Orthopaedics Hip and Knee Joint Replacement Class Patient and Care Partner Guide

Meet your University of Chicago Medicine Team Dr. Hue Luu Associate Professor of Orthopaedic Surgery, Associate Director, Molecular Oncology Lab University of Chicago Medicine Specialty: Hip and Knee Replacement Bone Reconstruction in Cancer Patients Dr. Aravind Athiviraham Assistant Professor of Orthopaedic Surgery Specialty: Sports Medicine Shoulder and Knee Surgery Dr. Tessa Balach Associate Professor of Orthopaedic Surgery Specialty: Hip and Knee Replacement Orthopaedic Oncology Pediatric Bone & Soft Tissue Sarcomas Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Knee or Hip Replacement Checklist Schedule your surgery Choose your Care Partner Get your dentist okay (form is in your folder) Pre-surgery anesthesia appointment Pre-surgery physical therapy and/or social work appointment (if needed) Pre-surgery X- Ray appointments (if needed) Attend the pre-surgery joint replacement class (Thursdays at 1pm) Pick up the medications you need before surgery: Bactroban Ointment (Prescription is in your folder. Fill at the pharmacy of your choice) Iron Supplement (Over the counter medication. Can be picked up at your pharmacy) Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Knee or Hip Replacement Checklist Get the right equipment to help you after surgery (walker or crutches) Talk with your provider and family about your discharge plan Are you going home? Who will take you home? Will you need to stay in a nursing home? Phone call from the nurse about one week before your surgery Phone call from University of Chicago case manager before your surgery Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Anatomy of the Knee Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Anatomy of the Hip Joint Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Reasons For Joint Pain Degenerative Joint Disease Bone on Bone Destruction of Cartilage Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Arthritic Hip and Normal Hip X-Ray Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Arthritic Hip and Normal Hip Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Healthy Knee and Arthritic Knee X-Ray Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Healthy Knee and Arthritic Knee Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Reasons For Cartilage Destruction Injury: Past history of trauma to the knee or hip Medications: High doses of steroids in the past could cause cartilage destruction Avascular Necrosis: Decreased blood flow to the joint Rheumatoid Arthritis: Disease that affects many joints in the body Osteoarthritis: Most common disease that affects cartilage destruction. It may affect one or more joints and may not progress Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Treatment of Joint Pain Oral Medication Non-Steroidal Anti-inflammatory Drugs - NSAIDS NSAIDS reduce the inflammation that may cause pain to the joint Injections (Shots) Also used to reduce inflammation Can receive injections every 3 months for as long as they are effective Surgery Joint replacement is a major surgery with moderate risk Your doctor will talk with you and help determine if the benefits are greater then the risks Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

When To Have Surgery Always An Optional Procedure This is not a procedure that you ever have to have This is not a life-saving procedure but we feel it will change your life 2. When Severe Pain is Having an Impact on Your Life Injections and oral medications no longer work When you have selected a Care Partner to assist you through this process Once you have discussed your work schedule with your employer. 3. When possible Benefits From Surgery are More Then the Risks Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Risks of Surgery: Infection An Infection Is Serious But Rare: 2% of patients in the United States Less than 1% of patients at University of Chicago Medicine An infection in the prosthetic joint can mean having more surgery to remove the infection. Treatment of infection can be difficult and include long term use of antibiotics and repeated surgery. It is possible that the new replacement may need to be removed and put back in at a later date. Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Preventing Infections Dental Clearance See your dentist before surgery and every 6 months for the rest of your life. One hour before your dentist appointment take an antibiotic prescribed by your dentist or your surgeon. Bactroban The prescription is in your surgical folder. Pick this up from your pharmacy. 2 times a day for 5 days before surgery. Put ointment on a Q-tip and rub inside your nose. Surgical Wipes: Antibiotic Cloths. 3 cloths in each pack. After showering the night before surgery, wipe down your whole body with 2 cloths. Do not use surgical wipes on your face or genitals. The morning of surgery use the third wipe on the hip or knee you are having surgery on. Dr. Athiviraham patients use wipes 5 days prior to surgery Lifelong caution about dental care, bacterial infections, and wound care Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Risks of Surgery: Blood Clots PE (Pulmonary Embolism) Pulmonary embolism is an obstruction of a blood vessel in the lungs, usually due to a blood clot. PE is an emergency situation. This can happen right after surgery to about 4 weeks after surgery. Symptoms include shortness of breath, coughing up blood, chest tightness. If you believe you have PE go to the emergency room right away DVT (Deep Vein Thrombosis) DVT is a blood clot in a major vein and is an emergency situation Symptoms include swelling in the leg that does not go away even after elevating your leg. If swelling does not decrease you should contact your doctor right away. Preventing Blood Clots Early moving around and walking On going leg and ankle pumps in the hospital Elevate your leg above your heart. TED hose: (Elastic stockings that compress veins in the lower limbs) Aspirin, Coumadin and Xeralto (medications to reduce the risk of blood clots) Sequential Compression Device Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Risk of Surgery There is Always Risk With Any Major Surgery, Including the Risk of Death. To Prevent This Any Risk: Your primary care doctor will talk with you about whether or not you should have surgery. The anesthesiologist will do a complete exam before surgery. They will also talk with you about the different options for anesthesia. Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Risks of Surgery Limb Length Discrepancy Hip Dislocation Nerve Pain It is common for your leg to feel slightly longer after surgery. This is because your hip shortens from having arthritis. The length goes back to normal after surgery. The feeling goes away in three to six months. Sometimes your leg may need to be made slightly longer to prevent dislocation. Hip Dislocation A dislocated hip is when two major parts of the hip replacement come apart. Your doctor will test your new hip during surgery to make sure it is stable. After surgery, dislocation happens in less than one out of 100 patients. Dislocation after surgery is often from patients doing improper activities. Your therapist in the hospital will teach you what you can and cannot do. If your hip becomes dislocated it will need to be set back in place in an Emergency Room. Nerve Pain Less than 1% of patients have nerve damage after surgery. Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Four Parts of a Prosthetic Knee Pre- Surgery measurements: We use X-rays to find what will fit your knee or hip the best Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Knee Replacement X-Ray Presentation Title Here |

Parts of a Prosthetic Hip Pre-Surgery measurements: We use X-rays to find what will fit your knee or hip the best Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Hip Replacement X-Ray Presentation Title Here |

Choosing a Prosthetic Knee or Hip Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Getting Ready for Your Hospital Stay A Nurse will call and talk with you a few days before surgery about: Time of arrival to Center for Care and Discovery (CCD) Equipment Care Partner (A person in your life to help you with this process) Medications Discharge Options: Home is the best option Work Situation 12 weeks off from work. You may be able to go back to work sooner depending on the kind of work you do. Check in at the Center for Care and Discovery (CCD), 7th Floor Sky Lobby Private room in 8W and a place for family to stay overnight Patient can order meals at any time Care Partner meals can be ordered for a small fee 1 to 2 night stay in hospital 11am discharge after 2nd day Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Getting Ready for Discharge Remove drain and Foley catheter Begin physical therapy Pain management Blood thinner medication education (Coumadin) Equipment Wedge Incentive Spirometer Walker Continuous Passive Motion Machine Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

After Surgery Care: Home Discharge Discharge to Home Health Care Care Partner readiness Care Partner Checklist Nurse and physical therapist will come 3 times a week If you have a preferred home care agency we can work with them. We can also make arrangements for your home care Make sure to prepare your home before surgery. Clear walkways, install nightlights, make arrangements for someone to take care of your pets. Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

After Surgery Care: Rehab Discharge A social worker can give you a list of nursing facilities that have rehab services. Our Orthopaedic social worker is Porcia Seals: 773-726-4130 Visit different nursing facilities that have rehab before surgery to know which one is right for you. Consider: The size The Location Transportation options for family Insurance coverage Time in Rehab 5-14 days at rehab Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

After Surgery Care and What to Expect A New Life Enabling NOT Disabling Procedure 12 weeks off from work with Temporary Disability You may return to work sooner depending on the kind of work you do Driving Again 4-6 weeks after surgery you can drive, but you must be off all narcotic pain medications for 48 hours before driving. 6 months of handicap parking DO NOT GET YOUR INCISION WET FOR THREE WEEKS 12 Weeks of Physical Therapy Follow Up Appointments: 2 weeks after surgery (with Dr. Balach) 3 weeks after surgery (with Dr. Luu’s Advanced Nurse Practitioner) 6 weeks after surgery 3 months after surgery 1 year after surgery Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

After Surgery Care and What to Expect Reduced Pain No Drainage or Bleeding Call the doctor right away if you have drainage or bleeding Warm Feeling In The Surgery Area This will happen for about 1 year and is a sign of healing not infection Swelling Remember to elevate higher than your heart. Remember you can never use too much ice. Pain As You Break Scar Tissue Knee replacements produce scar tissue for about six weeks. Part of physical therapy is to break this tissue to get good motion for your knee replacement. Take your pain medication on a regular basis as needed. You Will Be 80% healed at three months and 100% at a year and a half (18 months) Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l

Thank You For Choosing The University Of Chicago Medicine Your Care About Your Care. We Are Always a Phone Call Away. General Call Center 773-834-3531 Notes ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Orthopedics Hip and Knee Joint Replacement Class l