Joint Replacement Education Class

[MUSIC PLAYING] Hi, guys. My name is Melissa. I'm an orthopedic nurse here at the University of Chicago. Today, I'm going to be going over the joints class PowerPoint presentation. This video should be about 30 to 45 minutes long.

All of our contact information will be laid out at the very end of the presentation if you guys have any questions. I'm going to begin with introducing our orthopedic joint specialist team. We have a wide range of specialists here at the University of Chicago who specialize in simple arthritic issues, also complex arthritic issues, such as total hip and knee revisions, oncological issues, such as tumors of the bone, soft tissue tumors of the skin, and then our simple total knee and total hip replacement, which is what I'm going to be going over today.

I'm going to start off with a brief anatomy of the knee. I will be also going over the hip and knee in conjunction during this PowerPoint, so the three areas you should be primarily concerned with the knee replacement are your femur bone, which is the long, thick thigh bone, very bottom of that, your patella or your kneecap, and your-- the very top of your shin area, the tibia bone.

There's a couple of types of arthritis that we primarily work with here at the University of Chicago. The two candidates that would make you a candidate for an elective joint replacement would be osteoarthritis, which is your run-of-the-mill osteoarthritic changes of the cartilage, and rheumatoid arthritis, and rheumatoid arthritis is unique in the fact that it's an immunological response in which your immune system is attacking the cartilage at the ends of your bones.

When you come in, we ask everybody to take X-rays. Both hips and knees need radiographic imaging. The PowerPoint you guys are about to see contains both a healthy knee and an arthritic knee. As you can see on the healthy knee, you have the healthy femur bone, so that top thigh bone. At the end of that bone, there's going to be healthy amounts of cartilage. Then you have your tibia bone, so that bone right at shin, with also a healthy amount of cartilage at the end of it and an ample amount of space for joint fluid or synovial fluid.

For an arthritic knee, or an unhealthy knee, that you're going to see on the other side, you see at the end of that bone that there's no cartilage at the end of either the femur or the tibia, and there's also no space for your joint fluid to go. That issue is what's bringing you guys typically in. There's no room for smooth movement. You're having a hard time walking. You're having pain with ambulation, and the point of the joint replacement procedure is to get rid of that damaged bone and replace it with a healthy implant and also to create space for your joint fluid.

For the hip, we are also concerned with your femur bone, but we're concerned with the top portion of that thick thigh bone. Right on the top, there's this unique area called the femoral head, and there's a nice little round knob at the end of it. And then we're also going to be working with your pelvic area. A normal hip, as I said, has a nice, healthy, round femoral head covered with cartilage, and on the inside of the pelvis, there's this area called an acetabulum. That's where the femoral head meets your pelvic surface, and that's going to-- of the healthy knee, it's going to create some smooth ambulation.

For an arthritic hip, what happens when the cartilage disappears is the bones start grinding together, and you're forming this unique function called bone spurs. In a knee replacement, we're resurfacing and getting rid of the damaged bone, but in a hip replacement, we're completely removing that damaged bone. Later on in the presentation, I'm going to have a model, and I'm to show you specifically what we're removing and what we're fixing in the surgery.

Here's also a radiograph of the hip. We have, on the right side, a normal, healthy hip joint, so, as you can see, the femoral head, or that femoral notch, is nice, and round, and smooth. There's going to be cartilage on top of that femoral knob, and it's nicely articulating with your pelvic area. You're going to have nice, smooth range of motion. You're able to walk forward, swing your legs side to side.

On the left side of that radiograph, you're going to see an unhealthy hip. The cartilage has been completely damaged. That femoral head, because of the grinding, is no longer nice, and smooth, and round. It's not easily fitting into your pelvic joint. It's a little bit flatter, and that's what's causing pain with ambulation.

The main reasons for cartilage destruction is osteoarthritis, which is basically a chronic condition that happens as you get older. You're starting to make less and less cartilage, and that cartilage at the end of the bone is damaged. And without that cartilage, you're not having anything to cushion or soften up the movement between the two joints. A next issue that you would come in for a replacement would be avascular necrosis. This disease is very specific to hips. Your provider would tell you if you have avascular necrosis.

This condition is when there's decreased blood flow to the joint causing cartilage and bone death simultaneously. There's many issues that can cause avascular necrosis-- chronic use of steroids, sometimes it could be something that you're born with. And then, as I mentioned earlier, rheumatoid arthritis is another condition that would make you a candidate for a joint replacement surgery.

This is an immunologic response, and your immune system is actively destroying your cartilage. Very specific diagnosis. You would know if you had rheumatoid arthritis. It affects multiple joints-- your elbows, your shoulders, fingers, and toes. You're typically on chronic and lifelong medications for rheumatoid arthritis.

And another reason for cartilage destruction would be a past injury to the joint area. So as we're getting a little-- as we see, patients are coming in younger and younger to have these joint replacements, and typically, it's because they were athletes in the past. So football players, wrestlers, track and field patients, we're seeing them coming in at 30 and 40. And that's because they had micro injuries to that joint site, so now we got to replace that deadened cartilage and that deadened bone.

There's a couple of treatments for joint pain, and we want to make sure that our patients are well aware of all the ways that we can help with joint pain. Our first line of defense is oral medication, so we will recommend over-the-counter medications such as Tylenol, ibuprofen, anti-inflammatories, or oral steroids. Sometimes we also do this in conjunction with physical therapy or aqua-therapy. If we're seeing that oral medications are no longer being effective, we'll start recommending injections or corticosteroid injections for both hips and knees.

Injections typically are temporary. We'll let you guys do a couple of them and see how you feel, but these are simply a Band-Aid for what the real source of the issue is. The issue is that you no longer have cartilage, and steroids aren't replacing the cartilage. It's only making it more comfortable for you to ambulate. If we've done all these lines of defenses and you're still coming to us that you're having pain, that's when we start considering surgery. Joint replacement surgery is a major surgery with a high risk, and we want to make sure that you guys are appropriate candidates for this procedure.

So as I said, it is a major surgery, and it's what we consider elective. It's not a life-saving surgery, but it is a surgery that we think is going to improve your quality of life. We take into consideration some of your complaints when you come see us in the office such as you can't sleep at night due to the pain, you can't go up and down stairs, you can't hang out with your kids or your grandkids. We want to make sure that we are increasing your quality of life. We want to make sure you're active, and comfortable, and pain free.

We also got to make sure that you have support at home after surgery. It is a long journey for both a hip and knee replacement. Lots of physical therapy is involved, and we really want you to be as independent as possible. But we also want you to be diligent with your health care.

Next, I'm going to be going over the implant that you guys are going to be receiving in surgery. The model here is showing the very bottom portion of your femur, which is essentially made out of a type of glass, and the very top portion of your tibia. Like I mentioned earlier, we're going to be resurfacing and removing any of the damaged bone on the very bottom of your femur and fixing an femoral component. This femoral component is made out of metal. It's titanium, chromium, cobalt, and nickel, and it's held together by medical grade cement glue.

On the very top portion of your tibia, we're going to, again, remove any of that deadened and damaged bone, and we're going to replace it with this tibial component. There's a nice stem in the tibial component, so we can put it right on top of your tibia. And right here in the middle is your new joint surface made out of a type of ceramic called polyethylene. Everything is secured in place by medical grade cement glue, then we close you guys back up. In regards to your patella, or your kneecap, we try to keep your natural patella, or your natural kneecap, as long as too much damage hasn't happened to it, but we do resurface the very back of the patella and reinforce it with the same materials of the implant in case arthritis has also gotten to the patella structure.

Now for your hip implant, this model right here is the left pelvis, so the left side of your hip. Right here we have the pelvic also, again, made out of a type of glass or plastic material, and here is your femur. Like I mentioned earlier, we're going to completely remove all of the damaged bone on the top of your femoral head. We're going to give you a femoral stem that's made out of the same metal. It's titanium, chromium, cobalt, and nickel. Securely fix it in place to your femur, and your new femoral head is made out of the ceramic polyethylene.

On the inside of your pelvic, there's this area called the acetabulum. We remove any of the damaged bone inside of the acetabulum and placed an acetabular cup right on the inside. The acetabular cup on the outside is made out of the metals, and the inside has the polyethylene surface. This is, again, to prevent any of the metal on metal or any of the metal grinding together. A unique feature when you're getting your hip replacement as these two areas are not close or sutured together. It's really imperative and really important that with physical therapy you work with the muscles around the implant to keep everything securely in place.

The next slide is going to be a radiograph of your-- a radiograph of the hip replacement. You can see where the metals are, and the same goes for the hip replacement as the knee replacement. They are MRI safe. They will set off alarms when you travel you. Just need to tell the security personnel that you have them.

The next part of this presentation, I'm going to be going over the risks of surgery. The biggest risk and the one that we're most concerned about is infection. And infection in an implant is serious, but it is rare. The issues with having an infection in the implant, it's very difficult to get rid of an infection in a total knee or a total hip replacement. Sometimes it can cause you to be on oral antibiotics longer than you need to, IV antibiotics, and, in very rare cases, we may need to completely take out the implant and reimplant you when that infection is completely resolved.

There are several things you can do before surgery to make sure that you don't get an infection after surgery. The first thing we do with all of our patients that have teeth is to get a dental clearance. We make you get a dental clearance so that way we can see if you have any latent or inactive infections in the teeth or gums. That infection can travel to your implant.

If you're not sure if you need a dental clearance or if your provider is requesting you to have a dental clearance, you need to call us immediately. We typically give you this form when you're signing up for surgery. We can also send it to you via MyChart. We can mail it to you, or you can come to our offsite locations or a high [INAUDIBLE] location to pick up a clearance.

In addition to getting that dental clearance form, we also want to make sure that you are of good nutrition, healthy weight, and you have good blood sugars. Being a diabetic or having uncontrolled blood sugar puts you at a much higher risk of infection. Sometimes if you're not within our BMI requirement or our healthy weight requirement, we will delay surgery to make sure that you get to the goal that we set out for you.

Additionally, we will prescribe you an antibiotic prior to your surgery called Backtroban or mupirocin. When you sign up for surgery, we send this antibiotic ointment to your pharmacy. This medication is going to be used for the five days prior to surgery. It comes in a little tube. It is an ointment.

You're going to place a pea-sized amount of this ointment on a Q-tip, swab the inside of both nostrils twice a day for five days. Your last dose will be the night before surgery. You do not need to use this medication the morning of surgery.

If you do not have this prescription, first you need to call your pharmacy and make sure that we didn't already send it there. If your pharmacy does not have it, please give us a call so we can make sure that we send it to the appropriate pharmacy. We also need to give you guys surgical wipes or chlorhexidine wipes. On this slide, there's a picture of what these wipes look like. They come in a packet of three. There's three individual wipes-- packets of wipes inside the clear cellophane.

You're going to use these wipes the morning before surgery and the night before surgery. So the night before surgery, you're going to take a shower the way you normally do, towel dry. The first two packets of the wipes are used for your entire body, so you're going to wipe off your entire body from the neck down skipping your face and private areas.

On the morning of surgery, you do not want to take a shower as the wipes make an antibacterial layer on your skin. So you're going to use the third and final packet of those wipes to clean off your surgical site, the front side and back of the surgical site. You will have a lot of wipes left over. That's normal. Just throw out whatever you have left over.

On the morning of surgery, you are also not encouraged to wear any perfumes, lotions, creams, nail polish, or deodorant. You can wash your face, and brush your teeth, and put on face cream, but nothing outside of that. We will also be giving you intraoperative IV antibiotics on the morning of surgery, a one-dose set of antibiotics the morning of your surgery into the OR room. It's just one more step we use to make sure you don't get an infection after surgery.

So having an implant, the first 12 weeks after surgery, you are at the highest risk for infection. After those 12 weeks, your risk does substantially decrease, but you do run the risk of getting an infection the rest of that implant's life. So you need to make sure for the rest of your life you're cautious with your implant. One thing that we require all of our patients here to do at the University of Chicago is to take an antibiotic, an oral antibiotic tablet, one hour prior to every and any dental procedure so any type of dental cleaning, dental surgery. It's just one hour prior. It's not lifelong antibiotics, but it is every single time you have a dental appointment.

At your post-op appointment, we will prescribe you several months worth of these antibiotics. Once you run out, please do call us within 48 hours of your dental appointment, and we can re-prescribe those antibiotics for you. We also want to make sure that you're keeping an eye out for any other type of infection, such as urinary tract infections, sinus infections, upper respiratory infections. These type of infections need to be treated by your doctor, your primary care doctor or a family doctor, sometimes requiring antibiotic treatment. Those infections can go into the blood and travel to your implant.

We also want to make sure you're maintaining good, healthy weight, good nutrition. If you're diabetic, keeping your blood sugars under control. We prefer to see an A1C of under eight. Again, your risk of infection does substantially decrease after surgery, but you are at risk of getting that implant infected later on in life.

The next risk of surgery is blood clots. There's two types of blood clots that we primarily focus on. And one is called a deep vein thrombosis or DVT, and this is a clot in the leg. The second clot that we watch out for is a pulmonary embolism or a PE. And DVT forms in the back of the thigh or the back of the calf area.

The symptoms of a DVT in the leg include swelling that does not go away even after elevating, and I will briefly go on elevation in the next slide, numbness or tingling in the toes, pain in the back of a calf or the back of the thigh area. If you're having these symptoms, what you need to do is give us a call here at the University, and we can try and coordinate for you to have an ultrasound and rule out if you have a clot in the leg or if you're just having post-operative pain. Signs of a clot in the lung includes chest pain, difficulty breathing, coughing up pink, frothy sputum.

This is a medical emergency, and what you need to do is call 9-1-1, get into an ambulance, and go to your nearest emergency room. Do not give us a call. Do not wait for us to call back because we need you to be seen immediately.

Because we know that this risk exists, we do everything we can to prevent blood clots, and one of the things we do is we send you home with blood thinners for the first few weeks after surgery. And patients who are low risk of clotting, so patients who've never had a clot before, we send them home with baby aspirin for the first few weeks. In patients who are high risk, so patients who have a history of clotting or other cardiac conditions, we can send them home with a different line of blood thinners such as Coumadin, heparin, or Lovenox. Do not discontinue your blood thinners without formal instructions. We will tell you when you need to stop taking the blood thinners.

But in addition to the medications, there are things that you guys need to do at home and after surgery to prevent blood clots. It's really important that you remain active after surgery. We get you up and out of bed the day of surgery, and it's important to make sure that your blood is circulating. Clots occur because you're staying in bed or you're not moving, and the blood tends to go to the same area, pool together, and get sticky, and essentially form these blood clots. So it's really important that you're up and active. We get you going up and down stairs.

We're also going to give you compression stockings here at the University. Compression stockings, or TED hose, are meant to be used throughout the day, not during the night. You keep them on for four to six hours, take them off for one or two hours to let your skin breathe, and put them back on. But, again, you do not need to wear these at night.

Lastly, we want you to elevate. Swelling after surgery for both the hip and the knee replacement is very, very common, and sometimes it can last for up to a year. So it's important that you appropriately elevate. Appropriate elevation includes laying all the way back down in bed or on the couch and popping your leg up with two to three pillows.

You're going to put those pillows directly underneath your ankle, not underneath your knee, and make sure your ankle is essentially above your heart, so not on the same level of your heart. This is going to push the fluid back to your heart and keep all of the blood in circulation so you can get rid of any excess fluid. As I mentioned earlier, swelling that doesn't go away with elevation can be a sign of a DVT, so if you notice that you're having swelling lying in bed or lying on your couch, prop your leg up and wait about one hour. If the swelling hasn't improved, please give us a call, and we can take it from there and assess if you have a DVT or blood clot.

The next risk of the surgery is specific towards our hips. So after surgery, the hip joint is a little bit less stable as it heals. Hip replacement dislocations happen in about 4% of first-time surgeries. Our physical therapists are very well equipped and understand the risks of hip dislocations, so they make sure that your physical therapy is geared towards strengthening the muscle around your implant. We work with you to stabilize your hip muscles and that implant, and if you have a hip dislocation, signs include inability to walk.

You will know if you've dislocated your hip. You need to come to the nearest emergency room, and we might need to do another surgery to fix that. Ways to prevent hip dislocation, so there's two different ways we can do hip replacement surgeries here at the University. One is a posterior approach or approach that's done in the back, and one is an anterior approach or one approach that's done in the front.

For the posterior, or robotic, hip replacement, you have a couple more restrictions. You are not allowed to bend at the hips more than 90 degrees in a sitting, standing, or lying down position. You're not allowed to twist your leg inward. You're not allowed to twist at the waist, and you must keep your legs apart at all times, so no crossing over or underneath your legs. We are also going to give you a wedge pillow to keep in between your legs to sleep during the first few weeks of surgery to prevent any crossing while sleeping.

For an anterior surgery, or a surgery that's done in the front, we do not want you to extend your leg behind you. That means if you are backing up, you have to lead with your non-surgical leg so your surgical leg is never ever behind. You also cannot lie on your stomach. We do not want you to rotate your leg outward, and we do not want you crossing your legs at the ankle. Again, if you have a hip dislocation, we want you to call 9-1-1 to have an ambulance come and pick you up and bring you to your nearest ER so they can either reduce the hip dislocation or we can do a further surgery to repair that.

The next part of this presentation, I'm going to be going over preparing for surgery day. Up to seven days before surgery, you also need to be aware of the medications that you can and cannot take. All of our patients are scheduled to see anesthesia before surgery. Anesthesia tells you the medications you can take the morning of, up until the day of surgery, and some medications even require you to hold within seven days.

It's really important that you understand the instructions from anesthesia. Some medications will affect anesthesia or cause delays in surgery. Additionally, the night of surgery, you're not allowed to have anything to eat or drink after midnight, but you can have small sips of water with your medications or clear liquids with your medications up until two hours prior to your arrival time.

For your hospital stay, so everyone's going to check in at the Center for Care and Discovery, or the CDD building. It's located right on the corner of 57th and Maryland. The address is 5700 South Maryland Avenue, and you're going to check in on the 7th floor Sky Lobby. Anticipate staying overnight for at least observation, and we'll try and discharge you the next day after 2:00 PM.

Things that will keep you longer than overnight would be uncontrolled pain, difficulties or issues with the anesthesia, or us feeling that you're not safe to go home quite yet. You will have a private room. At this time, it's only one patient allowed in each room, and one family member is allowed to visit you throughout the day.

What to bring to the hospital? So we want to make sure you bring comfortable clothing, such as pajama pants, sweatpants, skirts, dresses. We want you to bring your walker to surgery. If you do not have a walker, we will provide one for you on surgery day.

And we encourage you to bring your own personal toiletries, but we will have basic toiletries set up for you here at the hospital. We do want to encourage you to leave all of your valuables at home, such as jewelry, watches, credit cards, or cash. You are bouncing around on the morning of surgery, so we want to make sure that nothing is going to be lost or misplaced.

Going home after surgery. So what to expect after surgery? We want you to understand that you're going to be pretty independent and mobile after surgery. You're going to feel better and begin to be more active.

We're going to coordinate a home health care team for you after surgery, which I will go over on the next PowerPoint presentation, but it's really important that you continue with your daily activities and daily exercise. We're also going to prescribe pain medication for you to take as needed, and we want you to use your walker for as long as you feel safe. Typically, I recommend using your walker for the first two to three weeks after surgery or until we see you at post-op appointment.

We encourage our patients to have a care partner. We want somebody to help you after surgery. It's always easier to send you home with a care partner than if you're living alone or you have no one to rely on. Care partners can be anyone. They can be neighbors, spouses, children. They do not need medical training. They just need to be a phone call away to make sure that you have everything you need and everything taken care of.

Small things that you'll need help doing after surgery are cooking, simple house chores, or helping to keep track of medications, and maybe help in moving around. But, again, we expect you to be as independent after surgery as you were before surgery, so a care partner is just something to ensure that you have somebody who you can give a call to. We will coordinate you with a home health care team here at the University of Chicago. Our case manager will meet with you on the day of surgery, and she will make arrangements for you to have a physical therapist and a home health care nurse see you at the home for the first two to three weeks.

The physical therapist is there to engage you in your exercise activities, and the nurse is there to monitor your medications and to manage your wound. There's nothing you need to do on your end. As I said, our case manager coordinates all of this based off of your insurance and your location. We do not have our own home health care team. We coordinate you with a home health care team that's in your vicinity.

Things to consider to prepare your home before surgery are things like clearing your walkways of any clutter. We don't want you bumping into anything with your walker. Installing nightlights in areas of higher traffic, such as the bathroom or stairs. Some of the medications we send you home with can make you a little bit groggy, and we want to make sure that you're not falling or stumbling on anything that you can't see at night.

Getting someone to take care of your pets is dependent on the temperament of your pets. We don't want your pets sleeping in the bed with you. We want to keep away any saliva or pet dander away from your incision. If your pets are prone to jumping on you, that might be something that you need to arrange before surgery because we do not want your pets jumping on you, and we do encourage you preparing for meals in advance or getting meals that are very easy to cook after surgery.

Going to a skilled nursing facility is something that's reserved for our very elderly patients or our very sickly patients. Most insurances do not cover rehab or skilled nursing for this type of procedure. It's only used in issues where we don't think the patients are safe to go home. As I said, insurances don't always cover the cost, and we want to make sure that you have a plan in place prior to your surgery.

If you think you can't go home immediately after surgery, you need to contact us right away because we may need to delay your surgery or arrange for other things to happen. If this is something that you really think that you want to do, give your insurance a call, tell them the surgery that you're having, and visit certain facilities within your area to see if a skilled nursing facility is appropriate for you. Again, with a hip replacement or a knee replacement, most insurances will not cover it unless there's other issues going on, so we really do want to send our patients home after surgery with a home health care team.

After surgery care, so the biggest concern with most patients after surgery is managing their pain. Pain after surgery is completely normal and expected. It should get better with time. We're going to prescribe you several different medications for you to take every four to six hours throughout the day, and it's really important that you keep yourself on a schedule.

For the first two weeks, I encourage you to always take medications every four hours. Do not only take medications when you're in pain because it's going to be very challenging to control your pain. In addition to the medication schedule of every four to six hours, we want you to ice, compress, and elevate. It's really important to ice the incision for about 15 to 30 minutes, and take it off for about an hour to make sure that your skin can readjust to the temperature.

We also want you to do compression, especially for the knees. The knees are going to go home with an ACE bandage or an ACE wrap. You can take this on and off as you would like. It's really meant for swelling. If you want to take it off but you're noticing that you're having swelling during the day, rewrap that ACE bandage from a downward to an upward motion to help with the swelling.

For both the hips and knees, it's important to elevate. As I said, you're going to have swelling sometimes for up to a year after surgery, and we want to make sure you're elevating above the heart. The picture on your slide shows appropriate elevation in which you are lying all the way back and you have two to three pillows underneath your ankle to make sure your ankle and your heart are not on the same level.

As I said, pain medication will be prescribed. The point of that medication is to take something different every four to six hours. Pain medication is determined based off of your allergies, your age, and your past medical history.

Our nurses will make sure that you understand your medications before we go home and make sure that everything is written out for you. Also try and coordinate your pain medication before physical therapy. It takes about 30 to 60 minutes for pain medication to start working, so try to take your medication around that physical therapy schedule and take it within 30 to 60 minutes before your physical therapist is scheduled to arrive or before you're scheduled to go to outpatient therapy.

Paint in your incision, so as I said, pain will get better with time. If you're realizing two to three weeks after surgery that your pain is increasing, you need to give us a call so we can make sure that everything is going OK. Physical therapy, it's also expected that it's going to be a little bit challenging and a little bit painful to work with physical therapy. The point is to really get those muscles working around that implant so you have some safe mobility.

It's normal for the surgery area to feel warm. That's a sign that it's healing. So a warm and pink surgical site is normal. A surgical website that's red and hot is not normal, and you need to give us a call if you're seeing that the temperature of your incision is increasing. It's also important to understand that nothing should be coming out of your incision. Your incision should be completely dry, no drainage, no redness.

Swelling will improve. The swelling will improve with elevation, and as I said, it can last for up to a year. But if you're not having any improvement with your swelling or with your pain by any of these recommendations, you need to give us a call so we can make sure that there's no infections happening.

Here on the PowerPoint, we have three different incisions. The first incision is an incision of the anterior robotic hip replacement. The incision is going to be right on the front thigh. It is pretty long, but it does shrink up over time.

The next picture is a picture of the posterior hip replacement so the hip replacement that's done on the back. It's right on the back thigh. And then right here on the bottom is a picture of the knee replacement incision. The hip replacement has underneath the skin wound glue that dissolves on its own, and the hip has staples that we will remove at two week post-op. So like I said, a pink and warm surgical site for both hip and knee is normal. Anything red, hot, or draining is not, and you need to give us a call so we can evaluate you as soon as possible.

For your surgical dressing, so here at the University of Chicago, for all of our hip and knee replacements, the surgical dressing we use is called Aquacel. Aquacel is a dressing that has antibacterial medication on the inside, and it is waterproof. You're going to keep it on for seven days after surgery, and your home health care nurse will change you to a new one.

You will be given an Aquacel dressing here at the hospital to take home with you for your home health care nurse to replace in seven days. Keep that new dressing on, that second dressing on, until your follow up appointment. It is OK for you to shower with this dressing as it is waterproof, but you cannot bathe, you cannot swim, or submerge in water for up to six weeks after surgery.

Recovery, so the knee takes some time to finally feel completely 100%. You should be at 80% healed at about three months and near 100% healed by one year. For the hip, you should be 80% healed within six weeks and typically 100% healed by three months. But the hips have a little bit more work to do with physical therapy. As we said, dislocation is something that's not very common in hip replacements but can be an issue in hip replacements, so it's important that you work really hard with physical therapy.

Follow up appointments, so we schedule a series of follow up appointments after your surgery. We'll see all of you guys here at the Hyde Park location two to three weeks after surgery. You'll either see the surgeon, our PA, or our APNs. For our knees, we're going to remove those staples, and for our hips, we want to make sure that those sutures are dissolving.

We'll also see you at six weeks. This appointment is always going to be with the surgeon, and that's to check X-rays and to see the health of the implant. We'll see everybody at three months, which is when you're ending physical therapy, and then we'll see everybody annually to check the X-rays.

Here's our final slide. This slide contains ways of getting a hold of us. Our phone number right here is 773-834-3531, but we also want to encourage our patients to sign up for MyChart. MyChart allows you to directly message your provider and your team. It lets you access your medical record and your test results, and it also lets you request refills for your prescription.

And if you guys need return to work letters, we can send that to you via MyChart. For any type of disability or FMLA, that paperwork needs to get to us right away. It can take us seven to 10 business days to complete that. If you want to know where you can send your short term disability or FMLA, please reach out to us. We'll give you the fax number or the email you can send that to.

And that's the end of our PowerPoint. Like I said, please do not hesitate to reach out to us if you have any questions. My name is Melissa. It was very nice working with you guys today.