Total Joint Replacement Surgery:

Should I be receiving a Total Joint Replacement?

• Once you have been seen by an orthopedic surgeon, they will decide based on your diagnosis if you’re indicated for a Total Joint surgery.
• At this time, you may meet or receive contact information for the Orthopedic RN. She will complete an intake form and begin to walk you through the process of receiving a total joint.

Types of Total Joint Replacements:

• Hip Replacement: the damaged parts of the hip are removed and replaced with metal and plastic implants called components. A total hip replacement replaces the damaged ball and socket.
• Knee Replacement: the knee joint is resurfaced with metal and plastic components.  The thigh bone (femur), the shin bone (tibia), and the knee cap (patella) have bone removed. The ends of these bones are then resurfaced with metal and plastic components. The ligaments and tendons of the knee are left in place so the new hinged knee joint can bend and straighten. 

• Partial Knee Replacement: A UKA removes only a portion of the knee joint, replacing only that diseased portion of the knee. Thus, you only need a partial knee replacement and not a total knee replacement.
• Shoulder Replacement: the damaged parts of the shoulder are replaced and materials such as metal and plastic components are inserted. Two types of total shoulder procedures are utilized. An Anatomic shoulder replacement and a revere shoulder replacement.
• Revision surgery: it replaces the worn-out or damaged implant with a new implant.
• ( Would be cool if we can have hyperlinks on each of these procedures that takes them to more information and has MAKO videos of the procedures if they are interested.) Knee replacement and partial knee will be same link.

Same-Day Procedures:

• Unless otherwise noted, most joint replacement procedures are performed in an outpatient setting, meaning the patient will come and leave the hospital the same day.
• In some cases, the surgeon may keep you in the hospital overnight, however the expectation is that you will return home the following day.

Hip Replacement:

• Two types of hip replacements are performed at Madigan. There is the anterior hip replacement and the posterior hip replacement.
• Neither approach is greater than the other as outcomes long-term are equal.
• The choice of hip replacement is surgeon dependent, and you can speak with your surgeon if you have questions on their preference of approach.

• The incision will be on the front side of the hip. Will replace the arthritic components of the hip with metal, ceramic, or plastic components. Has less precautions than the posterior hip after surgery.

• The incision is on the back /outside of the hip. Will replace the arthritic components of the hip with metal, ceramic, or plastic components. Has more specific guidelines that need to be followed for the first 6 weeks after surgery.

Video of the Mako robot performing a Total Hip Replacement:

Knee Replacement:

• Majority of individuals that will come in for joint replacement surgery receive a Total Knee Replacement.
• A total knee replacement treats the entire knee joint.
• During total knee replacement surgery, the knee joint is resurfaced with metal and plastic components.  The thigh bone (femur), the shin bone (tibia), and the knee cap (patella) have bone removed. The ends of these bones are then resurfaced with metal and plastic components. The ligaments and tendons of the knee are left in place so the new hinged knee joint can bend and straighten. 
• Depending on a lot of factors, total knee replacement surgery can be done either a same day surgery (you go home on the day of surgery) or as an inpatient surgery (you stay in the hospital after your surgery).
• Additionally, depending on a lot of factors, your knee replacement surgery can sometimes be done with the use of a robot called the Mako Stryker robot. 

Partial Knee Replacement:

• You may be indicated for a partial or unicompartmental knee replacement.
• Sometimes the end-stage arthritis of the knee joint only affects part of the knee joint.
• A UKA removes only a portion of the knee joint, replacing only that diseased portion of the knee. Thus, you only need a partial knee replacement and not a total knee replacement.

Video of the Mako robot performing a Partial Knee Replacement:

Shoulder Replacement 

• Two types of shoulder replacements are performed at Madigan. There is the anatomic shoulder replacement and the reverse shoulder replacement.
• Depending on your condition and symptoms with indicate the type of replacement the surgeon chooses.

• Maintains the position of the ball and socket with the new total joint implants.

• This surgery switches the location of the joint’s ball and socket to allow for improved recovery after a severe injury to the surrounding shoulder musculature.

1. MAJ Joseph Dannenbaum, MD
   1. Staff Surgeon, Adult Reconstruction
   2. College: Texas A&M University
   3. Medical School: University of Texas Health Science Center at San Antonio
   4. Residency: Madigan Army Medical Center
   5. Fellowship: Aufranc Fellow in Adult Reconstruction - New England Baptist Hospital 
   6. Military Experience: ROTC at Texas A&M, General Orthopedic Surgeon - Fort Campbell 2016-2019,  Teaching Faculty/Orthopedic Clinic OIC - Madigan Army Medical Center 2020-Present

2. MAJ Gabriel Pavey, MD
   1. Staff Surgeon, Oncology
   2. College: Northern Virginia Community College
   3. Medical School: Uniformed Services University of Health Sciences
   4. Residency: Residency: Naval Capital Consortium – Walter Reed
   5. Fellowship: University of Washington, Musculoskeletal Oncology

3. MAJ Spencer Schulte, MD
   1. Staff Surgeon, General Orthopaedics
   2. College: Gonzaga University
   3. Medical School: University of Washington
   4. Residency: William Beaumont Army Medical Center
   5. Military Experience: Madigan Staff Surgeon

• There is a checklist that the in-clinic nurse will go over with you in person/ over the phone. You can find checklist under the tab of pre-operative checklist
• Schedule Total Joint class
• Meet with in clinic Orthopedic Physical Therapist for intake/pre-operative teaching.
• Complete clearances as needed (Internal Medicine/ Family Medicine/Dental)
• Complete Pre-operative labs, DEXA scan, or additional imaging requested by surgeon.

• Once labs and clearances are complete, patient will be contacted to schedule a surgery date. (Waitlists are extensive and it may take a while for nurse/surgery scheduler to contact you on date).
• Choose a caregiver: (this person should joint you for preoperative appointments to learn how to care for you.)
• Strengthen those muscles and move the joint to help to improve outcomes for after surgery. We want you to be as strong as you can for the surgery day.
• Find an outpatient Physical therapy location if you are a beneficiary or retiree.
• Begin to prepare your home for after surgery.
• Find FMLA paperwork for time off work.
• Read the joint booklet below for additional information and preparation for surgery. Bring the joint book to appointments to assist with taking notes and guiding questions.

1. Pre-op checklist
2. Dental form
3. Medication list
4. Patient agreement
5. Important phone numbers and hours of operation
6. Orthopedics surgical passport (white paper stapled to blue folder)
7. Physical Therapy booklet

• Go to the pre-surgery area on the 2^nd floor. You will receive these directions at your pre-operative visit with your doctor.

• Your caregiver will need to wait for you within the hospital. Discharge directions and training will be provided, and the caregiver needs to be present.

• Physical and occupational therapy will come to make sure that you are cleared to return home safely. They will have you get out of bed, walk, and perform steps to make sure you are safe to transition home.
• Staff will review the discharge information with you and your caregiver. Medication list will be reviewed, and the patient will be prepped to return home. If you require an overnight stay, you will be transferred to a room and PT will meet with you the next morning to clear you to safety return home.

• Pain management Reminder

• Take your pain medication on a schedule
• Don’t wait for the spinal or nerve block to wear off. Take your first dose either on the ride home or as soon as you get home.
• Regardless of the instructions on the bottle, depending on your pain level, you may take as much as 2 oxycodone tabs every 3-4 hours if needed.
• Wake up through the night to maintain the schedule.
• You can do that for the first 2-3 days and then spread out the dosing during the daytime and see how you do by MONDAY.
• USE THE PINK MEDICATION LOG to help keep track
•  
• !!!! ICE - ICE – ICE – ICE  !!!
• Every hour for 20 minutes during the daytime.
• Swelling will occur roughly day 3-5, therefore please maintain icing schedule.
• After icing, get up and move around each hour. Movement will help keep your joint loose. “Motion is Lotion”
• Do not touch the dressing. Allow it to be intact to the skin to maintain closure.
• EXERCISES
• Perform your exercises 3 times per day. If you are not able to perform your exercises due to pain, then you should increase your medication dose or frequency.
• Performing your exercises will help prevent stiffness! (The enemy!)
• Make sure you follow-up and have an appointment set up with your outpatient PT team.
• If there’s an emergency with your knee, please utilize the ON-CALL number in the front of your Pre-op packet.

• Due to Covid curtailment and current staff limitations we have extended wait times for surgeries. Each surgeon has their own waitlist. Please contact surgery scheduling to provide an accurate timeline.

• Surgical Services will call one business day prior to surgery between 1200 to 1600 to get your check-in time for surgery

• Please provide us with your companies specific FMLA paperwork. Have all the sections that you can fill out completed prior to sending to us. We have 5-7 business days to complete paperwork.

• Please call or email Nurse Christy Woodruff. For after hour, over the weekend, or on a holiday please call the on-call provider number that is listed on the post-operative packet.

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