1. Preparing for Surgery
When scheduled for surgery, you will receive a Patient Guidebook with Pre-op information from your surgeon.
It is a communication tool to link each step of the process together.
You need to prepare your house for when you return from your surgery; remove rugs, place handrails by stairs and in shower.
It is good to have someone with you at the hospital to help with your physical therapy.
You will need some assistance at home after discharge.

2. Special Soap for germ free skin used night before and morning of Surgery)
Shower with regular soap and shampoo first. Do not shave surgical site leg.
Rinse body and hair
Apply cleanser to entire body from neck down
Turn off water to prevent rinsing off, wait 5 minutes, then rinse off.
Do not wash with regular soap after using the cleanser.
Do not use any lotion, powder, perfumes, or hair gel or spray after showering the day of surgery

3. Surgery Tips Brush teeth morning of surgery Do not wear contact lenses
Do not wear make-up, hair clips, hair bands, or jewelry
Have someone put clean sheets on your bed prior to you arriving home.
Do not sleep with your pets after surgery until your staples are removed.

4. Things to Bring to the Hospital
Bring your Guidebook.
4 pair of loose fitting clothes (long nylon mesh gym shorts with an elastic waist and short sleeved T-shirts)
Comfortable walking shoes and/or house shoes
Personal care items for overnight stay
Don’t bring valuables, leave them at home.
A list of your current medications

5. The Night Before your Surgery
Do not eat or drink ANYTHING after midnight prior to your surgery –
NO water or anything! It is Very Important to have your tummy empty!

6. Day of Surgery
Report to the Admissions Desk in the main lobby at the time your physician instructed.
Estimate surgery time 1 ½ hours, time in recovery room 1 ½ hours.
You will then be moved to a room on the Joint Ranch, on South 6. Your family will be notified of your room number.
Continue resting in the bed
Physical Therapy will start the next day

7. Arrival to Joint Ranch
The nurses will do an assessment when you arrive.
Check dressing and drain site
Offer ice chips first.
May eat and drink when you feel up to it.
Usually start with ice chips, then progress to clear liquids and then to a regular diet by dinner time.

8. Pain Medication
Most patients will have pain medication ordered every 4-6 hours, this will be given by the nurse.
You will be taught how to rate your pain on a scale from 0-10.

9. Post-op Exercises that start the day of surgery
Foot Pumping helps prevent blood clots from forming in legs
Incentive Spirometry (breathing exercise) helps you take deep breaths, cough and keep your lungs clear.

10. Morning after surgery
Assisted with bathing, dressing changed, and assisted to dress in your clothes for the day.
At home, always cover the dressing with
Press and Seal. Buy it at grocery store.
Breakfast served in your room.
Walk after breakfast with Physical Therapy
You will sit in a recliner chair during the day, not back in bed until after dinner time.

11. Physical Therapy
All Physical Therapy will be done in a group setting in our “Joint Ranch Gym”
Walking with physical therapy exercises will be done twice daily

13. Use ICE for Pain Relief Always use ICE for pain control and swelling.
It is good to use ice for 20 minutes after each therapy session.
At home you can use more often if needed.
Do not put directly on the skin.

14. Discharge Usual hospital stay 2-3 days
You will be set up with directions for continued physical therapy
Continue exercises that for 6 weeks
Follow up in physicians office will be scheduled
Staples removed and will receive further instructions

15. Helpful Equipment
You will be using a rolling walker for ambulation. We will help you get one for home, unless you have one.
Most patients will need a walking device for about 4-6 weeks
We will help set up PT for after the hospital, as directed by your surgeon

16. Please Call Us if you have Questions
Please Call Us if you have Questions We Want to provide Excellent Care for you!!!!!!

29. Aquatic Exercises
Must have approval from your surgeon before starting Aquatic Exercises.
Usually not until 6 weeks post-op.
Best in water 85 degrees or more.
Hydrostatic pressure has a positive effect on swelling.
Very effective at improving CORE Strength.

31. Things To Have / Do At Home
Check your home for obstacles. Remove throw rugs; investigate your bathroom for the need for grab bars.
Assess your stairs at home (if present). Stairs represent a potential hazard. If there is an area in your home you must access that has more than one step and no railing, you should consider installing at least one rail for safety.

32. Things to do (Cont.)
Review your Joint Replacement Guidebook.
It is important to do the exercises so that you are familiar with them prior to surgery.

33. Things to do (Hip patients)
Inspect your chairs
Make sure you have a good comfortable armchair of at least 18” to use at home.
Low couches/chairs are not acceptable as you could dislocate you hip.

34. Things to do Advisable to have a chair with arms to push off of.
Use cold packs. This will help with swelling and pain.
You may use crushed ice, frozen peas, or you may purchase commercial cold packs.

35. Cont. Obtain a 5 lb. weight for the knee ext exercise.
You may use a 5 lb bag of rice/birdseed if you choose not to purchase one.
If one is purchased, we recommend a 5 lb cuff weight with removable sections as this may also be used for progressive resistive exercises as you progress with your post-op therapy.

36. Cont. Bring a plastic trash bag to have on the day you are discharged.
This will assist you to slide in the seat when getting into your vehicle.
Hip may also need to bring a pillow in order to elevate the height of the car seat.

37. Weekly Schedule Schedule is tentative and frequently must be changed.
We will inform you of any changes.
The PT staff begins working with people around 0700.

38. Weekly Schedule Cont.
You will be seen for the Initial Evaluation the morning after your surgery. Exercises and your first walk will be included with this.
You will then have a bit of time to rest and sit up in the recliner. Depending on time, you may take a second walk before lunch.

39. Weekly Schedule Cont. You will have time for lunch from 1130 to 1230.
Beginning at 1230, you will go for your second or maybe your third walk.
The first group session is in the afternoon around 1:00 pm or 1:30 pm depending on the number of people.
After group (depending on the number of people), you may take a third walk, if you haven’t already done so.

40. Weekly Schedule Cont.
The following days of your stay will basically be the same except for the addition of another group session at approximately 9 am.

41. Weekly Schedule Cont.
We work to get people ready for discharge in 2-3 days.
This means that Monday surgeries will be ready for discharge either Wednesday or Thursday.
Tuesday surgeries will be ready either Thursday or Friday.

42. What To Bring To The Hospital:
Do not bring clothes for therapy that you don’t mind getting soiled (drainage from the incision).
Bring loose, comfortable clothing. Shorts (knee length if possible).
Hip patients need to account for a bulky dressing when looking at the size of clothing.

43. What to bring: Cont.
Short sleeved shirts. If you tend to get cold, bring a light jacket or sweater.
Shoes or house slippers that give good support.
Coaches please unpack the first day of clothing and guidebook and have out on the counter in the room.

44. What to bring: Cont.
Bring any ambulation aide (rolling walkers, canes, etc.) Especially if you are borrowing it, we want to make sure it is at the correct height for you.
Make sure you bring the Joint Ranch Guidebook.

45. Durable Medical Equipment
We will ask about any medical equipment you may own.
All patients will need an ambulation aide to use at home.
Most use a rolling walker.

46. Equipment Cont.
Hip and some knee patients will also need the use of a bedside toilet at home.
This may also be used to raise the height of your existing toilet.

47. Discharge Day
Usually discharged after the morning therapy of the 2nd or 3rd post-op day.
May have to wait for your doctor to see you if he has not written a discharge order.

48. Knee and Hip checklist page 18

51. Hold the short arc quads for a count of 5 seconds

52. Hold for a count of 5 seconds

54. Just for the hips (#9)

55. Exercise # 9 for the knees and # 10 for the hips

56. #10 for the knees

57. #11 for the knees

58. We look forward to working with you and getting to know you all.

59. Important Hip Information
Hip patients - please stay for some important information and demonstrations on how to be safe after a Total Hip Replacement.

60. Hip Dislocation
Dislocating your new hip is a big risk to Total Hip Replacement Patients
ALWAYS follow the Hip Precautions that you have been taught
Follow the Hip Precautions for as long as your physician says.

61. Hip Precautions Do not bend your operated hip more than 90 degrees.
Do not lean forward from a seated position.
Do not raise your knee higher than your hip.
Do not sit on low toilet or commode.
Always keep feet and knees separated.

64. Hip Precautions con’t. Do not cross your legs at any time.
Place a pillow between your legs to help remind your brain that your legs should not cross.
Always keep feet at least 6 inches apart, flat on the ground.
Do not lie on your side without a pillow or wedge between your legs.

67. When Sitting Down
Back up until you feel the bed or chair. Reach back for the mattress of the bed or armrests of the chair.
Slide your operated leg straight out in front of you.
Don’t lean forward as you sit.

69. When Standing Up
Push with your arms from the bed or armrests, keeping your operated leg straight out in front of you.
Raise yourself without leaning forward.
It is in standing up from a seated position, that you have to concentrate the most on not bending your hip more than 90 degrees.

70. Do Not Bend Way Over
From a standing position, do not bend over more than 90 degrees.
You may put your operated leg behind you and support yourself on your other leg while reaching over.
Using your reacher to pick things up off the floor, is the safest route.

72. When Will You Hear from Us?
We try to call everyone the week after discharge, to check on you and to answer any questions you might have.
If you have questions before we call you, don’t hesitate to call us or your surgeon.