Table of Contents 

Introduction
Goals of Joint Replacement Surgery
What is Joint Replacement Surgery?
How to Prepare for Surgery
What I Need to Know Before my Surgery
The Day of My Surgery
Admission to Placentia-Linda Hospital
During Your Stay at Placentia-Linda Hospital
Discharge
After You Go Home

Introduction

We would like to welcome you to the Orthopedics Department at Placentia-Linda Hospital. At Placentia-Linda Hospital, we emphasize wellness and customer satisfaction, both of which are important factors in your successful recuperation. To help you adjust quickly and comfortably to your new environment, we have compiled some "helpful hints."

Our therapists, nurses, case manager and surgeon will be discussing your goals and plans with you for your surgery, rehabilitation stay and follow-up rehabilitation therapies you may require. Please don’t hesitate in asking questions. We are here to help you -- our staff needs your input to tailor a program to fit your individual needs.

If you have any questions, please don’t hesitate to discuss with your treatment team. You can reach our Orthopedics Department directly at 1-866-96-JOINT (1-866-965-6468).    <Back to Table of Contents>

Goals of Joint Replacement Surgery

Joint replacement surgery may mean the difference between needing a cane and swinging a golf club. The goals of joint replacement surgery are:

• Pain relief
• Increased endurance for standing, walking, mobility
• Improved range of motion
• Increased ability to improve strength

When knee or hip pain from arthritis severely limits your ability to walk, work or perform even simple activities, your doctor may recommend that joint replacement surgery is for you. If you should require surgery, Placentia-Linda Hospital’s Orthopedics Department offers a program tailored for patients who are having joint replacement surgery.

What is Joint Replacement?

According to the American Academy of Orthopaedic Surgeons (AAOS), 300,000 people undergo knee replacement; 193,000 undergo hip replacement; and 23,000 undergo shoulder replacement surgery each year. Knee or hip replacement is offered through our highly specialized Orthopedics Department and may be a solution to your pain. Joint replacement is surgery done to replace all or part of the diseased portions of the joint with an artificial device (prosthesis) to restore joint movement. The most common reason why patients undergo hip or knee replacement is from the natural wearing down of the joint. This is known as osteoarthritis.

The rough, worn surfaces of the joint are relined with smooth-surfaced metal and plastic components. Knee or hip replacement uses a metal and plastic covering for raw, arthritic bone ends. It replaces worn-away cartilage and for many people with arthritis in their knees, replacement also straightens the leg.

Initially, if a person is feeling pain in their joints, it’s likely they will undergo some tests to determine the extent of the damage. A physical examination will be given, as well as laboratory tests and X-Rays. A physician may decide that joint replacement is appropriate for you if other attempts to relieve the pain fail.

Possible reasons for replacement of the hip or knee joint may include:

• Pain that has failed to respond to conservative therapy (medications, steroid injections, physical therapy, lifestyle and activity adjustments, rest)
• Osteoarthritis or arthritis confirmed by X-Ray
• Inability to work, sleep or move because of pain
• Loose prosthesis
• Joint fractures, tumors or deformities

The track record for joint replacement is very good. It gives years of pain-free and mobile living that may not have been possible otherwise. Older patients can expect their replacement to last about ten years, while younger patients may require an additional replacement.  <Back to Table of Contents>

 How To Prepare For Surgery

Pre-Op Tour and Meet The Staff
Pre-Operative Testing
Pre-Registration
Insurance
Preparing Your Home

Pre-Op Tour and Meet The Staff

We invite you to come to Placentia-Linda Hospital prior to your surgery to attend our pre-operative surgery class and tour our facility and meet the physical therapist, case management, nursing staff and Admitting department. Our classes are held the 2nd and 4th Thursdays of each month from 9:30 a.m. to 11:00 a.m.  Hospital tours are available after the class. 

To schedule a separate pre-op tour, we ask that you please call us at least 48 hours in advance so we may give you the best individualized attention as possible.

After the tour and if arrangements are made ahead of time, you can meet with a Physical Therapist for a one-on-one session to evaluate your current level of mobility, limitations and help teach you strengthening exercises, post-operative limitations and precautions. If you have questions about follow-up care and equipment, we recommend that you also meet with a member of our Case Management team to discuss your options and resources we have available to help you.

During this time, you can also pre-register in the Admitting Department. Please be sure to bring your doctor’s orders, identification and insurance information with you.

Priority Testing

Please arrange to have any laboratory tests, X-Rays or other tests requested by your physician performed 24 to 48 hours prior to your scheduled surgery time. Please bring the physician’s order to the pre-op testing appointment.

Between the Hours of 10 a.m. and 5 p.m., we offer Priority Testing and a Designated Team Member Accompanies You Through the Process.  Most Patients are In and Out In About an Hour.   No Appointment Necessary.

Pre-Registration

To help make your visit as efficient as possible, we recommend that you pre-register on our web site or by calling our Admitting Department at (714) 524-4872. For routine hospitalization, our Admitting Department hours are 5:00 a.m. to 8:00 p.m., Monday through Friday. To pre-register on-line, please go to www.placentialinda.com and click on "Pre-Registration" on the home page.

Insurance

Please bring your insurance card(s) with you to your pre-op testing appointment.

Placentia-Linda Hospital accepts most insurance plans, including HMO’s, PPO’s, private insurance, Medicare, Worker’s Comp and TRICARE. Please contact our Admitting Department at (714) 524-4872 for current insurance information.

If you have any questions regarding your hospital billing or payment arrangements, you may contact one of our financial counselors at (714) 524-4260.

Preparing Your Home

Before your surgery, please check your home to remove loose throw rugs to help prevent tripping. You can also move frequently used items to a lower cupboard or shelf for easier access. We also suggest you install a rubber mat in the shower and safety bars to help prevent falls. The therapist and member of the case management team can help you prepare your home for your return after surgery (if you are going home).

Also, when you meet with a member of our Case Management team, you can discuss equipment your physician has determined is needed such as a walker, raised toilet seat or crutches.

Post-surgery dietary considerations include healthy food choices. If you return to home right after surgery, you will want to have light, non-fatty foods on hand such as soups, jello and fruits. When you’re up to eating a heavier meal, we suggest you make a couple of dishes, such as casseroles, that freeze well and you can heat up quickly.  <Back to Table of Contents>

Diet and Smoking

Unless your physician instructs you differently, it is important that you have nothing to eat or drink for 8 to 12 hours prior to your scheduled surgery time, including water. This measure is critical to your safety during anesthesia.

We recommend that you do not smoke for 24 hours prior to surgery and no alcoholic beverages 12 hours before surgery as it could exacerbate the effects of the anesthesia.

Personal Preparation

Do shower just before arriving at the hospital. This may help reduce the chance of infection.
Don’t wear make-up, perfume or cologne. If you do, you will be required to remove it.
Do wear comfortable shoes and clothes that are easy to put on. Don’t wear contact lenses.
Don’t wear jewelry of any kind. If you do, you will be required to remove it.

If you have dentures, you may wear them the day of surgery.

What to Bring

Sleepwear is not needed. You will be given a hospital gown to wear during your surgery and post-surgical recovery. You may want to bring comfortable, supportive shoes to be worn during your physical therapy treatments.

Your room is equipped with cable TV. You may also wish to bring a book or magazine.

Bring glasses if you use corrective lenses. Contact lenses may not be worn during or after surgery and should be left at home.

• A signed consent form
• Completed anesthesia questionnaire

Arrival

It is important that you arrive at the hospital at least 2 hours before your scheduled surgery time. You will check-in at the Reception Desk in the Main Lobby and wait for your name to be called. From that point, you will be escorted to the next Department.

If your procedure will be paid for by insurance or Medicare, please bring your card with you.  <Back to Table of Contents>

Admission on Day of Surgery

Waiting Area
Important Phone Numbers
Visiting Hours
Newspaper
Pain Control

The day of surgery is a busy day for everyone. To help the day run smoothly we ask your assistance in the following:

• Once you are taken to surgery, families are asked to wait in the Main Lobby for the physician to come out. Families and friends are welcome to stay with you up to the time you go to the operating room. You can expect the patient to be in the recovery room at least 1-1/2 hours. Please do not be alarmed if it is longer.
• Family members or friends may check with the Operator for patient status.
• On return to the unit after surgery, the nurse will assist the patient in turning and positioning in bed. Pain medication will be administered as necessary. Diet is resumed immediately as tolerated by the patient.
• Patients receiving epidural anesthesia will need to elevate the bed no higher than 30 degrees for up to 6 hours after surgery. The nurse will inform they patient when you may sit up. The

Waiting Area

Our Main Lobby waiting area is also our surgical waiting area. On the day of surgery, families and friends wait here for the physician to call with a report of the patient’s surgery and condition.

The Placentia-Linda Café is right next door to the Main Lobby and is open daily. Hours are: Breakfast – 7:00 a.m. to 9:00 a.m.; Lunch – 11:15 a.m. to 1:30 p.m.; and Dinner* -- 4:00 p.m. to 6:00 p.m. (*Dinner served Monday through Friday only). Complimentary coffee is available 24 hours a day for your convenience. In addition, vending machines and an ATM are also located in the cafeteria.

Important Phone Numbers

• Main Hospital Phone Number – (714) 993-2000
• Admitting – (714) 524-4872
• Joint Replacement Nursing Station Phone Number– Ask the Operator to overhead page the House Supervisor
• Physical Therapy – (714) 524-4859

Visiting Hours

Daily visiting hours are from Noon to 8 p.m. Family and friends may visit anytime until 8 p.m. on the day of surgery.

Newspaper

A complimentary copy of The Orange County Register newspaper will be delivered to your room daily during your stay with us.    

Pain Control

Placentia-Linda Hospital uses a pain assessment scale to determine your pain levels. Pain is rated from 0 to 10 (10 being the worst pain ever). We always want to manage your pain effectively. You may have:

• IV medications / PCA
• Epidural
• Oral medications
• Possible side effects will be discussed
• Please notify us of any allergies!  

<Back to Table of Contents>

During Your Stay

The average hospital stay is about 5 days.

Exercise Classes and Physical Therapy

Activity: We recommend that you wear supportive, comfortable shoes during your physical therapy. Your physical therapist will work with you during your stay and will progress you with exercises and ambulation. You will receive physical therapy two times per day.

Equipment: Your physical therapist and case manager may advise you and assist you in obtaining equipment you may need at home. Equipment will be delivered either to your home or the hospital.

Education: You will receive ongoing education about exercises, precautions, medical equipment and medications. Your case manager will arrange for your family to come in prior to your discharge for education, if needed.  

Exercise Classes and Your Physical Therapy

Total Knee Replacement patients: The day after surgery, the physical therapist and nurse will treat each patient individually, depending on what your physician has ordered. We suggest that you ask the nurse for pain medication ½ hour before exercise class begins. This will help you reach your flexion and ambulation goals with less discomfort and help ensure a speedy recovery!

Total Hip Replacement patients: You will be instructed by your physical therapist and nurse on an individual basis in total hip precautions and certain exercises, ambulation and transfers out of bed. We suggest you ask your nurse for pain medication ½ hour before exercising begins. This will help you in meeting your ambulation goals quickly and comfortably.    

Total Shoulder Replacement patients: You will be instructed by your physical therapist and nurse on an individual basis in total shoulder precautions and certain exercises, ambulation and transfers out of bed. We suggest you ask your nurse for pain medication ½ hour before exercising begins. This will help you in meeting your ambulation goals quickly and comfortably. Also, you will wear an arm sling during the day for the first several weeks after surgery, per your physician’s instructions.  <Back to Table of Contents>

Discharge

Discharge Planning and Your Plan of Care
After Discharge
Transportation
Ice
Incision Care
Pain Medication
Other Medication
Difficulty Sleeping
Poor Appetite
Stairs
Shoes
Showers
Driving
Getting Back to Work
Other Activities
Airport Metal Detectors
Call the Doctor!
Your Diet and Nutrition -- Plan Ahead!

Usually discharge is planned by your physician, based upon your needs. If you are in need of further rehab before going home, the physician may recommend you go to a skilled nursing facility or acute rehab facility. If you are able to go home, the physician frequently orders a home health physical therapist for you. Please take home all exercise handouts given to you by your therapists. Continue to perform your exercises as directed.

Discharge Planning and Your Plan of Care

The case manager will help coordinate your care, should you require placement in a rehabilitation facility, home health care, a lower level of care or medical equipment. Your case manager will also be able to assist you with any resource information regarding home health, transportation, medical equipment, meals-on-wheels and other community services.

We recommend that you arrange for a "Care Person" for 2 weeks after your discharge to check on you and help you (i.e. your spouse, friend, family, or hired care taker). Please have the "Care Person" arranged and confirmed prior to your surgery.

After Discharge

Your program of physical therapy is necessary to continue during your early recovery period. Frequently, the physicians will order follow up care at home such as a home health physical therapist. If your physician determines that you cannot return home immediately, acute rehab or a skilled nursing facility may be recommended. Every day you should walk at least 200 feet, bend your knees 90 degrees 10 times, do 30 leg lifts and exercise daily.

Transportation

For your safety after surgery, hospital policy requires that you be released to a reliable adult who can drive you home. You will not be permitted to drive yourself home after surgery.

If you are unable to arrange your own transportation to and from the hospital, please call our Admitting Department at (714) 524-4872 one or two days before your surgery to arrange for free local transportation within a 10-mile radius.

Ice

Ice is helpful to relieve pain and swelling. Apply to the knee 3 to 4 times daily for 20 to 30 minutes. This is effective, especially after physical therapy.

Incision Care 

Your incision will have staples and be bandaged for approximately 8 to 10 days after surgery. Once the bandages have been removed, keep your incision clean by wiping it daily with rubbing alcohol. Do not apply any oils or creams to your incision. There should be not be an increase in drainage from the time that you left the hospital. The skin edges may appear red or irritated due to the staples. Once the staples are removed, the redness will gradually decrease. Redness that spreads beyond the staple line should be reported to your surgeon. Bruising and blood under the skin will gradually go away. Keep water off your incision until the staples are removed (18 to 20 days after the date of your surgery).

Pain Medication

Your doctor may give you a prescription for pain. Take your medication as directed on the label. If you feel you need a refill, please call the pharmacy and the pharmacist will contact your physician office. You can begin to substitute Tylenol or Advil for the prescription at any time. If you take aspirin, do not take more than 2 tablets within 24 hours.

Other Medication

Unless otherwise directed, you should resume any regular medication. You should drink plenty of fluids and eat fruit to prevent bowel problems that are sometimes caused by medication.

Difficulty Sleeping

Many folks have trouble sleeping for the first 6 weeks after surgery. We recommend you take Benadryl, an over the counter medication, if you do not have glaucoma. Check with your physician prior to taking medication. Also, you may want to limit your intake of caffeine (coffee, tea, chocolate) and try to stay awake during the day. Warm milk may also help.

Poor Appetite

A combination of pain medications and vitamins may create a temporary loss of appetite and even upset your stomach. Light, non-fatty foods are more easily digested. But, please don’t forget to drink plenty of liquids. Please refer to the "Preparing Your Home" section for more information on meal preparation ahead of time.

Stairs

During the first few weeks after surgery, you should learn to walk stairs with a physical therapist or nurse in your home. The pace at which you regain agility on stairs depends on individual traits and is hard to predict.

Shoes

High heels should be avoided for the first three months. A well fitting, flat, closed-toe shoe is safest. A good example would be a tennis shoe or sneaker. Slip on shoes or sling backs tend to slide off your foot and may cause you to lose your balance.

Showers

You may take a shower once the staples have been removed, which is in approximately 8 to 10 days. Keep water off your incision until the staples are removed (18 to 20 days after the date of your surgery). The bandages need to stay dry so you will need to cover the area with a plastic bag, attached with rubber bands, for example, to make sure it does not get wet.

Driving

Your surgeon will let you know when you can drive. It is usually 4 to 6 weeks after surgery. You should not drive while you are taking pain medication.

Getting Back To Work

Getting back to work depends on how quickly you heal and on how much demand your job puts on your new knee or hip. It is not unusual for someone who does a lot of walking, standing or physical labor to be off work 3 to 6 months. Someone who has a desk job and can park their care close to the office may be able to return to work for a few hours each day as soon as 3 weeks after surgery. Your doctor and the therapist will help you decide when you are ready and strong enough to return to work.

Other Activities

Within a few months, you may resume activities such as limited walking, swimming, golf, dancing and low resistance bicycling. Total Knee Replacement patients can slow dance in six to eight weeks and play golf in ten to twelve weeks after surgery. After surgery you can expect gradual improvement for the next 18 months. You can look forward to less pain, stiffness and deformity. You will begin to enjoy the activities of daily living with more comfort and move toward a more independent lifestyle.

Airport Metal Detectors

The sensitivity of metal detectors varies and it is unlikely that your prosthesis will cause an alarm. You should carry a medic alert card indicating you have an artificial joint, just in case.

Please be sure to call your physician office immediately if you have:

• Increased pain
• Swelling not reduced by elevation
• Incision drainage
• Wound opening
• Bright red blood
• Calf or groin pain and tenderness that is not lessened by elevation
• Fever (anything over 100 degrees)

Your Diet and Nutrition – Plan Ahead Before Your Surgery!

• Eat a variety of foods
• Include vegetables, fruits and grains in your diet
• Control fat and cholesterol intake
• Eat only moderate amounts of sugar
• Maintain a healthy weight
• Use salt only in moderation, and limit your sodium intake
• Drink alcohol only in moderation

Placentia-Linda Hospital will make every effort to provide nutritious meals for you during your hospital stay. We can accommodate special requests and dietary needs at your request.        

All of us in Placentia-Linda Hospital’s Orthopedics Department look forward to taking part in your recuperation. From a rose at your bedside to our "I have time" attitude and quality care, if there is anything we can do for you and your family during your stay, please feel free to use your nurse call light or call the Operator (dial "0") and have the House Supervisor paged.

For further information, you may also contact the Arthritis Foundation, Southern California Chapter, at (714) 436-1623 or on the internet at www.arthritis.org.

Thank you for choosing the Orthopedics Department at Placentia-Linda Hospital. We are honored to have the pleasure of caring for you and get you on the road to recovery as soon as possible!  

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