Joint Center Pre-Op Education Classes

Dawn Brooks: Hello, and welcome to the online presentation of the pre-op joint replacement class presented by Lee Health. I am Dawn Brooks, and I am one of the nurses from the Joint Center on the orthopedic unit. The next several segments are designed to help you prepare for this surgery, and we invite you, your family, friends, or caregivers to watch this presentation with you. This is designed as an overview of what you can expect, and the content is the same as the live presentation. At the end, we will give you a series of phone numbers for you to use for any additional questions or concerns. Our goal is to help you prepare for the surgery, answer questions that you may have, and hopefully reduce the amount of anxiety you and your family feel as you prepare for the surgery. Let's get started.

So, the plan is to cover all the listed items. These include: planning ahead for your surgery; the exercises you need to do before, during, and after surgery; as well as the pre-op and post-op plan of care. We will go over what you can expect once you're in the hospital and how to recognize and prevent possible complications. And finally, we will review what you can expect as you go home and continue the process of recovery.

You should have received a guide book from your surgeon. This book is also available online on the Lee Health website. Please read this book carefully as it details many of the things we will discuss today. There is also a page to help you list your medications, to make it easier to gather information for your pre-op appointment. And, we'll also help our pharmacist answer any questions that you might have in regard to the administration of those medications while you are in the hospital.

Our surgeons require that you have someone stay with you for at least 72 hours after surgery, and this makes sense. You will have had anesthesia and pain medications, and you will need help at home. Imagine trying to make yourself a cup of tea and get to the table while using your walker. So, having someone to assist you is a crucial part of your recovery. We call that person the coach. We know from experience that having this second person helps create a faster recovery, as they're a second set of ears for instructions, can help record and keep track of medications that you are taking, and will be there to help recognize and prevent complications. We invite and encourage this coach to be a part of the complete process. There are situations where a patient may not be going home, but is going to a short-term rehab facility after discharge from the hospital. We will discuss this later in the presentation.

The first thing that we will discuss is home preparation. This is a big surgery, and you will be using a walker for about three to four weeks once you are home. Also, think about food preparation, especially if you are the person that primarily prepares the meals in your household. Prepare some meals ahead, perhaps freezing some high-protein meals that you like and are easy for your caregiver to help prepare. Also, stock up on snacks. Protein drinks are helpful, as well as crackers for nausea, and prunes or prune juice, or stool softeners to help prevent constipation. Pudding cups are a great idea for taking medications that require food when you may not feel like eating. Make sure that you have changed the sheets on your bed the night before surgery, as you will be doing a special shower the night before and the day of surgery to reduce the risk of infection.

Be sure to clear away any rugs or furniture that could cause you to trip or fall with your walker. You may need nightlights for finding the bathroom. Arrange for someone to collect your mail and to care for your pets, especially those that may jump on you or create the potential for falls. Make sure that you have a comfortable chair to sit in after surgery. We use a recliner in the hospital and you should plan to have a comfortable, sturdy chair with arms. You may want to purchase a stool to help elevate your legs if you don't have a recliner at home. Arrange for transportation to and from the hospital and to any appointments that you may need to make. Expect that you will not be driving for at least three to four weeks, depending on your recovery.

You can expect to be using a two-wheeled walker for several weeks after surgery. It is our recommendation that you get this ahead of time. Some patients may already have a three-wheeled walker with a seat and breaks, but most of our orthopedic physicians do not want you to use that in the early stages of your recovery. If you have a walker with tennis balls or a slide on it, that's fine. If your walker does not have wheels, these can be purchased at most pharmacies. The wheeled walker helps you roll the walker and helps to create a gentle glide as you walk, rather than lifting it with each step. You should also look carefully at your toilet. Are there grab bars or an elevated seat? The commode pictured here can be purchased, but usually most insurances will not cover the walker and the commode. The commode is designed to fit over your existing toilet to add height and arms, to ease with getting up and down. Finally, we suggest a large garbage bag, which will help you slide into your car on the day of discharge.

Kimberly Trapan...: Hi, I'm Kimberly Trapanese, And I'm another one of the nurses from the Joint Center in the Orthopedic Unit. The next segment is designed to help you understand the preoperative process here at Lee Health.

You can expect to get a call from our pre-op nurse. About one to two weeks prior to your surgery. Please have a complete and accurate list of all medications that you're taking, including all doses. Make sure to add your supplements and any medications that you may take only occasionally, things like an allergy pill or something you might take for your stomach. Be sure to add these as your orthopedic surgeon will be using this list to order your medications while you are a patient in the hospital. You do not bring any medications from home.

Once this interview is completed, the anesthesiologist will review your history and medications, and may request that you see your general physician for surgical clearance or cardiologist, depending on your history. The pre-op nurse will also set up your preop testing appointment. At this visit, you will have labs drawn, may have to give a urine sample, and we may swab your nose to check for early signs of an infection. You may have an EKG or chest x-ray depending on your history or physician preference.

You will also have access to an orthopedic nurse navigator. This person is available to you for any questions, concerns, or issues. And the phone number is listed on the Lee Health website, and also at the end of this presentation. Be sure to contact him or her for anything that concerns you. The entire job of the navigator is to be here for you.

Be sure to partner with your physician. Let them know of any concerns such as a history of infections or a recent scratch, burn, or injury. Many patients are afraid to share this information, thinking their surgery will be canceled. This is rarely the case, but instead gives the physician an opportunity to treat something in advance that could become a devastating complication later on in your recovery. Make sure to follow all preop instructions and keep hydrated before your surgery. You will be given instructions on when to stop food and drink prior to your surgery, but helping to increase fluids in the days before your surgery can prevent postoperative dehydration. Be sure to reduce alcohol consumption as this can be dehydrating as well. Also, constipation is a real concern for most people after this surgery. Be sure that you have had a bowel movement at least one to two days prior to your surgery.

You will be given instructions on which medications to stop taking prior to your surgery. Surgeons generally recommend that you stop most medications that have the potential to cause bleeding both during and after surgery. Therefore, it's suggested that you stop most over the counter herbal medications. This would be things like Glucosamine, multivitamins, red rice yeast. You should stop any over the counter NSAIDs, such as Aleve or ibuprofen. Please be sure to keep these medications on your list so we can tell when you can resume them. Remember, we're not talking about your prescription medications. You continue to take them as instructed.

If you are taking a blood thinner that's ordered by your primary care physician or your cardiologist, you should receive specific instructions on when to stop them. And our unit pharmacist will work with your doctor to resume them as soon as it is safe to do so.

Most of our physicians agree it is okay to take Tylenol, Mobic, which is Meloxicam, or perhaps Celebrex. It is okay to continue to take your prescription pain medications, but there was a recommendation that you cut back if you are taking large amounts of narcotic. Cutting back ahead of time will help treat pain in the early part of your recovery. Also, be honest with your orthopedic surgeon. If pain has been an issue for you prior to surgery, or you are taking large amounts of medication, or more than may have been prescribed, let your physician know. It will give the physician an opportunity to plan ahead to address your specific pain needs.

You will receive a call from the preop area the night before your surgery, telling you when to arrive at the hospital. The recommended arrival time will be one and a half hours before the actual surgery time. If your surgery is on a Monday, you'll receive this call on Friday evening. During this call, you'll be advised of when to stop eating and drinking and which prescription medications you should take the morning of surgery. The example is that you may be told to take your heart and blood pressure medicines, but not your diabetic medicines, as you may not be eating or drinking before surgery. You will have been given a special soap to use the night before surgery and the day of surgery. You may shampoo your hair if you like, but use half of the bottle of soap from the neck down on the rest of your body. You'll do the same thing using the remainder of the soap on the morning of surgery. The science shows us that use of this preoperative cleanser used in the shower the night before and the day of surgery helps reduce the chance of a postoperative infection.

Some patients will be going home the day of surgery directly from the recovery room. If this is the plan, you will discuss this prior to surgery and your family will be invited into the recovery room to prepare for the discharge activities, including physical therapy prior to going home. But for most of you, joint replacement is an overnight surgery. Therefore, there is not a lot to pack. We suggest you come into the hospital in clean, loose fitting clothes, something that is easy to get on and off, nothing tight or with belts or buckles. Many patients will wear this same outfit the next morning after surgery. It can get cool in the rooms and in the gym, so please bring a sweater as well.

Cell phones are permitted in most areas of the hospital. So, you are welcome to bring your phone and it will be kept with your family member during surgery. We have wifi available in all areas of the hospital. Distraction items, such as sleep masks, headphones, or earplugs are encouraged if noise can be a challenge for you. If you use a C-PAP machine at home, please plan on bringing the mask, facial prongs, and tubing, and we will provide the machine for your use while you're here with us. If it is valuable, leave it home. We can lock things in the hospital, security safe, but this is time consuming and still may have the potential for problems.

Do not bring any medications from home. All of your medications will be ordered by your physician and administered by nursing. All campuses are 100% smoke free. This includes vaping and e-cigarettes and any type of tobacco products. All patients, families, visitors, and staff cannot smoke in the building or on the property at any of our facilities. Finally, you'll be provided with slipper socks. Most patients will get fully dressed the next day after their surgery, so there's no need for slippers, robe, or pajamas. If you stay an additional night, most patients will get back into a patient gown to sleep in.

Kimberly Trapan...: Hello, I'm Kimberly Trapanese and I'm one of the nurses from the joint center on the orthopedic unit. The next part of this presentation is designed to help you understand what you can expect while you're here with us in the hospital. We strongly encourage your family, friends, and caregivers to watch the section with you. Let's continue.

On the day of surgery, you will wake up and take your medications as directed with a sip of water. You will arrive at the main entrance and report to the registration area. This will be a quick process as you are already in our system. You'll be escorted to the pre-op area and checked in by the surgical team. Your family member will be asked to wait as we take you back and weigh you, start your IV and continue preps that are needed and make you comfortable. We will then invite your family member back to stay with you.

Together, you will meet the anesthesia team, review consents and meet with your physician for any additional questions. Your family member will then be escorted back to the waiting area once your surgical team is ready. In the waiting area, they will be given an ID number to help track your progress through the OR. The waiting area will also collect contact information, so they may be notified as soon as the surgery is completed. The family would be contacted when the surgeon is free to talk with them. If the surgeon is unable to come out, the waiting room personnel will provide an update to the family until the physician is available.

Once surgery is completed, it may take several hours in the recovery room before the patient is ready to go to their room. You will be provided with updates as they become available. If the patient is scheduled to leave from the recovery room, the family will be brought back to the recovery room as soon as the patient is awake. Patients who are leaving the same day will have an evaluation by a member of physical therapy in the recovery room and therefore a family is encouraged and expected to participate. Most patients will receive general anesthesia for their surgery.

Some patients may be considered for a spinal anesthetic with sedation. This discussion continues with you and your anesthesiologist, but most of our patients will receive a general anesthetic as they will be walking soon after they arrive to their room. Some patients may also have the choice of receiving a nerve block. This is usually physician's choice and administered by an anesthesiologist in the pre-op area after the patient has received some sedation, you and your family will have plenty of time to discuss this with anesthesia while you were in the pre-op area.

For knee replacement patients, you may be offered a single shot nerve block, or you may receive a block administered by a catheter that will be attached to the front of your thigh. This catheter may be attached to a pain pump immediately after surgery. More information on the pain pump is available on the screen, and you will find videos to review online. If you're having a pain pump or a block, you and your family will meet with the block nurse prior to any sedation to review the block and all of the equipment. Depending on the surgeon, you may receive a shot nerve block.

Again, this will be discussed with your surgeon at your pre-op appointment and again with anesthesia at the time of surgery. Some surgeons use a numbing agent at the site of the hip replacement, and therefore do not use a standard block. There are no pain pumps for hip replacement. We use a multimodal pain approach. This is a combination of blocks if ordered in different types of narcotic and non-narcotic pain meds in the initial post-operative period. We use IV pain meds until the patient has tolerated some food and drink.

Once diet is tolerated, the patient will be offered different types of pain pills, depending on physician preference. We also use a combination of Tylenol and anti-inflammatory medications ordered in alternating doses to help reduce the amount of narcotic that may be needed. We use lots of ice as our cold therapy, and the recommendation for home cold therapy is to apply ice every two to three hours for at least 20 minutes to help reduce swelling and bruising. You should plan to have a method of cold therapy at home, and there are many products available.

Finally, we use aroma therapy to help reduce nausea and anxiety in patients that may be prone to these types of post-operative problems. Be sure to partner with us ahead of time to discuss any anesthesia or pain medication complications that you have had in the past. We know that your concerns about pain management is one of the worries from our patients and their families, so we ask you to think about this. We try and understand your pain needs by asking you to identify your pain number in a scale from one to 10, with 10 being the worst pain you've ever had in your life.

So what's your usual pain number? Most people wouldn't be having this surgery if they weren't having pain every day. So what's the pain number that makes you sit down, put your leg up, ice it down or take a pain pill? And that number is different for everyone and everyone treats those numbers differently. Some patients have had pain every day and never take more than an aspirin. Others may need pain medication every single day. So in order to keep you safe, we need to know how your pain usually is and how you treat it.

Physicians order medications for postoperative pain and it is the job of the nurse to partner with your pharmacist to find out what works best for you. Some patients cannot or do not want pain medication. Others can not take the medications that the doctor has ordered for them because it makes them sick or drops their blood pressure. It is our job to find out what works for you and to advocate to the physician on your behalf. But recognize that pain after joint replacement is different for everyone.

For some patients, they may have had so much pain before surgery because it was bone on bone. And although they have incisional pain after surgery, they're able to deal with that pain with just our multimodal non-narcotic pain medications. Others will find they need more medications than they expected. We know that best way to help you recover is to get you moving. Most patients are encouraged to remain in their recliner chair during the day. This helps with ankle pumps, positioning and easing when standing to go to the restroom.

There may be some things that hold us back such as nausea or problems with blood pressure, but we will help you to see that the sooner we get you moving, the better you will feel. Ask any joint replacement nurse what our biggest concern is, and they will tell you patient safety. You have had anesthesia and perhaps pain medications and it can cloud your judgment. Many times you may try to convince yourself or your family member that it is safe to get up on your own. It is not safe. There is nothing worse than getting up by yourself and then falling on your new joint because you wanted to pull up your own pants.

Please use your call bell at all times. It is our job 100% of the time to get you up each and every time. The patient is allowed to eat or drink whenever they want to, but nursing reminds you to go slowly. Anesthesia and pain medications can bring on nausea and vomiting without warning, so we try to go slow, jello, ginger ale and crackers, then soup and puddings until you're ready for a full meal. Many patients will lose their appetite for several days after surgery. If you have little snacks or protein bars that you like, pack them in your bag and bring them with you so you have them readily available.

You will be given lots of written information about your new medications and potential side effects. Your therapist will discuss your plan of care for therapy with you and your family. Most of you will be going to the gym for joint camp therapy. In the gym, we have the ability to teach the exercises, car transfers, and steps or stairs, depending on the need of the patient. We find that having the coach in class working with the patient is incredibly important to a successful transition to home. After arrival to the floor, most patients will meet with their physical therapist.

This is usually done at the bedside. Depending on how you're feeling, some patients will be placed in the recliner rather than in the bed. This makes it easier for you to get up to use the urinal or the bedside commode. If cleared by therapy, some patients will be allowed into the restroom, but for many, the side effects of anesthesia may require the patient to recover a bit more before these transfers are considered safe. Your therapist will assign you to a class for the next morning. Be sure to make sure that your family member is available to be there for that class.

For those who do not have a coach or for those going into rehab, the therapy department may have a coach available for you in class. Today, you are expected to rest and relax the rest of the day and help sleep off the anesthesia. Family is welcome to stay or head home, whatever's best for both of you. Later in the day, depending on how you're feeling, you'll be up walking with your nurse in the room or in the hallway. You'll be getting regular meals and your family can bring you anything to eat, unless you are on a restricted diet.

During the night, we will have continued to check your vital signs and have drawn some blood to check for your blood counts and your electrolytes. The nurse will change your dressing and you can expect to see your incision. You'll have some bruising and possibly some bleeding from the incision. You will get up and fully dressed, and most patients will eat breakfast in the recliner. You'll be having your morning medicines and perhaps a pain pill and use the restroom before class. Your therapist will come to the room to take you to the gym for joint camp class.

Most patients will be going home after this first therapy class. Your orthopedic surgeon will have made rounds before that class. And if your lab work and vital signs look good, the discharge order will have been written along with any prescriptions that are to be filled. Behind the scenes, your case manager will have been making arrangements for your home physical therapy, which will begin the next day after discharged to home. If you still need equipment, please make sure it is addressed upon admission to the unit so that we can assist you in getting what you need.

Your prescriptions can be filled here and you will pay the same co-payment that you would pay anywhere else. We strongly encourage you to have your scripts filled here to prevent problems that can occur at an outpatient pharmacy. These include having your pharmacy not have the required drug or the quantity that you need or problems with the script, such as issues regarding price, insurance, and co-payments. In the week before surgery, all patients will receive a call from the hospital to review the plans for discharge. This will discuss your home environment, living situation and equipment.

There is always a case manager on the unit and they are working behind the scenes after your arrival to set up any home health and home physical therapy. The case manager and your bedside nurse will review equipment and discharge plans and address any concerns that may impact your discharge plan. All joint center patients will work with a physical therapist and your physician may ask an occupational therapist to be involved in your treatment plan. Based on the plan of care, recommendations are made for home or a possible need for inpatient rehab.

Please keep in mind that the case managers can assist with setting up a rehab center, but your insurance company will make the ultimate decision on where and when the patient will go. Also, please keep in mind that insurance companies do not become involved in social issues, such as a lack of caregiver, caring for pets or stairs at the home. These are issues that you will have to address before admission. If you know in advance you need inpatient, skilled nursing rehab, you must speak with your physician from the beginning.

It is recommended that you check with your insurance to determine length of stay and copayments and visit those facilities ahead of time. Many have waiting lists even for scheduled surgeries, so it is advised that you have three choices to give to a case manager at the time of admit. At the end of this presentation, you will be given phone numbers for case management departments at each campus should you decide that you need assistance with rehab placement.

Robert Vega: Hi there. I'm Robert Vega, and I'm one of the nurses from the Joint Center on the orthopedic unit. This final segment is created to help you understand and recognize potential complications. It will also give you an idea of what to expect during the first month after joint replacement surgery. Please make sure to share this information with your caregivers so they can assist you in your recovery.

Blood clots. We know that people can get blood clots just from long travel in a car or from riding on an airplane because of lack of mobility. Joint replacement surgery and the lack of mobility puts you at risk for a DVT, which is a deep vein thrombosis in your leg. It could happen in either the operative or the non-operative leg. That DVT can then travel to the lung and cause a PE, or pulmonary embolism. The risk of these complications is greatly reduced by the use of anticoagulants and mobility. That is the main reason that we get you up and moving so quickly. Ankle pumps are critically important as they pump the blood back up the leg. We use STDs or foot pumps that wrap around the legs to assist in this. Some surgeons encourage the use of compression stockings. If your surgeon uses compression stockings, you will have them placed at the time of surgery.

In addition to these things, hydration is critically important to prevent a blood clot. Dehydration can thicken the blood and cause it to clot. Be sure to take your water pitcher home and drink often. And finally, you are encouraged to get up and move around often, using your walker at all times for safety.

By the time you leave us, most of you will have seen your incision. The exception is those who have a physician that uses specially coated dressing that does not come off until their follow-up appointment. We will give you specific instructions about showering and dressing changes in your discharge paperwork. Some doctors will allow you to shower and get the incision wet. Others want you to wrap the incision in Saran wrap to prevent it from getting wet. If you have a pain pump in place, you will want to wait until the pain pump is removed before showering. The most important things to remember are to keep your hands clean and do not touch the incision until advised to do so by your physician or your therapist. Hand washing for you and your family are extremely important. If others are ill, ask them to stay away during your initial recovery.

And finally, if you are a diabetic, we will be working with you to keep your blood sugars down and expect that you will be checking those sugars at home and following up with your primary care physician if they become worrisome.

Prevention is the key, and the research shows that constipation will affect 60% of all patients, and up to 90% of patients who have a history of bowel problems. Be sure to stay hydrated and increase your fiber intake. Stool softeners are encouraged, and you should have them prior to your surgery for use when you get home. You may need to be taking them daily when you are on pain meds or until your bowel habits have returned to normal. You may need a laxative, and most over the counter laxatives are acceptable for use after surgery. Check with our pharmacist for any additional advice on bowel protocol.

Most of us take shallow breaths. During surgery, anesthesia gets down into the cells of the lungs and can cause complications such as atelectasis or pneumonia. The use of pain medication can also reduce deep breathing and coughing that helps to keep the lungs clear. The use of an incentive spirometer helps to remind you to take long, deep breaths that help to clear your lungs. To prevent complications such as pneumonia, the patient needs to use the incentive spirometer every hour, get moving, and do deep breathing and coughing. You will be provided with an incentive spirometer and should expect to take it home and use it as instructed.

You will be meeting with your therapist three times a week for about an hour. You should be doing your exercises twice a day. You will work on learning to dress and shower independently. You will be increasing your ambulation, and knee patients should be actively bending your knee to prevent the formation of scar tissue behind the knee. You will continue to work to stretch your knee to work on flection and extension. Hip patients will be working with their therapist to being maintain any hip precautions advised by your surgeon. You will be working with your therapist to custom design your recovery based on your goals.

Continue to improve and increase your endurance. Patients and families will continue to progress toward goals. Some patients will be able to move from a walker to a cane. Some may be able to drive depending on the type of surgical intervention and narcotic use. No swimming pool or hot tub, no beach or boating until you are cleared by your surgeon at your follow-up appointment. Your appetite should return to normal. You will have good days and an occasional bad one, but most patients will see a decrease in pain and an increase in energy and strength. Continue your followup appointments with your surgeon and call with any questions or concerns.

You will receive our phone numbers on the discharge instructions for any questions or concerns, but please do not hesitate to call at any time. We will be calling to check on you within the week, and you may get a survey to complete after discharge. Please take the time to fill it out and return it, as it truly does help us improve our program.

The following slide has the phone numbers that you may need. Please be sure to contact the correct campus where you are planning to have your surgery to make it a productive phone call. And finally, good luck with your planned surgery. We have been working hard to make this process as easy as possible for you, and we look forward to caring for you before, during, and after your surgery.

(Silence).

Speaker 1: Welcome to The Joint Center Class. Thank you for choosing us for your care. We would like to take a few minutes to demonstrate exercises you can begin prior to your surgery. These will be some of the same exercises you will do with us while you're here as a patient. We will also show you how to safely move about as you recover.

After your surgery, a physical therapist will evaluate you as soon as you are medically stable to determine your goals and develop your plan for recovery. This may be the same day for your surgery or the following morning. During your evaluation, you will get out of bed and walk with the assistance of a therapist. You may be transferred to a chair or assisted to use the restroom if needed. The day after surgery, you will begin attending the Joint Center classes. We will let you know the times of your classes and write them on the board in your hospital room. Every morning, the nurse will help you dress in loose fitted clothing and sit in a recliner chair. Please make sure you have used the restroom and received your pain medication before your class time.

Twice a day, you will walk to and from the gym and perform exercises with other patients who have had hip and knee surgeries as well. You will need a close friend or family member with you to act as your coach to assist you with your exercises and learn along with you during your class. Our goal is to help get you out of the hospital and onto the next stage of recovery safely and as quickly as possible.

If you have a total hip replacement, you may be limited with certain activities. Your therapist will discuss this information with you individually to ensure we address to your specific needs. A case manager will be assigned to you while you are in the hospital. This person will help you get the appropriate equipment for use at home. He or she can also set up discharge plans, including home health care or rehabilitation if you've decided to go to another facility before you go home. Here are some of the exercises we would like you to begin before your surgery. Ankle pumps, gluteal sets, quad sets, straight leg raise. Each exercise should be performed 20 times with a brief rest in between.

The straight leg raise is for patients having total knee arthroplasty. Patients, having total hip surgery will not perform a straight leg raise.

Ankle pumps. Pump your foot up and down from the ankle. You may perform this exercise lying down or seated.

Gluteal sets. Contract or squeeze the muscles of your buttocks together. Hold for 5 to 10 seconds, your pelvis will raise slightly when you perform this exercise correctly. Remember, do not hold your breath while performing these exercises.

Quad sets. Contract the muscles on the top of your thigh by pressing the back of your knee into the bed. Hold this position for 5 to 10 seconds. You may notice your foot rises slightly with this exercise as your knee straightens. Continue to breathe normally and do not hold your breath during these exercises.

Straight leg raise. Remember this exercise is only for patients having knee replacement. Hip replacement patients will not perform this exercise. To perform a straight leg raise, you will bend the knee of your non-operated leg and place your foot flat on the bed. Tighten the thigh muscles in your surgical leg to keep your knee as straight as possible, then slowly raise your leg six inches off the bed. Keep your toes pointed toward your face and hold your leg off the bed for five seconds. Slowly, lower your leg back down.

Using your walker. You will use a rolling walker while you are recovering from your surgery in the hospital. If you have been instructed by your doctor to use other equipment, we will be glad to address that with you on an individual basis. The proper way to use your rolling Walker is to move the walker ahead of you, then step halfway into the walker with your surgical leg, followed by your good leg. To walk backward, you will step back with your good leg first followed by your surgical leg, then pull the walker to you.

Getting out of bed. Bend your non-operative leg and slide your bottom toward the edge of the bed. Use your elbows to help push yourself up and your hands to support your upper body. Slide your legs over the edge of the bed and press up to a sitting position. You may need assistance to slide the operative leg and safely lower it over the edge.

Sit-to-stand transfer. Keep your surgical leg extended in front of you, press up from the bed, using your hands and supporting yourself on your strong non-operative leg.

Stand-to-sit transfer. Back up to the bed or chair until you can feel it against your non-operative leg. Extend your surgical leg outside in front of you, reach back for the bed with your hands and lower yourself to a sitting position.

These exercises are designed to aid you in your recovery. Patients who comply with their medical protocol recover more quickly. Thank you again for choosing us to help you return to your normal activities.