This is the "wear and tear" type of arthritis. It usually occurs after the age of 50, although it can happen earlier and usually in an individual with a family history of arthritis. The cartilage that cushions the bone breaks down and wears away, leaving the bones rubbing against each other. This causes pain, stiffness, and loss of movement in the joint that worsens over time. This type of arthritis may also be called degenerative joint disease or degenerative arthritis.

Rheumatoid Arthritis (RA) is an autoimmune disease characterized by inflammation of the lining (the synovium) of the joints. It starts with pain, swelling, warmth, redness, and stiffness around the joints. Then the synovium thickens damaging the cartilage and the joint may lose its shape causing more pain and loss of movement. RA affects more women than men. It is a systemic disease and can affect other organs. It is chronic with flare-ups. Early diagnosis and treatment is essential.

This is an arthritis that follows a serious injury to the joint. A knee or hip fracture or soft tissue injury can damage the articular cartilage over time.

After your surgeon schedules your surgery you will get a call from the hospital to schedule an appointment for Pre-admission Testing and Education Class. During this appointment you will have any necessary lab work, EKG, or X-rays. You will meet with an Occupational Therapist and a Physical Therapist who will do evaluations and teach you exercises and strategies to regain your strength and return to your normal activities.

You will attend a group class led by an orthopedic nurse who will review the things you need to know prior to surgery, including what to expect and how to achieve the best possible results.

You will be seen by an internal medicine physician who will do an assessment and then will follow you while you are in the hospital to oversee any medical needs. This physician works closely with your orthopedic surgeon to ensure that you are in optimal condition before and after surgery.

Our surgery team consists of people who care about giving you the best possible experience on your day of surgery to ensure that you get the optimum results from your joint surgery. We are able to accomplish this by utilizing our expertise, years of experience, and advanced technology that is available to us.

This team consists of the following:

• Pre-op nurses who greet you on the day of your surgery to get you ready to receive your new joint. You can expect these nurses to ask you lots of questions to obtain an accurate picture of your health so that the team in the operating room knows all about you.
• Physician Assistant
• Surgical team is comprised of not only your orthopedic surgeon, but also the professionals that work alongside of him. This includes:
• Anesthesia Care Provider - Anesthesiologist and / or a CRNA (Certified Registered Nurse Anesthetist) who will talk to you about options and risks of anesthesia as well as administering your anesthesia.
• Circulating Nurse - Registered nurse that will take you back to the operating room and be your advocate while you cannot speak for yourself. They assist anesthesia in monitoring your safety while constantly observing during the procedure that the sterile environment is maintained.
• Scrub - Surgical technologist or Registered nurse who assists the surgeon during the procedure by providing the necessary supplies and instrumentation needed.
• Patient Care Assistant (PCA) - The PCA is a support staff member that is a vital part of our surgical team. The PCA aids in obtaining equipment or supplies that are necessary for the case as well as aid in positioning.
• Recovery or PACU nurses care for you directly after your surgery until you are ready to go to your hospital room. They are registered nurses that help you have a safe return to consciousness after you have had your joint surgery.

The orthopedic nursing unit has a very experienced, highly skilled nursing team specially dedicated to high quality, compassionate care of the joint patient. The nursing staff will check on you hourly in order to make sure all your needs are met.

• The focus is on pain management and early mobility to facilitate optimal post-op recovery.
• The nurse collaborates with your internist, surgeon, physical and occupational therapists, and discharge planner in order to best meet your needs.
• We have newly renovated rooms with the latest in medical equipment to assist in post-op recovery. Rooms are equipped with a walker, bedside commode, raised height hip chair, and sleeper chair for a family member to spend the night.
• Our customer satisfaction scores are above national averages.

The Rehab portion of your hospital stay could be the most important part of your entire post-operative process. We instruct the patient in safe movement (functional mobility) and educate you on modified techniques for activities of daily living so you can return home and be as independent as possible. We also instruct the patient in a progressive home exercise program so that optimal range of motion and function can return after you receive your new joint. Remember-it is up to the patient to do your therapy at home so you can achieve the full range of motion and return to an active lifestyle.

Post-Operative PT and OT may begin as early as 4 hours after you return to your hospital room from surgery, depending on the type of anesthesia you received in surgery. We will work with nursing to get all our joint patients sitting up on the edge of the bed the day of surgery.

Physical Therapy
Physical therapy begins for all joint patients in Pre-Admission testing. A pre-operative evaluation is performed to assess your mobility, strength, and range of motion. The patient is educated on the post-operative rehab process including walker training, stair training, and initial leg or lower extremity exercises that should be performed by the patient on the evening of your surgery day.

Post-Operative Physical therapy may begin as early as 4 hours after you return to your hospital room from surgery, depending on the type of anesthesia you received in surgery. We work with nursing and Occupational therapy to get all our joint patients sitting up on the edge of the bed the day of surgery.

Occupational Therapy
Occupational therapy also begins in pre-admission testing. The pre-operative evaluation will assess upper body strength/coordination and your ability to complete your activities of daily living (ADL's). The patient will be educated on home safety, various pieces of adaptive equipment, and transfer techniques you will need post-operatively to mobilize safely. For example, getting in and out of the shower and also getting in/out of a car.

Post-Operative Day 1
The PT will come in and review the exercises that were given to the patient in PAT. New exercises will be added for the patient to perform. On Post-Op Day One the patient will begin walking with the walker. The OT will come in and assess the patient's bed mobility and transfer ability to a bedside chair.

Day 2
Post-op day 2 includes additional home exercises, further distances to walk as tolerated, lower body dressing with assistance, and getting up and down stairs. The patient will be taken to the bathroom to work on toilet transfers. Hip replacement patients will work with the OT in beginning use of adaptive equipment so that daily skills can be performed without breaking the post-op hip precautions. This is a good day for you helper at home to come in and observe your afternoon PT session. By then we will have a good idea of how much help you are going to need at home.

Day 3
Post-op day 3 is usually the day most patients are discharged to home. Your therapy on this day will include instruction and performance of your complete home exercise program, going up and down the number of stairs that you have to maneuver at home, and walking a longer distance with the walker. The OT will be able to work on any remaining difficulties with ADL's you may have. Your at home helper should come to therapy in the morning to make sure they are confident in all they have to do to make you safe at home.

If you have any questions about rehab following a joint procedure please call (937) 384-8783.

Outpatient Therapy
You will be discharged with a home exercise program developed specifically for either a hip or knee replacement. Do you exercises at home as prescribed until your 2 week follow up appointment with your surgeon. At that time, he will either order outpatient physical therapy or tell you to continue your home exercise program you were instructed in at the hospital. Outpatient physical therapy will progress the exercises you were given at the hospital and begin more strengthening activities.

The day after you surgery, a Social Worker/Discharge Planner will meet with you in your room. One's home situation and possible discharge needs will be discussed. The Social Worker/Discharge Planner can obtain needed equipment for home, arrange home care services, as well as set up extended care for rehab purposes. Though your needs will be addressed while you are in the hospital, you may want to verify your coverage for services with your insurance prior to admission.

An interdisciplinary team including your physical therapist, occupational therapist, case manager, social worker and nurse, in consultation with the physicians, collaborates to assure appropriate goals are established and post-hospital arrangements are addressed well in advance of discharge. Our goal is to give you the information, therapy and education you need so you can return home safely.

At discharge you will be given prescriptions for pain medicine and an anticoagulant to prevent blood clots. Because discharge generally takes place late in the day you may want to ask for these prescriptions earlier so that a family member can get them filled for you. Our Sycamore Pharmacy can fill these prescriptions for you.

You will return to your surgeon's office about 2 weeks after your surgery to have the staples removed and the incision checked by a nurse. At about six weeks after surgery you will see your surgeon for a check up.