Our Patient Navigator is available to help you during your surgical journey.
Whenever you see , know that you can call the navigator to get help if you need it.
416-284-8131 Ext. 5220
We want you to have all the information you need to be at ease through your surgical journey. Use this handbook to prepare for your hip or knee surgery, plan for your recovery after surgery, and learn what to expect during and after hip or knee surgery. Overview
JOINT REPLACEMENT SURGERY p1
How the hip and knee joint and replacement surgery works
BEFORE YOUR SURGERY p2
Preparing for surgery: Learn what to do to plan ahead and get physically fit before your surgery
AFTER YOUR SURGERY p4
What to know: Do's and Dont's to staying safe and what to expect in the hospital
GOING HOME p6
Physiotherapy after surgery: Setting goals and starting on the road to recovery, and planning for transportation
EXERCISE PROGRAM p7
Exercises to do at home before your surgery
ASSISTIVE DEVICES p8
Recommended support equipment that can help you before and after surgery
During joint replacement surgery, they remove part of your bone and replace it with artificial parts. One of the biggest benefits is improving your quality of life – you should be able to move with less pain. After surgery, many people can go back to the activities and hobbies they had before joint pain interfered.
There are some risks, which your surgeon reviews before you consent to surgery. Your surgical care team will do everything possible to reduce chances of complications during your surgery.
HOW THE JOINT WORKS
The hip joint helps you keep your balance and supports your weight in all of its movements.
Your hip joint is formed by the rounded upper end (ball) of your femur (thighbone) that fits into the acetabulum (socket) in your pelvis.
The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and helps them move easily.
In an arthritic hip, the cartilage is destroyed and bone rubs against bone. This causes pain and difficulties moving your hip.
HOW THE JOINT WORKS
Your knee joint allows your leg to bend and straighten. It is located at the meeting point of the thigh bone (femur) and the shin bone (tibia) and it is covered by the knee cap (patella).
The bone surfaces of the thigh bone and shin bone are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and helps them move easily.
In an arthritic knee, the cartilage is destroyed and bone rubs against bone. This causes pain and difficulty moving your knee.
HOW REPLACEMENT SURGERY WORKS
During replacement surgery, the arthritic part of your knee joint is removed and replaced with an artificial knee joint.
In a total knee replacement surgery, the complete knee is repaired.
In a partial knee replacement or oxford knee surgery, only one side of the knee is repaired.
Total hip replacement surgery replaces your arthritic hip joint with an artificial ball and socket.
Your surgeon will discuss your condition and treatment options with you.
A successful outcome for your surgery starts before your operation. Preparing for your surgery by participating in these activities will set you up for success when you are in the hospital and when you have returned home.
Feel prepared for your surgery and take advantage of the resources available (i.e. videos, handbooks, FAQs and live education sessions).
Live education sessions are highly recommended and will be led by a physiotherapist and a nurse, who will discuss:
• How to prepare for your surgery
• How to do strengthening exercises before your surgery
• What to expect during your hospital stay
• How to get the best possible outcomes after your surgery
• How to book your after surgery physiotherapy sessions
• What equipment you may need to get before your surgery
View resources and start learning at SHN.ca/hipandknee or scan the QR code.
If you have trouble accessing our education materials, contact the Patient Navigator for assistance.
Some people will need assistance to physically prepare for surgery. If you do, your surgeon will refer you to our Prehabilitation Clinic to be assessed by a physiotherapist. Please let the Patient Navigator know if you need help arranging transportation to the clinic.
At the Prehabilitation Clinic, a therapist will:
• Assess your current challenges
• Create and teach you a personalized home exercise program
• Help you plan for your care needs after surgery
• Teach you how to use support equipment
• Decide whether you need to attend exercise classes before your surgery
Prehabilitation exercise classes:
• Occur twice a week
• Teach you exercises to improve your strength, endurance, and mobility
• Are supervised by a physiotherapy assistant
If extra support is needed, your surgeon or Patient Navigator can refer you to a Social Worker who can help connect you with community resources and services. These may include:
• A supportive environment to recover after your surgery if you are worried about being alone at home
• Community resources and services such as:
→ Grocery and/or prepared meal delivery services
→ Banking and financial supports
→ In-home supports for housekeeping and personal care
• Transportation for medical appointments and physiotherapy appointments
You will recover from your surgery faster if you participate in a program to build your strength, movement and endurance before and after surgery.
Research shows that patients do best when they get themselves physically prepared before their surgery, and attend physiotherapy soon after their surgery.
Please review the exercise sheet on page 9 and begin doing the exercises as soon as possible before your surgery.
To make sure you start physiotherapy on time, you have to plan your therapy before surgery. The health care team will give you instructions to book your first appointment, choosing from one of the following three options:
1. Book your physiotherapy at SHN
2. Attend an SHN Partner clinic near your home
3. The patient navigator can help you find another option if the first two do not work for you
Your appointment must be booked within one week of knee surgery and two weeks of hip surgery. Please contact the Patient Navigator one week before your surgery if you haven't arranged your physiotherapy.
Write your appointment here
Clinic: Date/time:
Your length of stay in the hospital after surgery depends on your type of surgery, your surgeon’s protocols, and your medical condition after surgery. Be prepared to stay in the hospital overnight.
After your surgery, you will be assessed by your health care team and they will decide if you need to stay longer than one night.
After your surgery, you will have to sit or lay in a way that does not harm your new joint. Please follow these positioning guidelines:
• No pillows under your knees and keep the bottom of your hospital bed flat;
• Sit in firm chairs with arms, avoid chairs that are too low or soft; and
• When lying on your side, place a pillow between your legs.
Note: Your surgeon will let you know if you need to take these extra precautions to keep your new hip safe.
U DO NOT bend your operated hip beyond 90 degrees
U DO NOT cross your operated leg or ankle
U DO NOT turn your operated leg inward
Your rehabilitation team will begin working with you the day of your surgery or the next morning. Ask your nurse for pain medication when you wake up before the physiotherapist arrives so that you can participate fully.
Your rehabilitation team will assess your strength and movement and will teach you how to:
• Get in and out of bed
• Walk with a walker or crutches and practice walking
• Climb stairs using a cane or crutches
• Ice joints to minimize pain and swelling
• Do your home exercise program and help you practice your exercises
• Review how you can use assistive devices at home to help with your daily activities
If you need extra support, an occupational therapist may see you to:
• Assess your ability to do daily activities and suggest equipment that may help
• Assess your understanding and make recommendations to you and your family to help with thinking tasks
• Make recommendations for additional supports at home
No matter what kind of surgery you have had, there are activities you can do to keep yourself safe and reduce the chance of developing complications while you are recovering in hospital.
Please see your Surgical Patient and Family Guide for after-surgery tips and recommendations.
Your team will make sure you can manage at home by helping you work towards these goals:
• Walk safely with the appropriate aid (e.g. walker or crutches)
• Get in and out of bed
• Get on and off the toilet
• Go up and down stairs (if needed)
• Get dressed
• Complete your exercise program
It can take up to a year to recover fully after joint replacement surgery. Your after-surgery physiotherapy program at SHN or another clinic near you will set you on the right path and give you the tools you need to continue to improve after you are done your physiotherapy program.
You and your therapist will set realistic goals that you can achieve within three to five weeks. Here are some examples of realistic goals:
1. Walk up and down the stairs like I did before my knee or hip got bad
2. Walk around (mall, street, etc.) with greater ease and less pain
3. Improve my walking so I don’t have to use a walker, cane or crutches
4. Get in and out of a chair without my knee or hip bothering me
5. Bend my knee/hip far enough to get into the car easily or up from a regular height chair or bed easily
6. Do daily activities like making my bed or cooking without my knee or hip bothering me
7. Understand how to continue to improve on my own after finishing physiotherapy
To get the best possible outcomes during recovery, it is important to continue doing your physiotherapy exercises at home, between therapy sessions.
You will not be able to drive after the first several weeks of surgery. Your surgeon will let you know when you are cleared to drive again. Until then, you will have to arrange other transportation to and from your physiotherapy and doctor appointments.
You may also need extra help with cooking meals, buying food, paying bills, doing banking, and caring for pets.
Find out more about getting help with life after your surgery in your Surgical Patient and Family Guide.
Do these exercises daily before your surgery to build your strength for a faster recovery.
Lying on your back, slide heel toward buttocks to bend hip and knee.
Repeat 10-20 times.
Lying on your back with roll under operative knee and other leg bent, tighten thigh muscle to straighten knee and raise foot off the bed (keep back of knee pressed against the roll). Hold for 5 seconds and relax.
Repeat 20 times.
Increase difficulty by putting a weight around your ankle.
Stand holding a chair. Keep your knees together and lift one foot until lower leg is parallel with the floor. Hold 5 seconds.
Repeat 20 times.
Lying on your back with operative leg straight and other leg bent.
Lift operative leg up 10 inches keeping knee straight. Hold for 5 seconds and slowly relax.
Repeat 10-20 times.
Lying on your side, lift the operative leg straight up 10 inches with toes pointing forward.
Repeat 10-20 times.
Stand holding a chair. Slowly bend your hips and knees as if you will sit in a chair. Keep your knees over your toes. Do not let your knees turn in or out during movement.
Repeat 10-20 times.
Stand holding a chair. Push up onto your toes and slowly lower back down.
Repeat 20 times.
Assistive devices are items that can make it easier to complete daily tasks after surgery. Please rent or purchase the equipment you need from a health care supply store before your surgery and practice using it.
RECOMMENDED AS NEEDED REQUIRED
Increase your independence with putting on your shoes.
Raises the height of the chair to maintain 90 degree hip angle or to make getting up from chair easier.
Increase your independence with putting on socks.
Hip with precautions
Hip with precautions
WALKER SINGLE POINT CANE
With two wheels in the front and skis in the back.
Helps you go up and down stairs.
Hip with precautions
BATH TRANSFER BENCH
Increases safety with transferring in and out of your bath tub.
Not needed for walk-in showers.
Hip with precautions
Hip with precautions
BATH CHAIR/STOOL
Helpful to use inside bath tubs and walk-in showers to increase safety when bathing.
Hip with precautions
Raises the height of your toilet seat, making it safer and easier for getting on and off the toilet
Hip with precautions| Hip no precautions
* Required for low chair † Required for tub/shower combinations ‡ Recommended for tub/shower combinations
§ Recommended for walk-in shower | Required for standard height toilets
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