Thank you for viewing this online presentation in preparation for your total hip or knee replacement surgery. My name is Jo Reeder. And I'm a physical therapist from Continuum Home Health Care, which is UVA's Home Health Division. We're very proud to have been awarded the Joint Commission Gold Seal of Approval. And we're also very proud that you have chosen UVA for your joint replacement surgery and for your care. The topics that I will cover today are how to prepare for your surgery, the logistics of the day of your surgery, your hospital stay, and how to recover safely at home. We use the enhanced recovery after-surgery protocol. It helps patients recover sooner so life can return to normal as quickly as possible. This involves planning and preparing for surgery, such as listening to this online presentation. It helps reduce the physical stress of the operation. It provides a pain relief plan that works for you, and also involves early feeding and making sure that you move around quickly after your operation. Before your surgery, there are a number of very important appointments that you must keep. Once the surgeon has decided that having a total hip or a total knee replacement surgery is your best option for helping manage your pain and discomfort, you will be asked to have your medical clearance with your primary care physician. Or if necessary, we can arrange this at UVA's UMA Pre-Op Clinic. This is to make sure that everything is medically OK, and you're OK to go ahead with your surgery. This is a very important appointment. And you must have it to prevent your surgery from being postponed. It has to be completed prior to your preoperative work up appointment in the orthopedic clinic. Your medical clearance will include a preoperative evaluation of physical, bloodwork, an EKG, which looks at the rhythm of your heart, and a chest X-ray if appropriate. After this appointment, you will have a consult with one of the nurse joint coordinators who will confirm your discharge plans and review your preoperative education and your screenings. Your orthopedic work up appointment is approximately one to three weeks before your surgery. At this appointment, you will complete any necessary paperwork prior to the surgery and also have an opportunity to ask any questions you may have of the surgeon. After your work-up appointment in the clinic, you will be asked to go to the Pre-anesthesia Evaluation Testing Center known as PETC. This is over at the main hospital. When you enter into the hospital in the main doors and see the information desk, the PETC clinic is just behind there. It is a walk-in clinic. And it is open Monday to Friday from 8:00 AM to 5:30. On Wednesdays, it doesn't open till 9:00. You should allow for two hours for this appointment. At this appointment, some more blood will be drawn. And you will be given a blood wristband that will be placed in a baggie. It's very important that you put this baggie somewhere safe, because you will need to bring it with you on the day of your surgery. You will also meet with one of our nurse specialists who talk to you about having an anesthesia. Wherever possible, our surgeons like to perform the operation under a spinal. Because this allows for you to move around quickly and without complications. The next few slides, we're going to talk a little bit about preparing for your surgery. 14 days before your surgery, we need you to please stop taking any multivitamins or over-the-counter herbal or joint supplements. Seven days before your surgery, you need to please stop taking any aspirin and any products that might contain aspirin. Aspirin's a bit of a sneaky substance. And it can hide in places you might not expect. For example, aspirin is in Pepto-Bismol. So please make sure that you read the box or the bottle of any products that you like to take to ensure that it does not contain aspirin. We also need you to please stop taking any over-the-counter, non-steroidal steroidal anti-inflammatories. You will know these as Ibuprofen or Advil or Motrin, Naproxen, that is also known as Aleve. You will also be asked to stop taking any prescription-strength non-steroidal anti-inflammatories. these are most commonly known as Volteren or Dicofenac, Mobic or Celebrex. You may be instructed by your physician to continue with your aspirin if this is something that's been prescribed for another medical condition, in which case, please continue to follow your physician's instructions. It's very important that you stay healthy and get into the best possible physical shape prior to your surgery. Because that was going to reduce your risk of complications and shorten your recovery and get you back to doing all the things you need to do. Try and stay active. Of course, this can be hard when you've got a sore hip or knee. But do your best. It's very important that you eat a healthy diet. And if you do have a special diet prescribed, such as a diabetic diet, you continue to follow that and be aware that while you're in the hospital we will make sure that you get your correct diet. Try, if possible, to lose weight if that's what your surgeon has asked you to do. That's very hard when you're hurting. But do your best. Know that even if you lose one to two pounds, it can make a big difference to the amount of pressure that's going through your new joint. It's very important that you stop smoking. Nicotine can affect the ability of the wound to heal and can cause post-operative complications. If you're having difficulty stopping smoking, please reach out to our joint coordinators or your primary care physician so they can advise you on smoking cessation. If you can, begin a low-impact exercise or a physical therapy program. There are many physical therapy clinics that offer what is called prehab. And that's helping you with some exercises that will strengthen your muscles and make sure that you can recover quickly. If you're interested in doing a prehab program, again, reach out to our joint coordinators. And they'll be able to guide you. You will require a doctor's prescription for this. It's very important that you reduce your risk of infection. So get used to doing vigorous hand washing. Maybe carry some hand sanitizer around with you. And try to avoid any sick contact in the weeks running up to your surgery. You need to keep the skin of the site of the surgery clean and avoid bruising, sunburn, poison ivy, cuts, abrasions or any other rashes. If there is an opening in the skin at the area where we need to operate, the surgeon might need to postpone your surgery because of the risk of infection. One of the side effects that are well-known is post-operative constipation. So we want to try and minimize the effect of that. So in order to prepare for your surgery and reduce your risk of constipation, we want you to take one dose, which is a heaped tablespoon of Miralax daily on each of the three days before your surgery. Do not take this on the day of your surgery. It's best to take it in the late afternoon or evening. Preparing for discharge home-- your discharge plan is a very important part of your recovery. After your hospital stay, you will be discharged to your own home. Prior to your surgery, the joint replacement coordinator will review your discharge plans with you and your family or your caregivers. Once you've had your surgery, the case manager in the hospital will finalize your plan before you leave the hospital and make sure you have all you need to continue to recover successfully and safely at home. Your discharge plan needs to include three important things-- a personal coach or care partner, a plan for ongoing physical therapy, and all the equipment and supplies to help you recover safely at home. We're going to look at each of these in turn. You need to identify a personal coach or a care partner. Choose a friend or a family member who can be your personal coach throughout the process and be available to you at home 24 hours a day for the first few days. Anybody can be your personal coach or care partner, such as a spouse, a partner, a friend, a family member, a neighbor, anybody who can be a support to you as you recover from your surgery. Some people like to choose a number of people to support them to ease the burden. The role of the coach is to do all the things that you don't need to worry about so you can continue to recover safely and focus on your home therapy. The coach will provide you meals, run errands, help take care of your pets and children, pick up the mail. They may need to assist you with personal care needs and your exercises. So make sure you choose somebody that you feel comfortable doing that with you. You will need to make sure that your coach is able to provide transportation to the hospital on the day of your surgery and to go home on the day of your discharge. They will also need to be available to take you to him from appointments until you are ready to drive again. Your coach needs to be at the hospital by 9 o'clock on the day of discharge to make sure that they are able to listen to your discharge plans and any physical therapy instructions. So please make sure that you inform your coach of this very important time. The physical therapists in the hospital really like it if your coach can attend your therapy sessions. Because that will help your coach know how to better support you once you go home. Physical therapy is an essential part of your recovery and success of your joint replacement surgery. Physical therapy will start in the hospital and will continue after you get discharged home. You will be expected to participate in therapy for at least six to eight weeks after your surgery. While you're in the hospital, the hospital therapist will make sure that you are able to get in and out of the bed safely, in and out of a chair, and on and off the toilet. They will teach you how to walk safely with a walker. And also this will include going up and down stairs. They will also teach you some simple exercises and how to position your leg and manage any of your pain. The physical therapist in the hospital will then make recommendations for therapy when you go home. The options are going to be home physical therapy then outpatient therapy. Or some people are able to go directly to an outpatient therapy clinic straight after discharge home. Home health physical therapy-- a physical therapist will come to your house two to three times a week to provide in-home physical therapy that will assist you becoming more independent with moving around your home. They will also be able to progress your walking. And they will provide exercises to increase the mobility and strength of your new joint and your balance. They will also help manage your pain and swelling. Home health will be arranged by the case manager in the hospital. We would like you to let us know if you think you may want to use a home health and also if you have a preference for a particular home health agency. UVA's home health agency is called Continuum Home Health Care. And they cover Charlottesville, Albemarle, Green, Orange, Madison, Culpeper, Rockingham, Augusta, Nelson, Buckinghm, Louisa, and Fluvanna. So if you live in any of those areas, you can use Continuum Home Health Care. If you are receiving home health physical therapy, the expectations of all surgeons is that you should be able to transition to an outpatient physical therapy clinic within two to three weeks. Outpatient physical therapy will continue for a number of weeks after your surgery. You will be given a prescription for an outpatient therapy at your work-up appointment. And we expect you to set up this appointment before you finish your home health physical therapy or before you leave the hospital. If you intend to start outpatient therapy straight away, outpatient therapy will continue to work with the mobility of your joint and strengthen the muscles. They will work with your walking your balance and make sure you can do all the activities that you want and need to do. Although, you will set up your outpatient physical therapy, it helps us if we know where you are planning to go. And if you require any guidance on this, our nurse joint coordinators will be able to help you. It's important to know if you're going to have any out-of-pocket expenses related to any of these therapy services, if you have a commercial or a private insurance, please call the customer service number on the back of your insurance card to check that the home health agency and the outpatient physical therapy clinic that you intend to use are in network and if you have any requirements to pay to pay a deductible or a copay. If you are on Medicare, home health is covered under Medicare Part A, which means it's covered 100%. And it is a standalone benefit. Once you transition to outpatient physical therapy, this will be covered by Medicare Part B. So you may have a copay associated with that. If you have any questions regarding your medical insurance or expenses, please call our joint coordinators before your surgery so they can put you in contact with the right resources. We want to make sure that everything is covered or you are able to continue with your therapy as you need to do so. Preparing your home in advance will make the transition from hospital to home much easier and allow for a smoother recovery. When you finished listening to this presentation, walk around your house and see if you have anything that might be considered a trip risk or a fall risk. For example, do you have trailing electrical cords? Are your hallways cluttered, which would make it difficult for you to walk with a walker? Have you got uneven floors? You will be permitted to go up and down stairs after your operation. And certainly, the therapist in the hospital will show you how to do this. But it is important that your banister rail is secure. So maybe give it a little wiggle and check that it feels able to support you. If you have any throw rugs, we recommend that you roll those up now. Because we are concerned that they might trip you up when you're walking with the walker. If you have a large area rug, which would be difficult to roll up, you might want to consider getting some two-inch painter's tape and taping around the outside of that rug so that will allow the walker to move smoothly over it. We also want to make sure that you have adequate lighting, especially if you have to get up at night. So consider adding a couple of night lights in the hallways, in the bathroom, or even in your bedroom. When you come home from the hospital, you'll still want to be able to be in the main part of your house. But it's important that you're able to sit in a chair that will be comfortable and also provide proper positioning for your new joint. Choose a chair that's sturdy and has good armrests the more make it easier for you to stand up from. We don't recommend that you sit on the sofa or the couch. Because they tend to be low and deep and make it very hard for you to get up safely without hurting yourself or your new joint. You may want to consider getting a footstool or something to rest your leg up on when you're not doing your exercises. You'll be given information in your book by the joint coordinators on types of dressings that we want you to have ready for after your operation. So please make sure you have a working digital thermometer, because we're going to ask you to check your temperature on a daily basis. Also, make sure that you have all the equipment that you need. And also, we recommend you get a bag of ice. Because you will be using ice to help manage the swelling of your operation. Home safety equipment-- when you first start walking after your operation, you'll be using a front wheeled walker. This is a walker that has two wheels on the front and straight legs at the back. If you don't already own a walker, you will be provided one before you leave the hospital. The therapist will make sure that the walker is the correct height for you. We also recommend that you have something to raise the height of your toilet. This is not something that we can provide to the hospital. We recommend that you either consider purchasing a raised toilet seat as you can see in the picture. This is an insert that sits on your toilet and has handles that will allow you to push out from and stand safely. You could also consider purchasing a three-in-one bedside commode, which is also pictured on the slide. This can be used by the side of your bed at night. But also you can remove the bowl in the middle. And it will sit over the top of your toilet, and, again, make it easier for you to stand up from. We recommend that you consider getting these ahead of time, because you will certainly need them when you're ready to go home. Other pieces of equipment you may want to consider is something to sit on when you're taking your shower. A shower chair comes with or without a back and can sit in most walk-in showers and in the tubs. A tub transfer bench is a rather large piece of equipment where the seat with the four legs below it sits inside the tub and then the other two legs are outside of the tub. And you can sit on it and slide across. You may want to consider waiting to purchase these. Because for the first seven days after your operation, you will not be permitted to take a shower. And during that period of time, you will be working with your physical therapist. And you might find that you have the sufficient strength and balance and mobility to be able to take your shower without having to sit down. The shower chair or the tub transfer bench, the raised toilet seat, or the three-in-one bedside commode are all items that you may have to purchase as most people's insurances do not cover them. Places that you can buy these pieces of equipment include CVS, Walmart, Rite Aid, Target, Walgreens, or any other company that's called a durable medical equipment company. You might also be able to purchase them online if you're Amazon.com shopper. It's quite all right if you have one that you can borrow from a family member or a friend as long as you check that it's in good working order. Some churches also have a closet that you can borrow equipment from. There are also organizations in our area that provide used and clean equipment in good working order for free. An example of this is All Blessings Flow that has a store front in Charlottesville and also in Elkton. There should be a card inside the book giving you information on these. The other piece of equipment that I'll often recommend as a physical therapist are grab bars installed in your tub or on the wall by the side of your shower. This will make it easier for you to step in and out of the tub or in and out of the shower. We don't typically like to recommend the suction grab bars, because they can come away from the wall. So wherever possible, please try to have them installed properly such as there in the picture. Care partners are adults identified by you, the patient, to be an active part of your health care team. When you are admitted to UVA Hospital, you will be given the opportunity to identify one or two care partners. Your care partners should continue to be a support for you during your hospital stay and, of course, when you go home. Your care partner will be asked to wear an orange wristband at all times while they're in the hospital to make sure we know who they are. Instructions for preoperative bathing-- to help prevent infection after surgery, you will be given a bottle of antibacterial body wash to use every day for five days prior to your surgery. This includes the night before and the morning of your operation. Instructions will be provided in your book. You will use this as part of your regular bathing routine. Wash your hair and face with your normal shampoo or soap. And rinse completely off. Step away from the shower stream and apply the antibacterial soap onto your skin using a clean, wet washcloth from the neck down. Wash gently, but make sure you avoid your private areas. Once you are fully soaped up, want to rinse thoroughly with warm water and dry off with a clean towel. Please do not use regular soap after washing with the Hibiclens. And also do not use any moisturizers. We also would like you to please purchase ahead of your operation a 20 ounce bottle of regular Gatorade. You will need to have this ready and available for the day of your operation. If you're a diabetic, then we want you to have a 20 ounce bottle of water available instead. If you do develop any infection or illness prior to your surgery, please call the orthopedic clinic to discuss. Hopefully, we will be able to get it treated. But depending on what type of infection you have, your surgery may need to be rescheduled. The day before your surgery, you'll be contacted by the operating room staff between the hours of 2:00 and 6:00 to tell you what time you need to report to the hospital on the day of your surgery. If your surgery is scheduled for a Monday, then you will be called the Friday before. Be aware that we want you at the hospital two hours before your operation time. If for some reason, you do not receive a call by 6 o'clock, please call the phone number this listed in your book. You will be told by the staff that call you to stop eating solid foods after midnight on the night before your surgery. You will also be informed which medications to take before your operation. You can continue to drink water during the night and the morning of your surgery. On the night before your surgery, shower with the antibacterial wash just as you've been doing for the previous five days. Put on clean pajamas and make sure you have clean bed linens. On the morning of your surgery, you will need to repeat that shower again using the antibacterial body wash. And then put on clean clothes. Do not use any deodorant, lotions, powder, or perfumes after washing on the day of your surgery. We want you to bring the following items with you when you come for your operation-- the blood bracelet in the little baggie if you received one at your PETC appointment. Make sure you're wearing comfortable, loose-fitting clothing because these will be the clothes that you will wear when you are discharged home. Bring with you a current list of your medications, any paperwork that's been given to you by the surgeon, and if you have a copy of your advance directives if you've not already given them to the hospital. Some people like to have a lip balm available, because they find their lips get dry in the hospital, and any additional toiletries that you may need. If you use a CPAP or a BIPAP machine, please make sure you bring your own machine and your mask. We will be able to provide the sterile water for you. Also, don't forget your joint replacement handbook. If you've already got your walker, have it available in the car for when you're ready to go home. But you will not need to bring it with you into the hospital. Before you leave home to come to the hospital, remove all nail polish, jewelry, and any body piercings. You may continue to drink water, but no other liquids. On your way to the hospital, please drink down the 20 ounces of Gatorade or if your diabetic, 20 ounces of water. Your operation will take place at the main hospital. And you need to report to the hospital admissions on the first floor. Once you have checked in, you will be taken to the surgical admissions suite to be prepared for your operation. You may be able to have a family member or friend wait with you during this time. Once you go for your operation, your family members or friends will stay in the surgery waiting room. And they will be kept informed as to your progress through your surgery. In the surgical admissions suite, you will be prepared for your operation. After being identified for your surgery and checked in by a nurse, you will be weighed and you will be given an IV that will stay in throughout the surgery and your hospital stay. You will be given medicines that will keep you comfortable during and after your operation. You will have the opportunity to meet your surgery team. And also, you will meet the anesthesia team who will review your medical history and determine the best and safest medications for you, whether you're having a spinal or a general anesthesia. You may also receive a nerve block ahead of your operation that will help with the pain during and after your surgery. The surgery normally takes about an hour and a half to two hours. When you wake up, you will be taken to the post-anesthesia recovery unit. In this unit, you'll be given clear fluids to drink and make sure that your pain is under control and that your vital signs are normal. During this time, a member of the surgical team will call your family in the surgical family waiting lounge to give them an update on your surgery and your progress. When you're awake and your pain is under control, you'll be transferred to your room on our orthopedic unit, which is called 6EAST. The average length of stay in the hospital is one to two days. The goal will be to have you out of bed on the day of your operation. So you will see your physical therapist on the day of your surgery. And they will continue to work with you until you are ready to be discharged home. On the day after your surgery, you'll be able to eat regular food as soon as you feel ready. Don't forget that if you have a special diet such as a heart healthy diet, or a diabetic diet, we will make sure that you get that while you're in the hospital. We will stop your IV. Because that will make it easier for you to move around. With the help from the physical therapist and the occupational therapist, you'll be getting out of bed, getting dressed, and walking in the hallways. They will also start talking to you about going home. The physical therapist will make sure you're able to move around safely and will also start you on some simple exercises. If you have stairs at home, they will make sure that you feel comfortable and safe going up and down stairs. The occupational therapist will teach you how to safely get bathed and dressed and making sure that you have any equipment you might need to keep you safe when you're doing those activities on your own at home. The physical therapist will also take you to the gym where you will practice getting in and out of a car. Because that will be your first big adventure when you're ready to go home. You may have a hemovac drain coming from your incision to remove any excess fluid from the surgical site. This drain will be removed by your doctor prior to your discharge from the hospital. You may also continue to require IV fluids to make sure you stay hydrated. At the end of your operation, a special sterile dressing is placed over your incision. This is highly absorbent. And it needs to stay in place for seven days. This dressing cannot get wet. And we certainly don't want you peeking underneath it for those seven days. You will be given instructions on your discharge paperwork about how to take care of this incision. And your home physical therapist or nurse will remove that dressing at the seven days. Or if you're going straight to outpatient therapy, you will be told how to safely remove it yourself. Post-operative pain and swelling and bruising are a normal part of the recovery process following total joint replacement surgery. Our goal is to help you manage the pain and ease your recovery. We use the UVA pain scale to measure how much discomfort you are having and if the treatments we are providing are working. We want to try and maintain your pain below a five, which is moderate pain and allows you to do most activities with rest periods. Managing your pain early is easier than trying to treat the pain after it starts. We will offer various options to increase your comfort after the surgery. We use oral pain medications while you're in the hospital. And then you will be sent home with these medications to continue your pain management once you are home. We use cold therapy to help control the swelling and the pain. For those of you who are having a hip replacement, we will provide you with reusable ice bags that you will be able to fill from your ice supply at home. For those of you having total knee replacements, we use the polar cube. This is an ice delivery system that you will be shown how to use while you're in the hospital and then you will take home with you. Please note that this takes quite a lot of ice and make sure you've stocked up with ice before you come to the hospital for your surgery. Physical therapy would also show you how to move and position your leg to minimize any pain or discomfort. You will be sent home with a prescription for pain medications. Or you can have your medications filled by the pharmacy delivery service and delivered straight to your bed at the hospital. This is called meds to bed. We also use a comfort menu. As part of your recovery on 6EAST, some of the available options to address your pain or discomfort are aromatherapy, distraction. We've already talked about ice, massage therapy, noise or light cancellation, pet therapy, positioning and movement, prayer and reflection, and controlled breathing. You will be provided with your comfort menu with your book. Constipation is a very common with the use of the narcotic pain medication. And we want to try and avoid constipation and hard stools after your surgery. Ways to do this are to eat food with plenty of fiber, increase your fluid intake, try to take six to eight cups of non-caffeinated fluids during the day, take the stool softener and a laxative to help prevent constipation once you're home. Increasing your activity, such as walking, can also help prevent constipation. You should have a bowel movement within a day or two of getting home after your operation. We also want to prevent blood clots. While you're in the hospital, you will have mechanical foot pumps on your feet. These inflate and deflate while you're resting in the bed and help pump up the fluid from your feet back up to the heart. You will also be encouraged to perform ankle pumps while you're resting in the bed. Moving around is the most important way to prevent blood clots. And that's why we want to get you up out of the bed as soon as possible and working with the physical therapists. You will also be provided with a blood thinner medication. And this will be started in the hospital. And you will continue to take this medication when you get home. A dressing will be applied over your incision during the operation. And it should remain in place for seven days. This dressing cannot get wet. And remember, no peeking for those seven days. You will be given instructions on how to take care of your incision before you leave the hospital. You may be instructed to change your dressing and should purchase those dressing supplies from the pharmacy before your surgery so you had them ready. This information is in your book. Most people's incisions will be closed with surgical glue. And once that dressing is removed at seven days, you will be permitted to shower. If the surgeon thinks it would be better for you to have staples or sutures, you cannot shower until they have been removed. And that occurs at 10 to 14 days. This will be done in clinic. Or it will be removed by the home health nurse if you are receiving home care. Remember, no creams or lotions on the incision until it is fully healed. You also should not take any tub baths, get in the hot tub, or use a swimming pool for at least six weeks or until you are instructed to do so. Please do not allow pets in the bed with you while your incision is healing. Total joint zone tool is provided for you in your book. This will help you understand your recovery. If you're in the green zone, it means your symptoms are under control. It's important to note that it's quite common to have a low-grade temperature. You should also expect a lot of bruising. Sometimes bruising can occur from your toes up to your groin. But we expect that. It's also common to have some swelling of the operated leg as long as that swelling is starting to go down as you recover from your surgery. It's important that you continue to increase your activity every day and, you're able to tolerate your physical therapy. If you're in the yellow zone, we want to know about that. If you're experiencing a temperature over 101, and you're noticing drainage from your incision, or you have redness or an odor around the incisional area, or you've noted the just swelling is continuing to get worse-- if you have any of these symptoms in the yellow zone, we want you to contact your home health nurse to help evaluate what's going on or call the orthopedic nurse line which is listed on the tool. If you have any symptoms in the red zone, this is considered a medical emergency. For example, if you have unrelieved shortness of breath or chest pain or bleeding profusely from your incision-- if that is the situation, you need to go to the nearest emergency room or call 9-1-1. Make sure you look at this tool before you come to the hospital and have it available for you to keep an eye on while you're recovering at home. Your activity after your joint replacement-- you need to be guided by your physical therapist and your surgeon. It will take some time for your muscles to strengthen or your joint to regain full mobility. We expect it would take a full year for you to get the full benefit from having a joint replacement surgery. You need to check with your therapist or your doctor to know what long-term activities will be good for you. Activities that our doctors recommend are walking, swimming, golfing, cycling, or light tennis. We want you to avoid activities that cause a lot of heavy pounding on your new joint, such as jogging or running or any high-impact activity or contact sports. Make sure you work with, your physical therapist and that they know what you need to do to get the best out of your joint replacement surgery and what your hobbies or your work is. And they will help guide you and get you to where you want to be. Dental care-- surgery team requests that you refrain from routine, non-emergent professional dental cleanings and procedures for three to six months after your joint replacement surgery. So try to get your routine cleaning done prior to your operation. If you have a dental emergency requiring an urgent dental procedure during the three to six months after your surgery, please notify your surgeon and request the pre-procedure antibiotic to be called into your pharmacy of choice by either your dentist or your surgeon. Antibiotics should be used prior to all dental procedures, including routine professional cleanings for at least two years after your joint replacement surgery. And sometimes our surgeons will request that you actually continue that for much longer. This dose of antibiotic medication is usually called into your pharmacy either by your dentist or your surgeon prior to your dental appointment. You will be given information about this when you have your first follow-up appointment in the orthopedic clinic. I'm sure all of you are anxious to know when you can return to driving. You will need to discuss with your surgeon when it is safe for you to return to driving. You certainly should not drive until you are off all pain medications. And you must have full control of your legs and no longer require a walker for getting about. If you've been put on any special precautions after your operation, these will need to be discontinued before you be allowed to drive. You are certainly allowed to ride in a car after surgery as long as you are following the techniques and precautions that have been given to you by your physical therapist. We will want to follow you closely for the first year after your operation. At six weeks, you will be seen in the orthopedic clinic. And at this time, some X-rays will be taken off your hip and knee. This appointment will be scheduled before you're discharged from the hospital. And it'll be listed on your discharge instructions. At this appointment, your surgeon will evaluate your progress to determine future follow-up visits. And it's quite likely they will want for you to come back and see them for about a year after your operation. Please expect to continue with your outpatient physical therapy for the first few weeks after your surgery. Thank you for viewing this presentation. And we hope it's helped you prepare you for your joint replacement journey. We are excited to help you return to a healthier and more active lifestyle. Please reach out to your nurse coordinates for any questions you may have. They are available to help you every step of the way and look forward to working with you. The joint replacement team wishes you the very best. Thank you.