Intro: With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.

Deborah Howell (Host): You or a loved one is scheduled for total joint replacement surgery, and you have a lot of questions like, how do I navigate my tasks at home when I'm released? Maile Keller, Physical Therapy Assistant and Orthopedic Care Coordinator at Pullman Regional Hospital is here to tell us how patients can best prepare their homes for their total joint replacement surgery. She's going to tell us how patients can set themselves up for success after discharge. Hello, Maile. Welcome to you.

Maile Keller, PTA: Hi, good morning. Thank you for having me.

Host: I think this is going to help a lot of people.

Maile Keller, PTA: I hope so,

Host: So, let's dive in. In preparation for a total joint replacement, what flooring and lighting considerations should be made?

Maile Keller, PTA: It's really important for patients to take time before their surgery to look for and remove any hazards that could lead to loss of balance or a fall when they get home after surgery. Making sure to remove throw rugs, any cords, and wires from walk areas, hallways. Clearing their stairs and floors of any clutter. We always recommend a therapist installing night lights that is also really helpful after surgery, whether that's in the bedroom, in their bathroom, in the hallways.

Another important consideration is making sure pet beds are out of the pathway, and not right next to the patient's bed

Host: Because that pet bed is for the pet and not the person's crutches or walking aids.

Deborah Howell (Host): aids

Maile Keller, PTA: Or walker. Correct. And we don't want to see when a patient gets out of the bed in the middle of the night and trips over a pet bed or the pet itself.

Host: Right. The reason you have these suggestions is because all these things have happened before. Someone stepped on a Lego or a dog toy or a dog bed and, ooh, that's not good.

Maile Keller, PTA: Yes. We've heard all the unfortunate stories. So, we like to prepare our patients prior to surgery so that we can decrease their fall risk.

Host: Okay, that's for sleeping. But now during the day, how high should sitting surfaces be to safely and comfortably get on and off? And are there any special pillows or cushions to get?

Maile Keller, PTA: Great question. Patients should consider firm chairs with armrests and the adequate height is one that a person can easily stand from. Usually, chairs should be tall enough that your hips are level with or higher than your knees, especially after a total knee replacement or a total hip replacement that allows to follow hip precautions if a patient has those, as instructed by their surgeon. And it also makes it easier to sit and stand after a total knee replacement.

A few things that patients can consider is using extra cushions or dense foam, sometimes furniture risers, if they're steady. They can help to increase height of a patient's furniture at home. For total knees and total hip replacements, considering a recliner or couch that they can easily elevate their leg on, because that helps to minimize swelling after surgery. And it's always a good idea for patients to practice sitting and standing from their couch, recliner, or their chairs at home before surgery. So, our therapists make recommendations to our patients while they're in the hospital.

Host: Great. Good to know. But load up on those pillows, tall people.

Maile Keller, PTA: Yes.

Host: Now, is there any equipment that's recommended for navigating the bathroom and the shower?

Maile Keller, PTA: if you're using a walker, you want to make sure that it can fit through your door, entering and exiting your bathroom. And you want to make sure that you have adequate space in there to move about the bathroom safely with your walker. A raised toilet seat and bath seat may be recommended. Sometimes a handheld shower head can be helpful for bathing when using a bathtub bench or shower chair.

Host: And of course, you don't want to slip in there either, so maybe a bath mat of some sort?

Maile Keller, PTA: Correct. Yes. Anything that's non skid that patients are not going to catch their toes on. Installing grab bars to help with safe movement and support, making sure that those bath rugs are slip-resistant and water-absorbent. A lot of patients will have, bath rugs that kind of slide on the floor, so we ask patients to pull those up and either get non-skid ones.

Host: Wow. This is kind of a lot. I hadn't thought about, you know, many of these things. Now, can patients who had a hip or knee surgery navigate stairs?

Maile Keller, PTA: Absolutely. Yes. And it's actually recommended to have at least one handrail going up or down their stairs. And our physical therapists, they practice with our patients going up and down the stairs before a patient is discharged home.

Host: That's really good, because I'm sure there's a process.

Maile Keller, PTA: Yes, absolutely. And it can be sometimes nerve-wracking for patients.

Host: Especially if you have to carry something up and down the stairs.

Maile Keller, PTA: Yeah. So, we go over a lot of that with our total joint patients in the hospital, and with their family members also.

Host: Excellent. Now the fun part. All right, Maile. How much space should be allotted for home exercises? And do patients need to pre-purchase any materials or equipment for these?

Maile Keller, PTA: No special equipment is needed for any of our total joint exercises. They can be done comfortably in the patient's bed at home. Some can be done sitting and some are standing while holding on to a firm surface. And our therapy team instructs all of our total joint patients in the exercises and makes the appropriate suggestions for the individual and their home environment. Because everybody's home is a little bit different, their setup is different. So, we tailor that to the individual and their specific surgery.

Host: Can you give us an example of an exercise you might be able to do from the comfort of your own bed?

Maile Keller, PTA: Sure. If somebody's had a knee replacement, they're laying on their back, and to bend your knee, you're doing a heel slide, and so we show patients several ways that they can do that, whether it's sitting at the edge of their bed or laying supine.

Host: That's a good example. Now, this is maybe a little bit out of your milieu, but maybe if patients are seniors, they could have their clothing laid out for the next day by someone who could help with that.

Maile Keller, PTA: Absolutely. And we encourage, our therapy team encourage patients to have someone at home after surgery to help them and navigate their home setup, exercises if they need it, transportation. The total joint surgeries, there's a lot to consider and a lot to think about, for before surgery and after surgery. And so, part of our job is to help patients navigate that.

Host: And I know it's extremely individual, but what is the average basic recovery time period?

Maile Keller, PTA: Our surgeons usually will tell patients, you know, after a total knee replacement, it takes a full year until you feel like you're done with your therapy and you feel like you are doing day to day activities without thinking about it. You're back to what you want to be doing after surgery.

Host: I think that's a good time estimate. And I think it's also important to know that within that year, you're going to be continually making progress.

Maile Keller, PTA: Absolutely. Yes.

Host: Well, is there anything else you'd like to add?

Maile Keller, PTA: Actually, yes, there's one last thing. I encourage all total joint patients to attend the free total joint preparation class. It's held once a month on the third Wednesday at Pullman Regional Hospital at 3:00 p.m. And it is for anyone who is considering or is scheduled for a total joint replacement. I like when patients bring a family member or friend with them. And it just provides a lot of information on how to prepare for and what to expect with a total joint replacement surgery.

Host: Wonderful, wonderful. Well, Maile, thank you so much. We appreciate your time and everything you do to help our wonderful patients. Thanks so much for being with us today.

Maile Keller, PTA: Thank you, Deborah.

Host: To learn more about total joint replacement at Pullman Regional Hospital, please visit pullmanregional.org/jointreplacement. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening, and have yourself a terrific day.