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ORTHOPEDIC SURGERY ORIENTATION

“THE JOINT

JOURNEY”

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Healthy Hip Joint

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Degenerative Hip & Hip Replacement

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Healthy Knee

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Degenerative Knee and Knee Replacement

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Preparing for Surgery

• Primary Care Physician – Blood tests – X-rays – Clearances

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Preparing for Surgery

• Dentist – Check up regarding your teeth and

gums. Be sure that there is NOT an infection present

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Preparing for Surgery • Stop Smoking. • Write down all the medication you are taking

including strength and frequency as well as over-the-counter drugs, i.e. baby aspirin glucosamine melatonin

• Get your lab tests and clearances done after

your primary care visit. • Stop blood thinners as directed by primary

care physician

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Preparing Your Home

• Arrange furniture & remove ‘scattered rugs.’

• Stock up on food and toiletries. • Refill Prescriptions. • Prepare meals and freeze them. • Utilize your resources

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PRE-OP VISIT

• BRING a list of ALL the medication you take to your visit.

• The pre op nurse will review your list of Medications and tell you which medication must be taken the day of surgery

• You may have your blood draw for a Type & Screen to determine your blood type. This can only be done within a week of surgery

• The exact time to report for Surgery is determined by the pre-op nurse.

• Call after 2pm the DAY BEFORE your scheduled surgery for the exact time. Please disregard the Dr’s office surgery time.

– East campus 561.737.7733, ext. 84361 – West campus 561.336.7036

• DO NOT eat or drink after midnight, this includes No gum, mints, or lozenges. You may

take the medication you are instructed to take the morning of surgery with a small sip of water.

• Anesthesiologist or Nurse Anesthetist will meet with you the day of Surgery.

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Skin Preparation • Wash the operative area

with antibacterial soap the NIGHT before and the MORNING of surgery (Hibiclens or a Chlorahexidine Product).

• No dark or red nail polish

• DO NOT shave the operative site.

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What should I bring? • Grooming items:

deodorant, toothpaste, comb, brush.

• Glasses, contact lens case with fluid, hearing aids, throat lozenges.

• Comfortable Closed Toe shoes

• Loose fitting clothes. Please be prepared to dress the day after surgery

• List of all meds & allergies

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Do Not Bring

• Jewelry • Wallet • Keys • Checkbook • Purses • After completing

financial transactions, send all valuables & credit cards home.

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MORNING OF YOUR SURGERY

EAST CAMPUS - entrance to the left of the main building WEST CAMPUS - 2nd floor Surgery center

• General Preparation: (remove ALL your clothing put on a surgical gown, remove glasses, dentures, underwear).

• Secure belongings with family member. • Review and sign consent (if not already

done). • Transported to pre-op Holding area (East) • Visit with surgeon – surgeon will mark the

operative site. • Meet your anesthesiologist or nurse

anesthetist.

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Post-Operative Information • Incision

– Closed with staples or skin glue. – Wound drain for 1-2 days. – Staples are removed 8-14 days after

surgery in physician office.

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Cool Ice Machine • Your doctor may want you to

use the cool ice machine. • Used primarily for Knee

Replacements. • Cooling will help decrease pain,

bleeding, and swelling. • Cooling system will be used

continuously for several days post op. At home, should be used intermittently after PT and exercise or as directed by your doctor.

• This is your machine. Please take all pieces home with you.

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CPM for Total Knee CONTINUOUS PASSIVE MOTION

• SOME surgeons use it

and some don’t. • Usage is scheduled

throughout the day. • Ask for pain medication

approximately 30min prior to scheduled use.

• The flexion degrees are increased each time it goes on.

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Post Hip Replacement • Abductor Pillow - This foam pillow is

sometimes used to prevent you from dislocating the operative hip.

• Prevents you from crossing your legs

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Hemovac drain • This drain is placed

in the incision at the end of surgery.

• The drain will be emptied frequently

• The drain is usually removed the day after surgery, sometimes day 2

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ConstaVac Drain - Blood Replacement

• This is a self-contained blood replacement system. – Sterile system and

never open to air. • Replaces your own

blood that has collected in the chamber.

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Home Care or Rehab? • The case manager will visit you after surgery to discuss

discharge plans. • If possible, have your family attend this meeting. • For the continuity of care of our patients, Bethesda offers

both Home Care and Outpatient Rehabilitation services. Please also inquire with your physician.

• Any needed equipment will be ordered by your case

manager/discharge planner. – The type of “walking assist” equipment that you will

need is determined by the physical therapist and ordered by the Discharge Planner/ Case Manager.

– Other assist devices can be purchased while in the hospital through the physical therapy department

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Pain Management • Exparel is a local pain medication administered in the OR. It is injected

into the operative site and may last up to 72hrs.

• A femoral block may be used, instead of exparel for patient having a total knee • Intravenous pain medication may be used on the first day post-op

• Pain Pills may take up to 30min to work

• Pain Scale will be used to assess your pain 0 – 10 , ten being the Worst

pain

• The goal is to keep you as comfortable as possible, however, you should NOT expect to be completely pain free post operatively.

• It is the expected outcome for your pain level to be a minimum of four post operatively.

• Bring sore throat lozenges

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Pain Scale

You will be asked if your pain control is satisfactory before you leave the Recovery Room. Upon arrival to your room you will be asked if your pain control remains satisfactory. The goal is to keep you comfortable. Question: When you left the RR, your pain was controlled. Is it under control NOW? Answer: YES

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Pneumonia Prevention • Incentive Spirometer

will be your new best friend

• Deep Breathe & Cough as often as possible

• You will be assisted to dangle your legs the same day of surgery

• You will be up early and walking the next day

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DVT Prevention: Blood clots

• SCD’s (sequential compression devices may be used to prevent the formation of clots

• Anti-embolism hose or Ted Hose may be used on opposite leg w/knee and may be used on both legs with a total hip

• Blood Thinners will be used Xarelto Coumadin Lovenox Aspirin • These medications may be

continued post operatively as your doctor orders. (possibly 30 days post op)

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Foley Catheter • You may or may not

have a foley catheter.

• Catheter will be inserted in the Operating Room while you are asleep.

• Catheter is removed within 24hrs after surgery.

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Activity

• Take Pain Meds up to 30 minutes prior to Exercise

• The Physical Therapist will assess your activity level. Safety is of upmost importance.

• Physical Therapist will assist you to improve and increase your walking tolerance and distance by using the appropriate devices.

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Case Manager will evaluate

your need for:

• Raised toilet seat • Cane • Reacher/grabber • Long handled sponge • Shoehorn • Sock aide • Walker • Bedside commode (3in1) can be used as a

1.bedpan 2. remove pail and add to your toilet 3. shower chair (do not place in a tub)

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Personal Safety • Pain meds can dull your senses, be careful,

do not sign any legal documents. • Wear shoes that give you good support. • Avoid poorly lit areas. Use a night light • Do not lift heavy objects or strain.

Straining can cause you to faint. • Follow your hip/knee precautions when you

need to pick something up

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Personal Safety …Continued

• Don’t use chairs or standing stools to reach things.

• Check for loose rugs or mats or cords. • Always know where your pet is. • Use caution in everyday tasks. • Be aware of electrical cords that lie across

the floor

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Personal Safety …Continued

• Be aware of electrical cords that lie across the floor.

• Wet floors - especially in the bathroom. Condensation can cause you to slip

• Have a chair handy in the kitchen to sit down when preparing meals.

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Doctor notifications

• Ask your doctor which stool softener he recommends.

• Alert Dr. if you do not have a BM for three days.

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Family-Initiated Bee Team • Bethesda Emergency Evaluation Team ‘BEE’ Team is a RAPID RESPONSE TEAM.

• Implemented in April 2005: Used to prevent a Code Blue.

• Empowering the family to alert staff of a SERIOUS CHANGE in the patient’s condition.

• Family should be instructed by nursing on admission to dial 83111 from any hospital phone if someone is not IMMEDIATELY available.

• Operator will call a bee team or direct the concern to the floor if it is not an emergency.

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FAQ’s

• When can I drive? – Approximately 4 to 6 weeks after surgery; CHECK

with your surgeon.

• When can I bathe? – Do not soak in a bath tub, shower is fine, pat

the incision dry afterward. • How long will I be in surgery?

– Typically, surgery lasts 1-3 hours. Your surgeon will come and talk to your family after the procedure.

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• Can I sit in my recliner? – Yes, if your knees are not higher than your hips.

• Does Medicare pay for equipment? – Yes, once every 5 years. Rolling walker and

commode are covered. Cane will be paid for within 30 days later.

• What kind of commode should I get? – 3-in-1 commode.

FAQ’s

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• Can I use a lift chair? – Yes, they can be purchased or rented for

$100/month. • Does Medicare pay for PT at home?

– Yes, even on weekends. • Can I get a home health aide?

– Yes, but the home health aide can only be used for bathing.

• What’s the hardest thing I’ll have to do? – Putting on your shoes.

FAQ’s

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Questions

Call (561) 737-7733, ext. 84549

*Please complete and print the certificate on the next page*

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is hereby awarded to

________________________________________

for completing the Joint Journey course on ___________________.

Certificate of Completion