Your New Knee - Capital Health

Your New Knee - Capital Health

2012

Your New Knee

Looking for more health information?

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For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca

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Please do not use perfumed products. Thank you!

Capital Health, Nova Scotia www.cdha.nshealth.ca

Images and text by: Special thanks to Hamilton Health Sciences, Hamilton, Ontario, for permission to use information from “Your New Knee”.

Prepared by: Orthopaedic Health Care Team

We would like to thank our Orthopaedic Health Care Team at the Queen Elizabeth Health Sciences Centre (QEII), Capital Health, Halifax, Nova Scotia, who provided us with comments and suggestions.

Designed and Printed by: Capital Health Audio Visual and Printing Departments

The information in this brochure is provided for information and education purposes only.

The information is not intended to be and does not constitute healthcare or medical advice.

If you have any questions, please ask your healthcare provider.

WE85-1223 Revised Sept. 2012

The information in this pamphlet is to be updated every 3 years.

Please visit our website: www.cdha.nshealth.ca

28

Your New Knee

Table of contents

Topic Page

Introduction............................................................................................................................. 2

Learning.about.knee.replacement.surgery................................................................................ 4

Getting.ready.for.surgery.......................................................................................................... 6

Pre-admission.clinic.visit........................................................................................................... 7

Day.of.surgery.......................................................................................................................... 9

After.surgery.-.in.hospital........................................................................................................ 10

Knee.rules............................................................................................................................... 13

Exercises................................................................................................................................. 14

How.to.move.......................................................................................................................... 17

Walking.................................................................................................................................. 18

Stairs...................................................................................................................................... 19

Follow.up............................................................................................................................... 21

What.to.watch.for.following.surgery....................................................................................... 21

Bathing................................................................................................................................... 22

Driving................................................................................................................................... 23

Preparing.your.home.............................................................................................................. 24

Health.Care.Team.Members.................................................................................................... 26

Additional.appointments........................................................................................................ 27

1

Introduction

You.are.going.to.have.knee.replacement.surgery..This.booklet.gives.information.that.will.help.

you.prepare.for.this.surgery.and.your.new.knee.

Please bring this booklet with you to all of your appointments, classes and to the hospital.

Please have someone come with you too.

Why do I need a knee replacement?

You may need a knee replacement to:

•. lessen.your.pain

•. improve.the.function.of.your.knee.and.your.ability.to.do.activities

•. make.your.knee.more.stable

Your.surgeon.will.tell.you.why.you.need.a.knee.replacement.

Orthopaedic Assessment Clinic (OAC) at QEII

The.clinic.offers.a.way.for.the.surgeons.along.with.the.team.to.work.together.to.reduce.waitlists.

and.wait.times.for.orthopaedic.care..At.the.clinic,.health.assessments.will.be.completed.by.a.

case.manager,.orthopaedic.surgeon.and.other.members.of.the.health.care.team..A.care.plan.will.

be.developed.to.address.your.health.needs.and.readiness.for.surgery.

Dartmouth General Hospital

If.your.surgeon.is.at.Dartmouth.General.Hospital,.you.will.meet.with.them.in.their.office.

Health care team

You.will.work.closely.with.your.health.care.team..They.are.here.to.support.and.guide.you.before,.

during.and.after.your.knee.replacement.

At.the.end.of.this.booklet.there.is.a.place.to.add.their.names.as.you.meet.them.

2

Additional appointments

_____________________________________________________________________________________

_____________________________________________________________________________________

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_____________________________________________________________________________________

Questions

_____________________________________________________________________________________

_____________________________________________________________________________________

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27

Health care team members

Surgeon/Resident/Clinical.Associate. .

Case.Manager.

.

Charge.Nurse.

.

.

.

.

.

.

.

_____________________________________________

_____________________________________________

_____________________________________________

Registered.Nurse/Licensed.Practical.Nurse. _____________________________________________

Physiotherapist.

.

Physiotherapy.Assistant. .

.

.

.

.

.

_____________________________________________

_____________________________________________

Occupational.Therapist. .

Occupational.Therapy.Assistant. .

.

Social.Worker.

Dietitian.

.

.

.

.

.

.

.

Spiritual.Care.

.

.

.

Home.Care.Nova.Scotia.Coordinator. .

.

Unit.Clerk. .

.

.

.

.

.

.

.

.

Unit.Aide. .

.

.

.

.

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________.

What to expect

After you see your surgeon:

. You.must attend.the.Pre-Admission.Clinic.at.the.Halifax.Infirmary.or.Dartmouth.General.

Hospital..This.visit.is.usually 2.to.4.weeks.before.surgery.

. You.may be.referred.to.an.exercise.and.education.program.based.on.your.needs..This.may.

take.place.months.before.your.surgery.

. You.may.attend.a.knee.education.class.at.the.Halifax.Infirmary.or.Dartmouth.General.

Hospital.to.learn.about.your.surgery,.hospital.stay,.and.going.home..The.class.may.be.several.

weeks.or.months.before.surgery..You.will.be.contacted.by.phone.for.the.class.sessions.

Health concerns

If.you.have.health.concerns.such.as.diabetes,.heart.or.lung.problems,.contact.your.family.doctor.

or.specialists.and.let.them.know.that.you.are.having.knee.surgery.

Dental Work or Other Surgery After Knee Replacement Surgery

Tell.your.dentist.or.other.doctors.that.you.have.had.knee.replacement.surgery..You.may.need.to.

take.medication.before.some.procedures.to.prevent.an.infection.in.your.knee.

Research

During.your.hospital.stay.or.clinic.visit,.you.may.be.asked.to.take.part.in.a.research.study..The.

research.will.be.explained.to.you..You.can.decide.whether.or.not.you.want.to.take.part..If.you.

decide.not.to.take.part,.your.care.will.not.be.affected.

26 3

Learning about Knee Replacement Surgery

It is helpful to know how the knee works to prepare yourself for surgery.

How does the knee joint work?

The.knee.joint.works.like.a.hinge..The.femur.(thigh.bone).in.your.upper.leg.is.hinged.to.the.tibia.

(shin.bone).in.your.lower.leg..The.knee.joint.lets.the.tibia.move.back.and.forth.on.the.femur.to.

bend.and.straighten.your.knee.

Ligament

Femur.

(thigh.bone)

Cartilage

Patella

(knee.cap)

Kitchen

You.may.find.having.a.stool.or.chair.with.arms.useful.in.the.kitchen.when.preparing.meals,.if.

space.allows.

There.are.many.options.in.the.grocery.store.for.easy.to.prepare.meals..Another.option.is.to.

prepare.and.freeze.items.before.your.surgery..Stock.up.on.canned,.boxed.and.freezer.food.so.

you.do.not.have.to.go.to.the.store.right.away.after.your.surgery.

Before.surgery,.organize.your.cupboards.and.fridge.so.things.you.need.are.easy.to.reach..

Bathroom

Attach.a.hose.or.install.a.removable.shower.head.for.easy.bathing.

Put.a.non-slip.mat.inside.and.outside.the.tub.or.shower.

If.you.have.difficulty.getting.on-off.a.toilet.or.in-out.of.bathtub.prior.to.discharge.from.hospital,.

your.multidisciplinary.team.will.refer.you.to.occupational.therapy..You.may.need.to.be.assessed.

for.equipment.to.help.with.these.tasks.

Useful website: mysurgery.nshealth.ca

...

Tibia

(shin.bone)

Fibula

3 things help the knee joint work easily and without pain:

•. the.smooth.coating.over.the.bones.called.cartilage

•. the.slippery.fluid.inside.the.joint.called.synovial.fluid

•. the.muscles.and.ligaments.which.support.and.move.the.knee.

3 things make the knee painful and hard to move:

•. the.smooth.coating.over.the.bones.gets.rough.and.worn.away

•. the.muscles.weaken

•. the.slippery.synovial.fluid.in.the.knee.begins.to.dry.up..

4 25

Work and relaxation

Your.therapist.can.talk.to.you.about.limitations.and.safety.during.work.and.relaxation.time...

Everyone.has.a.different.lifestyle..You.should.increase.your.activities.gradually..Ask.your.doctor.or.

therapist.to.help.you.plan.your.return.to.work.and.activities..

Prevent knee pain or injury by:

1. Doing your exercises.

2. Using the right equipment.

3. Changing your position often.

4. Stop doing an activity if you have severe

pain.

Sexual activity

There.are.no.restrictions.regarding.sexual.activity.after.knee.surgery..Positions.where.you.are.

kneeling.on.your.operated.leg.will.not.be.comfortable.

Preparing your home

Remove scattermats and extra furniture to create clear pathways.

If you need to use stairs, you will need a handrail. If you do not have a handrail, you will need to install one.

You will need someone at home with you to help you for at least the first 48-72 hours.

24

What is a Knee Replacement?

Your.surgeon.removes.the.old.knee.joint.and.puts.in.a.new.joint..This.is.called.a.knee.

replacement.or.arthroplasty..Your.new.knee.joint.is.made.of.metal.and.plastic..These.new.parts.

make.the.knee.joint.smooth.again..There.are.2.types.of.knee.replacements:

1. Total knee replacement –.All.the.damaged.bone.and.cartilage.on.the.femur.and.the.tibia.

are.replaced.

2. Partial Knee Replacement (unicompartmental).–.Some.people.only.need.part.of.the.knee.

joint.replaced..If.only.one.side.of.the.femur.and.tibia.are.damaged.your.surgeon.may.do.a.

partial.knee.replacement..This.is.also.referred.to.as.unicondylar.or.unicompartmental.

Your.surgeon.will.tell.you.what.type.of.knee.replacement.you.need.

Metal

Metal

Femur.

(thigh.bone)

Patella

(knee.cap)

Plastic

Cement

Tibia

(shin.bone)

Fibula

How is my new knee attached?

•. A.cemented.replacement.uses.a.special.cement.or.glue.to.hold.the.new.parts.in.place.

•. A.non-cemented.type.has.a.coating.(rough.or.smooth).to.help.the.bone.grow.into.the.new.

replacement.parts.and.hold.it.in.place.

5

Getting Ready for Surgery

It.is.helpful.to.plan.ahead..Research.shows.that.people.manage.their.surgery.and.recovery.better.

when.prepared...

Blood management program

The purpose of the program is:

•. to.reduce.and/or.remove.the.need.for.blood.transfusion.during.planned.surgery

•. to.educate.patients.about.the.risks.and.benefits.of.blood.transfusions.and.other.blood.

alternatives.

Patients.who.undergo.knee.replacement.surgery.may.or.may.not.require.a.blood.transfusion.

More.information.will.be.provided.in.the.Pre-Admission.Clinic/surgeon’s.office.regarding.this.

program.

Help at Home

You.may.require.assistance.with.tasks.such.as.meal.preparation,.cleaning.and.some.aspects.of.

personal.care.following.your.surgery.

If.you.live.on.your.own,.arrange.to.have.someone.stay.with.you.or.stay.with.someone.after.

discharge.for.at.least.48-72.hours.or.until.you.feel.safe.to.stay.alone.

Getting into shape before surgery

Getting.in.shape.before.surgery.helps.your.recovery.after.surgery..To.help.you.get.in.shape,.you.

may.be.referred.to.an.exercise.program.in.the.community.or.at.the.hospital.

Depending on your needs, the therapists will give you information about:

. an.exercise.program

. your.equipment.needs

. how.to.prepare.your.home.

If.you.are.having.difficulty.getting.into.the.tub/shower.or.reaching.your.feet.after.surgery,.your.

multidisciplinary.team.may.refer.you.to.occupational.therapy.

Bedroom

A.standard.or.regular.bed.with.a.firm.mattress.is.best..

It.is.a.good.idea.to.have.a.place.to.rest.during.the.day.on.the.level.you.are.doing.your.daytime.

activity.

You.may.want.to.move.a.bed.to.the.ground.floor.so.you.will.not.have.to.climb.stairs.the.first.

week.or.two.that.you.are.home..If.you.do.need.to.use.the.stairs,.try.to.limit.the.number.of.times.

by.organizing.yourself.and.having.the.things.you.need.close.at.hand..Organize.the.dresser.

drawers.and.closet.so.things.are.within.easy.reach...

Driving

Do.not.drive.until.your.surgeon.tells.you.that.you.are.ready..If.you.choose.to.drive.before.the.

surgeon.gives.you.the.okay,.you.may.not.be.covered.by.your.insurance..Remember.to.move.

your.knee.and.leg.often.while.riding.in.a.car. Try to avoid long rides at first, or at least stop

often for stretch breaks; for example every hour.

Please talk with your occupational therapist if you have any concerns about getting into your vehicle.

6 23

Physiotherapy

Most.patients.are.walking.with.a.walker.before.they.go.home.and.are.able.to.climb.stairs.safely...

Your.therapist.will.review.your.mobility.equipment.needs.with.you.before.you.go.home..You.will.

need.to.have.this.equipment.at.home.before.you.leave.the.hospital.

You.will.need.physiotherapy.after.you.go.home..Your.therapist.will.talk.to.you.about.options:.

outpatient.clinic.at.the.hospital.vs.private.clinic.

Exercises

It is important for you to keep doing your exercises at home to strengthen your muscles

and get your knee moving well..The.therapist.will.progress.your.exercise.program.to.help.

improve.the.strength.and.range.of.motion.of.your.knee.

Walking.is.an.excellent.exercise..It.is.important.to.bend.your.knee.when.you.walk..Go.for.several.

walks.a.day..Gradually.increase.the.distance.you.walk.

Being active keeps you and your new knee healthy.

.

Occupational Therapy

If.you.cannot.put.your.pants,.shoes.or.socks.on.independently.before.you.leave.the.hospital,.the.

multidisciplinary.team.may.refer.you.to.occupational.therapy.

Bathing

You may shower 3 or 4 days after your surgery if your incision is not draining. You will have to put a new bandage over the wound once the area is thoroughly dry.

There are a few choices for bathing:

1.. Take.a.sponge.bath.at.the.sink.

2.. Once.you.and.your.therapist.feel.your.balance.is.adequate,.you.may.go.into.the.shower.or.

use.a.bath.seat.

22

Knee education class

The.class.takes.about.2.hours..The.class.at.the.Halifax.Infirmary.is.held.at.the.Orthopaedic.

Assessment.Clinic..At.the.Dartmouth.General.the.class.is.held.on.the.same.day.as.your.preadmission.clinic.visit.

In this class you will learn about:

•. your.surgery,.hospital.stay.and.managing.at.home.home..

•. what.items.you.need.to.bring.to.the.hospital

•. different.types.of.pain.control

•. exercises.and.how.to.use.a.walker.or.crutches

•. how.to.do.everyday.activities.such.as.bathing,.dressing

•. equipment.needs

•. care.after.discharge.from.hospital

Please.come.to.class.with.your.questions.about.your.knee.replacement.

Bring.along.a.family.member.or.friend.so.that.they.can.learn.how.they.can.support.you.through.

this.process..

Pre-Admission Clinic visit

This.clinic.visit.may.take.up.to.3.to.4.hours..It.is.very.helpful.to.bring.a.family.member.or.friend.

to.this.appointment.

Bring.all.your.medications.in.the.original.containers,.vitamins,.plus.herbal.or.natural.

supplements.you.take.at.home.to.this.appointment.

Also.bring.a.list.of.any.known.allergies.

During the Pre-Admission Clinic visit you will:

•. Have.an.ECG.heart.test.and.blood.tests..

•. You.will.have.an.x.ray.done.that.day.if.your.last.x-ray.was.taken.more.than.6.month.ago.

7

Items to bring to the hospital

•. This.book.

•. A.denture.container.and.appropriate.cases.if.applicable.

•. Personal.items.such.as.toothpaste,.shampoo.and.grooming.items..Perfumes.and.scented.

items.such.as.scented.soaps.and.deodorants.are.not.allowed.as.the.hospital.has.a.Scent Free

Policy.

•. A.few.outfits.to.wear.during.your.stay,.for.example.loose.stretchy.clothing.such.as.jogging.

pants.and.a.loose.top..Housecoats.should.have.front.button.or.zipper.closure.and.be.short.

enough.to.avoid.tripping.when.you.walk..You.will.wear.a.hospital.gown.during.part.of.your.

hospital.stay..

•. Pack.light-weight,.supportive.shoes.with.a.non.slip.sole,.like.running.shoes..Supportive.

slippers.with.a.back.and.a.non.slip.sole.are.okay..Backless.slippers.are.not.allowed..Using.

elastic.laces.or.Velcro.will.make.fastening.shoes.easier..

Please leave the following at home

•. large.sums.of.money

•. credit.cards

•. cell.phones

•. jewelry

•. perfumes.and.scented.items

•. toileting.equipment,.for.example.raised.toilet.seat

Telephone or television

You.may.wish.to.order.a.telephone.or.TV.during.your.stay..Further.information.can.be.given.to.

you.when.you.are.admitted.to.your.room.

8

Follow-up

You.will.see.your.surgeon.2.to.6.weeks.after.you.leave.the.hospital..If.you.have.stitches.or.staples.

to.close.your.incision.you.will.need.to.have.them.removed.10.to.14.days.after.surgery..Your.

nurse.may.give.you.a.staple.remover.to.take.with.you.to.the.family.doctor.or.instructions.if.you.

are.to.return.to.your.surgeon.for.removal.

Once.your.incision.is.dry.it.can.be.left.open.to.the.air..If.you.have.steri.strips.over.your.incision.

they.will.fall.off.on.their.own..If.you.need.bandage.changes.for.your.incision.after.leaving.the.

hospital,.your.nurse.will.arrange.with.VON.or.Continuing.Care.to.send.a.nurse.to.your.home..

What to watch for following surgery

Infection

Bacteria.in.your.blood.can.get.into.your.new.knee.and.cause.an.infection..Any infection must

be treated right away.

Signs of infection are:

. increased.redness.around.the.incision

. swelling

. drainage.from.the.incision

. increased.pain

. fever.above.38

o

C.or.100

o

F

Blood Clots

Blood.clots.sometimes.form.after.surgery. The.best.way.to.keep.a.clot.from.forming.is.to.keep.

active.and.moving. Any.blood.clot.must.be.treated.right.away.

Signs of blood clots are:

. Pain.and.redness.in.the.calf.area

. Chest.pain.with.difficulty.breathing

If you have any of these changes, call your surgeon right away.

21

Going down steps with a handrail

1.. Face.the.step.with.the.cane/crutch.in.the.hand.away.from.the.handrail.

2.. Stand.close.to.the.edge.

3.. Put.your.other.hand.on.the.handrail.

4.. Put.cane/crutch.in.the.middle.of.the.next.lower.step.followed.carefully.by.the.operated.leg.

5.. Step.down.with.the.unoperated.leg.

Day of Surgery

It.is.very.important.not.to.have.solid.food.after.midnight.the.night.before.your.surgery..Please.

follow.the.fluid.guidelines.you.received.at.the.Pre-Admission.Clinic.or.during.your.doctor’s.

appointment..Take.only.the.medications.that.you.were.told.to.take.the.morning.of.your.surgery,.

with.sips.of.water..

Please follow the instructions given to you by the

Pre-Admission Clinic nurse, or you risk having your surgery cancelled.

You.will.register.in.the.Same.Day.Surgery.department.on.the.5

th

.floor.of.the.Halifax.Infirmary...

Take.the.elevator.by.the.Robie.Street.entrance.

At.the.Dartmouth.General.enter.at.the.main.entrance.and.stop.at.the.Admitting.Desk.in.the.

front.entrance.

A.nurse.will.prepare.you.for.the.operating.room.

All.equipment.that.you.will.need.will.be.provided.while.in.the.hospital..If.you.came.to.the.

hospital.with.a.walker,.cane,.crutches.or.a.wheelchair,.please.have.a.family.member.take.

them.home..Please.arrange.for.this.equipment.to.be.brought.back.to.the.hospital.on.the.day.

of.discharge.as.the.physiotherapist.will.check.your.walking.aid.to.ensure.that.it.is.the.correct.

height..You.will.need.the.walking.aid.to.get.to.you.vehicle..

Cane and operated leg step down together. Step down with the unoperated leg.

Note: Shaded leg is the operated leg.

When.you.are.first.home.have.someone.with.you.when.you.do.the.stairs.–.that.person.should.

follow.close.behind.you.on.the.way.up.and.should.be.one.step.below.you.on.the.way.down.

Going home – Arrange to be picked up before 11:00 am on discharge day.

20 9

After Surgery – In Hospital

Your surgery will take about 1

1

/

2

to 2

1

/

2 hours.

After.surgery.you.are.taken.to.the.Post-Anesthetic.Care.Unit.(PACU).or.recovery.room.where.you.

will.stay.and.be.closely.watched.until.you.are.ready.to.go.to.the.inpatient.unit..If.you.have.pain.

or.feel.sick,.tell.the.nurse...

If.you.need.closer.observation.or.cardiac.(heart).monitoring.following.surgery.you.may.go.to.the.

Intermediate.Care.Unit.(IMCU).or.Intensive.Care.Unit.(ICU).for.24-48.hours.or.until.the.doctor.

feels.that.you.can.go.safely.to.an.inpatient.bed.

While you are on the inpatient unit

Once.you.arrive.on.the.inpatient.unit,.the.nurses.check.your.vital.signs.and.affected.leg..This.

includes.your.blood.pressure,.heart.rate,.breathing.rate,.temperature,.and.pulses,.sensation.and.

movement.in.affected.leg.and.foot..

The.nurse.will.examine.your.abdomen.with.a.stethoscope,.checking.for.bowel.sounds..Once.

bowel.sounds.have.returned.your.diet.will.be.increased.appropriately..It.is.common.to.start.with.

ice.chips.or.sips.of.water.for.the.first.few.hours.following.surgery.

Bloodwork.is.generally.done.following.surgery.

You.will.be.encouraged.to.do.as.much.for.yourself.as.possible.

Your.leg.may.be.bruised.and.swollen,.and.painful.as.you.move..The.nurses.will.check.your.

bandage.and.ask.you.about.your.pain.

Pain control

It.is.normal.to.have.pain.after.surgery..A.pain.scale.(where.”0”.means.no.pain.and.”10”.means.

worst.pain).will.be.used..You.will.be.asked.to.rate.your.pain.using.this.scale.

. . 0.——.1.——.2.——.3.——.4.——.5.——.6.——.7.——.8.——.9.——.10

. No.Pain. .

.

.

.

.

.

.

.

.

....Worst.Pain.

The.pain.will.be.controlled.with.medications..Members.of.the.health.care.team.will.help.

you.with.pain.relief..The.pain.will.lessen.over.time.as.you.heal..It.is.important.to.have.your.

pain.controlled.so.that.you.can.do.your.exercises.and.move.around..Ask.the.nurse.for.pain.

medications.as.needed.

10

For stairs, curbs and steps

Your therapist will show you how to climb stairs safely.

Going up steps with a handrail

1.. Face.the.step.with.cane/crutch.in.the.hand.away.from.the.handrail.

2.. Stand.close.to.the.step.

3.. Put.your.other.hand.on.the.handrail.

4.. Put.your.weight.on.the.handrail.and.the.cane.

5.. Step.up.with.your.unoperated.leg.

6.. Straighten.your.unoperated.leg.and.bring.the.cane/crutch.and.the.operated.leg.up.together.

. . Step up with the unoperated leg.

Cane and operated leg step up together.

Note: Shaded leg is the operated leg.

19

Walking

You.may.be.up.to.a.chair.or.walking.on.the.day.

of.your.surgery..You.will.use.a.walker.first,.and.

may.progress.crutches.or.a.cane..The.first.few.

times.you.get.out.of.bed,.you.may.feel.weak.

or.dizzy..Make.sure.a.nurse.or.therapist.is.with.

you..Tell.them.anytime.you.feel.weak.or.dizzy..

The.physiotherapist.will.give.you.feedback.to.

help.make.sure.you.are.walking.correctly..Your.

therapist.will.tell.you.when.it.is.safe.for.you.to.

walk.by.yourself.

When you are walking with a walker, follow these steps:

1.. Move.your.walker.ahead.first.

2.. Step.forward.with.your.operated.leg,..

.

. followed.by.the.unoperated.leg.

Take short walks as often as you can using your walking aid. Walking helps prevent joint stiffness and is good for your general health, strength and circulation. Remember to bend your knee as you are walking.

Try to increase your distance as you are able.

When turning avoid twisting your knee and turn towards your good side.

18

Confusion

Some.people.may.become.confused.from.anesthetic,.or.use.of.pain.medication.after.surgery...

If.you.have.a.history.of.being.confused.while.in.the.hospital,.please.tell.your.surgeon.or.other.

health.care.provider.

If,.as.a.family.member.or.friend,.you.notice.that.your.loved.one.is.acting.differently.or.is.restless,.

please.tell.the.nurse.

Nausea

You.may.have.an.upset.stomach.or.nausea.after.any.type.of.anesthesia..Nausea.is.also.a.side.

effect.of.some.pain.medication..If.you.feel.unwell.or.have.nausea,.tell.your.nurse..You.will.be.

given.some.medication.to.help.with.the.symptoms.

Skin

Healthy.skin.helps.prevent.infections..Your.bandages.and.incision.will.be.checked.often.while.

you.are.in.the.hospital.

Lying.in.bed.puts.pressure.on.your.skin..Over.time.you.can.develop.a.pressure.ulcer..The.first.

signs.of.this.problem.are.burning,.redness.or.pain..If.you.have.any.of.these.signs.on.your.

buttocks,.ankles,.heels,.elbows,.shoulders.or.ears,.talk.to.your.nurse.or.therapist.

The best way to avoid skin problems is to change position. Avoid lying down in bed for long periods of time. The nurses and therapists will remind you to get up and move as much as possible after surgery. You should be getting up and out of bed for all your meals. You should also remember to do this when you go home.

Swelling

It.is.normal.to.have.some.swelling.in.your.operative.leg.after.surgery.–.this.can.occur.for.the.

first.few.weeks.after.surgery..Swelling.may.increase.as.you.become.more.active..To.help.reduce.

the.swelling.avoid.sitting.for.prolonged.periods.and.pump.your.ankles.and.feet.to.keep.the.

circulation.going.

11

Weakness

You.may.feel.tired.and.dizzy.when.you.get.out.of.bed.after.surgery..Make.sure.someone.helps.

you.get.up.until.you.are.safe.to.move.around.on.your.own..Staff.will.tell.you.when.it.is.safe.for.

you.to.get.up.to.the.washroom.or.to.walk.by.yourself..

Urinary problems

You.may.have.trouble.urinating.or.passing.water.after.surgery..If.you.have.any.problem.passing.

urine,.are.urinating.often,.or.have.burning.when.passing.urine,.talk.with.your.nurse..If.you.are.

unable.to.urinate.12.hours.following.your.surgery.your.nurse.will.do.a.urinary.catheterization.to.

empty.your.bladder.

Bowel problems

There.can.be.a.change.in.your.bowel.habits.after.surgery.

Your.surgeon.may.start.you.on.a.laxative.or.stool.softener.because.pain.medication.can.cause.

constipation..If.you.are.going.home.on.pain.medications,.you.may.need.to.continue.taking.a.

laxative..You.can.buy.these.as.an.over-the-counter.medication.at.any.drug.store.

Remember.to.drink.plenty.of.liquids,.eat.foods.with.natural.roughage.(fiber).and.be.as.active.as.

possible.

Lung problems

After.surgery,.your.activity.will.be.less.than.normal..Deep.breathing.and.coughing.exercises.are.

important.to.do.every.hour.while.awake..Your.nurse.may.teach.you.how.to.use.a.device.called.

an.incentive.spirometer.that.can.help.with.deep.breathing.

Deep breathing and coughing helps to:

•. keep.your.lungs.expanding.fully

•. clear.mucus.from.your.lungs.and.throat

•. reduce.the.chance.of.getting.a.chest.infection.

Getting up and moving around is one of the best activities to help keep your lungs clear.

Blood clots

You.have.an.increased.risk.of.forming.a.blood.clot.after.surgery..It.is.very.important.to.do.your.

exercises.and.get.up.and.move.as.much.as.you.can.after.surgery.to.prevent.blood.clots.

Signs.of.a.blood.clot.in.your.legs.are.redness,.swelling,.warmth.or.pain.anywhere.in.either.leg...

12

How to Move

Getting in and out of bed

The.day.of.surgery.or.the.first.day.after.surgery,.your.nurse.or.therapist.will.show.you.the.right.

way.to.get.in.and.out.of.bed..

To get out of bed from a lying position:

•. Push.up.on.your.elbows.and.hands.

•. Then.slide.your.hips.and.legs.over.to.the.edge.of.the.bed.to.sit.

•. When.possible,.get.in.and.out.of.bed.by.leading.with.your.unoperated.leg.

•. Sleep.on.the.side.of.the.bed.that.you.are.most.confortable.on.

Sitting down

When you sit down, follow these steps:

1.. Back.up.to.the.edge.of.the.chair.or.bed.

2.. Feel.the.edge.of.the.chair.or.bed.with.the.

back.of.your.knees.

3.. Slide.your.operated.leg.forward.

4.. Hold.the.arm.rests.or.bed.with.your.hands..

5.. Lower.yourself.to.sitting.position.slowly.and.

gently...

Standing up

When you stand up, follow these steps:

1.. Move.to.the.edge.of.the.chair.or.bed.

2.. Bend.your.unoperated.leg.under.you..

. to.hold.your.body.weight.

3.. Slide.your.operated.leg.forward.

4.. Push.down.with.your.hands.on.the..

. chair.arms.or.bed.to.stand.up..Put...

. most.of.your.weight.on.your..

. unoperated.leg.

.

5.. Once.you.have.your.balance,.use.your..

. walking.aid..

17

Ice

Ice.reduces.pain.and.swelling. You.will.be.given.an.ice.pack.every.1-2.hours.to.use.across.your.

knee..Do.not.leave.the.ice.pack.on.for.more.than.15.minutes.at.a.time..Elevating.the.leg.on.

pillows.while.applying.ice.will.help.to.reduce.the.swelling.

Weight bearing

Weight.bearing.is.the.amount.of.weight.you.can.put.on.your.operated.leg..Usually.after.knee.

surgery.you.are.allowed.to.bear.weight.as.tolerated..If.you.have.restrictions.in.the.amount.of.

weight.that.you.are.allowed.to.put.on.the.operated.leg.the.nurse.and.physiotherapist.will.review.

how.to.walk..

Resting positions

Find.a.position.of.comfort..Nothing.limits.you.from.sidelying.however.it.may.not.be.as.

comfortable.in.the.early.days.after.surgery.when.compared.to.lying.on.your.back.

For.long.periods,.the.best.way.to.lie.in.bed.is.on.your.back.

Try.to.keep.your.knees.and.toes.pointing.up. Do not put a pillow under your operated knee.

It.is ok.however.to.place.a.pillow.lengthwise.under.your.leg.to.help.with.swelling.as.long.as.the.

knee.is.able.to.be.kept.in.a.straightened.position.

When.lying.on.your.side.put.1-2.pillows.between.your.knees.for.comfort.

If.you.need.to.reduce.swelling.in.your.leg,.you.can.lie.on.your.back.and.put.a.pillow under

your ankle.to.keep.your.ankle.higher.than.your.knee.

16

Signs.of.a.blood.clot.in.your.lung.are.sharp.chest.pain,.rapid.heart.rate,.blood-tinged.sputum,.

shortness.of.breath,.or.low.grade.fever..Tell.a.member.of.your.health.care.team.right.away.if.you.

notice.any.of.these.signs.

Your.surgeon.will.assess.and.decide.what.anti-coagulant.or.blood.thinning.medication.you.will.

need..Blood.thinning.medication.can.be.ordered.in.pill.or.needle.form..You.may.need.to.go.

home.on.blood.thinning.medications..If.the.medication.is.in.needle.form.you.will.be.taught.self.

injection..Your.surgeon.may.also.want.you.to.wear.special.stockings.called.TEDS.to.help.reduce.

the.risk.of.clots..If.you.are.on.medications.to.prevent.blood.clots,.it.is.important.to.complete.all.

of.the.medication.

Knee Rules

Follow these rules to help your muscles heal, get strong and work well.

.

Rule # 1

Move.your.knee.often..Do.the.exercises.your.

therapist.has.taught.you.

Rule # 2

Do.not.use.a.pillow.or.support.under.your.

knee..Pillows.and.supports.cause.the.muscles.

and.ligaments.to.shorten,.making.it.difficult.

to.straighten.your.knee..

.

It.is.OK.however.to.place.a.pillow.lengthwise.

under.your.leg.to.help.with.swelling.as.

long.as.the.knee.is.able.to.be.kept.in.a.

straightened.position.

Rule #3

You.should.sit.on.a.chair.with.arms.to.make.

getting.up.and.down.easier..Higher.seats.will.

be.easier.to.get.up.from.than.lower.ones.in.

the.early.days.after.surgery.

13

Exercises

Exercise following surgery will help:

. strengthen.the.muscles.in.your.legs

. move.your.new.knee.and.prevent.joint.stiffness

. improve.blood.supply.to.your.legs.

Your.physiotherapist.will.instruct.you.in.your.exercises.

You.are.expected.to.do.these.exercises.daily.while.in.hospital.and.when.you.go.home..As.you.

get.stronger,.your.physiotherapist.will.progress.the.exercises..

Repeat the exercises below at least 3 times a day.

Do each exercise 10 times.

Leg Exercises - While lying down

Heel slides.

•. Slide.your.heel.towards.your.buttocks.

•. Keep.your.heel.and.buttocks.on.the.bed.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

Quad Isometrics.

. .

Quad over roll

•. Straighten.your.leg.by.tightening.the.muscles.on.. .

. the.front.of.your.thigh.

•. Push.your.knee.into.the.bed.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

•. Wrap.a.large.can.in.a.towel..Place.under.your.knee.

•. Lift.your.foot.off.the.bed.by.straightening.your.leg.

•. DO NOT lift.your.knee.off.the.can.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times..

14

.

Straight leg raise

Knee extension - sitting

•. Lying.on.back.with.leg.straight,.opposite.knee..

.

. bent.

•. Tighten.thigh.muscle.

•. Slowly.raise.the.leg.off.the.bed.keeping.the.knee.. .

. straight.

•. Hold.20.seconds.

•. Repeat.10.times.

.

•. Straighten.your.leg.as.far.as.possible.

•. Hold.for.5.seconds.

•. Then.bring.your.heel.as.far.back.under.the.chair.as...

. possible.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

Let Pain be Your Guide!!

15

Exercises

Exercise following surgery will help:

. strengthen.the.muscles.in.your.legs

. move.your.new.knee.and.prevent.joint.stiffness

. improve.blood.supply.to.your.legs.

Your.physiotherapist.will.instruct.you.in.your.exercises.

You.are.expected.to.do.these.exercises.daily.while.in.hospital.and.when.you.go.home..As.you.

get.stronger,.your.physiotherapist.will.progress.the.exercises..

Repeat the exercises below at least 3 times a day.

Do each exercise 10 times.

Leg Exercises - While lying down

Heel slides.

•. Slide.your.heel.towards.your.buttocks.

•. Keep.your.heel.and.buttocks.on.the.bed.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

Quad Isometrics.

. .

Quad over roll

•. Straighten.your.leg.by.tightening.the.muscles.on.. .

. the.front.of.your.thigh.

•. Push.your.knee.into.the.bed.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

•. Wrap.a.large.can.in.a.towel..Place.under.your.knee.

•. Lift.your.foot.off.the.bed.by.straightening.your.leg.

•. DO NOT lift.your.knee.off.the.can.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times..

14

.

Straight leg raise

Knee extension - sitting

•. Lying.on.back.with.leg.straight,.opposite.knee..

.

. bent.

•. Tighten.thigh.muscle.

•. Slowly.raise.the.leg.off.the.bed.keeping.the.knee.. .

. straight.

•. Hold.20.seconds.

•. Repeat.10.times.

.

•. Straighten.your.leg.as.far.as.possible.

•. Hold.for.5.seconds.

•. Then.bring.your.heel.as.far.back.under.the.chair.as...

. possible.

•. Hold.for.5.seconds.

•. Relax.and.repeat.10.times.

Let Pain be Your Guide!!

15

Ice

Ice.reduces.pain.and.swelling. You.will.be.given.an.ice.pack.every.1-2.hours.to.use.across.your.

knee..Do.not.leave.the.ice.pack.on.for.more.than.15.minutes.at.a.time..Elevating.the.leg.on.

pillows.while.applying.ice.will.help.to.reduce.the.swelling.

Weight bearing

Weight.bearing.is.the.amount.of.weight.you.can.put.on.your.operated.leg..Usually.after.knee.

surgery.you.are.allowed.to.bear.weight.as.tolerated..If.you.have.restrictions.in.the.amount.of.

weight.that.you.are.allowed.to.put.on.the.operated.leg.the.nurse.and.physiotherapist.will.review.

how.to.walk..

Resting positions

Find.a.position.of.comfort..Nothing.limits.you.from.sidelying.however.it.may.not.be.as.

comfortable.in.the.early.days.after.surgery.when.compared.to.lying.on.your.back.

For.long.periods,.the.best.way.to.lie.in.bed.is.on.your.back.

Try.to.keep.your.knees.and.toes.pointing.up. Do not put a pillow under your operated knee.

It.is ok.however.to.place.a.pillow.lengthwise.under.your.leg.to.help.with.swelling.as.long.as.the.

knee.is.able.to.be.kept.in.a.straightened.position.

When.lying.on.your.side.put.1-2.pillows.between.your.knees.for.comfort.

If.you.need.to.reduce.swelling.in.your.leg,.you.can.lie.on.your.back.and.put.a.pillow under

your ankle.to.keep.your.ankle.higher.than.your.knee.

16

Signs.of.a.blood.clot.in.your.lung.are.sharp.chest.pain,.rapid.heart.rate,.blood-tinged.sputum,.

shortness.of.breath,.or.low.grade.fever..Tell.a.member.of.your.health.care.team.right.away.if.you.

notice.any.of.these.signs.

Your.surgeon.will.assess.and.decide.what.anti-coagulant.or.blood.thinning.medication.you.will.

need..Blood.thinning.medication.can.be.ordered.in.pill.or.needle.form..You.may.need.to.go.

home.on.blood.thinning.medications..If.the.medication.is.in.needle.form.you.will.be.taught.self.

injection..Your.surgeon.may.also.want.you.to.wear.special.stockings.called.TEDS.to.help.reduce.

the.risk.of.clots..If.you.are.on.medications.to.prevent.blood.clots,.it.is.important.to.complete.all.

of.the.medication.

Knee Rules

Follow these rules to help your muscles heal, get strong and work well.

.

Rule # 1

Move.your.knee.often..Do.the.exercises.your.

therapist.has.taught.you.

Rule # 2

Do.not.use.a.pillow.or.support.under.your.

knee..Pillows.and.supports.cause.the.muscles.

and.ligaments.to.shorten,.making.it.difficult.

to.straighten.your.knee..

.

It.is.OK.however.to.place.a.pillow.lengthwise.

under.your.leg.to.help.with.swelling.as.

long.as.the.knee.is.able.to.be.kept.in.a.

straightened.position.

Rule #3

You.should.sit.on.a.chair.with.arms.to.make.

getting.up.and.down.easier..Higher.seats.will.

be.easier.to.get.up.from.than.lower.ones.in.

the.early.days.after.surgery.

13

Weakness

You.may.feel.tired.and.dizzy.when.you.get.out.of.bed.after.surgery..Make.sure.someone.helps.

you.get.up.until.you.are.safe.to.move.around.on.your.own..Staff.will.tell.you.when.it.is.safe.for.

you.to.get.up.to.the.washroom.or.to.walk.by.yourself..

Urinary problems

You.may.have.trouble.urinating.or.passing.water.after.surgery..If.you.have.any.problem.passing.

urine,.are.urinating.often,.or.have.burning.when.passing.urine,.talk.with.your.nurse..If.you.are.

unable.to.urinate.12.hours.following.your.surgery.your.nurse.will.do.a.urinary.catheterization.to.

empty.your.bladder.

Bowel problems

There.can.be.a.change.in.your.bowel.habits.after.surgery.

Your.surgeon.may.start.you.on.a.laxative.or.stool.softener.because.pain.medication.can.cause.

constipation..If.you.are.going.home.on.pain.medications,.you.may.need.to.continue.taking.a.

laxative..You.can.buy.these.as.an.over-the-counter.medication.at.any.drug.store.

Remember.to.drink.plenty.of.liquids,.eat.foods.with.natural.roughage.(fiber).and.be.as.active.as.

possible.

Lung problems

After.surgery,.your.activity.will.be.less.than.normal..Deep.breathing.and.coughing.exercises.are.

important.to.do.every.hour.while.awake..Your.nurse.may.teach.you.how.to.use.a.device.called.

an.incentive.spirometer.that.can.help.with.deep.breathing.

Deep breathing and coughing helps to:

•. keep.your.lungs.expanding.fully

•. clear.mucus.from.your.lungs.and.throat

•. reduce.the.chance.of.getting.a.chest.infection.

Getting up and moving around is one of the best activities to help keep your lungs clear.

Blood clots

You.have.an.increased.risk.of.forming.a.blood.clot.after.surgery..It.is.very.important.to.do.your.

exercises.and.get.up.and.move.as.much.as.you.can.after.surgery.to.prevent.blood.clots.

Signs.of.a.blood.clot.in.your.legs.are.redness,.swelling,.warmth.or.pain.anywhere.in.either.leg...

12

How to Move

Getting in and out of bed

The.day.of.surgery.or.the.first.day.after.surgery,.your.nurse.or.therapist.will.show.you.the.right.

way.to.get.in.and.out.of.bed..

To get out of bed from a lying position:

•. Push.up.on.your.elbows.and.hands.

•. Then.slide.your.hips.and.legs.over.to.the.edge.of.the.bed.to.sit.

•. When.possible,.get.in.and.out.of.bed.by.leading.with.your.unoperated.leg.

•. Sleep.on.the.side.of.the.bed.that.you.are.most.confortable.on.

Sitting down

When you sit down, follow these steps:

1.. Back.up.to.the.edge.of.the.chair.or.bed.

2.. Feel.the.edge.of.the.chair.or.bed.with.the.

back.of.your.knees.

3.. Slide.your.operated.leg.forward.

4.. Hold.the.arm.rests.or.bed.with.your.hands..

5.. Lower.yourself.to.sitting.position.slowly.and.

gently...

Standing up

When you stand up, follow these steps:

1.. Move.to.the.edge.of.the.chair.or.bed.

2.. Bend.your.unoperated.leg.under.you..

. to.hold.your.body.weight.

3.. Slide.your.operated.leg.forward.

4.. Push.down.with.your.hands.on.the..

. chair.arms.or.bed.to.stand.up..Put...

. most.of.your.weight.on.your..

. unoperated.leg.

.

5.. Once.you.have.your.balance,.use.your..

. walking.aid..

17

Walking

You.may.be.up.to.a.chair.or.walking.on.the.day.

of.your.surgery..You.will.use.a.walker.first,.and.

may.progress.crutches.or.a.cane..The.first.few.

times.you.get.out.of.bed,.you.may.feel.weak.

or.dizzy..Make.sure.a.nurse.or.therapist.is.with.

you..Tell.them.anytime.you.feel.weak.or.dizzy..

The.physiotherapist.will.give.you.feedback.to.

help.make.sure.you.are.walking.correctly..Your.

therapist.will.tell.you.when.it.is.safe.for.you.to.

walk.by.yourself.

When you are walking with a walker, follow these steps:

1.. Move.your.walker.ahead.first.

2.. Step.forward.with.your.operated.leg,..

.

. followed.by.the.unoperated.leg.

Take short walks as often as you can using your walking aid. Walking helps prevent joint stiffness and is good for your general health, strength and circulation. Remember to bend your knee as you are walking.

Try to increase your distance as you are able.

When turning avoid twisting your knee and turn towards your good side.

18

Confusion

Some.people.may.become.confused.from.anesthetic,.or.use.of.pain.medication.after.surgery...

If.you.have.a.history.of.being.confused.while.in.the.hospital,.please.tell.your.surgeon.or.other.

health.care.provider.

If,.as.a.family.member.or.friend,.you.notice.that.your.loved.one.is.acting.differently.or.is.restless,.

please.tell.the.nurse.

Nausea

You.may.have.an.upset.stomach.or.nausea.after.any.type.of.anesthesia..Nausea.is.also.a.side.

effect.of.some.pain.medication..If.you.feel.unwell.or.have.nausea,.tell.your.nurse..You.will.be.

given.some.medication.to.help.with.the.symptoms.

Skin

Healthy.skin.helps.prevent.infections..Your.bandages.and.incision.will.be.checked.often.while.

you.are.in.the.hospital.

Lying.in.bed.puts.pressure.on.your.skin..Over.time.you.can.develop.a.pressure.ulcer..The.first.

signs.of.this.problem.are.burning,.redness.or.pain..If.you.have.any.of.these.signs.on.your.

buttocks,.ankles,.heels,.elbows,.shoulders.or.ears,.talk.to.your.nurse.or.therapist.

The best way to avoid skin problems is to change position. Avoid lying down in bed for long periods of time. The nurses and therapists will remind you to get up and move as much as possible after surgery. You should be getting up and out of bed for all your meals. You should also remember to do this when you go home.

Swelling

It.is.normal.to.have.some.swelling.in.your.operative.leg.after.surgery.–.this.can.occur.for.the.

first.few.weeks.after.surgery..Swelling.may.increase.as.you.become.more.active..To.help.reduce.

the.swelling.avoid.sitting.for.prolonged.periods.and.pump.your.ankles.and.feet.to.keep.the.

circulation.going.

11

After Surgery – In Hospital

Your surgery will take about 1

1

/

2

to 2

1

/

2 hours.

After.surgery.you.are.taken.to.the.Post-Anesthetic.Care.Unit.(PACU).or.recovery.room.where.you.

will.stay.and.be.closely.watched.until.you.are.ready.to.go.to.the.inpatient.unit..If.you.have.pain.

or.feel.sick,.tell.the.nurse...

If.you.need.closer.observation.or.cardiac.(heart).monitoring.following.surgery.you.may.go.to.the.

Intermediate.Care.Unit.(IMCU).or.Intensive.Care.Unit.(ICU).for.24-48.hours.or.until.the.doctor.

feels.that.you.can.go.safely.to.an.inpatient.bed.

While you are on the inpatient unit

Once.you.arrive.on.the.inpatient.unit,.the.nurses.check.your.vital.signs.and.affected.leg..This.

includes.your.blood.pressure,.heart.rate,.breathing.rate,.temperature,.and.pulses,.sensation.and.

movement.in.affected.leg.and.foot..

The.nurse.will.examine.your.abdomen.with.a.stethoscope,.checking.for.bowel.sounds..Once.

bowel.sounds.have.returned.your.diet.will.be.increased.appropriately..It.is.common.to.start.with.

ice.chips.or.sips.of.water.for.the.first.few.hours.following.surgery.

Bloodwork.is.generally.done.following.surgery.

You.will.be.encouraged.to.do.as.much.for.yourself.as.possible.

Your.leg.may.be.bruised.and.swollen,.and.painful.as.you.move..The.nurses.will.check.your.

bandage.and.ask.you.about.your.pain.

Pain control

It.is.normal.to.have.pain.after.surgery..A.pain.scale.(where.”0”.means.no.pain.and.”10”.means.

worst.pain).will.be.used..You.will.be.asked.to.rate.your.pain.using.this.scale.

. . 0.——.1.——.2.——.3.——.4.——.5.——.6.——.7.——.8.——.9.——.10

. No.Pain. .

.

.

.

.

.

.

.

.

....Worst.Pain.

The.pain.will.be.controlled.with.medications..Members.of.the.health.care.team.will.help.

you.with.pain.relief..The.pain.will.lessen.over.time.as.you.heal..It.is.important.to.have.your.

pain.controlled.so.that.you.can.do.your.exercises.and.move.around..Ask.the.nurse.for.pain.

medications.as.needed.

10

For stairs, curbs and steps

Your therapist will show you how to climb stairs safely.

Going up steps with a handrail

1.. Face.the.step.with.cane/crutch.in.the.hand.away.from.the.handrail.

2.. Stand.close.to.the.step.

3.. Put.your.other.hand.on.the.handrail.

4.. Put.your.weight.on.the.handrail.and.the.cane.

5.. Step.up.with.your.unoperated.leg.

6.. Straighten.your.unoperated.leg.and.bring.the.cane/crutch.and.the.operated.leg.up.together.

. . Step up with the unoperated leg.

Cane and operated leg step up together.

Note: Shaded leg is the operated leg.

19

Going down steps with a handrail

1.. Face.the.step.with.the.cane/crutch.in.the.hand.away.from.the.handrail.

2.. Stand.close.to.the.edge.

3.. Put.your.other.hand.on.the.handrail.

4.. Put.cane/crutch.in.the.middle.of.the.next.lower.step.followed.carefully.by.the.operated.leg.

5.. Step.down.with.the.unoperated.leg.

Day of Surgery

It.is.very.important.not.to.have.solid.food.after.midnight.the.night.before.your.surgery..Please.

follow.the.fluid.guidelines.you.received.at.the.Pre-Admission.Clinic.or.during.your.doctor’s.

appointment..Take.only.the.medications.that.you.were.told.to.take.the.morning.of.your.surgery,.

with.sips.of.water..

Please follow the instructions given to you by the

Pre-Admission Clinic nurse, or you risk having your surgery cancelled.

You.will.register.in.the.Same.Day.Surgery.department.on.the.5

th

.floor.of.the.Halifax.Infirmary...

Take.the.elevator.by.the.Robie.Street.entrance.

At.the.Dartmouth.General.enter.at.the.main.entrance.and.stop.at.the.Admitting.Desk.in.the.

front.entrance.

A.nurse.will.prepare.you.for.the.operating.room.

All.equipment.that.you.will.need.will.be.provided.while.in.the.hospital..If.you.came.to.the.

hospital.with.a.walker,.cane,.crutches.or.a.wheelchair,.please.have.a.family.member.take.

them.home..Please.arrange.for.this.equipment.to.be.brought.back.to.the.hospital.on.the.day.

of.discharge.as.the.physiotherapist.will.check.your.walking.aid.to.ensure.that.it.is.the.correct.

height..You.will.need.the.walking.aid.to.get.to.you.vehicle..

Cane and operated leg step down together. Step down with the unoperated leg.

Note: Shaded leg is the operated leg.

When.you.are.first.home.have.someone.with.you.when.you.do.the.stairs.–.that.person.should.

follow.close.behind.you.on.the.way.up.and.should.be.one.step.below.you.on.the.way.down.

Going home – Arrange to be picked up before 11:00 am on discharge day.

20 9

Items to bring to the hospital

•. This.book.

•. A.denture.container.and.appropriate.cases.if.applicable.

•. Personal.items.such.as.toothpaste,.shampoo.and.grooming.items..Perfumes.and.scented.

items.such.as.scented.soaps.and.deodorants.are.not.allowed.as.the.hospital.has.a.Scent Free

Policy.

•. A.few.outfits.to.wear.during.your.stay,.for.example.loose.stretchy.clothing.such.as.jogging.

pants.and.a.loose.top..Housecoats.should.have.front.button.or.zipper.closure.and.be.short.

enough.to.avoid.tripping.when.you.walk..You.will.wear.a.hospital.gown.during.part.of.your.

hospital.stay..

•. Pack.light-weight,.supportive.shoes.with.a.non.slip.sole,.like.running.shoes..Supportive.

slippers.with.a.back.and.a.non.slip.sole.are.okay..Backless.slippers.are.not.allowed..Using.

elastic.laces.or.Velcro.will.make.fastening.shoes.easier..

Please leave the following at home

•. large.sums.of.money

•. credit.cards

•. cell.phones

•. jewelry

•. perfumes.and.scented.items

•. toileting.equipment,.for.example.raised.toilet.seat

Telephone or television

You.may.wish.to.order.a.telephone.or.TV.during.your.stay..Further.information.can.be.given.to.

you.when.you.are.admitted.to.your.room.

8

Follow-up

You.will.see.your.surgeon.2.to.6.weeks.after.you.leave.the.hospital..If.you.have.stitches.or.staples.

to.close.your.incision.you.will.need.to.have.them.removed.10.to.14.days.after.surgery..Your.

nurse.may.give.you.a.staple.remover.to.take.with.you.to.the.family.doctor.or.instructions.if.you.

are.to.return.to.your.surgeon.for.removal.

Once.your.incision.is.dry.it.can.be.left.open.to.the.air..If.you.have.steri.strips.over.your.incision.

they.will.fall.off.on.their.own..If.you.need.bandage.changes.for.your.incision.after.leaving.the.

hospital,.your.nurse.will.arrange.with.VON.or.Continuing.Care.to.send.a.nurse.to.your.home..

What to watch for following surgery

Infection

Bacteria.in.your.blood.can.get.into.your.new.knee.and.cause.an.infection..Any infection must

be treated right away.

Signs of infection are:

. increased.redness.around.the.incision

. swelling

. drainage.from.the.incision

. increased.pain

. fever.above.38

o

C.or.100

o

F

Blood Clots

Blood.clots.sometimes.form.after.surgery. The.best.way.to.keep.a.clot.from.forming.is.to.keep.

active.and.moving. Any.blood.clot.must.be.treated.right.away.

Signs of blood clots are:

. Pain.and.redness.in.the.calf.area

. Chest.pain.with.difficulty.breathing

If you have any of these changes, call your surgeon right away.

21

Physiotherapy

Most.patients.are.walking.with.a.walker.before.they.go.home.and.are.able.to.climb.stairs.safely...

Your.therapist.will.review.your.mobility.equipment.needs.with.you.before.you.go.home..You.will.

need.to.have.this.equipment.at.home.before.you.leave.the.hospital.

You.will.need.physiotherapy.after.you.go.home..Your.therapist.will.talk.to.you.about.options:.

outpatient.clinic.at.the.hospital.vs.private.clinic.

Exercises

It is important for you to keep doing your exercises at home to strengthen your muscles

and get your knee moving well..The.therapist.will.progress.your.exercise.program.to.help.

improve.the.strength.and.range.of.motion.of.your.knee.

Walking.is.an.excellent.exercise..It.is.important.to.bend.your.knee.when.you.walk..Go.for.several.

walks.a.day..Gradually.increase.the.distance.you.walk.

Being active keeps you and your new knee healthy.

.

Occupational Therapy

If.you.cannot.put.your.pants,.shoes.or.socks.on.independently.before.you.leave.the.hospital,.the.

multidisciplinary.team.may.refer.you.to.occupational.therapy.

Bathing

You may shower 3 or 4 days after your surgery if your incision is not draining. You will have to put a new bandage over the wound once the area is thoroughly dry.

There are a few choices for bathing:

1.. Take.a.sponge.bath.at.the.sink.

2.. Once.you.and.your.therapist.feel.your.balance.is.adequate,.you.may.go.into.the.shower.or.

use.a.bath.seat.

22

Knee education class

The.class.takes.about.2.hours..The.class.at.the.Halifax.Infirmary.is.held.at.the.Orthopaedic.

Assessment.Clinic..At.the.Dartmouth.General.the.class.is.held.on.the.same.day.as.your.preadmission.clinic.visit.

In this class you will learn about:

•. your.surgery,.hospital.stay.and.managing.at.home.home..

•. what.items.you.need.to.bring.to.the.hospital

•. different.types.of.pain.control

•. exercises.and.how.to.use.a.walker.or.crutches

•. how.to.do.everyday.activities.such.as.bathing,.dressing

•. equipment.needs

•. care.after.discharge.from.hospital

Please.come.to.class.with.your.questions.about.your.knee.replacement.

Bring.along.a.family.member.or.friend.so.that.they.can.learn.how.they.can.support.you.through.

this.process..

Pre-Admission Clinic visit

This.clinic.visit.may.take.up.to.3.to.4.hours..It.is.very.helpful.to.bring.a.family.member.or.friend.

to.this.appointment.

Bring.all.your.medications.in.the.original.containers,.vitamins,.plus.herbal.or.natural.

supplements.you.take.at.home.to.this.appointment.

Also.bring.a.list.of.any.known.allergies.

During the Pre-Admission Clinic visit you will:

•. Have.an.ECG.heart.test.and.blood.tests..

•. You.will.have.an.x.ray.done.that.day.if.your.last.x-ray.was.taken.more.than.6.month.ago.

7

Getting Ready for Surgery

It.is.helpful.to.plan.ahead..Research.shows.that.people.manage.their.surgery.and.recovery.better.

when.prepared...

Blood management program

The purpose of the program is:

•. to.reduce.and/or.remove.the.need.for.blood.transfusion.during.planned.surgery

•. to.educate.patients.about.the.risks.and.benefits.of.blood.transfusions.and.other.blood.

alternatives.

Patients.who.undergo.knee.replacement.surgery.may.or.may.not.require.a.blood.transfusion.

More.information.will.be.provided.in.the.Pre-Admission.Clinic/surgeon’s.office.regarding.this.

program.

Help at Home

You.may.require.assistance.with.tasks.such.as.meal.preparation,.cleaning.and.some.aspects.of.

personal.care.following.your.surgery.

If.you.live.on.your.own,.arrange.to.have.someone.stay.with.you.or.stay.with.someone.after.

discharge.for.at.least.48-72.hours.or.until.you.feel.safe.to.stay.alone.

Getting into shape before surgery

Getting.in.shape.before.surgery.helps.your.recovery.after.surgery..To.help.you.get.in.shape,.you.

may.be.referred.to.an.exercise.program.in.the.community.or.at.the.hospital.

Depending on your needs, the therapists will give you information about:

. an.exercise.program

. your.equipment.needs

. how.to.prepare.your.home.

If.you.are.having.difficulty.getting.into.the.tub/shower.or.reaching.your.feet.after.surgery,.your.

multidisciplinary.team.may.refer.you.to.occupational.therapy.

Bedroom

A.standard.or.regular.bed.with.a.firm.mattress.is.best..

It.is.a.good.idea.to.have.a.place.to.rest.during.the.day.on.the.level.you.are.doing.your.daytime.

activity.

You.may.want.to.move.a.bed.to.the.ground.floor.so.you.will.not.have.to.climb.stairs.the.first.

week.or.two.that.you.are.home..If.you.do.need.to.use.the.stairs,.try.to.limit.the.number.of.times.

by.organizing.yourself.and.having.the.things.you.need.close.at.hand..Organize.the.dresser.

drawers.and.closet.so.things.are.within.easy.reach...

Driving

Do.not.drive.until.your.surgeon.tells.you.that.you.are.ready..If.you.choose.to.drive.before.the.

surgeon.gives.you.the.okay,.you.may.not.be.covered.by.your.insurance..Remember.to.move.

your.knee.and.leg.often.while.riding.in.a.car. Try to avoid long rides at first, or at least stop

often for stretch breaks; for example every hour.

Please talk with your occupational therapist if you have any concerns about getting into your vehicle.

6 23

Work and relaxation

Your.therapist.can.talk.to.you.about.limitations.and.safety.during.work.and.relaxation.time...

Everyone.has.a.different.lifestyle..You.should.increase.your.activities.gradually..Ask.your.doctor.or.

therapist.to.help.you.plan.your.return.to.work.and.activities..

Prevent knee pain or injury by:

1. Doing your exercises.

2. Using the right equipment.

3. Changing your position often.

4. Stop doing an activity if you have severe

pain.

Sexual activity

There.are.no.restrictions.regarding.sexual.activity.after.knee.surgery..Positions.where.you.are.

kneeling.on.your.operated.leg.will.not.be.comfortable.

Preparing your home

Remove scattermats and extra furniture to create clear pathways.

If you need to use stairs, you will need a handrail. If you do not have a handrail, you will need to install one.

You will need someone at home with you to help you for at least the first 48-72 hours.

24

What is a Knee Replacement?

Your.surgeon.removes.the.old.knee.joint.and.puts.in.a.new.joint..This.is.called.a.knee.

replacement.or.arthroplasty..Your.new.knee.joint.is.made.of.metal.and.plastic..These.new.parts.

make.the.knee.joint.smooth.again..There.are.2.types.of.knee.replacements:

1. Total knee replacement –.All.the.damaged.bone.and.cartilage.on.the.femur.and.the.tibia.

are.replaced.

2. Partial Knee Replacement (unicompartmental).–.Some.people.only.need.part.of.the.knee.

joint.replaced..If.only.one.side.of.the.femur.and.tibia.are.damaged.your.surgeon.may.do.a.

partial.knee.replacement..This.is.also.referred.to.as.unicondylar.or.unicompartmental.

Your.surgeon.will.tell.you.what.type.of.knee.replacement.you.need.

Metal

Metal

Femur.

(thigh.bone)

Patella

(knee.cap)

Plastic

Cement

Tibia

(shin.bone)

Fibula

How is my new knee attached?

•. A.cemented.replacement.uses.a.special.cement.or.glue.to.hold.the.new.parts.in.place.

•. A.non-cemented.type.has.a.coating.(rough.or.smooth).to.help.the.bone.grow.into.the.new.

replacement.parts.and.hold.it.in.place.

5

Learning about Knee Replacement Surgery

It is helpful to know how the knee works to prepare yourself for surgery.

How does the knee joint work?

The.knee.joint.works.like.a.hinge..The.femur.(thigh.bone).in.your.upper.leg.is.hinged.to.the.tibia.

(shin.bone).in.your.lower.leg..The.knee.joint.lets.the.tibia.move.back.and.forth.on.the.femur.to.

bend.and.straighten.your.knee.

Ligament

Femur.

(thigh.bone)

Cartilage

Patella

(knee.cap)

Kitchen

You.may.find.having.a.stool.or.chair.with.arms.useful.in.the.kitchen.when.preparing.meals,.if.

space.allows.

There.are.many.options.in.the.grocery.store.for.easy.to.prepare.meals..Another.option.is.to.

prepare.and.freeze.items.before.your.surgery..Stock.up.on.canned,.boxed.and.freezer.food.so.

you.do.not.have.to.go.to.the.store.right.away.after.your.surgery.

Before.surgery,.organize.your.cupboards.and.fridge.so.things.you.need.are.easy.to.reach..

Bathroom

Attach.a.hose.or.install.a.removable.shower.head.for.easy.bathing.

Put.a.non-slip.mat.inside.and.outside.the.tub.or.shower.

If.you.have.difficulty.getting.on-off.a.toilet.or.in-out.of.bathtub.prior.to.discharge.from.hospital,.

your.multidisciplinary.team.will.refer.you.to.occupational.therapy..You.may.need.to.be.assessed.

for.equipment.to.help.with.these.tasks.

Useful website: mysurgery.nshealth.ca

...

Tibia

(shin.bone)

Fibula

3 things help the knee joint work easily and without pain:

•. the.smooth.coating.over.the.bones.called.cartilage

•. the.slippery.fluid.inside.the.joint.called.synovial.fluid

•. the.muscles.and.ligaments.which.support.and.move.the.knee.

3 things make the knee painful and hard to move:

•. the.smooth.coating.over.the.bones.gets.rough.and.worn.away

•. the.muscles.weaken

•. the.slippery.synovial.fluid.in.the.knee.begins.to.dry.up..

4 25

Health care team members

Surgeon/Resident/Clinical.Associate. .

Case.Manager.

.

Charge.Nurse.

.

.

.

.

.

.

.

_____________________________________________

_____________________________________________

_____________________________________________

Registered.Nurse/Licensed.Practical.Nurse. _____________________________________________

Physiotherapist.

.

Physiotherapy.Assistant. .

.

.

.

.

.

_____________________________________________

_____________________________________________

Occupational.Therapist. .

Occupational.Therapy.Assistant. .

.

Social.Worker.

Dietitian.

.

.

.

.

.

.

.

Spiritual.Care.

.

.

.

Home.Care.Nova.Scotia.Coordinator. .

.

Unit.Clerk. .

.

.

.

.

.

.

.

.

Unit.Aide. .

.

.

.

.

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________.

What to expect

After you see your surgeon:

. You.must attend.the.Pre-Admission.Clinic.at.the.Halifax.Infirmary.or.Dartmouth.General.

Hospital..This.visit.is.usually 2.to.4.weeks.before.surgery.

. You.may be.referred.to.an.exercise.and.education.program.based.on.your.needs..This.may.

take.place.months.before.your.surgery.

. You.may.attend.a.knee.education.class.at.the.Halifax.Infirmary.or.Dartmouth.General.

Hospital.to.learn.about.your.surgery,.hospital.stay,.and.going.home..The.class.may.be.several.

weeks.or.months.before.surgery..You.will.be.contacted.by.phone.for.the.class.sessions.

Health concerns

If.you.have.health.concerns.such.as.diabetes,.heart.or.lung.problems,.contact.your.family.doctor.

or.specialists.and.let.them.know.that.you.are.having.knee.surgery.

Dental Work or Other Surgery After Knee Replacement Surgery

Tell.your.dentist.or.other.doctors.that.you.have.had.knee.replacement.surgery..You.may.need.to.

take.medication.before.some.procedures.to.prevent.an.infection.in.your.knee.

Research

During.your.hospital.stay.or.clinic.visit,.you.may.be.asked.to.take.part.in.a.research.study..The.

research.will.be.explained.to.you..You.can.decide.whether.or.not.you.want.to.take.part..If.you.

decide.not.to.take.part,.your.care.will.not.be.affected.

26 3

Introduction

You.are.going.to.have.knee.replacement.surgery..This.booklet.gives.information.that.will.help.

you.prepare.for.this.surgery.and.your.new.knee.

Please bring this booklet with you to all of your appointments, classes and to the hospital.

Please have someone come with you too.

Why do I need a knee replacement?

You may need a knee replacement to:

•. lessen.your.pain

•. improve.the.function.of.your.knee.and.your.ability.to.do.activities

•. make.your.knee.more.stable

Your.surgeon.will.tell.you.why.you.need.a.knee.replacement.

Orthopaedic Assessment Clinic (OAC) at QEII

The.clinic.offers.a.way.for.the.surgeons.along.with.the.team.to.work.together.to.reduce.waitlists.

and.wait.times.for.orthopaedic.care..At.the.clinic,.health.assessments.will.be.completed.by.a.

case.manager,.orthopaedic.surgeon.and.other.members.of.the.health.care.team..A.care.plan.will.

be.developed.to.address.your.health.needs.and.readiness.for.surgery.

Dartmouth General Hospital

If.your.surgeon.is.at.Dartmouth.General.Hospital,.you.will.meet.with.them.in.their.office.

Health care team

You.will.work.closely.with.your.health.care.team..They.are.here.to.support.and.guide.you.before,.

during.and.after.your.knee.replacement.

At.the.end.of.this.booklet.there.is.a.place.to.add.their.names.as.you.meet.them.

2

Additional appointments

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Questions

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

27

28

Your New Knee

Table of contents

Topic Page

Introduction............................................................................................................................. 2

Learning.about.knee.replacement.surgery................................................................................ 4

Getting.ready.for.surgery.......................................................................................................... 6

Pre-admission.clinic.visit........................................................................................................... 7

Day.of.surgery.......................................................................................................................... 9

After.surgery.-.in.hospital........................................................................................................ 10

Knee.rules............................................................................................................................... 13

Exercises................................................................................................................................. 14

How.to.move.......................................................................................................................... 17

Walking.................................................................................................................................. 18

Stairs...................................................................................................................................... 19

Follow.up............................................................................................................................... 21

What.to.watch.for.following.surgery....................................................................................... 21

Bathing................................................................................................................................... 22

Driving................................................................................................................................... 23

Preparing.your.home.............................................................................................................. 24

Health.Care.Team.Members.................................................................................................... 26

Additional.appointments........................................................................................................ 27

1

2012

Your New Knee

Looking for more health information?

Contact your local public library for books, videos, magazine articles and online health information.

For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca

Capital Health promotes a smoke-free and scent-free environment.

Please do not use perfumed products. Thank you!

Capital Health, Nova Scotia www.cdha.nshealth.ca

Images and text by: Special thanks to Hamilton Health Sciences, Hamilton, Ontario, for permission to use information from “Your New Knee”.

Prepared by: Orthopaedic Health Care Team

We would like to thank our Orthopaedic Health Care Team at the Queen Elizabeth Health Sciences Centre (QEII), Capital Health, Halifax, Nova Scotia, who provided us with comments and suggestions.

Designed and Printed by: Capital Health Audio Visual and Printing Departments

The information in this brochure is provided for information and education purposes only.

The information is not intended to be and does not constitute healthcare or medical advice.

If you have any questions, please ask your healthcare provider.

WE85-1223 Revised Sept. 2012

The information in this pamphlet is to be updated every 3 years.

Please visit our website: www.cdha.nshealth.ca

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