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Sydney Adventist Hospital
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Clinical Specialties - Rehabilitation

Going for Hip or Knee Surgery

Pre-admission and pre-operative processes

  • Patients are usually admitted to hospital on the morning of their surgery
  • Pre-operative investigations usually take place approximately a week prior to surgery either at the hospital’s Pre-Admission Clinic (PAC) or at a place of your doctor’s choice
  • At PAC, or on admission, you will have the hospital routine explained
  • During your visit to PAC you may see the Case Manager, a Physiotherapist and an Anaesthetist; otherwise your anaesthetist will see you on admission
  • Prior to or on admission you will receive a booklet with visiting times & services we offer
  • Your anticipated length of stay for a hip or knee procedure is approximately 5 days, however each person is different and recovers at a different rate
  • You may be shown how to use the PCA (Patient Controlled Analgesia machine). This allows you to safely administer pain medication
  • At the request of your doctor you may be measured for anti-thrombotic stockings. These help to minimise the risk of clots forming in your legs
  • Your blood pressure, pulse, temperature and weight will be checked prior to your operation
  • A Case Manager is available to discuss and help with any support services you may require after discharge. These arrangements are best organised prior to admission as they may require some time to arrange, including home help and safety equipment for example
  • Prior to going to theatre your leg will be prepared with antiseptic skin solution (Betadine); an allergy check will be done beforehand. Your knee or hip will then be wrapped in a sterile drape
  • It may be helpful if you prepare and freeze a few meals before your admission
  • Plan to order your groceries online or phone through an order for home delivery
  • Discuss how you will be getting home with your family

Hygiene and Mobility

  • Staff in PAC will give you a special foaming antiseptic wash to use in the shower the morning of surgery. Ensure you wash your entire body, including skin folds below the neckline. DO NOT mix with other cleansing / washing solutions. Avoid contact with eyes.
  • Please DO NOT use powder or creams etc after showering
  • Clipping the hairs on your leg will be done in hospital
  • If you use a walking aid please bring it with you, labelled with your name
  • Keep your bowels regular pre-operatively

You will be free to walk around prior to your surgery, however we request that you do not leave the Surgical Centre area. Footwear must be worn at all times when mobilising.

Nutrition

  • AM Surgery – NIL BY MOUTH from 12 midnight
  • PM Surgery – Light breakfast (eg Tea and Toast) at 6AM and then NIL BY MOUTH, unless otherwise instructed by your Doctor or nursing staff
  • Please let staff in the Pre-Admission Clinic (PAC) know if you are a Diabetic 
  • You may require a special bowel preparation the evening before surgery if ordered by your Doctor.

After Your Hip or Knee Operation

When you return from theatre you will have:

  • A 'drip' in your arm delivering fluids (IV fluids, antibiotics & possibly pain relief)
  • You may have a tube from your wound to drain any blood loss from the surgical field
  • You may require oxygen which will be administered through small nasal prongs, as narcotic drugs which you may be given can reduce your respiration rate
  • You may have a urethral catheter connected to a bag on the side of the bed for drainage of urine from your bladder
  • A waterproof dressing over the wound area

Mobility starts the day of, or the day after surgery. Staff will assist you when getting out of bed for the first time.

Staff will regularly check:

  • your catheter and urine output
  • your blood pressure, pulse, temperature and oxygen levels
  • your dressing and any drainage tube that may be present
  • the fluids going into your vein
  • your pain level and the effectiveness of your pain relief
  • circulation device (SCD) used to assist in preventing clots

Over the next one to two days your IV fluids and pain relief machine (if used) will be removed. You are encouraged to do leg exercises and deep breathing exercises. If required by your doctor the anti-thrombotic stockings are worn throughout your stay in hospital and should be taken home and worn until you are fully mobile.

Visiting Hours

Visiting times on the Ward are 11.00am to 8.00pm. Please note that visitors may be asked to leave the room for important treatments such as physiotherapy or nursing care.

Medications

You will be offered regular pain relief. This may come in a number of forms including injections, through a drip (PCA) or tablets. Please let staff know if your pain relief is NOT adequate. You may have a degree of discomfort but should NOT have uncontrolled pain. Your regular medications will be recommenced once you are drinking and eating.

Hygiene and Mobility

  • As you will have a number of tubes attached we ask that you remain in bed until nursing staff are able to assist you in getting out of bed for the first time.
  • You will have a wash in bed the first and second day, and on the the third day you may shower
  • For your first shower a staff member will assist you, and then you may shower independently if you and the nursing staff are comfortable
  • Mobility commences with a nurse and physiotherapist assistance, with a forearm support frame
  • If you feel you need further assistance please don’t hesitate to ask the nursing staff

Nutrition

  • You may be given a light diet initially but should proceed onto a normal diet reasonably quickly. 
  • It is important you have a good fluid intake
  • After your catheter has been removed the nursing staff will monitor your urine output for 24 – 48 hrs
  • Please let staff know if you are having any problems with your urine or bowels as pain medication can cause constipation.

Procedures prior to discharge home

  • Staff will return any medications and X-rays you brought with you
  • Any staples / clips need to be removed by either your GP or surgeon when instructed. Dissolvable sutures will have their ends cut prior to discharge. Your nurse will confirm your instructions with you
  • Please arrange transport for a 10am discharge time
  • Your doctor will advise of post op visit four to six weeks following your surgery.

Minimising the risk of Blood Clots

Partial immobility during your hospitalisation places you at risk of developing a blood clot. Your level of risk will depend on a number of factors including your age, type of surgery, previous illnesses and past history.

What is a Blood Clot?

Blood clots can form in your legs (DVT) and travel to your lungs (PE) with the partial immobility associated with your orthopaedic surgery. Your surgeon is aware of this risk and will be taking measures to prevent such an event.

What can you do?

  • You might wish to visit your GP to discuss your risk of blood clots and what can be done. 
  • Talk to your surgeon about your risk and what will be needed before, during and after surgery
  • Maintain an optimal level of activity prior to your surgery. Activity level will be different for everyone but staying active will be important prior to your admission.
  • Maintain adequate fluid intake. In the days leading up to your surgery you should be careful to avoid dehydration. Drinking adequate amount of fluids prior to your 'Nil by Mouth' stage before surgery will be important in minimising the risk of blood clots.

While in Hospital

Your doctor may ask you to wear white elastic anti-embolic stockings that help maintain your circulation and minimise blood clot formation. It is important to keep these compression stockings on to gain maximum benefit in clot reduction. During your immediate post operative period you may also have plastic inflatable sleeves wrapped around your lower legs that further aid circulation (SCD). These sleeves are often ceased after 48 hours when you are up and walking. Your surgeon may prescribe low dose blood thinners while in hospital. These may take the form of injections or tablets. You will be ask to wiggle your toes and move your feet frequently while in bed and be expected to get out of bed soon after surgery. Early mobilisation is shown to be most effective in minimising the risk of blood clots. Physiotherapy will help you with this and you will be encouraged to be out of bed at least twice daily. Avoid prolonged sitting or lying in bed.

On Discharge

You may be asked to wear your anti-embolic stocking for up to 6 weeks after returning home. Your surgeon may also wish that you remain on a low dose blood thinner for a prescribed amount of time after discharge. Be sure to discuss this with your surgeon and your nurse before discharge.

You should notify your doctor immediately if you have any of the following:

  • Unusual pain or swelling in your legs or calf
  • Pain in your lungs or chest
  • Difficulty breathing.

Preventing Pressure Ulcers

  • A pressure ulcer (also known as a pressure sore or bed sore) is an area of skin that has been damaged due to unrelieved pressure.
  • Pressure ulcers may look minor, such as redness on the skin, but they can hide more damage under the skin surface.
  • Pressure ulcers usually occur over bony areas – especially heels, buttocks and toes.
  • Anyone confined to bed or a chair, who is unable to move, has loss of sensation, loss of bowel or bladder control, poor nutrition, poor circulation or is unwell is at risk of getting a pressure ulcer.

What can you do?

  • Move, move, move - The best thing you can do is relieve the pressure by keeping active, and changing your position frequently, whether you are lying in bed or sitting in a chair. If you are unable to move yourself, the staff will help to change your position regularly. Special equipment such as air mattresses, cushions and booties may be used to reduce the pressure in particular places.
  • Look after your skin - Keep your skin and bedding dry. Let staff know if your clothes or bedding are damp. Tell staff if you have any tenderness or soreness over a bony area or if you notice any reddened, blistered or broken skin. Avoid massaging your skin over bony parts of the body. Use a mild soap and moisturize dry skin.
  • Eat a balanced diet

If you have any questions whilst in hospital, please ask your nurse. 


Planning for your Discharge

Assessments by your doctor and medical team both prior to admission and after surgery will help determine which of the following options are appropriate for you:

  • Return directly home
  • Transfer to inpatient rehabilitation at the San
  • Discharge home with rehabilitation day program

If you are going directly home …

In order to return directly home it is essential you are independent and safe with all your activities of daily living, whilst using crutches. You'll need to be able to get in/out of bed, chairs and attend to your own personal care activities. The critical element to planning your discharge home from hospital is organising for adequate supports and equipment to be available to you on your return home. Following are some important factors to consider:

Support Network

  • Family members, friends, religious or church group.
  • CARERS
  • Please phone our social work department on 9487 9660 well before coming into hospital if you require assistance in arranging this support.
  • Private agencies are available if you need extra support.
  • Check your local newspaper classifieds, otherwise your case manager can provide you with a useful list of home help agencies.

Food

  • Consider cooking in advance and freezing this food
  • Friend or relative assist with meal preparation
  • Buying frozen meals
  • Private meal delivery services
  • Online or phone ordering for home delivery of your groceries


Mobility, Hygiene and Equipment
The environment in and around your home can make it difficult for you to manage, especially if you have stairs or a difficult bathroom layout.

Your bathroom will need special equipment such as a raised toilet seat, shower chair and possibly rubber mats to ensure stability, safety and well-being. This equipment can be found in any large pharmacy. Alternatively, your case manager can provide you with a list of suppliers that can deliver equipment for you to hire or purchase, to your door.

At all times, you must be careful to balance activity and rest. You should avoid sitting on low chairs and crossing your legs. Obtain your doctor’s permission regarding driving, working, and any restricted activities or sports.

Ongoing physiotherapy and aquatic physiotherapy visits as an outpatient are beneficial in assisting you to regain optimal strength, movement and return to normal function. Speak to your physiotherapist or call San Physiotherapy on 9487 9350 to arrange any appointments required.

Your Medications and X-Rays
Before leaving hospital, staff will organise any new medications, including prescription painkillers, for you to take home. Please ensure you take regular painkillers as described, to help maintain optimum comfort levels.

Ice therapy can also be used to relieve pain and swelling and this should be done as instructed.

You may also be required to administer sub-cutaneous Clexane (anti-coagulant) for a short period post discharge. Nursing staff will provide you with a special kit and instruct you on how to administer this medication.

Also, don’t forget to take home any X-Rays you brought in or have had done whilst in hospital.

Before you leave
Before you leave you should receive the following:

  • A doctor’s discharge summary for your GP.
  • A summary from nursing staff concerning your medications and how to care for your wound. The San will provide you with pain killers to take home and a script to purchase more if required. Your GP may prescribe sedatives if still needed.
  • Information from the physiotherapist about your exercises.
  • Any referrals you may need.
  • The ward’s telephone number in case you have queries.
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Sydney Adventist Hospital Clinical Specialties and Services