Clinical Pathway

Day of Surgery

• you will return to 4 Irving after surgery
• blood pressure and pulse monitored
• bedrest
• do ankle pumps, glut sets and quad sets (exercises 1, 2 & 3)
• begin breathing exercises and use inspirex when awake
• Intravenous catheter (IV) for fluids and medications
• oxygen if needed
• a drain may come from your surgical dressing
• you will receive pain medication; let your nurses know how your medication is working
• you can begin to drink and then eat as your stomach allows
• let us know if you are nauseated
• ice bag to your knee
• you may have a machine, Continuous Passive Motion (CPM), ordered by your doctor to move your knee

Post Surgery Day 1

• increasing self care
• physical therapy evaluation for exercise
• your physician will have you get out of bed, sit in a chair, and walk
• continue exercises
• use an inspirex and deep breathe to keep your lungs clear
• oxygen may be discontinued
• continue to eat and drink as tolerated
• review your plans for after the hospital
• you will be able to put full weight on your leg when walking, unless otherwise indicated by your physician
• wear TED stockings during the day and off at bedtime

Post Surgery Day 2

• you will start on oral pain medication, which you will need to ask for
• IVs discontinued
• self care
• continue exercises and work on range of motion
• goal is to walk 20 feet with walker
• sit in a chair with arms to assist with transferring
• physical therapy 2 times a day
• continue deep breathing
• drink extra fluids and add fiber to your diet to prevent constipation
• the incision drain will be removed
• bulky dressing removed by physicians
• ice can be used 20 minutes on, 20 minutes off your knee
• after the large dressing is removed, you may use a pillow under your heel or calf only to straighten your leg
• no pillow directly under your knee

Post Surgery Day 3

• ask for your pain medication as needed, especially 1/2 hour before therapy and before sleep
• goal is to walk at least into hallway
• physical therapy 2 times a day
• up in chair for meals
• continue coughing and deep breathing
• the discharge planner will see you regarding equipment, help at home or short term rehabilitation, if necessary

Post Surgery Day 4

• continue to increase walking endurance
• sit in chair
• total self ADLs (Activities of Daily Living)
• goal: normal bowel movement within last 72 hours; if not, medications are available
• learn stairs, if applicable
• continue exercises
• avoid using a footstool when sitting so that gravity will help with bending your knee
• goal: to be able to walk to your bathroom, do your exercises and take care of your personal needs to go home with a family member or friend
• goal: to be able to get in and out of bed on your own
• possible day for discharge

Post Surgery Day 5

• you will be discharged on an anticoagulant to prevent blood clots
• use the pain medication for discomfort, as needed
• range of motion of your knee should be 70°
• apply ice to your knee after exercising to reduce swelling

Within 1 Week Post Hospital

• if home care services have been arranged, a home health nurse will call you within 48 hours.
• if you are going home on coumadin, blood draws will be arranged for 2 times a week with the results called to your doctor for 1 month
• take your pain medication as needed
• continue active range of motion/knee bending exercises taught in the hospital
• increase your walking as tolerated with crutches, walker, or cane
• schedule your post-op visit with your doctor
• your balance may seem unsteady at first but will improve as you progress with walking
• take your temperature daily and when feeling hot or chills. Record your temperatures and bring to your office visit
• appointment with physical therapy: either outpatient or home
• continue with your TED stockings

Weeks 2 and 3

• a visit with doctor or nurse to have staples or sutures removed, usually in 7-10 days
• you may shower 24 hours after staples are removed, or earlier if doctor allows
• lab technician to draw blood if you were discharged home on coumadin
• continue exercise and walking

Post 3 to 6 Weeks

• continue exercise and walking
• check return appointments with your doctor
• discuss the physical activities that you can return to after your recovery
• discuss driving an automobile when you have full, complete control over the leg and no pain with motion
• tone your thigh muscles, which have the greatest control over your new knee
• goal 110° 90° to go up and down stairs

Tips

1.Remove scatter rugs to avoid tripping on them.
2.Sit on a high stool or chair instead of standing for any lengthy tasks.
3.Use an apron with many pockets to transport objects. Slide objects along the countertop rather than carrying them.
4.Plan easy meals in advance to avoid frequent shopping.
5.Wear low-heeled shoes.
6.Use a utility cart to carry items from place to place; push it ahead of the walker.
7.Sit in chairs that have arms.
8.Get up and walk around every hour or so to prevent stiffness and increase circulation to your legs.
9.Use handicapped bathrooms at public facilities.
10.Stairs with hand rails are best.
11.Store items at the height of your knee and shoulder.
12.Plan each day by setting priorities and eliminating unnecessary tasks.
13.Elevate operative leg above heart frequently to avoid swelling.
14.Walk slowly and do not rush to answer the phone.

Tub Transfer

• Put a tub chair in your tub facing the faucet.
• Back up to the side of the tub and sit down on the chair.
• Swing legs around and into the tub, one leg at a time.
• May use a shower if available.

Car

• Move the seat all the way back and recline the seat.
• Back up to the car with the walker.
• Lower yourself slowly to the seat.
• Push yourself back onto the seat.
• Turn to bring one leg at a time into the car.

Toilet Transfer

Using a regular or raised toilet seat:

• Make sure the toilet paper is within reach.
  
• Back up to the toilet seat until you feel it against the backs of your legs.
  
• Reach back with one hand at a time to the edges of the toilet seat.
  
• Lower yourself by bending your good leg.

A toilet transfer using a commode chair is just like using a regular armchair.

Sitting

When sitting:

Move operated leg forward, reach back for the chair, one hand at a time, and lower yourself slowly.

When standing from a seated position:

Push up from the armrests or the surface seated on. Push yourself up. Gain your balance before taking hold of the walker.

DO NOT:

Pull up on the walker when rising - it could tip.

Bed

1.Sit down on the edge of the bed.
2.Slide yourself backwards on the bed.

• Bring your legs around and onto the bed.
• You can use your good leg to assist your operated leg, if no previous Total Hip Replacement.

Stairs Using Crutches

Up With the Good, Down With the Bad

• UP: Up with the good leg first, sore leg second, crutches last
• DOWN: Down with the crutches first, sore leg second, good leg last

Walker

• All 4 legs of the walker should be on the ground before taking a step.
• Take small steps when turning; do not twist on either leg.
• When walking, concentrate on bending at the knee when bringing your operated leg forward, just as with the good leg. Do not bring it forward straight.

Chairs

Use a firm, sturdy chair with armrests.

Exercises

1.Ankle Pumps

• Pump your foot back and forth slowly

2.Gluteal Sets

• Squeeze your buttocks together.
• Do not hold your breath.
• Hold for a count of 3.

3.Quad Sets

• Tighten muscles on top of thigh by pushing back of knee down against the table or bed.
• Hold for a count of 3.

4.Short Arc Quads

• Lie on back, towel roll under knee.
• Lift foot and straighten
• knee.
• Do not raise thigh off roll.
• Hold for a count of 3.

5.Heel Slides

• Lie on back.
• Slide heel to bottom, bending your knee.

6.Straight Leg Raise

• Tighten stomach muscles and slowly raise locked leg 8 to 12 inches from floor.