Hello. My name is Blair, and I'm the clinical nurse manager of the Piedmont Joint Replacement Program at Highpoint Medical Center. Today we welcome you to the Piedmont Joint Replacement Center Pre-surgical class.
We want to congratulate you on your decision to have joint replacement surgery, as this gets you one step closer to increasing your quality of life. Should you have any questions, please feel free to reach out to me at (336) 781-2579. During this class, we will discuss what got you to the point of having to have elective total joint surgery, what to expect during surgery, and what to expect after surgery for your recovery.
First, we will discuss the knee and hip changes that you may have experienced with arthritis. Some symptoms that you all may be experiencing with joint pain include swelling and tightness, you may have a grinding sensation or some stiffness when trying to walk or move your limb. You may have decreased range of motion, so you're not able to move your leg or hip as easily as you could. And you may have some pain, whether that be while walking, or maybe even at rest or while you're asleep.
Causes of this joint pain include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis that may be caused by fractures, or a meniscus tear.
Some conservative treatments that you all may have experienced so far are nonsteroidal anti-inflammatory drugs. You may have taken some acetaminophen, some other pain medications or analgesics. You may have had cortisone injections or Synvisc injections. If these treatments have not previously worked, that has probably aided in your decision to have elective total joint surgery.
First, we will discuss your knee prosthesis. The replacement of the knee joint is comprised of a contoured metal implant that will fit around the end of your femur, and a flat metal plate and stem will then be implanted into your tibia, and then a polyethylene component will then act as your new meniscal cartilage.
For your hip prosthesis, the hip prosthesis is comprised of both the ball and socket of the hip joint, and a plastic spacer that will go between. Materials may vary, but they generally will consist of metal and plastic. Some implants are metal-on-metal, and some are ceramic-on-ceramic.
There are different materials that can be used for your total knee or total hip prosthesis. There can be stainless steel, cobalt, chromium, titanium, zirconium or ceramic. The materials used are going to depend on several factors which include your age, the activity level, and your surgeon's preference. Knee implants are generally cemented into place with medical-grade cement, and hip implants are either secured by cement or by a press-fit maneuver.
Your surgery will last approximately two hours. This does not include the time that it takes to prep you for surgery or the time that you will be recovering after surgery. You will receive a call the night before surgery with the time that you need to report to the hospital. If your surgery is on a Monday, you should receive a call Friday evening before.
Once you're completed with your surgery, you will then go to our recovery room, or PACU, which is the Post-anesthetic Care Unit. While you are in the PACU, you will be monitored for about an hour. Where they will observe your vital signs, so your blood pressure, your heart rate, your respiration rate. They will address your pain, and they will address any nausea if you may experience that.
Once you have been cleared from the PACU, you will then come to the Piedmont Joint Camp. The Joint Camp unit is comprised of patients just like you who have had elective surgeries for knees, hips, shoulders, backs, and other minor orthopedic procedures. We do keep you separated from the general population of the hospital to reduce your risk of postoperative infection.
Some patients may begin therapy the afternoon of surgery, some patients may be discharged the day of surgery. Same-day discharge decision is made prior to surgery. You will be first on the surgery list. Once you come to Piedmont Joint Camp unit, you will have one therapy session to make sure your needs are met prior to discharge.
When you come to the unit, one thing that we will be focusing on is pain management. Patients may have a nerve block inserted into their groin, or an extended release anesthetic placed at the surgical site to aid in pain relief. Oral pain medications will be prescribed by your surgeon for you to stay ahead of your pain.
The nursing staff will ask for a pain goal for you, which is the goal that we will use to ensure that we are medicating you appropriately. Should you experience any pain, please let the nursing staff know so that we can stay ahead of your pain.
Other things that we will be helping to prevent while you are in the hospital is a deep vein thrombosis, which is a blood clot. One of the risks of surgery is the possible formation of a blood clot. Sequential compression devices, which are leg pumps, and ted hose will be placed on your legs and feet during your stay to ensure the blood continues to circulate, and clots do not form. Performing foot exercises or ankle pumps in bed can help prevent clots from forming as well.
Most patients will take aspirin twice a day for three weeks after surgery. This dosage will be up to your surgeon, and will be determined closer to discharge.
Another risk will be developing pneumonia while you are in the hospital. One way to lower your risk is to regularly perform deep breathing exercises by using your Incentive Spirometer. An Incentive Spirometer will be supplied for you once you arrive to the unit. You will use the incentive speedometer to slowly but forcefully breathe in through the mouthpiece. You will then relax. You will repeat this 10 times every hour while awake.
Post-op day one, our physical therapist and occupational therapist will start your rehab process. If you arrive to the unit before 1:00 PM, you will have therapy the day of surgery and the day after surgery. If you arrive to the unit after 1:00 PM, you will have both of your therapy sessions the day after surgery. Each of you will have two sessions.
During these sessions we will focus on range of motion and stretching exercises, gait training, and how to use your walker. If you do have a caregiver, you are encouraged to attend. If you have a Foley Catheter, it will be removed the day after surgery.
After surgery, there will be precautions that both total knee patients and total hip patients will have to follow. If you are having your knee replaced, you will not place a pillow under your knee. The pillow will go under your ankle. You always want to be sure that you keep your surgical leg elevated.
For those that are having a total hip replacement, you want to make sure that you do not cross your legs, you do not point your toes inward, you do not bend at the waist at a 90-degree angle, and you do not lie directly on the affected side.
One thing to remember while you are in the hospital is, please call for a staff member if you need to get up. Each of you will have a emergency call light in your room that will be available for you at all times. All joint replacement patients will use a walker and a gait belt when ambulating anywhere on the unit to ensure that you are safe.
We will place chair exit alarms in the chair, which will be activated for your safety while you are out of bed. At night, your bed exit alarm will also be turned on to ensure your safety.
On surgical day, you will be provided a clear liquid diet for your first meal. Please alert staff if you are diabetic. You may order lunch to arrive prior to noon, to give you enough time to eat and digest prior to your afternoon therapy session.
Eat to provide your body with protein that will aid in the healing process. If you take medicines on an empty stomach, you will likely get nauseous, so please make sure that you have food in your stomach before you take pain medications.
If you are not discharged the same day or the day after surgery, you will continue to do two therapy sessions until you are discharged. While you are admitted to the hospital, please make sure that you do not get up on your own, you do not rush while performing exercises, you pay attention when walking with staff, listening to their instructions.
After surgery, you will be at risk for developing a surgical site infection. One way to prevent a surgical site infection is by always washing your hands with soap and water. If you are going to be working with your incisional area, please be sure to wash your hands with soap and water before and after touching your incision.
You want to make sure that you change your bed linen prior to discharge and as needed, especially if you have pets in the home. You will take any unused antibacterial soap used during your hospital stay home with you, which you will use for two more washes after surgery. When using the antibacterial soap, you want to make sure that you avoid your face and perineum areas. While at home, limit all pet contact with your incision by placing a clean sheet between you and your pwt.
Staff will set up and assist you with any bed basin bath while you are in the hospital. You will be encouraged to do as much as possible, but we will always be there to help. At home, after discharge, please do not take any tub baths. You don't want to immerse your incision in dirty water. Depending on your surgeon, he may or may not want you to shower. If you are cleared to shower, do not let the water beat down on your incision.
For your home medications, if there is a particular home medication that your surgeon wants you to continue but our pharmacy does not carry, we will need for you to bring in the medication. Should you have to bring in a medication, please make sure that it is in a labeled bottle with your name and the prescription. We will then send it to pharmacy, where it will be verified and then we will store in a medication room.
Please do not self-medicate and take your own medicines. Our qualified registered nurses are responsible for dispensing and accounting for your medications while on the unit.
When you come to the hospital, please be sure to bring loose-fitting and comfortable tops and bottoms shoes. Should have good gripping tread, and they should not be backless.
For discharge, physical therapy and occupational therapy will provide you with stair training. They will show you how to transfer in and out of a tub, transfer in and out of a vehicle, and transfer in and out of bed. Nursing will provide you with your discharge instructions, your medication instructions, and how to care for your incision.
Social work will be working with you, and they will be able to assist with setting up any durable medical equipment or assisted devices. You may be discharged on post-op day one, two, or three, so please make sure that you have a post-operative plan ready and have someone available to take you home at discharge.
Most patients will be discharged home with home health unless previously discussed with your provider. Home health visits will start the next day, per-your physician order. Patients who experience any medical complication may be transferred to another medical unit for further treatment. Social workers will meet with you and your caregivers to ensure your discharge needs are met.
High Point Medical Center is not responsible for any personal items that are misplaced, lost, stolen, or damaged. Please be mindful of cell phones and chargers, tablets, laptop computers, and any other personal items that are brought into the hospital during your stay.
Several opportunities that we have for our patients. We do have MyChart, which allows you to view your records. We have tablets on the unit that you can use to view your records at all times. We have a retail pharmacy that can help provide you with your prescription fields, and we have patient experience survey that will be sent to you called NRC.
Please do not forget to follow your surgeon's orders, and do not eat anything after midnight on surgery day. Follow the instructions from pre-admitting regarding the use of the four chlorhexidine sponges that will be provided to you. You will shower every day three days prior to surgery, and the morning of surgery, using these chlorhexidine sponges.
Good luck to you, and thank you for attending our class and for choosing Atrium Health Wake Forest Baptist High Point Medical Center for your total joint replacement. We look forward to seeing you on the Joint Camp.