Before, During and After Hip and Knee

Before, During and After Hip and Knee
the northern way of caring
Before, During and After
Hip and Knee
Replacement Surgery
A Patient’s Guide
the northern way of caring
Acknowledgments
This revised booklet is based on information produced over
the years by a variety of organizations. We would like to
acknowledge the contributions made by:
This edition of the booklet was developed by Northern Health
staff at Prince George Regional Hospital. The original edition
was developed by OASIS (OsteoArthritis Service Integration
System) in partnership with staff at:
The Arthritis Society, BC & Yukon Division
The Mary Pack Arthritis Program
Vancouver Island Health Authority
Northern Health
the northern way of caring
Hip Hip Hooray
Interior Health Authority
BC Orthopedic Association
Fraser Health Authority
Canadian Orthopedic Foundation
Providence Health Care
Your feedback and suggestions on this booklet are welcome.
You are a candidate for hip or knee replacement surgery. Patients
who are prepared for surgery and who take part in their care can
recover in less time and with less pain. This booklet will give you the
general information you need to get yourself, your family and your
home ready for surgery. Read this booklet with care. We hope that
you find this booklet a useful reference guide before, during and
after your joint replacement surgery.
IMPORTANT: If your surgeon or health care team gives you
different advice than what has been provided in this booklet,
please follow the specific directions you receive.
My Joint
Replacement
Plan
Contents
Hip Surgery
• Hip Anatomy.................................................1
• Hip Replacement Surgery............................2
• Joint Components and Attachment...............3
• Hip Precautions............................................4
Knee Surgery
• Knee Anatomy..............................................6
• Knee Replacement Surgery.........................6
• Joint Components and Attachment...............7
• Knee Precautions.........................................9
Before Surgery
• Home Set-Up ...............................................11
• Exercise .......................................................16
• Nutrition .......................................................17
• Pre-Operative Education..............................20
• Pre-Admission Clinic.....................................20
• Final Checklist Before Surgery.....................22
During Your Hospital Stay
• Day of Surgery..............................................23
• Length of Hospital Stay................................25
• Rehabilitation................................................26
• Pain Control..................................................27
• Rivaroxaban.................................................29
• Going Home.................................................29
After Surgery
• Recovery At Home........................................30
• Everyday Activity Guidelines........................33
• Returning to Work.........................................38
• Complications...............................................39
• Dental Work and Medical Procedures...........42
Resources.........................................................43
Index..................................................................44
Hip Surgery
In this section, you will learn about:
 Hip Anatomy
 Hip Replacement Surgery
Joint Components and Attachment
HIP PRECAUTIONS
Hip Anatomy
The hip joint is a ball and socket joint –
that’s why you can move your hip in many
directions. The ball is the round head of the
thigh bone (femur). It moves in the socket
of your pelvis (acetabulum). Muscles and
ligaments support and strengthen the joint.
Pelvis
Acetabulum
Cartilage
Femur
Normal Hip Joint
Hip Disease
The most common reason for joint
replacement surgery is OSTEOARTHRITIS.
Osteoarthritis results in the breakdown of
cartilage on the ends of the bones. It usually
appears in joints that carry your body weight,
such as hips and knees. Osteoarthritis can
cause joint pain and stiffness. Advanced
joint damage can be repaired through joint
replacement surgery.
Other disease conditions may also lead
to damage of the joint, requiring joint
replacement surgery. These include
conditions such as rheumatoid arthritis,
bone infection or a lack of blood supply to
the bone. Talk to your doctor if you have
questions about your joint health.
Joint Damage
Worn Cartilage
Bone Spurs
Osteoarthritic Hip Joint
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Total Hip Replacement
Pelvis
In total hip replacement surgery, the surgeon replaces
the diseased joint with an artificial joint (prosthesis).
First, the surgeon makes an incision and moves the
muscles and ligaments away from the hip joint. Then
the head of the thigh bone is replaced with an artificial
ball and stem. The pelvic socket is smoothed and
lined with a molded shell. Then the joint is put back
together with the ball fitted into the shell. Once the
new joint is in place, the muscles and ligaments are
repaired. Your skin is closed with sutures or staples
(staples are metal clips that hold your skin together
while the incision heals). This surgery takes about
one and a half hours.
Today, many patients who have hip replacement
surgery can move their joint more easily, have less
pain and are able to walk more comfortably for up to
25 years after surgery.
Prosthetic
Cup
Head
Stem
Femur
Artificial Hip Joint
Hip Resurfacing
Resurfacing
Prosthesis
Resurfaced Hip Joint
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Before, During & After Hip and Knee Replacement Surgery
Hip resurfacing is a type of hip replacement surgery
that may be suggested by your surgeon based on a
number of factors including the degree of damage to
your joint and your overall health.
In this surgery, the surgeon replaces the diseased
joint with a special form of artificial joint (resurfacing
prosthesis). First, the surgeon makes an incision and
moves the muscles and ligaments away from the hip
joint. Then the damaged cartilage and some parts of
the bone surface are removed from the head of the
thigh bone (femur) and the hip socket (acetabulum).
A ball-shaped cap is placed over the head of the thigh
bone. The hip socket is smoothed and lined with a
molded shell. Once the joint is put back together,
the muscles and ligaments are repaired. Your skin
is closed with sutures or staples (staples are metal
clips that hold your skin together while the incision
heals).
Hip Revision (Repeat)
Some people who have had a hip replacement may need another surgery
because:
•The joint has dislocated
•The joint is loose or worn out
•There has been bone loss or an infection in the joint
These surgeries can be more complex and you may need more rehabilitation
after surgery. You may not be able to carry as much weight on your new joint
while you recover.
Joint Components (Prostheses)
Artificial joint components may be made of medical-grade metal, plastic,
ceramic or some combination of these materials. Your surgeon will determine
the type of joint to be used, matching your individual needs with a suitable
type of material.
Joint Attachment (Fixation)
The type of fixation used to secure the artificial joint in your body will depend
on a variety of factors including your age, disease type and bone quality.
CEMENTED:
The artificial joint pieces are secured to the bone with a quick-hardening adhesive.
CEMENTLESS:The artificial joint pieces are closely fitted into the
bones. These pieces are covered in a rough material that
encourages bone growth. Bone growth into the artificial
joint can provide additional long-term joint stability. Some
parts of the artificial joint may be screwed in place to keep
the joint stable.
HYBRID:
In this type of surgery, one piece of the artificial joint is
attached with cement while the other piece is covered in a
rough material that encourages bone growth. Bone growth
into the artificial joint can provide additional long-term joint
stability. Some parts of the artificial joint may be screwed
in place to keep the joint stable.
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Hip Precautions
After Hip Surgery, you will need to follow HIP PRECAUTIONS for
3 MONTHS unless otherwise advised by your surgeon. These activity
restrictions will help your joint to heal and reduce the risk of hip dislocation.
See “Complications” section for more information, page 39.
Shaded leg is the surgical leg.
45°
90°
DO NOT bend your hip past 90 degrees
DO NOT cross your legs at the ankles or knees
Additional Notes for Hip Surgery and
Precautions:
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________ ___________________________
___________________________
___________________________
DO NOT twist your body or legs
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Before, During & After Hip and Knee Replacement Surgery
Things you CAN DO after hip surgery:
DO sit on a raised chair or use a high-density foam cushion to increase
surface heights. Use a raised toilet seat. (see page 34 for how to sit)
DO use long-handled aids, such as a shoehorn and reacher, to help you
dress and pick up items.
Shoehorn
Reacher
DO sleep with pillows between your legs for the first 3 months after surgery.
You may require assistance placing the pillows or choose to use an extra-long
pillow.
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Knee Surgery
In this section, you will learn about:
 Knee Anatomy
 Knee Replacement Surgery
 Joint Components and Attachment
 KNEE PRECAUTIONS
Knee Anatomy
Femur
The knee joint is where the thigh bone (femur)
meets the shin bone (tibia). The knee is a hinge
joint that allows you to bend and straighten your
leg.
Patella
Ligament
Cartilage
Knee Disease
The most common reason for joint replacement
surgery is OSTEOARTHRITIS. Osteoarthritis
results in the break-down of cartilage on the ends
of the bones. It usually appears in the joints that
carry your body weight, such as hips and knees.
Osteoarthritis can cause joint pain and stiffness that
may require joint replacement surgery.
Other disease conditions may also damage the
joint, requiring joint replacement surgery. These
include rheumatoid arthritis or an injury to the joint.
Talk to your doctor if you have questions about your
joint health.
Tibia
Normal Knee Joint
Worn
Cartilage
Osteoarthritic Knee Joint
Total Knee Replacement
In total knee replacement surgery, the surgeon
replaces the diseased joint with an artificial joint
(prosthesis). First, the surgeon makes an incision
and moves the muscles and ligaments away
from the knee joint. Then the damaged bones are
reshaped to fit the artificial joint. The ends of the
thigh bone and shin bone are covered with metal
shells separated by a plastic liner. If the kneecap
(patella) is damaged, it may be lined with a plastic
disc. Once the new joint is in place, the muscles
and ligaments are repaired. Your skin is closed with
sutures or staples (staples are metal clips that hold
your skin together while the incision heals). This
surgery takes about one and a half hours.
Today, many patients who have knee replacement
surgery can move their joint better, have less pain
and are able to walk more comfortably for up to 25
years after surgery.
Patellar
Button
Femur
Prosthesis
Plastic Liner
Tibial
Prosthesis
Artificial Knee Joint
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Bilateral (Both) Knee Replacement
In some cases, a surgeon may decide that both knees need
to be replaced at the same time. This depends on a number
of factors including your overall health, joint damage and
lifestyle. The surgery will be the same as a total knee
replacement. Your hospital stay may be longer and you
may need more rehabilitation after surgery to help you get
back to your daily activities.
Unicompartmental (Partial) Knee Replacement
Partial Artificial Knee
Joint
If you only have bone damage on one side of your knee,
your surgeon may decide that you are a suitable candidate
for partial knee replacement surgery. As with total knee
replacement surgery, the surgeon reshapes the damaged
parts of the bone to fit the artificial joint (prosthesis). Many
people who have this kind of joint replacement surgery recover
more quickly than people who have total knee replacement
surgery. People who have partial knee replacement surgery
are often sent home from the hospital the day after surgery.
Knee Revision (Repeat)
Some people who have had a knee replacement need
another surgery. This can be because:
•Your new joint is loose or worn out
•You had bone loss or an infection in the joint
These surgeries can be more complex and you may need
more rehabilitation. Compared to your first surgery, you may
not be able to carry as much weight on your new joint while
you recover.
Joint Components (Prostheses)
Artificial knee joint components are made of medical-grade
metal and plastic. There can be differences in the anatomy
of men’s knees and women’s knees. Your surgeon may
choose a “gender-specific” knee joint for you, depending on
the shape of your knee.
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Joint Attachment (Fixation)
The artificial joint can be secured in different ways:
CEMENTED:The artificial joint pieces are secured to the bone with a
quick-hardening adhesive material.
CEMENTLESS:The artificial joint pieces are closely fitted into the bones.
These pieces are covered in a rough material that
encourages bone growth. Bone growth into the artificial
joint can provide additional long-term joint stability. Some
parts of the artificial joint may be screwed in place to keep
the joint stable.
HYBRID: A combination of these methods.
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Knee Precautions
After Knee Surgery, you will need to follow KNEE PRECAUTIONS for
3 months unless otherwise advised by your surgeon. These activity
restrictions will help your joint to heal and reduce stiffness in the new joint.
See “Complications” section for more information, page 39.
Shaded leg is the surgical leg.
DO NOT put a pillow behind your knee.
Your knee may become stiff if you keep it
bent.
DO NOT do deep squats (squatting
down to the floor.)
DO NOT carry heavy loads (e.g. more
than 10 pounds.)
DO NOT kneel on your new knee joint
Additional Notes for Knee
Surgery and Precautions:
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
Please consider moving objects in low cupboards to the counter top before
surgery. Use caution when loading a wood stove or carrying heavy objects
(e.g. groceries or small children)
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Before, During & After Hip and Knee Replacement Surgery
Things that you CAN DO after knee surgery:
Depending on your height, you MAY need to sit on a raised chair or use
a cushion. It will be easier to get on and off higher surfaces after surgery.
Consider using a raised toilet seat.
You MAY need to use long-handled aids, like a shoehorn and reacher,
to help you get dressed or pick up items.”
Shoehorn
Reacher
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Before Surgery
In this section, you will learn about:
 Home Set-up
 Exercise
 Nutrition
 Pre-Operative Education
 Pre-Admission Clinic
 Final Checklist Before Surgery
Home Set-Up
It is important to set up your home BEFORE joint surgery. This will allow you to
easily move around your home with a walker or crutches after surgery, reduce the
risk of falls and maintain your hip or knee joint precautions.
•Ensure hallways and rooms are free of clutter and tripping hazards (e.g. scatter
rugs, footstools, etc.)
•Add non-slip surfaces to outside stairs and walkways in warmer months
•Arrange snow or ice removal of outside stairs and walkways in winter months before you return from the hospital and while you recover
•Install stair railings or make sure the existing ones are secure
• Set up a firm chair with armrests. If you have had hip surgery, see page 38 for
more information on seating heights.
•Ensure good lighting in hallways and other well used areas during the day and
night (e.g. nightlights)
•Arrange for extra help with household tasks if needed (e.g. vacuuming, laundry)
•Move frequently used household items to counter height (e.g. pots and pans).
Consider moving items in the lower parts of the fridge/ freezer to a higher shelf.
•Stock your freezer/pantry with healthy foods and snacks. If needed, private food/
meal delivery services are available in many areas.
•Ensure an adequate stock of wood if used for heating. Assistance will need to be
arranged if wood stove is not on main (living) floor of home.
•Keep an ice pack in your freezer for possible joint swelling after surgery.
Alternatively, you can use a bag of frozen peas.
•Have a thermometer at home to check your
temperature if needed after surgery.
• Arrange to have someone with you for the first
72 hours after you leave the hospital.
Secure Stair Rails
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Bathroom
•Install a raised toilet seat with armrests/toilet safety frame to assist you to
sit or stand
•Remove sliding doors from your bathtub and replace with a shower curtain
•Set up a tub transfer bench (in the bathtub) or a shower chair (in a shower
stall) Do not use a regular stool or garden chair.
•Use a non-slip bathmat both inside and outside the bathtub or shower
•Install a hand-held shower hose in the bathtub
•Grab bars in the bathtub/shower stall and by the toilet are very useful.
Removable grab bars are available. Do NOT use towel racks or toilet paper
holders to assist you to stand or sit.
Raised Toilet Seat
Tub Transfer Bench
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Before, During & After Hip and Knee Replacement Surgery
Removable Tub Clamp
Seating After HIP SURGERY:
•As you are not able to bend your hip past 90 degrees for 3 months
after hip surgery, ALL surfaces that you sit on MUST be 2 inches above
knee height. This includes chairs, beds and toilets.
2”
•Use a high-density (firm) foam cushion or bed blocks to increase chair
height. The cushion should be firm enough that it will not compress when
you sit on it. Plan to take your foam cushion with you to adapt chairs outside
of the house.
•Set up a firm chair with armrests (not a rocking chair).
•Set up a table beside your chair for frequently used items as you
will not be able to bend forward to the coffee table.
•If your bed is too low, add another mattress or place the frame on bed
blocks.
Extra Mattress
Bedblocks
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Equipment List – Arrange up to 1 week before surgery.
Equipment you MUST bring to HOSPITAL — unless otherwise told
Hip Surgery
Knee Surgery
•Walker
q Standard OR q 2-wheeled
•Walker
q Standard OR q 2-wheeled
•Crutches
•Crutches
•High-density (firm) foam
cushion* (at least 4 inch x 16
inch x 18 inch, needed for
going home in the car)
•Dressing equipment (long
handled reacher, long handled
shoe horn and sock aid) –
OPTIONAL but recommended
•Dressing equipment (long
handled reacher, long handled
shoe horn and sock aid)
Equipment for HOME
Hip Surgery The equipment below is required
Knee Surgery
The equipment below is recommended
•Raised toilet seat and safety frame (armrests optional)
•Long-handled reacher
•Long-handled shoehorn
•Sock aid
•Long-handled sponge*
•Non-slip bathmat*
•Elastic shoe laces* or use slip-on shoes with an enclosed heel
•Hand-held shower hose*
Bathing – use a walk-in shower: OR bathtub:
q Shower chair q Tub transfer bench OR
q Bath board
q Removable tub clamp
OR installed grab bars*
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Before, During & After Hip and Knee Replacement Surgery
Where to Get Equipment
Red Cross Loan Cupboards
•Locations throughout BC
•Provides “free” equipment for 3 months (donations gratefully accepted)
•REQUIRES a signed equipment request form. This form will be provided
by the hospital, at your hospital Pre-Operative Education class or through
your community therapist. If you do not have this form less than 1 week
before surgery, please contact your local hospital.
• Be aware that The Red Cross has a limited supply of equipment and may
not have all the items you need.
Medical Supply Store
•Equipment for rent and/or purchase
•May deliver to your home and/or install
•Costs may be covered by extended health plans – check your plan
Equipment Funding Sources
(please tell the Occupational Therapist if you qualify)
•Department of Veterans Affairs (DVA)
• Work Safe BC
• ICBC
• Non-insured Health Benefits
• Local Band Office
Friends/Family
Check with friends and family who may have equipment you can borrow
Transportation Support
Some transportation support services require application forms to be
completed by you and your doctor or health professional. These services
include temporary disabled parking passes (SPARC pass) and HandyDart.
For more information on the services listed above, see the Resources
section of this booklet, page 43.
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Exercise
Exercising before surgery will help you have a faster
and easier recovery. Do activities that put less stress
on your joint. Try:
• Exercises in water, such as swimming or water
walking at a community pool
•Walking as able
• Easy cycling
• Nordic pole walking on level ground
• Gentle stretching and strengthening
• Specific exercises suggested by a
physiotherapist
• Balance exercises (valuable in preventing falls)
These activities will make your muscles strong,
improve your endurance and help keep your joint
moving. Exercising before surgery will also help you
to build up your confidence and knowledge of how to
exercise after surgery.
Be sure to strengthen your arm muscles. You will
need strong arms after your surgery to use walking
aids, get in and out of bed and get on and off a chair.
If possible, do strengthening exercises for at least 3
weeks before surgery.
For example: Push up through your arms while
seated. Work up to 10 repetitions 2 times each
day.
If this exercise causes you discomfort or if you are
new to exercise and/or have other health conditions,
always talk to your family doctor before starting
a new exercise program. If you don’t know how to
get started, talk to a physiotherapist.
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Before, During & After Hip and Knee Replacement Surgery
Nutrition
Getting good nutrition before and after surgery will promote recovery and
reduce the risk of infection. If you are the cook in your home, make sure to
stock up the freezer and cupboards before going to the hospital so that you
have food to eat when you return home. Good nutrition should include:
Protein
Protein promotes healing after surgery. Most people get enough protein
from the food they eat and do not require a supplement.
The two food groups from Canada’s Food Guide that provide the most
protein are Meat and Alternatives and Milk and Alternatives. Circle the
number of servings you need daily from each food group in the table below.
Age
Gender
Milk and Alternatives
Servings
Meat and Alternatives
Servings
Adults
19 - 50
Females
Males
51+
Females
Males
2
2
3
3
2
3
2
3
Meat and Alternatives
Milk and Alternatives
1 serving =
1 serving =
> 2-3 oz of meat, poultry or fish
> 1 cup milk or soy beverage
> 2 eggs
> 1.5 oz cheese
> ¾ cup of beans or tofu
> ¾ cup yogurt
> 2 Tbsp nut butter or
¼ cup of nuts
Calcium
Daily requirement
• 19-50 years: 1000 mg/day
• 51+ years: 1200 mg/day
Dairy Sources: Milk, yogurt, cheese
Non-dairy Sources: Canned salmon and sardines (with bones), almonds,
beans, lentils, broccoli, bok choy
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Vitamin D
Daily requirement
•19-70 years: 600 IU
•71+ years: 800 IU
IF >50 years Canada’s Food Guide recommends taking a supplement of
400 IU/day. (The need increases with age)
Food Sources: Fortified dairy products, fatty fish, fortified soy/rice
beverages, fortified juice, 1 cup of milk = approx 100 IU
Other: Sun exposure
Both calcium and Vitamin D are important for strong bones. These two
nutrients work together in the body to promote bone health. Residents of
Northern BC are at increased risk of Vitamin D deficiency because of limited
exposure to sunlight. Talk to your Doctor, Dietitian or Pharmacist about
supplementation of Vitamin D.
Multivitamin
While a basic multivitamin is recommended to promote healing, large doses
of any nutrient are generally not recommended.
Fibre, Fluid and Regularity
It is important to have regular bowel movements before joint surgery
because constipation can be a complication of surgery. It is not true that
everyone must have a daily bowel movement. There is no exact definition
of constipation. If you have small, hard stools that are difficult to pass, you
may be constipated. You may feel that you are not completely able to empty
your bowel. If your stools are soft and can be passed without straining or
discomfort, you are not constipated.
Include fibre in your diet from foods such as whole grains, bran, fruits,
vegetables, beans and lentils. Spread fibre foods throughout the day and
drink plenty of fluid. A minimum of 8 cups (250 mL) of water or other lowcalorie fluid is recommended each day.
You should see your doctor if:
• There are sudden changes in your bowel habits
• You have been constipated for some time and dietary changes do not
seem to help
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Weight Management
Being overweight or underweight can affect your recovery from surgery. If
you are overweight, moderate weight loss is a good strategy to reduce hip
and/or knee pain. If you are trying to lose weight before surgery, aim for a
gradual weight loss of no more than 1 pound per week. Avoid fad diets as
they may cause you to be undernourished and prolong recovery.
approximately
1 EXTRA POUND = 3-6 POUNDS OF FORCE
on your knees and hips
Tips for Successful Weight Loss
• Leave your cooking pots on the stove and serve up your meal away from the table to avoid multiple refills
• Ask for a to-go box when you order at a restaurant. Portion sizes are generally large and can be split in two for lunch the next day
• Do your grocery shopping on a full stomach
• Make a grocery list and stick to it
• Shop on the perimeter of the grocery store – where the essentials are!
• Remember that calories from alcohol can add up. E.g. 3 beers = about 500 calories
Remember that being underweight is not healthy and can make it harder
for the body to heal after surgery. Talk to a Registered Dietitian if you are
worried about supplements, bone health, constipation, fluid intake or body
weight.
In BC you can reach a Dietitian by calling HealthLinkBC at 811 or visiting
www.healthlinkbc.ca/dietitian/
For more information on healthy eating and nutrition visit the Dietitians of
Canada website www.dietitians.ca
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Pre-Operative Education
You will be contacted with an appointment to see an orthopedic surgeon
and to attend a Pre-Operative Education Session. At this session, you will
learn more about your surgery, what to expect while you are in hospital and
what you need to prepare at home. For more information on preparing for
surgery, see Resources on page 43.
Pre-Admission Clinic (PAC)
WHEN? 2 -3 weeks before your surgery
The Pre-Admission Clinic will call you to schedule an appointment. This
appointment will last 3-4 hours.
•Please dress comfortably and bring a small meal or snack if needed.
•We recommend you bring a family member or support person with you to
this appointment
•Do to the length of the appointment and amount of walking involved, we
recommend you bring a “loonie” to access a wheelchair
The nurse will discuss many points including:
•When to stop eating and drinking before surgery
•Medicine management before and after surgery. Some medicines and
supplements must be stopped 1-2 weeks before surgery to avoid
problems with bleeding or sleepiness. Talk to your surgeon if you have
questions about your medicines.
•Allergies
The occupational therapist will assist you with the following:
•A questionnaire to provide details on your home environment and support system
•Viewing a video on joint replacement
•Safely using equipment for the bathroom and dressing
You will also receive your equipment referral at this time.
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Before, During & After Hip and Knee Replacement Surgery
Bring ALL of your medicines/supplements to your Pre-Admission
Clinic appointment.
You may have some tests done including:
•Blood work
•X-ray
•ECG (electrocardiogram)
You may also be scheduled to meet with an anesthesiologist. This is a
medical doctor who is trained to give anesthetic drugs and monitor you
throughout your surgery.
Your surgery may be cancelled if you have: an active infection
anywhere in your body, a skin infection over the joint, a cold or the flu.
If you are sick before surgery, call the Pre Admission Clinic at the
hospital.
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1 Day Before Surgery: A FINAL Checklist
By now you should have picked up your medical equipment and set up your
home. You should have arranged for someone to stay with you for the first
72 hours after you leave the hospital. Here is a final checklist of things you
need to do before coming to the hospital:
 Label all of your equipment with your name (e.g. walker, crutches,
dressing equipment) – if you are bringing these items to the hospital
 Make arrangements for transportation to and from the hospital
 Have a bath or shower using regular soap the night before, or the
morning of your surgery (do not shave your legs as any cuts or skin
irritation may result in your surgery being cancelled)
 Pack your bag for the hospital. Bring:
 toiletry items (e.g. toothbrush, hair brush etc.)
 loose fitting clothes to exercise in and to wear home
 comfortable, closed toe and heel shoes/slippers with non-slip soles.
Your shoes should be roomy since you will have some swelling in your
feet.
 if you wear elastic support stockings, bring them with you
 eye glasses and reading materials
 hearing aids
 if needed, credit card information for items such as hospital TV rental
DO NOT bring valuables to the hospital
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Before, During & After Hip and Knee Replacement Surgery
During Your
Hospital Stay
In this section, you will learn about:
 Day of Surgery
 Length of Hospital Stay
 Rehabilitation
 Pain Control
 Rivaroxaban
 Going Home
Day of Surgery
Before Surgery:
•Go to the Patient Registration Dept in the hospital
•You will be directed to the Day Surgery Dept. to be prepared for surgery.
•Ask friends or family to bring your suitcase and labelled equipment to the
hospital ward unless otherwise instructed
During Surgery: Anesthesia
Each hospital manages your anesthetic differently. Many people who
have joint replacement surgery have spinal anesthetic. This is like the
freezing you get at the dentist, except this freezing goes into your back
and makes you numb from the chest down and stops you from feeling pain.
The anesthesiologist will make sure you are comfortable throughout the
surgery, giving you medicine through your IV that makes you relaxed and
sleepy. If you have a spinal anesthetic, you will not be able to move your
legs for up to 4 hours after surgery.
Some people receive general anesthetic. This is medication to make you
completely lose consciousness so the surgery can be
performed without causing pain or distress.
Sometimes a small catheter may be placed into your
groin area that delivers medication to numb your leg to
assist in pain control and physiotherapy. This catheter
may be placed before or after surgery. Another form
of pain management is the injection of a special “cocktail” of medication
directly into the joint during surgery. Other medications may be used in
combination with these options to manage your pain throughout your stay
in the hospital.
After Surgery: Recovery Room
•You are moved from the operating room to the recovery room
•You may have oxygen by mask for a short time or nasal oxygen overnight
•The nurse monitors your vital signs, including your pulse and blood
pressure
•You will have pain medicine on a regular basis. Tell your nurse if you
are in pain.
•The stay in the Recovery Room is usually 1 to 3 hours
Before, During & After Hip and Knee Replacement Surgery
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23
After Surgery: The Hospital Ward
•Once you are medically stable, you are transferred to the orthopaedic
ward
•You will be told how much weight you can put on your new joint (weight
bearing status). This can vary for each individual. Often people are told to
weight bear as tolerated, but you may have a weight-bearing restriction
such as partial, feather, or non-weight bearing on your surgical leg
•The ward staff will help you to stand on your new joint if allowed by your
surgeon
•The nurse will assess you for pain and nausea
•You will use a commode/raised toilet seat during the first day and night.
When you are able, you will walk to the bathroom. Some people who
have spinal anesthetic find it difficult to urinate and will need a catheter (a
temporary tube placed in your bladder to empty it).
•You will have blood work done daily
•You may have an intravenous line (IV) for medicine
•After the surgery, you may have a drain on your leg to collect blood from
your hip or knee
•You are taught exercises to help reduce complications after surgery, such
as:
> breathing deeply and coughing every hour to keep your lungs clear
> pumping your ankles to improve circulation in your legs
•You may be started on a blood thinning medicine after surgery to help
reduce your risk of developing a blood clot.
Length of Hospital Stay Guidelines
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Before, During & After Hip and Knee Replacement Surgery
Your time in the hospital is short. Your healthcare team will work with you
to make sure you are medically stable and able to manage daily tasks to
go home. Before surgery, it is important to make arrangements to have
someone pick you up from the hospital when going home. Discharge time
is usually in the morning.
Be aware that you may go home sooner than expected.
Ensure your travel arrangements are flexible.
Total Hip Replacement = 3 - 4 nights
(includes resurfacing and revision surgery)
Total Knee Replacement = 3 - 4 nights
(includes revision surgery)
Partial Knee Replacement = overnight
Bilateral (both) Knee Replacement = 5 nights or LESS
For example: If you have surgery on Monday and are spending 3 nights in
the hospital, you will probably be sent home on Thursday morning.
Monday Tuesday
Wednesday
Thursday
SURGERY DAY
DISCHARGE HOME
Rehabilitation
Before, During & After Hip and Knee Replacement Surgery
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25
•P
hysical activity is a very important part of your recovery. Not only
does it help to improve the function of your joint, but it also helps clear
your lungs, reduces the risk of blood clots in your legs, reduces pain, and
starts your bowels moving.
• The physiotherapist (PT) will work with you throughout your stay. Your
physiotherapist will teach you how to:
> walk with a walker and/or crutches
> do your daily exercises
> use the stairs safely
• The physiotherapist will give you exercises to do in hospital and at home.
They may also refer you to a physiotherapist in your local community.
• Your occupational therapist (OT) will teach you how to do daily activities
such as dressing and bathing, and help you to use your equipment, while
following precautions and protecting your new joint.
Pain Control
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Before, During & After Hip and Knee Replacement Surgery
Pain Control After Surgery
• Your nurse will teach you how to use the pain scale to describe your level
of pain. “0” is no pain and “10” is the worst possible pain.
Pain Assessment
0
No Pain
1
2
Mild
3
4
Moderate
5
6
Severe
7
8
Very Severe
9
10
Excruciating
• It is our goal to keep your pain at “3-4” or below at all times.
• Generally, pain medicine is given as a pill taken by mouth.
• If you have had a general anaesthetic, you may have a patient controlled
analgesia (PCA) pump. This is when a controlled amount of pain
medication is pumped into your IV tube when you push a button.
• A combination of medicines will likely be used to control your pain after
surgery. This normally would include acetominophen (e.g. TylenolTM)
plus possibly an anti-inflammatory (e.g. NSAID) and/or narcotic (e.g.
morphine). By taking a combination of these medicines, you may be
able to reduce the side effects of any one of these medicines and have
improved pain control. It is important to talk to your healthcare team to
understand how and when to take these medicines to best control your
pain and symptoms.
• Some side effects of pain medicine can include: nausea, vomiting,
drowsiness, itchiness and/or constipation. Tell your nurse if you have any of
these symptoms.
• Studies demonstrate that the risk of addiction is low when using opioids
for acute pain. It is important to have adequate pain control to ensure a
successful recovery from your surgery.
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27
Pain Control at Home
Most people have less and less pain over the next 6 to 12 weeks. If pain
is preventing you from caring for yourself, sleeping and/or exercising, talk
to your physiotherapist or doctor. If your pain becomes increasingly
worse OR if you have pain in a new part of your body, seek medical
attention immediately. (See back cover of this booklet for guidelines).
Here are some ways to manage your pain:
• Take pain medicine as directed. It is normal to have some increased pain
or symptoms during physical activity or physiotherapy sessions. It may be
helpful to take a dose of pain medicine 1 or 2 hours before engaging in
these activities in the first weeks after surgery. It is better to take medicine
BEFORE the pain is severe.
• Ice can reduce pain and inflammation. It is particularly useful for
people who have had knee replacement surgery. Place an ice pack
wrapped in a towel on your joint as directed by your physiotherapist.
• Pace yourself. Do not push yourself. Regular rest is an important part of
your healing process.
•R
elax. Use relaxation techniques such as breathing exercises or
progressive muscle relaxation (progressive muscle relaxation is when
you tighten and relax each part of your body, starting with the toes and
working up to your neck).
•D
istract yourself. Listen to music, visit with friends, write letters, watch
TV.
•T
hink positively. You will become more and more comfortable as you
recover from your surgery.
Ice Pack on Knee Joint
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Before, During & After Hip and Knee Replacement Surgery
Rivaroxaban
After hip or knee replacement surgery, you are at risk for developing a
blood clot (see “Complications”, page 39). Many people are given an oral
medication called Rivaroxaban to reduce this risk. Your doctor will decide if
this medicine is right for you.
Here is some information about Rivaroxaban:
• Rivaroxaban is given DAILY for 14 days after knee replacement surgery and 35 days after Hip Replacement Surgery
• Rivaroxaban is given at the same time each day
• The main pharmacies near city hospitals carry this medication. Pick up
your perscription the day you are discharged from the hospital. If you are
planning on using your local pharmacy, be aware that they may need 48 72 hours to get your medication in stock.
•The cost of Rivaroxaban may differ depending on your PharmaCare
deductible or if you have 3rd party coverage. Each pill costs about $10.00
Going Home
Most people will be discharged home, not to a rehab facility. Before leaving
the hospital, plan appointments with the following people:
Follow-Up Medical Appointments
• The person (e.g. family doctor or surgeon) who will remove your staples,
7-14 days after surgery
• Your surgeon, usually around 6 weeks after surgery
• Your physiotherapist, usually within 1 week of discharge (if recommended
by your surgeon)
• Your family doctor, once you are back on your feet, to review your general
condition
Before, During & After Hip and Knee Replacement Surgery
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29
After Surgery
In this section, you will learn about:
 Recovery at Home
 Everyday Activity Guidelines
 Returning to Work
 Complications
 Dental Work or Other Medical Procedures
Recovery at Home
Physiotherapy After Hospital
The hospital physiotherapist will tell you where you can obtain physiotherapy
services when you get home from hospital. Depending on your needs, where
you live and local services, your appointment may be at a physiotherapy
clinic, out-patient hospital centre, rehab facility or home health program.
Your physiotherapist will give you exercises to stretch and strengthen your
legs and improve your walking and balance. As you recover, the exercises
will get harder. Doing the exercises assigned by your physiotherapist will
help you move your new joint and enjoy greater independence. It is important
to continue with the exercises for at least 1 year after your surgery.
Talk to your physiotherapist if you have questions about your exercises or
concerns about your progress.
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30
Transportation
Personal Vehicle
Taxi
There are many different ways to get around after surgery.
Here are some options:
• Friends / family
• Taxis
• Temporary disabled parking pass (SPARC)*
• HandyDART* (if available in your community) — transit
service for those who cannot use the regular bus
service. HandyDART will pick you up and drop you off at
appointments such as medical visits.
• Travel Assistance Program (TAP)*– assists with costs for
out-of-town medical travel
•Northern Health Connections - travel for out-of-
town medical appointments.
Visit www.northernhealth.ca/nhconnections/
HandyDART
Air Travel
You may have some extra challenges travelling by plane
after surgery. Be sure to give yourself extra time when flying.
Your new joint may set off metal detectors at the airport. If
you are flying within 3 months of having hip surgery, bring
your high-density foam cushion to raise the height of your
seat. While on the plane, do foot pumping exercises every
hour to help reduce the risk of clots. If flying home from
hospital, check with your air carrier if medical documentation
is needed.
Driving
Driving is restricted after knee or hip surgery. There are
a number of factors that can impact your ability to safely
return to driving. These include using mobility aids and
taking prescription pain medicines. Talk to your surgeon and
physiotherapist before driving. Most people can safely start
to drive within 6-8 weeks after surgery.
Car Transfer
It can be challenging to protect your joint getting into some
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Before, During & After Hip and Knee Replacement Surgery
cars, particularly following hip surgery. Please practice these instructions
before you come to the hospital. If this is problematic, please ask your
occupational therapist to help you.
• Park away from the sidewalk or curb so you are not stepping down from
the curb to the car. If you have a high truck or sport-utility vehicle, you
may need to park near the curb so that you do not have to climb up to the
seat.
• Move the seat as far back as possible
• Recline the seat
• Place your high-density foam cushion on the seat. If it is a wedge
cushion, position the thick end at the back of the seat.
• Back up to the seat until you feel the back of the seat on your legs
• Extend your operated leg
• Hold onto the back of the seat and the car to stabilize yourself
• Lower yourself to the seat
• Slide back and lift your legs into the car. (If you have had hip surgery, do
NOT bend more than 90 degrees).
• A piece of plastic or a large garbage bag over the cushion may help you
to slide in more easily
•You can also try a device called a “Handybar” that can assist you to
get in and out of a regular car. This can be purchased at medical supply
stores.
Shaded leg is the surgical leg.
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32
Everyday Activities Guidelines
Walking
You can expect to use walking aids, such as a walker, crutches or
cane, for up to 3 months or longer after surgery. By 4 to 6 weeks after
your surgery, you should be walking with more confidence, have more
strength and be able to walk longer distances. Regular physiotherapy
after your surgery will help you get the most out of your new joint.
Physical activity will help you have a faster recovery and will get your
blood moving. This will also reduce your risk of developing a blood clot.
Stairs
It is a good idea to practice the stairs with the hospital physiotherapist so
that you are able to manage stairs safely and independently. If you have
had both knees replaced (bilateral), your physiotherapist will practice a
technique with you that allows you to alternate your surgical legs when
going up and down the stairs. Shaded leg is the surgical leg.
Going UP the stairs:
Going DOWN the stairs:
•Use a handrail and/or crutches,
cane
•Use the handrail or your crutches
•Step UP with your good
(non-operated) leg first
•Follow with your operated leg and
crutch, one stair at a time
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•Place your crutch on the step
below
•Step DOWN with your operated
leg first
•Follow with your good (nonoperated) leg, one stair at a time
Getting Into Bed
•Sit at the side of the bed. It may be easier to get into bed on your stronger
side.
•Slide back across the bed using your arms for support
•If necessary, a half bed rail can allow you to get in and out of bed more easily.
A half bed rail consists of a handle with 2 long metal rods that are placed
between the mattress and the box spring. A half bed rail can be obtained
through the Red Cross or medical supply stores.
•Lift your operated leg into bed or use a “leg lifter” (this may be the belt from
your housecoat or a crutch turned upside down, hooked over your foot so
you can help lift the leg using your arms) if needed
•DO NOT use your non-operative leg to lift your surgical leg.
Getting Out of Bed
• Slide your body to the edge of the bed
• Use your arms to push yourself to a sitting position. (If you have had hip
surgery, do not push yourself up past 90 degrees. Remember your hip
precautions!)
• Slide your operated leg off the bed
• Bring your body to a sitting position at the bedside
Sitting Down
• Use a firm chair with arm rests
• If you have had hip surgery, measure the chair height
against your leg before you sit. The chair should be 2 inches
above your standing knee height. Use a high density foam
cushion or bed blocks to increase the chair height.
• Back up to the chair until you feel the edge behind your
knees
• Move your operated leg forward and reach back for the
arm rests
• Slowly lower yourself into the chair
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34
Getting Dressed
• Sit on a raised chair or bed
• Dress your operated leg first and undress it last
• Use adaptive aids like a long-handled reacher, sock aid and
shoehorn to reach the foot of your operated leg and put on
socks, pants, shoes, etc. while protecting your new joint
• While you are in hospital, your occupational therapist will
show you how to use these aids and give you tips on how
to dress while maintaining joint precautions
Removable Tub Clamp
Raised Toilet Seat
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Bathroom Safety
Falls can happen anywhere but are most likely in the
bathroom. Here are ways to reduce the risk:
• Do not rush. Plan to use the toilet often. Have a bedside
commode if needed.
• When bathing, use a bench or chair, non-slip bath mats,
grab-bars and/or a removable tub clamp
• Make sure the route from your bedroom to the bathroom
is well-lit
• Wear sensible, non-slip shoes or slippers
• If you feel dizzy or unsteady, talk to your family doctor
Using the Toilet
• Use a raised toilet seat for the first 3 months after your
surgery
• Make sure that the toilet seat has secure armrests or that
you can use the counter to push yourself up. You can also
install grab bars to help you stand or sit. Do NOT use towel
racks or toilet paper holders to help you stand or sit down.
• Toilet seat should be 2 inches above standing knee height
• Sit down as you would in a chair (see page 34)
Before, During & After Hip and Knee Replacement Surgery
Bathtub Transfer
• Use a tub transfer bench with a hand-held shower (in a bathtub) or
shower chair (in a shower stall) for the first 3 months after surgery. Do
NOT try to sit on the bottom of the tub.
• Remove glass shower doors on your tub and replace with a shower
curtain
• Place a non-slip bathmat inside and outside the tub
• Your transfer bench or shower chair should be 2 inches above your
standing knee height. If you are tall, you may need bench leg extensions.
• Sit down as you would in a chair (see page 34). Slide back as far as you
can on the seat. Then lift your legs over the edge of the tub. Do not bend
your hip past 90° if you have had hip surgery.
• Use long-handled aids to clean your feet and other hard-to-reach places
• A hand-held shower hose will allow you to bathe more easily. If you have
had a hip replacement, you will not be able to reach forward for the taps
due to hip precautions.
• Some surgeons will want you to do sponge-baths until your staples are
removed in order to avoid getting the new incision wet
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36
Wound Care
You will have a cut (incision) at the site of your surgery. Your nurse will
teach you how to care for your incision at home. While it is normal to have
some redness and clear drainage from your wound, watch for signs of
infection (page 45). You do not need a bandage unless there is drainage.
The edges of your skin may be held together with sutures, staples or steristrips. Staples are metal clips that hold the edges of your skin together
while your skin heals. Your staples will be removed 7 to 14 days after
surgery. If you have steri-strips, leave them alone. They will fall off on their
own.
It is important to keep your incision dry until it is fully healed. Showering
is permitted, but avoid aiming the shower head at your incision. Use mild
soap, rinse the area well and gently pat dry.
Sexual Activity After Hip Replacement:
• You may return to sexual activity when you feel ready and comfortable;
this is often around 4 to 6 weeks after surgery
• You must maintain hip precautions for 3 months during all daily activities,
including sexual activity
• Think about how you will maintain your hip precautions of not twisting and
not bending more than 90 degrees
• You may need to consider trying some new positions. Talk to your partner.
• If you have questions or concerns about how to protect your new hip
during sexual activity, talk to your occupational therapist, physiotherapist
or surgeon.
• Visit the website: www.aboutjoints.com for illustrations of sexual
positions that maintain hip precautions
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Returning to Work
Allow yourself time to recover from surgery and focus on your
rehabilitation before returning to work. Some people return to some form
of work quickly after surgery but others need a longer time to heal and
recover. This depends on factors such as health status and the type of
work you do. Talk to a health care professional, such as an occupational
therapist, about what is right for you.
Work Environment Adaptations:
• Chair: Choose a standard chair for sitting. Avoid chairs with wheels; they
can roll away from you when you are getting up. Use your high-density
foam cushion to increase the seat height if necessary.
•D
esk: Position your phone, paperwork and computer close to you. If
you have had a hip replacement, you should NOT bend forward to reach
these items. This will break your hip precautions.
•K
eyboard Tray: If you have raised your chair and your desk is too low,
use a height-adjustable keyboard tray so that you can sit comfortably
while typing.
•S
chedule: Plan lots of stretch breaks. Get up and move around
frequently. Avoid sitting in the same position for more than 45 minutes at a
time.
•B
athroom: Check the height of the toilets at the office and the location of
grab bars.
Clear desk space of clutter
Standard chair no wheels
Hip angle greater
than 90 degrees;
use high-density
foam cushion if
necessary
Before, During & After Hip and Knee Replacement Surgery
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38
Complications
After surgery, a few people have complications and need more medical
treatment. Here are some possible complications:
•Constipation/bladder function
•Blood clots
•Swelling
•Infection
•Anemia (low blood count)
•Joint loosening
•Hip joint dislocation
Constipation/Bladder Function
Constipation can be a problem after surgery. A change in your diet, less
activity and pain medicine may make your constipation worse. Here are
some ways to stay regular at the hospital and at home:
•Drink at least 8 glasses of water or low-calorie fluid a day
•Eat fibre, such as prunes, bran, beans, lentils, fruits and vegetables
•Move around as much as you can – do your exercises!
Your nurse may give you laxatives and/or stool softeners. You may need
to keep taking these medicines at home. If you have constipation at home,
talk to your family doctor or pharmacist. Constipation can be serious so do
not ignore your symptoms.
Some patients have difficulty urinating after their joint surgery. Please talk
to your nurse right away if you are having problems. You may need a
catheter.
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Before, During & After Hip and Knee Replacement Surgery
Blood Clots
A small number of people may get blood clots after surgery. Blood clots
usually develop in the deep veins in the legs. People who have problems
with their circulation and/or are inactive are more likely to develop a blood
clot.
To reduce the risk of blood clots:
• Take your daily dose of Rivaroxaban or LMW Heparin (if prescribed by
your doctor)
• Walk short distances at least once an hour (except when you are
sleeping)
• When you are sitting or in bed, pump your ankles and flex your leg
muscles
Tell your family doctor or surgeon
immediately if you have:
• Pain, aching, heat or redness in your calf area
• Increasing severe swelling in your surgical leg
Call 911 immediately if you have:
• Shortness of breath
• Sudden chest pain
Swelling
It is normal to have some swelling in your leg after surgery and during
your recovery. Swelling may increase as you become more active. To help
reduce swelling:
• Point and flex your feet hourly when awake
• Lie down flat and raise your legs (maintain hip or knee precautions) by
placing pillows under the length of your leg
• Do short periods of activity. Walk a few steps. Rest. Repeat.
• Place an ice pack wrapped in a towel on your joint. For some people, a
“cryocuff” may be used after knee replacement surgery. This is a type of
ice pack/compression device for the lower leg. For more information, talk
to your physiotherapist about using ice at home.
Before, During & After Hip and Knee Replacement Surgery
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40
Infection
Less than 1% of people have an infection around their new joint. An
infection in the body can reach the new joint through the bloodstream.
People who develop joint infections need antibiotics and, on rare
occasions, further surgery. To prevent infection or incision problems, it is
important to keep the incision and dressings dry. Do not touch or pick at the
incision and maintain good cleanliness of the surrounding skin.
Tell your doctor or surgeon if you have any of these signs of
infection:
Incision Infection:
•The area around your incision is becoming more red and the red is
spreading
•New drainage (green, yellow or foul smelling pus) from the wound site. It
is common for new surgical wounds to have some drainage for the first
few (3-5) days after surgery but this will slowly stop
and the wound should stay dry.
•There is increased pain or swelling of wound site and surrounding area
•Fever above 38°C or 101°F
•Call your surgeon if you think you have a possible wound infection
Urinary Tract Infection:
•Pain when you urinate
•Frequent or urgent need to urinate
•Foul smelling urine
•Fever above 38°C or 101°F
Sore Throat/Chest Infection:
•Swollen neck glands, pain when you swallow
•Frequent cough, coughing-up yellow or green mucous,
shortness of breath
•Fever above 38°C or 101°F
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Before, During & After Hip and Knee Replacement Surgery
Anemia (low blood count)
If you have signs of anemia, see your family doctor. You may need an iron
supplement. The signs of anemia are:
•Feeling dizzy or faint
•Feeling very tired
•Shortness of breath
•Rapid pulse
Joint Loosening
Over many years, the bond between the joint replacement and your bone
may loosen. This can cause pain and make it difficult for you to move your
artificial joint. To reduce the risk of this complication, avoid high-impact
physical activities. If you notice increased pain in your artificial joint, talk to
your doctor as soon as possible.
Hip Joint Dislocation
Call 911 if your surgical leg is suddenly extremely painful, shortens, and
the hip cannot be moved.
Dental Work and Medical Procedures
It is important to tell your health care professional that you have had joint
replacement surgery before having dental work or medical procedures
(including procedures with the bladder, prostate, lung or colon). You
may be put on antibiotics to prevent infection from moving through your
bloodstream to your new joint. Talk to your dentist or doctor about what is
right for you.
Before, During & After Hip and Knee Replacement Surgery
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42
Resources
Resources
Arthritis & Surgery Information
The Arthritis Resource
Guide for BC
www.argbc.ca
OASIS Program;
“Osteoarthritis Service Integration
System”
Vancouver Coastal Health
www.vch.ca/oasis
Email: oasis@vch.ca
Phone: 604-875-4257
The Arthritis Society
www.arthritis.ca
Email: info@arthritis.ca
Arthritis Answers Line:
1-800-321-1433
Equipment
Veterans Affairs Canada
www.vac-acc.gc.ca
Toll Free:
1-866-522-2122
Home Safety
Home Safety Renovations
(low income seniors)
www.cmhc-schl.gc.ca.
Toll Free:
1-800-639-3938 Red Cross
www.redcross.ca
Toll Free:
1-800-565-8000
or check local listings for area
phone number
Canadian Orthopedic Association
www.coa-aco.org
Health Professionals
HealthLinkBC
www.healthlinkbc.ca
Phone: 8-1-1
Access Nurses, Dietitians,
Medication Library & Check your
symptoms
Canadian Orthopedic Foundation
www.canorth.org/en/
patienteducation
and Ortho Connect
www.canorth.org
Physiotherapy Association of
British Columbia (PABC)
– to find a physiotherapist in your
area
www.bcphysio.org
Transportation
HandyDART
www.bctransit.ca
P
rovided by local bus services
throughout BC – check your
local listings for phone numbers
In Lower Mainland:
Phone: 604-430-2692
SPARC –
disabled parking pass
www.sparc.bc.ca
Phone: 604-718-7744
TAP – Travel Assistance Program
www.health.gov.bc.ca/msp/
mtapp/tap_patient.html
Phone: 250-952-1587
“My Joint Replacement”
information
www.myjointreplacement.ca
Surgical or Orthopedic
Information
American Academy of
Orthopaedic Surgeons
http://orthoinfo.aaos.org
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Index
acetabulum..............................1, 2
air travel.....................................31
anemia...........................17, 39, 42
anesthesia...............21, 23bathing
14, 26, 36
bed (getting in and out).............34
bed blocks...........................13, 34
bilateral knee
replacement.....................7, 25, 33
blood clots...24, 26, 29, 33, 39, 40
blood thinner..................24, 29, 40
both knees.............................7, 33
car transfer................................32
chest infection...........................41
complications....................... 39-42
constipation...................18, 27, 39
crutches...................14, 22, 26, 33
day of surgery............................23
deep breathing and coughing....23
dental.........................................42
Dial-a-Dietitian.....................19, 43
disabled parking pass
(SPARC pass)...............15, 31, 43
discharge (hospital).............25, 29
dislocation (hip)...............4, 39, 42
dressing.. 5, 10, 14, 20, 22, 26, 35
driving........................................31
education...................................20
emergency situations....40, 41, 45
equipment......................14, 15, 43
exercise.16, 22, 24, 26, 28, 30, 39
falls prevention..............11, 16, 35
femur...................................1, 2, 6
follow-up....................................29
grab bars.................12, 14, 35, 38
government agencies..........15, 43
hand-held shower hose.12, 14, 36
HandyDART..................15, 31, 43
high-density foam cushion....5, 13,
14, 31, 32, 34, 38
hip precautions....4, 34, 36, 37, 38
hip replacement...2, 35, 36, 37, 38
hip resurfacing.......................2, 25
hip revision............................3, 25
home set-up..............................11
ice..................................11, 28, 40
incision infection..................37, 41
infection...................37, 39, 41, 42
intravenous..........................23, 24
joint loosening.....................39, 42
knee precautions...................9, 40
knee replacement..............6, 7, 25
28, 29, 40
knee revision...............................7
knee stiffness.......................1, 6, 9
leg lifter......................................34
length of hospital stay................25
lighting.......................................11
long-handled reacher............5, 10
14, 35
long-handled shoehorn..........5, 10
14, 35
loosening (joint)...................39, 42
medical appointments...............29
medical supply stores................32
medicine..................20, 23, 24, 27
................................28, 29, 31, 39
nausea.................................24, 27
nutrition......................................17
OASIS.......................................43
occupational therapist...20, 26, 32 35, 37, 38
office work.................................38
Ortho Connect...........................43
osteoarthritis............................1, 6
pain..............1, 2, 6, 19, 23, 26, 27
28, 40, 41, 42
pain assessment scale..............27
partial knee replacement.......7, 25
physiotherapy....26, 28, 29, 30, 33
Pre-Admission Clinic.....20, 21, 23
Pre-Operative checklist.............22
Pre-Operative education...........20
prosthesis............................3, 6, 7
protein.......................................17
railings.......................................11
raised toilet seat..............5, 10, 12
14, 24, 35
recovery room...........................23
Red Cross Loan Cupboards.15, 43
rehabilitation..............................26
resources...................................43
returning to work........................38
revision........................3, 7, 14, 25
Rivaroxaban........................29, 40
sexual activity............................37
shower chair........................12, 36
showering..........12, 14, 22, 36, 37
sitting.........................................34
sleep................................5, 20, 28
sore throat.................................41
SPARC pass..................15, 31, 43
stairs (going up, down)..............33
staples...................2, 6, 29, 36, 37
steristrips...................................37
swelling..............11, 22, 39, 40, 41
The Arthritis Society..................43
toilet transfer..............................35
transportation................15, 31, 43
Travel Assistance Program (TAP)
............................................31, 43
tub clamp.......................12, 14, 35
tub transfer bench.........12, 14, 36
underweight...............................19
urinary tract infection.................41
unicompartmental knee
replacement.................................7
urinating...............................24, 39
vitamins.....................................17
walker................11, 14, 22, 26, 33
walking..........................16, 30, 33
weight-bearing status................24
weight management..................19
work environment......................38
wound care................................37
wound infection.........................41
Before, During & After Hip and Knee Replacement Surgery
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When to seek medical attention
CALL 911 if you develop:
SEE your doctor if you develop:
• Sudden severe pain in your surgical leg
•Redness and drainage at the
• Inability to move the surgical leg
incision site
• Shortening of the leg
• Fever
• Shortness of breath
• Severe fatigue
• Chest pain
• Dizziness
Before, During & After Hip and Knee Replacement Surgery
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45
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