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Knee Replacement Surgery Guidebook

Table of Contents 3 Your Guide to a Successful Recovery 4 Pre-Operative Care Focus On You Focus On Your Home Focus On Your Upcoming Surgery Preparing Your Skin for Surgery What to Bring to the Hospital

9 Hospital Care/Discharge Planning Day of Surgery The Plan for Your Pain Criteria for Discharge Coach's Discharge Checklist Know your zone. Preventing Surgical-Site Infections

14 Post-Operative/Home Care What You Can Do at Home Controlling Your Discomfort Body Changes Total Knee Arthroplasty Protocol Blood Clots in Legs Blood Clots in Lungs Decreasing Fall Risk

Knee Replacement Surgery Guidebook

16 Appendix A — Pre-Operative Exercises Arm-Chair Push-Up Seated Long Arc Quad Active Straight Leg Raise with Quad Set Supine Ankle Pumps

18 Appendix B — How to Move After Surgery Lying in Bed Standing Up From a Chair or Toilet Transfer — Bed Transfer — Tub Transfer — Vehicle Stair Climbing Walker Ambulation

23 Appendix C — Medications Anesthesia Blood Thinners

23 Appendix D — Nutrition 24 Our Health Equity Promise

Your Guide to a Successful Recovery Preparation, education and a pre-planned discharge are very important for joint replacement surgery. This guidebook was made to help you understand: • What to expect through every step of your surgery process • What you will need to do before and after surgery • How to care for your new joint Remember, this is just a guide. Your care navigator, physician, physician’s assistant, nurses or therapists may add to or make changes to any of the suggested care plans. Always use their recommendations first and ask questions if you are unsure of any information. Keep your guide as a handy reference for at least the first year after your surgery.

The Care Navigator Your care navigator is dedicated to guiding patients through their journey to orthopedic health. Our wholeperson approach to care is designed to help you take your heal th — and your happiness — into your own hands. An orthopedic care navigator is a specially trained, registered nurse who provides expert clinical assistance and support to patients who are receiving care at AdventHealth. This confidential service is free of charge and available to all orthopedic patients. The orthopedic care navigator is here to ensure you receive the care you need when you need it. They are an advocate during your orthopedic health journey. Your navigator provides the following services tailored to your individual needs. • Serves as the clinical liaison between you and your health care team • Acts as a patient advocate through the surgical process and hospitalization • Educates the patient on their diagnosis and treatment options • Oversees the entire care process to help answer questions and ease patient concerns after surgery • Provides education about the surgical and expected recovery processes that will be discussed in the pre-surgical joint replacement class

You’re not alone. We’re here to help.

Pre-Operative Care Focus On You Stop nicotine products. • All nicotine products should be stopped before surgery. This includes cigarettes, nicotine gum, patches, vaporizers and smokeless tobacco. • Nicotine makes it harder to get oxygen to your new joint. Oxygen is needed for healing. Now is the time to stop in order to aid in recovery after surgery. • The American Heart Association provides many tips and resources to help you quit smoking. Call 1-800-AHA-USA1 or visit https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco • If you need help quitting smoking, contact your care navigator.

Exercise. • For exercises, goals and activity guidelines, see Appendix A in this guidebook. • Under the guidance of your surgeon, it may be recommended that you perform pre-operative exercises or attend physical therapy. • Do not do any exercises that cause extreme pain or are not within your current range of movement.

Eat right. • See Appendix E for guidelines on eating healthy and preparing for surgery. • Practice good dental hygiene before and after surgery.

Knee Replacement Surgery Guidebook

Focus On Your Home Prepare your home by doing things in advance. Cook meals and freeze them for after surgery

Clean, do laundry and put laundry away, including bed linens.

Cut the grass and/or do any yard work.

Install night lights in bathrooms, bedrooms and hallways.

Prepare your home by doing things in advance. Arrange for someone to collect your mail and help with your trash.

Arrange for someone to care for your pets.

Arrange for someone to help with heavy housework cleaning.

Arrange for someone to do your grocery shopping.

Check your home for obstacles. Remove throw rugs and tack down any loose carpet in your home.

Remove electrical cords and other obstructions from walkways.

If you have more than one step, consider having a rail installed.

Your seats should be firm and should not have wheels or swivels. Arms are helpful for mobility.

Is your bed too high or low? Is there enough space to use the walker?

Will the space around your toilet fit the 3 in 1? (Approximately 19” x 28”)

Your shower chair should also fit flatly in the interior of your shower or tub.

Check if your bathroom needs grab bars. DO NOT USE SUCTION BARS.

Focus On Your Upcoming Surgery Survey Your health care team would like you to complete a quick survey about your pain, mobility and whole quality of life. We’ll send you a link via text or email so you can answer the questions electronically. We may also ask you to respond in person or over the phone.

You can access your AdventHealth patient portal (also called MyChart) by scanning this QR code.

Pre-Admission Testing You must pre-register before your testing appointment

You will complete any lab work or tests ordered and review your medication list.

Pre-Operative Visit to Surgeon You may be scheduled for an appointment in your surgeon’s office before your surgery. This will serve as a final check-up and a time to ask any questions that you might have.

Stop medications that increase bleeding.* Stop all anti-inflammatory medications, including aspirin, Motrin, Naproxen, vitamin E, fish oil, etc., as your doctor instructs. These medications may cause an increased risk of bleeding.

If you are taking a blood thinner, you will need special instructions for stopping the medication by the prescribing physician.

Knee Replacement Surgery Guidebook

Preparing Your Skin for Surgery Instructions for Pre-Operative Showers With a Chlorhexidine Prep Solution Evidence shows that pre-operative showers with an antiseptic solution can reduce the risk of infection at the surgical site. • These showers decrease the number of normal bacteria on your skin, thus reducing the risk of infection. • You will perform these showers as instructed by your surgeon.

Take a shower and wash your entire body in the following manner. 1.

For the first shower, wash and rinse your hair first using your normal shampoo. Make sure you completely rinse the shampoo from your hair and body.

2. Do not wash your hair. Wash your face with your regular soap or cleanser and rinse completely. Then, turn off the shower. 3. Apply the antiseptic solution to a wet, clean washcloth and lather your entire body from the neck down. 4. Never use the antiseptic solution near your eyes or ears. DO NOT apply to your face, hair or groin area. 5. Gently wash your body, and focus on the areas where the incision(s) will be located for three minutes. Avoid hard scrubbing. 6. Once you have completed the scrub, wait three minutes. This wait time allows for the soap to kill the bacteria. 7.

Turn the shower on and rinse the antiseptic solution off your body completely. DO NOT wash with regular soap or shampoo after using the antiseptic solution.

8. Pat yourself dry with a clean, freshly washed towel. After the last shower before surgery, DO NOT apply powders, deodorants, lotions or perfumes. 9. Dress in freshly washed clothes. Sleep in freshly washed sheets and linens the night before surgery. Chlorhexidine 4.0% Prep Solution can be purchased from retail pharmacies, amazon and your local AdventHealth Pharmacy.

Special Instructions You will be instructed by your physician about skin care and showering before surgery.

Do not shave your leg or groin within 48 hours of surgery on the surgical leg.

Do not use any lotions, powder or deodorant on surgery day.

Please take medications the morning of surgery only as directed by your physician or nurse.

Use chlorhexidine soap for showers. See more above.

Arrive on time. A late arrival can move or even cancel your planned surgery.

DO NOT TAKE MEDICATION FOR DIABETES ON THE DAY OF SURGERY.

What to Bring to the Hospital

Pack a suitcase for the hospital. • Loose clothing is preferred

• CPAP if you use one

• Sturdy shoes for walking

• DO NOT BRING any valuables

You can bring an electronic device to pass the time. Staff is not responsible for valuables during your stay.

Bring any assistive devices (walker) so we may inspect them for safety and adjust them to fit your height.

Bring a copy of your Advance Directives or Power of Attorney.

Bring your insurance card, prescription card, driver’s license or photo I.D., and any co-payment.

Bring a list of any medications you have taken in the last 30 days.

The morning of surgery, only clear liquids (coffee or tea with nothing added, or water) are allowed up until 1 hour before leaving home.

Note: Please leave your suitcase, tote bag and/or personal belongings in the car. Your family/friend can retrieve these once you are done with your surgery.

Knee Replacement Surgery Guidebook

Hospital Care/ Discharge Planning Day of Surgery Before Surgery, in the Pre-Op Unit You will be asked to put on a hospital gown and your clothes and shoes will be placed in a belongings bag. We will check your temperature, blood pressure, heart rate and breathing rate, as well as conduct safety checks including verifying your site of surgery and evaluating your risk for falls. You may be provided additional skin preparation. For information about the different types of anesthesia and what to expect before, during and after your surgery, please refer to Appendix D.

Immediately After Surgery You will be taken to a recovery area (PACU – Post Anesthesia Care Unit). During this time, pain control is typically established, and your vital signs are monitored. You can expect to have the following equipment: • Sequential compression devices (SCD) - used to prevent blood clots

• Incentive spirometer/coughing and deep breathing - used to prevent pneumonia • Cold therapy - used to prevent swelling

Family visitation is limited in the recovery room, but the recovery team will keep your family updated on your progress. The recovery time can vary for every patient. During this time, your surgeon will speak to your family member to update them on your surgery.

After Surgery • You should also begin using your incentive spirometer and doing the deep breathing exercises that you learned in class. • You can expect to be assisted out of bed and walk with assistance. • You will be receiving medication for pain, as needed.

• It's very important you begin ankle pumps as soon as you are able. You should do 10 reps every hour you are awake. This will help This will help prevent blood clots from forming in your legs.

The Plan for Your Pain Having pain is normal when recovering from surgery. Your dedicated health care team is here to control your pain so you can actively participate in your recovery through breathing exercises, getting out of bed and physical exercise. Everyone feels pain differently. Your nurses will ask you to rate your pain on a scale from zero to 10, with zero being no pain and 10 being the worst pain you can imagine. Your nurse will also ask you to identify a tolerable goal for pain for you to participate in your recovery and daily activities like bathing, eating and talking with your family and friends. Remember, some pain is normal during recovery; zero is not an achievable goal. Your nurses and care team are very dedicated to keeping you comfortable and controlling your pain during your stay.

Local Anesthetic

Alternative Pain Measures

A local numbing medicine may be utilized by your doctor during surgery. This will reduce your pain and ensure that you are able to do your exercises. The effects of this numbing medicine will wear off.

The pain after your surgery will lessen as you recover. Additional therapies may be used to help control your pain: • Cold therapy is used to lessen pain and also decrease swelling.

Type of Pain Medication

• Positioning you for comfort.

You may receive a combination of medications that work together to provide maximum pain relief. Your nurses will describe any new medications to you, including what they are for and any side effects you may experience. Tell your nurse if you experience any side effects from your medications.

• Providing distractions like soothing music, prayer, deep breathing or relaxation. Your nurses can assist you in using these therapies to reach maximum comfort. You may also choose a “face” that matches how you are feeling. Important: You must let your nurse know early if you are having pain so they can intervene early to provide you the best relief.

Oral medication is medicine given in pill form. Your surgeon may prescribe pain pills on a scheduled basis around the clock or they may be prescribed as needed. Constipation can occur as a result of pain medications. Constipation lasting longer than three days should be reported to your physician.

Pain Scale 0

No Pain

Mild Pain

Knee Replacement Surgery Guidebook

Moderate Pain

Serious Pain

Severe Pain

Worst Pain Possible

Criteria for Discharge How long you stay after surgery will be decided by your provider. Some patients will discharge the same day, while others may need to stay overnight. Patients are discharged once medically and surgically ready. Please make sure that your coach is available to provide transportation home.

• •

•

You will be able to go home when the following have said it's safe for you to go home. Your physical therapy team Your orthopedic team

Your medical doctor

Coach’s Discharge Checklist Coaches, are you ready for discharge day? Before patient discharge, we want to make sure you know how to help the person you are coaching. Check if you feel comfortable with the following: £ What blood thinner is your loved one going home on? Does it need monitoring? If so, when and where? (See Appendix D) £ Is there a surgical dressing? If so, when does it need to be changed? £ What are the signs and symptoms of infection? £ Do you have the instructions for the On-Q pump, if the patient has one? £ How should you assist the patient in and out of bed? £ What exercise program should the patient follow at home? £ How should you assist the patient up and down stairs? If you have any questions or concerns, please do not hesitate to ask a member of the Joint Care Team prior to discharge.

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Know your zone. Recovery From Orthopedic Surgery

DAILY CHECK • Do not smoke. • Walk several times a day using a walker, cane or other assistive devices as instructed by a physician • Keep dressing clean, dry and intact if you have one. or physical therapist. • Continue to take your medications as prescribed. • Follow your physician’s prescribed activity precautions • Eat a balanced diet. including elevation and bracing if applicable • Do your exercises as prescribed by your provider. • Continue doing your breathing exercises. • Apply ice as ordered by your physician.

GREEN ZONE Your symptoms are under control if: • Your Incision or dressing is clean, and there is little to no drainage • You have mild pain that can be controlled with medications • You can do exercises and activities of daily living

• You are not having shortness of breath, chest pain or fever • You have regular frequency in bowel movements • You are following your provider’s instructions for exercise and weight-bearing

YELLOW ZONE Call your health care provider if: • You notice lots of bruising or bleeding • You are having nose bleeds • You are bleeding from the gums or see blood in your urine or stool • It’s hard to urinate or you are unable to have a bowel movement for three days in a row or longer Call your surgeon/orthopedic doctor’s office if: • You have new numbness or tingling • You have issues with cast/splint or sling • You have more swelling or pain than normal since surgery (It is not unusual to have swelling for up

to six months after surgery.) • You have a fever greater than 101°F for more than 24 hours • You have drainage, redness or odor at the incision site • You feel calf tenderness, swelling or warmth in either leg • For hip and knee surgeries: You are unable to walk or put weight on your leg • You are not able to move your impacted extremity • You had shoulder surgery, and you have uncontrolled pain in your arm, deformity in the shoulder and/or lengthening of the arm

RED ZONE | Call 911 immediately. DO NOT DRIVE YOURSELF TO THE EMERGENCY DEPARTMENT. Call 911 if: • You have stroke symptoms including: loss of balance, blurred vision, face drooping on one side, arm and/or leg weakness or speech difficulty. • You have severe headache • You have chest pain • You have pale, gray or blue nail, lip or skin color

Knee Replacement Surgery Guidebook

• You are coughing up blood • You have a rapid heart rate • You have severe shortness of breath • You experience sudden wheezing

Preventing Surgical-Site Infections What is a surgical-site infection (SSI)? A surgical-site infection is an infection in the part of the body where the surgery took place. Most patients do not develop an infection. However, about one-to-three out of every 100 patients who have surgery do develop infections. Some of the common signs of a surgical site infection are: • Redness and pain around the area where you had surgery • Drainage of cloudy fluid from your surgical wound • Fever

PREVENTION IS THE KEY.

How do I prevent a SSI? Before your surgery:

Wound Healing Well

Infected Wound (Redness and Puss)

• Tell your doctor about other medical problems you may have. • Consider removing acrylic nails or trimming long natural nails. They are full of bacteria. Sometimes patients itch near the site, without washing hands. The mindless itching can pass the bacteria from the nails to the wound. • Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before surgery. • Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection. • Use Hibiclens or CHG soap the night before and morning of surgery to cleanse skin of ALL bacteria, as directed by your surgeon. • The day of surgery, you may also have povidone iodine or mupirocin applied to nostrils. This will reduce the chance of bacteria from your nose spreading to your surgical wound. At the time of your surgery: • Ask if you will get antibiotics before surgery. • Make sure that your health care providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you don’t see your providers clean their hands, ask them to.

What should I do when I go home? • Your doctor or nurse should explain what you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital. • Always wash your hands before and after caring for your wound. • If you have any symptoms of an infection, call your doctor immediately. • If you don’t see your providers clean their hands, ask them to. • No one should touch the surgical wound or dressings, including you. • Anyone who visits should clean their hands with soap and water or an alcohol-based hand rub. If you do not see them clean their hands, ask them to. • Do not let your incision get wet or dirty. No hot tubs, pool or ocean swimming. • Cleanliness at home should include freshly laundered towels and clothes after a daily shower. Clean linens on your bed.

Post-Operative Care When you go home, there are a variety of things you need to know for your safety, recovery and comfort.

What You Can Do at Home • Ankle pumps (See Appendix A). • Deep breathing with an incentive spirometer — you will take this home. • You should continue taking a stool softener (i.e. Senokot S, Colace) until you are no longer on prescription pain medication. It is important to maintain a good bowel program since constipation can occur. • See Appendix B for information and examples on proper body positioning when sitting down, standing up and lying down.

Controlling Your Discomfort • Take your medications as prescribed by your physician. • Change your position every 45 minutes throughout the day. • Use ice for pain control as directed.

Body Changes • Your appetite may be poor. Drink plenty of fluids to keep from getting dehydrated. Your desire for solid food will return. • You may have difficulty sleeping, which is normal. Do not sleep or nap too much during the day. • Your energy level will be lower than normal for at least the first month. • Narcotic pain medication can cause constipation. Use stool softeners or laxatives if necessary.

Total Knee Arthroplasty Protocol (TKA) — Single and Bilateral • Full weight-bearing: You may go from a walker to a cane to nothing, as instructed by your physician and/or physical therapist. • Ice should be used after activity, exercise or physical therapy. In addition, it may be used at any other time to assist in reducing pain and swelling. • Remember, most of your success depends upon the effort you put into physical therapy after your discharge. • Please refer to activity guide for goals.

Knee Replacement Surgery Guidebook

Blood Clots in Legs (DVT) Surgery may cause the blood to slow and thicken in the veins of your legs, creating a blood clot in a condition called deep vein thrombosis or DVT. This is why blood thinners are prescribed after surgery. If a clot occurs despite these measures, you need to contact your surgeon immediately. (See Appendix D for more information about blood thinners.)

Signs of Blood Clots in Legs • Swelling in thigh, calf or ankle that does not go down when raised above heart level • Pain, heat and tenderness in calf, back of the knee or groin area (NOTE: blood clots can form in either leg)

How to Prevent Blood Clots • Ankle pumps (right and left sides) • Walking • Compression stockings • Blood thinners

Blood Clots in Lungs An unrecognized blood clot could break away from the vein in the leg and travel to the lungs and is called a pulmonary embolus. This is an emergency and you should CALL 911 if suspected.

Signs of Pulmonary Embolus (PE) • Sudden chest pain • Difficult and/or rapid breathing • Shortness of breath • Sweating • Confusion

How to Prevent Pulmonary Embolus • Prevent blood clot in legs • Recognize a blood clot in the leg and call physician promptly

Decreasing Your Risk of Falls Falls are a leading cause of injury for older adults. These falls usually happen on a level surface from a standing or sitting position. Often the fall results in a fracture. Please closely review these fall prevention strategies: • Have regular medical physical exams. • Review your medications each time you visit your medical doctor. Some medications or combinations of medications can cause one to be lightheaded, dizzy and weak - all potential risks for falling. • Have routine eye exams. You may be wearing incorrect glasses or develop cataracts without realizing it. • See the section on preparing your home for additional tips.

Post-Operative/ Home Care

Appendix A — Pre-Operative Exercises

Prepared By: J Coomes Prepared By: J Coomes

Arm-Chair Push-Up | Reps: 10 Push | Sets:Up Arm-chair Arm-chair Push Up3 |

REPS: 10 Setup REPS: 10

Daily: 1

Weekly: 7

SETS: 3 SETS: 3

DAILY: 1 DAILY: 1

WEEKLY: 7 WEEKLY: 7

Begin sitting upright with your feet resting flat on the floor and your hands on the armrest.

Exercise image Exercise step image step

1 1 1

2 22

Setup Movement Setup

Begin sitting upright flatchair. on the floor andthen yourlower hands ondown the armrest. Straighten your arms, with liftingyour yourfeet bodyresting off of the Hold briefly, back and repeat. Begin sitting upright with your feet resting flat on the floor and your hands on the armrest. Tip Movement

Movement Make sure to use a sturdy chair and use your legs to balance as needed. Do not shrug your shoulders during the exercise. Straighten your arms, lifting your body off of the chair. Hold briefly, then lower back down and

Straighten your arms, lifting your body off of the chair. Hold briefly, then lower back down and Seated Seated Long Arc ArcQuad Quad repeat. Long repeat. Seated Long Arc Quad

REPS: 1010 TipREPS: Tip| Reps: 10 | Sets: 3

SETS: 11 WEEKLY: WEEKLY: 77 |SETS: Daily: 3 1 3 | Weekly:DAILY: 7DAILY: | Make sure to use a sturdy chair and use your legs to balance as needed. Do not shrug your Make use a sturdy chair and use your legs to 2balance as needed. Do not shrug your 1shoulders 11 sure toduring 22 the exercise. shoulders during the exercise.

Exercise Exercise image image step step

Setup

Setup Setup Begin sitting upright. Begin Begin sitting sitting upright. upright. Movement

Slowly straighten one knee so that your leg is straight out in front of you. Hold, then lower it back to the starting Movement Movement position and repeat.

Slowly Slowly straighten straighten one one knee knee soso that that your your legleg is is straight straight outout in in front front of of you. you. Hold, Hold, then then lower lower it back it back to to Tip thethe starting starting position position and and repeat. repeat. Make sure to keep yourThisback straight during the exercise. Disclaimer: program provides exercises related to your condition that you can perform at home. As there is a risk of injury with any activity, use caution when

Tip Tip 16

performing If you experience pain to or your discomfort, discontinue the perform exercises contact yourishealth provider. Disclaimer: Thisexercises. program provides exercisesany related condition that you can atand home. As there a riskcare of injury with any activity, use caution when performing exercises. If you experience any pain or discomfort, discontinue the exercises and contact your health care provider.

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Page 1 Page 1

Active ActiveStraight StraightLeg LegRaise Raisewith withQuad QuadSet Set REPS: REPS: 8-10 8-10Leg RaiseSETS: SETS: 33 Set HOLD: HOLD:2-3 2-3SEC SEC Active Straight with Quad |

WEEKLY: WEEKLY: Reps: 8‑10 |77 Sets: 3

Hold: 2–3 Sec

Exercise Exercise image image step step

Daily: 1

DAILY: DAILY:11

Weekly: 7

Exercise Exercise image image step step

111

2 22

Setup Setup Setup

Begin lying your back with one knee bent andand your other leg straight. You can lay on your bed if needed to Begin Beginlying lyingon onon your your back back with with one one knee knee bent bent andyour yourother other leg legstraight straight do this exercise.

Movement Movement Movement

Squeeze Squeezethe thethigh thighmuscles musclesininyour yourstraight straightleg legand andflex flexyour yourfoot, foot,then thenslowly slowlyliftliftyour yourleg leguntil untilit itisis Squeeze the thigh muscles in your straight leg and flex your foot, then slowly lift your leg until it is parallel with parallel parallel with with your your other other thigh. thigh. Lower yourstarting leg legback back totothe the starting starting position positionand andrepeat. repeat. your other thigh. Lower your legLower back toyour the position and repeat.

Tip Tip Tip Make Makesure suretotokeep keepyour yourback backflat flatagainst againstthe thefloor floorduring duringthe theexercise. exercise.

Make sure to keep your back flat against the floor during the exercise. Supine Supine Ankle AnklePumps Pumps

Supine Ankle REPS: REPS: 20 20Pumps |

Exercise Exercise image image step step

Reps: 20

Exercise Exercise image image step step

Do20 20 repetitions you are awake. Do Do 20repetitions repetitionsevery every everyhour hour hourwhile while while you you are are awake. awake.

Setup

Setup Setup Begin lying on your back with your legs straight. Begin Beginlying lyingon onyour yourback backwith withyour yourlegs legsstraight. straight.

Movement

Slowly pump your ankles by bending and straightening them. Movement Movement Disclaimer: Disclaimer: This This program program provides provides exercises exercises related related to your to your condition condition thatthat youyou cancan perform perform at home. at home. As As there there is aisrisk a risk of injury of injury withwith anyany activity, activity, useuse caution caution when when performing performing exercises. exercises. If you If you experience experience anyany pain pain or discomfort, or discomfort, discontinue discontinue thethe exercises exercises andand contact contact your your health health care care provider. provider. Slowly Slowlypump pumpyour your ankles ankles by by bending bending and and straightening straightening them. them.

Tip Login Login URL: URL: adventhealth.medbridgego.com adventhealth.medbridgego.com• Access • Access Code: Code: X7FHEVPL X7FHEVPL • •Date Date printed: printed: 09/03/2020 09/03/2020

Try to keep the rest of your legs relaxed while you move your ankles. Tip Tip

Page Page 33

Try Trytotokeep keepthe therest restofofyour yourlegs legsrelaxed relaxedwhile whileyou youmove moveyour yourankles. ankles. Source: MedBridge

Appendix A — Exercises

Appendix B — How to Move After Surgery Lying in Bed • When lying in bed, keep your knee straight. Do not put a pillow underneath your knee. • The knee should be kept as straight as possible. • You can place a small pillow or rolled blanket under your ankle to assist in straightening.

Sitting Down and Standing Up From a Chair or Toilet When sitting down on a chair/toilet: *Sit in a chair with armrests when possible. • Take small steps and turn until your back is to the chair/toilet. • Back up until you feel it touch the back of your legs. • If armrests are available, lower yourself until seated. When standing up: *When standing up, do NOT pull up on the walker to stand. • Scoot to the front edge. • Push up with both hands on the armrests. If no armrest, place one hand on the walker while pushing off the side of the chair or wall with the other. • Balance yourself before grabbing for the walker.

WRONG

Knee Replacement Surgery Guidebook

CORRECT

Transfer - Bed Getting Into Bed • Back up to the bed until you feel it on the back of your legs (you need to be midway between the foot and the head of the bed). Slide your operated leg out in front of you when sitting down. • Reaching back with both hands, sit down on the edge of the bed and then scoot back toward the center of the mattress. (Silk pajama bottoms, satin sheets, or sitting on a plastic bag may make it easier.) • Move your walker out of the way but keep it within reach. • Scoot your hips around so that you are facing the foot of the bed. • Lift your leg into the bed while scooting around (use assistive device if instructed to do so). • Keep scooting and lift your other leg into the bed. • Scoot your hips towards the center of the bed. NOTE: Do NOT cross your legs to help the operated leg into bed.

Getting Out of Bed • Scoot your hips to the edge of the bed. • Sit up while lowering your non-surgical leg to the ﬂoor. • If necessary, use an assistive device to lower your surgical leg to the ﬂoor. • Scoot to the edge of the bed. • Use both hands to push off the bed. If the bed is too low, place one hand in the center of the walker while pushing up off the bed with the other. • Balance yourself before grabbing for the walker.

Appendix B — How to Move After Surgery

Transfer - Tub Getting Into the Tub Using a Bath Seat • Place the bath seat in the tub so it faces the faucet. • Back up to the tub until you can feel it on the back of your knees. Be sure you are in front of the tub bench. • Reach back with one hand for the bath seat. Keep the other hand in the center of the walker. • Slowly lower yourself onto the bath seat, keeping the surgical leg out straight. • Move the walker out of the way, but keep it in reach. • Lift your legs over the edge of the tub, using a leg lifter for the surgical leg, if necessary.

Getting Out of the Tub Using a Bath Seat • Lift your legs over the outside of the tub. • Scoot to the edge of the bath seat. • Push up with one hand on the back of the bath seat while holding on to the center of the walker with the other hand. • Balance yourself before grabbing the walker.

Transfer - Vehicle • Push the car seat all the way back; recline it, if possible, but return it to the upright position for traveling. • Place a plastic trash bag on the seat of the car to help you slide and turn frontward. • Back up to the car until you feel it touch the back of your legs. • Reach back for the car seat and lower yourself down. Keep your operated leg straight out in front of you and duck your head so that you don’t hit it on the doorframe. • Turn frontward, leaning back as you lift the surgical leg into the car.

Knee Replacement Surgery Guidebook

Stair Climbing • Ascend with non-operative leg first (“up with the good”). Descend with operative leg first (“down with the bad”).

Walker Ambulation • Move the walker forward. • With all four walker legs firmly on the ground, step forward with the operative leg. • Place the foot in the middle of the walker area. Do NOT move it past the front wheels of the walker. • Step forward with the operated leg. • NOTE: Take small steps. Do not take a step until all four walker legs are flat on the floor.

Appendix B — How to Move After Surgery

Appendix C — Medications Anesthesia What types of anesthesia are available? Decisions regarding your anesthesia are tailored to your personal needs. The types available to you are listed below. • General anesthesia provides loss of consciousness. • Regional anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain, or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks, epidural blocks, and saphenous nerve blocks.

Will I have any side effects? Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options as well as any complications or side effects that can occur. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Medications to treat nausea and vomiting will be given if needed. The amount of pain you feel will depend on several factors, especially the type of surgery. Your pain should be minimal, but do not expect to be totally pain-free.

What will happen before my surgery? You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all information needed to evaluate your general health. This will include your medical history, laboratory test results, allergies and current medications. With this information, the anesthesiologist will determine the type of anesthesia that is best suited for you. If a regional anesthetic is to be used, it will be administered in the pre-operative area. Your anesthesiologist will also answer any questions you may have.

What happens during surgery/anesthesia? Anesthesia will be provided by an anesthesia care team. An anesthesiologist with a Certified Registered Nurse Anesthetist (CRNA) will provide your care while in the operating room. They will monitor your vital signs (blood pressure, heart rate and oxygen level) during surgery and administer any medications necessary to provide you a safe surgical procedure.

What can I expect after the operation? After surgery, you will be taken to the Post Anesthesia Care Unit (PACU) where specially trained nurses will watch you closely.

Blood Thinners The surgeon will place you on an anticoagulant, also called a blood thinner, in order to help prevent blood clots. Most patients will go home on a blood thinner. The specific medication will be decided on by your surgeon based on your medical history.

Blood Thinner Medication Examples: Generic (Brand) Injectable • Enoxparin (Lovenox®) • Fondaparinux (Arixtra®) • Heparin

Oral blood thinners • Aspirin • Rivaroxaban (Xarelto®)

• Warfarin (Coumadin®) • Apixaban (Eliquis®)

Most Common Side Effects of Blood Thinners • Risk of bleeding • Upset stomach • Bruising 22

Knee Replacement Surgery Guidebook

• Burning at injection site • Decrease in platelets

• Tell your nurse or doctor if you notice any bleeding or black colored stools.

Appendix D — Nutrition Your body needs to be well-nourished to heal bones, muscles and skin that are affected by surgery. Healthy nutrition is important before and after surgery. Your doctor will determine the appropriate diet for you after discharge based on your medical history. Some nutritional considerations are included below. More information on healthy nutrition can be found at ChooseMyPlate.gov.

Protein It is normal for your appetite to be decreased after surgery. Eat a small amount of protein at each snack and meal. Protein contains all the essential amino acids to aid in wound healing and keeps your immune system strong. Protein is not just for muscle building. It is a key nutrient in bone building. Aim for two to three servings of protein-rich foods.

Protein-rich food: Eggs, red and white meat, turkey, chicken, fish, cheese, low/nonfat milk, beans, nuts/ seeds, soy protein

Iron Iron is an important mineral for your body to make hemoglobin. Hemoglobin is a part of the blood that carries oxygen.

Iron-rich food: Red meat, egg yolks, dark green leafy vegetables, ironrich cereals, beans, lentils, dried fruit, liver, watermelon, baked potato, dark meat turkey

Calcium and Vitamin D Calcium and Vitamin D are nutrients associated with healthy bones.

Calcium- & Vitamin D-rich food: Low-fat dairy, like milk and yogurt

Fiber Fiber-rich foods can help avoid constipation. It is important to increase your fiber intake slowly, along with adequate fluid intake, to avoid gas, bloating and constipation.

Fiber-rich food: Whole grains, bran, fruits, vegetables, beans, lentils

Water Adequate hydration will prevent constipation and promote healing. Unless your physician is restricting the amount of fluids you drink, the focus should be on drinking six to eight glasses of water a day.

Vitamin C Vitamin C is needed to make a protein called collagen and is needed for repairing tendons, ligaments and healing surgical wounds.

Vitamin C-rich food: Citrus fruits, strawberries, kiwi, baked potatoes, broccoli, bell peppers

Zinc Zinc is important for wound healing. Zinc is a mineral found mostly in animal foods. It is better to get zinc from foods than supplements.

Zinc-rich food: Meat, fish, poultry, dairy, wholegrain foods, breads, cereals, nuts

Appendix E — Nutrition

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Knee Replacement Surgery Guidebook

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Notes

Appendix E — Nutrition

Notes

Knee Replacement Surgery Guidebook

Notes

Appendix E — Nutrition

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