Patient Instructions - Joint Replacement Surgery at White River Medical Center

The Physicians and staff at White River Medical Center are dedicated to your care.  This is a day-by-day account of what to expect from joint replacement surgery at White River Medical Center’s Joint Resort. Our Patient Satisfaction Coordinator will deliver a welcome note, gift bag with snacks, and a t-shirt. 

Each day, your activity agenda will be delivered to keep you and your family fully informed.  If you have questions, feel free to contact Lisa Crumley, MSN, Orthopaedic Liaison at 870-262-3134 or via email at lcrumley@wrmc.com.

We hope this is the beginning to regaining your life one-step at a time!

Before Surgery is Scheduled

If you and your Orthopaedic Surgeon decide to pursue joint replacement as a course of treatment, the first step is obtaining a medical clearance for surgery.  In consultation with the Orthopaedic Surgeon, your Primary Care provider will evaluate the following risks that might affect your surgical outcome.

  • Medical History (chronic conditions, allergies, past surgeries, mental health, and other condition that could impede your recovery)
  • Diabetes Compliance (A1c Results)
  • Tobacco Cessation – Smokers and tobacco users are twice as likely to develop postoperative infections. The Orthopaedic Liaison can provide you with resources to help you quit.*
  • Body Mass Index – Maintaining a healthy weight is important to a successful joint replacement surgery.

Surgical Preadmission Testing

  • After your Surgeon and/or Primary Care Provider have cleared you for surgery, a date will be set for Surgical Pre-admission testing at White River Medical Center.
  • During  the Surgical Pre-admission Appointment we will  
  • Obtain a urine specimen
  • Perform an EKG or chest x-ray, (depending on your overall health)
  • Review your complete medical history
  • Swab your nose for the presence of MRSA/MSSA bacteria
  • Salvia swab test for nicotine use 
  • Conduct your anesthesia interview
  • Additional laboratory studies may be ordered depending on your overall health
  • Provide the time you should arrive at the hospital and the scheduled time of your surgery

Infection Prevention

  • If the nasal swab determines you are a carrier of MRSA/MSSA you will be prescribed a mupirocin ointment to place into your nostrils twice a day for two days before your surgery and three days after your surgery.
  • Every patient will bathe with a special antibacterial soap called Hebiclens. Bathe or shower with Hebiclens each day for two days before your surgery and on the morning of your surgery.  The Orthopaedic Liaison will provide special instructions and you may purchase Hebiclens at your local pharmacy without a prescription.  

The Day Before Your Surgery

  • Follow the Infection Prevention Guidelines previously outlined.
  • Do not eat or drink anything after midnight.

What to Bring to the Hospital and What to Leave Home

  • A list of your current medications
  • Exercise clothes – sweat pants or shorts and t-shirt
  • Sensible shoes for your trip home.  Shoes should have non-skid sole and closed back.
  • You may bring a cell phone and/or laptop computer, however you will be asked to sign a waiver taking responsibility for these personal items.
  • Leave jewelry, cash, and credit cards at home or with your family.

Surgery Day

  • Follow the Infection Prevention Guidelines previously outlined.
  • Drink two (8 oz.) bottles of Ensure Clear before your leave to come to the hospital. If you are a diabetic, substitute Gatorade G2 or a sugar free Powerade drink. 
  • Arrive at the hospital at least two hours before you surgery to begin the preoperative process.  Arrival time and surgery time will be provided to you during the pre-admission testing appointment.
  • Use the East Entrance of the hospital and check-in with the Volunteer Greeter.  You and your family will wait in the Surgery Seating area for the Pre-operative Nurse.
  • The Preoperative Care Nurse will complete your admission paperwork and verify all of your health and insurance information.  You will change into a hospital gown. The nurse will start the IV that will be used to give you medicine and fluids throughout your surgery.
  • One of the medications is an antibiotic given before and after your surgery to reduce your chance of developing a post-operative infection.
  • Once you are taken to the operating room, your family will receive a tracking number to identify your case.  Your family will be able to monitor the progress of your surgery by watching the monitor in the Surgery Seating area.
  • Total joint replacement surgery typically lasts about two hours.
  • The Surgeon will speak to your family after surgery while you are in recovery.
  • The nurses will inform your family when you are taken to your room on the hospital’s fourth floor.

After Your Surgery

  • Your room will be in the hospital’s orthopaedic wing on the fourth floor.
  • Your room will have all the equipment you need along with a separate thermostat and private shower.
  • A couch can be made into a bed for the family member that will be assisting you.
  • The nurses on this unit are well trained and experienced in providing orthopaedic care.  The nurses are your resource during your hospital stay.  We encourage you to ask questions and rely on your nurses for information.
  • Leg pumps will be placed on your legs to reduce your risk for blood clots.
  • A compression stocking on your non-operative leg will also help reduce the risk of developing a blood clot.
  • It is best to limit visitors in the first few hours after your surgery so that you can rest.
  • Once your surgical medications have decreased and it is safe, the nurses and patient care techs will assist you in getting up and into a chair, usually in the evening after your surgery or the morning after.
  • A physical therapist will evaluate you for therapy by asking about your activity level before surgery and your goals for your recovery.  The Physical Therapist will complete the evaluation in the afternoon after surgery or the next morning. Therapy will begin the morning after surgery.

Pain Control After Surgery

  • The nursing staff will ask you to rate your pain from one to 10 using the Wong Baker Faces scale. 
  • One is pain free and 10 is the worst pain you have ever experienced.
  • IV pain medication will be ordered and available if needed. 
  • Oral pain medication will also be ordered and available if needed to aid in pain control.
  • The nursing staff will time your medication to your therapy and teach you how to continue this at home if needed.
  • Ice, elevation, and repositioning may also be used to relieve your pain and make you more comfortable.

The Morning After Surgery

  • You will move to your chair for breakfast.
  • Group Therapy for hip replacement and knee replacement begins at 10 am. Cell phones are not allowed during therapy.
  • You will be taken to the therapy gym using the high-back rolling recliner in your room. 
  • You will return to your room to rest and have lunch before afternoon therapy at 2 pm.
  • You will be expected to sit in your chair for all your meals.
  • Please ask family and friends not to visit during therapy.
  • Shoulder Replacement patients receive therapy in their rooms with an Occupational Therapist.

Going Home

  • Most patients are discharged in the afternoon the day following surgery. If you are not discharged the day after surgery, you will have therapy again the 2nd day after surgery before being discharged to go home.
  • Total hip and total knee replacement patients- Most patients are able to do home exercises.  The Therapist will provide printed exercise instructions with illustrations explaining each exercise.  Ask your Therapist to explain the exercises if you have any questions.  To gain the full benefit of your new joint, do all the prescribed exercises twice a day for four weeks after your surgery.  If you are unable to do self-therapy, outpatient therapy may be ordered for you.
  • Outpatient Therapy/Home Health – Shoulder replacement patients will be prescribed outpatient or home health therapy depending on personal/insurance requirements. Therapy is usually ordered for three times a week for two weeks.  Attending and fully participating in therapy is vital to your complete recovery.
  • Total hip replacement and total knee replacement patients will need a rolling walker with 5-inch wheels to use at home.   The hospital’s discharge planners can arrange for equipment. 
  • The hospital will send materials for changing your dressing and plastic shower guard to keep your dressing dry when you shower.
  • Your follow-up appointments, prescriptions, and discharge instructions will be explained to you before you are discharged.
  • The nurses will call the agencies you may need for support to let them know you are going home and to ensure you have the support and equipment you need.

At Home

  • It is important to ice and elevate your leg at home. After knee replacement, it is important to keep the knee straight when elevating and at rest. Place a pillow lengthwise from your thigh to calf, which will keep your knee straight.
  • Timing of your pain medications around therapy sessions may be helpful in reducing your pain. 
  • Small rugs with no gripper backing caught in a walker creates a trip hazard. It is best to have someone remove them before you return home.
  • Electrical cords also create a trip hazard. Be sure that cords are removed from high traffic areas of your home.
  • The dressing over your incision will stay in place until your follow-up appointment with the Surgeon and APRN/PA. After the follow-up, you and your family will be responsible for changing the dressing at home.  Remember – Handwashing is the #1 way to prevent infections.

*Nicotine Testing

All patients are tested for nicotine use as a part of the preoperative process.  Our Surgeons recommend that you reframe from nicotine use for at least four weeks prior to surgery and six weeks after surgery.  Studies show that patients who use nicotine products (smoke) have a higher incidence of post-operative infection, slower wound healing, slower bone healing, and increased risk for tissue death (ACS, 2016).  Patients testing positive for nicotine use will be referred to White River Health System’s smoking cessation program for consultation. Surgery will be delayed.  Additional resources are listed below:

 

Arkansas Quit Line                                             

1-800-QUIT-NOW  or 1-800-784-8669

Quit Smoking Resources  

 

http://teen.smokefree.gov

http://espanol.smokefree.gov

http://women.smokefree.gov

Centers of Disease Control                    

https://www.cdc.gov/tobacco/

 

American College of Surgeons (ACS) (2016) -Quit Smoking before Your Operation- http://www.facs.org/patienteducation