Total Joint Experience Guide CMH-OHSU Health Orthopedic Clinic How can we help you?
Total Joint Experience Guide © 2026 CMH-OHSU Health Orthopedic Clinic and Columbia Memorial Hospital
Preparing for Total Joint Replacement | 1 Table of contents CMH-OHSU Health Orthopedic Clinic 5-9 Welcome 5 Who is on my health care team? 6-7 What will happen during surgery? 8-9 Preparing for surgery 10-18 Medical clearance before surgery 11-12 Insurance and billing 13 Improve your health before surgery 14-18 Countdown to surgery 19-23 1-2 weeks before surgery 19-20 2 days before your surgery 21 1 day before your surgery 21-22 Day of surgery 22 At the hospital 24-28 Before surgery 24 What to expect after surgery 25-26 Rehabilitation and recovery 26-28 Recovering from surgery 29-35 Leaving the hospital 29 Recovering at home or elsewhere 29-30 Healing your joint 31-33 Healthy choices for better healing 34-35 Conclusion 35
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CMH-OHSU HEALTH ORTHOPEDIC CLINIC Welcome Thank you for choosing Columbia Memorial Hospital (CMH) for your joint replacement surgery. CMH is a not-for-profit community hospital with a strong collaboration with Oregon’s leading academic medical center, Oregon Health & Science University (OHSU). By having your surgery in our community, you are benefiting from the comfort and convenience of CMH and the medical excellence of OHSU. As part of the OHSU medical staff, your surgeon is among Oregon’s best. Our team looks forward to providing you with joint replacement services and wants your stay with us to be as comfortable for you as possible. We hope this guide is helpful for you and your loved ones as you plan for surgery, post-surgery rehabilitation and recovery. What to expect Everyone’s experience with joint replacement surgery is going to be different. Your surgery and recovery will depend on things like your age, overall health and the state of your joint. Your surgeon and rehabilitation team will develop a plan for your specific needs. This guide is not meant to replace your doctor’s or rehabilitation team’s instructions. It is intended to introduce you to joint replacement surgery and to address any common concerns you might have. If you have any further questions or concerns about your surgery, please be sure to talk to your doctor or anyone else on your health care team. Preparing for Total Joint Replacement | 3
4 | CMH-OHSU Health Orthopedic Clinic Who is on my health care team? Surgeons: Orthopedic surgeons are doctors who have been trained to fix problems with bones, joints and muscles. They have years of additional surgical training to perform total joint replacement operations. Hospitalists: A hospitalist is a physician specially trained to care for hospitalized patients. They work closely with your entire care team including your surgeon and nurses to ensure you receive the high-quality care needed to help you recover from your joint replacement surgery in the hospital. Physician Associates (PAs): PAs perform examinations, assist in surgery, order diagnostic tests and prescribe medications and therapy. You will often see a PA for your pre- and post-operative appointments. Nurse Practitioners (NPs): Nurse practitioners have advanced training in treating illness or injury and can prescribe medicine and therapy. They focus on education, prevention and wellness. Nurses: Nurses provide care in a variety of settings. They will prepare you for surgery, assist in your recovery from anesthesia and care for you after your surgery. Nurses partner closely with doctors, PAs, therapists and others to help you recover after your surgery. Medical Assistants: MAs assist providers with patient care and help clinics run more efficiently. They make calls and complete administrative tasks, in addition to taking vitals, recording patient history and helping with exams. Nurse Anesthetists (CRNAs): CRNAs are highly specialized nurses who provide anesthesia (the medicine to make you “sleep” during your surgery). They will go over your medical history with you and decide what type of anesthesia to use. During your surgery, your CRNA will monitor you, and afterward, determine
Preparing for Total Joint Replacement | 5 when you can be safely transferred out of the operating room. Physical Therapists (PTs): Your PT will work with you to strengthen the muscles around your new joint and improve your mobility. They will give you exercises to help. Occupational Therapists (OTs): Your OT will teach you ways to protect your new joint while doing activities of daily living, such as safely using the bathroom, getting dressed and caring for yourself. Care Managers: Care managers are registered nurses and licensed clinical social workers who work with your entire health care team to help when you leave the hospital (when you are “discharged”). They can also answer questions about insurance coverage for services and equipment you may need after surgery. “Coaches”: Coaches may be friends or relatives who help you during your recovery. Choosing a “coach” We recommend you recruit a “coach” for your total joint surgery. This person may be a friend or relative who can help you during your recovery. This person should come to at least one of your therapy sessions in the hospital. There, they will learn how to help you with things like getting in and out of a car, bathing, etc. It’s also good to have a back-up “coach.” My coach: My back-up coach:
6 | CMH-OHSU Health Orthopedic Clinic What will happen during surgery? Hip replacement The hip joint connects the upper end of your Ⓐ thigh bone (femur) to the Ⓑ hip (pelvis). A Ⓒ “ball joint” on the end of your femur fits into the socket of the hip. Both ends are covered in cartilage (a smooth lining that protects the joint). When the cartilage in your hip wears out, the bones can rub together, causing hip pain. During hip replacement surgery, the worn-out or damaged cartilage is removed from the hip joint and upper thigh bone and replaced with artificial parts. This restores the smooth surface of your hip joint and helps it move without pain. Knee replacement Your knee joint is made up of: • The lower end of the Ⓐ thigh bone (femur) • The top of the Ⓓ shin bone (tibia) • The Ⓔ knee cap • Cartilage (a smooth lining that protects the joint) When cartilage wears out, the bones rub against each other and can cause pain in your knee. During total knee replacement surgery, the worn-out or damaged cartilage is removed and replaced with metal and plastic parts. This restores the smooth surface of your knee joint and helps it move without pain. Ⓐ Ⓑ Ⓒ Ⓐ Ⓓ Ⓔ
Preparing for Total Joint Replacement | 7 Shoulder replacement Your shoulder is where three bones come together: • The Ⓕ upper arm bone (humerus) • The Ⓖ shoulder blade (scapula) • The Ⓗ collarbone (clavicle) The shoulder is a “ball-and-socket joint,” which means the end of one bone (ball) fits into a hollow in another bone (socket). The shoulder socket is called the glenoid. Cartilage covers and protects the surfaces of your bones where they meet. When the cartilage wears out, the bones rub together and cause pain. In shoulder replacement surgery, the surgeon removes worn or damaged parts and replaces them with metal or plastic parts. This restores the smooth surface of your shoulder and helps it move without pain. Questions for my care team: Ⓗ Ⓖ Ⓕ
8 | CMH-OHSU Health Orthopedic Clinic PREPARING FOR SURGERY There are several things you should do before your joint replacement surgery, including: • Getting medical clearance for surgery • Planning ahead for hospital bills • Improving your health for a better recovery • Preparing your home for surgery My plan for surgery I am working toward surgery. My surgeon’s name is . My tentative surgery date is . I may need to stay in the hospital nights.
Preparing for Total Joint Replacement | 9 Medical clearance before surgery Appointments before your surgery You will have several appointments to prepare you for your surgery. These may include appointments for medical clearance from your primary care provider, dentist and/or specialists (e.g. cardiologist). You will also have two appointments with our surgical team 1-2 weeks before your surgery date. Please be sure to allow enough time for them in your day: • A pre-surgery appointment with your surgical team. This appointment is to discuss your surgery and answer any questions you might have. This may be with a nurse practitioner (NP), physician associate (PA) or your surgeon. • A pre-admission testing (PAT) call or appointment. This call or appointment is to evaluate your fitness for surgery and anesthesia. You may also receive a call from our medical social worker a week or two before your scheduled surgery. They will ask you questions about your home and who will be able to help you during your recovery. Their goal is to help you make plans for the best recovery possible. Pre-surgery appointment Your pre-surgery appointment is very important to the success of your surgery. What to expect during this appointment: • We will ask you about your past and present medical history, including medications. • We will discuss potential risks based on your medical health and make recommendations on how to physically prepare before your surgery (for example, if you will need to change your diet). • You will have a physical exam. • You will meet the members of your health care team, who will work closely with your orthopedic surgeon. • We will instruct you on infection prevention techniques, and you will be instructed on how to bathe and eat/drink before your surgery. • If you’re having hip or knee surgery, we will help you obtain a front-wheeled walker for you to use at home. You will need this when you leave the hospital after surgery. This appointment is also a good time for you to ask questions you may have about your surgery, anesthesia, hospital stay and recovery. You may want to ask how long you will be in the hospital and what you can do to improve your recovery. It may be helpful to write down your questions and bring them with you to your appointment.
10 | CMH-OHSU Health Orthopedic Clinic Pre-admission testing (PAT) call or appointment Based on your medical health and current medical condition, this appointment may be completed by phone or in-person and usually takes about 30-60 minutes. During this appointment, you will speak with the pre-admission testing nurse to: • Review your medications, health history and current medical conditions. • Discuss potential risks based on your medical health and make recommendations on how to physically prepare before your surgery (for example, if you will need to change your diet). • Make recommendations on any medications that you take regularly. • Instruct you on infection prevention techniques. • Determine, based on your medical health and type of surgery, if you will need final blood work or any tests such as X-rays, an EKG or other diagnostics. • Assist or make any necessary arrangements for you prior to your surgery. My appointments before surgery Checklist to prepare for pre-surgical appointments: Bring this guide (including your completed forms) with you to all appointments. Pre-surgery appointment questions and notes: Pre-admission testing questions and notes:
Preparing for Total Joint Replacement | 11 Insurance and billing At the time of your pre-admission clinic appointment, your insurance information will have been obtained including: • A current copy of your insurance card • Accurate and current address • Accurate and current employment information, if it applies to your insurance eligibility Please bring your insurance card with you each time you come to the hospital for treatment. The prior authorization process is started at your surgeon’s office, but it is your responsibility to make sure that you receive pre-authorization before your surgery, or your insurance company may not pay for the services. Your insurance card should tell you if you need prior authorization; however, it is a good idea to review your benefit coverage and eligibility in your insurance booklet. CMH does not enter into disputes over your insurance coverage. Billing and payments CMH will bill your insurance for you. Your insurance may require a co-payment, which is the amount of money you will need to pay in addition to what your health insurance covers. This is usually listed on your insurance card. Your co-payment is due at the time you arrive at the hospital for treatment. We will accept the following forms of payment: cash, check, credit card or debit. An ATM is available for use in the CMH Health & Wellness Pavilion across the street from the East Lobby and in the Emergency Department lobby in the main hospital. Statements are sent out monthly for all accounts with balances due. You will receive a monthly statement even if your insurance has been billed and they have not yet paid. This is to keep you informed of the status of your account. Once your insurance has paid and it has been determined that the balance is your responsibility, you will see an amount due in the “Please pay this amount” section of your statement. If you are not able to pay the full amount due, please contact a payment representative at 503.338.7530 to make payment arrangements. CMH offers a financial assistance program for patients who meet eligibility requirements. Money questions? Call CMH Patient Financial Services at 503.338.7530.
12 | CMH-OHSU Health Orthopedic Clinic Improve your health before surgery Planning for your first few days at home can make coming home easier and more comfortable. The home safety tips on pages 19-20 provide helpful suggestions to prepare your home for your recovery after surgery. Strengthen yourself before surgery — start today! It is important to begin to exercise as soon as you know you are having surgery, if okayed by your surgeon. Performing these exercises will help strengthen your arms, thighs and hip muscles. Having stronger muscles will help you recover quicker after surgery. Start slowly, and if exercise causes pain, fatigue or shortness of breath, call your surgeon. Ask your surgeon for a referral to physical therapy if you feel like you need additional instruction and/or assistance. Cardiovascular conditioning Begin a cardiovascular conditioning program per your physician’s approval. Start slow and increase your time as your endurance and joints will allow. If your pain increases, slow down, decrease your time or stop the program. Work up to a 20-minute program. You should be able to carry on a conversation while exercising, but feel as though you are working fairly hard. • Swim: This would ideally be done in a warm pool. Swim laps, walk or perform general exercise in a pool. • Bike: If you are unable to use a pool, biking would be the next choice. If balance is challenging for you, use a stationary bike. Strength-building before hip or knee surgery Chair push ups Put your hands on the arms of a chair and push down in order to lift your body up. Repeat 10x, 2-3x per day as able. Long arc quads While sitting in a chair, slowly raise your foot until your knee is completely straight. Repeat 15x, 2-3x per day as able. Don’t forget to exercise both legs. Straight leg raises Lie down on your back with your good knee bent and foot flat on the ground. Lift the other leg up while keeping the knee straight. Raise your leg no higher than the height of the other leg’s knee. Repeat 15x, 2-3x per day as able for both legs.
Preparing for Total Joint Replacement | 13 Hip strengthening With one hand on a support and the other on your hip, lift your leg out to the side. Keep your knee straight. Hold for 1 second, then return to the ground. Repeat 10x, then turn around and repeat with the other leg. Sit to stand Find a sturdy chair that is high enough to get in and out of easily. Make sure that the chair will not move (place the chair against a wall). Make sure your feet are evenly spaced and that one foot is not in front of the other. Now, either cross your arms or place your hands on the front of your thighs, then slowly lower yourself into the chair. Try to maintain control and not flop into the chair. Keep your hands where they are and stand up from the chair. Repeat 10x. Calf raises Focus on a spot in front of you. With your knees and hips straight, rise up onto your toes and stay for 3 seconds. You may need to hold onto a bench or sturdy table to help you balance. Lower your heels to the ground. Repeat 10x. Hamstring strengthening Standing with your hands on a support, take your right leg out behind you with your knee straight. Keeping your leg behind you, bend your knee as far as you can. Hold for a second. Return your foot to the ground. Repeat 10x and again with your other leg. Ankle pumps Move your feet up, down and in circles. Strength-building before shoulder surgery When a shoulder needs surgery, range of motion is limited, and often pain is experienced with movement of that shoulder. In addition, overall function of your shoulder during activities is lessened. After surgery, there will a recovery phase to advance the movement and function of the shoulder. Prior to surgery, it is helpful to perform basic stretching and exercises to enhance recovery after surgery is complete. Below are some recommendations to assist in maintaining range of motion and strength prior to surgery. Remember, do the exercises slowly and complete without increasing your pain level.
14 | CMH-OHSU Health Orthopedic Clinic Pendulum These are exercises you will do following the surgery and will be helpful prior, as well. Let gravity move your arm. Lean forward and keep your arm straight, as indicated in the picture. Slowly move the weight of your arm. Once momentum starts, let that move your shoulder — try not to move where are engaging your muscles (this is to stretch and open the shoulder capsule). Complete small circles clockwise and counter clockwise; move the arm up and back and in and out, 3-4x in each direction, 3x a day. Shoulder blade The shoulder blades are very important to movement and stability of the shoulder. Maintaining movement in the shoulder blades is essential. While standing or sitting, with your arms at sides, slowly lift shoulders up to the ears and hold for 5 seconds, letting shoulders relax back down. Then, with your arms at your sides and elbows bent, slowly squeeze your shoulder blades together, hold for 5 seconds and relax. Complete each movement 5x, 3x a day. Wall climbs If you are having difficulty moving the arm up against gravity, the wall can help you move your arm away from the body and promote range of the shoulder. Facing the wall with your elbow slightly bent, slowly glide your hand up the wall to tolerated reach (above shoulder). Turn your body and reach out with the elbow slightly bent, gliding the hand to tolerated reach. At maximum range, hold the position for 10 seconds before you return to start. Both glided exercises you should complete 3-5x, 3x a day. Wall push ups Position yourself so the feet are away from wall and the upper body is leaning into the wall (elbows bent). Slowly push yourself away from the wall until the arms are straight. Do this 10x, 2x a day. Side/lateral raises Perform with both arms. Light hand weights, otherwise home items, such as cans of beans, paint cans, etc., can be used for resistance. With your arms at your side, slowly move them straight up to shoulder or ear level (depending on what is tolerated) and return to the start. Also try with arms at side, slowly bringing them up and out, away from the body to shoulder level and then back down. Complete 5-10x, 2x a day. Bent over row Lean on a counter and slightly flex forward. Your arm should be straight and forward slightly. Slowly squeeze the shoulder blade back while you bend
Preparing for Total Joint Replacement | 15 your elbow and pull up toward the ceiling (as if starting a lawn mower). Complete 5-10x, 2x a day. Lying lateral raise While laying on your stomach, rest your arm straight down and slowly lift it up (elbow straight). Complete 5-10x, 2x a day. Sidelying external rotation With your affected side up, bend the elbow and palm toward your stomach. Keeping the elbow glued to the side, slowly rotate the arm up and toward the ceiling 5-10x, 2x a day. You can sit to do these, as well.
16 | CMH-OHSU Health Orthopedic Clinic My plan for surgery A nurse will call you the afternoon before your surgery to confirm the time and place you should arrive at the hospital the day of your surgery. Date: Time: Entrance: My support team To ensure your safety, we cannot proceed with surgery unless: 1. You have a ride home in a private vehicle, and 2.Someone to stay with you for the first 24 hours after surgery. This safety measure is required by the U.S. Centers for Medicare and Medicaid Services. If you do not have someone who can care for you after surgery, please talk with the medical social worker. We can help you find alternative solutions. Friend or relative who will drive me to the hospital: Name: Phone: Friend or relative who will drive me home: Name: Phone:
Preparing for Total Joint Replacement | 17 COUNTDOWN TO SURGERY 1-2 weeks before surgery Make eating healthy easier We recommend that you prepare and freeze meals a few weeks before your surgery so you have easy, healthy meals for your recovery. It may also be helpful for you to stock up on individually packaged drinks or a water bottle to make carrying drinks easier after your surgery. Read more on page 34 about eating well before and after your surgery to help you recover. Make your home safe You may need to make some changes to your home as you recover. Make sure your home is clean and orderly before you have surgery, so cleaning won’t be necessary when you return. Remove tripping hazards Remove clutter and tripping hazards where you will be walking. Make sure your walker will fit through tight spaces and doorways. Tape down loose carpet edges that stick up. Remove throw rugs until you recover and are more stable. If you have pets that tend to be underfoot, maybe have a neighbor or friend babysit your pet(s) until you recover and are more stable on your feet. Take care of you Please ensure that you are being careful to not injure yourself prior to surgery. Any small injury, including scratches, rashes or infections on your body can pose a risk for you. Let the health care team know immediately if you have any skin issues or injuries.
18 | CMH-OHSU Health Orthopedic Clinic Create a clear pathway between the bedroom, kitchen, bathroom and living room Place your chair, remote control, radio, telephone, medicine, tissues, wastebasket and water pitcher/glass in the place where you will spend most of your time while you recover. Arrange your kitchen so you won’t have to bend below the waist, reach or lift. Furniture Arrange furniture so you will have space to move around easily. You may need to move furniture so you can have spaces wide enough for a walker. Put a chair with armrests in each room you intend to use after surgery. Avoid chairs that are lower than 24 inches; trying to stand up after sitting in a low chair is difficult. Store away any furniture with wheels. All furniture must be secure so it will not roll away from you (including your bed). You may want to move your bedroom to the main floor so you do not have to use stairs until you are ready. In the bathroom, for hip or knee surgery, consider the following: Install a handrail to help you on and off the toilet. Use a shower or bath chair with non-slip pads. Also, many people find it easier to sit on a shower bench and use a handheld showerhead. If your toilet seat is less than 20 inches high, or if you have trouble rising from your seat, you may need a raised toilet seat after surgery. If your bathroom is small and using a walker would be difficult, you may wish to consider a portable toilet chair (called a “commode”). Personal care ; Do not shave the area near your operative site within 2 weeks of surgery.
Preparing for Total Joint Replacement | 19 2 days before your surgery Arrange to have someone bring you to the hospital the day of your surgery. Ask a friend or family member to be available to bring you home from the hospital. Collect the items you would like to bring to the hospital for your stay. (Remember not to over-pack, since you will only be with us for a short time.) Please leave your valuable belongings at home. Put your front-wheeled walker with the items you’re bringing to the hospital. We will work with your insurance company to order one after your pre-operative appointment (1-2 weeks before surgery). 1 day before your surgery Pack your bags Bring with you Government-issued identification Insurance billing information Money for any insurance co-pay or deductible your insurance plan requires A short, wrap-around robe (one that opens completely in the front) Comfortable or loose clothing and slip-on walking shoes for the trip home Personal toiletries, if desired A copy of your Advance Directive or durable power of attorney (if you have one) Your home CPAP machine, if needed Front-wheeled walker (for hip and knee surgery) Leave at home ; Valuables such as jewelry, watches and clothing items ; Electronic devices such as laptops, tablets, e-readers and games ; Tobacco products ; Medications ; Contact lenses — they cannot be worn during surgery
20 | CMH-OHSU Health Orthopedic Clinic Personal care: The night before surgery Follow medication instructions as applicable. Remove nail polish. Nail polish can block the sensor that we will attach to your finger to measure your blood oxygen. Shower or bathe as instructed with the cleanser provided. Wash from your neck to your toes. Be careful not to wash your face, hair or genitals with the cleanser. Use a fresh, clean towel to dry your body. Dress in freshly washed clothes. Sleep in freshly washed bedding. ; Do not shave near your operative site. ; Do not use lotions, powders or creams. ; Do not eat or drink after midnight the night before your surgery, unless your surgeon gives you other instructions. This is important to avoid problems during your surgery. Day of surgery Personal care: The day of surgery ; Do not eat or drink. ; Brush your teeth, but do not swallow any liquid. Remove any body jewelry and contact lenses. Shower or bathe as instructed with the cleanser provided. Wash from your neck to your toes. Be careful not to wash your face, hair or genitals with the cleanser. Use a fresh, clean towel to dry your body. Dress warmly in freshly washed clothes. Staying warm before surgery decreases your risk of infection. Shave or trim facial hair as you normally would. ; Do not shave near your operative site.
Preparing for Total Joint Replacement | 21 Filling prescriptions The CMH Pharmacy can fill your pain medication prescriptions before you leave the hospital. If you choose to have your prescriptions filled by our pharmacy, a pharmacist will deliver them to your bedside and discuss any questions or concerns you may have.
22 | CMH-OHSU Health Orthopedic Clinic AT THE HOSPITAL Before surgery Checking in at the hospital • Arrive at the hospital at the time you were told during your confirmation call the day before. Your driver may park near the entrance to the hospital, unless otherwise directed. • Sit in the surgical waiting area. A registration clerk will call your name. Preparations for your surgery • After you have checked in, a caregiver will escort you to a room in Same Day Surgery. A nurse will take your blood pressure, temperature, heart rate, height and weight. • You will change into a hospital gown. We will store your personal clothing. • The nurse will start an IV in your arm, which is how you will receive medicine during your surgery. • You will meet your CRNA (nurse anesthetist), who will review your medical history with you and discuss his/her anesthesia recommendations. The recommendations may include general anesthesia, spinal nerve block/epidural or regional anesthesia, such as nerve blocks. • Once everything is clear for surgery, a team member will show your family members and/or friends where to wait, and you will be taken into surgery.
Preparing for Total Joint Replacement | 23 What to expect after surgery Monitoring your progress After your surgery, the nursing and surgery teams will closely monitor you. They will: • Check your breathing, heart rate, blood pressure and pain level. • Ask you to take deep breaths regularly using a special device to help keep your lungs clear. • Get you out of bed as soon as you safely can. Your physical/occupational therapist will develop a rehabilitation plan with you to get you moving, beginning on the day of surgery. Standing and walking safely will be one of your first goals after surgery. • You may have a catheter (a small tube inserted in your bladder that drains into a bag to collect urine), which will be removed at the surgeon’s direction. Caring for your incision Your care team will regularly check the bandage or dressing covering your incision and will change it when needed. Keep your dressings in place unless instructed by your care team. Managing your pain Usually oral (pill) or intravenous (IV) pain medications are used to relieve your postoperative pain. You might also have an epidural or nerve block catheter to help control pain. Your CRNA will discuss these options with you on the morning of your surgery. After surgery, your nurse will ask you to rate your pain on a scale of 0-10 (0 is no pain and 10 is the worst pain you can imagine) at regular intervals. It is important that you are comfortable enough to change position, cough, take deep breaths, sleep and get out of bed, as these activities are an essential part of your recovery. Oral pain medicines provide long-lasting pain control and fewer side effects such as nausea. The goal will be to get your pain controlled with pills early after surgery, since you will be discharged home with oral pain medicine. No Hurt Hurts Little Bit Hurts Little More Hurts Even More Hurts Whole Lot Hurts Worst www.wongbakerFACES.org ©1983 Wong-Baker FACES® Foundation. Used with permission. Wong-Baker FACES Pain Rating Scale ®
24 | CMH-OHSU Health Orthopedic Clinic You can anticipate some type of pain medications. There are many non-drug treatments that can be used to treat pain. These non-drug options may help in reducing the amount of pain medicine needed to relieve your pain. Some of those non-drug options include: • Relaxation exercises • Applying heat or cold to muscles • Music • Massage • Meditation • Aromatherapy • Elevating the limb • Distraction Please ask your nurse if these are available to you following surgery. The most important thing to remember is not to ignore pain. Pain is your brain’s way of telling you there is a problem. Pain that is relieved will help you heal faster both emotionally and physically. Preventing blood clots Surgery and not moving for long periods of time can increase your risk of developing a blood clot in your veins (deep vein thrombosis or DVT). Getting out of bed and walking greatly helps to reduce this risk. Your surgeon may also recommend using ice, elevation, calf pump exercises, tight stockings (TED hose) or compression sleeves (SCDs) on your legs to help control swelling and increase circulation after surgery. Medicines are also often used to help prevent blood clots. Depending on your surgery and your medical history, you may have additional risk factors for clots and may require taking an additional anticoagulation (blood-thinning) medicine. This can include aspirin, Coumadin (warfarin) or Lovenox, among others. Rehabilitation and recovery Physical and occupational therapists will develop a rehabilitation plan with you, directed toward your goals. Your initial physical therapy plan is typically focused on the activities you need to be able to do to return home, including: • Safely and independently moving in bed, getting in and out of chairs. • Walking, going up and down stairs and getting into and out of the car. • Using a walker or other assistive devices. An occupational therapist will show you how to safely and independently perform activities of daily living, such as using the bathroom, dressing and cooking. Your occupational therapist will also show you how to use various long-handled devices, such as: • A reacher to help you dress and pick things up from the floor. • A sock-aid for putting on socks. • A long-handled sponge to wash your legs and feet. • A leg-lifting device to move the operated leg in and out of the car or bed. • An elevated toilet seat to limit bending when using the bathroom.
Preparing for Total Joint Replacement | 25 • An elevated bathtub chair to fit in the shower or tub. It’s a good idea to have your “coach” join you at one of your early physical and occupational therapy sessions so they can learn more about how they can best help you at home. Strength-building exercises It’s a good idea to be familiar with these exercises prior to surgery. Ankle pumps 1. While lying down or sitting, point your toes as far as you can. 2. Next, flex your foot up as far as you can. 3. Repeat 10x or as many times as you can tolerate. Quad sets 1. While lying down, stretch one leg out straight. 2. Squeeze the muscles on the top of your leg (your thigh muscles). 3. Concentrate on pushing your knee down into the surface you’re lying on. 4. Hold for 5-10 seconds. 5. Repeat 10x or as many times as you can tolerate. Heel slides 1. Only perform this exercise in a pain-free range. 2. While lying down, bend one knee gradually while gently dragging your heel toward your buttocks. 3. Repeat with the other leg if desired. 4. Repeat 10x or as many times as you can tolerate. Watch for infection Check your incision daily, and call the doctor if: There is an increase in redness or swelling. The edges of the wound begin to separate. There is any change in the color of the drainage from your wound (for example, yellow, green or foul-smelling drainage). You have an increase in tenderness around your incision. There is any red streaking. You have an oral temperature greater than 101 degrees Fahrenheit.
26 | CMH-OHSU Health Orthopedic Clinic Glute sets 1. While lying down, stretch your legs out straight and squeeze your buttock muscles. 2.Hold for 5-10 seconds. 3.Repeat 10x or as many times as you can tolerate. When can I travel after surgery? You may travel 4-6 weeks after your surgery.
Preparing for Total Joint Replacement | 27 RECOVERING FROM SURGERY Leaving the hospital Most people who have had joint surgery are ready to go home one day after surgery, and some will leave the day of surgery. You will be cleared for discharge by the surgeon when: • Your pain is well-controlled, • Your medical condition is stable, and • You are able to stand and walk safely (including stairs, if necessary). • Some numbness is expected and okay. We encourage your “coach” to be part of your discharge from the hospital and at your early physical and occupational therapy appointments. It’s important for them to understand how best to help and support you when you are home and may need assistance. Recovering at a rehabilitation center This is uncommon, but if you and your surgeon have discussed going to a rehabilitation center to help you manage with your new joint, those arrangements will be made by our care manager, working with your insurance provider, and will be discussed with you and your family.
28 | CMH-OHSU Health Orthopedic Clinic Recovering at home Caring for the area around your surgery (the “incision”) • Keep your incision clean and dry. If it gets wet, pat it dry; do not rub. • You may shower when there is no drainage from your incision. • Leave your bandage intact until your post-operative appointment. Call the clinic if you notice drainage. • If you have steri-strips (white strips across your incision), leave them in place. They will fall off on their own. ; Do not put any creams or ointments on your incision. ; Do not wear tight clothing that rubs on your incision. ; Do not take tub baths. Do not soak the incision in water — this includes swimming or using hot tubs. Prevent blood clots Blood clots are more likely after having surgery. Signs of a blood clot include: Pain in extremity (commonly in the calf), at rest, with exercise or when compressed. Weakness, numbness, burning, tingling sensation, swelling or loss of sensation. Noticeable cooling, increased warmth or changing color of extremity. Chest pain or shortness of breath. Swelling. After your surgery: • When sitting, prop up the arm or leg that was operated on. • Use a pillow between your legs when lying on your side. • Do ankle pumps. • Do not sit longer than 30 minutes without changing positions. ; Avoid long car rides. If necessary, get out and walk a few minutes for every 30-45 minutes in the car. ; Do not sit with your legs or ankles crossed. ; Do not wear constrictive stockings (e.g. knee-highs, ankle socks) or tight-fitting clothes. Wear surgical stockings when provided (TED hose).
Preparing for Total Joint Replacement | 29 Healing your joint Outpatient physical therapy Your surgeon may recommend going to outpatient physical therapy. This could occur directly after you leave the hospital, or a decision may be made at your follow-up visit about how to proceed. Outpatient therapy is an important part of your recovery process to ensure the best possible recovery. Activity after surgery Your surgeon and health care team may recommend someone come to your home to assist you for a few visits. It’s important that you continue to follow the range-of-motion and weight-bearing limitations given to you during your hospital stay. You should gradually increase your activity daily by following your physical therapist’s activity and exercise program, as well as any restrictions. Keep these things in mind: • Walking is always recommended; small walks several times a day are ideal. • Perform the strength-building exercises 3x a day. • Plan for rest periods. • Ice and elevation help reduce pain and swelling to your affected joint. ; Do not drive until your doctor says it’s okay. You may cause damage to the joint that you had surgery on, and pain medications may affect your ability to drive safely. Hip replacement precautions After hip replacement surgery, you will have specific precautions to follow while you heal. General precautions: • Keep your knees and toes pointed forward, and do not allow your operative leg to move across the midline of your body (i.e. don’t cross your legs). ; Do not bend forward more than 90 degrees at the hip. ; Do not turn your foot inward. When sleeping: • Sleep on your back with a pillow between your knees and your toes pointed out. • When sleeping on your non-operative side, put two or more pillows between your legs to keep your operative leg above the midline of your body. • You may sleep on your operative side when it’s no longer painful. When sitting: • Use a straight-backed chair with arms. The seat high should be 2 inches above your knees. Use pillows or cushions to raise the height of the seat.
30 | CMH-OHSU Health Orthopedic Clinic • Keep both feet flat on the floor. • Avoid sitting on low surfaces, such as church pews, restaurant booths, soft chairs and couches. ; Do not bend forward at the hip more than 90 degrees. This may require you to raise the level of your bed, chair or toilet seat. ; Do not sit for long periods of time. ; Do not cross your legs or ankles. When standing up: • Scoot to the edge of the bed or chair before trying to rise. • Place your operated leg in front of you, push yourself up to standing with your arms. • Use your walker and grab bars to help. (Use accessible toilets in public restrooms.) Caring for yourself: • Use a dressing stick to put underwear and pants over the operative leg first. • Keep knees apart while sitting on the toilet. Wipe without twisting. ; Do not bend forward to reach for objects or lift your operated leg to reach your feet. Sexual activity: • It is generally safe to resume sexual intercourse 4-6 weeks after surgery, but be sure to keep your hip joint and leg in proper alignment. • Avoid movement that bends the hip joint past 90 degrees and/or in or out from its normal position. • Both men and women tend to find being on the bottom most comfortable after hip surgery. Other acceptable positions include being on top, lying on your side with the operated leg on top, and standing. Knee replacement precautions After knee replacement surgery, you will have specific precautions to follow while you heal. General precautions: • Walking is one of the better kinds of physical therapy and is good for muscle strengthening. However, walking does not replace the exercise program you were taught; continue to do your physical therapy exercises. • You are encouraged to bend your knee throughout your recovery. • If you have a brace or splint, wear it as directed by your doctor, nurse and/or physical therapist. • Bear weight and walk on your leg as much as is comfortable. • You may use ice for pain and swelling. Do not use ice for longer than 15-20 minutes per hour.
Preparing for Total Joint Replacement | 31 When sleeping: • When lying on your back, do not put a pillow under your knee. This may cause you to develop stiffness in your hip and knee, making it difficult to straighten your leg. • When lying on your side, you may find it more comfortable to place a pillow between your legs. When sitting: • Sitting may be easier on a chair that allows your hips to be higher than your knees. • Sit with your operated leg elevated. When standing up: • Scoot to the edge of the bed or chair before trying to rise. • Place your operated leg in front of you, push yourself up to standing with your arms. • Use your walker and grab bars to help. (Use accessible toilets in public restrooms.) Caring for yourself: • Get dressed while sitting with the thigh of your operated side supported. • You are encouraged to dress without any dressing aids to promote knee bending. If necessary, use a dressing stick, sock reacher and/or shoe horn. Sexual activity: • It is generally safe to resume sexual intercourse 4-6 weeks after surgery, but avoid kneeling in the early stages of recovery. • Use pillows to pad or support your knee as needed. • Many couples find sidelying positions to be comfortable. Shoulder replacement precautions • Your arm will be in a sling when you leave the hospital. Wear it as directed by your doctor, nurse and/or physical therapist. • Continue to do the range of motion exercises you were taught to increase your mobility and endurance. A formal physical therapy program may also be recommended to strengthen your shoulder and improve flexibility. • You should be able to care for yourself within a few weeks after surgery. • Avoid moving your arm in strenuous ways for the first 6 weeks, such as behind your body or straight out to the side. ; Don’t lift anything heavier than 5 lbs. for the first 6 weeks after surgery. ; Don’t push yourself up out of a chair or bed, and don’t do repetitive heavy lifting.
32 | CMH-OHSU Health Orthopedic Clinic Make healthy choices for better healing Eat nutritious foods A well-balanced diet is especially important before and after you have surgery to help you heal. You should also aim to drink 8-10 glasses of water daily. Talk to your doctor if you are on a special diet. Protein: Protein is important for tissue and wound healing. One serving of protein is 3 oz., which is the size of a deck of cards. Good sources of protein include: • Meat (beef, chicken, turkey, pork) • Fish • Eggs (the whites of the eggs contain most of the protein) • Dairy products (cheese, milk, yogurt) • Vegetarian sources (legumes, nuts, tofu) Carbohydrates: Carbohydrates are your body’s preferred source of energy. There are 2 forms of carbohydrates: simple (honey, sugar, juice) and complex (bread, fruits, grains, vegetables). Whole grains are best for you. For example, choose whole wheat bread over white. Fat: Although it’s best to consume fats in moderation, your body does need a certain amount of fat to function. Essential fatty acids store energy and protect your body’s organs. There are two types of fats: saturated and unsaturated. Unsaturated fats tend to be liquid at room temperature and are healthier. Avoid alcohol and tobacco Avoid alcohol until you are no longer taking your pain medication. Avoid smoking. Tobacco/nicotine use of any kind increases the risk of major problems after surgery, such as infections or blood clots. Nicotine replacement therapy is available. We can send a referral for CMH Tobacco Cessation services to help you quit before your surgery. Keep your bowels moving Constipation can be an uncomfortable side-effect of surgery. Both pain medication and decreased activity levels can slow your digestion and lead to constipation. To avoid this, eat a high fiber diet and drink more water. Foods with high fiber include whole grains, fruits, beans and vegetables. You should not go too long without a bowel movement after surgery. You can get over-the-counter stool softeners (docusate sodium). If you have tried these
Preparing for Total Joint Replacement | 33 and are still unable to have a bowel movement, call your doctor or the Orthopedic Clinic. Managing your pain Pain medication: Your doctor will give you a prescription for pain medicine when you are ready to go home from the hospital. You will receive instructions to gradually reduce the amount of pain medication you take at your first follow-up appointment. DO NOT TAKE NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) IF YOU ARE ON A BLOOD THINNER (e.g. ibuprofen, aspirin). Cold therapy: Ice can help reduce swelling and pain during your recovery. We recommend that you purchase reusable “Blue Ice” cold packs or large packs of frozen vegetables in plastic bags (peas or corn work). These form to the body well and can be refrozen and reused many times. Conclusion Our health care team thanks you for partnering with us to provide you with surgical options to help you reach your health care goals. We look forward to being a part of your recovery.
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