Your Comprehensive Guide to Joint Replacement Surgery

1. Your Guide to Joint Replacement Surgery

2. Your journey to wellnessbegins here. Welcome. Thank you for choosing Rome Memorial Hospital and Rome Orthopedics & Sports Medicine for your joint replacement surgery Updated June 28, 2016

3. How this class can help you. • This class is designed to give you some basic, important information about joint replacement surgery • We will cover what to expect before, during, and after your surgery • You will be given a booklet in the physician’s office • The booklet contains detailed information about your specific surgery (hip or knee), your care and recovery • Please bring your booklet to all preadmission visits and hospital stay

4. Our goals for you. • To answer any questions you have about your upcoming surgery • To inform you of what to expect so you are comfortable with your surgery and your stay at Rome Memorial Hospital • To be discharged within 2-4 days

5. What are your goals? • Golf? • Walking? • Playing with your children and/or grandchildren? • Gardening? • Vacationing with your family? We will work with you to help you achieve the goals you set for yourself.

6. Why joint replacementsurgery? “I work closely with my patients to understand their goals as we develop the best plan of care to relieve their pain and restore their activity to the highest level of function possible. For my surgical patients, managing post-surgical pain is a priority so patients can begin the rehabilitation process promptly and recover more quickly.” Dr. Mihail (Mike) Radulescu, M.D., FRCSCOrthopedic Surgeon

7. Normal joints. • Allow for movement between bones • Each bony surface of the joint is lined with cartilage • Cartilage provides smooth friction-free movement, nutrition to the joint, and provides shock absorption

8. Hip joint. • Ball (femur) and socket (acetabulum) joint • Moves in three directions • Socket not lined completely with cartilage

9. Knee joint. • Hinge joint is largest joint in the body • The thigh bone (femur) and the shin bone (tibia) meet to form the knee joint • The knee cap (patella) covers and protects the knee joint • Cartilage covers the end of the knee bones and “cushion” the knee for smooth, easy movement

10. What is arthritis? Osteoarthritis • Slow developing joint pain • Stiffness, bony enlargement • One or both sides affected • Usual onset is middle age RheumatoidArthritis • Symptoms come and go • Affects all ages • Chronic systemic inflammatory disease Rheumatoid arthritis usually affects joints symmetrically (on both sides equally), may initially begin in a couple of joints only, and frequently attacks the wrists, hands, elbows, shoulders, knees and ankles

11. How do we treat arthritis? Non-surgical care • Medication • Injections • Activity modification • Physical therapy Minor surgery • Arthroscopy Surgical Care • Joint replacement surgery Healthy Knee Arthritic Knee

12. People just like youare having joint replacement surgery. • There are over 1.1 million procedures done each year in the United States • Knee and hip joint replacement surgeries are two of the most common surgeries performed in the United States • With the rise in the number of baby boomers reaching retirement and increasing demands on athletes, the number of joint replacement surgeries is expected to increase each year

13. Prepare yourself for surgery. • Stop aspirin, aspirin containing medications, Coumadin (Warfarin) and anti-inflammatory (NSAIDS) 5 days before surgery • Stop factor Xa inhibitors, ie: Xarelto (Rivaroxaban), Eliquis (Apixaban) 24 to 48 hours before surgery • Stop Plavix (Clopidogrel) 7 days before surgery • Stop smoking as soon as possible • Stop drinking alcohol as soon as possible • Eat a healthy diet • Become familiar with the exercises in your joint replacement surgery guide

14. What to bring to the hospital. • Your joint replacement guide • Eye glasses, dentures, hearing aid • Supportive rubber soled shoes or sneakers • Loose fitting clothes (no jeans) • Health Care Proxy • Insurance Card • Written list of home medications • Leave all valuables at home

15. Your Care Team. • Surgeon • Physician Assistants/Nurse Practitioner • Anesthesia Care Provider • Nurses - Registered Nurses - Licensed Practical Nurses (for short-term rehabilitation) • Physical Medicine and Rehabilitation Professionals- Physical Therapists - Occupational Therapists • Case Manager • Pharmacist

16. Who else plays a vital role? YOU and YOUR COACH play a key role in your recovery.

17. What is the role of the coach? A coach can be: • Your spouse, friend, family member, neighbor • Anyone that can be a support to you as you recover from your surgery Your coach will help you with: • Activities of daily living (as needed) • Transportation to follow-up appointments • Preparing your home • Any necessary errands

18. How to prepare your home:both inside and outside. • Good lighting • No trip hazards • Clear pathways (plan for leaf, snow removal) • Handrails • Frequently used items within reach • A comfortable place to sleep and rest • Please refer to your booklet for more information

19. Preventing complications:Pre-surgery testing. To evaluate your overall health and prevent complications from unknown or uncontrolled medical problems, we will order pre-surgical testing including: • Blood work for diabetes, iron levels for anemia, kidney and liver function, clotting function • EKG • Chest x-ray • Urinalysis • Physical Therapy Functional Evaluation

20. Preventing complications:What we do to prevent infection. • We wash our hands frequently • We clean our equipment and workstations frequently • Each patient has a dedicated walker, equipment is not shared between patients • Rome Memorial Hospital is top rated in the region for protecting patients from surgical site infections At Rome Memorial Hospital, we take great pride in our track record for keeping our patients safe from infection.

21. Preventing complications:What can you do to prevent infection? • Do not shave the surgical site prior to surgery • Wash with chlorhexidine soap as directed in your pre-admission visit • Complete nasal ointment application as directed in pre-admission visit • Wash your hands often including before meals and after using the bathroom • Ask family members to wash their hands often • See your dentist on a regular basis

22. What to expectthe day before your surgery. The business day before your surgery date, you will receive a call from the hospital about your expected arrival time. (Please arrive on time.)

23. What to expect the day of your surgery. • You will be “NPO after MN” – this means no food or drink after midnight (including chewing gum) • Morning medications will be taken with just a sip of water, enough to get the medication down • Limit belongings and leave all valuables at home. Your family will be responsible for carrying your personal items • You are expected to arrive on time. Go directly to the Ambulatory Care Unit, 2 East DAY 0:

24. What to expectbefore the operating room. • Nurses will review your medical/surgical history • Medications will be reviewed • An IV will be inserted • You will receive multiple pre-op medications including those for pain, nausea and antibiotics • You may have a urinary catheter inserted (most patients do not) • You will be transferred to a holding room prior to entering the operating room • Your surgeon will talk to you and mark the surgical site • Your Anesthesiologist will talk to you

25. Anesthesia. You may receive spinal anesthesia Spinal anesthesia blocks the nerves to a specific area • You will be in a comfortable twilight state while in the OR; you may be able to hear what is happening around you • You will not feel any pain during your surgery • Research has shown that this type of anesthesia results in less complications and shorter hospital stays You may receive general anesthesia Please ask your surgeon any questions you have regarding anesthesia

26. For your family. Family Surgical Waiting Room and Visiting Hours • Your family will be directed to the Information Desk in the main lobby and receive a pager • Your surgeon will speak with your family after surgery in the Surgical Consultation Room next to the Information Desk. • Visiting hours are from 8 a.m. – 8 p.m. • We encourage family members to visit and stay as long as possible if it will aid your recovery

27. What to expect after you leave the operating room. • Arrive in Post Anesthesia Care Unit (PACU), you will be there approximately 1-2 hours • When you are ready, you will go to your room; you will be greeted by your nurses • You will have a private room as soon as one becomes available

28. What to expectafter arriving in your room. • Frequent vital signs and assessments • Clear liquid diet, advanced to regular food as you can tolerate • Physical Therapy (PT) evaluation if able • You should take deep breaths and cough; use your incentive spirometer • Pain control is important • Please talk to you nurse about pain Incentive Spirometer

29. Managing your pain. • We use oral medications for pain control • Medications may be adjusted based on your specific needs • Asking for pain medication one hour before Physical Therapy is an option • If you have spasm, uncontrolled pain and/or you can’t sleep, ask your nurse, there are more therapies/orders for medications that can be used • We also use an ice cyrotherapy device on your surgical site to help with pain management and swelling • Mobility and other therapies can help (music, imagery, etc.)

30. Pain scale 0-10.Pain control can help speed your recovery. If your pain is well controlled (at or below 3 on the pain scale), you will be better able to participate in physical therapy and deep breathing exercises and sleep. 0= No Pain 10= Worst Pain Possible

31. Your White Board:Communicating with your caregivers. • On the wall across from your bed • A way to keep you involved in your care; use the white board to make notes and post questions • Names of your Care Team • Family members may use it to leave notes for your providers • Pain Control Goals

32. Preventing complications after surgery:Blood clots and pneumonia. Sequential stockings and compression devices • Compression stockings and devices help prevent post-op blood clots • Wear them when you are in bed or in the chair • Various anti-coagulation medications Incentive Spirometry and deep-breathing • Use your spirometer 10 times every hour while awake to prevent pneumonia after surgery • Pre-op antibiotics (post-op if indicated)

33. Preventing complications after surgery:Constipation. • Pain medications can cause constipation • We will start you on a post-operative bowel regime with various stool softeners • Good hydration is important, you will have clear liquids first then advance to solid foods as tolerated • Return to activity – get moving

34. Preventing complications after surgery:If you have diabetes • We may monitor your blood glucose while you are in the hospital more frequently than you do at home • We may give you insulin while you are here • If you currently take insulin at home, we may give you a different insulin while you are in the hospital

35. For some knee surgery patients. CPM (continuous passive motion) machine • For knee replacement surgery patients only • May be used by some physicians • Helps range of motion with passive motion of the knee

36. Your post-surgery team. • The nurse practitioners (NPs) and hospitalists that see you post-operatively are an extension of your surgeon • They work together closely to take care of you

37. What to expectthe first day after surgery. • Your Case Manager will visit to discuss your discharge plan • Physical/Occupational Therapy begins, exercise is important • Any drains or catheters are removed by your nurse • Ask for pain medications when you need them, pain should be at or below a 3 • Use your call bell and wait for nurse before getting out of bed DAY 1:

38. Physical Therapy. (PT) Physical Therapy is important for your recovery • During PT, you will be doing exercises laying down, sitting and standing • You will learn how to use an assistive device (as needed) and practice getting in and out of a chair, laying down, getting into a car and using stairs • A therapist will come to meet you at your bedside • You will receive PT once on the day of your surgery • You will receive PT twice a day thereafter • Your nurses will get you up to walk and encourage you to do your exercises throughout the day

39. Occupational Therapy. (OT) Occupational Therapy teaches you strategies to: • Perform self-care tasks (dressing, bathing and toileting) • Use adaptive equipment as needed for self-care tasks • Function safely in your home • Address barriers to movement precautions • You will receive OT one time each day

40. Adaptive Equipment for joint replacements. • After surgery you will need extra support • Use adaptive equipment as needed for self-care tasks Your Occupational Therapist will determine if you need adaptive equipment and what would be most helpful to you

41. Time to start moving. Remember, your surgeon will put your new joint in, but you are the one who has to move it! It is important that you are an active participant in your recovery!

42. What to expectthe second day after surgery. • PT will continue, 2 times a day • Occupational Therapy, 1 time a day • Your nurse will help you walk in the hall • You will continue to be monitored and assessed • Pain level should be at or below 3 • You may be discharged on this day, depending on your progress and recommendations from your physician and physical therapist DAY 2:

43. Discharge to home. • You may heal better in your home • Arrange for someone to assist you at home (your Coach) • If you need home care services, your Case Manager may arrange for visits from a nurse, physical therapist and/or home health aides • Most people are able to begin outpatient physical therapy immediately upon discharge

44. Outpatient Physical Therapy. • You will require outpatient physical therapy • Arrange for someone, such as your coach, to assist you at home and with transportation to Physical Therapy • Most people are able to begin outpatient physical therapy immediately upon discharge • Rome Memorial Hospital’s physical therapy services:Chestnut Commons Physical & Occupational Therapy 107 E. Chestnut St., Suite 104, Rome

45. Discharge to Short-term Rehabilitation. • Short-term Rehab may be an option for those who still require help getting in and out of bed and for those who may not have support at home (please talk to your Case Manager for current rules and criteria) • Rome Memorial Hospital provides short-term rehabilitation on the hospital’s third floor. Easy transition from your hospital room may be an option • Transportation to short-term rehab is NOT covered by insurance, and many transport companies require payment upfront with a credit card • We do not recommend having family or friends transport patients to a rehab facility

46. What to expect on your discharge day. • In the morning, your Nurse Practitioner will see you and assess if you are able to be discharged • Your Physical Therapist may visit you, depending on your discharge time • Your Nurse will review instructions and medications with you • Discharge time varies, we do our best to coordinate a timely discharge • Patients are discharged through our Bartlett Wing entrance, please ask your ride to meet you there

47. What to expect after discharge. • Continue with your PT and exercise regiment • Increase activity based on your tolerance • Use assistive devices until no longer needed • Keep your follow-up appointment • Drive only with your doctor’s approval • Resuming sexual activity - Knee replacement: as soon as you feel able - Hip replacement: 4-6 weeks (or sooner) - Ask your doctor, physical therapist or nurse for more information • Your patient booklet has more information

48. Thank you. • Thank you for choosing Rome Memorial Hospital and Rome Orthopedics & Sports Medicine for your joint replacement needs • Do not hesitate to ask our knowledgeable team of physicians, nurses and therapists any questions you may have as you recover from your surgery

49. Important phone numbers. • Rome Orthopedics & Sports Medicine315-338-9200 • Rome Memorial Hospital Pre-op Coordinator 315-338-7355 • Chestnut Commons Physical & Occupational Therapy 315-337-7952