Knee Replacement Class at Williamson Medical Center


Hello, I’m Dr. Brian Perkinson. We’ve made
you this educational video for your upcoming joint replacement at Williamson
Medical Center. Please watch it and learn. Hello, I’m Dr. Colin Looney. Our joint
team put together these very helpful videos. I hope you enjoy them and find
them very educational. Thank you. Hi. My name is Richard Hamilton.
I’m a physical therapist here at Williamson Medical Center, and I’m part
of the Joint and Spine team. Now that you’ve decided to have a knee
replacement we’d like to go over some of the highlights of what you can expect
before you have your surgery. When you come in for your pre-admission testing
you’ll receive a book, “The Ins and Outs of Joint Replacement,” which will be a
comprehensive review of everything you need to know. In this video, we’re about
to hit the highlights of that book. Let’s get started.
It’s important to prepare your home before you have surgery. When you come
home you can expect to most likely be using a walker.
Sometimes the walker can tend to get tangled up in things, like throw rugs,
loose cords, anything else that might get in your way and trip you when you’re
using a walker. Keep in mind that small animals often can be problematic when
you return home, using a walker. You may want to make some kind of accommodation
for that. If you have stairs, it’s highly recommended that you have a handrail.
It’s very difficult to go up and down stairs without a handrail after surgery.
It’s also important that your home is adequately lit. We recommend considering
night lights for when you need to get up during the middle of the night. Motion
lights are excellent. The bathroom is one of the most dangerous places, especially
after surgery, because you’ve got a slick surface and lots of sources of water. We
usually recommend some kind of a shower chair, rather than standing to bathe. “Grab
bars” can also be very helpful, as just another apparatus to hold on to, and,
possibly, a toilet riser, if you’re going to have difficulty getting up from your
toilet. Hi, I’m Amanda Marcin, and I’m one of the nurses on the Joint and Spine
Center. I’m going to talk to you a little bit about staying healthy prior to your
surgery. We want to keep you as healthy as we can prior to surgery. Part of that
is protecting your skin. So, if you’re outside, you want to wear things like bug
spray to protect your skin, so you don’t get infection. When you come in for your surgery, if you have any signs of
infection that could cause your surgery to be rescheduled. So, please try and stay
as healthy as possible. One of the side effects of your pain medicine is
constipation. So, it’s important that before surgery you don’t come into the
hospital constipated. We recommend that you have a bowel movement before you
come in. You can take an over-the-counter stool softener to help with this. If
you’re diabetic it’s very important that you maintain your blood glucose levels.
Maintaining your blood glucose levels helps promote healing and keeps you
healthy after surgery. My name is Lisa Mathews. I’m one of the registered dietitians here at Williamson Medical Center, and today I’m going to talk to
you a little bit about the importance of having good nutrition prior to your
surgery. Something to keep in mind, protein is important. After any kind of a
surgery, protein aids and wound healing. Also, whenever we’re inactive for ten
days, even, we can lose up to two pounds of muscle. So, to help prevent that muscle
loss we recommend snacks that are high in protein, high in fiber. You may be on
some pain medicine, which can cause constipation. So, to help prevent some of
that, we recommend foods that are higher in fiber and drinking plenty of fluids.
Some good examples of things to have at home, before you go in for your surgery,
are these high-fiber crackers along with tuna. This packet is wonderful because
you don’t have to drain it, you just open it, place it on the cracker, and it makes
for a great high fiber, high protein snack. In addition, we have Greek yogurt
here. Greek yogurt is a higher amount of protein than normal yogurt, so this is an
excellent choice for a snack, as well. Trail mixes: Nuts are high in fiber and
as well as a good source of protein. These are great to have on hand. After
your surgery, you’re not going to feel like being in the kitchen, doing a lot of
cooking, so these are excellent to have around at your house. Also, we’ve got
these drinks. There’s many versions of these in the grocery store. The higher
protein version, that has the lower amount of calories, is an excellent
choice. Those will also help you main paying a good weight. We want to maintain
a good weight because being obese or overweight adds extra pressure to our
joints. So, eating a great, balanced diet, high in lean proteins and fiber, low in
fats and sugars, will help you do that. It’s important that you plan ahead to
have someone stay with you for the first few weeks after your surgery. On your day
of discharge, it’s best if you have someone at the hospital by 2:00 p.m. who
can help take you home. Getting in and out of a car can be difficult, so please
plan ahead to have a small SUV or mid-sized vehicle that’s easier to get
in as you’re discharged home. While you’re at the hospital, you’ll be
receiving a lot of education. So, we recommend that you have your family and
support participate in that education while they’re here. Hi, I’m Frances Scott,
Nursing Director of the Joint and Spine Center here at Williamson Medical Center.
I’m going to talk to you a little bit about what happens the day before
surgery. You will receive a call from us stating when to be here the morning of
surgery. You will also have met with an anesthesia team that will tell you which
medications to take before surgery and also when to not eat or drink before
surgery. Please make sure you follow these instructions, as directed. Please
bathe with the antibacterial soap given to you prior to surgery. This soap helps
remove germs from your skin and prevents infections. Please remember to bring your
booklet, “the Ins and Outs of Joint Replacement Surgery” with you while
you’re here in the hospital. We can use it as a workbook and we can use it
also as a reference during your stay with us. Hi, I’m Samantha. I’m a nurse here
at the Joint and Spine Center at Williamson Medical Center. I’m gonna talk to you
today about getting ready for surgery. So, when you get here you’ll come to your
room, where we will have you sign your consent.
From there, we’ll have you wipe down with our chlorhexidine wipes–hese will help
prevent any kind of infection–as well as getting into a purple gown for surgery.
So after we get you all set up you will be in your room until they come and get
you for surgery. From there, you’ll be about three or four hours, so if your
family is here and they have any questions at all, they are more than welcome to come find a staff member or nurse up at the desk to ask any questions.
After surgery, you’ll be brought back to your room where we have two main goals:
mobility and pain control. We’ll be getting you out of bed as soon
as you’re back from surgery. Mobility helps prevent any kind of complications.
Second goal is pain control. We want to keep your pain as tolerable as we can, so that you can look forward to therapy and be able to regain your mobility faster.
After surgery, we also encourage deep breathing. Anesthesia, drowsiness, being in
bed can all prevent you from taking good deep breaths. That’s why we use the incentive spirometer. With your incentive spirometer, you’re going to wrap your
mouth tightly around the mouthpiece. Here, you will take good deep breaths by
inhaling; kind of like sucking on a straw. As you see, taking good, deep breaths
helps move the indicator up. Our main goal with incentive spirometer is to
prevent pneumonia after surgery or any other complications from anesthesia. You
will do this about 10 times after surgery, every hour. Another important
thing to remember is that if you have a CPAP, to bring it with you the day of
surgery, so that we don’t have any other further complications with breathing.
After your surgery you can expect to be receiving physical therapy. A therapist
will most likely be in to see you just a few hours after you return from surgery.
We’ll get you up and moving, and start with some basic exercises. We encourage
you to start those exercises as soon as possible, even today. They’re included in your workbook, “the Ins and Outs of Joint
Replacement,” and we’ll review them now. Just remember, the stronger you are going
in the stronger you’ll be coming out, and the easier your physical therapy will be.
We’ll now let Kristin Storey, physical therapist at Williamson Medical Center,
review some of those exercises with you. Hi. My name is Kristin Storey, and I’m a
physical therapist at the Joint and Spine Center at Williamson Medical
Center. While you are here, physical therapists we’ll be working with you to
help regain your strength and your range of motion. I’m going to be
going over some exercises with you and will want you to do these three times a
day, for 30 repetitions each. This exercise is called “quad sets.” For this
exercise, you’re going to take your operative leg and tighten the muscles on
the front of your thigh, which will push your knee down into the bed. You want to
hold that for three to five seconds and then relax. You’ll repeat this 30 times
and do it three times a day. This exercise is called “glute sets.” For
this exercise you’ll tighten the muscles in your rear, or your bottom. Hold for
five seconds and then relax. You’ll repeat this exercise 30 times, three
times a day. This exercise is called “ankle pumps.” To perform this exercise,
you’re going to move your ankles up and down, either in the bed or sitting in a
chair. We ask that you do this 10 times every hour you’re awake.
This exercise is called “heel slides.” Taking your operative leg, you’re going
to slide your heel up towards your bottom as far as you can get it; and you
want to push through the pain. You want to perform this 30 times, three times
a day. This exercise is called “Hip Abduction.” Keeping your toes and your
knee pointed straight up towards the ceiling, you’ll want to slide your leg
out to the side and back into the center, being careful not to cross midline.
You’ll perform this exercise 30 repetitions, three times a day. This next
exercise is called “short arc quads.” Folding up a blanket or pillow, or even
using a playground ball, you want to place it underneath your knee; keeping
your knee on top of the surface. You want to kick the lower part of your leg up, so
that your leg becomes fully straight and then lower it back down nice and slowly.
Make sure your knee stays on the object you have it propped on. You’ll perform
this exercise 30 repetitions, three times a day. To perform “stairs,” you’ll want to
go up with your non-operative or stronger leg first, and then bring your
operative leg to meet it, making two feet end up on each step. You’ll continue the
sequence until you’ve reached the top of the stairs. To come down the steps, you’re
going to come down with your operative leg first. Next, bring your stronger leg
down to meet your operative leg, making two feet beyond each step. Continue this
sequence until you’re all the way down the stairs. This exercise is called a
“static extension stretch.” You’ll prop your heel up on a pillow or towel roll,
so that there is nothing underneath your knee. The goal of this is to help your
leg get straighter and push into extension. We hope that you can hold this
for up to 15 to 20 minutes, starting out with a minute or two the first time. This next exercise is called a “straight leg raise.” You’re gonna bend your non-operative leg
and, keeping your operative leg straight, you’re gonna lift it, keeping it nice and
locked and straight to the height of your other knee. And then you’ll slowly
lower it back down. We want you to perform this exercise 30 repetitions,
three times a day. This next exercise is called “seated knee flexion.” While sitting
in a chair, you’re going to bend your operative knee so your foot slides back
under the chair. Hold it for a second or two, and then slide it back out. You’ll
perform this exercise 30 repetitions, three times a day. Getting you ready for discharge is a team effort, and you’re the most important part of that team. But
it also includes your doctors, your nurses, your physical therapists, your
occupational therapists, and case management. Our goal is to develop a plan
that fits your individual needs. If you require any equipment or supplies, we’ll work to ensure that you have them before you’re ready to go home. Tanya Smith is now going to talk with you a little bit about the discharge instructions you’ll receive before you go home. Hi, my name is Tanya, and I’m a nurse at the Joint and Spine Center here at Williamson Medical Center.
We want your transition from the hospital to home to be as smooth as
possible, so we are going to provide you with discharge information before
leaving the hospital. You will receive instructions on how to take all of your
medications at home, prior to discharge. If you are taking a blood thinner, you
will receive information from our pharmacy team here at the hospital, and
you will also receive a prescription, if indicated. You will also receive specific
instructions on how to care for your surgical incision upon discharge. Please
be sure to watch for signs and symptoms of infection, such as redness, heat,
separation of your incision, or a fever greater than 101.4 (degrees). If any of these signs or symptoms occur, please be sure to contact your
physician. The normal progression for your pain is for it to improve on a day-to-day basis. If you are taking your pain
medication as indicated, and this is still not improving your pain control
please call your physician. Our goal is to keep your surgical dressing clean, dry,
and intact. If, for any reason, your dressing becomes saturated please remove the dressing and call your physician. We also want to prevent blood clots. It is
important to be able to recognize the signs and symptoms of blood clots, such
as increased pain, redness, or swelling in that calf area. If any of these do occur
please contact your physician. Also call your physician if you have any
unresolved abdominal issues, such as nausea, vomiting, or you are unable to
have a bowel movement. Please remember if you have any trouble breathing or chest
pain this is always an emergency and you need to call 911. Continue to take your
pain medications as indicated upon discharge and watch for side effects
such as constipation. Your doctor will prescribe over-the-counter stool
softeners, so please be sure to take those as indicated and remember to eat
healthy, protein-rich foods to help promote healing. Continue to move and do
your exercises as instructed. Please avoid sitting for long periods of time.
And when you are at home, taking care of your incision, it is okay to shower over
your incision–but please avoid submerging in any type of water, such as
bathtubs, hot tubs, or swimming pools. Do not apply lotions, creams, or ointments,
unless indicated by your physician, and please remember you cannot drive until
you are cleared by your physician. A follow-up appointment will be made with
your surgeon’s office a couple of weeks after your surgery. If you have any needs,
you can feel free to call the office 24/7, as someone will be on call to
answer your phone call and take care of your needs. On behalf of myself and the
entire team at the Joint and Spine Center, we would like to thank you for
choosing Williamson Medical Center for your orthopeadic needs. I hope the video
has been helpful in getting you ready for your surgery. Please remember that
the two main goals is that we get you up and walking the day of surgery and that
we keep your pain as tolerable as can be. For more information, please call (615) 435-6454 for information on our live joint classes.

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