Total Joint PREP Class

Knee Replacement
T. Andrew Israel, MD
Luther Midelfort Orthopaedic &
Sports Medicine Center

Goals for you and your family

attending this class
Recognize knee replacement is a
reliable operation to relieve pain and
restore function.
Describe what to expect of the knee
replacement procedure.
Discuss the risks of knee replacement
surgery.

Goals of your knee

replacement
Improve your quality of life
Relieve your pain
Restore function (knee movement,
alignment)
Increase activity

Knee Arthritis
Loss of
cartilage leads
to narrowing
of the joint
space.
See the bone
spur
formation?

Knee Arthritis
As the
cartilage
wears, bone
spurs develop
which can
cause
stiffness

Surgical Technique
-Resurface the bony
surfaces with metal
and plastic
-Balance the
ligaments
-Restore alignment
and motion
(straighten the leg)

Implant materials
Metal and plastic are used

The metal is usually a cobalt-chrome

alloy.

The plastic is UHMWPE or poly.

Implants
-The end of the femur
is capped with a metal
component.
-The end of the tibia
may have a metal
plate or plastic.
-A plastic spacer goes
between the metal cap
and plate.

Implants
If the back of the
kneecap is worn, it is
resurfaced with a
plastic button

Surgical Technique
Incision

Made in front of the knee, usually from above the

kneecap down to bump on shin bone

Length of the incision depends on the thickness of

soft tissue

Surgeon will make the incision long enough to see

the area around the knee

Surgical techniques continue to improve as

technology advances

Surgeon will use techniques to spare muscle

Day of Surgery

Your surgeon will meet you in SurgiCenter to

initial your knee and answer final questions.
Family can wait with you in the SurgiCenter.
You will go to the Operating Room (OR) first,
then to Recovery (PACU).
Surgery lasts 1-2 hours, recovery 1-2 hours.

Finally, you will go to the Med-Surg Unit 4500.

Post-op
Therapy

Physical & Occupational Therapy is important for a

good outcome.
Your participation will improve your result
You may have a machine that bends the knee
called a CPM.
Therapy starts the day after surgery
Get you out of bed
Bend the knee!
Straighten the knee!
Walk with a walker

Other Doctors

Additional Doctors take care of nonorthopedic issues (such as high blood

pressure or diabetes).
If you have an Internal Medicine doctor here
they will see you after surgery.
If your regular doctor does not see patients in
the hospital, a Hospitalist will see you after
surgery.
If you are not getting a medication you think
you should, please ask.

Blood Clot Prevention

You are at risk of a blood clot after knee

surgery.
You will receive medication (warfarin or
aspirin) after surgery to prevent blood clots.
TED hose should be worn for 3 weeks after
surgery, you may remove these at night.
SCD (calf squeezers) are used when you are
in the hospital and should be worn whenever
you are in bed.

Risks of Surgery
Blood Clots

High risk (>20%) if no treatment

Clots can go to the lungs and be fatal

Your risk is reduced to <1% if treated with

medication, squeezers

Getting out of bed and walking helps to

prevent blood clots

Risks of Surgery
Infection

You will get antibiotics at the time of surgery

and for 24 hours after surgery.
Surgeons, assistants and scrub techs wear
spacesuits.
Using all precautions, risk of infection is ~1%.
Infection may occur months or years after
surgery.
An infection may mean removal of your
implants.

Risks of Surgery
Blood loss

Tourniquets are used during surgery.

There may be some bleeding into the knee
after surgery.
Your surgeon may use a drain in the knee
and give you some blood back.
Your blood count will be checked each
morning after surgery.
If you have symptoms from a low blood count,
you may need a blood transfusion.

Risks of Surgery - Stiffness

It is painful to move the knee after surgery

and some people get stiff.
You need to work hard to prevent stiffness.
Work on both getting the knee straight (0
degrees) and bending the knee (90 degrees.)
Goal is more than 90 degrees flexion by the
first week
If you have limited motion at 6 weeks, your
surgeon may need to perform treatment
under anesthesia.

Risks of Surgery
Need for Revision

We encourage patients to wait as long as

possible before knee replacement.
Implants wear with time
~90% of implants last 12 years
Revision surgery may involve changing the
plastic or changing one or both metal parts.
Revision surgery is more challenging with a
more difficult recovery.

Risks of Surgery
Medical Complications

Surgery is a stress to your body.

Heart and lung problems, stroke, stomach

problems, constipation all may occur.

A physical with your regular doctor and an

EKG are required before surgery.

Despite precautions, unforeseen medical

complications may still occur.

Risks of Surgery
Anesthetic Complications

You will meet the Anesthesia providers the

day of surgery.

They will discuss anesthetic options such as;

general, spinal, epidural, nerve blocks.

Nausea and vomiting are common but more

serious side effects or complications may
occur.

Please tell the anesthesia provider of any

past experience with anesthesia.

Summary

Knee replacement is a reliable operation to

relieve pain and restore function.

As with any operation, there are associated

risks.

All of the precautions we take are to minimize

risk and provide for a routine operation.

The purpose of this talk is to provide you with

information about knee replacement.

Questions or Concerns?

Joint PREP Class

Patient Resource and Education Program

Goals for you and your family

Discuss steps to take to get ready for the

surgical procedure.
Discuss what to expect of the surgical
experience.
Identify what you need to do to achieve the
best outcome.
Recognize why it is important for you to
participate in your plan of care.

Plan Ahead

Finish any planned dental work at least 2 weeks

before your surgery date.
Plan for your return home.
Identify who will take care of you after surgery.
Plan for about 2 weeks.
Simplify meals. Plan for 2 weeks of easy or no
preparation meals.
Prepare your home now- take notes today
and get started!

Plan Ahead
Appointments:

Regular doctor for pre-surgery;

Blood work, EKG, Physical exam, discuss medications.
Surgeon for final discussion and update.

Stop smoking talk to your regular doctor to

get help.
Call your surgeon if you get a fever, cold,
infection or rash before your surgery date.

What to bring to the hospital

Loose comfortable clothing

Comfortable nonskid walking shoes
Personal items
Copy of your advanced directives
Insurance cards
Medication list, inhalers, C-PAP mask
Any assistive devices you have
Prepaid long distance calling card (optional)
Your Total Joint Replacement information folder

What not to bring to the hospital

Valuables/Jewelry
Credit cards, check book or large sums of

money
Your medications (except inhalers)

The day before surgery

A SurgiCenter nurse will call you to:

Review your medications

Tell you what medications to take and not take the
day of surgery
Update your health history and review allergies
Review eating, drinking and smoking restrictions
Give hygiene instructions
Tell you what time to arrive at Luther Hospital

Day of surgery
Take medications
at home as
instructed.
Check in at
Luther Hospital
Registration
Desk.

Day of Surgery

(continued)

You will be taken to the SurgiCenter

You will be asked your name and date

of birth by everyone who has contact

with you this is done for your safety.
Family and Friends are welcome. Try
to limit to 2 people on day of surgery.

SurgiCenter
Nursing admission in the SurgiCenter- We will ask

you many questions and discuss your:

Medical history
Plan of care
Rights and
Responsibilities
Safety

Anesthesia visit
Surgeon visit

SurgiCenter (continued)
If ordered for your surgery: blood work, x-

rays, clip hair at the surgery site.

Your personal items are stored and later

taken to your hospital room.

Leg squeezers (SCDs Sequential

Compression Devices) and TED hose are

applied.

Leg Squeezers SCDs

Going to the Operating Room

Operating Room (OR)

Monitors
Antibiotics
Anesthesia
Surgical scrub
Foley catheter
Time in operating
room area
OR Staff will
communicate to
your family if the
surgery is 2-3 hours

Recovery Room/Post Anesthesia

Care Unit (PACU)
You will be in recovery

for about 1 hour.

You will have Monitors
and Oxygen on
Your nausea and pain
are monitored and
controlled
When you are ready, you
will be transferred to a
hospital room.

Arrival in your Hospital Room

You will have
Oxygen to help breathing and healing
A foley catheter to measure urine output
An IV to give you fluids and medication
Incentive spirometer to encourage you to
take deep breaths to prevent congestion in
your lungs.
A pulse oximeter a device that fits on your
finger to measure blood oxygen level

Pulse Oximeter

Arrival in your Hospital Room

(continued)
We will check on you,

take your vital signs

Start your Nutrition
Activity as you tolerate
Work together with you
to keep you safe.
Help you with control of
pain and nausea

Pain Management

After Knee Surgery

We will care for your skin and incision
You may have a drain in your knee

incision area
You may have a Cryo Cuff or ice pack
on your knee
You will have a continuous passive
motion (CPM) machine

Continuous Passive Motion

Machine (CPM)

Post operative day ONE

Blood work
Medication

Pain control *Anticoagulation Warfarin

Catheter and drain removed.

Nutrition as you tolerate
Activity-Physical Therapy and Occupational

Therapy
Work together to keep you safe.

You are a Partner in your care!

Post operative day TWO plan

The person who will be taking care of you after you go

home needs to come to the hospital to learn about:

Safety
Incision care
Activity Physical and
Occupational Therapy
Medication for pain control
and anticoagulation

Day THREE/Discharge day.

Prepare for discharge to home or transitional care

unit.
The person who will be taking care of you after you
go home needs to come to the hospital again to
learn about and get discharge instructions for:

Incision care
TEDS and how to keep swelling down
How to take pain medications correctly
Anticoagulation Warfarin and blood work
Antibiotic coverage card
When to contact your Surgeon

You are a Partner in your care!

Elevation of your leg

Elevate knee

above hip
and toe above

knee
to decrease
swelling and
pain

After Discharge
A person to care for you will need to be

available 24 hours a day to:

assist you at home the first two weeks

drive you to appointments
encourage you in your therapy and progress

Bathing
You may shower when your incision is dry (no

drainage)
Place a new dressing on the incision after
shower
Do not submerge the incision in a bathtub,
pool, hot tub, etc, until the incision is
completely healed

Driving
Talk with your surgeon about when you

will be allowed to drive again.

You must be:

off narcotic pain medicines to drive

able to sit in car comfortably
able to move foot from gas to brake pedal easily

You need a valid drivers license!

Practice in a safe area.

A Follow-Up Appointment with your surgeon

will be made 10-14 days after surgery

At your appointment we will:

Remove your staples
Give you care instructions about your:

Incision
Bathing
TEDS
Assistive devices
Medications warfarin and pain control
Joint replacement - dental procedures and antibiotics

Questions or Concerns?

Start getting ready for surgery.

Make your plans.
Watch the Total Joint Replacement Video at
www.luthermidelfort.org
Click on Medical Services,
then Orthopedics Center
Thank you!

Joint PREP
Physical Therapy
Total Knee Replacement

Home Preparation
Become familiar with
exercise handout

If you have a walker,

practice using it and make

sure you can get through
your house with it.

Physical Therapy
Your therapy will start the day after
your surgery

Activities include getting into a

chair, walking and working on the
exercises

Therapy will continue twice daily

until goals are met or you are
discharged from hospital

Therapy Goals
1. Independence with
mobility
Includes in/out of bed,
getting out of a chair,
walking and stairs

2. Independence with
an
exercise program to
continue at home

Therapy Goals Contd

3. Learn appropriate use of walking
devices such as walker/crutches
Can bring your own to hospital to make
sure its sized correctly and get familiar
with its use

Goals Continued
4. Your family member or friend

should be available on the 2nd or 3rd

day after your surgery to become
familiar with the exercises and any
assistance that you will need at
home.

Gaining full knee

Range
of
Motion

extension
(straightening)
Is

KEY!

Range of Motion contd

Goal is 90 degrees
of flexion (bending)
by the
end of the
hospital stay

Range of Motion
CPM
(continuous passive
motion)
You will use this machine
while in the hospital

Exercise after Discharge

WALK!
Continue with exercises from
hospital

Outpatient PT if ordered by your

surgeon

Questions or Concerns?

Rehabilitation Services

Joint PREP
Occupational Therapy

Why Occupational Therapy?

Your occupational
therapist (OT) is
trained in the field
of rehabilitation
and is concerned
about your safety
in performing
activities of daily
living

Activities of Daily Living

Your OT will show and teach you ways to
safely do your daily tasks

-Dressing
-Bathing
-Toileting

Your goals for OT include:

-Increased Independence
-Increased Strength
-Increased Mobility

Adaptive Equipment
Your OT will help you order/purchase

adaptive equipment if it is needed to assist

you with dressing and bathing

-Reacher
-Sock aid
-Long-handled shoe horn
-Dressing stick
-Elastic shoelaces
-Long-handled bath sponge
-Tub/shower chair or transfer bench
-Raised toilet seat

Before surgery

Prepare your home with safety in

mind
-Remove throw rugs and clutter
from traffic paths
-Rearrange your kitchen so you can
easily reach often-used items
-Install grab bars in bathrooms

In the hospital

Occupational therapy will begin the

day after your surgery

You will be seen by your OT once a

day

Day One

Your OT may
-Learn about your home set-up and
help available to you at home
-Begin home safety instruction
-Discuss home equipment needs
-Instruct you in an upper body
exercise program

Day Two

Your OT may
-Practice with adaptive dressing

equipment
-Order dressing/bathing equipment
as desired
-Review upper body exercise
program

Day Three

Your OT may
-Work with you on safety with room
maneuvering
-Help you practice getting in and
out of a tub with the use of a tub
bench or chair
-Encourage you to participate in a
bathing/dressing session to
determine the level of assistance
you may need

When you leave the hospital

Keep SAFETY in mind!

Stay ACTIVE and INDEPENDENT!

Questions or Concerns?

Thank You!

Joint PREP

Social Services and Case

Management

Department Role
Social Services and Case

Management staff can assist with:

-Insurance concerns
-Home Health Services
-Skilled Nursing Care
-Community Services and referrals
-Power of Attorney for Health Care
-Counseling and Advocacy

Insurance Assistance

Once you and your Doctor decide

you will proceed with surgery you

should :
-Pre-register at the front counter
-Notify your insurance company
-Get your insurance companys
approval.

Insurance Verification continued

Insurance plans vary in what is

required to authorize your surgery.

Our insurance notification may not be

enough. Some plans require you to call

too.

Many Medicare Advantage plans

require prior authorization.

Your insurance company may take 1530 days to complete this process.

During your stay

Doctor decides when you are ready

for discharge to the next level of
care.

The next level of care might be:

home with or without Home Care
Nursing home
Rehabilitation Hospital
Transitional Care Unit/Swing Beds

During your stay

The usual hospital stay is 3 nights

and 4 days.

Talk with your Case Manager about

services you want after discharge as

soon as possible.

Check your insurance to see if it

limits who you can use.

Options for continuing care once you

can leave the hospital

1. Transitional Care Units or Swing

Beds

2.
3.
4.

Skilled Nursing Facilities

Home Care options
Home with outpatient services.

Transitional Care Units

Bloomer, Barron and Osseo

Transitional Care Units are owned by

Luther Midelfort .

Other Transitional Care units include

Durand, Stanley, Spooner, Hayward,
and Medford to name a few.

Medicare pays for your transitional

care stay like it would if you went to a

nursing home.

Continuing Care Discharge Options

Transitional Care Units (also referred

to as Swing Beds) provide continued

skilled nursing and rehabilitation
care after your hospital stay.

Can provide closer medical

monitoring and more intensive

rehabilitations therapies than regular
nursing homes.

Nursing Homes (skilled nursing

facilities)

Area nursing homes offer a range of

services from short term rehabilitation

stays to long term medical and residential
care.

Eau Claire area skilled nursing facilities

include:

Clairemont
Dove
Oakwood Villa
Syverson

Other nursing homes include but not

limited to:

Chippewa Manor-Chippewa Falls

Wissota Health and Regional Vent Unit-Chippewa Falls
Cornell Care Center- Cornell
American Lutheran Home-Mondovi/Menomonie
Hetzel Care Center-Bloomer
Dunn County Health Care Center
Colfax Area Nursing home-Colfax
Dallas Health Care-Dallas
Pepin Manor-Pepin
Spring Valley Nursing Home- Spring Valley

Medicare Skilled coverage

Medicare requires the following to

pay for your nursing home or

transitional care stay:
1.You have a skilled nursing or
rehab need (PT/OT)
2. You participate in therapies and
show progress.
3. That you have a qualified 3 day
stay at a hospital.

Home Care options

Medicare will pay for home care services:
-if you are homebound
-if you have skilled nursing needs.
-if you have skilled therapy needs.

Medicare does not pay for:

Help with meals, grocery shopping, etc.
Shopping
Personal Care (bathing, dressing, etc.)
Housekeeping services

What are Advance Directives?

Written documents that tell your Doctor
what you want for care when you are
unable to speak for yourself.

Allow you to describe the type of medical

treatment you would like to receive or not
receive.

Allow you to identify the person you wish

to be your decision maker if you are
unable to make your own decisions.

How do you get an Advance Directive?

Luther Hospital Social Services

Luther Hospital Chaplaincy
Your personal attorney

2 types of Advance Directives

Declaration to Physicians or Living

Will

The Power of Attorney for Health

Care

Power of Attorney for Healthcare

With this document, you appoint a family member
or friend to follow you wishes and act as your
health care agent.

Your Health Care agent will make decisions for

you only when you are unable to make your own.

This document is recommended because it is

much more flexible that the Living Will and gives

health care providers a person to discuss your
wishes with.

This document also lists what you want in

different situations when you are unable to speak

for yourself.

Safekeeping of Advance Directives

You should always keep the original document.

Copies can be given to family members.
A copy can be brought to your doctors office or
to the hospital to be kept in your medical record.

It is important that you discuss your wishes with

family and friends close to your.

Decision making becomes easier when these

discussions have taken place and your wishes

are clear.

Questions or Concerns?