Nutrition Recommendations

In preparation for your surgery and following your surgery, eat a well-balanced diet.

Special emphasis is placed on promoting healing (protein) and preventing constipation (fiber and fluids).

FIBER AND FLUID

Constipation after surgery is common due to the side effects of medications, anesthesia and decreased movement. Include foods that contain dietary fiber and drink plenty of fluids to help keep bowel movements regular and prevent constipation. Increase dietary fiber in your diet.

Common sources include: vegetables, fruits, legumes (beans), whole grains (i.e. brown rice and quinoa), whole grain breads and pasta, unsalted nuts and seeds

Protein

Protein is the most important nutrient for muscle growth and wound healing. High-quality protein is found in Milk & Milk Products and Meat & Alternates groups. Choose lean or low fat options more often.

Common sources include: eggs, cheese, cottage cheese, nuts and seeds, legumes (beans), tofu, fish, meat, milk

Calcium

Calcium is needed for bone healing and maintenance. Milk and milk products are the best source of easily absorbable calcium. Choose low fat or skimmed versions. Aim for 3-4 servings daily.

Common sources include: milk, cheese, sardines (soft bones), yogurt, cottage cheese, frozen yogurt or ice cream, tofu, canned salmon (soft bones)

Vitamin D

Vitamin D is essential for calcium absorption. This vitamin is made in the skin when it is exposed to sunlight. Canada’s Food Guide recommends that adults over 50 consume a daily vitamin D supplement.

The best food sources of Vitamin D include: fatty fish (salmon and mackerel), margarine, milk, fish liver oils

Iron

Iron is a mineral that is needed to carry oxygen to all cells in the body. Enough iron is needed before and after surgery to prevent anemia due to blood loss. It can be better absorbed if eaten with vitamin C-rich foods like oranges and peppers or other sources of heme iron. Iron in foods come in two forms:

• Heme iron is found in meat, poultry, and seafood. This iron is the most easily absorbed by the body.

• Non-heme iron is found in plant foods like vegetables and legumes. This form of iron is less well absorbed.

At the Hospital

Day of your Surgery

•  Please present yourself at the Admitting offce (Main Pavilion, Ground Floor, Room G-310).

•  You will be directed to the Surgical Day Center (Main Pavilion, 2nd floor, Room 2324).

•  You will be asked to change into a hospital gown and the nurse will go over a preoperative checklist with you.

•  The nurse may administer some medications that your doctor may have prescribed for pain and nausea before surgery.

•  An orderly will walk with you to the operating room. Family members will not be allowed to accompany you.

•  An anesthesiologist will discuss your anesthesia with you.

After Surgery

 In the recovery room, the nurse will monitor you.
 You will have:

• Intravenous for fluid

• Surgical dressing covering your operated site (hip/ knee)

 You may have:

• Oxygen through a nose piece or mask

• Urinary catheter

• Compression stockings on your legs

 Pain control:

• Epidural (in your back)

• Nerve Block (in your groin/ thigh)

• Patient controlled analgesia (a button that you press for pain medication through IV)

• Medication pills

Transfer to Post-Operative Care Unit

• You must ask for pain medication as soon as you feel the need

•  You must do your respiratory exercises every hour (incentive inspirometer)

•  You must do your circulatory exercises every hour

•  You must change position in your bed every two (2) hours (prevent pressure ulcers)

•  You may be allowed to sit at the edge of the bed, or pivot into a recliner (nurse evaluation required)

Until You Go Home

• You must ask for pain medication as soon as you feel the need

• You must do your respiratory exercises every hour (incentive inspirometer)

• You must do your circulatory exercises every hour

• You must walk with a walker and with the assistance of a healthcare professional

• You must do your exercise program three (3) times a day

• You must walk to the bathroom with assistance to wash yourself

• You must prepare for your discharge home two (2) to three (3) days after your surgery

Getting Around After Surgery

WALKING WITH A WALKER

A walker is often used for the frst several weeks after your surgery.

• Move walker forward

• Take a step with your operated leg

• Shift weight onto walker and take a step forward with the non-operated leg

• DO NOT take sharp turns with a walker

WALKING WITH A CANE OR SINGLE CRUTCH

A cane or single crutch offers a minimal degree of support while walking. It is usually used for several months after the use of a walker until your full strength and balance have returned.

• Hold cane or crutch in the hand opposite the operated leg

TRANSFERS (CHAIRS/ TOILETS)

• To sit, slide the operated leg forward while holding onto the armrests and go down slowly.

• To get up from the chair/toilet seat, bring your buttocks to the edge of the chair/toilet seat and slide your operated leg forward, pushing with your hands on the armrests. Get up slowly.

SITTING POSITION TO STANDING POSITION

• Place hands on bed/armrests of chair.

• Move buttocks to edge of bed/chair.

• Slide your operated leg forward, pushing with your hands on the armrests.

• Get up slowly.

• Put your weight onto non-operated leg and push off with both hands from bed/armrests of chair.

• Once standing, place your hands on walker and slide your operated leg back at the same level as non-operated leg.

STANDING POSITION TO SITTING POSITION

• Use your walker for support as you back up until you feel the edge of bed/chair behind your knees.

• Slide the operated leg forward.

• Place one hand at a time on the armrest of the chair

• Slowly sit down.

GETTING INTO BED

• Position yourself close to the head of the bed.

• Move back so the back of your knees touch the bed.

• Slide your operated leg forward.

• Place one hand at a time on the bed and slowly sit down.

• Using your arms for support, start turning your body and lift one leg at a time.

GETTING OUT OF BED

• Lying on your back, bend your non-operated leg and move yourself to the edge of the bed

• Use your arms to push yourself up in a sitting position as you start turning your body and legs towards the floor

If needed, the therapist will assist your operated leg until it reaches the floor safely.

GOING UP STAIRS

• Put the good leg up first

• Bring up the operated leg and crutch or cane together

GOING DOWN STAIRS

• First lower the operated leg and the crutch or cane

• Lower the good leg using the crutch or cane

GETTING IN AND OUT OF THE CAR

• Always sit in the front seat on the passenger side.

• Ensure that the car seat is positioned as far back as possible so that you can straighten out your leg. Recline the back of the car seat.

• Standing on the street (and not on the sidewalk), turn your back to the car and give your walker or crutches to your family member/friend.

• Position yourself with your right hand on the back of the car seat and your left hand on the car dashboard.

• Put your weight onto non-operated leg and push off with both hands from bed/armrests of chair.

• Sit and keep your feet on the ground.

• Slide your buttocks as far as you can on the seat.

• Bring your legs into the car, use your hands or a towel underneath your thigh to lift your operated leg.

• DO NOT attempt to swing your operated leg inside the car in one motion.

Follow the above steps in the reverse order to get out of the car.

Home Instructions

MEDICATIONS

Ensure you understand the medications that your doctor prescribed.

Blood thinning medication – To prevent blood clots

Caution: Blood thinning medication may cause bleeding.

Pain medication – To control your pain so you can continue to walk/ physiotherapy

• A good way to get pain relief is to take the pain medication as soon as the pain starts.

• Pain medication taken by mouth takes at least 30 to 45 minutes to start working.

Caution: Pain medication may cause drowsiness.

LEG SWELLING

• Most patients develop leg swelling in the operated leg. This varies from patient to patient and may be accompanied by “black and blue” bruising that resolves over a few weeks.

• The more swelling you have, the more diffcult it will be to bend, straighten or even lift your leg. It is therefore important to minimize swelling to enhance your recovery.

To reduce swelling in the frst two (2) weeks:
Apply cold therapy to your joint frequently for 10- 15 minutes at a time.

After two weeks:
If you advance your activity too quickly or overdo it, your operated joint may become more swollen.

Here are some suggestions that will help reduce swelling if it occurs:

• Move your ankles up and down (ankle pumps).

• Ice for 10 – 15 minutes after long walks, if painful, or after exercise. Ice may be in the form of ice wrapped in bags or towels or commercial cold packs.

• Lie in bed for 20 minutes periodically during the day.

• Limit your sitting time to 45 minutes to one (1) hour. Walk around, then return to sitting.

• Wear your support/ compression stockings as prescribed by your surgeon.

TRAVEL

• Inform the airport security that you have a hip or knee implant. No medical certifcate or note by your surgeon is needed.

• Modern airport security will detect all joint replacements. To minimize the inconvenience and avoid a full body pat down, you must go through the body scanner.

• If you walk through the metal detector doorway, the alarm will go off and you will have to wait for a security agent to do a full body pat down.

REST PERIODS AND SUPPORT

• Schedule rest periods throughout the day.

• The CLSC will call you to plan their home visits.

• Ensure that someone will stay with you for the first couple of nights.

SHOWERS AND BATHS

• You may shower after your staples from your incision have been removed.

• You may bathe one (1) week after your staples have been removed.

PREVENTING INFECTION AFTER A TOTAL HIP AND KNEE REPLACEMENT

Current guidelines DO NOT recommend routine antibiotic use for dental procedures. Antibiotics are recommended only in high risk patients. If you think you may be at risk, please discuss it with your doctor (the one who did your surgery) before any procedure.

FOLLOW-UP WITH YOUR DOCTOR

• Post-operative follow-up is in 6 weeks at your doctor’s ofFIce where you saw him before your surgery.

• Hip surgery: A hip x-ray is needed. Knee surgery: No x-ray is needed.

• Resume driving when instructed by your doctor which is usually 4-6 weeks after your surgery.

RECOVERY AFTER SURGERY

You will likely feel tired and fatigued for several weeks and this is normal. You may experience numbness around your incision and this is normal. You may notice clicking: This is due to the plastic and metal surfaces moving together and this is also normal. The benefts of a joint replacement usually become fully evident by 4-6 months after the surgery.