MidMichigan Health Joint Camp

Welcome to the Total Joint Replacement Class. As you prepare to have your knee or hip replaced there may be many questions and concerns that you may have. Our goal is that this class will help answer these questions and ensure that you come ready and prepared for your surgery. What should you do to prepare for surgery? Start with these homework assignments, prior to your surgery date: First, please identify a support person who will be available to help you at home after your surgery. Many people will need extra assistance during the recovery period for mobility or activities in the home.

It is important 00:33 - to have someone available as the need arises. If you have a pet consider some options ahead of time in case you’re unable to provide care for them. Another step to take is to safety proof your home. Pick-up all throw rugs and remove all extension cords and anything that may increase your risk of falls. Make sure you have pathways in your home to everywhere you will need to go in the first few days and weeks after surgery.

Work on getting ready for your surgery 00:58 - by completing any recommended pre-operative exercises. You may also be referred to some physical therapy ahead of time. Gather items for your hospital stay: It is a good idea to bring your guide to total joint replacement book, this is a good resource with references you can use during your stay. If you have an Advanced Medical Directive such as a Durable Power of Attorney, bring this in so that we can make a copy and add it to your MidMichigan electronic medical records. Bring your updated prescription medication list with you.

Our pharmacy 01:30 - will provide your medications during your stay and we ask that you do not take your home medications while you are in the hospital. However, if you have an unusual medication that you believe the pharmacy will not stock please bring your own along in a Ziplock bag with your name on it. It is important to pack comfortable loose-fitting clothing for your stay. You will need to attend a group therapy session, so you will want to wear something that you will feel comfortable in. Loose-fitting clothing such as sweats, athletic shorts or lounge pants work the best.

For shoe wear avoid backless shoes 02:03 - or slippers, as they can pose a tripping hazard for walking. Shoes should be supportive and evenly worn. Keep in mind when choosing footwear that you may has some swelling in your feet due to the surgery. If you have a front-wheeled walker please bring this with you to the hospital on your surgical day. Bring along any personal hygiene items you wish to have with you during your stay.

02:25 - Things you can do to prepare for surgery: Consider having stool softener such as Seneca or MiraLAX available as a major side effect of your pain medications can be constipation. Consider options of medical equipment to make your recovery easier. Please make sure you have transportation arranged for discharge and in the days and weeks after in case that is needed. Call the hospital as noted on page 3 in your workbook for your arrival time. On page 9, in your booklet you will find detailed instructions on skin preparation. You must wash with antibacterial wash starting 3 days prior to surgery. Do not shave the surgical area within 72 hours of surgery as this can increase infection risk. What should I do the night before surgery? Please do not drink any alcohol for 24 hours prior to surgery and after midnight do not eat anything including chewing gum or any throat lozenges. Do brush your teeth at you if you wish, but do not swallow any water. Once again, use the antibacterial wash. What will happen when I arrive to the hospital? Nurses will complete your check-in at this time and anesthesia will meet with you and discuss your plan.

03:35 - Most patients will have spinal anesthesia for this procedure but sometimes general anesthesia is used for total joint replacements. Due to HIPAA privacy laws we are unable to give any of your health information over the phone to family or friends during your stay unless they provide us with your four-digit pin. You will be provided this number when you check-in. What happens after surgery? After surgery you’ll be able to order food after arriving to your room. There will be approximately an hour of recovery before coming to the floor.

You will be up and moving as soon as possible after your surgery. For most patients this is within the first four to six hours after the surgery is completed. For your safety you will ambulate with a gait belt and walker and hospital staff at all times. This means you may not move around the room without assistance from staff at any point during your stay. Please call before getting up for any reason. What equipment would I experience? Expect to have an IV access throughout your stay. This will be likely in one of your arms and will provide fluids and antibiotics as needed as well as pain or nausea medication. You’ll likely have this disconnected on your first day of stay. A PCA pump, a patient controlled analgesia pump, is used for some patients who experience severe pain in the recovery period but most patients will not have this extra measure. Ted holes are tight white stockings that keep compression on the legs to reduce swelling and reduce risk of blood clots after surgery.

These come in knee-high or thigh-high versions and will be placed 05:06 - throughout the most of your stay. You’ll be asked to wear these at home as well per your physician’s guidelines. A Foley catheter is a urinary catheter that helps drain urine from the bladder. This is a physician specific and not all patients will have one. If you do, it will likely be for the first part of your stay only and will be removed to get you urinating on your own.

Compression boots 05:29 - another form of blood clot prevention, these are boots with velcro straps that go around the leg pumping with air and massaging the leg to promote blood flow. A drain may be placed during your surgery, depending on your provider. This is placed at the surgical site and it will remain for one or two days. This helps with healing process and help to drain the extra swelling from blood accumulation. Most patients will require some oxygen in their coverage period, as your body wakes from anesthesia. This is typically given via small nasal cannula and you will be weaned off this as soon as possible. An incentive spirometer is a simple device we use to help you achieve good deep breathing post-operative, to reduce risks such as pneumonia. It ensures air gets to the base of your lungs. An induction pillow is a foam wedge placed between the legs and these use for some support. It is a pillow with velcro straps which keeps your legs and an abducted position preventing movements that may cause damage or injury to your new surgical joint.

The day after surgery you can 06:29 - expect to start your day early. Joint Camp mornings start early because all patients need to be ready for the day before 7 a.m., when PT and OT and physicians come through. This means all patients need to be moved from their bed to their chair, get washed up and dressed and have drains and catheters pulled and medications given. And, this means we need to start early. We apologize for this as we know now everyone is the morning person.

The hospital is the place where you need sleep the most and you will 06:56 - find it’s the hardest ways to get sleep. You will be up and walking with physical therapy and occupational therapy during the day. Your coach or your care partner should attend the family training with you. These times and dates will be posted on the communication board in your room. When I go home? Our goal will be for you to be discharged home the day after surgery.

Some of the criteria we look for 07:19 - are that you are walking greater than 50 feet, you’re sitting and standing with minimal assistance and that your pain is controlled with oral medication. If you are not meeting this goals it may be possible for you to stay another day. But, our goal from the beginning will send you home the day after surgery. At home remember that movement is key. You should get up and move around often. Do your exercises and take short naps. Meds to Beds MidMichigan Health Pharmacy provides your home medications. The benefits are no need to stop at a pharmacy, close interaction with the healthcare team and it ensures that you obtain all correct medications.

The costs and insurance - we 07:57 - accept most major insurance plans and you’re just responsible for your co-pay. They take cash, check, credit cards or health savings accounts. There is no delivery fees. What medications will I be provided? Everyone will receive an anticoagulant such as aspirin or some type of blood thinner. Pain is expected part of the post-operative process, so everyone will have pain medication provided also. Most patients also will be provided with anti-nausea medications and stool softeners.

At home make sure to keep a notebook or notepad keeping track 08:32 - of when you take medications, especially your pain medications. Ways to control pain without opioids ice to the surgical site for knee replacements you will also receive an Ice Man elevate the leg turn lights down in your rooms at home use distraction TVs visitors music and games or reading now that we’ve covered your hospital stay less just briefly what to expect in your recovery time at home having a total knee or hip replacement is a big decision it can be a challenging experience but it is also a worthwhile experience I mean Michigan Medical Center has a lot of repeat customers who are glad that they had their joint replaced and say that it’s right decision remember each day gets a little easier so keep your chin up and keep working hard fatigue will occur at home during exercise so rest as necessary and take short naps especially for knees but occasionally for hips outpatient physical therapy may be necessary and your provider will let you know if they recommend us some patients will experience post- surgical blues so do your best to plan activities and have visitors regarding your dressing and incision most patients currently go home with a dressing called meppel X which stays in place until the physician or assistant removes it at your follow-up appointment these are water resistant but not waterproof so avoid soaking soaking or swimming but you may show with a dressing on gently dab dry when you are done reinforcing dressing is necessary with paper tape and notify your surgeon’s office if the bandage comes off please take your time to read through the following and final screen to familiarize yourself with what is normal and expected what are reasons to call your physician and what is an emergency situation again we are so glad you have chosen MidMichigan medical center for your joint replacement we will work with you to ensure your have excellent experience please let us know how we can best help you to achieve that thank you for attending this virtual class we look forward to seeing you on your surgical day hi my name is ELISA and I’m an occupational therapist here at mid-michigan health and my name is Kim and I’m one of the physical therapists assistant here at mid-michigan health physical therapy will educate and address your bed mobility walking strengthening range of motion and any equipment needs that you may have at home including a two wheeled walker if you have hip precautions you will not be allowed to bend past ninety degrees no twisting on that hip joint and no crossing your legs knees no twisting at the knee joint pre-op and post-op exercises the following exercises can be completed while lying in bed or in a chair ankle pumps bend the ankles going up and down ten times then make circles going in clockwise direction ten times and counter clockwise ten times glute sets squeeze both buttock muscles together as tightly as possible and hold for five seconds do 20 times quad sets use the front muscle of your thigh to press up the back of your knee against the bed with toes up straighten the knee on your surgical leg as much as possible hold it for five seconds do 20 times short arc quads place towel roll or coffee can under the knee on your surgical leg keep your knee on the roll point toes up and try to straighten it by lifting your foot towards the ceiling and hold it for five seconds then slowly return to starting position do 20 times heel slides gently bend knee on surgical leg by sliding the heel up towards your buttocks keeping the heel on the bed don’t let your knee fall in or out keep it straight make sure you do not bend your hip more than 90 degrees if you have hip precautions hold this exercise for 20 to 30 seconds and then slowly return down to straighten out the knee do 20 times abduction hips only keeping your surgical legs straight slowly move it out to the side carefully return it to the starting position being careful not to cross the midline do not turn toes in or out keep up and straight do 20 times do not do this exercise if you have anterior lateral precautions following surgery straight leg raises knees only slightly bend your non-surgical knee and place that foot flat on the bed lift the surgical leg up towards the ceiling approximately 8 to 10 inches holding for 3 to 5 seconds and keeping the knee as straight as possible and slowly return it down to a flat position do 10 times seated knee flexion knees only while sitting in a straight back chair bend your surgical knee underneath the chair as far as possible hold the stretch for 30 to 60 seconds remembering that to force the knee slowly return to starting position do 10 times long art quad hips and knees sitting in a chair with your knee in a bent position slowly straighten your knee as you raise your foot upwards hold for 3 to 5 seconds and slowly lower back down toward starting position do 20 times each leg using your two wheeled Walker move the Walker forward with all four Walker legs firmly on the ground step forward with the surgical leg place the foot in the middle area of the Walker do not move it past the front feet of the Walker step forward with the non-surgical leg takes off Mall steps your doctor and physical therapist will instruct you in your proper weight-bearing status do not carry items in your hands while using your Walker your hands must be directly on the Walker handles 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 reaching back with both hands sit down on the edge of the bed extending your surgical leg and then scoot as far back towards the center of the mattress as you can 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 onto the bed while scooting keep scooting and lift your other leg onto the bed scoot your hips towards the center of the bed getting out of bed sit up scoot your hips to the edge of the bed while lowering your surgical leg to the floor and then the other leg onto the floor scoot to the edge of the bed grabbing your Walker two foot in front of you use both hands to push off the bed balance yourself before grabbing the Walker going up and down the stairs it is recommended that you have at least one handrail installed prior to your surgery date to go up the stairs lead with your non-surgical leg followed by your surgical leg non-surgical leg surgical leg to go down the stairs lead with your surgical leg followed by your non-surgical leg surgical leg non-surgical leg occupational therapy will address your ability to perform self-care tasks following surgery including equipment needs for your bathroom and dressing dressing bathing and toileting transferring in and out of your vehicle shower and toilet some things to keep in mind and prepare for at home prior to your surgery includes adequate lighting especially night lights within your bathroom bedroom and kitchen it is also very important to make items accessible this includes keeping frequently used items with an easy reach especially in the kitchen bathroom and bedroom and finally laundry and cleaning make sure you have a few weeks of clean clothing available as you will not be able to carry a laundry basket while using your walker equipment that the occupational therapist will address with you includes in the bathroom a shower chair a toilet riser or commode the occupational therapists will also address your ability to get dressed if you are a patient with hip precautions you will be given the following equipment sack aid shoehorn Reacher and long handled sponge the occupational therapist will go over this equipment with you in regards to the proper use and you will have the ability to practice using this equipment prior to going home the following slide is a visual of all the equipment that you may need for home including the shower chair a tub transfer bench a toilet safety frame toilet riser bedside commode and finally the dressing equipment getting into the tub shower chairs grab bars and handheld shower heads make bathing easier and safer use a rubber mat or non-skid adhesive on the bottom of the shower or tub first place the shower chair in the tub facing the faucets back up to the tub until you can feel it at the back of your knees be sure you are in front of the shower chair seat reach back with one hand for the shower chair keep the other hand gently on the Walker slowly lower yourself onto the shower chair keeping the surgical leg out in the front move the Walker out of the way but keep it within reach turn and lift your legs into the tub do not cross your legs while doing this getting out of the tub turn and lift your legs over the outside of the tub without crossing legs scoot to the edge of the shower chair push up with one hand on the back of the shower chair while holding the Walker gently with the other hand balance yourself before grabbing the Walker you will use the same technique for getting into and out of the vehicle using the front passenger seat getting onto the toilet you will need a raised toilet seat or a three-in-one bedside commode over your toilet following surgery your occupational therapist will assist with this information first take small steps and turn until your back is to the toilet never pivot back up to the toilet until you feel it touched the back of your legs keep one hand on the Walker while reaching back for the toilet seat with the other hand slide your surgical leg out in front of you before sitting down when getting up from the toilet place one hand on the Walker slide your surgical leg out in front of you and push off the toilet seat with the other balanced yourself before grabbing the Walker having a joint replacement is a big decision and we want to make sure that your experience at mid- michigan health is an excellent one thank you for choosing us .