Welcome to the Total Joint Replacement Education Class

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Welcometo theTotal JointReplacementEducation
Class
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The Human Motion Institute

• Taking care of all your
• Musculoskeletal needs
• Joint Replacement
• Spine Surgery
• Sports Medicine
• Rehabilitation

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Joint CarePlus Program

• Total Knee Total Hip
• Replacement Program
• Known for its.
• Quality of care
• Clinical Expertise
• Compassionate treatment philosophy
• Exceptional Customer Service

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Joint CarePlus Program

• Features include
• Preoperative education class
• Patient Guide Book
• Hospital stay of only 4 days. home by the
  weekend
• Orthopaedically-trained staff
• Group therapy sessions
• Large private rooms

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Total Joint Replacement Education Class

• Provides you with valuable information on what to
  expect before, during and after surgery
• Gives you an opportunity to meet fellow patients
  that will be having surgery the same day
• Gives you an opportunity to familiarize yourself
  with the HMI Unit and the HMI Staff
• Decreases your anxiety level

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The Knee Joint
Knee joint is formed at the meeting point of 2
major leg bones, the Femur and Tibia
Femur Thigh bone Tibia Shin bone Patella
Knee Cap Cartilage elastic tissue to
cushion Ligaments connects bone to bone Tendons
connects muscle to bone
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The Hip Joint
Ball and Socket Joint Femur thighbone
Femoral Head Femoral
Neck Acetabulum socket
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Osteoarthritis

• Degenerative Joint Disease
• Affects the cartilage lining on the ends of bones
• Cartilage becomes worn, no longer allowing smooth
  movement inside the joint
• Painful grinding sensation as the joint works
• Pain, stiffness, and loss of function are common

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Osteoarthritis
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Total Knee Replacement Surgery
Removal of the damaged cartilage and bone to
position the new metal and plastic joint surfaces
to restore alignment and function of your knee
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Total Hip Replacement Surgery

• Incision is made on side of thigh
• Cartilage is removed
• Implant is inserted into your femur

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Anesthesia

• Spinal or General anesthesia is required to be
  administered before your surgery
• You will meet your anesthesiologist prior to
  surgery in the pre-op holding area
• Your Anesthesiologist will review your history
  and discuss the best option for you

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Preparing Your HomeFor Surgery

• Remove all throw rugs out of your path
• Move things you might need to area where you can
  reach them (medications, phone, cooking utensils)
• Widen pathways to get your walker through (do not
  rearrange furniture)
• Prepare and freeze nutritious meals to have on
  hand after discharge

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Controlling Risk Factors

• Inform your surgeon if you see a primary care
  physician or a specialist on a routine basis
  and/or have been following a physician-prescribed
  diet
• Review all medications with your surgeon
  including herbal supplements, vitamins and/or
  minerals
• Check with your surgeon regarding blood thinners
  and when you should discontinue them

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Controlling Risk Factors

• If you are overweight, losing weight will help
  reduce the pressure on your joints and reduce
  your pain
• If you are diabetic, follow your diet ,check your
  blood sugars at least twice daily, and take your
  medications as prescribed
• If you are a smoker, stop 3 to 5 days before your
  surgery to decrease chances of lung problems and
  speed your recovery

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Surgery Event Calendar

• Pre-Operative Doctors Appointments
• Discuss your surgery, the risks and complications
  that may occur
• Discuss possibility of a blood transfusion
• Sign consents
• Opportunity to ask last minute questions
• Your surgeon may request that you see your
  primary care physician and/or specialist for
  medical evaluation

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Surgery Event Calendar

• Pre-Surgical Testing Appointment
• Gaston Professional Building, Entrance C on the
  Hospital Campus
• Visit may last up to 2 hours
• Medical Tests performed (blood test, urine
  sample, nose swab, possibly an EKG)
• Medical/surgical history will be reviewed
• List of medications that you need to stop taking
  and which you need to take the morning of surgery
  will be provided
• Hibiclens Soap will be given with instructions

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Pre-Surgical Testing Appointment

• What to bring with you
• Packet that your surgeon has given you
• Patient Guide Booklet (complete the
• Patient Home Medication List)
• List of all the physicians you see on a regular
  basis
• List of your allergies and your reactions to them
• List of your surgical/medical history
• Insurance card

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Preparing For Surgery

• What to Bring with you to the Hospital
• Patient Guide Booklet
• Copies of Advance Directives
• Loose comfortable clothing, enough for 4 days
• Flat supportive walking shoes that are non-lip
  with an enclosed heel
• If you wear a C-Pap, mask only

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Preparing For Surgery

• What NOT
• to bring to the Hospital
• Large amounts of money
• Credit cards
• Valuables, jewelry

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Day Before Surgery

• Do not shave legs the day before or day of
  surgery
• Shower with the Hibiclens Soap the night before
  and the morning of surgery
• Do not eat or drink after midnight, including
  water, chewing gum or candy

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Morning of Surgery

• Take any morning medications that you were
  instructed to take, sip of water only
• Arrive at the hospital 2-3 hours before your
  scheduled surgery time
• Park in the Emergency parking lot
• Enter at Emergency Room entrance
• Take HMI elevator to 3rd floor
• Report to the nurses station on the Human Motion
  Institute Unit

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Day of SurgeryPre-Op on the HMI Unit

• The HMI staff will prepare you for surgery
• You will change into a hospital gown
• A name band will be verified and applied
• An IV will be started (using Lidocaine)
• Your medical/surgical history will be reviewed
• Your completed Patient Home Medication List
  will be reviewed and recorded
• Instructions will be given to you and your family
  

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Day of Surgery Pre-Op on the HMI Unit

• You will be transported in your bed to the Pre-Op
  Holding Area
• Your family/friends will be directed to the
  Surgical Waiting Area
• Both areas are located on the 1st floor
• Family members/Friends please sign in at the
  reception desk

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Day of Surgery Pre-Op Holding Area

• Meet your surgical team
• Pre-Op Holding Nurse reviews your
  medical/surgical history
• Surgeon, with your assistance,
• marks the operative leg
• Anesthesiologist will speak to you
• about anesthesia options
• Prophylactic antibiotic will be administered
• Relaxing medication will be administered

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Day of Surgery Operating Room

• Anesthesia administered
• Catheter inserted in bladder to drain urine
• Length of surgery varies approximately 1 to 2
  hours
• Patient Tracker Board in Surgical Waiting Area
  informs friends and family when you are out of
  the OR

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Day of SurgeryPost Anesthesia Care Unit

• Also known as the PACU
• Close monitoring until you are fully awake
• You will awaken to
• oxygen tube in your nose
• blood pressure cuff on arm
• pulse oximeter on finger
• catheter in your bladder
• surgical bandage on your incision
• Request pain/nausea medication if needed
• Your surgeon will speak to your family/friends in
  the surgical waiting area

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Pathway to RecoveryHMI Unit

• Transported back to your HMI room from the PACU
• Your Nurse and Patient Care Tech will
• Monitor your vital signs closely
• Manage your pain
• Instruct you on daily exercises and using your
  incentive
• spirometer
• Receive a clear liquid meal tray
• You may be assisted out of bed into the chair
• Overnight you will continue with
• Oxygen tubing in your nose
• IV fluids to continue hydration
• Catheter in your bladder to drain urine

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Pathway to RecoveryPlan of Care
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Pathway to RecoveryPain Management

• In order for your pain to be treated effectively
  it is important for you to
• Tell your doctor/nurse what pain medications have
  or have not worked for you in the past
• Request pain relief when you begin to feel any
  discomfort
• Help the doctor/nurse assess your pain and report
  whether the pain relief measures are adequate
• Ice packs will also be provided to reduce
  swelling and relieve pain for total knee
  replacement patients

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Pathway to RecoveryPhysical Therapy

• Our Rehabilitation Team will work with you to
  improve your functional abilities
• Physical Therapists Will instruct you on
  transferring, walking with a walker,
  strengthening exercises, stair climbing, and
  review precautions
• Occupational Therapists Will instruct you on
  transfers, self care activities and use of
  adaptive equipment
• Our goal is to help you reach your maximum level
  of independence before you are discharged

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Group Therapy

• Patients motivating each other to improve
• 1 hour session scheduled twice daily (10 am and 2
  pm)
• Your coach should be available to assist and
  motivate you with your therapy during your
  hospitalization and when discharged

Motivation and participation in your therapy
program are important to the speed and success of
your joint replacement surgery
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Preventing Complications

• Blood clots
• Blood thinners (Lovenox and /or Coumadin)
• Stockings/Foot pumps
• Leg Exercises/Early mobility
• Pneumonia
• Incentive spirometry, coughing deep breathing
• Early Mobility
• Infection
• Prophylactic antibiotics for 24 hours
• Hand gel sanitizers

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Preventing Complications

• Nausea
• First meal Clear Liquids
• Medication provided when/if needed
• Constipation
• Daily Stool Softener administered
• Laxative given when/if needed
• Swelling
• Ice Therapy provided

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Recovery At HomeDischarge Planning

• Depending on your physical and clinical status
  you will be discharged home three days after your
  surgery
• Your progress and readiness for discharge will be
  assessed daily
• Your case manager and/or social worker
• Visit with you the day after surgery
• Discuss with you the discharge plan
• Assist you with insurance questions
• Make arrangements for medical equipment home
  delivery

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Recovery At HomeDischarge Destination

• Once home, your physical therapy will continue
• Based on your physicians, nurses and
  therapists recommendations you may choose
• Outpatient Physical Therapy daily therapy at
  an outpatient facility (transportation
  arrangements can be made)
• Home Health physical therapist will come to
  your home 3 d days per week
• When a patient is not mobile enough to go
  directly home, arrangements can be made to go do
  a skilled inpatient facility

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Recovery At HomeDischarge Day

• Case manager and/or social worker will make final
  discharge arrangements
• Medical equipment, if needed, will be delivered
  to your house
• AM Group Therapy and Occupational Session only
  (stair Climbing)
• Nurse will review discharge instructions in your
  Patient Guide Booklet, with you and your family
• First Post Operative Surgeons Appointment in 10
  to 14 days (staples will be removed)

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Your success is very important to us. We strive
to make your stay with us an exceptional
experience. Please let us know if there is
anything we can do to improve your care. We
look forward to caring for you!
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Thank you for choosing the Human Motion
Institute for your upcoming Total Joint
Replacement