Brett Young, M.D., Joe Mccormick, M.D., Chris Prato, M.D., Daniel Metz, M.D

Brett Young, M.D., Joe McCormick, M.D., Chris Prato, M.D., Daniel Metz, M.D.

1531 S. Madison Street, Appleton, WI 54915

(920) 996-3700

Total Knee Replacement Surgery Packet

I.Instructions for Total Joint Replacement

II.Packing List

III.Preparing Your Home

IV.Equipment Needs Following Total Knee Replacement

V.Herbal Supplements and Orthopaedic Surgery

VI.Managing Pain Prior to Orthopaedic Surgery

VII.Autologous Blood Donation

VIII.Iron Supplements

IX.General Anesthesia

X.Regional Anesthesia

XI.Total Joint Replacement and Dental Procedures

XII.Classes to Prepare for Total Joint Replacement

XIII.Total Joint Replacement Questionnaire

XIV.Physical Therapy Following Total Knee Replacement

Instructions for Total Joint Replacement

Your doctor has recommended that you have the following procedure:

______.

You will be scheduled for admission to St. Elizabeth’s Hospital on the following date:

______.

Things to do before surgery:

1. You should have an appointment in Anesthesia prior to your surgery date. You will be notified of the time and date. Please call xxx-xxxx if you have any anesthesia questions.

2. If you are already taking routine medications for your health care, the practitioners from Anesthesia will decide how/when you should take the medications prior to surgery.

3. One week prior to surgery, please stop taking any anti-inflammatory medications and avoid using aspirin. These medications may interfere with your blood counts and prevent you from having surgery on the scheduled date.

4. If your health insurance company requires a co-payment, please make necessary arrangements as soon as possible before surgery.

5. Please shower the evening and morning before coming to St. Elizabeth’s for your surgery. This will help to prevent infection. Use an antibacterial soap such as Dial™ or Lever 2000™.

Packing List

It would be helpful if you brought a list of medications you are taking including time schedule and dosage. If you bring your medications, please let your nurse know you have them.

Please leave valuables and all jewelry at home.

Television is available for each patient in every room.

At the hospital, you will be working with the physical therapist outside your room. They would like you to feel comfortable and potentially wear your own clothes. Previous patients have told us that the most comfortable clothes for working with physical therapy are:

1. Short bathrobe

2. Boxer shorts and T-shirt; satin or other slinky material helps

3. Good support shoes

4. Sweat pants

5. Loose-fitting leisure clothes

6. Crutches or a walker labeled with your name

You may also want to bring: your own pajamas or nightgown, underwear, toiletries, a comfortable pillow, reading books, battery-operated radio/CD player with headset, other handiwork.

Preparing Your Home Before Knee Replacement Surgery

There are certain things you’ll want to do to prepare your home before your joint replacement surgery. This will make it easier for you once you return home post-operatively.

Bathroom

If you use a tub shower with a door, you may need to have the door removed. You may need a raised or adjustable tub bench for use in the tub. You might consider a plastic lawn chair for an inexpensive option. If you are 5’3” or taller, you may be more comfortable using an elevated toilet seat. Grab bars are an optional item.

Bedroom

Place your bedroom on the first level if possible. Raise your bed to increase height if the bed is too low to the floor or creates too much bend in your knee (for example, placing blocks or books under the legs). Place your bed so that transfers can be made in and out with ease. Rearrange items in your drawers and closets to higher levels. You will not be able bend down low right after knee replacement surgery.

Kitchen

You may want to freeze some meals ahead of time or purchase microwave food that can be easily prepared when you get home. Place your most frequently used pots and pans to a higher level to prevent you from excess stooping.

Around The House

Remove throw rugs to prevent tripping. Be especially careful if you have cats and dogs, since they tend to be “underfoot.” You will need a chair with arms (similar to a captain’s chair) or an elevated recliner. A low chair or sofa may be difficult to get in and out of, so use firm steady furniture.

Equipment

The Hospital does not provide equipment to take home. Please call your insurance company to find out what vendor to use. You may also choose to borrow items from a friend. See the equipment list on the next page of this packet. Please label your equipment when you bring them to the hospital. If you live any distance from Appleton, bring your crutches or walker so you have it available during the ride home.

Equipment Needs Following Total Knee Replacement Surgery

Before returning home, your physical therapist at St. Elizabeth’s will likely recommend the following equipment to help with your safety and independence at home.

1. Crutches or a walker

2. Raised toilet seat (if you are at least 5’3” or if you’re having both knees replaced at the same time)

3. Hand held shower (optional)

Affinity Orthopaedics and Sports Medicine does not provide this equipment for you. You will be responsible for obtaining and/or arranging for delivery of these items. Your insurance company may have someone that they prefer you to use to obtain this equipment (called a vendor). Be sure to check with your insurance company before ordering. Listed below are a few vendors in the FoxValley area who may be able to assist you in supplying the needed equipment.

Westhill RehabWIVA-Affinity PlusWalgreen’s #02921

920 Westhill Blvd2725 Jackson St1901 S Oneida St

Appleton, WI 54914Oshkosh, WI 54901Appleton, WI 54911

(920) 749-3777(920) 303-3475(920) 739-7321

WIVA-Affinity PlusWalgreen’s #05102Walgreen’s #02922

3000 C Enterprise Dr700 W College Ave102 E Northland

Appleton, WI 54911Appleton, WI 54914Grand Chute, WI 54911

(920) 832-8836(920) 733-6599(920) 954-8100

Area drug stores such as Shopko, Wal-Mart, and Osco Drug are places that may also have these items at a good price.

Herbal Supplements and Orthopaedic Surgery

Many people take vitamins and herbal supplements either once in a while, or all of the time. These “herbs” are very popular, and many media outlets such as television or Internet or magazines describe them as being totally “natural and safe.” However, research has shown that some of these herbs can cause abnormal blood pressure, heart rates, bleeding, or over-sleepiness. “Herbs” can also interfere with medicines that your health care provider gives you. The effects of herbal treatments could cause problems if you are having surgery and anesthesia.

It is very important that you tell all your doctors if you are taking any “over-the-counter” medications, including aspirin, herbs, vitamins, and dietary supplements.

Many orthopaedic surgeons and anesthesiologists feel that all herbs should be stopped one week prior to surgery to keep you from having any problems. Your doctor suggests that you stop the following herbal treatments prior to surgery, as they have a proven to cause excessive bleeding*:

Dong QuaiTurmeric(curcuma longa)Quercetin

Gingko BilobaBoswellia(bosellia serrata)Reservatrol

GingerStinging Nettle(urtica dioica)Cayenne

GinsengCat’s Claw (uncaria tomentosa)Omega-3 FA

White Willow Bark(salix alba)St. John’s Wort

Devil’s Claw(harpagophytum procumbens)

*AAOS, August 2001

Managing Pain Prior to Orthopaedic Surgery

Your orthopaedic surgeon is asking you to stop taking any non-steroidal anti-inflammatory medications or any medicines containing aspirin at least one week before your total joint replacement surgery.

Non-steroidal anti-inflammatory medications are also called NSAIDs. Examples of these medicines include Ibuprofen, Advil®, Motrin®, Naprosyn®, Celebrex®, Vioxx®, Relafen®, Clinoril®, Lodine®, Tolectin®, Orudis®, Daypro®, Voltaren®, and Anaprox®.

You need to stop taking these medications because they prolong the time it takes your blood to clot. This can cause serious problems after surgery. Failure to stop these medications in time may prevent you from having surgery on your scheduled date.

In place of these medications you may use: Tylenol® or Extra-Strength Tylenol® as directed. If this plan does not provide adequate pain relief, please call Affinity Orthopaedics and Sports Medicine at 996-3700.

Autologous Blood Donation

Some people want to give their own blood to receive during or after surgery. This is called an autologous blood donation. You may donate one unit of blood per week, starting several weeks before surgery. The latest possible donation time is one week prior to surgery. If you have heart problems, you will need a letter from your primary doctor stating it is alright to give autologous blood.

If you are giving your own blood, you should take iron supplements. Start taking them one week before you start giving your own blood. Please see the separate instruction sheet for directions and dosage.

If you are unable to give blood, a directed blood donation can be arranged. A directed donation is when someone else with the same blood type gives blood for you. Directed donations can be done closer to the time of surgery. If there are reasons you prefer not to give blood, please discuss this with your orthopaedic surgeon. If you plan to set up an autologous or directed blood donation, please call the blood bank and schedule the necessary appointments.

CommunityBloodCenter

4406 W Spencer

Appleton, Wisconsin 54914

(920) 738-3131

Iron Supplements

These supplements are used to treat low blood iron or anemia by helping the body make red blood cells. You should not use this medicine if you have had an allergic reaction to iron supplements.

Brand Name(s): Feosol®, Fer-In-Sol®, Slow-Fe®, Femiron®, Feostat®, Fergon®, Ferralet®, Ferra-TD®, Mol-Iron®, Niferex®, Hytinic®, Nu-Iron®

Other brands are available.

How to use and store this medicine:

Your doctor will tell you how much medicine to take and how often. Take with plenty of fluids to avoid the problem of constipation. Store at room temperature and out of reach of children; too much iron can be very dangerous to them.

Tablets: Is best taken on an empty stomach, although it can be taken with food if upset stomach occurs.

Liquid: Is best taken on an empty stomach, although it can be taken with food if upset stomach occurs. Iron may stain your teeth. This problem can be avoided by mixing with water or other liquids (fruit or tomato juice) and drinking the medicine through a straw. Stains can be removed by brushing with baking soda or peroxide. Store this medicine at room temperature only, and avoid heat, direct light, or moisture.

If you miss a dose: Take the missed dose as soon as possible. Skip the missed dose if it is almost time for the next regular dose. You should never take two doses at a time.

Drugs and foods to avoid: Tell your doctor if you are taking any antibiotics or Vitamin E. If you are taking ciprofloxacin or tetracycline, then take these medicines three hours before or two hours after the iron supplement. You should not use iron at the same time as antacids (such as Maalox® or Mylanta®). You should not use iron at the same time as certain foods such as eggs, milk, cheese, yogurt, coffee, tea, cereals, or whole-grain bread.

Warnings: If you are pregnant or breastfeeding, talk to your doctor before taking iron. Make sure your doctor knows if you have hiatal hernia, stomach ulcers, intestinal ulcers, or bleeding problems. Iron can cause dark stools. This is normal.

Side Effects: Call your doctor right away if you have bloody diarrhea, severe vomiting, unexplained weakness, nausea, darkened urine, heartburn, constipation, or staining of the teeth.

General Anesthesia

“Anesthesia” is the loss of feeling or sensation. General anesthesia can be used for surgery, and puts you into a deep sleep. This means you are unaware and do not feel anything going on during surgery. General anesthesia acts on the brain, causing you to not feel any of your body. Since consciousness is lost, there is usually no memory of the surgical event. Some people remember events at the ends of a procedure, such as a dressing being applied. This is because the drugs used to keep you asleep have been stopped, in order to allow you to awaken.

At first, general anesthetics are given through the bloodstream using the intravenous access (iv) to get you to sleep. A mask is placed over your face with oxygen flowing through it. Once you are asleep, the anesthesiologist places a breathing tube into your windpipe. The tube is about the size of your index finger and helps you breath while you are in the deep sleep. Once asleep, inhaled gaseous medicines that go to the lungs may be administered through the breathing tube. These medications are designed to keep you asleep. To aid the surgeon, a medicine to relax your muscles may also be used.

Benefits of General Anesthesia

General anesthesia is usually reserved for long or extensive surgical procedures. It may also be used for shorter surgeries when indicated. The purpose of the general anesthesia is for you to be unaware and not feel anything going on during your surgery.

Risks of General Anesthesia

Some people feel sick to their stomach (nausea) and experience vomiting after general anesthesia. Your anesthesiologist orders medication to help with this, if needed. Other side effects of general anesthesia may include:

• Damage to the tongue or a tooth during breathing tube insertion
• A sore or “scratchy” throat from the breathing tube
• A headache after surgery
• Muscle aches
• Feeling tired up to a few days after surgery

Regional Anesthesia

Regional anesthesia is a type of anesthesia used for surgeries that only need a part of the body numb, or without feeling. A medicine called a local anesthetic is used to make the necessary part of the body lose feeling. Local anesthetics are injected with a needle near a group of nerves and “block” or stop feelings of pain. They also stop the movement of muscles in that area until the anesthetic wears off. Before receiving a local anesthetic, the skin area is cleaned with a soap that kills germs and then numbed with a small shot. Regional anesthesia allows you to not feel the surgery without using general anesthesia (putting you completely to sleep). A regional anesthesia technique can spare you many of the side effects of using a general anesthesia during the recovery phase of your surgery. Though you will be awake during surgery, sedative medicines are given to help you relax. These may even cause you to doze off during the procedure. You may not remember much of the surgery. Of the common types of regional anesthesia listed below, epidural and spinal anesthesia are used (most commonly in obstetrics) for surgery of the lower stomach, pelvis, and legs.

• Epidural-Local anesthetic is injected in the fatty area outside the spinal canal where the nerves are located, low enough in the back to be below the spinal cord. A small plastic catheter can be placed here to continue the flow of anesthetic for several days if needed.
• Spinal-Local anesthetic is injected into the spinal fluid low enough on the back to be below the spinal cord.
• Arm & leg blocks-Local anesthetic is injected around the nerves running to the area.

Benefits of Regional Anesthesia

Regional anesthesia allows you to have surgery without the side effects of being put into deep sleep. With a regional anesthetic, you only receive sedatives to make you relaxed or sleepy. Many patients actually fall asleep from these sedatives and remember nothing from surgery. When the procedure is finished, you will be awake and aware of things around you much faster than if you had been put to sleep. You will usually experience less nausea and have less pain right after surgery.

Risks of Regional Anesthesia

• It may feel a little hard to breathe during surgery, if the local anesthetic relaxes the muscles of your chest.
• Lower blood pressures may occur. This may make you feel dizzy or lightheaded, and you could feel sick to your stomach for a short time.
• Many people complain of aching pain in the low back area for a few days after a spinal or epidural anesthesia. It feels the same as your arm feels after getting a shot, or similar to backache after heavy lifting or shoveling.
• About 1 out of 200 people may get a “spinal headache” after spinal or epidural anesthesia. The headache may last a few days. If you get one, you will be given suggestions of things that can be done to make it go away faster.

Total Joint Replacement and Dental Procedures