? Medical supply stores - Rent or purchase - Check for coverage through medical plan Local Red Cross locations: - Equipment on loan for up to 3 months - Need a signed equipment form
Nutrition and Weight Management
Nutrition is important because A healthy body supports healing A healthy immune system fights infection
Weight Management Each extra pound = 4-6lbs of stress on joints Need for weight loss: High BMI Waist circumference
Set a SMART goal Overweight? Do not lose more than 3 lbs /wk Regular exercise Long-term changes in eating habits Limit calories from fluids Look at what causes you to eat
Underweight? Risks of being underweight include: Poor bone health Weak immune system Low energy levels Nutrient deficiencies Consult a dietitian
Canada s Food Guide Vegetables & Fruit 7-10 servings Grain Products 6-8 servings Milk Products 2-3 servings Meat & Alternates 2-3 servings Be aware of serving size! Consider vitamin/mineral supplements
Vegetables and Fruit 7-10 servings/day Provides energy, fiber, vitamins, minerals, antioxidants Choose(more often): dark green, orange and red vegetables orange and red fruit
Grain Products 6-8 servings/day Provides carbohydrates, fibre, vitamins, minerals Choose whole grains, high fibre, low fat
Milk Products 2-3 servings/day Provides protein, carbohydrate, vitamins, minerals, calcium Choose low fat
Calcium & Vitamin D Promotes bone healing Vitamin D; decreases risk of falls, hip fractures, cancer Aim for: 1000-1200 mg calcium 600-2000 IU vitamin D
2-3 servings/day Supports muscle building, healing Meat and Alternates Sources: Fish, eggs, meat, poultry, tofu, peas, beans, lentils, nuts and nut butters.
Protein and Healing Protein needs increase 20-50% for healing Achieve this by eating: 3 servings of meat/meat alternates 3 servings of milk products
Iron and Surgery Low hemoglobin = anemia Fatigue, light-headed, weak Low iron stores may delay replacement of blood loss Choose iron-rich foods Discuss iron supplements with your doctor
Prevention is key Constipation Fiber: 25-35 grams/day Fluids: 8 cups (2L)/day Exercise Take extra precautions before/after surgery
Resources Health Link BC www.healthlinkbc.ca or dial 8-1-1 www.dietitians.ca
Pain Management
What medication is right for me? Talk to your Doctor or pharmacist about: Pain level Risks, side effects Drug interactions
Medications for arthritis pain Multi-modal analgesia Acetaminophen (Tylenol Arthritis Formula) Lowest risk Non-Steroidal Anti-inflammatory (NSAID) Nonspecific NSAIDS Advil (ibuprofen), Voltaren (diclofenac), Naprosyn Affects blood pressure, stomach lining Stop 5 days preop Cox 2 Inhibitor (Celebrex) no platelet effect, doesn t have to be stopped
When should I take medication? Pre-medicate Smaller dose to prevent Larger dose to treat Take regularly Review with pharmacist or GP
Supplements and Surgery Some supplements and medications affect blood clotting Suggested to stop supplements 2 weeks before surgery, talk to your doctor or Pre-Admission Clinic
Time to quit? The single best thing you can do to improve your health Hospital no-smoking policy New strategies to help quit; Champix (prescription) acupuncture
Alcohol Use Tell the hospital staff if you drink daily Suddenly stopping alcohol use may lead to withdrawal symptoms Withdrawal will impact your rehab!!
What s next? Pre-op Education 1 3 weeks before surgery Pre-admission Clinic up to 2 weeks before surgery * Richmond residents do not attend group Pre-op; Home Care PT will contact you directly
Resources OASIS website www.vch.ca/oasis OASIS Primary Education The Arthritis Society www.arthritis.ca Arthritis Info Line: 1-800-321-1433 OrthoConnect www.canorth.org
Summary People who are prepared for surgery tend to have a positive experience Set some SMART goals: Exercise Home safety, equipment Nutrition Weight management Pain control
Questions?