Business Case for FHIR and Argonaut: Patient Directed Post Acute Care
Saving Money with High Deductible Insurance: Drugs and Imaging

Preparing for a Knee Replacement: A Checklist for the Family

You get a phone call from Mom; "Hi honey, I'm getting my knee replaced in 4 weeks, can you help Knee-replacement-rehabme?". Don't panic. We went through this and here are some tips to help you through this (disclaimer: this is not medical advice and your situation will always be different).  

Mayo Clinic has great overview of knee replacement (arthroplasty) here.

Pre-Surgery:
Book your airplane ticket now figuring you will need to be there at least one week after surgery. Try to find an airline that is forgiving in changing your ticket should you need to (SouthWest Airlines for example).

Since you are in charge, get a healthcare directive for the state your Mom resides. This allows you to make medical decisions if Mom cannot and gives you the right to talk to the physicians and other healthcare providers on behalf of the patient. Here’s a good place to start.  This is important because many times there are communication breakdowns between the doctor, the surgeon, physical therapists, etc. It shouldn’t be, but it happens. Be prepared. 

If you are curious about the surgeon and the hospital, you can access Medicare’s performance data here

Your mom will receive a pre-surgical packet of information. Read it and go over it with her. Put it in a “medical folder”. Make sure you both understand it. When in doubt, ask.  Don't be shy.

Get a notebook and write down the contact information for everyone on the medical side (and get their fax numbers). Make sure you have emergency contact information if something goes wrong. This notebook will also be used to create a daily log. The notebook is your best friend. Also get a calendar to record all the appointments and major tasks on it. 

Have copies of all the insurance and Medicare (if over 65) information. 

More things to do:
- Have transportation set up for your arrival if Mom does not have it: rental car, neighbor, car service, taxi, Uber, Lyft.
- Go grocery shopping and make sure you have enough to last 2-3 days after Mom comes home.
- Make sure there is a clear path for Mom to walk with walker after coming home. Remove throw rugs, runners and piles of books and magazines or anything else that might be an obstacle.
- Are there handrails for the stairs? Around the toilet? Toilet height extension? Bedpan / Urinal (if Dad)?
- Get a walker / cane  (put tennis balls on the front legs of the walker).
- Access to a fax machine (Fedex and UPS office centers have them). Many times the different parties involved cannot be reached and sending them a fax is the only way to get to them. Set up an inbound fax line like faxage.com ($3.50 / month). They can send an incoming fax right to your email box.

Still with me?  Let us continue.

- If Mom has pets, make sure they are taken care of during the hospital stay. Do you need lawn care / snow removal / house cleaning? Now is the time to set it up. Also put all those contacts in your notebook.
- Buy extra dressings for the surgical site. The hospital never seems to send enough home.
- Have a second complete set of bedding. Make sure they have clean bedding when they come home.
- Set up social and entertainment suited for your family member’s situation. Do you have the names of their friends? Books? Movies? Games to play?
- Follow up on everything. Just because someone says they will do something, doesn’t mean they will (hence the complete contact list, notebook and calendar). Be tenacious. The healthcare system is very frustrating most times.

At the Hospital (normally two days):
Become friends with the nursing staff. They will tell you how your mom is doing and give great suggestions. Find out when the doctors do rounds. Be there. Listen carefully to the physical therapists because they will be teaching what Mom needs to do to get better.

Keep your Mom's spirits up and give encouragement.  Have her talk to other family members and friends.  Bring some books or an iPad to watch a movie, or whatever else your Mom likes to do.

Make sure you have a copy of medications and understand what they are for and when and how long to take them. You may also want to talk to a pharmacist and make sure there are no adverse drug reactions. When our family member was at St. Joseph’s hospital in Atlanta, they didn’t do that and two of the drugs had the potential for a fatal interaction. Fortunately we caught it in time, but the medical team did not notice it.

Understand pain management thoroughly.  You may have opiates, Tylenol (acetaminophen) or Advil (ibuprofen) recommended. Make sure you know what to use, when.  Especially the opiates.

Go over the discharge papers carefully and understand what needs to be done when Mom goes home.

When leaving the hospital take the water bottle, emesis basin, washbasin, any lotions, creams, sundries and all supplies that came into your Mom's room. They could be useful at home. You paid for them. Take them home.

Back Home and Recovery:
The first week is the most critical. Your first order of priority is prevent infections. Wash your hands. A lot. Make sure the dressings are changed on schedule (aren’t you glad you picked up extras?).  Be on the lookout for anything that doesn’t look right at the surgical site. When in doubt call. You probably will be asked to take the patient’s temperature several times a day. This too is an early warning sign if it is too high.

That knee joint needs to be used especially during the first week so it does not freeze or limit range of motion. Having them lie in bed is not good for movement and also could lead to pneumonia or blood clots. Your packets will guide you on what to do. You should see a physical therapists on the first day home and 2-3 times a week, usually for an hour. Pay close attention to what they do and their instructions. Record this in your notebook and log all the exercises done.

Have meals at the table, not in bed.

Keep Mom's sprits up.  Play games, watch TV, whatever works for the two of you.  When she is ready, invite some friends over for a visit.

And finally, be very diligent on making sure the exercises are done (record them in the log book). Remember your Mom will be using a joint that just had surgery.  Being diligent becomes habit.  And that's a good thing.

Best of luck to you and your family.  Over 700,000 knee replacements are done every year.  You're in good company.

Do you have a personal experience or advice to share?  Leave a comment!

Comments

Annmariastat

Interesting that you assume it is "Mom" that will be having the surgery. I had my knee replaced when I was 51. The doctor had been recommending it for years and when I got to where I couldn't run any more, I gave in. A few more tips : See what your insurance will cover. I was in the hospital four days and had a physical therapist come to the house for a few weeks and then physical therapy a few times a week for several weeks after that. DO THE PHYSICAL THERAPY RELIGIOUSLY. No matter how tough you may be, this can be a surgery that wipes you out. Make sure you have someone at home to help you for at least the first week. Not sure why you recommend having meals at the table - my husband got me some kind of breakfast in bed table and it was great.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Your Information

(Name is required. Email address will not be displayed with the comment.)