Orthopedic Surgery Video Resources
How-To Use Crutches: Series
These four videos will help you learn how to properly adjust your crutches, how to walk, go from sitting to standing and how to crutches while climbing stairs.
Libby: Hi. I'm Libby with Physical Therapy. Your provider has recommended crutches for you. I'm here to make sure you use them safely. Sarah's going to help us.
The first thing that you'll want to do is adjust the crutch height at your armpit. It's best to do this with tennis shoes on, as it may affect the height.
You'll want the crutch height to be about 2 inches or two fingers underneath your armpit. For the handgrip height, you'll want the top of the handgrip to be about where your wrist bends when you're standing up normal posture.
These crutches pop out to adjust. Some of them will have a screw. There is a guide on the outside of most crutches for height, but it's best to adjust them to your own body.
How does that feel, Sarah?
Sarah: It feels good.
Libby: Excellent. Thanks for watching. Check out our other videos for tips for using crutches.
Sitting to standing with crutches
Libby: Hi. I'm Libby with physical therapy. Your provider has recommended crutches for you. I'm here to make sure you use them safely. Sara is going to help us. This video will show you how to stand up and sit down using your crutches.
You'll keep both crutches together on your sore side, and use an overhand grip. Before you stand, you'll want to hold your foot out in front of you. Or, if your provider has said that you're allowed to put some pressure through your foot, you can keep your heel on the floor. Reach for the armrest, and stand up. Once you're standing, you can move one crutch to the opposite side.To sit down, you'll bring both crutches back over to your sore side, use an overhand grip, hold your foot out front, reach back, and sit.
Thanks for watching. Check out our other videos on tips for using crutches.
Walking with crutches
Libby: Hi. I'm Libby with physical therapy. Your provider has recommended crutches for you. I'm here to make sure you use them safely. Sarah's going to help us.
Sarah: This video will show you how to use your crutches as you walk.
Libby: You'll bring your crutches forward first, and take a step, swing through. It's okay to hold your foot out in front of you, or back behind you, as Sarah's doing. Whichever is more comfortable for you. If your provider has said that you're allowed to put some pressure through your foot, you'll touch your foot down even with the crutches as you take a step, taking the pressure off of your leg, more through your hands than your armpits.
How does that feel, Sarah?
Sarah: Feels good.
Libby: Great. Thanks for watching. Check out our other videos on tips for using crutches.
Using stairs with crutches
Libby: Hi, I'm Libby with Physical Therapy. Your provider has recommended you use crutches, and I'm here to help you use them safely. This video will show up and down the stairs using your crutches. Sarah's here to demonstrate.
When you come up to the step, step up close. You'll push through the hand grips and hop up with your good leg first. The crutches will always stay with your sore foot. Keep your sore foot behind you, so it doesn't catch on the step.
As you come down the steps, bring your crutches and your sore foot down first and ease yourself down, using the handgrips. If you're provider has said that you can put some pressure through your foot, then you may do so. You'll keep your foot with the crutches.
Stairs can be tricky. This might be a good video for your family to watch and you may make sure that they're there with you the first time you practice, just for safety. Sarah, you're doing great.
If there's a situation where you do have a rail available, the rail will offer more stability than the two crutches. Bring both crutches to one side, and keep your body close to the rail. You'll get more stability. Same sequence, step up with your good foot. This will allow you to have both crutches with you when you get to the top of the stairs.
Great job, Sarah. Thanks for watching. Check out our other videos on tips for using crutches.
Knee and Hip Surgery: Series
Preparing for Surgery
Jill Chadwick: Preparing for surgery starts at home, and following the directions in this video will make your transition from hospital to home easier and safer.
Patient: Why don't I sleep in the spare bedroom after surgery? It's closer to the bathroom.
Jill: If possible, sleep in a room close to a bathroom on a ground level. Consider getting a toilet seat riser for low commodes, and perhaps a shower chair or three in one. You can find these at most pharmacy discount or medical supply stores.
Ensure hallways are clear for a walker so you can safely walk through your home. Plan to have a family member or a close friend stay with you for the first couple of weeks after surgery. It is not safe for you to go home alone directly after your hospital stay. If you're having a total hip replacement, you'll also want to test different setting surfaces, to make sure you can maintain a 90 degree angle. Essentially, your knee should never be higher than your hip when setting.
Think of the height of your toilets, couches and chairs at home. If your knees are higher than your hips, you are breaking the 90 degree angle. Test out different types of surfaces in your home to make sure they are the right height. You may want to purchase a three in one bedside commode that you can also use in the shower. Your physical therapist will thoroughly guide you through this before you leave the hospital. There are some do's and don'ts the night before and the morning of your surgery. Do wash with a strong anti-bacterial soap from the neck down, called chlorhexidine gluconate, or CHG, concentrating heavily on your operative leg the night before surgery and then again the morning of.
Don't use CHG on your face or hair. Instead, use your regular face wash and shampoo. Do dry with a clean towel, and sleep in clean pajamas and bedding. Do wear loose, comfortable and clean clothing the morning of your surgery. Don't eat or drink anything past midnight the night of your surgery. This includes gum, hard candies, and chewing tobacco. Do take any medications given to you by the pharmacist and discuss during your pre-operative assessment clinic, but only with a small sip of water. And then leave the rest of your medications at home.
During the pre-operative assessment, you meet the anesthesia team and review your health history to ensure you are safe to undergo surgery.
Patient's Caretaker: Don't forget your glasses.
Jill: Do remember to bring your eye glasses, hearing aids, a rescue inhaler if you have one, and your CPAP equipment, only if you have sleep apnea. Don't bring anything of value with you, such as money or jewelry. Please refer to your patient and family guide to hip and knee replacement surgery for more details. And, remember to complete your pre-surgery checklist on page three before your pre-operative assessment.
Thanks for watching and choosing The University of Kansas Hospital.
On the Day of Your Surgery
Jill Chadwick: Your surgery day is here. It's important to arrive at the hospital at your designated time. Park in the Cambridge parking garage across from the main entrance and make your way to admissions, located in the lobby just past the information desk. After you are admitted, take the elevators to waiting room number one, on the second floor, and wait to be called to the preoperative area. Here is where you will change into a gown and get an IV started. Two family members may join you in the perioperative area, once you are changed and an IV has been started. There is not room for more.
Anesthesiologist: Hi, how are you?
Patient: Hi. Nice to meet you.
Anesthesiologist: Nice to meet you. I'm Gina. I'm the staff anesthesiologist. I'll be helping take good care of the other day.
Jill: Here, you will meet and discuss any last minute questions you have with your anesthesia team and surgeon, and then it's off to the operating room. While in the operating room, you will have a Foley catheter placed to collect urine until you can safely walk or use a urinal. Ideally, that's within a day or two, to guard against a UTI or a urinary tract infection. During your surgery and recovery, a nurse liaison will keep your family fully informed of how you're doing. Following your surgery, you'll be in recovery for at least two hours. When ready, you'll be transferred to unit 43, which is the orthopedic unit at the hospital. Here, the staff is expert at caring for patients who have undergone a total hip or knee replacement. Unit 43 is a mixture of private and semi-private rooms. Private rooms are given first to patients with medical necessities. Your family can stay with you from 6:00 AM to 8:30 PM daily.
Nurse: Hi. How would you rate your pain on a scale from zero to 10?
Jill: During your stay, we will work to keep you as comfortable as possible. Unfortunately, it is unrealistic to feel zero pain after surgery. Our goal is to manage your pain at levels allowing you to participate in physical therapy and other activities. We have many tools to attack pain, starting with the peripheral nerve catheter or PNC, inserted into your operative leg by the anesthesia team. The PNC delivers numbing medication to surround the nerve that supplies feeling to your hip or knee. We supplement the PNC with other medications as needed, either in pill or IV form. One big help in controlling your pain is to keep your new joint active by moving and working with therapy. Lying in bed too long can result in more pain as the joint grows stiff.
In addition to pain medication, you will receive a 10 day supply of Lovenox, a blood thinner to guard against the development of blood clots. We hope you are discharged after three days, which means you or a family member will need to feel comfortable continuing with the shots at home. But don't worry, we'll show you how and make sure everyone is ready for this step. You will also wear tight, white knee high stockings called T.E.D. hose, and while in the hospital bed, foot pumps will help the blood circulation in your lower legs. While in the hospital you can expect to have your vital signs checked every four hours. Labs will be drawn between 4:00 AM and 5:00 AM. These checks are necessary to get the results from the lab before doctors make their rounds starting at 6:00 AM. Now, depending on your total joint replacement, we invite you to watch the messages from the doctors describing your specific surgery.
Jill Chadwick: You've just had a total joint replacement, and it's time to get to work on daily goals designed to get you moving and discharged in two to three days. Your safety is priority number one during this process. You are considered a high fall risk, so you'll be given a bundle which includes a wristband, yellow socks, and bed alarm to alert us if you're trying to get around on your own. We don't want you getting up on your own or with a family member. We are here to help you.
Nurse: All right. It's time to sit on the edge of the bed.
Jill: The day of your surgery the goals are to tolerate food and fluids and sit at the edge of the bed with your legs dangling. If you tolerate this well, we may even help you transfer to a chair. This helps normalize your blood pressure after lying flat and being under anesthesia, and it will help get you ready for your first day of therapy.
There are four goals on day one of your surgery, sitting up for all your meals either at bedside or in a chair, working with physical and occupational therapy, and, finally, the removal of the bladder catheter if you're able to safely walk to a bedside commode or the bathroom. You will also meet with a case manager and social worker to discuss your discharge plan.
On day two, your goals include eating your meals in a chair, removal of the PNC or the nerve block catheter, and participating in physical and occupational therapy. Therapist will help you walk in the halls. On this day if you have stairs in your home, physical therapy will train you how to safely use the stairs.
The goals of physical therapy are to maximize your independence, speed your recovery, and help prepare you to leave the hospital. You'll practice building your strength by getting in and out of bed or a chair, navigating stairs, and walking with a walker. If you don't have a walker, we will loan you one and make sure you have one at home that is the right height. You may have therapy twice a day. The times will be written on the whiteboard in your room. The nurse will give you pain medication prior.
The occupational therapist will help you achieve daily tasks safely like getting dressed while adhering to weight bearing and movement restrictions. You will also be trained on any adaptive equipment you need including sock aids, reaching devices, and long handled shoe horns.
Patient: How much weight can I put on my leg?
Jill: In some cases, the surgeon may limit the amount of weight you should put on your new joint, which will be discussed during your first therapy session. Now, just a few more important guidelines, if you received a total knee replacement, there is really one important precaution to follow. Do not place a pillow under your knee while lying in bed. While it feels good, keeping your knee flexed works against the goal of gaining full extension or straightening of your knee.
If you received a full hip replacement, there are more guidelines you must follow for six weeks for proper healing and preventing dislocation. Rule one, keep your trunk and top of your legs at no smaller than a 90-degree angle. Think of sitting in a chair with your feet flat on the ground. Your trunk and top of your leg should create a 90-degree angle. If you bend over to tie your shoes, you are breaking the 90-degree angle. If you bring your knees up to reach your feet, you are breaking the 90-degree angle. You may refer to your booklet and watch this video again to make sure you understand these recommendations.
Your understanding and work will help the therapy team determine when you can return home or if further rehabilitation at another facility is needed.
Healing at Home
Jill Chadwick: It's time for you to leave the hospital. A nurse will read over the discharge instructions that your physician has written specifically for you.
Let's start with your followup appointments. They are scheduled prior to your discharge. Make sure you have a ride arranged as you cannot drive while on pain medication. Your doctor will let you know when it's safe for you to drive again. Generally, knee replacement patients have a two week followup to remove sutures or staples, while total hip replacement patients have six weeks. Your followup appointment is scheduled based on your procedure and recovery.
Next, dressing changes. Most incisions are covered with an Aquacel dressing at the hospital and should remain on for seven days. The date the dressing comes off is written on the bandage. The Aquacel dressing is waterproof so you can shower. You may want to purchase a three-in-one bedside commode to safely shower. Your physical therapist will show you how to use a three-in-one before you leave the hospital. So, you may shower, but don't submerge your leg in a pool, bath, hot tub or lake.
After the Aquacel is removed, dry gauze and tape covers your incision. Once you switch to the gauze and tape no more showers until the surgeon says it's okay. Getting it wet too soon can slow healing and lead to infection. Change the gauze and tape every one to two days to keep the incision clean and dry.
Walking, it's an important part of your recovery. Your bones take from six to eight weeks to heal. Remember to always use your walker. Walk daily, and increase the distance each day, but don't overdo. Make sure you allow yourself time to rest.
A big part of your recovery may include physical therapy, or PT, or occupational therapy, OT. Depending on your needs, you may have PT and OT, or in some cases the doctor may want you to stay in a skilled nursing facility until you are strong enough to complete your recovery at home safely.
Once at home, it's important to watch for urgent signs you need to call the doctor. Signs and symptoms of a blood clot include: sudden shortness of breath; sudden onset of chest pain; localized chest pain with coughing; severe pain in your calf and leg unrelated to your incision; tenderness or redness of your calf; swelling of your thigh, calf, ankle or foot. Those could be signs of a blood clot.
Warning signs of an infection include: persistent fever of 101 degrees fahrenheit; shaking; chills; difficulty breathing; feeling confused or disoriented; increasing redness, tenderness, or swelling of the wound; thick, foul-smelling yellow drainage from the wound; or increasing pain with both activity and rest. You should also report excessive drainage or pain that you can't control with your medication to your physician at the University of Kansas Hospital.
You can call the orthopedic clinic at (913) 588-6100 from 8:00 AM to 4:30 PM during the weekdays. After hours, weekends and holidays call (913) 588-5000 and ask for the orthopedic resident on call.
We hope you have found these videos informative. Please direct any questions you have to your physician's office.