1. Joint Replacement Surgery
Pre-operative Education
2012

2. Objectives Prepare for the day of surgery Describe plan of care
Learn how to prevent complications after surgery

3. Pre-operative (Pre-op): What happens before surgery?
Pre-op appointment
Home preparation
Infection prevention
Constipation prevention
Daily medications
Exercise
Outline of topics to be covered

4. What to bring to your pre-op appointment at the hospital
A FULL list of medications
(including over-the-counter and herbal medications)
Driver’s license
Health insurance card including
medication card
Results of a recent EKG if you have it
You will be asked about your medical history and allergy status

5. Notify your surgeon before surgery if…
You have a history of blood clots
You are taking anticoagulants
(blood thinning medication)
You are taking herbal medications or vitamins
You are or have been a smoker within the past
5 years
You have diabetes or pre-diabetes
You have sleep apnea
You had a heart stent placed in the last year
Tell your surgeon this information at your pre-op appointment or no later than 1 week before surgery

6. Home medications
You may be asked to stop blood thinning medications to avoid bleeding too much during or after surgery
Included: glucosamine, vitamin E, and
anti-inflammatories (i.e. Motrin)
Possible: Plavix, Aspirin, Coumadin

7. Stop smoking today
Smoking makes your heart beat faster, raises your blood pressure, makes your blood clot easier, and makes your blood vessels smaller
All these things increase your risk for blood clots, slower healing, and infection

8. Quiz question What should you tell your surgeon about
before surgery? (click the correct letter)
You are taking blood thinning medication
You are a smoker
You have diabetes
All of the above

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11. Preparing your home
You need help after returning home until you feel safe doing daily activities
You will likely need help for exercises
Stairs to climb? Any way to keep activities on one level?
Quick-cook meals prepared ahead of time
Throw rugs picked up and put away
Remove electrical cords from walkways
Handrails by stairs and in the bathtub/shower
Short-term pet care

12. We can help with plans before surgery
What if I can’t go home?
Let us know if you feel you are not able
to go home after surgery
Can you go to someone else’s home?
Short term nursing home rehab
(a few days to a few weeks) is an option
We can help with plans before surgery

13. Infection prevention Shower the night before surgery
Special soap provided at your
pre-op appointment
You will wipe down your body with antiseptic cloths the day of surgery at hospital
Swab both nostrils the day of surgery (the nose is a common route of infection)

14. How do I prevent constipation?
2-3 days before surgery
Increase your fluid intake
(Water, fruit juice, etc.)
Consider having laxatives
handy when you get home
Constipation is a common nuisance after total joint surgery. Constipation occurs because of a slowing of bowel activity. This happens due to decreased physical activity, possible decreased food and fluid intake and as a side effect of narcotic pain medication.

15. Exercise before surgery?
Yes… please start the exercises today!
We want you to:
Strengthen your legs and arms
to help with your recovery
Learn the exercises to
prepare for after surgery
Please click here for exercises

16. Day of surgery: What to bring
Loose-fitting clothing (avoid long sleeves)
Equipment you plan to use after surgery
- Walker and/or crutches
- Raised toilet seat
- Reaching device
- Other adaptive equipment
Well-fitting, flat shoes or slippers
Breathing machine for use while sleeping, if you have one
Activities to pass time (reading materials, music player, etc.)

17. About your surgery
Have your questions ready for your surgeon at your pre-op appointment
Please click here to watch a short video about your surgical procedure.

18. Post-operative (Post-op): What happens after surgery?
Pain Management
Complication Prevention
Wound Care
Exercises & Mobility
Goals

19. Pain Management
Surgeons give injections during surgery to help with pain immediately after surgery
Keep moving!
Your leg or hip will get stiff and sore sitting in one place
Change your position
every couple of hours
throughout the day

20. Prevent pain & swelling
Do not wait for pain - Stay ahead of it
Pain pills take about minutes to work
Take pain medication before exercise sessions and as instructed to keep pain at 3 or less on a 0-10 scale
Cold packs or ice to your knee/hip 5-6 times each day for 20 minutes at a time
Rest and elevate lower leg and foot above heart level 5-6 times each day for 20 minutes at a time

21. Quiz question
Which of these statements is true (click the correct letter)
A. Elevate your lower leg 5 to 6 times per day
B. Do not take your pain medication until your pain is a 3
C. Pain and swelling should not be expected after surgery
D. Staying still will prevent you from being sore

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24. Complication prevention
Possible complications:
Infection
Constipation
Blood clots
Pulmonary embolism

25. Infection prevention Surgical site: Appropriate wound care is needed
(wound care instructions ahead)
You will take antibiotics while in hospital
You will need to take antibiotics before future invasive procedures
Tell dentist, family doctor and others that you see regularly that you have a new joint replacement

26. Surgery site infection
Monitor for signs
Increased pain
Fever of degrees
or more lasting longer than 24 hours
Smelly drainage
Increased swelling and redness at incision

27. Surgery site infection
You are at higher risk for infection if:
You smoke
You are diabetic
You are overweight
You have a weakened immune system (such as cancer or organ transplant)
You are malnourished

28. Infection prevention Pneumonia:
Use a breathing exercise machine (incentive spirometer) every hour while awake for one week post-op (machine and instructions will be provided)
We prefer that you get out of bed ASAP – you breathe better and deeper when sitting and standing

29. Prevent constipation Be sure you are drinking enough fluids
Water!
Minimum of eight, 8 ounce glasses each day
Physical activity promotes bowel activity
Consider:
Fruit juices
Stool softeners daily
Laxatives as needed to have
regular bowel movements
Avoid caffeine

30. Quiz question
How can you prevent constipation (click on the correct letter)?
Drink lots of coffee
Take a daily laxative even if you are having bowel movements regularly
Drink at least eight 8-ounce glasses of water per day

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33. Prevent blood clots
All patients will be given blood thinning medication post-op until the surgeon stops it
Engage in ankle pumps with both feet multiple times each day (such as during TV commercials)
Continue exercises and walking
each day (increase as tolerated)

34. Signs of a blood clot
Swelling in your leg that does not go away with raising your leg above heart level
Pain, tenderness in the calf
Homan’s sign – increased pain in the calf when toes are pulled up toward head
* Keep in mind that your leg will likely have some natural swelling and will already be painful – monitor for increased symptoms *

35. Pulmonary embolism (PE)
The pulmonary artery in the lung becomes blocked (or a branch of it)
usually occurs when a blood clot from a vein travels from where it formed
Symptoms:
Difficulty breathing
Shortness of breath
Chest pain
Rapid breathing
Sweating
Confusion
Anxiety

36. Wound care
Keep your incision dry- do not apply lotions or creams to your incision until your surgeon says you can
Keep incision covered until drainage stops, then you may leave uncovered
Avoid touching the incision
Keep pets away from incision area
Do not shower or tub bathe until your surgeon says you can

37. Quiz question
Which of the following statements is false about infection prevention (click the correct letter)
A. Apply cream daily to your incision
B. Do not touch your incision
C. Tell your dentist and family doctor that you
have a new joint replacement
D. Do not shower or bathe until your surgeon
tells you can

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40. Perform 10-30 repetitions of each exercise 2 times per day
Exercises
Perform repetitions of
each exercise 2 times per day
Please click here for instructions on post-op exercises

41. Mobility
You will be given instructions in the hospital about any limits to movement.
Surgeons use 3 surgical approaches for hip replacement surgery. Your instructions will be related to which was used.

42. Goals Resume walking without assistive device
Continue therapy at home or at a therapy center
Strengthen your leg and hip muscles to assist with walking and provide support to your new joint
Full range of motion for the new joint

43. Thank you for participating in the Borgess Online Joint Camp program
Great job!
Thank you for participating in the Borgess Online Joint Camp program
Please be sure to complete the patient intake form provided on our web site, for our records

44. Contact Information
Linda Brown, MSN, RN, ONC
Clinical Nurse Specialist
Borgess Joint Replacement Center
Phone: (269)
Pager: (269)