TOTAL KNEE REPLACEMENT – WHAT YOU SHOULD KNOW….

TOTAL KNEE REPLACEMENT: TIPS ABOUT YOUR UPCOMING SURGERY!

From your Faith Community Nurse, Lyn Posner, RN. C

Pre-Op Instructions

Things you should know before Total Knee Replacement

Knee replacement surgery is one of the most successful surgeries available today. Studies have shown that patients get more improvement in their quality of life from hip and knee replacement surgery than any other operation from any surgical specialty.

The vast majority of patients who undergo a knee replacement surgery can expect multiple decades of pain relief and increased function from their knee replacement. With modern designs and materials most patients will never need to face a second replacement.

There are some things that you can do to help your knee replacement to last as long as you.

You should exercise and eat well to control your weight

You should avoid high impact activities such as jogging and sports which require extensive running and jumping

After your replacement you should take antibiotics when you have any dental work, a colonoscopy or an endoscopy

Getting ready to have a knee replacement is a process. There are a number of things you will need to think about between now and the time of your knee replacement

Things you should do before your surgery

It is very important to build up your nutritional status before surgery. Studies have shown that patients with higher levels of protein in their system have fewer infections, fewer complications and heal better. We start at least one month before surgery with a program to increase your nutrition. I recommend that you use a nutrition bar or drink with each meal.

Most patients undergoing a knee replacement will not require a blood transfusion. The surgery is performed using a tourniquet and blood is collected in a drain after surgery, filtered and returned to the circulation. Because of this only 1 out of 10 patients will need a blood transfusion after their knee replacement.

  •   Before surgery you will need a complete checkup from your internist or family practitioner.
  • That physician will need to certify that your medical condition is strong enough to withstand               surgery.
  • As part of the pre-surgical evaluation you will have laboratory work and will likely need a chest x-ray and an EKG. Occasionally testing will indicate a potential problem that may delay surgery while it is evaluated.
  • If you have had heart surgery or have had a heart condition you will need approval from your cardiologist prior to surgery.
  • Check with your doctor about what you will need for DME (durable medical equipment), stockings, and other equipment at the time your surgery becomes definite. Don’t accept crutches.  Older people generally are safer on a walker.
  • Most physicians will require you  to wear anti-embolism hose ( purchase online at amazon.com or Northeast Medical in Old Saybrook among other places. Check with the doctor what amount of compression he wants you to have – it ranges from 15mm to 30 or higher. They come in colors, designs, flesh or white tones now and those your purchase for home use do not need to have the holes at the toes.
  • You will probably need a cryopack – this is a unique specialized cooling system to use instead of regular ice packs and if your insurance will cover it it can be approved before surgery by your orthopedist. This is especially useful because you don’t have to constantly get up and refreeze the pack, make ice cubes etc.   It may be given to you in the hospital and if it is, chances are it is yours to take home, paid for by insurance so check on this with your doctor or hospital orthopedic unit ahead of time and then call your insurance customer care number to determine if they will preauthorize it.
  • Barring the cryopack you can ask for disposable ice packs upon discharge. But has plenty of ice on hand – ice is your best friend after knee surgery. 🙂
  • You can obtain a walker from a DME loan closet at WBPH nurses, The Estuary Council of Seniors in Old Saybrook and other local VNAs and homecare offices. medicare will pay only once in your lifetime for a walker so this is not the one you want!! You will use this for a week at most and it is a simple aluminum, tennis balls on the feet type – nothing fancy with brakes and a seat – save your medicare walker for when you need a fancy one!! 
  • BUT, talk to your physician about where he prefers you go to physical therapy (PT) and then take the walker to them to adjust properly for your height. You may wanna purchasese a little plastic basket type thing to carry your eyeglasses or a bottle of water or tissues or the TV remote.  You can tape it or tie it on with rag strips – it’s only a week. Don’t spend big bucks. 🙂
  • talk to your physician about starting knee exercises  in PT BEFORE your surgery. If you can strengthen the muscles and tendons a few months before your surgery your recovery will be much easier. Most insurances will pay for pre op PT and most physicians will like the idea. If insurance won’t pay pre op then – ask the doctor what exercises you can do on your own for the 3 months before your surgery.
  • Some people will need a cane once the walker is done so get fitted for that too before surgery. Buy or borrow but find one with a palm rest – they are more sturdy and more comfortable to use.  (ask me and I will show you what this looks like).This too should be adjusted to your height by the Physical Therapist before you use it.

You will be admitted to the hospital on the same day as your surgery. You will be asked to come to the hospital several hours before your scheduled operation. During that time before your surgery you will be checked in, have an IV started, and meet the anesthesiologist. Most patients undergoing a total knee replacement at Missouri Baptist Medical Center or St. Luke’s Hospital will have a continuous femoral nerve block placed before surgery. This is a small catheter placed along the main nerve in the front of the leg.  Local anesthetics are administered through this small catheter for two days after surgery dramatically decreasing the level of pain. The choice of a main anesthetic will be either a spinal anesthesia or a general anesthesia. A spinal anesthesia is my preference as I feel it gives better postoperative pain relief and a faster recovery. You will need to discuss this choice with the anesthesiologist.

Your family will be kept informed of your progress during surgery and  your physician will meet with them immediately after surgery. Following surgery you will spend about  2 hours in the recovery room and will then be transferred to the orthopedic floor. You can expect to have a splint on your leg after surgery as well as pneumatic compression stockings and support stockings to help prevent blood clots. You will also have a cooling pad over the area of your knee for extra pain relief.

Soon after your surgery you may be started on a continuous passive motion machine (CPM). This device will bend and straighten your leg automatically. It is very important to follow the physical therapy and nursing staff instructions concerning the continuous passive motion machine.  You will be probably up and walking at least to the lavatory  with a walker and assistance or  you may just pivot from bed to wheelchair, wheelchair to toilet, and back again on the same night as your surgery.

The following day you will start on physical therapy.  Your therapist will work with you first on getting in and out of bed and then walking. Before you leave the hospital your therapist will work with you on going up and down steps and getting in and out of a car.

Most patients can expect to be discharged from the hospital and go home two to three days after their operation. Those patients who are weaker before surgery or live alone may need a short stay in rehabilitation afterwards. Because of Federal Government rules rehabilitation in the hospital is no longer an option for most patients and those patients who need extra care will need to go to an extended care facility/nursing home if required.

In a perfect world, before you leave the hospital arrangements will have been made for home health physical therapy and nursing.  A walker and a bedside commode will be arranged.  Your home therapist will meet with you three times a week and you will do home exercises daily. Unless you’ve been told otherwise you can put your full weight on your operated leg. You will  need to see your physician in the office in one month after your surgery so book the appointment when your book the surgery.  Don’t be a squeeze appointment!!

Most patients after total knee replacement will be able to move from a walker to a cane in two to three weeks. Once you are safe on a cane and you can resume driving a car. You can expect 90% of your improvement after your knee replacement by two months. However it may take six to nine months for you to get complete improvement.

References Parkcrest Orthopedics, LLC – Specialists in Upper & Lower Extremities –

Saint Louis, Missouri Parkcrest Orthopedics, LLC: (314) 997-1777