Joint Replacement Program
The Regional Leader in Joint Replacement Care
Joint pain can drastically affect your lifestyle. All of a sudden, things that you used to do without a thought are accompanied by pain and you may even be forced to resort to a more sedentary life than you've been used to. Joint replacement surgery can help you get back to your normal lifestyle! In 90-95% of our patients, joint replacement surgery has significantly reduced pain and restored function to the failing joint. Our highly trained staff can help you through every step of the process.
Why Choose PVHMC?
PVHMC has earned The Joint Commission's Gold Seal of Approval on hip and knee replacement surgeries and outcomes. In order to earn this seal, hospitals and health care centers must adhere to certain standards of excellence. Overall, the standards emphasize patient care and organizational functions that are necessary to high quality care that is above and beyond in terms of safety. At PVHMC, we are proud to be among the leaders in the region for safety and quality in orthopedic services.
The Joint Replacement Program
Frequently Asked Questions about Joint Replacement Surgery
What is osteoarthritis and why does my joint hurt? Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction. Osteoarthritis, the most common form of arthritis, is a wear and tear condition that destroys joint cartilage. Sometimes, as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. Over time, cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect a single joint or many joints.
How long will my new joint last and can a second replacement be done? All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical conditions. A total joint implant’s longevity will vary with every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specified length of time.
What are the major risks? The following is a list of potential complications and risks associated with major surgeries such as total joint replacement. This list is provided not to scare you but to inform you of the possible risk of the procedure:
- Complications from anesthesia
- Loosening of implants
- Injury to nerves
- Injury to blood vessels
- Leg length inequality (leg shorter or longer)
- Fracture of your bone during implantation
- Blood clots
- Blood loss
- Transfusion reactions
Your surgeon is aware of these possible complications and takes many precautions to reduce these risks. If you have any question or concerns about these or other complications of surgery, please discuss them with your surgeon.
What is total knee replacement? The term total knee replacement is misleading. The knee itself is not replaced, as is commonly thought, but rather an implant is used to re-cap the worn bone ends. This is done by placing metal alloy on the femur (thigh bone) and tibia (shin bone), a plastic spacer between the metals, and a plastic “button” behind the patella (kneecap). This creates a new smooth cushion and a functioning joint that can reduce or eliminate pain.
What is total hip replacement? In a total hip replacement (also called total hip arthroplasty) the damaged bone and cartilage is removed and replaced with prosthetic components.
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
- A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Will my new joint set off security sensors when traveling? Your joint replacement is made of a metal alloy and may or may not be detected when going through some security devices. You can carry a medic alert card indicating that you have an artificial joint, but security at check points usually don’t heed the cards, they will need to use their wand devices to check you. Check with your surgeon on how to obtain a medic alert card.
Will I need a blood transfusion? You may need blood during or after surgery. The risks are higher after hip replacement versus knee replacement. Your surgeon may choose to give you a medication called tranexamic acid, in the operating room, to help decrease the amount of blood loss in surgery. Your surgeon may recommend that you take iron pills after surgery to help your body regenerate hemoglobin, the oxygen carrying portion of your blood, after surgery.
When can I have sex after joint replacement surgery? Sexual activity is not recommended immediately after surgery. Sexual activity can often resume safely at four to six weeks after surgery, but it could be longer. Your surgeon will determine what timeframe is safe for you. Following precautions to prevent dislocation is very important.
PVHMC’s Joint Replacement Program
Overview of our Joint Replacement Program
We offer a unique program in which each step is designed to encourage the best results leading to a discharge from the hospital one to two days after surgery. Features of the program include:
- Dedicated nurses and therapists trained to work with joint patients.
- Family and friends participating as “coaches” in the recovery process.
- Pre-Op education to prepare you for surgery and allow you to ask questions called the Total Joint Preparation Class.
- A comprehensive patient guide for you to follow from six weeks before surgery until three months after surgery and beyond.
- A Nurse Practitioner who coordinates your care in the hospital stay.
- A Nurse Clinical Coordinator who coordinates your preoperative education and care and follows up with you after discharge.
Your Joint Replacement Team
The Orthopedic Surgeon is the skilled physician who will perform the procedure to repair your damaged joint.
The anesthesiologist is the physician responsible for your anesthesia (putting you to sleep or numbing your lower body) for surgery. The anesthesiologist may also be involved in pain management issues before and after surgery.
Medical Doctor or Hospitalist
Your own primary care provider may request that a hospitalist be in charge of your care during your hospital stay. If that is the case you have the benefit of being seen by a physician whose practice is entirely focused on the care of the hospitalized patient. The hospitalist will be involved in every aspect of your hospital stay, including: collaborating with other physician specialists, nurse practitioner, case managers, nurses, therapists and others involved in your care; ordering tests, medications and treatments; Communicating regularly with you, your family and your doctors.
Nurse Practitioner (NP)
The Nurse Practitioner (NP) is a registered nurse with advanced skills training and education that works with your surgeon to manage your care while you are here in the hospital. A NP can diagnose and treat health care problems, prescribe medications, order and interpret needed tests. The NP also helps in coordinating a timely discharge from the hospital.
Clinical Coordinator (CC)
The nurse Clinical Coordinator will contact you before surgery to schedule a preoperative education class. She will also act as your navigator through the course of treatment from before surgery to discharge. She will call you after discharge to check how you are doing and answer any questions.
Registered Nurse (RN)
Much of your care will be provided by a nurse responsible for your daily care. Your nurse will assure orders given by your physician or nurse practitioner are completed including medications and monitoring your vital signs.
Physical Therapist (PT)
The physical therapist plans your physical therapy rehabilitation after your total knee or hip replacement. This therapist will help you regain range of motion, muscle strength, and balance to walk safely with your new joint, as well as stair training. They will teach you how to use assistive devices such as a walker, crutches, or cane, which will be needed temporarily after your surgery. Your first PT treatment will take place on the Day of Surgery once you are able to wiggle your toes. Starting the day after surgery, you will receive PT twice a day until you are discharged from the hospital.
Occupational Therapist (OT)
The occupational therapist will guide you in performing daily tasks such as bathing and dressing with your new joint. The OT offers ideas to assist you to create a safe home environment. Adaptive equipment is used to simplify self-care tasks while conserving energy. The OT will see you once a day, starting the day after surgery, until you have mastered the skills.
Case Manager (CM)
The Case Manager (CM) will help you with the discharge process. The surgeon will order the needed durable medical equipment (DME) and Home Health Services (HHS) immediately after surgery. The CM will communicate those orders to the insurance company who will authorize or unauthorized the ordered services and equipment. The authorization is given based on your insurance policy.
Preparing for Surgery
Our goal is to help you understand what is going to happen and to empower you to be a partner in your recovery. The Joint Replacement Preparation Class and the Pre Admission Testing appointment will provide you with education and information to promote a more successful surgical outcome.
Joint Replacement Preparation Class:
Class is held on Wednesday’s from 10 am to 12 pm. To reserve your space in the pre-operative education course, please call (909) 630-7403. The Total Joint Preparation Class is held in the Robert and Beverly Lewis Outpatient Pavilion, 2nd Floor Multipurpose Room, P200C. (The Outpatient Pavilion is located on the main hospital campus of Pomona Valley Hospital Medical Center at 1798 N. Garey Ave, Pomona, CA 91767). The goal is to have this education class approximately 4 weeks prior to surgery.
The outline of the class is as follows:
- Preparing for surgery
- What Happens in the Hospital
- What to Expect When you Go Home
- Blood Clot Prevention
- Pain Management
- Physical and Occupational Therapy
- Question and Answer Session
Bring your support person who will be helping you after surgery with you to class (we call this person your coach) to receive the same education. You will receive your Joint Replacement Guidebook when you attend the class. Keep your Guidebook as a handy reference at least the first year after your surgery. The information in the Guidebook covers a lot of information so it may look overwhelming. Since it will assist you with your surgery, we recommend reading the entire guide, at a pace that suits you.
Pre Admission Testing (PAT):
Please schedule your appointment for two weeks prior to your surgery date. You will need to call Centralized Scheduling at (909) 469-9395 or click here to schedule this appointment. Please allow approximately 2 hours for this appointment. You must have the Pre Admission Testing folder (see picture below) from your surgeon’s office to complete this appointment.
The Pre Admission Testing unit is located at the Robert and Beverly Lewis Outpatient Pavilion, on the main hospital campus, on the 1st floor.
Bring below information with to PAT appointment:
- Physician’s orders- in the Pre-Admission Testing folder the surgeon’s office provided you with.
- Insurance Card and / or policy, Medicare or Medi-Cal card
- Driver’s licenses and / or photo ID cards of the patient and the insured
- Emergency contact information
- Legal Arrangements –Living Will or Durable Power of Attorney, Advanced Directive
- Medications List - include dosage, how often, why you take it & last time you took it.
- Allergies- what your reaction was to the medication (Hives, shortness of breath…)
- Reactions to anesthesia
- Doctors Names and Numbers and why you are seeing them
- Dietary Restrictions
- Medical History-(i.e. Diabetes, hypertension, heart problems, asthma, Hepatitis, HIV, Sleep Apnea, CPAP machine, kidney or liver disease, MRSA, VRE, any infections you were isolated for in the past)
- Email address if you want access to your medical information through the MYHEALTH Patient Portal.
- “Coach’s” number and information
Surgical Site Infection Prevention Program
What You Can Do To Prepare For Surgery
Staphylococcus aureus or “Staph” is a germ that lives on the skin and in the nose of some healthy people. Your skin protects you from those germs. When you have surgery, we will be cutting your skin. Sometimes germs can get into those cuts and cause infection.
PVHMC will swab your nose at your Pre Op appointment, 14 days before surgery, to see if you have Staph. The test will take 3-5 days to get the results. The results will be communicated to your Surgeon. A positive test means that Staph is present (this is referred to as being “colonized”) but does not mean you have an infection or illness.
Showering before Surgery
To decrease the amount of germs on your skin, PVHMC is providing you with a medicated soap called Chlorhexidine Gluconate 4% and instructions to cleanse the skin for FIVE consecutive nights before surgery. You will receive this packet when you complete your pre op admission appointment at the hospital. Start the showering process 5 nights before your surgery. (Example: If your surgery date is April 16th then start the showering on April 11th.) The showering is done whether or not the nasal screen is positive or negative for Staph.
CHG 4% Showering
PVHMC Pre Op Skin Preparation Packet contains 2 bottles of the medicated soap called Chlorhexidine Gluconate (CHG) 4%, a measuring cup, 5 cloth mittens and showering instructions. The instructions will provide you with specific information about showering for FIVE nights in a row before your surgery. Read the showering instructions completely before showering. Follow the instructions for all 5 showers.
Positive Test for Staph
If your test is positive, your surgeon’s office will call you and ask you for the information to your preferred pharmacy. They will call in a prescription for Mupirocin ointment which you will need to pick up from your pharmacy. The medicine will come in one large tube or many small packets. You can call your Clinical Coordinator for any questions concerning the showering and ointment application.
Mupirocin Ointment Application (only if positive for Staph)
Apply a pea size amount of the ointment to a cotton swab. Place the cotton swab inside your nose, applying the ointment to the inside of the nose. Remove cotton swab and discard. Apply a pea size amount of the ointment to another cotton swab. Place the cotton swab inside the other side of your nose, applying the ointment to the inside of the nose. Remove cotton swab and discard. Gently press your nose together and release, together and release for about one minute to get the medicine all over the inside of your nose. Do this once in the morning and once at night for FIVE days before surgery (the same FIVE days you are showering with CHG soap.) Complete the checklist on the showering instruction sheet for the Mupirocin application.
Day of Surgery
Bring with you the completed checklist (on the showering instruction sheet) and give to the holding room RN (this is the nurse getting you ready for surgery). When you arrive to the holding room you will be given CHG cloths to wipe with from “the neck down except the genitals” before you get dressed in your hospital gown. Before surgery you will receive antibiotics that are appropriate for you according to the nasal swab results.
MRSA (Methicillin-Resistant Staphylococcus Aureus)
If you have a type of Staph called MRSA you will be placed on “Contact Isolation”. This means your doctors and nurses will wear gloves and gowns when taking care of you. We do this to make sure we do not spread MRSA to another patient we are caring for. Your family and visitors will also need to wear gowns and gloves when they visit you in the hospital. When leaving your room, they will need to remove the gowns and gloves and clean their hands with alcohol rub found in the room or the isolation cart outside the room.
For any questions, call your Clinical Coordinator at PVHMC or call Pre Admission Testing at PVHMC at (909) 865-9546.
References: vll 2/2016; EBBP: AAOS, Orthopaedic Infection Prevention and Control: An Emerging New Paradigm. 2010. EBBP: IHI. How-to Guide: Prevent Surgical Site Infection for Hip and Knee Arthroplasty. 2012. EBBP: AORN, Evidence for Using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection. Nov 2010.
Post-Surgery, In-Hospital Goals:
Post-Surgery, In-Hospital Goals:
- Day of Discharge is Post Op Day (POD) #2 for both Hip and Knee Replacement Patients. (Day of Surgery is considered POD #0).
- Physical Therapy (PT) Evaluation and Treatment on the Day of Surgery occurs in the afternoon or evening after surgery, once the patient is on the floor. Our goal is for patients to stand at bedside, take steps, or walk on the day of surgery.
- PT twice a day until discharged home.
- Occupational Therapy (OT) once a day until discharged home for Hip Replacements and until tasks are mastered for Knee Replacements. OT addresses Activities of Daily Living such as using the restroom, getting dressed, etc.
- Case Management begins on POD #1 to ensure a timely discharge.
- Patients are discharged home with their coach on POD #2. Durable Medical Equipment and Home Health RN or PT services, or Outpatient PT, may be ordered by the surgeon based on patient’s needs prior to discharge.
BASICSS after Joint Replacement: HIP or KNEE:
The BASICSS is the pneumonic we use to help educate patients on the important factors in self-care after surgery.
Post-Discharge Follow-Up Phone Call:
- Patient who are discharged home from the hospital receive a follow up phone call from the Joint Replacement Program checking on:
-Patients progress now that they are home.
-Verify patients received their Durable Medical Equipment and / or Home Health Services.
-Educate as needed.
Our Joint Replacement Program includes a comprehensive, multidisciplinary team approach to standardize care and to provide optimal outcomes for our patients. We believe in providing “Expert Care with a Personal Touch.”
Most insurance plans cover joint replacement surgery, but you should check with your health plan to determine the extent of your coverage.
Need a Doctor?
Call PVHMC’s Physician Referral Line at 909.865.9782 or visit our website to find a doctor.
For more information about our Joint Replacement Program, please call 909.630.7815 or click on the PDF below for a copy of our brochure.